Dealing With Tongue-Tie
By Joni N
From: NEW BEGINNINGS, Vol. 13 No. 2, March-April 1996, pp. 41-2
We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time.
When I discovered I was pregnant for the third time, I didn't give much thought to breastfeeding. I would just care for the baby the way I had taken care of her two older brothers. I would breastfeed on demand, cuddle, and treat this new member of our family as the special, delicate gift that she certainly would be. I did reread my copy of THE WOMANLY ART OF BREASTFEEDING to refresh my memory about certain things, but after all my experience with John and Michael, I didn't believe that there was anything I would run into that I wasn't prepared for. I thought about going to an LLL meeting, but I couldn't muster up the energy to go.
During my pregnancy, there was no indication that Laura was going to have problems after birth. But when we were discharged three days later, we had a horrible time. Laura woke up crying, wanting to eat. I tried to nurse her, but it didn't feel right, and I did not have any let-downs. She had only three wet diapers, and no messy ones in twenty-four hours. I didn't want to give her a bottle as I had been told to do, but she kept on crying, so I did. This went on through the night. By the next morning, I was crying constantly, feeling like a failure, and did not know what was wrong.
I called Sarah, the lactation consultant at the hospital, and she made time to see me. At first, she thought that Laura was just a sleepy baby who wasn't interested in nursing unless the milk was flowing. I had to work hard, she said, to keep Laura interested. In addition, Sarah suspected that Laura wasn't latching on properly, but it wasn't until Laura was screaming that Sarah discovered the major problem. When her mouth was wide open crying, Sarah could see that Laura had a short frenulum. The frenulum is the membrane that attaches the tongue to the floor of the mouth. A short frenulum prevents a baby from extending the tongue to grasp and milk the breast properly. Many refer to this condition as tongue-tie.
Sarah helped me to nurse Laura in her office, using the supplemental nursing system (SNS). When Laura tasted the formula, she started sucking vigorously. I still did not have a let-down. Halfway through the feeding, I switched sides, and let Laura finish nursing, still using the SNS. Afterwards, Sarah had me pump my breasts to see how much milk was left. It turns out I did have mature milk, not colostrum, but my supply was low.
Sarah recommended that I do several things if I really wanted to breastfeed Laura. First, she recommended that we take Laura to our pediatrician for his advice on her tongue-tie. We went later that same day, but the doctor didn't feel her condition was severe enough to warrant clipping the frenulum. Besides, I didn't want Laura to go through the pain of having this operation. I didn't think the situation was as serious as Sarah had made it sound. Second, I had to use the SNS every time I nursed so that Laura would get enough to eat while I was building up my milk supply. Third, I had to pump after each nursing. But most importantly, Sarah said that I must be determined and strong in my belief about how good breastfeeding is for a baby. She would give me the support, but I had to do all the work.
I was willing to do a lot of work, but I didn't know what to do about Laura's frenulum. I really wanted to nurse my baby, but I wasn't sure if I was up to the task. I was so tired and upset. "What's the big deal if I just give it all up and bottle-feed her?" I asked myself. I couldn't do it, though. I wanted the closeness of nursing. I wanted to feel Laura's tummy next to mine as she nuzzled my breast. I wanted to love her through breastfeeding. My husband, David, knew how important nursing was for babies and their mothers and was willing to help me as much as he possibly could. So, I gave it a try.
We took an SNS home and a portable pump. Getting the SNS attached to my breast, and sticking it in Laura's mouth with her latched on properly was a nightmare. Sarah made it look so easy using the football hold, but Laura and I couldn't get the hang of it. She would become frustrated and start screaming, then I would become frustrated and start crying.
But finally, after several tries, we got it right. After feeding Laura, I had to rinse out the SNS and get the pump together to pump for twenty minutes on each side. I stored what breast milk I expressed to put in the SNS for the next feeding so Laura would get less formula. I did end up with sore nipples, as Laura was not sucking correctly.
I called Sarah every day and received support from her. I did everything that she told me to do, except get Laura's frenulum clipped. After ten days, I could no longer go on. I either had to get Laura's frenulum clipped, or give up breastfeeding. I contacted Sarah, and she referred me to an ear, nose, and throat doctor who could do the procedure. I made an appointment for the next day.
First, the doctor anesthetized Laura's tongue, which she didn't like at all. Then he left to see other patients while the medicine took effect. Laura wanted to nurse, but couldn't because she couldn't feel anything. She had this puzzled look on her face every time she tried to latch on. The procedure didn't take very long, and there wasn't much blood. Laura went to sleep afterwards and didn't wake up for three hours.
I called Sarah when we got home. She was very supportive and understanding of my feelings. Sarah said that a lot of babies can nurse properly right after surgery and that many mothers' sore nipples go away soon. Laura was able to nurse better, but it took several days for my soreness to go away. I still had to feed Laura supplements and use the breast pump. When I went to visit Sarah at the hospital a few days later, I told her about the anesthetic. She was surprised that the doctor had used it. She said that most of the time, doctors don't use anesthetic for this procedure. When she looked into Laura's mouth, she said that the doctor had made a very deep cut.
The following week, I discontinued using the SNS. Laura did fine. I continued to pump my breasts to build up my milk supply. A week after that, I stopped pumping. I monitored her wet and dirty diapers closely, and while she didn't have many wet diapers at night, Laura was finally gaining the weight that her pediatrician wanted her to. Laura had only gained two ounces per week for the first three weeks. After I had her frenulum clipped and it healed, she gained ten ounces in the fourth week. We were finally a nursing couple.
I started attending La Leche League meetings when Laura was two months old. The support and encouragement that I received from the meetings helped to keep me nursing throughout Laura's baby- and toddlerhood.
Editor's Note: Incidence of tongue-tie is rare. Sore nipples are more often related to improper positioning at the breast or incorrect latch-on. For help with either of these situations, contact your local LLL Leader.