Why is reducing tongue-ties important?
- Tongue-tie in newborns can cause multiple issues in the initiation and continuation of breastfeeding [World Health Organisation]
- We wanted to provide the most effective treatment for tongue restriction caused by tongue-tie in order to support the continuance of breastfeeding
Our goal was to establish a service to assess and treat tongue-tie in newborns for the Waitemata district.
What did we find?
- The most effective treatment for tongue restriction caused by tongue-tie is frenotomy, which is a division of the frenulum [Cochrane 2010].
- Waitemata DHB did not have a publically funded frenotomy service which meant that parents had to pay to have this service provided in the community by private providers.
What have we done?
- We developed an evidence-based clinical pathway (see below) with a multidisciplinary team
- The team identified that midwives were the most appropriate workforce to provide a tongue-tie assessment and frenotomy service
- We developed a process to credential midwives to provide this service, as although this is part of the midwifery scope of practice, it is not a core competency
Tongue-tie pathway for breastfed babies
A peer reviewed credentialing process was developed for midwives to provide a frenotomy service including:
- theory readings / workbook
- 8-hour workshop on the use of the agreed assessment tool (Hazelbaker)
- theoretical assessment
- supervised clinical practice of both assessment and technique
- training in documentation and record keeping, including ongoing data collection
Did we make a difference?
Frenotomy clinics were commenced in October 2015 at North Shore and Waitakere hospitals with 4 credentialed midwives with the following results:
- 127 babies assessed with 104 frenotomies performed and 5 referrals to Starship ORL department
- average 68% increase in tongue function score at re-assessment
- more babies fully breastfeeding
- high satisfaction reported from mothers and community midwives
There has been high satisfaction reported from mothers and community midwives for the service: