Sunday, January 3, 2010

Breastfeeding and Tongue Tie

In all my recent breastfeeding blogging and tweeting, I realized I never finished documenting our current state of affairs with breastfeeding the Baby Piranha.

At 4 days, my pediatrician was concerned about her weight loss (birth weight was 9 lb 4 oz, 4 days was 7 lb 14 oz) and suggested it was due to her not latching well. She suggested I start pumping and syringe feeding, and that I try using a nipple shield. Done.

In retrospect, I realize that part of the reason for the dramatic weight loss was that I was given IV fluids during labour, and that inflated my weight - I only weighed 3 pounds less the day after I came home from the hospital, than I weighed going it! It can also inflate babies' weight - so her birth weight was probably higher than it would have been naturally, making her normal post-natal weight loss look more dramatic. I've since mentioned this to my ped and she agrees this could have been a factor.

At 11 days, the BP was gaining weight but not latching, so I went to see an IBCLC, who wrote in her notes that the BP has a posterior tongue tie. She encouraged me to continue pumping, offering the breast with and without the shield, trying out finger feeding, and sold us a larger syringe. Done. Nothing was said about tongue tie, it was just written down.

At 3 or 4 weeks, after only getting the BP to eat directly from my breast by manually expressing into her mouth, we returned to the IBCLC to be told to keep up the good work and get some coaching on side lying nursing. Done.

All of this time, my friend whose baby not only was tongue tied but after having the tie clipped, had to have it re-clipped at 4 months because it regrew, was encouraging me to visit her ENT to have the BP's mouth evaluated for tongue tie. I resisted because the IBCLC surely would have told me if that were the cause of our woe.

By 7 weeks, however, I was ready to throw in the towel on breastfeeding directly, and just buy two pumps: one for work, where I would be soon returning, and one for home. My friend made another appeal to call her ENT.

I thought it couldn't hurt and even if he clipped her tongue and it didn't help, the clipping was not supposed to be that traumatic.

I phoned the ENT, said the BP was losing weight (not precisely true, but I didn't have the patience to wait three weeks for an appointment) and was able to come in for an appointment two days later - on my second day back at work.

We drove waaay out into the suburbs where the ENT's office is - he is reputed to be the best ENT for tongue tie in the DC area. He's a nice, short, older man clearly fond of babies. He looked in the BP's mouth and said he thought her tongue tie was the cause of our latch problems and recommended clipping it.

I immediately agreed - it was really what we were there for.

Minutes later, I'm in an examining chair, holding the BP in my lap. A nurse is holding her head and the ENT is opening her mouth. An observer, possibly a student, is watching behind the ENT, and he is explaining to her what he's diagnosed and is about to do.

The BP starts to cry when her mouth is opened up. The ENT makes a quick clip - I can see the motion of his hands when the clip is made. The BP doesn't cry any harder, which makes me think the clipping really didn't hurt much. The ENT pops a bit of gauze in her mouth to absorb the few drops of blood that is coming from under her tongue.

The BP continues to cry for a few minutes. We're shown to a nice waiting area, not the main reception room, where we're encouraged to sit and try to nurse.

I'm told that after the clipping, it's important to try to nurse as much as possible - I'm not sure, but I assume it's either to help heal the wound in a way the tongue can keep moving well, or for the baby to have a good first day on the breast, to really learn to latch well.

She calms down fairly quickly - though I'm sure any caregiver will agree than even a few minutes of crying caused by something YOU CHOSE TO DO TO THEM! is hard to listen to. Those few minutes, I was busy doubting myself and my decision. I was thinking "oh I should have just given in and pumped for her, this wasn't necessary, I'm a horrible person, succumbing to the medical-industrial complex."

While I was busy berating myself, I was dutifully offering my breast to her. Suddenly, I noticed the BP had stopped crying and had latched on. Really latched on, and was sucking and gulping milk.

I'd never heard her gulp before. It was amazing. I got a little verklempt.

Since then, I've really only had to pump while at work and once or twice for car rides. Any time we're together, I can feed her directly from the breast. It is soooo much easier than all the pumping and bottles!

I also realized a day or two later, while watching her stick out her tongue in preparation to latch on, that I'd previously never seen her stick her tongue out of her mouth before. I'd seen her tongue, but it'd never before extended beyond her lips. Now it does!

I also spoke with the supervisor of the IBCLC I had seen twice, and let them know that I felt I should have been referred to an ENT much earlier. Their response was that they hesitate to make that referral other than in the most severe cases, because they don't want new moms to think their baby is deformed. I think that's the most absurd thing I've ever heard, but maybe I'm too much of a pragmatist.

The BP is a few days over 5 months old now, and still latching and eating like there's no tomorrow. She's rather big for her age, but tall as well as chubby. DH and I were big babies too, so it's probably genetic. We were at a party recently where she was about the same size as a 9 month old baby!

She's also tolerating me reintroducing a bit of dairy into my diet. I'm not eating dairy like the old days yet, but a bit of cheesecake here, a bit of pizza there, and we're both happy campers. (When I say tolerating, I mean she is showing no signs of having trouble with the dairy - no screaming when pooping, no green poo, etc...)

So, that's really the full breastfeeding saga thus far. I'm reading Baby Lead Weaning now, and I'm so excited to have found out about it. It seems like a very natural and sensible approach.

Anyone else have thoughts on tongue tie and clipping of tongues?

Photo courtesy of Qole Pejorian on Flickr.