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.


Shannon said...

Fantastic! That must have been such a relief for you, and Emily too.

CaroLyn said...

It was huge!

Multiple Reasons said...

Great Blog! As an IBCLC I'm astonished that you were not told or referred right away. Is that a picture of your baby? If that's the case, I wouldn't call that posterior I would say type 2, it's so evident to me. (there are 4 classifications)
I have heard IBCLC's mostly from the US say they have been told NOT to tell parents when they see tongue ties by the doctors. Ridiculous I know. Looks who ends up suffereing in the end because of it. Glad you we're able to get it clipped and have a wonderful breastfeeding relationship!

CaroLyn said...

@multiplereasons Camilla, thanks for stopping by and commenting! The photo is not actually my baby. I went through all of our photos of her, and couldn't find one showing the bottom of her tongue. I guess I delete almost all of the photos I've taken where she's crying! Her tongue tie wasn't so pronounced as this little one's, but it was visible when her mouth was open for a good howl. This photo I found on Flickr searching for Creative Commons licensed photos mentioning tongue tie.

Melodie said...

I can just imagine that moment when she latched on. What a huge sigh of relief and excitement!

Anonymous said...

Wow! I'm amazed that it took 7 weeks and that the LC never said anything. That's horrible - I'm sure many moms would have given up in frustration. Well done for sticking it out, and I'm glad you found such immediate and total resolution with the clipping.

CaroLyn said...

@Amber - thanks! I'm stubborn... :)

TheFeministBreeder said...

I'm sure you must be SO RELIEVED to find out the true cause of your bfing struggles. When I first brought Julesy home, they claimed he was losing weight because I wasn't producing enough, and their first solution was to supplement. I search the internets until I found a different cause and a different solution. I took matters into my own hands, fixed the problem, and never had to use formula. It's really too bad that an actual IBCLC couldn't help you solve your problem - even when it was clear what it was.

This is just your first lesson in listening and trusting your own instincts! You'll have to do a LOT of that with this parenthood stuff.

Life through the Slim Lens said...

Glad you've found BLW already - we did it and it was fab!

CaroLyn said...

@TFB - oh my, you know it. I was really speechless, like, oh, finally, this is what it's supposed to be like. I'd heard that tongue tie clipping can make a dramatic and quick improvement... but I'm skeptical of things promised to be an easy fix. When it was true, I was so thrilled!

@Life Through Slim Lens - I'm so excited about BLW. Each chapter in the book makes me more sure this is the right path. Can't wait to get started!

Betsy B. Honest said...

Interesting. My first baby was very tounge tied and had lots of trouble latching on. The LC recommended formula and when I refused suggested a nipple shield which worked like magic. When I took her to the doctor he noticed the tounge tie and suggested just leaving it if it wasn't causing feeding problems (she was gaining plenty). But now that she's 4 her grandma thinks she's having trouble with diction. I'm like, oh no, so we might be back to the doctor after all.

CaroLyn said...

@Betsy B. Honest OMFG, I rubbed my eyes to check what you'd read. Your LC suggested formula? That's hardcore weird. And reminds me of the first LC I met, in the hospital, who came by once about two hours post partum, asked if I needed anything... I didn't know what I needed, so I said no and I never saw her again! Good for you for sticking with it. I've heard some pediatricians will actually do the tongue clipping themselves, but it's not customary here in DC.

Tommy & Michelle said...

Wow, that is a tough one. So happy to hear all are well. Way to stick with the breastfeeding. Post some pictures of this cutie! :)

Anonymous said...

A bird in hand is worth two in the bush. ....................................................

Kristin said...

Found your blog through google, and I must say it gave me the hope I need. :-) Our two week old son has a severe tongue tie, and can't latch at all. I'm so grateful for the LC at the hospital who noticed it before we left, after our son's birth weight dropped dramatically. I've been pumping while we wait for our appointment with the ENT next week, and it makes me feel so much better hearing your experience. Thank you!

amie said...

I got my baby girls clipped last week. She is eight months old. I almost gave up bp. I'm glad I didn't. It took me calling in a lc to my house and paying 150$. It was after her ped said she was failure to thrive and her barely weighing 12 pounds where I put matters in my own hands. He suggested putting butter an oil in mashed potatoes. And apparently after getting his referral to the ent his nurse said they seen tongue tie before! Wow thanks for telling me about it. They never suggested or looked for it and she suffered the lack of nutrition all that time.

Amber said...

I believe my baby has a posterior tongue tie and upper lip tie and am looking for the right doctor to evaluate her. I live in the DC metro area and am willing to drive further out if I need to. Can anyone recommend any of the doctors your babies have seen?

CaroLyn said...

I've sent Amber a seperate message bit for the rest of the world, the wonderful ENT who clipped the BP was Dr Epstein. Phone:(301) 340-1355