10 things they don’t tell you about breastfeeding
Knowing what to expect, as well as better support, is key
On an average week, he treats between 10 and 13 babies – with a waiting list of two to three weeks for private patients and up to six weeks for public patients.
“It undoubtedly works,” he says, although not for absolutely everybody. An early audit he did of 150 cases, some 95 per cent reported an improvement in the baby’s feeding – and for more than two-thirds it was a “marked” improvement.
It was personal experience as a father of six children – three of whom were born with tongue tie – which led to him providing a frenotomy service.
He had been sceptical about the procedure until not only his eldest daughter had it done in the UK but then it was also recommended by a lactation consultant for his youngest daughter who was born here.
He ended up doing that one himself – the first time he carried out a frenotomy, although he has since gone to the UK for training to ensure he was following best practice.
The UK’s National Institute for Health and Clinical Excellence (NICE) provided guidelines for the tongue-tie procedure back in 2005, concluding that dividing the frenulum was safe and “worked well enough” for use in the NHS.
There it is mostly lactation consultants who are doing it, although availability is still patchy.
Here in Ireland, the National Breastfeeding Strategy is looking for the introduction of guidance around diagnosis, referral and treatment of tongue tie, according to the HSE’s national breastfeeding co-ordinator Siobhán Hourigan. It is, she adds, a “work in progress” with the national clinical programme.
Treatment is generally not available in maternity hospitals. For instance, a spokesperson for the Coombe Women and Infants University Hospital tells The Irish Times: “We believe tongue tie rarely complicates feeding. In the small number of cases where it does, the Coombe Women and Infants University Hospital believes that the procedure to release the tongue, a frenulectomy, [another name for frenotomy] is best carried out by an experienced surgeon/plastic surgeon.
“For that reason, any case identified in this hospital is referred onwards to Our Lady’s Children’s Hospital in Crumlin.”
Lisa Finnegan is one mother whose baby was diagnosed with tongue tie by O’Byrne and referred to Roche, after weeks of struggling with breastfeeding.
“I was in so much pain, I was crying at each feed,” recalls Finnegan.
She hadn’t been able to get baby Rory to latch on properly after he was born at the National Maternity Hospital in Dublin in 2011.
But she and the midwives put this down to him being “lazy” after having bottles while she was in recovery following delivery by Caesarean section.
“He would latch on but he just wouldn’t suck,” she says. He was checked by midwives, the public health nurse and a paediatrician, but all suggested his feeding would soon settle.
After weeks of excruciating pain, and supplementing with a bottle, it was her husband, Mark, who finally said this couldn’t be right and she should seek help again – which led her to O’Byrne.
After a four-week wait the couple brought Rory down to Roche in Clonmel.
“He talked us through everything and then did the procedure, which took two seconds compared with the 20 minutes he took making sure we were happy,” she says. Rory bled a little and she was advised to feed him.
“The first feed afterwards was completely different. I was still sore but it was a different kind of pain. It was pain that was already there, rather than injury being done. We haven’t looked back since,” she adds.
Kellie Sweeney, a nurse living in Tallaght, Dublin, found her baby daughter Madison kept “bobbing on and off” the breast after birth in the Coombe hospital eight months ago. She knew this wasn’t right and, when O’Byrne saw Madison at just five days old, she identified tongue tie.
Sweeney gave it a few weeks to see if it was going to cause ongoing problems. When the pain persisted, she had Madison’s tongue tie snipped at six weeks by a GP in Maynooth, Co Kildare.
He has since had to stop offering the procedure as his insurers deemed it should be done only in hospital which, according to Roche, is “horse manure”.
The lack of a frenotomy service in Ireland is partly, Roche believes, because his generation of paediatricians were trained using text books which advised against it.
Yet, up to the 1950s, any baby with a tongue tie was likely to have it divided, he points out.
“The pendulum probably swung too far – some of them probably didn’t need doing, then we went to where nobody was having it done.”
He’s hoping his medical colleagues here will eventually be convinced that we need something in between.