October 7, 2021
It was the spring of 2021 when Kaitlyn Moses had her second child. The initial plan was to have a home birth, but she had to go to London Health Sciences Centre (LHSC) the night of the delivery. She was grateful to be at the caring and capable hands of midwives throughout the entire process, from administering the epidural, pushing, meeting her son for the first time and having breastfeeding support.
Her primary midwife, Katie Pountney, checked over Moses’s son and noticed his tongue-tie after checking his weight. A tongue-tie is when a short piece of skin underneath the tongue can restrict the movement of the baby’s tongue, interfering with breastfeeding. It can affect the baby’s ability to latch and nurse effectively and can sometimes be a problem.
A tongue-tie becomes problematic when the baby can’t remove milk from the breast effectively. It can cause problems with weight gain and milk production for mothers. Newborn babies need sufficient nutrients from breast milk to grow into a healthy weight. Breast milk also contains antibodies and live white blood cells to help babies fight infection. Furthermore, when a mother’s breasts are not drained sufficiently, blocked ducts occur and become painful.
Before leaving the hospital, Pountney talked her through how the baby can latch and feed until she can come for a home visit. Moses was grateful to have the support. She was unable to breastfeed her first child due to jaundice and used pumped breast milk as a supplement.
Receiving breastfeeding support was high on Moses’s priority list. It was important for her to know the options available for breastfeeding support for her second baby. This support is provided to all midwifery clients. Even with Moses’s baby boy having a tongue-tie, there are recommendations and procedures midwives can suggest moms take to ensure the baby is getting the right milk supply.
As a tongue-tie revision is outside of the scope of a midwife, a paediatrician was consulted to release the tongue-tie with a scalpel a few days later. Frenulectomy is the method to release the band of tissue to allow the tongue to move freely, efficiently and effectively to create a comfortable latch. There are also situations when a laser is used. This procedure is not necessary for all tongue-ties. In other cases when a lip tie and a tongue-tie is present simultaneously, a dentist is referred.
Sometimes a tongue-tie isn’t problematic and a procedure isn’t necessary. “The main issue with breastfeeding is usually the latch. Midwives can help fix that by referring the patient to the pediatrician or the dentist. Though in many cases, it can be fixed with the right positioning,” Pountney explains. Educating moms on positioning of the baby and listening for the sounds of swallowing puts them on the right track to check if the baby is receiving enough breast milk.
Besides coaching moms how to breastfeed, midwives provided Moses with a binder with handouts on breastfeeding to show what to expect, breastfeeding schedule and how to position the baby for an effective latch. This binder is provided to all midwifery clients and is helpful to have until the midwife’s home visit.
The midwives with privileges at LHSC offer care for both mom and baby up to six weeks after birth. Home visits are offered for the first week to 10 days postpartum to support screening tests for newborn babies, assessments of both mother and baby and family teachings. Midwifery clients have the ability to be discharged early from a hospital birth as they have access to a midwife 24/7 through a pager and a midwife will follow up with the family at home the next day. This service was just recently expanded to all obstetrical and family medicine patients with the roll out of the Early Discharge Program in July 2021. This was supported through The Ministry of Health COVID-19 funding that sought to help families discharge home early with home visits provided by midwives. Unfortunately, the funding ended September 30th and the program has ended.
“I was ecstatic when I heard I could discharge early. Since I had no complications and I met all the conditions required, I was able to be back at the comforts of my home,” Moses says. It’s much easier to breastfeed at home, Moses recalls, remembering how her first baby woke up other patients in the middle of the night. In the meantime, early discharge made it possible for Moses and her baby boy to be back in their bed until the midwife’s home visit the day after.
Midwives conduct home visitations to check the baby’s weight and for risks of jaundice. They also provide hands-on breastfeeding support to show moms how the baby can latch effectively. Through the home visit, Moses was able to learn the football hold position, ensuring her baby boy got the right amount of breast milk. In other situations when moms are still unsure and request extra support, lactation consultants are referred. Several midwives that have privileges at LHSC have completed extra training in lactation and are certified lactation consultants to support the needs of their clients.
A lactation consultant in LHSC’s Mother Baby Care Unity, Elisabeth DaRocha, notices a lot of mothers struggle with breastfeeding and first-time mothers need more support. She recently returned from maternity leave and understands the struggle mothers go through with breastfeeding. DaRocha says, “The first two weeks are a roller coaster ride. If you can survive the first two weeks, it means the breastfeeding will get better.”
Establishing a breastfeeding pattern can take from two to four weeks. It requires patience and mothers shouldn’t be afraid to ask for help if they need extra support. The midwives, paediatricians, dentists and lactation consultants are here to help and support mothers and their babies, like Moses and her baby boy, successfully breastfeed.