Untied for The Win

Alexa
· August 24, 2020 ·

10 minutes

I know this is the Queen of Dental Hygiene, but as the daughter of the Queen of Dental Hygiene, and very loyal editor of the blog, and August being National Breastfeeding Month, I’m taking a liberty to tell you my breastfeeding story.  And never fear – there is absolutely a tie-in! 

I’ve been mentally writing this for the last 10 months. My little guy is closing in on one year! Where has the time gone? (Does every mother ask this every year?) 

Last September, my baby boy was born, and he had a tongue tie.

I’m writing this and sharing this to create awareness.  Awareness that ties are commonly missed.  Awareness that your average provider isn’t adequately educated about ties.  Awareness that you may have a tie! When I tell people that we dealt with a tongue and a lip tie at the beginning of our nursing journey, it’s a courtesy “aww” – they don’t know what that means, or what we went through, and it’s not exactly something that one dives into when company comes over. So here we go:

My sweet little boy was born one week early, at one of our region’s best maternity hospitals.  A designated Baby-Friendly hospital, with a breastfeeding center! We had, overall, a great birth experience.  We had skin-skin immediately, and latched shortly after birth.  All amazing and great and wonderful! Preliminary examination from the on-call pediatrician was fine, the nurses brought in about a million pillows and showed me breastfeeding basics, and everyone was supportive. 

Sometime in the middle of the night, a nurse came in to check on us, and was concerned that the babe hadn’t nursed recently enough. He was difficult to rouse, and wouldn’t latch, so we spoon-fed him some colostrum, tried a nipple shield, and she called the RN IBCLC on duty.  

Sidebar

IBCLC stands for International Board Certified Lactation Consultant.  They are, simply put, breastfeeding professionals, and have taken lactation-specific courses, various college classes, have 500+ hours of clinical experience, and passed a comprehensive exam surrounding human lactation. CLC or CLE’s have 45-90 hours of education before they receive their credentials.  Many hospitals require their IBCLCs to also be Registered Nurses, but IBCLCs are also professionals in their own right.

Back to 2 a.m.

She got him to latch, and wasn’t especially concerned. The next morning, we got our official visit from another one of the IBCLCs, and I asked her specifically to check for ties (my mom is the Queen of Dental Hygiene, after all).  No, nothing that would cause an issue. Awesome! 

We had a visit to the breastfeeding center on day 3, and the next IBCLC also claimed no tongue tie.  However, she was concerned that my son hadn’t regained enough of his birth weight. He did acceptably on his weighted feed, and my milk had come in that day, but she was still worried and insisted we make an early appointment with our pediatrician. We barely talked about how his latch was uncomfortable. It was just too shallow and I needed to follow the step-by-step instructions. When we got home from that appointment, I cried. It felt like my fault, but I was doing my best to do everything I had been taught, my husband was supportive and helping me. It was all not enough and my sweet baby was, apparently, suffering.

The next day we had our nervous, first-time-parent trip to the ER. He hadn’t pooped within the requisite amount of time (he pooped as soon as we got admitted to the ER, on the poor nurse who was trying to weigh him), and was hard to rouse again (he promptly nursed once that poop was out). In addition to the ER doctor, we got another meeting with another IBCLC from the center, and another tongue check. She was a wonderful, warm woman, and assuaged the nerves that had been vibrating since the previous day. It’s all good, and it’s all just a learning curve! 

We saw our pediatrician a day later, and he had gained more weight, so she wasn’t terribly worried. We saw her again for the regularly scheduled appointment, and the weight gain was better still.

Then I had mastitis

Another week, that was cleared up, with the help of antibiotics. But breastfeeding was still uncomfortable… no, it was now painful at first latch. My nipples were cracked. I learned later that they were also bruised. (It’s the learning curve, right? Breastfeeding is painful at the beginning? That’s what I had heard from several sources.) It was just the latch, not the whole experience; once he was on there, it was alright. Okay, maybe it wasn’t great, but it wasn’t “pain” exactly. I’m just not latching him well enough (right?). My mom suggested it was a tongue tie. But, if you’re counting, we had seen four RN IBCLCs, nevermind the two pediatricians, two of my midwives, and the ER doctor. None of them alerted. Either they didn’t look, told me he didn’t have one, or said there was nothing to worry about. Between nine professionals, one would have noticed, right? (Besides my mom?)

Another few days and still in pain at latch, I had “lipstick-shaped nipples” after we nursed, and they were blanched. I told my mom, and before I knew it she was in my apartment with her cousin on the phone for me. Cousin’s La Leche League leader handbook was on hand, and we went through the notes. In my head it was still a battle of the internet telling me “breastfeeding hurts at the beginning” and my mom’s voice going “breastfeeding is not supposed to hurt!” I was overwhelmed, and just wanted to snuggle down with my baby and my husband and get through the days. Going out to another appointment, or waiting it out until the next local La Leche League meeting- it was just too much right then.

Another few days and I was starting to dread each latch.  

Finally, one evening I cried in pain.

I didn’t cry during birth. Apparently, that’s my limit. 

I made an appointment right then with Dr. Thomas at Health:Latch, who my mom knew through the dental grapevine. He got back to me immediately, and I saw him three days later.  

If I had any doubts, they evaporated as soon as I settled in for my appointment, which included a lactation consultation. Finally, relief that someone would listen and could help both my son and me. Dr. Thomas’ IBCLC knew her business, and I knew she would take care of us. She was truly lovely.

How much pain was I in?  At first latch, between… an 8 and a 9? I think my mom (who came to the appointment with me) gasped.  A few minutes later, when I unclipped my nursing bra, I think the IBCLC would have gasped, too, if she didn’t have her professional pants on. (Ah, nope, that’s not normal.) My nipples were, according to her, “open wounds” and, according to me, “absolutely wrecked.”  

Yes, I know, I know- I should have made an appointment earlier. I have a tiny stubborn streak that makes me dread asking for help sometimes. Plus, this also meant that I had to admit my mother was right! This is the only time it’s really been to my detriment, but it certainly built some more self-awareness in me. 

Dr. Thomas determined that my little guy had a Class IV (posterior) tongue tie as well as a lip tie. Oh yeah, I’ve been flipping out his upper lip for him. He had lip blisters from his poor latch, too. 

Before and After

Zip-zap-zop, three minutes after he went back for the laser frenectomies he was back in my arms and (deep breath) latched for an immediate nurse with… no pain. Zero. I felt nothing but a nursing baby. 

I almost cried again, but this time out of relief.

Better Beginnings of a Nursing Journey

That wasn’t the end of my pain during nursing, or the end of our journey, but it was the beginning of the end. Baby went from the 60th percentile at birth, to the 50th percentile at his one-month check up, just after the procedure. At his two month, he was in the 75th percentile. That averaged to gaining 1.77 oz per day between months one and two.  At his three-month appointment, he was just shy of the 90th percentile, and gained about 1.5 oz per day between two and three months. Normal is considered roughly 1 oz per day. (More info on growth charts: https://kellymom.com/health/growth/growthcharts/)

I continued to get breastfeeding support as he and I both healed, and we had to keep working as my baby’s high palate redeveloped with the help of his newly free tongue. It wasn’t days of recovery, it was weeks of recovery, months even. But gradually, gradually it improved until one day I finally realized I understood what my older sister meant when she said she loved the snuggly feeling of nursing. It was a “Eureka” moment. 

Without the support I had, the resources I had, and the mom I have, I don’t think I would still be nursing today. I wouldn’t have made it much longer, I don’t think, in the acute pain that I was in. 

My breast pump got lost somewhere in the bureaucracy of insurance. It didn’t arrive until a few weeks after our release so it wasn’t a lot of relief for me.  

side-lying nursing mother and baby
Finally Getting it all Right

I’m sure some of you reading this will wonder why I didn’t supplement with formula to get a break or some relief.  I think I’ll have to blame that stubborn streak.  I knew the first weeks are crucial for establishing your supply, and I just didn’t want to use formula. I did use a Haakaa while I was waiting for my pump, and we did bottle-feed occasionally as I was recovering. 

Hidden Ties

Tongue ties like my son’s get missed often because they can be “hidden” and many babies overcome them to a point. They compensate.

Guess what? I have one. My mom didn’t experience pain during breastfeeding, but she did experience difficulties with production when I was about three months old, when her letdown stopped. She pushed through it, and I nursed for two years with my tie. So sure, for me, breastfeeding with my tie was “nothing to worry about.”

Assessing ties is a matter of function. For babies, that function is about the transference of milk: are they able to get their tongue into action enough to eat. If they’re not gaining, if they’re not satisfied after a nursing session, if (like my son) they’re squashing the nipple in order to create suction, that’s not effective function. Breastfeeding is all about supply and demand.  As an infant, I had to work harder to create supply, so the demand was slow in coming, leading to my mom’s milk shortage.  

As an adult, there’s still a function issue; it does affect my life. I don’t have as many of the negative side effects of a tongue tie as many people do, but I’m still planning to get mine taken care of, and hopefully, I also get rid of my headaches and migraines!

Assessing Ties Correctly

While I am still frustrated with my healthcare providers, they are sadly the majority, and to a degree I don’t fault them. Lactation education is something that most medical providers would have to seek out specifically, as would “Tethered Oral Tissue” education.  Knowing now how to evaluate for an infant’s tongue tie (more here) none of the professionals I saw initially did so.  

There’s also quite a resistance, controversy even, to the belief that tongue ties are the cause of many breastfeeding issues. The fact that I found that (in my opinion) outdated resistance in my RN IBCLCs at a Baby Friendly hospital’s Breastfeeding Center is troublesome to me, though, and so I find myself looking up Lactation Educator courses. I don’t want other women to go through what I went through.

Am I alone in this frustration? No, I am not.

While I’ve gained a lot of knowledge from being the daughter and editor of the Queen of Dental Hygiene, I’m not a medical professional (yet?), so I’m leaving you with some resources, in addition to the links above.  Please check them out, and do your own research!  

The Queen can, of course, help you out with any questions if you comment below or send her an email.

Thank you for reading!

-Alexandra

Update August 2023:

Alexandra is now a Lactation Consultant. She has completed all the course work required to sit for the International Board Certified Lacation Consultant (IBCLC) examination next month. As a mother and advocate for the importance of breastfeeding I am proud of her.

Breastfeeding is so critical for a baby’s development because it is ideal nutrition for babies. It helps develop the baby’s immune system and promotes proper weight gain. Babies that breastfeed may be smarter. It helps establish proper tongue rest posture and facial development, and prevents crooked teeth and temporomandibular jaw joint dysfunction. It enhances mother-baby bonding. It helps mom lose her baby weight, recover from childbirth faster, and reduces her risks of breast and ovarian cancers as well as postpartum depression.

Not every woman wants to or can breastfeed. For those that want to, consulting with an IBCLC can go a long way towards supporting new moms and babies on this important journey. Had I known then what I know now I would have done so many things differently in caring for my babies. At least I knew how critical breastfeeding was and continued it until my babies were done. To me, it was the most important thing I could do to establish a healthy immuune system and microbiome for my children, setting my babies up for a healthier life.

As a mom, I am proud of my daughter and all her hard work so other new moms won’t go through what she has experienced.

Sincerely,

Barbara Tritz BRDH,
Specialist in Orofacial Myofunctional Therapy and Of Course, Proud Mom and Grandmom

For Further reading Alexandra recommends:

From this site, an oldie but a goodie (and why I should have known better than to go through all of this:): The Mighty Tongue, Cat Got Your Tongue

Are ties contributing to your child’s tooth decay? Check out #5:  Tooth Decay: Hard Facts About Soft Teeth

Dr. Larry Kotlow, the East Coast’s tie guru: https://www.kiddsteeth.com/breastfeeding.php#sos

Dr. Kotlow’s top 10 myths surrounding ties: Top 10 Myths in Diagnosing and Treating Tethered Oral Tissues (Tongue Ties and Lip Ties) in Breastfeeding Infants (Guest Blog Post by Dr. Kotlow)

Dr. Ghaheri, the West Coast’s tie guru: https://www.drghaheri.com/blog

Effects of tongue ties on infants through adults: https://tonguetie.net/consequences/

This article from ENT Today briefly covers the controversy, evaluations, and treatments: The Dramatic Rise in Tongue Tie and Lip Tie Treatment

General information about the state of the country’s relationship with breastfeeding: https://www.cdc.gov/breastfeeding/data/reportcard.htm

Tongue Tie Babies Support Group (also has links to local support groups where you can get recommendations for “preferred providers” who are educated in ties and releases, and many other resources in the group’s Files): https://www.facebook.com/groups/tonguetiebabies/

List of resources from Kelly Mom: https://kellymom.com/health/baby-health/bfhelp-tonguetie/

Six-Foot Tiger, Three-Foot Cage: https://www.goodreads.com/en/book/show/34490961-six-foot-tiger-three-foot-cage

Hello, I'm Barbara Tritz

Unveiling the Stories Behind Dental Hygiene

Loving science, especially biology, from an early age, Barbara is a registered dental hygienist, certified biological hygienist, and orofacial myofunctional therapist. In 2019, she received the Hu-Friedy/ADHA Master Clinician Award from the American Dental Hygienist Association.

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1 Comment

  1. Megan

    I had almost the exact same experience just last month. It was wonderful how quickly the latch problem can be solved and breastfeeding can be pain free! Thank you for advocating for your daughter (and all new mothers!)

    Reply

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