ALCI At The Aras 2019

ALCI Council and members recently represented ALCI as part of a special reception in Áras an Uachtaráin in celebration of National Breastfeeding Week. This year two ALCI members Mairead Murphy IBCLC and Danielle Sullivan IBCLC (and Danielle’s baby) attended along with ALCI Council members Sue Jameson IBCLC, Lorraine O’Hagan IBCLC, Aine  O’Leary IBCLC and Fiona Rea IBCLC.



The reception, which was hosted by Sabina Higgins, included a  ‘Latching on’ morning and involved representatives, mothers and babies from ALCI, Cuidiú, La Leche League, Friends of Breastfeeding and  Association for Improvement in the Maternity Services Ireland (AIMS),






Breastfeeding Multiples by Kay Hoover Reviewed by Barbara Noonan Sexton


Kay Hoover MEd and IBCLC was the keynote speaker at the recent ALCI Conference. Kay’s final session was about breastfeeding multiples.

Kay highlighted that sometimes people can frighten mothers of multiples by saying things like “Better you than me”, “Were you on fertility drugs?” or “Do Twins run in your family?”

Kay would say to these Mothers “You will have double or triple the amount of hugs. ” Focus on positive comments not on the negative ones.

(Photo:  ALCI delegates enjoying the Conference recently.)

Infertility treatments have increased the numbers of multiples from 1991 to 2016 the twinning rate per 1,000 births went from 12% to 19%. In 2016 in Ireland there were 2,363 sets of twins and 79 sets of higher order multiples.


Kay highlighted that there are many Pregnancy, birth and post- partum concerns

  • Kay stated that there is maternal, physical and emotional strain.
  • Increased risk of durgical delivery ( caesarean section ) and pre term labour,
  • Pregnancy induced hypertension increases with each baby
  • Risk of gestational diabetes increases with each baby


There are Risks with Multiples

  • Neo – natal Mortality
  • Birth – defects
  • SIDS
  • Child – abuse
  • Developmental – disabilities


Kay stated that there can be growth restrictions that affect breastfeeding

  • Intrauterine growth restriction and prematurity
  • Increased Incidence of congenital anomalies
  • Infant death is five times higher than for single infants.


Kay highlighted the importance of mothers not being afraid to ask for help from family. In one case, Kay encouraged one mother to ask her parents to stay with her for a month so that while she was breastfeeding the babies, the parents were making the meals and doing the households jobs.


Strategies for breastfeeding is very important

  • Make sure the babies can establish a milk – supply,
  • Pumping if necessary
  • Transitioning premature babies to total breastfeeding
  • Discharge planning
  1. Sometimes one baby comes home before the other,
  2. Frequently one breastfeeds better than the other at the start.


Kay stated that 60% of Twins are born preterm. When a mother pumps by her bedside nears the babies, she usually pumps more times and gets more milk. Donor milk is available in America until the mother has milk.


Kay highlighted practical tips

  • Keeping track of each baby by feeding record using different coloured paper for each baby, Individual differences in the normal range,
  • Ways to tell the babies apart
  1. Clothing
  2. Toe nail polish
  3. Bracelets


Kay also highlighted the importance of mothers getting out of the house

  1. Take one baby and leave one at home
  2. Strollers made for multiples
  3. Elastic waist band so she can go the toilet easier herself,
  4. Start saving weekly for the children
  5. Accept all help offered
  6. Remember it does get easier when the babies get older and the night feeds stop


Barbara Noonan Sexton October 2019.

Barbara received a bursary of €50 from ALCI to attend the 2019 ALCI Conference.

Tongue Tie by Alan O’Reilly reviewed by Barbara Noonan Sexton

Dr. Alan O’Reilly MB BCH BAO DCH DRCOG IBCLC facilitated two workshops entitled “Tongue Tie: Lactation Support V Frenotomy” at the recent ALCI Conference.

Dr. Alan O’Reilly is a GP who works in Camden Street in Dublin. He qualified as a Doctor in Galway, In 2013 he trained in assessing and releasing tongue ties. He qualified as an International Board Certified Lactation Consultant (IBCLC) in 2017. Margaret O’Connor IBCLC works alongside him in his Gp surgery in Dublin.


Objections of the Workshop

  • Normal tongue movement and function
  • Symptoms of tongue tie
  • Examination of tTongue tie
  • Lactation Support
  • Tongue Movement during breastfeeding

What is a Tongue Tie

This is a lingual frenulum that causes a restriction in tongue movement. Reduced tongue movement leads to impaired tongue function.


Examination of Tongue Movements

  • Extension: rub chin just below the lower –lip.
  • Lateralisation: run a finger along outside of lower gum from side to side.
  • Elevation: may be noted when infant cries.
  • Suction: allow infant to suck on the clean finger.
  • Grooving: allow the infant to suck finger and assess how well the sides of the tongue holds on to the finger.

Examination of Tongue tie

  • Insertion of Lingual frenulum on

1. Inferior surface of tongue

  1. Floor of mouth
  • Elasticity of Frenulum on elevation
  • Thickness and Fibrosity of Frenulum



Tongue tie and Frenotomy

  • Everybody seems to have a tongue tie.
  • Parents are leaving Lactation Consultations believing a Frenotomy is that sliver bullet that will solve all of their feeding problems.
  • The Focus needs to always be on lactation support and Frenotomy if indicated should be just part of the plan.

Lactation Support: First few days

Baby not Latching on

  • Hand express colostrum
  • Avoid bottle – feeding
  • Consider finger – feeding, spoon or cup feeding
  • Syringe feeding is also a good option
  • Suck training
  • Electronic pump when milk comes in


Single most Important factor in getting baby to latch is an abundant milk supply”   (Jack Newman).


Dr. O’Reilly also stated that treating nipple pain is very important.  He highlighted the importance of working on a deeper latch. Topical steroid may help reduce inflammation and take pain killers if needed. Feed expressed milk to allow nipples time to heal. Ensure to maintain an abundant milk supply.


Nipple shields are also useful if a baby is unable to sustain a latch or has a dysfunctional suck. Nipple shields may transfer more milk with a nipple shield that without. Useful for flat or inverted nipples. The shield is a barrier for inflamed or ulcerated nipples.

A mother protects her milk supply by pumping intermittently. Monitor weight gain. Supplement if required with feeding tools. Use for a short period if possible. Wean slowly if used for an extended  period (over 7 – 10 days).


  • If a baby is not gaining weight, look at history of mother: Breast surgery, PCOS and Hypothyroidism.
  • Improve latch.
  • Ensure mum recognizes effective feeding and swallowing
  • Breast Compression towards end of feed.
  • Consider galactogogues.
  • Consider additional feeds by feeding – tube: further stimulates supply.

There should be a Weight Gain of 155 grams per week. Fluid requirements: 160 mls per Kilo e.g 4 kg baby requires 640 mls per 24 hours, which equates to 80mls per feed.

Useful Handout here.


Barbara Noonan Sexton October 2019.

Barbara received a bursary of €50 from ALCI to attend the 2019 ALCI Conference.