I've had the dubious pleasure of working all weekend, three days here as it
is Monday after Pentecost, which is a public holiday, and it's been insanely
busy.  Thanks to a reasonable collaboration between professions, we were
able to get two tongue-ties released, one Saturday and one yesterday, and in
short order, too.  
The maternity care aide in one case made the diagnosis.  The midwife didn't
have a clue, was in on the newborn exam by the pediatrician, and wasn't able
to convince the pediatrician to refer to ENT to get it fixed.  The maternity
care aide persisted and the next day succeeded in getting the pedi to
reconsider, with the help of the same midwife who was becoming a convert to
the tongue-tie cause by then, and it turned out great.
In the other case, I spotted the tongue tie while talking to mother as she
changed a diaper on her crying, nearly 2 day old baby.  He had been nursing
continuously for about 18 hours, mother said, but never seemed satisfied.
Closer investigation revealed all the cardinal signs: trouble maintaining
latch, snap-back sound, and incipient soreness in mother.  This was a
classic, with the frenulum attached at tip of tongue and all the way at the
top of the gum line.  It was stretchy but not stretchy enough, even with a
marked asymmetrical latch.  
The young, inexperienced pediatrician who did the newborn exam commented on
the tongue but didn't ask mother how BF was going.  I waited til she was
done and then helped her fill in the blanks, so to speak.  She agreed we
should refer to ENT.  The ENT doctor was a delight, came directly to the
mother's room instead of requiring a staff member to bring the baby to the
ENT floor on the other side of the hospital, and snipped the frenulum while
I steadied the baby's head with the method I learned from Lisa Amir.  He'd
never seen it before and was positively impressed.  You hold both the baby's
hands in one of yours, and lift the arms up over the baby's head.
Stabilizes the head and keeps the hands out of the way!  Baby went straight
to breast afterwards and started feeding effectively for the first time.  

The point of these stories is to illustrate how well we help mothers and
babies when we collaborate, when no one has to save face by pretending to
know more than they do, and no one has to waste energy trying to act
subordinate when they actually are the reigning authority in the situation.
The maternity care aide and I are the tongue-tie dynamic duo on our ward,
but others are starting to come around, and in a situation where knowledge
is shared calmly, caringly and convincingly it promotes learning which again
leads to better care being given by more practitioners.

These were some of the good things that happened during a weekend that was
otherwise absolutely nuts, shining examples of the best we can do, and they
give me the hope that I need to keep slogging along in this crazy hospital
system.

Rachel Myr
Kristiansand, Norway

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