Podcast: Tongue Tie with Midwife/IBCLC Carmelle Gentle

Tongue Tie with Midwife/IBCLC Carmelle Gentle

Season 2, Episode 2

Does Tongue Tie just affect breastfeeding?

Can a baby actually have a tongue that that DOESN'T affect feeding?

Is there a link between Folic Acid and Tongue Tie?

I challenge anyone that's encountered more than a handful of babies to have encountered Tongue Tie at some point in conversation. But there is so much misinformation about it.

Midwife, IBCLC, Founder of The Tongue Tie Centre for Infant Feeding and Tongue Tie Specialist Educator Carmelle Gentle joins me to finally shine a light on Tongue Tie once and for all. The answers to all your questions, ideas on how to support your family and where you can turn for help moving forwards.

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TRANSCRIPT

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Ready to meet today's guest?

Hi, everybody.

Welcome back to The birth-ed podcast.

Today, I am joined by the very aptly named Carmelle Gentle.

And we are going to be discussing the topic of tongue tie, which is probably something you, if you're kind of thinking about breastfeeding, you know, anybody that's had a baby, something that you might have heard of before.

Carmelle Gentle is an independent midwife, an international board certified lactation consultant, sometimes known as an IBCLC and a tongue tie specialist trainer and educator.

Carmelle has been a midwife for over 16 years working in the NHS independently and has recently founded The Tongue Tie Centre for Infant Feeding.

Carmelle, thank you so much for joining me today.

So people listening may have heard of tongue tie through friends and family, or it might be something that they have experienced with their own children or even themselves.

But for those of the listeners that don't know already, can you explain what we mean by the kind of the term tongue tie?

So in simple kind of terms that people might know or relate to is when you look in the mirror and you lift your tongue up and you see that band underneath the tongue, that's what we are referring to.

And so although it looks a bit like a band, it's actually a dynamic structure formed of fascia or mucosa.

And when that structure is restricted in some way, so it's either shortened, teeth thick and inelastic, it will impact or can impact the way that a baby, a child or an adult is able to immobilize their tongue.

And so do you think this is something that we're seeing more of?

Is it becoming more and more frequent or do you think we're just talking about it more and identifying it more readily these days than maybe in the past?

I mean, it's a really hard question to answer because we don't collect the data of every baby that's born.

So it's certainly not a new thing.

And you know, tongue tie has been around since around the seventh century.

So it's definitely not new.

I think we are definitely seeing a re-emergence of tongue tie as more people are wanting to breastfeed.

They're seeking answers for their breastfeeding challenges, perhaps.

And also, you know, we can touch on it a bit, but also bottle feeding challenges, solid food challenges, you know, it's showing up in other ways and people are not just, you know, accepting, oh, well, you know, feeding didn't work for me or, you know, they're seeking the answers.

So I think we're definitely seeing it a lot more now in practice.

And so before you sort of mentioned feeding difficulties there.

Now, before we're able to understand what feeding difficulties might encompass, can we chat a little bit about what normal breastfeeding, what effective breastfeeding or kind of normal infant behaviour, I suppose, looks like?

How would somebody know that that was actually going well?

So it's going well when you, if a person's choosing to breastfeed their baby, so they're, you know, they are latching well with a wide, deep attachment to the breast.

They are able to effectively transfer the milk, and they are typically satisfied after most of their feeds, and you kind of have, you know, a content baby.

And if they're bottle feeding, again, the baby is able to easily drink their bottle.

They have a rhythmic suck, swallow and breathing pattern, whether they're breastfeeding or bottle feeding.

And so that would reduce any air that they are taking in when they're feeding.

And then the digestive system is also then working the way that it needs to work, without the discomfort that might follow for a baby who may not be feeding well.

And so it's looking at kind of the actual feeding, so how they are feeding, how they are swallowing is what we really want to understand, to know that they're latched well or they're taking their feed well.

And then as well as that, they are, they will be having good nappy output, wet dirty nappies, and they will be gaining weight around the 10 to 20, 30 grams per day on average in those first few weeks and months.

And so what would we be, what would you kind of identify then as some of the kind of common difficulties that arise in a baby that has tongue tie or that is experiencing feeding difficulties of another kind?

So quite commonly with breastfeeding might be one that we hear of often is sore or damaged nipples.

And there's this misconception that feeding is painful to begin with, and it really shouldn't be.

So whenever there's a pain with latching, or even if it's in the first 5 to 10 seconds and you have to hold your breath or toe curling pain, that's a sign that maybe something's not quite right.

And it could just be that the slight adjustment to the latch is all that is needed, but it's a sign that something's not quite right with that latch.

So sore, damaged nipples.

And if that does not improve and continues, again, there's something's not quite right for why that's happening.

A difficulty with the baby actually latching on, so they might not be able to latch at all.

You're trying and they just physically cannot attach to the breast.

There's a lot of fussing from the baby's perspective, so kind of hitting at the breast, pulling on and off.

And that is quite often frustration that they either can't get on or it's difficult to, or they're in pain in some way.

Recurrent mastitis, blocked ducts, blebs, so might be signs that the baby is unable to transfer that milk effectively.

You might have poor weight gain as a result.

So again, if baby's not able to remove the milk effectively, that could lead to poor weight gain or plateauing in their weight.

So they're kind of dropping on the centile chart.

And so it's working with specialists, infant feeding specialists, getting the support that is needed to understand what is the underlying issue there.

Is it truly a low milk supply, which is often what people are told?

Well, it's because you've got a low milk supply.

But if a baby's not latching on well, they're not removing the milk from the breast and the body doesn't know to produce more.

And so naturally it will start to deplete.

But is that the real underlying cause or is there something else going on?

So it's really trying to get that specialist support to find out what is actually happening rather than just because there's a lot of misinformation and you have different healthcare practitioners coming in and out, having different opinions on what might be going on.

And then you don't see them again.

So there's no consistency.

They're not maybe having the time to sit and really observe a full feed.

So it's getting somebody who really does focus on just feeding to help have a different set of eyes and just understand what is truly going on with the feeding challenge that might be presenting.

I think that's one of the really big things that people report from that postnatal period, even just on the postnatal ward.

Every single person that they meet tells them to try or do something different.

And that in itself can prove so difficult because it's about knowing which voice should I be listening to, which thing is going to work.

And that's a really difficult thing.

Have you got any tips on navigating that as a new, particularly first-time mom or first-time breastfeeding?

How do you navigate all that conflicting information that comes from people that ultimately are all generally qualified or appear to be qualified in providing care to you when they're all saying something different?

Yeah, it's really hard and you said, what voice should they be listening to?

And I always say, listen to your own voice, listen to that voice within themselves, because although they might not know exactly what it is that's not quite right, they'll know something's not right.

And when something's not right with the feeding, yes, there's midwives, there's health visitors who all have mandatory breastfeeding training every year, but they're not specialized in breastfeeding.

And then the five minutes snapshot, that kind of cursory glance, oh, yes, your baby's latched on is not breastfeeding support.

And if you're at a position where, you know, because something's not quite right with feeding and they're offering, say, a supplemented feeder formula, again, that is not a substitute for breastfeeding support.

So if it's because there's an issue with feeding, we need to go to those who are specialized in it.

So most hospitals, if not all, should have an infant feeding team.

And so if you're in hospital and, you know, you're waiting to be discharged or you can't be discharged because it's a feeding challenge, sometimes the tendency is to just give them the bottle until we get home, or, you know, whatever the situation might be.

It's actually asking, can I see somebody from the infant feeding team?

I need someone to assess my feeding so that when I go home, I know actually what it is that I need to do.

Yeah, definitely.

So if someone's pregnant right now, and they're thinking about breastfeeding or they're intending to breastfeed, it's actually looking at, you know, does your hospital have an infant feeding team?

What are the local breastfeeding support groups in your local area?

So as soon as you do get home or if you're at home having a home birth, then you've got your options around you.

Look at there's lots of virtual cafes on now, because since the pandemic, so there's places that you can reach out to.

And then you've got your private independent practitioners, such as IBCRC's breastfeeding specialists.

And you've also got national breastfeeding helplines.

And there are resources, so it's just tapping into what is available in your local area that you are kind of well-armed before you've had your baby.

Yeah, and gathering that information while you're pregnant is a hell of a lot easier than scrabbling for it, I suppose, when you're kind of in the depths of actual kind of feeding difficulties.

So is tongue tie something that your midwife will routinely check for, or is it something that they would check for if a difficulty arose or not?

She's smiling and laughing.

No, no, they don't routinely check for it, one because we're not trained to look for it.

It's not part of midwifery training.

You know, I, from my own perspective, I kind of stumbled across tongue tie just from being in the community and seeing lots of kind of damage around kind of the nipples.

And I kind of just was, I was curious.

And so I went on to explore it more, but on a whole, and that was like nine years into my practice.

And so we're not trained.

There will be some who are maybe more, they're seeing it more.

Once you see tongue tie, you can't unsee it.

And so those who are maybe used to seeing a little bit more, they know what they might be looking for, or some of the signs and symptoms that might be presenting, you know, they might say, oh, your baby's got tongue tie.

If they follow that by, oh, but it won't cause a problem, then always hold that in mind that there is a tongue tie, because we cannot say that it will or won't cause a problem.

And can it be that it doesn't cause a problem?

Can a baby have or a person have a tongue tie, and actually they feed effectively and it doesn't cause any issues?

So again, that brings it into that kind of wider scope of what's normal, what we kind of normalise to within our feeding, because if there's a true restricted frenulum, which is a tongue tie, then it has the potential to cause kind of compensations in the body.

So the baby will have to compensate for that restriction.

And how well they compensate will vary from baby to baby.

And so you might, I had a two year old who I saw the other day, who I actually saw very early on in their newborn check, and they're 100% tongue tied, and they've breastfed until two, with their tongue tie right at the tip of their tongue.

Now, it's what symptoms may be presenting, maybe the front of frequent feeds, or it's something else will show up in some other way, which you've got used to, but how subtle or how severe that symptom might be will vary from baby to baby.

So, we can't say at birth, this tongue tie is going to impact speech, for example, because we don't know.

We don't know how that baby is going to compensate, and they will have their aim is to eat, their aim is to eat solid foods, their aim is to develop and to talk.

So they will find a way to do that and compensate if they can.

Those that really struggle to compensate may then present with a speech issue or present with weaning issues on solid food.

And so it has the potential to impact them in some way, and they have to learn to compensate.

Well, that's exactly it, is that actually, I don't think anybody really considers Tongue Tie past the kind of immediate establishing feeding stage.

That's where we hear the association is to do with it.

If you've got Tongue Tie, and particularly Tongue Tie and breastfeeding, that tends to be where we hear about it.

But what you're saying is that actually, it goes beyond that into childhood, adulthood, can affect bottle feeding, you know, it's wider than simply a breastfeeding issue.

Totally.

And breastfeeding or bottle feeding is the first time it's presenting as a problem, or as a symptom, or as a health issue.

Because that's when the baby is needing to use their tongue to mobilize to essentially breathe, and that's where we get the issue with feeding, because if they can't suck, swallow, breathe and sink, they have to protect their breathing first and foremost.

So they will adjust their latch and make a shallow latch so that they can breathe easier, they can then swallow easier, and then they can continue to suck and feed.

That then might cause a problem for sore nipples because they're now on a shallow latch.

And so we got to take notice of these symptoms that are showing up and, you know, why are they showing up and, you know, is the tongue tie, you know, at that point needed to be divided or is there other reasons why?

I think the biggest thing for parents is changing something about their baby, so, you know, causing harm or pain and, you know, with all the knowledge that it will it be the thing that makes everything better.

So what is the treatment then for if a tongue tie is identified and it's acknowledged that it is causing an issue with either breastfeeding or bottle feeding or later down the line?

What is a family's options once that has been identified?

So once it has been identified, it's and that identification being a functional assessment, so how well that tongue is able to mobilize and…

In fact, let me take it a step back.

How do we identify it?

Who do we go to?

How does that happen?

I was just about to say, because, you know, like you say, you might ask your midwife thinking that they'll be the person who can help you, or your health visitor, or your GP.

And if they've not had training or they don't know what they're looking for, then you may receive kind of misinformation around it.

So it's going to somebody who is qualified to assess, has had training on how to assess.

So that might be a lactation supporter, an IV, CLC, it may be a midwife, but they have to understand what it is they're looking for.

So asking the question, have you received training on, you know, how to do an assessment?

The thing is, if they haven't had any training, but they've recognised actually their symptoms here, then it's signposting them to a tongue tie practitioner who can, who will make the diagnosis.

So, you know, anyone else that we're asking an IV, CLC or any other healthcare professionals, if they're not in the position to do the procedure, then actually they can't make a diagnosis, but they can recognise symptoms and they can refer appropriately.

And that's really all we're asking for here, is that they get prompt signposting to the people that can support them.

Because I see babies up to 12 months and, you know, they've gone round the houses asking so many different people and getting lots of opinions and at 12 months, they're still having challenges with, you know, breastfeeding or they've gone down the bottle feeding route because of, because breastfeeding was difficult and then they might be having reflux symptoms.

They may be having issues with solid foods, not able to mobilise the food around the mouth and then their baby might be waking up in the hour every hour at night because their tongue's not in the right place or position in their mouth and they've still got all these other symptoms that are presenting with feeding.

It can have a wider impact other than just breastfeeding alone.

So hopefully somebody would be able to kind of attend this appointment either on the NHS or kind of opting for a private appointment.

We, I mean, I know from experience working with lots and lots of parents who've just had babies that the wait for treatment or diagnosis on the NHS can be quite long, particularly if you are trying to breastfeed in the time in between, you know, if somebody says it's, you know, 10 to 14 day wait and you are facing feeding difficulties with every feed, that's quite a lot of feeds that you are going to have to do before you can potentially access that tongue tie specific support.

Is there anything that can be done in the meantime, in that waiting period, particularly if somebody can't access the support privately that they can do to support and protect their breastfeeding journey if that's important to them?

Yeah, so I think the key is maintaining supply because even if you had to pause feeding for 10 days or however long it might take to get an NHS appointment, if at the end of it, you've still got your supply, if that's to protect nipples from being damaged or for healing, helping with healing, then it's protecting that milk supply so that actually when your baby does come back to breastfeeding, then there's a supply there for them.

The other thing that can help is a really good tool.

So there'll be lots of conflicting information around nipple shields.

So a nipple shield can be sometimes that barrier, just that layer between, say, a baby that's clamping to hold on to their latch and getting more and more soreness to the nipples.

So that can be something that can really help in the interim period.

Sometimes alternating from nipple shields, nipple shield, breast, just to, again, relieve that pressure on the nipples.

And also adjusting the position, because quite often it is that fight that happens.

So when a baby can't extend their tongue to latch on to the breast, they will clamp in response to staying latched.

It's a reflex action.

And so they'll clamp down to hold on and that can feel sometimes like they have teeth.

And so if they're clamping in that same position, each and every feed, there's going to be more friction on that side.

So doing a cross cradle hold, one feed, the next feed you might switch around and do a rugby hold so that clamp or bite is in a different position.

And so you just rotate around with different feeding positions to try and just move that area where the baby might be clamping if that is sustainable.

And even just still going to any drop in groups locally just to try and adjust and tweak the position because feeding itself is therapeutic.

So where the tongue is not functioning well, if you can achieve the best latch that can achieve with support, then that is all going to help the baby start to use their tongue more and more, hopefully in preparation to have their tongue tie division.

And are there any particular positions that other than kind of alternating positions, are there positions that you see particularly more effective to get a good latch in those early days or is it just different from person to person?

It will vary from person to person depending on the kind of, you know, the dyad.

But I often find the laid back nursing position and not so much the koala kind of bolt upright, but like laying back in that kind of 45 degree angle.

Yeah, semi-recumbrant, whatever they say.

Lounging, lounging back.

Yeah, slouch.

I usually slouch.

This is the time in your life to be able to slouch and just really lay back and that actually kind of helps to slightly deepen the latch, helps the tongue to come forward more and hopefully prevent some of that friction that might be occurring.

And it's also initiating a baby's own instincts to kind of feed as they kind of bob over and try to latch themselves.

So I like that one quite a lot and it can really make a difference.

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Now back to the podcast.

Okay, so let's go back to the original question.

If Tongue Tie has been identified, what are the options?

What are the treatment options moving forwards?

So here in the UK, the kind of pathways that you have is NHS referral or private practice.

And so that could be, that will be by a midwife or a healthcare professional that is qualified to do the training.

Some will go to your home, so it can be done at home procedure.

And some will be in a clinic setting.

And so here in the UK, we, most practitioners, majority of practitioners will use scissors.

And so we use short kind of blunt-ended scissors, which we use to do the division.

And there are some providers who use laser, typically the dentists.

And in terms of kind of laser versus scissors, I, it's as good as the person using the tool.

I am in the majority of the cases.

And so it's really just kind of having a read around both options and seeing what feels right for you and your family.

But I use scissors.

That's how I've been trained.

And the procedure itself is very simple as far as procedures go.

But it, you know, it has come with risks and you have to understand the risks and the benefits in order to make that, as well as weighing up what's going on with feeding to make that kind of informed decision for your baby.

So talk me through if I was a mum coming to a clinic and we'd gone, yeah, baby's got a tongue tie.

Yes, we've decided we want to make the division.

What does that actually look like?

Who's holding the baby?

How long does it take?

Does it hurt them?

What do we do immediately afterwards?

Like, what does that actually look like, that appointment?

So my own appointments, when I'm seeing, so the actual appointment time is about 90 minutes, 75 to 90 minutes depending.

And most of that consultation is taking kind of a history, gathering kind of what's been going on, asking around birth.

And, you know, because birth has impact and what's been going on with birth has impact with how the baby might be feeding or the current situation around feeding.

And, you know, we get to the point where we're going to do the procedure.

I would, um, I would hold a baby's head, a baby's head, or a blanket, or a baby's head, or a blanket, or a blanket, or a blanket, or a blanket, or a blanket, or a blanket, or a blanket, or a blanket, or a blanket, or a blanket, or a blanket, or a blanket, or a blanket, or a blanket, or a blanket, or a blanket, or a blanket, and I just wait.

So I will lift the baby's tongue up to elevate the frenulum, and I wait for that moment where I can get my scissors in, because I've got a moving target here, and so the tongue is moving, the baby doesn't want me in their mouth, and that is often actually the bit where they're crying most is actually just elevating their tongue.

And so when I kind of get that right moment, I use the scissors, and for some babies, it might be one kind of snip with the scissors, and in other times, I need to go two or three snips, just smaller snips, just to actually allow for that tongue to be elevated at the right point, so I don't always go in in one go.

And so once the cut is done and the frenulum is fully divided, I put a swab underneath the tongue, a bit of gauze, a small square of gauze, and that just mops up a few drops of blood, and then baby's handed over to the parent to feed, whether they're breast or bottle feeding, so however they are feeding at that time, they will feed.

If the baby is a bit older, or they're too upset in that moment, actually just walking with them and rocking them a bit, that kind of soothes them down, and then they're usually ready to start feeding again.

You know, it is very, in terms of the pain aspect, you know, they're crying for usually a very short moment in time, often just sitting them back up, they've kind of soothed and stopped crying already, and that's for the majority of babies.

There'll be a few either side, so very, very small babies, often they're a bit sleepy in those early newborn days, actually might not make any noise at all, and some have stepped through it.

And then the other side of the spectrum, those older babies or sometimes a bit younger babies, they're just very aware and true of what's happened, their sensory perception is a bit kind of heightened, and they are not happy at all, then they cry a bit longer, and it might be intermittent crying, kind of around five minutes or so, but that's extremely rare.

And so from that kind of point forward, it's not like an instant fix, is it?

That's not job done, baby's going to go away and breastfeed.

What would the kind of aftercare and follow-up support be, or that you would recommend people are making sure they're receiving in terms of kind of ongoing support after that?

It's definitely not an instant fix, although they'll sometimes, most of the time, there'll be an instant difference in how the baby's feeling.

There'll be that instant change.

But that's because we've got now this nice release of the tongue.

But what has to happen then over the next couple of weeks is the healing process.

And in that healing process, that's where things start to get a little bit tight again.

There's granulation of the wound, so it starts to go a white colour or a yellow colour as it begins to heal.

So it's usually yellow when the baby's jaundiced, and that's quite normal to see.

And so in that healing time, that's really when we want to be, well, I recommend, which again, it's something that's not universal, but I recommend oral exercises and kind of intra-oral massage to really help the tongue learn the new movements that it's got to make.

And so when I say intra-oral massage, I'm not talking about disruptive wound massage.

That's something that's very different.

And if I don't recommend it in terms of wound healing, it kind of goes against wound healing.

And so that's where you actively break the wound every day, which I won't go into, but it's very different when you're all trying to teach the tongue to do something new in terms of exercise, and that's on a neurological level.

Yeah, almost like tongue physiotherapy.

Yeah, exactly.

It's physiotherapy, it's suck training, it's releasing tension in the face, and the muscular structure around the frenulum is just one aspect.

We were allowing that tongue to be freer now, but now we've got to work on improving the way the tongue is able to work, because the tongue's been functioning in a way that's dysfunctional from in utero.

And we might be seeing this maybe at six months of age, where they've had all this time of using their tongue in a different way.

Even if we see them at day one, they've had how many weeks in utero of already setting patterns of dysfunctional swallowing.

And so we're working to change that.

Amazing.

So I have a few, I suppose, common things that people hear or say about tongue tie, and I wondered if you would be able to do some kind of myth busting for us.

So the first one we've sort of answered, but is tongue tie isn't an issue if baby is gaining weight and feeding is comfortable.

So I suppose you sort of answered that one, but kind of true or false?

It's false.

Yeah, I think that's what we sort of said, is that it may not be an issue kind of right away, but in the longer term.

There can be.

The next one that sometimes people hear or say that they have kind of received a diagnosis is what is meant by a posterior tongue tie?

OK, so posterior tongue tie is, it does confuse a lot of people actually, and it's a bit annoying because actually it's a tongue tie, is a tongue tie, is a tongue tie, whether it's anterior, posterior, midline, all that describes is the position of where that frenulum attaches underneath the tongue.

So it's either at the front, which is anterior, or it's at the back, which is posterior.

The same, I always relate it to pregnancy because I think we hear it a lot more and understand it a lot more in pregnancy when that baby is in an anterior position or a posterior position.

It's just the position that that baby's in in relation to the spines, where it's the same as the tongue.

It literally means back, doesn't it?

The back or front, and it's the medical terminology which we use to describe our findings and it confuses everybody.

Would it be fair to say that it's potentially less obvious to diagnose?

So if a baby had an anterior tongue tie, even as a parent, you're probably going to be able to see it.

And so maybe it's something that is often picked up later, or needs more specialist support to pick up?

You might only see it if you are...

I was going to say you might only see it when you're lifting up the tongue.

You have to physically lift up the tongue.

But actually, if that frenulum has got a bit more elasticity to it, you might see it when the baby cries.

So it really just depends on the integrity of that frenula tissue.

But actually, unless you're doing a proper functional assessment, whether it's anterior or posterior, you're not going to really know what it is.

And I've seen anterior tongue ties that have been long and stretchy and more elastic, so you get more range of motion.

And you've got posterior tongue tie that is short, really thick, inelastic.

You're going to have less function.

So that's why irrespective of what we're seeing, we've got the symptoms.

Now we need to understand, okay, well, how well is this tongue functioning, irrespective of where the frenula is positioned?

I've got another one that I don't think was on the list I sent you.

But the other one that I've got that I've just remembered people come up with is, if your baby can stick their tongue out, then they haven't got a tongue tie.

That is so false and not true.

It's just, but you hear it a lot and even from healthcare professionals, oh, your baby's got their tongue sticking out, they're not tongue tied.

Like, no, that's only one aspect of the tongue function.

The tongue has to also be able to elevate.

It's got to cut and create a funky shape.

There's an incredible video that's the, it's like, I think it must be either an X-ray or an ultrasound or some sort of scan where they show like the rippling that a baby's tongue does when they feeds.

And so if you want to, I'll see if I can find a link to it to put in the, in the notes.

But if you want to have a look at it to see when we sit, when we're talking about tongue function, it's not like us sipping at a straw where we kind of just like tip it back with our tongue to swallow.

Like what the tongue is actually doing is absolutely incredible.

And so you'll, you'll definitely see why having a range of motion is so important.

It's so important, exactly.

And, you know, what we might just see, like at the front of the tongue, what we see, you know, even in our own mouth, we don't really see that full movable part of the tongue.

Like two thirds of the tongue should be able to come forward and move, but we don't really see the front.

And if that back of the tongue is being held down underneath by a restricted frenulum, it's going to impact how the tongue moves overall.

So, yeah, it's really important to look beyond the tongue sticking out.

So the final one then, and this may be meaty, I don't know, is there an association between folic acid and tongue tie?

Or do we just not know?

What I say is that prior to folic acid, there was tongue tie.

Whether it's to do with the MTHFR gene and mutation, whether they are predisposed, I don't know.

There's not enough evidence to know either way.

I think we definitely need more research.

And then also what is going to be the change in practice if we are looking at weighing up spina bifida and tongue tie, what do we do about that?

But I think there's just not enough evidence really.

And in the day, we have to have the current guidelines with folic acid and they're there until practice changes.

But tongue tie has been around a lot longer.

Yeah, good to know.

OK, so then I suppose the final question that we ask all of the guests on The birth-ed podcast is if you could gift a pregnant or a new parent one thing, it can be real or hypothetical, what would you give them?

In an ideal world, I think every baby born would have that functional assessment of the tongue.

And I think every parent would be educated on how important the tongue is, not just for feeding, but for life, how our tongue sits in the palate, how it impacts our breathing.

That would be my gift.

Just to have that kind of power out of, this is what we need to know and start to explore and research.

But in reality, I think everyone could be given a, if they're choosing to breastfeed or even not bottle feeding as well, people are not shown how to bottle feed.

No.

Like actually having an in-depth feeding assessment by a trained specialist would be my gift to everyone.

Amazing.

Thank you so much.

That's quite a good one actually to stick on your like baby wish list.

Instead of like a million different baby greys, actually can everyone club together and book me an hour.

Of feeding support.

Of both feeding support.

So finally then, where can people find you, reach out to work with you?

Where are you in the world, on the internet, all of that?

On the internet, I'm at Gentle Births and Beyond.

And I say that it's got all the underscores, but just put Gentle Births and Beyond and I should come up on Facebook, Instagram.

On my Instagram, it's got how to book appointments, how to do virtual consultations.

And where in the world is The Tongue Tie Centre located?

Yes, we have got, I will just mention that because I'm so proud of it.

It's started up in October and it's a donation-based clinic.

So all parents can receive skilled assessment and support around their feeding and understanding the baby's tongue function, irrespective of their means to pay.

So it's a student-led clinic.

It's based in Ballum in South London.

And yeah, it's amazing.

Amazing.

And I will put links of how to get in touch and how to book appointments and things in the show notes of this podcast.

Thank you so, so much for joining me and for all that insight and expertise.

I think that's going to be really helpful for people that have just faced like such either misinformation or conflicting information around tongue tie.

So thank you so much for joining me.

Thanks for having me.

Pleasure.

Thanks for listening to The birth-ed podcast.

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