(Note: I failed to pull out my camera at the clinic, so pictures on this post are from a google image search.)
Yesterday was my first clinic shift. Endorsements from night shift to day shift (when the off-going midwives share information about patients in labor or who have just given birth with those who are coming on shift, and the staff pray together) is at 6:00 am, so I was up very early. I discovered the water pressure in my shower is fantastic before 5:00 am and that walking to the clinic (takes about half an hour) is still sweaty in 90% humidity, even when the sun isn’t up yet!
I had planned not to be the primary midwife for any births for the first several shifts I attended, in order to give myself time to “re-orient” to the clinic. It’s been two and a half years since I was last here, and during that time I’ve been working in my own private practice in the States. A lot of the protocols are different here, and the paperwork (such a big part of any healthcare provider’s job!) is very different. So no birth stories yet.
There was still plenty to do without catching a baby. I took over care of a family who had given birth a few hours earlier, giving baby’s first bath and monitoring mom and baby until it was time for them to be discharged. I did a 6 week postpartum checkup for another midwife who is out of town right now. I discussed clinic protocols and paperwork and watched how the supervisor worked with her two students during the one birth that occurred during our shift. And then, the “God appointment” for the day.
One of the students who I had not met before had come in to do a postpartum check for a mom who had given birth yesterday. The baby had already lost an excessive amount of weight during the first 24 hours of life and though the new mother was patiently working with her baby, breastfeeding was clearly not working. The baby struggled to latch on and then once at the breast was not able to suck effectively.
Effectively supporting breastfeeding is one of the most important jobs a midwife has during the early postpartum period. Especially among poor families in the developing world, successful breastfeeding can literally mean the difference between life and death for a baby. After both the student midwife and the supervisor had spent some time working with this mother and baby with no success, the supervisor asked if I could come and help.
I took a brief history from the student, observed the baby’s breastfeeding attempts for a few minutes, and then asked the student if she had checked the baby’s mouth for a tongue tie. “Well, I did the usual newborn exam, but I don’t know how to check for tongue tie,” she said. I took the baby from the mother. Before I could even begin my exam, the baby began to cry, showing a very obvious anterior tongue tie. The lingual frenulum (the small piece of tissue that attaches the underside of the tongue to the floor of the mouth) was tight and extended all the way to the tip of the tongue.
A baby’s tongue mobility is very important for effective breastfeeding, and tongue tie is a frequently overlooked cause of breastfeeding problems. A frenulotomy — a simple “snip” to release the lingual frenulum — often makes a dramatic difference. The earlier it can be corrected, the better for breastfeeding, so when tongue tie came up in my practice in Ohio I usually did the frenulotomy within a few hours after birth or at the 24 visit. I was fortunate to have received excellent training on tongue tie while in Ohio from two tongue-tie experts, IBCLC Alison Hazelbaker and Dayton dentist Dr. Gregory Notestine, who has been correcting tongue ties for decades and whose technique I adopted. I’ve clipped quite a few tongue ties over the last few years, including a few older-than-newborn babies whose issues were not discovered soon after birth.
The supervisor and the other midwives at the clinic were excited to hear I had experience with frenulotomy and eager to see the technique. After explaining what we wanted to do to the baby’s mother, we got out sterile gloves and small sharp sterile scissors. The procedure takes only a few seconds. Moments later, the baby was breastfeeding — sucking well and effectively for the first time. Wish I could have bottled the joy and amazement on this mother’s face.