I am working for a few weeks as a maternity nurse for Debbie, a first time mother whose baby came earlier than expected.
he first few days are going really well. Debbie, Josh and I are settling into a gentle routine, which seems to suit Josh. He is feeding well, Debbie is remembering to make sure she wakes him before she puts him down to sleep and she is managing to ensure visitors only come in the afternoons so she can have a rest in the morning. Josh is a bit scratchy in the early evenings, probably because he hasn’t been able to sleep properly in the afternoons – it is a bit like Pass the Parcel and he obviously likes snoozing in the arms of friends and relations, but Debbie is determined not to let him fall into the habit of being rocked to sleep and we are working well together to sustain the routine we are developing.
One afternoon, a friend of Debbie’s comes to tea with her baby, born a few weeks before Josh. Sue arrives with baby Matt in his car seat and collapses on the sofa. I offer to make tea, leave a tray with them and vanish to my room. A large part of my job is knowing when not to be around! I check e-mails and log onto the websites which look as if they might have useful information – attitudes and research into babycare are changing all the time and it is important to remain at the top of the game. I notice that a new set of babycare DVDs has been published by The Essential Parent Company and send off for them – sometimes visual aids can be more effective than written aids. Then I hear my name being called from downstairs.
When I go into the sitting room, Debbie says, “Sue is finding it hard to feed Matt, he doesn’t look as if he’s latching on the way Josh does. Can you help her?”
Sue has Matt on her lap and looks at me with concern in her eyes. I sit beside her and watch as she tries to get Matt to latch on. Her nipples are very sore and she is obviously not enjoying the experience. Matt seems to latch on correctly, but slips off very quickly and cannot grip properly. I ask her a bit more about his feeding habits. She says, “He doesn’t seem to be very hungry when I try to feed him, he gives up quite quickly, but then he doesn’t settle well. I don’t think he has colic, as he doesn’t draw his knees up to his stomach. But he is certainly uncomfortable, possibly even in pain sometimes. So, although I was really determined to follow a routine and stick to it, I am sure he is hungry so I try to feed him again. And he seems keen, but then he gives up. I’ve also tried him on a bottle but even on that he seemed to fuss and take in lots of air. And honestly, my nipples are so sore I’m almost grateful when he gives up.” By the time she has finished, Sue is on the verge of tears. “I really wanted to breastfeed, but I didn’t think it would be this hard.”
I hold her hand gently. “Don’t worry,” I say, “we ought to be able to sort this one out with a little bit of thinking through. What does your health visitor say?”
“Well, she has said the latch is good and she has suggested cream for my nipples. She says I should persevere because breastfeeding doesn’t always come easily, but it is so painful that I just don’t see it ever becoming easy.”
By this time Sue is holding Matt’s face to her nipple and stroking it across his mouth to encourage him to latch on, but I can see how hard this is for her. Matt latches on well but seems to fall off quite quickly; as he is obviously hungry, this seems to be frustrating him and he begins to grizzle angrily. I suddenly have a brainwave.
“Let’s have a quick look in his mouth,” I suggest. And there it is – his little tongue is not curved at the end, it has a tiny fork in it, almost unnoticeable unless you know what you are looking for. Upon closer inspection, I see that the tiny piece of skin which anchors the tongue to the base of the mouth is unusually short in Matt, thus restricting the movement of the tongue and reducing his ability to hold onto his mother’s breast. He has what is commonly known as tongue-tie.
“But don’t worry,” I reassure Sue as she looks at me in horror. “It is a really minor thing, but it can have a major impact.” I explain how easy it is to take Matt to the doctor and ask to have the frenulum cut. “The frenulum is the proper name for that tiny piece of skin, but if you forget, just ask to have a tongue-tie division. It takes moments and won’t hurt him at all.”
She looks at me in wonder. I explain that, once Matt’s tongue has been released from the bottom of his mouth, his tongue will cover his lower gum when he latches on, which will mean he isn’t chomping on her breast when he feeds. It will enable him to maintain the latch and feed properly, and her nipples will soon recover once they are no longer subjected to the chewing and sucking Matt has had to resort to in order to try to feed. “I imagine he will become a more settled baby too – I think his discomfort between feeds may be because he was genuinely hungry and couldn’t satisfy himself and because he was taking in so much air that he did indeed have some colic,” I explain.
Sue grins with relief. “But how come no one noticed it?” she asks. I explain that only 3-10% of babies are born with tongue-tie and some of them manage to deal with it in other ways. Older children may manifest speech problems and push food to the back of their mouths to be chewed, but even for them, the operation is minor, almost painless and will make a huge difference to their lives.
“Like you’ve made a huge difference to my life!” says Sue, gratefully.
For more information on anything mentioned in this article contact: Night Nannies London:Contact Nicola Bennett or Anastasia Baker on 020 7731 6168 email@example.com or firstname.lastname@example.org
For more information on tongue-tie, go to www.nhs.uk/conditions/tongue-tie