Tuesday 25 July 2017

Breastfeeding: The pain didn't lessen, it intensified

Andrea Mara had no idea a simple snip could stop the pain tongue tie was causing her when breastfeeding her third child

Andrea Mara and son Matthew, who was born with tongue tie – a condition that left his breastfeeding mum in pain
Andrea Mara and son Matthew, who was born with tongue tie – a condition that left his breastfeeding mum in pain

Andrea Mara

TONGUE tie. Have you heard of it? Most people haven't. I hadn't, when my third baby was born a week before Christmas in 2011.

I felt very blessed to have a healthy baby and I felt confident about breast-feeding. So very different to how I felt when my first baby was born – unsure, hesitant, needing help.

This time I knew what I was doing. Or so I thought.

Breastfeeding was a little sore for the first day or two, as is often the case. But unlike my first two experiences, instead of decreasing over time, the pain intensified.

When he was four days old, I was at home, asking a friend if boys just have a stronger suck – would that explain the pain? I knew by her facial expression that I was grasping at straws, reaching for any kind of explanation as new mothers so often do.

Two days before Christmas, my public health nurse phoned and I told her that breastfeeding had now become extremely painful.

She asked "Could he have tongue tie?"

I had no idea what she was talking about.

She explained that it's when the frenulum (the piece of tissue that connects the tongue to the base of the mouth) is shorter or thicker or tighter than normal, and it makes it difficult for the baby to feed efficiently.

This in turn can be very painful for the mother, although pain is not present in all cases (indeed some mothers breastfeed successfully, with no pain, and later discover that tongue tie is present).

I returned to the Dublin maternity hospital from where we'd been discharged two days earlier and a very sympathetic member of staff arranged to see me that day. She told me that my baby had a "mild" tongue tie and she mentioned that there was "a man in Clonmel" who carries out tongue-tie divisions but that the maternity hospital doesn't believe that this procedure is generally necessary.

The pain continued. It was excruciating.

Every time I prepared to latch the baby on, I asked my husband to take my two daughters out of the room, so that they wouldn't see the fear on my face, bracing myself, anticipating the pain.

Soon I could feed on one side only. I got mastitis on St Stephen's Day.

I fed through it (as you should), on the "good" side, pumping on the other side. I cried. A lot.

I was miserable. Miserable with pain, and sad that these newborn days that should have been so happy were being sabotaged by this condition that I'd never heard of.

I went back to the maternity hospital, desperate for help. I was given a name – Nicola O'Byrne, who was a private lactation consultant who could help me.

I called Nicola that day and we arranged for her to come to my house.

She said she saw signs that were typical of a grade four tongue tie.

She sat on my couch and talked to me and listened to me and gave me information and reassurance and hope.

She explained that tongue tie is not normally diagnosed and/or treated in Irish maternity hospitals.

She explained that there were only a handful of medical professionals in Ireland who carried out tongue-tie divisions.

She told me that two generations ago, midwives dealt with tongue tie in newborn infants once diagnosed, soon afterbirth.

She explained that because formula feeding had replaced breast feeding for so many mothers over the last two generations, knowledge about tongue tie had been lost.

She referred me to "the man in Clonmel" – Justin Roche, a consultant in Clonmel General Hospital.

So on a rainy, cold Wednesday in January, my husband and I drove our five-week-old baby to Tipperary and had his frenulum snipped.

He cried for a few seconds, then latched on and fed happily. It took just two weeks for his ability to feed to be fully transformed – no more pain for me, no energy sapping, inefficient feeding for my little boy.

All good so.

But not really.

I'm still angry that I had to go through this unforgettable pain for five weeks.

I'm still angry that the newborn days were full of frustration and tears.

I'm still angry that I had to drive on a rainy Wednesday from Dublin to Clonmel to have the tongue tie snipped – a simple procedure that could be carried out in maternity hospitals before going home.

And mostly, I'm angry because there are hundreds of mothers all over Ireland who have had a shortened breastfeeding relationship due to untreated tongue tie.

How many mothers every day, every week decide they can't continue breastfeeding their newborns because it's too painful?

Because the baby doesn't seem to be getting enough milk?

Because the baby is crying and seems hungry?

The reason that I continued to persevere, continued to look for help, continued to search for answers, is that he was my third baby. I had breastfed my first two babies successfully – yes I had needed help in the hospital to latch the first baby, as most mothers do. And yes there had been some discomfort in the early days.

And yes there were bumps along the way; days when I wondered why my baby was crying although I'd just fed her, nights when she was up for longer than usual. Normal bumps.

I knew that what I was experiencing with my third baby was not normal. Breastfeeding should not be painful.

If it is, it is likely that there is something wrong with the latch, or perhaps there is tongue tie – as I know now but didn't know then.

So every time I approached staff in the maternity hospital, phoned the lactation clinic, spoke to my public health nurse, my first sentence was: "This is my third baby."

This was a means to ensure that I would be heard – my fear was that I would otherwise be dismissed, as a fretful first-time mother, someone who could not handle the relatively small level of discomfort that often accompanies the initial days of breastfeeding.

New mothers are extremely vulnerable, and are often anxious about asking questions, unsure about seeking help. Easy to dismiss.

I was adamant. "This is my third baby. I am experiencing excruciating pain, unlike anything I have ever gone through before. Please help me."

What would a first-time mother say? What would she think?

If unknown to her, her baby has tongue tie and this is causing unbearable pain?

Some first-time mothers persevere – the more confident mothers, the mothers who have support, the mothers who have friends or family who can steer them towards a source of help. But many say nothing. Many think: "I can't do this". Many assume that the pain is "normal" and that they are supposed to be able to bear it.

Or they let a healthcare professional know that it's painful, and are told that it will ease off in time. But it doesn't.

There is no way to measure or compare pain; there is no way for these new mothers to know that what they are experiencing is not normal and that they should have their babies checked for tongue tie, especially as the condition is not mentioned in hospital literature nor covered as standard during ante-natal classes.

So some mothers will stop breastfeeding as a result. Understandably.

They look at friends or acquaintances who have breastfed their babies and feel sad that they're not able to continue to do the same. They feel guilty.

They feel as though they have let down their babies, because of a perceived lower pain threshold.

Between 4pc and 10pc of babies are born with tongue tie.

And maternity hospitals are not treating it, not informing mothers.

How many breastfeeding journeys are cut short by tongue tie?

I don't know.

Actually, nobody knows, as there are no real statistics, no records.

And a very limited official recognition of the condition.

As Nicola O'Byrne said to me recently: "It's pretty unbelievable that there is no service in our capital city for breastfeeding babies who are having difficulties because of tongue tie."

There are small, small changes, coming slowly; changing attitudes of some healthcare professionals as they become more informed, and increased awareness through online forums, and word of mouth.

A friend who said her baby was crying a lot and that breastfeeding hurts sounded confused when I said that the cause may be tongue tie and that it could be treated.

"What's tongue tie?" she said. "I've never heard of that?"

I know. That's the problem.

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Irish Independent

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