Invisible Umbilical Cord: the mother-child bond

Today is the saddest day yet. Its my birthday. The first one after my my mum’s death. 

Before starting my journey into motherhood I never really understood the depth of bond between mother and child. The invisible umbilical cord that was severed the day my mum died. I was not her first child, infact I was her last. And I sat next to my dad today wondering if he felt sadness remembering the moment his best friend gave birth to his first child 37 years ago.

After my mum’s death I felt strangely compelled to seek out her mother’s resting spot. Like I felt the link of motherhood was dying along with her. Although I know that is not true, for I have my own children whom I love inexplicably.

I remember how I transitioned into motherhood myself, lucky enough to have my own mum stood right beside me. Terrified, keen to do everything ‘right’, uncertain how I even came to want children. 40 years apart in age, we were from different generations so didn’t always see eye to eye. She didn’t do a bad job though; she raised a liberal family who know their own mind. Even in times of severe adversity in our family, mum and I never fell out. I understood things in a way that only another mother can. She was there every step of my journey with advice, comfort, support. Even if she didn’t agree, she rarely let it be known as she nurtured me to become the mother I am today. 

Without her support, her ability to drop everything to look after my child, I would not have become a midwife. I would not be blessed with the opportunity to do what she did for me; to stand beside women who are becoming mothers. To hold their hand, to help them realise their strength and to watch them create their own invisible umbilical cords. It is a privilege to be a midwife; a calling which arose only after I gave birth to my own child. Despite our differences it was my mum’s strength of character, acceptance of those around her and determination to succeed that subconsciously led me down the path I follow today.  

Death is the only thing certain in life. I embrace that fully. The devastation I feel is channelled into life changes: buying my first house, a career move. All for my family; to give them the gift of time, unending love and an emotionally and financially secure future. I will be everything my mother was. And more. For that invisible umbilical cord was never severed. It is not just between one mother and her child, it is a continuous link through the generations of mothers. 

Posterior Tongue-Tie: “The latch looks perfect”

First Breastfeed 1 hour old

Two days old

For the love of boob! 7 months old

Anwyn Marie was born 8th October 2015. Breastfeeding was the only option; as a midwife and a mother I am fully aware of the physical and emotional benefits to both mother and baby.

My past experience of feeding (8 years ago) was challenging. I had a poor start postnatally. Skin to skin was interrupted for suturing, midwives used a ‘grab the baby, grab the boob’ approach, staff were busy overnight and when I needed support with feeding there was no-one available to help. By the morning I was convinced I couldn’t feed my baby and desperate to get to the comfort of my own home…formula milk…this was my ticket out of the hospital! Back home the hormones kicked in. Uncontrollable tears. My community midwife was a rock. Over a couple of days breastfeeding became a reality. But unrealistic expectations, ‘harmless’ comments made by family members, peer pressure and lack of the right support saw my breastfeeding journey end after just 3 months.

This time I was determined. In preparation for any feeding challenges I had expressed plenty of colostrum between 38 and 40 weeks of pregnancy and stashed it in the freezer. I believe you can never be too prepared.

A couple of hours after Anwyn was born, I lay on my bed with her snuggled into my breast. I am elated. I am in love. Her latch is just perfect. “You will have no problems feeding” I whispered to her.

In that first day I am reassured five times by three separate people (all friends or health professionals with plenty of experience supporting mums with breastfeeding) that Anwyn’s position and attachment looked really good. But slowly, steadily it was becoming more painful. The first night was awful and I spent several hours the next morning relaying pictures and videos to my close friend and breastfeeding specialist. We considered everything. Thrush. Raynauds. PPH recovery. Tongue-tie. We had no definite answers. With some tweaks to position and attachment I felt some minor improvements but the pain continued to be unbearable.

Despite a good latch, Anwyn definitely had a small gape and a shallow latch. On close examination there was a prominent heart shape in her tongue, just like her dad, although the frenulum wasn’t clearly visible. Her tongue did not stretch past the edge of her lips. Yet she appeared to be swallowing milk and was clinically well. My midwife was amazing. I could see she wasn’t entirely convinced, especially as Anwyn’s latch continued to be visually very good, but taking a holistic view she made a referral to the Trust breastfeeding specialist midwife for a tongue-tie review. That was late on a Friday afternoon…all I had to do was get through the weekend.

The next few days and nights were the toughest I have ever experienced. Physically I was recovering from a PPH so felt weak and tired. My nipples progressed from red to damaged. I experienced razor sharp sensations during feeds and felt as though my nipples were being clamped in a vice. I reverted to expressed milk, starting with the colostrum in the freezer. Initially Anwyn was comforted by finger feeding. Michael and I shared syringe and finger-feeding and I managed a little sleep. I hand expressed to give my nipples a rest. Then my milk arrived on day 2.

Anwyn needed more and more milk. I reverted to the electric pump but it was too painful against my already damaged nipples. She found it impossible to lap from a cup because she couldn’t extend her tongue. I utilised all the resources I could. Friends. Midwives. Online videos. Local NCT breastfeeding counsellor. Blogs. Despite all the practical advice to help with positioning and attachment, Anwyn’s latch looked perfect. So I persisted with breastfeeding, remaining steadfast in my position that she would not have a bottle or formula milk.

Hypnobirthing techniques were my saviour. I gazed at my daughter, repeating to myself how much I loved her. This emotional battle was intense. Michael felt my mental health was being pushed to the limit. He would place his hands on my shoulders and tell me how incredible I was. Not once did he utter those fateful words (“just give her a bottle”); something I am eternally grateful for.

The tongue-tie review gave us hope. Following her examination, it was evident Anwyn had a posterior tongue-tie…her tongue did not reach the roof of her mouth, the extension was limited and on suckling it moved in a humped motion. However, the paediatrician who co-assessed Anwyn did not feel he had the skills to perform a frenulotomy on a posterior tongue-tie, believing the risks of bleeding and cutting the nerve outweighed the benefits of sustained breastfeeding. So another referral was made, this time to the ENT consultant, with no guarantees and a wait of up to 3 weeks.

I was crushed. I sobbed into my baby’s neck, wanting only the best for her. Determined to breastfeed, I made the decision to see a private lactation consultant and tongue-tie specialist. After all, the short term investment was significantly less than the long term cost of formula feeding. My appointment was the next day. Anwyn would be 5 days old. In the meantime I had a call from the ENT department and could be seen by the consultant, just 2 hours before my private consultation. This was incredible news! I decided to see the lactation consultant regardless; if nothing else she would be able to offer more in-depth feeding support.

The ENT consultation was appalling. It transpired that the consultant did not ‘believe in the existence of posterior tongue-ties’. He made this proclamation within 3 minutes of us entering the room, without examining Anwyn or asking me about the feeding experience. He did not know where I could seek alternative support and had no suggestions for how I continued my breastfeeding journey. For so many women this consultation would have been the end of the road. But I was determined.

Still recovering from the birth, we made the 45 minute car journey to Suzanne Barber, Lactation Consultant and Tongue Tie Practitioner. As we entered her small clinic, I was awash with nerves and a feeling of hope. Using physical examination, observation of a feed and holistic questioning about the feeding experience, Suzanne very quickly diagnosed a posterior tongue-tie. Michael was torn out of his comfort zone…he

was asked to make an on the spot decision regarding a frenulotomy for his daughter, without having time to research and consider the evidence. Suzanne was respectful of this, giving very balanced information and space for us to reach a decision together.

After the frenulotomy Anwyn and I shared a remarkably comfortable feed, with a latch deeper than any that had been achieved previously. Tears trickled down my face expressing the relief that I was not imagining the pain and delight that our breastfeeding journey could now flourish.

As we drove home, I felt relaxed for the first time in 5 days. I knew it would take Anwyn time to relearn the art of suckling. There was a risk that scar tissue would form and require another frenulotomy. Over the next few weeks the support from Suzanne was incredible; internet video conferencing to help with position and attachment, additional clinic reviews, emails, drop-in sessions. Slowly but surely Anwyn and I overcame our breastfeeding difficulties and now 7 months on we continue to breastfeed responsively, mixed with baby- led weaning which began when she was 27 weeks old.

The emotional battle and physical pain of feeding a baby with tongue-tie should not be underestimated. I truly believe nearly all women and babies can breastfeed. What starts and ends a breastfeeding journey varies greatly from woman to woman. Self- belief, determination and adequate support from family, friends and the health service were paramount to my own continued breastfeeding journey. We cannot control a woman’s interaction with her peers and sadly breastfeeding services that address physical and psychological barriers are an NHS postcode lottery. As midwives we must prepare women for the realities of breastfeeding but crucially we must listen; physical discomfort is a sign of breastfeeding problems no matter how perfect position and attachment appear to be. Lets arm ourselves with a better knowledge of tongue-tie, act quickly to refer mothers and work tirelessly with breastfeeding specialists to improve the services our Trusts offer to women.

 

This article was originally published in The Association of Radical Midwive’s magazine Midwifery Matters, Issue 150. Available at: http://www.midwifery.org.uk

If you need advice or support abut bresatfeeding your baby, think your baby may have tongue-tie, or are a professional looking for further information, any of the following organisations will be able to help:

Association of Tongue-Tie Practitioners

Association of Breastfeeding Mothers

Baby Cafe 

Tucking Baby into Bed

I cosleep with my daughter, and have done since she was born. The closeness and ease of breastfeeding has enhanced the last two years of parenting for our family. But I am saddened every time I hear new parents utter the words “I’ve been told not to put baby into bed with me, its too dangerous”. Health professionals across the UK need to give parents informed choice, simply telling them that ‘cosleeping is dangerous’ is as helpful as saying ‘a caesarean section has no risks’. 

New parents, especially mothers, are vulnerable. They are often exhausted from the birth and overwhelmed with love and a sense of responsibility. With a high initial breastfeeding rate, it is reasonable to assume that most new mothers will be spending their first 24 hours getting used to the needs of their baby waking frequently. In a hospital ward environment their baby’s rhythm is disrupted by other babies waking, bleeping of various machines, call bells, ‘routine’ monitoring, laughter in the midwives’ office. The fear of falling asleep in bed with baby has been fed almost intravenously from media scare stories and ill-informed health professionals, so women will try to carefully place their just-fed sleepy baby into the cold plastic cot beside them, and baby wakes almost instantaneously.

Why?

Because it is a primal instinct is to be close to its mother, where it is warm and safe, where it can feed when it needs, where it’s body temperature, heartbeat and breathing are regulated, where it can stimulate the vital supply of breastmilk. This is how we have survived as a human race. 

So a mother’s instinct will respond to this. She will hold her baby close and climb into bed after settling her baby in the cot has failed for the seventeenth time. She will feel relaxed, her oxytocin will start to flow, triggering her milk supply. She will fall asleep. Contented with her baby. It is in these moments that if, as a midwife, you step back and just watch you will see the glow of a mother being born. 

Now is not the time to pluck the baby from the mother’s arms without her permission. Now is not the time to tuck the baby into the cold plastic cot. The baby and its mother will wake, horrified by what you have done, but too terrified that they are endangering their baby to complain about it. Instead it would be better to quietly get a sheet from the linen cupboard and secure mother and baby together. For we should never be in this situation in the first place. Open and honest discussions should be had with ALL women about how to care for their baby at night time and how to create a safe sleeping space in the bed. 

Co-sleeping is a survival tool. It prolongs the breastfeeding journey. It helps mothers get more sleep. The frequent night wakings of a breastfed baby are infact a protective factor against SIDS (Horsley, et. al., 2007). Roughly half of all parents in the UK take their baby into bed with them at some point (UNICEF, 2016)…so why are midwives, health visitors and maternity support workers hiding from this? Are they afraid that their career will be on the line if they tell parents that cosleeping is safe and a life is lost? Do they even know about the benefits of cosleeping and the situations that make it hazardous?

I would NEVER perform a midwifery intervention without gaining informed consent, by that I mean a full and honest discussion about the benefits and potential complications, and application of the evidence to the individual’s circumstances. I even explain why I want to palpate, monitor blood pressure, dip urine. Protecting a baby from SIDS is no different – we should not tell only half a story; this does not allow parents to make informed choices. Midwives work with women, and I will always discuss the evidence and encourage parents to respond to their instincts, plan for the unexpected and take sensible precautions to keep their baby safe. 

A little note:

I thought long and hard about sharing this image with you, but its the reality of motherhood! It was taken about year ago. Now my daughter sleeps on her own floor-bed in her own room (with me tucked up right next to her). Even my ten year old yearns for the comfort of someone beside him at night from time to time. As for my husband – his patience is more than I could ever possibly ask for.

 

References

UNICEF (2016) Cosleeping and SIDS Health professionals resource. Available at: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/leaflets-and-posters/co-sleeping-and-sids/

Horsley T et al. (2007) Benefits and harms associated with the practice of bed sharing. Arch Pediatr Adolecs Med; 161 (3): 237-245

Connecting with other mothers

Anwyn is 18 months (or there abouts). We co-sleep, breastfeed responsively and I work 3 long days a week. This is tiring and demanding, wonderful and connecting all at the same time. It is also new. Anwyn is my husband’s first child and my second. I raised my first born differently – a story that deserves a blog site of its own! This time I am making different choices. Informed choices. And there are two things that I value the most in doing so;

Shared ideals, morals and values with my husband: we both believe birth is a normal life event, comfort from parents is crucial for strong emotional development, that children should take risks in order to widen their experiences, being outdoors is an essential part of physical learning. Whats more, we are both open to new directions in parenting and have fluid discussions about how to improve our skills.

Surrounding myself with people who have a similar parenting ethos: this is something I didn’t do first time round, and I quickly became isolated and lost focus of what I held as my true parenting style. Now I attend a local nature play session every week and it is such a great opportunity to connect with other parents, and reminds me that whatever I am experiencing with Anwyn is NORMAL.

I work so closely with parents-to-be and new parents in my role as a midwife. I see myself reflected in their hopes and fears, their elation and anxiety. I always remind parents that what they are going through is normal. That seeking the support of others is good only if it does not cloud their own parental instincts. Many of the parents I care for have the ability and freedom to navigate research, evaluate evidence on mumsnet versus evidence on the UNICEF website for example. Others need more time and guidance, some will fall into the trap of societal expectation from their social circle.

So how to connect with those who share similar parenting ideals? From my two diverse experiences of raising young children, it is all about going to groups or entering virtual support forums and ‘testing the water’. Keep testing until you find something that is right for you. A place that is welcoming. A group of people that have a similar parenting style. It could take a long time. But once you have found it, connecting with other mothers is worth its weight in gold.