A tongue-tie tale
Dr Kass Jane’s doctoral thesis explored differences in professional opinion when it comes to tongue-tie in Aotearoa—but what does Shakespeare have to do with it?
Tongue-tie (ankyloglossia) is a congenital condition that impacts tongue mobility. Around five to ten percent of babies in Aotearoa are born with a tongue-tie, with two to five percent of babies encountering issues with breastfeeding as a result.
Dr Kass Jane, who is also a registered midwife, wanted to understand what shapes the knowledge and practice of different health professionals when it comes to the condition—although she admits she was nervous about wading into a topic this contentious and inadvertently becoming “the tongue-tie person.”
There are different schools of thought across the health sector when it comes to the assessment, diagnosis, treatment, and follow-up for cases of tongue-tie in newborn babies. Prior to commencing her PhD, Dr Jane didn’t think she had a strong professional opinion about tongue-tie.
However, when she started reviewing the literature on the topic, she coincidentally also had two different professional experiences with tongue-tie in her midwifery practice.
“From this my interest was piqued about how it is that various characters have formed their opinion about tongue-tie—what version of ‘the truth’ do people subscribe to?”
This is when Shakespeare entered the equation, something that Dr Jane says happened by chance but was “so much fun”.
“It was quite early on in my PhD and I was like a sponge, very open to different ideas and reading everything and anything to do with tongues and tongue-tie.”
“I happened upon a quote from Shakespeare that referred to the tongue and the more I read the more I came across references to tongues and tongue-tie in his work—it got to a point where I just had to really own it.”
Shakespeare is woven throughout Dr Jane’s thesis, from quotes and references to support a point, to structuring her thesis much like play—with acts, characters, asides, and soliloquys.
The approach is unusual for a health sciences thesis but reflects Dr Jane’s philosophical approach to a complex topic.
“My research sets out to enhance tolerance and understanding, to interactively engender learning from difference by using a dialectical pluralism approach to investigate the division about tongue-tie.”
The ‘characters’ in this tale included midwives, lactation consultants, nurses, general practitioners, pediatricians, neonatologists, osteopaths, pediatric surgeons, dentists, and speech language therapists.
Dr Jane’s findings showed that yes, there is division in opinion about tongue-tie amongst health professionals in Aotearoa, however, this division occurs because the characters are human and subject to the vagaries of human nature.
Dr Jane says that while her research did uncover division between health professionals, it also uncovered that there is much that health professionals in Aotearoa agree on when it comes to tongue-tie.
“We agree neonatal tongue-tie exists, which is not necessarily the case internationally, and we agree that it can cause breastfeeding issues.”
“No matter where participants were situated in terms of their opinion, everyone seemed to agree that holistic care and support was required for people experiencing breastfeeding issues due to neonatal tongue tie, and that this care needs to be delivered in a team approach between professionals.”
Dr Jane’s passion for education is unwavering, even at the end of the rigorous PhD process.
“I think it’s really important for midwives to be involved in research. It’s about demonstrating the ability to be reflective as a health professional and contribute to midwifery knowledge.
She wants everyone to know that a PhD can be a positive experience.
“If anyone is thinking about doing it to enrich and develop themselves then that is just as good a reason to do a PhD as any other.”
As Shakespeare observes in Dr Jane’s thesis conclusion—“But man, proud man, drest in a little brief authority, most ignorant of what he’s most assur‘d”—there is always more to learn.
Dr Kass Jane graduated with her PhD in December 2023.