Friday, 26 April 2013

Upper Lip Tie – Part 2

In Upper Lip Tie - Part 1, we discussed the implications of an Upper Lip Tie on the Newborn Infant and the Breastfeeding mother. However, there can be long term implications too.

▪Speech difficulties – due to the limited range of movement of the lips (and tongue), speech difficulties are more common and may be harder to treat.

▪Gap between the two front teeth – due to the tissue connecting the gum to the lip. This causes the top front teeth to have a gap.

▪Cavities – an upper-lip tie makes it more difficult (and painful) to properly clean the top front teeth, increasing the likelihood of dental decay.

▪Gagging – can cause problems with swallowing and gagging when eating solids (this is more commonly associated with a tongue-tie).

So what can be done? Referral to a specialist is paramount. This could be a Dentist, Paediatrician, ENT or Lactation Consultant. This specialist should be experienced in tongue-tie and upper-lip tie, and supportive of breastfeeding.

If revision is  necessary, the specialist will likely recommend laser treatment to release the tie. Laser is preferential over cutting with scissors as laser shows decreased swelling, pain and less likelihood of needing a second revision.

The Tongue Tie Babies Support Group on Facebook has a list of specialists that their users have positive experiences with and this can be a good starting off point. Your Midwife, GP or a Lactation Consultant may also be able to help. Knowledge is power. Arm yourself with as much good-quality information as possible and make an informed choice.

No one knows your baby better that you. If a health care professional tells you nothing is wrong or it’s not that bed, but you feel there is – ask someone else and keep asking until you are heard.


Upper Lip Tie - Part 1

Wednesday, 17 April 2013

Upper Lip Tie - Part 1

Not much is known about Upper Lip Tie’s – try Googling it. Basically, it is like a cousin of Tongue Tie. An Upper Lip Tie - or Maxillary Labial Frenulum - is when the upper lip is abnormally attaches to the upper gum (sometimes extending as far as the hard palate). It is also possible to have a Lower Lip Tie.

A Tongue Tie – or Ankyloglossia - is where the tongue is abnormally attached to the floor of the mouth. All can cause big feeding issues for the newborn baby.

Basically, if any of these symptoms are present, the health care professional should assess for the presence of an Upper Lip Tie and Tongue Tie;

◦Nipple pain during and after Breastfeeds

◦Nipple Damage – cracking, bleeding, looking flattened when baby comes off, presence of a line or mark on the nipple indicating shallow attachment

◦Apparent shallow suck

◦Apparent ‘good’ attachment that still feels painful or not right for Mum

◦Top lip doesn’t flange out when attached to the breast

◦Baby makes clicking noise when feeding

◦Milk escapes out of corners of baby’s mouth

◦Signs of decreased breast emptying – baby not gaining weight adequately, low supply or over supply and engorgement, etc.

◦Baby’s tongue not extendable over lower gum

◦Mum saying it ‘doesn’t feel right’.

For bottle-feeding babies, many of these symptoms will still be present – shallow suck, bottle falling our of baby’s mouth, clicking noises, milk exceping, etc.

Assessment for Upper Lip Tie and Tongue Tie can be easily attended during the Newborn Assessment attended by Midwives after birth. Look into the baby’s mouth and lift the top lip. Feel under the baby’s tongue with a gloved index finger. Dr. Kotlow (based in the USA) has described the process very well with excellent pictures of what to look for here

Don’t assume these checks have been done - if any of the above symptoms are present, check again.

The following is a list of great resources regarding Upper Lip Tie and Tongue Tie. Especially useful is the articles contained on Dr. Kotlow’s website. I have used information from these sites in writing this article. Another place to find more information and support from parents is the Tongue Tie Babies Support Group on Facebook

As always, no one knows your baby better that you. If a health care professional tells you nothing is wrong but you feel there is – ask someone else and keep asking until you are heard.


Upper Lip Tie - Part 2 -

Wednesday, 10 April 2013

Models of Care

Not everyone knows that there are different models of care you can choose when you are expecting a baby. There are many different options out there than simply booking into your local public hospital (or into your Sisters Obstetrician). Some are limited by the where you choose to birth – at home, in a Birth Centre, at the local Public Hospital or the local Private Hospital.

Independent Midwifery

In this model you choose your own Privately Practicing Midwife to care for you throughout your pregnancy, during your labour and birth and until your baby is 6 weeks old. Some Independent Midwives work collaboratively with Obstetricians for true continuity of care (if Obstetric care is required), some are even employed by hospitals so you can choose to birth your baby at home or in the hospital (cared for by your own Midwife). Some are Medicare Eligible which means you can get rebates for some services from Medicare, some Private Health Funds may also offer rebates. All appointments are typically 1 hour long with some Midwives seeing you in your own home.

Caseload Midwifery or Group Practice

In this model you are booked into your local Public Hospital for care and are allocated a Primary Midwife for your care. Usually, you will see the same Midwife throughout your pregnancy and after your baby’s birth, with an on-call system utilised for birth. Some hospitals run a Homebirth program through this model. It is always worth asking about this if you are going public – but ask early as places are often booked up by 6 weeks of pregnancy. Antenatal visits are usually longer than through the clinic, and these Midwives usually continue to see their women until their babies are 1 week old – with some continuing care until 6 weeks of age. Some of these Midwives will do home visits – some only at the hospital.

Antenatal Clinic (Midwives Clinic or Doctor’s Clinic)

In this model you are booked into your local Public Hospital and allocated to either the Midwives Clinic or Doctors Clinic based on your risk factors. You may see the same clinician at each antenatal visit (although this is rare), you are cared for by the hospital staff for your birth and postnatally. Some hospitals run a ‘Midwifery-at-Home’ program where a hospital Midwife visits you at home for a few days. Typically, your antenatal visits will be 15 minutes long, and Midwifery at Home visits 40 minutes until your baby is 5 days old.

Private Obstetrician (Public or Private Hospital) or GP/Obstetrician

In this model you book in with your chosen Obstetrician (or GP with additional Obstetric qualifications - this is usually in rural areas) for antenatal care and your chosen hospital for birth. Your Obstetrician will see you for your antenatal visits. During labour, you will be cared for by the hospital midwives with your Obstetrician usually arriving for the birth to ‘catch’ your baby. He/she will then continue to care for you while you remain in hospital and most will do your 6 week check.

Midwife Shared Care or GP Shared Care

In this model, you see your own Private Midwife or GP for most antenatal visits. During labour you are cared for by the hospital team (Midwives and Doctors) and can return to see your Midwife or GP postnatally.

Basically, whatever model you choose do your research. There is no use going to the Midwife or Doctor who cared for your Sister/Mother/Best Friend if you don’t like them, or if their birthing beliefs are far from your own. You are perfectly entitled to ask questions, get statistics and change care providers at any time. As you pregnancy progresses, you may find that the idea of a Homebirth appeals to you or that your Obstetrician who was once supportive of your wish to VBAC is now trying to book you in for a Caesarean Section at 38 weeks as he/she is going on holidays.

It's worth mentioning that Midwives working in Public or Private hospitals rarely look after one labouring woman. A more realistic picture is two labouring women, plus women for assessment, plus answering the phone, plus assisting other Midwives with births checking drugs, etc. An Independent Midwife is just looking after you! Remember it is Your Body, Your Birth and Your Baby – YOUR CHOICE.


Tuesday, 9 April 2013

National Core Maternity Indicators

The Australian Institute of Health and Welfare and the University of New South Wales have recently (2013) published the National Core Maternity Indicators.

“This is the first report of 10 national core maternity indicators for monitoring the quality of maternity care in Australia. National rates have decreased for smoking in pregnancy, episiotomy among women having their first baby and giving birth vaginally, and the proportion of babies born weighing less than 2,750 grams at or after 40 weeks. However, for some indicators, including induction of labour, caesarean section and instrumental vaginal birth, rates have increased and point to areas for possible further attention.”

This report is good in many ways, mainly because it quantifies key areas we as health care professionals should be concerned with. Perhaps the most concerning statistic is the rate of normal (non-instrumental) vaginal birth for selected women giving birth for the first time – 49.6%. This means that as a first-time Mum, you are more likely to have a Caesarean Section, Forceps or Vacuum-assisted birth then you are to push your baby out unassisted! Scary stuff!

Place of birth is also important

“Selected women giving birth for the first time in public hospitals were more likely than those giving birth in private hospitals to have a normal vaginal birth (56.7% and 36.9% respectively).”

Sometimes difficult to access, the information can be found. You are perfectly entitled to ask your chosen care provider what their statistics are.

The MyBirth website contains statistics on most hospitals which makes very interesting reading For example; if you’re planning a VBAC (Vaginal Birth After Caesarean) the hospital with the highest VBAC success rate in NSW (2009) is Bega Hospital – 38.1%. Private Hospitals in NSW average 7.4% success rate (so an average of 92.6% end with a caesarean section). Public Hospitals in NSW average 13.44% success rate (so an average of 86.56% end with a caesarean section). Clicking onto various Independent Midwives VBAC Success rates produces results ranging from 82-90%. Food for thought.

As health care providers I think we need to take a serious look at these statistics and reflect on our own practice. As women, we need to research, research and do some more research. Educate ourselves and make informed choices. Remember, it’s Your Body, Your Birth and Your Baby.

The Australian Institute of Health and Welfare report can be found at

MyBirth statistics can be found at

The Best Way to Birth

Anyone who knows me has probably heard this rant before. When Parents-to-be do hours of research on the best pram, coordinating nursery items and maternity jeans but don’t even do one Google-search on the best way to birth. Arriving to the Birthing Unit in active labour is the wrong time to start thinking about your options. By this stage, you have already engaged with a care-provider (be it Midwife, Obstetrician, public-hospital antenatal clinic, etc.), missed your window to prepare your mind, body and support person for birth, and are not in a good frame of mind to hear about the risks of certain medicalised forms of pain relief or other interventions.

Take pain relief for example, a labouring woman is not able to take in all the information – risks and benefits to them and their baby – between contractions and make a truly informed choice. This can lead to women accepting medicalised forms of pain relief (and the cascade of intervention that may follow) and later regretting that decision.

A truly informed choice is when the woman is educated and researches during (or ideally even before) her pregnancy. This enables her to look at the information objectively, take the time to process it and then take steps to ensure she is supported.

If she decides a natural, non-medicalised birth is for her, then preparing herself and her support person is paramount. She also needs to carefully consider her care-provider. An Independent Midwife, for example, is usually far more experienced in facilitating natural, non-medicalised birth and is far more likely to make non-medicalised suggestions like change of position, use of bath or shower, etc. to facilitate a natural, non-medicalised birth then other care-providers such as a Private Obstetrician. If she decides that an epidural is a very big possibility and she is happy with the risks, then a care provider that empowers this decision is important.

It is important that the woman discusses her decisions with her support person and care provider well before labour begins. Support persons and care providers need to be on-board 100% to easily facilitate the woman’s choices. She doesn’t need to be explaining her choice to not have an epidural between contractions at 8cm when she should be in her birthing zone and resting.

My advice to all pregnant woman, their partners and support people, is do your research and research and more research! Talk to your Midwife or Doctor and take steps to ensure your choices are supported. It is Your Body, Your Birth and Your Baby.


Bellies, Births and Babies - Introduction

I started Bellies, Births and Babies basically to get information out there. As a Midwife, I was frustrated at the lack of recent information relating to my practice, in an easily accessible environment that worked around my shift-worker life. As a Mum, I was also frustrated, but not over the lack of information, but over the overwhelming amount of junk available on-line.  There are some very good sites and forums out there, specific to particular topics or problems. But with my daughter on my lap, I wanted to find information relating to us and our life. I felt this desire to write and share articles constantly on my Facebook profile but restrained myself so my friends newsfeeds wouldn’t become clogged with my constant sharing and writing. 

So, Bellies, Births and Babies was born. I aim to appeal to women and men interested in all aspects of midwifery, pregnancy, birth, breastfeeding, babies and children. I am a passionate Wife, Mother and Midwife, with an amazing Husband, a beautiful Daughter, two mischievous Labradors, and the best job in the world.

Bellies, Births and Babies hopes to share information about
◦Birth - particularly Homebirth and natural birthing
◦Parenting – particularly Attachment-Style Parenting
◦Modern Cloth Nappies
◦Baby-Led Solids
◦Midwifery – particularly Homebirth, Midwifery-Led Models of Care and Midwifery in Australia

Through educating midwives, women and their families, I hope to empower women and their families to make the best possible informed decisions, that is the right choice for them . It is Your Body, Your Birth and Your Baby.