Joint Statement on the Upcoming Pregnancy and Baby Fairs

We, Amanda Glynn IBCLC (www.lactation.ie), Carol Smyth IBCLC (www.carolsmyth.co.uk) and Nicola O’Byrne IBCLC (www.breastfeedingsupport.ie ) have come together to make the following statement re International Board Certified Lactation Consultants (IBCLCs) attending non-WHO Code compliant baby fairs.

The adoption of and adherence to the International Code of Marketing of Breast-milk Substitutes is a *minimum* requirement and only one of several important actions required in order to protect health practices of infant and young child feeding. (Resolution WHA 34.22)

Why would a formula company invite a breastfeeding advocate and/or healthcare expert, such as an IBCLC, to attend its Pregnancy and Baby fair?

Having an expert such as an International Board Certified Lactation Consultant associated with a Code violating company, lends credibility to it's products and activities. It’s a clever marketing ploy that achieves endorsement by association, whether or not that was the IBCLC’s intended outcome. When an IBCLC has an association with a formula manufacturer, directly or indirectly, we believe that the IBCLC is not meeting his or her responsibilities under the spirit of the Code. It is our contention that lending support to such events not only serves to undermine the professional integrity of the IBCLC credential and profession but also threatens future breastfeeding advocacy efforts. 

Stand holders and presenters at baby fairs are there to increase sales through discounts and complimentary gifts, which in turn builds brand awareness and loyalty. Some of the stand holders and presenters have chosen to further promote this non-Code compliant Pregnancy and Baby fair by offering mothers “free” attendance tickets. It is worth noting that even when a company offers free tickets to an event, the cost of providing those free tickets is simply absorbed by the marketing department of the formula company and added to the price of the products that fall within the scope of the Code. We do realise that the two upcoming Pregnancy and Baby fairs are being run by an event company. However, we believe the main sponsors are funding the bulk of the costs.

Recognising the complexity and susceptibility of the Code as a minimum standards document which is open to interpretation, we further our commitment to upholding the spirit and intention of the Code by declaring that we will not accept, or offer to the public, any inducements (such as free tickets, samples, gifts, material items containing logos etc.) relating to products or entities which fall within the scope of the Code. To strengthen our adherence to the provisions and obligations of the Code and to avoid any conflict of interest, we further declare that we will not offer nor accept any invitation to speak at non-Code compliant events.

Amanda Glynn - www.lactation.ie

Carol Smyth - www.carolsmyth.co.uk

Nicola O’Byrne - www.breastfeedingsupport.ie 

For further information on WHO Code and IBCLC Code of Professional Conduct please use these links

http://www.unicef.org.uk/.../A-guide-for-health-workers.../

http://iblce.org/.../08/code-of-professional-conduct.pdf

No... Your Baby Won't Swallow His Tongue!

I can't believe I'm writing this post but this needs to be addressed. Today at the tongue tie clinic, I was asked three times by different parents if this was possible? To divide so far back the baby might swallow it's own tongue.... It is years since I heard this myth being touted by doctors, midwives and lactation consultants (it's the latter that really astonishes me..)
One  very anxious mother asked - " I know this is a stupid question, but could he swallow his tongue afterwards?"
Various people in the maternity hospital had said to today's parents..
"It's a dangerous procedure , your baby might swallow its tongue"
"I wouldn't advise getting that tongue tie divided, its only mild, it will stretch and more importantly the tongue might double back on itself and choke the baby"   Wow, three myths in one sentence!
Seriously?
Let's have a little anatomy lesson..

The tongue is an amazing thing - it is a muscular hydrostat (this means it can change shape in many ways-  like an elephants trunk or an octopus's tentacles) . I can understand this might make people nervous of going near it with a scissors.

 This is why tongue tie division should be performed by someone who has had surgical training.

However it is necessary to have good movement of the tongue for a baby to breastfeed well. 
Scaring parents by telling them myths is unfair and not supportive of women, babies or breastfeeding. It's unprofessional, personal opinion and has no place in a ethical  evidence based profession, such as the IBCLC. 

The tongue is a muscle that is connected to the hyoid bone in the throat and the mandible (the lower jawbone). The frenulum is a piece of tissue that is underneath the tongue - it is not connected to the tongue muscles. When a frenulum is divided ( a tongue tie release)-  the trained person doing the procedure cuts back as far as the muscle. They don't cut into the muscle. They cut the tissue in front of it and make a diamond shaped wound.  This diamond gives the baby extra lift, lateral movement and extension to manage the  mechanical work of breastfeeding.
Look at this image below, Can you see where the tongue is connected in both places? It's just not possible for the tongue to fold back on itself.

Image from https://www.studyblue.com/notes/note/n/comd-462-final/deck/10357109

Here's another nice video going into a lot more detail on the muscles and  nerves of the tongue and also the hyoid bone. 

HOW TO PREPARE FOR BREASTFEEDING: TOP TIPS FROM A LACTATION CONSULTANT

Here is a piece I wrote for herfamily.ie recently... 

Are you thinking about breastfeeding? If so, you might be confused about where to even start. I was.

And even when I did feed, I encountered problems. The details of which are for another day. But, with perseverance and some professional help from a Lactation Consultant (aka Lifesaver/Legend/Fairy Godmother), I got there in the end. And it was worth every single second.

For some, nursing isn't a problem. For others, it takes a little time to get into the groove and some help along the way. And then there's the few that need help with spotting things like Tongue Tie to get them there.

When you're plodding along with your bump, you just don't know which of these boxes you might fall into. Chances are it'll all happen easily and naturally, and in most cases, it really does. But, despite this, everyone – even the natural nursers – need a helping hand with things like knowing how long to feed, whether to feed both sides, when to wind, when to start expressing, and just how much or how little to express.

If there's one piece of advice I could tell my naïve self before I had my first baby (Full disclosure: I was clueless), it's that the best money you will ever spend, hands-down, is on a breastfeeding course with a Lactation Consultant or a one-on-one session once the baby rears its little head.

So, I chatted with leading Lactation Consultant, Nicola O'Byrne – the go-to woman in Dublin, renowned for her brilliant approach and gentle nature – for a little bit of her wisdom for preparing to nurse.

1. Your breasts have been preparing to feed and nurture your baby since the minute you became pregnant. Be confident and learn as much as possible before the baby arrives so that if you run into a problem, you will know what to do and where to get good effective help.

2. There's no need to prepare your nipples for breastfeeding. There are tiny glands around your areola that secrete oils and get them ready for the important job ahead.

3. Breastfeeding pillows are not really necessary – I find they can cause more problems than they help. Put lots of pillows and cushions under your arms and let your body support your baby by lying back when breastfeeding.

4. Going to a breastfeeding class is a great idea. You will learn lots and you'll know what to do if you run into trouble like if your baby not latching easily after the birth. A good class will shows lots of videos, have practical demos and lots of chat. In my class, everyone has time to ask questions and can stay behind if there is anything they would prefer not to discuss in the group.

5. What should you buy? Generally, I recommend a sleep nursing bra or a breastfeeding vest for the hospital. These are much more comfortable to wear in bed. Two nursing bras is sufficient for the early weeks.

6. Should you buy a book? Yes (and give it to your partner to read!). I recommend The Womanly Art of Breastfeeding by La Leche League International. It’s a breastfeeding bible, beautifully written and easy to dip in and out of.

7. Going to a breastfeeding group before you have your baby is invaluable. Most mothers think they can't go beforehand, but the voluntary groups welcome pregnant mothers with open arms. You get to see lots of babies breastfeeding and chat to the trained counsellors. Sometimes in Ireland, it’s easy to assume that everyone has problems breastfeeding. Going to a group will show you that there are lots of happy mothers and babies out there.

8. Websites to learn about breastfeeding? At the moment,Nancy Morbachers Natural Breastfeeeding channel on Youtube is my favourite. And the HSE has recently updated the National Breastfeeding Website.

Nicola O’Byrne is a lactation consultant in Dublin who holds regular breastfeeding classes. Find out about booking and class times via her website,Breastfeedingsupport.ie

What does crawling have to do with breastfeeding?

Sometimes I  will suggest  a mother brings her baby to a bodyworker ( CST, Osteopath or chiropractor) . If a baby is having problems breastfeeding on one side or if a baby won't extend it's tongue and or head  to feed, or if the baby clamps its jaws-  it causes problems breastfeeding. Most of these babies hate being on their tummies (because its not comfortable).

 This is a wonderful article from an Occupational Therapist on why crawling is so important.

Crawling starts with tummy time...

                         http://mamaot.com/2015/01/19/how-does-crawling-develop/

Tweets from the recent 2014  IATP conference included a lot of discussion about tummy time. Michelle Emanuel an Occupational Therapist from Cininnati Childrens Hospital spoke about the benefits of putting babies on their tummies as part of rehab after tongue tie division.  

Her website is here for more info ( click here)

If you find that your baby hates tummy time sometimes wearing them in a stretchy wrap sling can build up tolerance to extending their head and neck . That in turn works the abdominal muscles. 

Here are some ideas for adapting tummy time to make it easier for your baby. 

http://mamaot.com/tips-for-making-tummy-time-a-little-less-um-miserable/

Officemum Interview

A quick hello from Lactation Land.
Today OfficeMum published an interview with me about the realities of being a working mother with 5 children.
I guess reading it might explain why theres so few posts on this blog!
So I do hope to post a bit more this year. If anyone has  suggestions about what they'd like to see then please let me know.
http://officemum.ie/office-mum-stories-nicola-obyrne/

Tongue Ties again - common questions asked .

Are there more tongue ties than ten years ago ?  I suspect there are more . Posterior tongue ties are very different to anteriors , they tend to have thicker , restrictive lip ties . This combination  really makes  obtaining a good effective latch quite  difficult . Some people think its not that we now recognise them more  but they are a result of environmental contaminants and dietary issues  .

And why are health professionals  so misinformed about them ? 
 They are not seeing breastfeeding mothers everyday , they are not looking in babies mouths , they are not getting enough (or any) breastfeeding education.  There are enough studies now to prove tongue ties cause breastfeeding problems and that frenotomy is safe , low risk , effective procedure ( provided the person performing it has been trained properly) . There are a small amount of paediatricians and GPs who are supportive , hopefully it will change in the future .
There are very few studies that include posterior ties , they are harder to spot and sometimes  tend to take longer to improve feeding  once divided. 

Do all tongue ties need to be divided ? 
No , definitely not . Some ties are really stretchy and cause no feeding  problems for the baby . We don't know which ones will cause a problem with speech or misaligned teeth later in life . What is a common myth is when people say "oh he is sticking his tongue out so that tongue tie will be ok " . Extension is only one part of tongue function . 

Will a tongue tie cause a speech delay ? 
No , its more likely to cause an articulation problem  with the following sounds  l, r, t, d, n, th, sh and z.   Some children will find another way to form the sound , other will improve with speech therapy - but they are always going to be living with a tension in their oral area , which can cause a myriad of structural problems later in life. 

So how does an IBCLC assess which ties need division and which do not ? 
First of all , its not just a matter of " divide the ties and all will be ok " . Frenotomy  a link in the chain of intensive breastfeeding support and osteopathy . This is what works, I see it all the time . 
I look in every babies mouth , I assess their tongue function, looking at a tie tells me very little , looking at what the baby can do tell a lot .
I assess all babies I see with a tongue function assessment tool . This tells me which babies need frenotomy, which ones need an osteopath and which ones just need positioning  and adjustment .

Lip Ties ?  We are still learning about lip ties, it's a new discovery. I have never seen a restrictive lip tie that doesn't have a tongue tie too. Again not all lip ties need treatment . Mothers and babies  have breastfed for thousands of years ,  good support is the main key to this .

Every Breastfeed Counts !

  I was talking about this yesterday at my breastfeeding class  .

 Some mums say to me "I only breastfed for 3 weeks or 6 months".

 While I recognise  it's a source of disappointment for mothers when they don't reach their goal, it's     really important to recognise what you did you do!  

Remember the Irish national statistic for ANY breastfeeding at birth is 56%. So just under half the babies in Ireland never get any breastmilk at all!  

The ESRI report from last year goes into more depth http://www.esri.ie/news_events/latest_press_releases/breastfeeding_in_ireland_/

Pinky McKay is a lactation consultant in Australia . She wrote a great article  yesterday saying every breastfeed is a success .

http://m.essentialbaby.com.au/baby/breastfeeding/every-breastfeed-is-a-success-20130514-2jjwt.html

Other sources where families can recognise what each day or week of breastfeeding gives to their baby (and their own body) are from IBCLC  Diane Weissinger   "What if i want to wean my baby " 

My personal favourite is the NCTs "Reasons to be Proud". I've had many of my clients pin this to their fridge and cross off each milestone. They say its a daily reminder when things are tough and their breastfeeding journey is difficult. Download here