Understanding the experiences of mothers who are breastfeeding an infant with tongue tie: A phenomenological study

In Australia, initial exclusive breastfeeding rates are 92 %, reducing to 14% at six months. One factor that contributes to early breastfeeding cessation is infant tongue tie. It is linked to breastfeeding difficulties and these problems contribute to early breastfeeding cessation. Tongue tie or ankyloglossia is described as a congenital condition with an unusually thickened, tightened or shortened frenulum (membrane or string under the tongue). The frenulum may vary in length, elasticity and placement along the underside of the tongue to the floor of the mouth, which then can affect infants' breastfeeding skills in different ways. Tongue tie has been reported as occurring between 2.8% and 10.7% of all infants with an average of 5.14%. The shortened membrane limits movement of the tongue, which can affect activities such as feeding, dental hygiene and speech. Since breastfeeding has been shown overwhelmingly to be of significant benefit to infants and mothers, it is important to address any condition that may impair breastfeeding. The purpose of this research was to describe the effect tongue tie has on the breastfeeding experiences of women in order to provide evidence that can be used to review and refine practices within the health service district. This study utilised a qualitative research approach: hermeneutic phenomenology. Because phenomenology seeks to explore the meaning, examination and description of the human experience and therefore gain an understanding of what has occurred, it is appropriate for this study, which focuses on description and interpretation of the breastfeeding experiences of women whose infants have tongue tie. In particular, hermeneutic phenomenology has been selected because it focuses on what the experience means for the individuals being-in-the world, and how these individuals interpret their experience and this experience influences the choices that they make. A purposive sample of ten women from lactation clinics within one health service district was selected for interview. Women were invited to participate in the research immediately following their visit to a lactation clinic. Tongue tie was identified as the probable cause of the breastfeeding difficulties that they were experiencing. These problems included difficulties latching their infant to the breast, cracked and sore nipples and low breast milk supply. The data collection method used in this study was in-depth interviews, using open-ended questions. Two interviews were conducted with each woman who consented to participate in the study. The themes that emerge from the analysis tell a common story. That is the story of the expectations, challenges, disappointment, frustrations and relief that the women felt during the initial period when they started to breastfeed their infants. Consistent with hermeneutic phenomenology, the interpretation of the findings which is presented within several themes is a fusion of the participant mother's perspectives with those of my own. The journey is marked in six distinct phases. These are Expectations; Something is wrong; Questioning, Seeking advice, No real answers; Symptoms and perseverance; Approaching the wall it's all too much and Relief. These themes are discussed and interpretations made as to their effect on the women's' breastfeeding experience. This study has explored what it is like to breastfeed an infant with tongue tie. Despite women in this research study being committed to breastfeeding because of its health benefits, they found that having an infant with tongue tie was a harrowing journey with many frustrations along the way. Breastfeeding did not always transpire to be the natural experience that they had anticipated. It became evident that many people including health professionals have limited knowledge surrounding tongue tie and its potential effect on breastfeeding.;This lack of knowledge had a significant impact on the women in this study who were breastfeeding as they did not receive appropriate advice in regards to the breastfeeding difficulties that they were experiencing. The absence of a universal diagnostic and assessment tool for infants with tongue tie was also identified as a significant issue in the research. Implementation of an appropriate diagnostic and assessment tool for tongue tie into all hospitals would help reduce the incidence of breastfeeding difficulties that the women in this research study described. Early identification and prompt management of tongue tie would subsequently contribute to increasing breastfeeding rates which currently are below government targets.