The Tie That Binds

Forward: This article is ultimately going to discuss Lip tie and Tongue Tie. But that's not where the story begins. 

NOTE: If you read nothing else from this point on, read this - If you live in the US, are about to have a baby, or just had your baby; get dental insurance when you add your baby to your medical insurance. If you don't need it, it's usually pretty inexpensive. But if your child needs a lip tie or tongue tie revisions surgery, your medical insurance will not likely cover it. Your dental insurance will.

Shortly after my daughter Ahsoka came into this world, she was hungry - Super hungry. If the hospital where you are giving birth knows that you intend to breastfeed (and if your hospital is worth their snuff), they're going to do everything in their power to help you be successful in your breastfeeding endeavors from the get go. This includes putting your new baby to your breast shortly (scratch that, almost immediately) after they are born.

Breastfeeding can be a tricky thing. It's beautiful, it's natural, but even in the most ideal circumstances, it can be incredibly difficult. Often times that first time at your breast, your baby will not latch. The hospital staff will tell you it's okay, they work with you, and they give you lactation consultants to help you and your baby learn how to latch. This was not the case for us. My baby girl latched immediately. She latched so well that the nurses (who are all trained lactation consultants at my hospital) never questioned if we would have a successful breastfeeding relationship. They called her "little barracuda" because she latched fiercely and often (and feeding often is what newborns are supposed to do).

In the short time in an American hospital, your breasts are typically only producing colostrum (the first secretion from the mammary glands after giving birth, rich in antibodies that helps your baby's stomach lining form so that their stomach can eventually properly digest breast milk that comes later), and your milk will not likely come in until you are home. My milk didn't come in until the night before my daughter's first post-hospital follow-up appointment (five days after she was born). I was breastfeeding her constantly; however, not only did she lose just over 10% of her body weight during our stay at the hospital (she was healthy otherwise, so they let us go), but she had lost even more weight since we left the hospital.

But my doctor and I had a plan. My milk had just come in the night before for Pete's sake! We needed to give it time. I was eating oatmeal every day, relaxing as much as possible with my sisters in town to help us out, and doing everything I could to support my milk production. So we set up another appointment the following week. When they weighed Ahsoka again the following week, my heart sank. She had not really gained much at all (actually, they mis-weighed her at first and it looked like she had lost any more weight, but fortunately she was just slow growing instead of still losing weight). So we set up another appointment for the following week. The lactation specialist at my doctor's office observed her latch at my breast, and said it looked good.

All in all it took four weeks for my daughter to get back up to her birth weight, so we had to continue to  bring her into the doctor's office to weigh her week after week.

Ahsoka didn't seem dehydrated, she was healthy and happy and on track otherwise. She was having regular diaper output that seemed in line for a baby her age. But she was still gaining very, very little weight. She was at my breast near-constantly. At that point, I was already hand expressing milk after each feeding, and giving her the hand expressed milk each day to supplement her long breastfeeding sessions. I began pumping milk and gave her pumped milk each day. We were giving her the milk with a dropper each feeding to avoid nipple confusion. It was all completely exhausting.

I knew that breastfeeding wasn't going to be easy. I knew that it was a process. But something seemed wrong. Was it really supposed to be THIS hard? I read every blog, article, book and study that I could about slow weight gain and breastfeeding methods. I started to question my milk supply, despite everything showing that my milk was fine. I felt like I was missing something.

Again, keeping in mind that because I had told them that I intended to breastfeed only, they wanted to do everything in their power to assist me in these efforts. Acquaintances who had their babies around the same time we had were all formula feeding. Now, I am of the opinion that "fed is best", so whatever works for your family is important. But I'm stubborn. I set out to breastfeed, there didn't seem to be anything wrong with my daughter or with my milk supply. So I continued down the breastfeeding only path. My doctor hadn't even mentioned supplementing with formula, or the potential of moving to formula; so I didn't consider it either.

Six weeks after my daughter was born her weight gain was still slow, but she was at least steadily gaining, and our doctor agreed it was time to give my daughter my pumped milk with the bottle to supplement her diet instead of the dropper. We switched to bi-weekly weigh-ins even though she was still below average weight for her age (some babies truly are just smaller or gain weight slower than others, but are otherwise healthy). We needed to start introducing the bottle anyways because eventually I needed to return to work and if you wait too long to introduce the bottle, the kid may never take to the bottle (or it can at least make the process of getting them to take the bottle much harder). Using the bottle to supplement her unfortunately had the opposite intended effect because her weight gain became even slower, which we did not discover until I had a lactation consultant come to our home to help me with breast pumping the following week.

Pumping milk is not as easy as it may seem, and when I first started using a breast pump, not only was I not getting much (2 - 3 ounces, which as it turns out is perfectly average for when you first start pumping), but my already tender nipples felt brutalized. I checked the Medela *my pump brand at the time* website to make sure I had the right sized shield for my nipple size, but something seemed off. If I tried to pump milk more than once a day, I was left in an incredible amount of pain.

So we had a certified lactation consultant come out. Different than the nurses and doctor's, this person's job is solely with infants and breastfeeding specifically.

First, she identified that I was using the wrong size breast shield. Some women mistakenly think they need a smaller shield, when in fact they need a much larger one. This was my case, and since moving up to larger shields, I've had a much healthier relationship with my pump. It's still not easy, but it's manageable. She also gave me several tips and pointers for more effective pumping methods. Despite my hours and hours of reading books and internet articles, having someone in person help you with your pump is simply a different experience. Regardless if your child has issues or if you have issues with using a breast pump, I highly recommend having a lactation consultant help you get started.

But she was really concerned with Ahsoka's weight gain. Of course she was concerned, Ahsoka was gaining even more slowly than she was before in the two weeks we had started to give her bottles on top of breastfeeding. So she observed  me feeding Ahsoka. She noted that I was literally holding my breast to Ahsoka's mouth; a maneuver I call "torpedoing" and hadn't realized that most moms do not need to "babysit" the latch in that manner. The she inspected Ahsoka's mouth and said - "this kid has a posterior tongue tie and an upper lip tie. She is having trouble latching properly, and she is probably having a terribly difficult time drawing and swallowing milk properly as a result."

I was in shock. EIGHT WEEKS of constant feeding, and supplementing, and worrying. They checked her mouth for tongue tie in the hospital and said that she did not have one. Not once since the hospital stay had anyone asked or checked or mentioned the possibility that she could have a tongue tie and/or lip tie. Truly, the only time I had heard about tongue ties and lip ties was very briefly in our Newborns 101 class where it was mentioned in passing as something that is very rare (it's not). The consultant gave me a referral for a couple of dentists in the area who are specialists who could perform revision surgery. She said it was up to us, but her exact phrasing was "I think if you choose to do a revision surgery for your daughter, you're going to see a world of difference."

After she left, I immediately made an appointment with the dentist for their next available appointment, which was two weeks out. The nice thing about the dentist we set up the appointment with is that they will do a consult and immediately do the revision if you so choose at that same appointment (with a laser, which is much less invasive than with a scalpel). I had an appointment for yet another weigh in with the doctor the following week, which gave me time to discuss the surgery with my doctor, and still have the dentist appointment in my back pocket.

The lactation consultant also gave us some great pointers for effectively supplementing Ahsoka's diet with the bottle as well. As a result, Ahsoka gained 11 ounces in the week between the lactation consultant and the next doctor's appointment (almost triple what she had been gaining each week). While this was very encouraging, I wanted to get to the point where I could breastfeed a meal or use the bottle for a meal - not both all of the time. At this point, I was still breastfeeding Ahsoka almost non-stop throughout the day and night.

Let me preface something. I love, love, love my OB/pediatrician. I still have her as my child's doctor and will continue to do so. But unlike dedicated lactation consultants who are typically called in when there is an issue and therefore run into lip tie and tongue tie issues on a consistent basis, my doctor just didn't have experience with these issues. At the next appointment she looked at Ahsoka's mouth and said that she wasn't convinced a revision surgery would help. She felt like Ahsoka had good range of motion with her tongue. But that it was ultimately up to us, and there certainly wasn't any harm in having the dentist do a consultation. We set another weigh-in appointment for a month later.

I was so torn. Was I considering a completely unnecessary procedure for my daughter? A deep dive into research on lip ties and tongue ties showed me yet another strong division in the world of babies - Simply put, some people believe that revision surgery is necessary, and some people do not. And there is a staggering amount of data to support both schools of thought. But what I found when I read about tongue ties and lip ties is that not only can they impact breastfeeding, but they can cause speech and dental issues later in life. This hit close to home with me because I personally had speech issues growing up, and I had braces/retainers for years (which was an awful experience in both cases). When I was little, lip ties and tongue ties were a relatively unknown thing. Ahsoka's tongue tie was even harder to identify because a posterior tongue tie is when there is a restriction at the base of the tongue (and most healthcare providers are looking for a restriction towards the tip of the tongue). This is likely why they did not catch her tongue tie at the hospital.

Something I have discovered as a new parent is that there are going to be many points in time where you have to look at the data, and make the best decision that makes the most sense for your situation and your family because there are always going to be studies and information and articles to support different parenting methods. And sometimes that decision boils down to "going with your gut". And you are going to make mistakes (hopefully not life threatening, but mistakes nonetheless). Furthermore, every child is different. What works for one child may not work for another child. And in the case of lip ties and tongue ties, you have to consider the severity of the restrictions.

During the consultation with the dentist the following week (Ahsoka was 10 weeks old at this point), I think I already knew in my gut that we were going to go with the revision surgery. But it helped having a trained professional confirm what I believed: That this surgery would help her breastfeed more effectively. That it would even help her take the bottle more effectively. That it would prevent potential speech and dental issues later in life. My husband agreed with me that going with the revision surgery was the best course of action.

They had us leave the room for the procedure, and brought her to us immediately afterwards to nurse. Ahsoka was screaming. I began to cry as I nursed her, but Ahsoka latched on and I felt better that I was able to comfort her.

The surgery wasn't the hardest part. For four weeks following the procedure, we had to stretch and massage Ahsoka's lip and tongue - Every four hours the first three weeks, and then phase out one stretch per day on the fourth week. Each time we had to do these stretches, Ahsoka would scream bloody murder. She also became much stronger in that time, and would squirm and jerk away from us. Her lip and tongue actually bled a couple of times (which is normal). It was awful. The worst time to do her stretches was at 2AM when I would actually have to wake her up for the stretch every night. I was already exhausted, but this process added a whole new level to new baby exhaustion. I think after the first week and a half, it wasn't so much painful to her as it was upsetting. But that thought did little to make it easier on either of us.

But I will tell you, almost immediately after the surgery, Ahsoka's latch was different. Along with the stretches, we had to do suck training to help her newly freed tongue and lip re-learn how to latch and unlearn some of our bad habits, but Ahsoka's latch was already different aside from us doing these exercises. She was sucking harder, staying at the breast for shorter periods, and refusing the bottle with the additional supplemental milk (we think because she was full).

At thirteen weeks old, Ahsoka had her next weigh-in appointment at the pediatrician. Not only was her weight on track, but she had caught up to the average weight for her age (50th percentile). Her doctor was completely blown away. Ahsoka's experience completely changed her mind about the revision surgery. And she believes the surgery is what put Ahsoka on track.

So that's my story. Ultimately, as hard as it was, I'm pleased that we had the revision surgery done. I'm even more  pleased that we are still breastfeeding. It's been a long road, but based on my personal preference as a mother, I'm glad we have been able to breastfeed for this long.

When I started out with breastfeeding, I said that I would be happy if we could do it for a month, for three months, for six months, for a year (etc); and after each of these milestones, I would see how realistic it was to continue. My next milestone is six months. I'd like to make it at least a year. When she's a year old, we'll see if we're ready to wean then, or if we want to try for 18 months.

Breastfeeding is another one of those baby things that has a huge amount of information and schools of thought as far as how long one should breastfeed. "The World Health Organization recommends exclusive breastfeeding (i.e. no other fluids or solids) for six months and then continued breastfeeding combined with solid foods for 2 years or as long as mother and baby desire."
I think overall, I'll know when the time to stop breastfeeding is right based both on my needs as a mother, my ability to keep my milk supply up; but mostly importantly and ultimately what Ahsoka dictates. She is, after all, the reason I'm doing all of this.