Tongue Tie & The Breast Whisperer

So, yesterday, one of my dearest friends allowed me to tag along for a private lactation consult.  Her baby is a gorgeous little 10 week old gal whose weight gain has slowed in the last two weeks.  I was concerned that the little gal wasn't feeding efficiently for the following reasons:

• She was spending a lot of time at the breast without adequate weight gain
• She was falling asleep at the breast early in each feeding
• Mom was experiencing significant pain and tissue damage

I suggested my friend go in to to see a private practice IBCLC to get an assessment and consult.  We made an appointment at The Mother'hood.  This place is the shit by the way, if you live in the Denver area, and the lactation consultant there is the bees knees, or as I like to call her, the Breast Whisperer.  

I felt extremely grateful for the opportunity to observe Amanda (the aforementioned breast whisperer) sleuth out the cause of the breastfeeding problems.  Here's what she suggested:

• This gorgeous little baby had possibly an posterior tongue tie
• We were to go consult with a pediatric dentist who would possibly perform a lingual frenectomy to correct the tongue tie.
• My friend was to do switch feedings before and after the possible frenectomy to help the baby remove more milk from the breast

More information on Posterior Tongue Tie:

Tongue tie is not uncommon, and is not a problem unless breastfeeding is impaired.  The tongue is connected to the bottom of the mouth by a little strip of tissue called the frenulum.  The tongue is HUGELY important to breastfeeding because it massages the breast tissue to help remove milk from the breast.  If the frenulum is too short, the tongue cannot extend far enough out of the mouth to assist with emptying the breast.  As a result, the baby is working hard to feed and yet not getting much milk which results in exhaustion (thus falling asleep on the breast before becoming satiated) and also may use his/her lips to try to remove milk from the breast which results in tissue damage (thus pain for mama).  A perfect storm.

Lingual Frenectomy:

The procedure used to correct tongue tie is a minor, out patient procedure done in office with the baby wide awake.  ENTs will suggest using general anastesia  which is totally unnecessary.  If this procedure is something you are considering see a pediatric dentist experienced with the procedure.

You can put the baby to breast immediately after the procedure which takes just a few moments.  While very minor, the procedure can be upsetting to watch.  There is very little blood because the frenulum is not vascular, however, no mama or daddy likes to see their child uncomfortable, even if for a few seconds.  Keep in mind that feeding and growing is your baby's number one job.  If he/she can't do it well, the results can be hugely impactful on his/her health.  Subtext:  It's worth it.
Also, these procedures can also be done with a laser which may be preferable as it has potentially fewer downsides.  

What are switch feedings?

Milk flow is stronger and faster early in a feeding.  So babies who are struggling to feed don't have to do much work at the beginning.  The milk is kinda just flowing/squirting/spraying into their mouths.  But after a few minutes, milk flow slows, and an inefficient nurser will be working hard for little milk, get tired, and get nappy on the breast.  Sometimes we think, "Oh, she must be full since she's sleeping now."  But in fact, she's just exhausted.  Not a good thing.  

So, with switch feeding, as soon as the baby gets sleepy on the breast, you switch the baby to the other breast.  Why?  Because on the other side, the babe will get another fast flow experience for a few moments.  Baby doesn't have to work very hard to get milk for a few more minutes.  Of course, milk flow will slow again, and what do you do next?  Switch again.  Keep at it until you feel your baby has had good milk intake.  

Low and behold, this little munchkin did in fact of a posterior tongue tie, and the dentist went ahead with the frenectomy.  I watched!  Pretty fascinating stuff.  Very quick, and we had this little babe nursing on mama within a few minutes.  Mom could feel a difference in the latch immediately.  Amazingness.  

Did you know that midwives used to perform the same procedure with their fingernail?  Some might find it horrifying, but think about it - it's pretty brilliant....  A baby who couldn't nurse, couldn't live.  If we still lived in a world without artificial infant milk, this procedure would be life saving.  And when you consider the health concerns associated with babies fed artificial milk, some might say it still is.