Our postnatal services

This is a common difficulty at different ages of the baby. Jane has considerable experience in elucidating the key underlying problem and building strategies to ameliorate it.

This may include working through:

• Supporting clients to overcome sore/damaged nipples – assessing if this is purely technique or caused by other contributing factors – i.e. small gape and or undiagnosed tongue tie;
• Assessing if prolonged feeds are due to insufficient milk transfer – caused by suboptimal attachment and or challenges due to the infants oral anantomy – i.e. high palate, small gape, or anterior/posterior tongue tie;
• Assessment of mothers anatomy – flat, and or inverted nipples;
• Raynaud’s syndrome – how to feed with this;
• Undiagnosed breast tissue hypoplasia.

As part of difficulties with attachment there is often a secondary effect on the mother’s breasts. Mastitis and/or candida (thrush) of the nipple can be a recurring sign of this.

Jane provides:

• Clinical diagnosis with associated feed observation;
• Alteration in attachment (as required) to minimise trauma thus mastitis;
• Practical immediate management techniques to reduce the pain/inflammation of mastitis;
• Recommended onward referral to GP with suggested treatments;

Whilst not relevant to most families, the feeding of twins or multips can be more involved than singletons. For those who have not sought help antenatally, it is still possible to provide successful postnatal methods to feed twins/triplets.

Jane has significant experience in successfully helping parents to establish and maintain breastfeeding for these cases and can assist with:

• Facilitating tandem feeding;
• Ensuring adequate milk supply;
• Feeding techniques in public.

Concerns about milk supply can arise from a variety of triggers (weight gain in the infant, inconsolable crying, prolonged, ineffective feeding).

There are a multitude of factors which affect maternal milk supply; these are well-documented⁵.

A small proportion of this group, however, have a previously unknown physiological reason why they have low milk supply, once all other factors are accounted for. This can be missed, or mis-diagnosed, during the pregnancy/immediate post-natal period.

Jane is able to:

• Determine if this is primarily a maternal, or infant cause; physical or physiological;
• Address methods to optimise correctable physical causes;
• Discuss methods to provide immediate amelioration, whilst planning to work on long term realistic goals;
• Properly assess for breast hypoplasia and suggested onward referral if needed;
• Liaise with GP surgeries for those who require a further medical assessment.

Infants are seen where concerns have been raised about weight acceleration. Whilst these often represent ‘normal’ developmental changes in feeding, for some there is an underlying issue.

The following would be considered during a consultation:

• Clinical assessment on current status and feeding techniques and patterns;
• Clinical assessment of milk transfer;
• Assessment of milk supply; methods to increase this, where indicated;
• Developmental age of the infant and predicted impact on breastfeeding;
• Management strategies to optimise feeds, if needed.

Advice and support will also be given to clients who wish to relactate.

Tongue-tie has become increasingly recognised as one factor which can adversely affect a baby’s ability to latch.

NICE recommends that tongue-tie release (frenulotomy) may be beneficial for attachment and for maternal pain associated with poor latch. However, this procedure should only be considered following appropriately trained assessment of latch/attachment. This is because the tongue-tie may not be the primary cause of sub-optimal feeding⁶.

A Cochrane review of the 5 available randomised controlled studies was published in 2017. This noted that frenotomy reduced breastfeeding mothers’ nipple pain in the short term. Investigators did not find a consistent positive effect on infant breastfeeding. They did note that the small number of suitable studies, and methodological shortcomings of those found, limited the certainty of their findings⁷.

Conservative measures to ameliorate this

Gables Breastfeeding Clinic has significant experience in using conservative measures to ameliorate the adverse effect on feeding.  Please see our Testimonials for details.

Onward referral for tongue-tie release (frenulotomy).

• For babies for whom frenulotomy may be indicated, this Clinic does NOT offer this service. However, Clients are referred to appropriately-trained clinicians with an expertise on division (and redivision, if this is the presenting problem).
• Referrals can be private or NHS.
• No renumeration is received by us for referrals made.

Follow up assessments

Following her previous work in a specialised tongue-tie clinic, it is Jane’s standard practice to offer 2 follow up appointments post frenulotomy.

These are additional appointments which are considered important to ensure that after-care is being appropriately administered and to assess if further changes are required with the latch.

Jane advises a day 2 post-procedure and a day 7-10 subsequent follow up.