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Improving services for mothers

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An initiative to improve the service for mothers with new-borns with tongue tie, a condition in neonates that can cause breastfeeding problems, has been chosen by a panel of experts as April’s 6Cs in Action: Celebrating success winner.

Elaine Merrills and Susan Henderson

Infant feeding co-ordinators Elaine Merrills and Susan Henderson

With limits on the capacity to carry out division of tongue tie in their Trust, Infant Feeding Coordinators Elaine Merrills and Susan Henderson at Doncaster and Bassetlaw Hospitals NHS Foundation Trust realised that the service for neonates with tongue tie could be improved.

Without trained staff able to carry out frenulotomy (also known as a frenulectomy) procedures – the removal of a frenulum, a small fold of tissue that attaches the baby’s tongue to the bottom of the mouth available at the Trust, Elaine and Susan knew that the issue still needed to be addressed.  

With the needs and well-being of the mother and baby placed firmly at the centre of care, the coordinators set out to change practice that would have a direct impact on and improve the overall experience. 

Elaine explained: “The system was that neonates in the Doncaster and Bassetlaw CCG boundaries who had a tongue tie and consequent breastfeeding issues were referred by the GP to a paediatrician, who then assessed the neonate and referred to the surgeons at Sheffield Teaching Hospital for treatment. This often meant a delay of weeks prior to a frenulotomy procedure taking place.”

Susan added: “As a result of a delay in treatment, many women decide to stop breastfeeding. This is often upsetting for the mother and prevents the health benefits of longer-term breastfeeding for the neonate.”

Making an impact on care

Working with the surgical team in Sheffield, Elaine and Susan devised a new clinical guideline, pathway and fast-track referral system and then made all the maternity, paediatric and health visitor staff aware of the new system.

The change in practice put in place by the pair now means that neonates with breastfeeding problems are seen promptly, enabling the mother to continue to breastfeed her baby.

The neonate is referred to the Infant Feeding Coordinators by the multi-professional team, contact is made by the coordinators with the mother, and then, if appropriate, a referral is faxed to Sheffield Teaching Hospital.

The neonate is usually assessed by the surgeons within a week and frenulotomy, if required, is performed and the coordinators at Doncaster and Bassetlaw are informed of the results. A follow up contact with the mother is then made as part of the audit process. 

Delivering 6Cs values

The new guideline, pathway, referral system and consequent audit reflect each of the values of the 6Cs.

  • Care: the pathway has ensured that the care is timely, helps the individual and improves the health of the whole community by maintaining longer rates of breastfeeding.
  • Compassion: the new pathway was driven by care and relationships with mothers babies based on empathy, respect and dignity. Compassion is central to how people perceive their care and satisfaction rates with the new service by parents confirm this [are there any survey results we could share?].
  • Competence: all staff caring for mothers and breastfeeding neonates has the expertise, and clinical knowledge to recognise tongue tie and refer to the coordinators so that effective care and treatments based on research and evidence can be provided in a timely manner.
  • Communication: by providing a successful caring relationship with parents and increasing the efficacy of multi-disciplinary team working.
  • Courage: by devising, innovating and embracing a new way of working.
  • Commitment: by building on the Trust’s commitment to improve the care and experience of our patients.

Marie Batey, Head of Acute Care and Older People and Lead for Compassion in Practice commented: “Elaine and Susan exemplify the values and ethos enshrined in the 6Cs. They identified an issue and used their knowledge and experience to devise a solution that improved the experience for mothers who wanted to continue breastfeeding. They were motivated in their desire to provide better care and had the confidence and courage to follow it through.

“With the support of their Trust, Sheffield Teaching Hospital and the local CCG, they have successfully devised a fast-track system that gives mums every opportunity to continue breastfeeding after their baby recovers from a small procedure.”

*What is tongue-tie?

It is estimated that one-in-ten babies are born with tongue tie, a thin piece of skin called the frenulum which attaches the baby’s tongue to the bottom of its mouth. Tongue tie restricts movement of the tongue and can often make breastfeeding difficult.

Babies may find it difficult to latch on to the breast, leading to an insufficient milk supply and poor weight gain. Mums may suffer from sore and damage nipples, mastitis and breast abscesses. Many mums who have trouble breastfeeding in the early days after birth will switch to bottle feeding, and babies will miss out on the nutritional benefits that breast milk provides

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