Friday 22 March 2013

Rene Schwencke - Independent Midwife Answers Questions About Dividing Tongue-Ties in Kent

Rene is an independent midwife practising in the South East of London/North Kent area providing ante natal, labour and post natal services in the comfort of your own home.

Rene uses a lot of complementary therapies during her day-to-day practise such as Australian bush flower remedies, Raiki. aromatherapy, homeopathy, massage and reflexology.  She has also taken additional training so that she can perform the initial infant checks and complete tongue-tie divisions all in the comfort of your own home at a time when you want to be safe and calm after the birth of your newborn.

Rene and I have somewhat crossed paths previously because we both work with pregnant women and new Mums and we both work in the same area doing home visits.  The subject of tongue-tie comes up a lot in breastfeeding forums, support groups and in random conversations on the bus when people find out I work in breastfeeding.  There are two complaints that are raised during these conversations;   

"It wasn’t diagnosed or the Doctor did not believe that a tongue-tie could cause feeding problems" and 
"I couldn’t find someone to do the procedure or convince the Doctor to make a referral"

Rene trained in Southampton to perform tongue-tie divisions (frenotomy’s) in 2012 and she has agreed to answer some questions about tongue-tie and about the services that she provides locally.

What is Tongue-Tie?

Tongue-Tie is when either, there is a piece of skin under the tongue (anterior) which being too tight stops the baby from latching onto the breast correctly, or under the tongue at the back is very thick (posterior).

With an anterior tie the tongue cannot reach the top of the mouth so the baby cannot create enough suction to hold the nipple in the mouth.  Baby will latch and then slip off causing damage to nipples.  Mum will usually experience nipple pain and baby will become exhausted as they try so hard get enough milk.  This is more obvious in the early days.

With a posterior tie, the tongue action pushes the nipple out of the mouth rather than pull the nipple in. You may also hear a “clicking” when baby is feeding and see milk dribbling out of the corner of the mouth as the suction is lost. This tends to show itself as the baby gets a little older.

This is my daughter's tongue shortly after birth.  I have a family history but this one caused no feeding problems

Is Tongue-Tie common?

Tongue-Tie occurs in about 10 in 100 babies of these about 4.5 will have a problem with feeding and or speech.  It can also run in families.

What are some possible symptoms of a tongue-tie?

Symptoms from Mum:
Sore Nipples
Pinched or blanched nipples after feeds
Mastitis (a breast infection) because milk emptying is not adequate
Lowered milk supply
Stress and exhaustion from frequent feeds or extended feeds and a feeling of failure to feed adequately.

Symptoms for Baby:
Restricted movement of the tongue or a not very wide mouth when feeding
A baby that is not content after feedings
A baby coming off of the breast a lot during feeding
A baby that falls asleep quickly at the breast
Very frequent feeds or very long feeds
A large weight loss or failure to gain weight
Clicking, drooling, excessive gas due to a lack of suction during feeds

Why have you decided to train and perform tongue-tie divisions (frenulotomy)?

In my Independent practice I have found more and more tongue-ties.  In the past I would need to refer them to a local lactation consultant and we would both have to agree that further treatment was needed.  The parent then had to get a referral from their GP to be seen by an NHS consultant, which could take weeks or even months.  This was unacceptable to me supporting Mums who were in pain, with a baby losing or not gaining, and Dad being completely at a loss as to what to do. Now I am qualified, I can do the procedure quickly and so minimise any disruption to breastfeeding.

How do you divide a Tongue-tie?

I use the same technique that is used in hospitals.  General anaesthetic is not needed and it only takes a minute or two.  I simply wrap the baby in a towel, divide the tongue-tie with a pair of sterile blunt-ended scissors, and then hand them back to Mum so that they can be fed.

Are there any potential problems with this procedure?

Not really, a number of small babies are asleep when I start, asleep when I do it, and asleep afterwards.  Older babies do not like being wrapped up so they usually cry out, and it can sometimes be really quite difficult to know whether or not dividing their tongue-tie is actually painful, as they are already complaining from being swaddled. I accept that some babies will cry for up to 60 seconds but on average its 15 seconds. I would emphasise that there are some babies who remain asleep. So although common sense says that it ought to hurt, there are some babies to whom it does not hurt at all and for the rest it does not hurt very much.

A few drops of blood are normal, but this always stops and is never a problem.
There will be a wound that you may feel needs something done about.  The inside of the mouth heals much faster than other areas of the body.  It is normal for the lining of the mouth to continually be worn away and renewed. This happens even more quickly in babies, so there is no need for any form of wound management, merely breastfeeding. Often there is a white patch under the tongue which takes 24 - 48 hours to heal.

What do you charge for this service?

I will be very happy to divide your baby's tongue-tie, especially if they have a feeding problem. There is a standard fee of £120, within 10 miles of Bexleyheath. If over 10 miles mileage is chargeable. All you will need is your child's Red Book (Parent Held Record) so that l can record relevant details.

If you have any questions about tongue-tie or would like to contact Rene for a consultation here are her details-

You can read more about the services Rene provides as an Independent Midwife on her website. 

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