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Meg Nagle, IBCLC “Supporting Families Through the Tongue Tie Journey” Reviewed by Tara Durkin

Breastfeeding Insight Online Conference (September 1-December 31, 2020, extended to January 31, 2021) on www.breastfeedingconferences.com.au

The Breastfeeding Insight Online Conference this autumn brought together healthcare professionals and academics from many different disciplines and perspectives on aspects of lactation and breast- and chestfeeding that we don’t always get to hear at conferences. All the talks offered food for thought and opportunities for growth in practice. Meg Nagle’s presentation on supporting families through their tongue tie journeys aimed to help rescue discussion around tongue tie from clinical debates among HCPs (e.g. the best way to assess tongue tie) to bring the focus back on the individual mother and baby. Nagle (“The Milk Meg”) stresses the importance of good listening skills, which she notes can take time to develop, and offers some valuable tips and techniques for IBCLCs to keep women and babies and their unique tongue tie journeys at the centre of care. In preparation for her talk, Nagle posed a question on social media inviting parents with experience breastfeeding a baby with tongue tie to tell her what they’d love HCPs to know about their tongue tie journey; it was enriching to hear those parents’ comments and the voices of Nagle’s clients guiding and shaping her talk. I’ll share some of the talk’s key messages.


The IBCLC as detective – taking a client’s history as art

Families who come to IBCLCs are often experiencing and exploring a wide array of issues and concerns. In order to really help a mother and baby, Nagle says, it is up to IBCLCs to be like detectives, asking questions to untangle what is going on for the particular dyad, as all mothers and babies are on unique journeys that don’t fit a mould or predetermined list. When taking a mother and baby’s history, asking key questions – and really listening to the answers, trusting the mother’s instinct and tuning into what her goals are – can help put the pieces of the client’s unique jigsaw together and support the mother’s confidence. Nagle suggests asking

  • How does it feel for you?
  • Does your baby effectively and efficiently drain the breast?
  • What are you feeling concerned about?
  • Is your baby settled when feeding?


IBCLCs are not magicians

Nagle stresses that lactation supporters need to start from the basis of listening well and trusting women’s intuition – especially when it comes to tongue tie, an area in which a great deal of research still needs to be done. While IBCLCs have their own professional expertise and knowledge based on the best available research, breastfeeding families need to be supported and trusted to find their own way, exploring the suggestions they’re given, and to come back to the LC if things aren’t improving. A referral to another professional such as a craniosacral therapist, speech and language therapist or dentist may be appropriate. At the end of the day, Nagle says, it’s detrimental that professional egos and assumptions about what’s going on don’t get in the way of giving the best possible support and building a mother’s trust in herself as a parent.


Consider your questions

Nagle stresses that mothers know how to describe how breastfeeding feels – we just need to ask the questions that prompt them to tell us. For example, how we ask women about pain is important; some mothers might not describe uncomfortable or suboptimal breastfeeding as “painful” so we need to be more specific. Instead of using a 1-10 pain scale, Nagle uses a language-based scale, e.g. “Do you feel a gentle pull that you barely feel, or pain/discomfort?” “Are you feeling a sensation like a chomping or clamping?” and so on.


Individualised, empowering care plans

Care plans, Nagle emphasises, have to start with the mother’s goals. Every plan will be different based on her goals and what she sees as her biggest challenges. Secondly, care plans always need to include options and alternatives, including having a tie release and not having a release; it’s important to discuss the known benefits, risks/side effects and alternatives of all the options with the mother. Thirdly, the care plan needs to include a range of positioning and attachment suggestions and alternatives that support the dyad before and after a release, or if the family decides not to release the tie. Skin-to-skin and laidback positions which support self-attachment, the least invasive techniques which activate innate skills, are good to try first. However, these may not work for everyone, or may not work right away. Alternatives such as side-lying, upright positions such as koala on an exercise ball, latching on while moving around and/or using the “flipple” technique may work better for different dyads at different times.


Never assume what mothers and babies are capable of

Nagle encourages IBCLCs not to shy away from offering a feeding option because they are worried it will be too much for the mother. She gave the example and showed a photograph of a mother tandem feeding her newborn twins, each using an at-breast supplementer with expressed breastmilk. Give women options, and they can explore, with support, what is right for them.


As a longtime Cuidiú breastfeeding counsellor preparing to take the IBCLC exam later this year I appreciated Meg Nagle’s presentation because it illustrated how my experience as a breastfeeding counsellor, and years of practicing active listening (two ears, one mouth, to be used in that proportion) can and should be put to good use in my future practice as a lactation consultant (fingers crossed!).


Tara Durkin February 2021.

Tara received a bursary of €50 from ALCI to virtually attend the Breastfeeding Insight Online Conference.

Further Reading


Presenting at the ILCA 2023 In-person Conference in Las Vegas:  A Personal Account


ILCA 2023 Conference Presentation: Building Policy Coalitions


WHO/Unicef Congress