Breastfeeding and Tongue-Tie
From New Beginnings, Vol. 25 No. 5, 2008, pp. 11-12
Breastfeeding experts say it takes patience and persistence to solve most breastfeeding difficulties. Patience and persistence became my mantra as I struggled to breastfeed my sons. For me, breastfeeding was a bumpy road -- sometimes agony, sometimes euphoria, but usually just hard work. I hope that sharing my story helps someone else facing an inexplicably painful latch-on.
When I gave birth to my second child, Aleksander, in 2004, I had reason to worry about breastfeeding. Three years prior, I had given up trying to breastfeed my first child, Nicklas, when he was four months old. Trying to breastfeed him had always been excruciatingly painful, even though the nurses and lactation consultants kept telling me the latch-on "looked good." No one could explain why it was so painful. More devastating than the actual failure was the absence of any explanation for it. I assumed that there was something wrong with me, with my breasts, that other mothers were more able to tolerate pain, that I didn't have enough willpower -- in short, that I was a failure.
I desperately hoped that things would be different with Aleksander. With help from a lactation consultant, we were able to get him to nurse, but he also had a painfully shallow latch-on, when I could get him to latch on at all. I was told that the nipple was being rubbed between his gums causing pain and nipple damage instead of being drawn back under the soft palate where it should have been.
The lactation consultant checked for tongue-tie and immediately ruled it out. A baby is considered tongue-tied when the lingual frenulum, the band of tissue that attaches the tongue to the floor of the mouth, is attached too tightly or too close to the tip of the tongue and restricts tongue movement. Classic tongue-tie means the frenulum is attached at the tip, and Aleksander's was not. My next thought was that the problem was with my breasts, but I was told that flat nipples shouldn't be an obstacle to a good latch-on. I was instructed in good latching techniques and encouraged to keep trying.
Unable to face the struggle alone, I began attending La Leche League meetings and spoke to every LLL mom I could about my problems, hoping for some insight. Two Leaders, Diana and Helen, spent countless hours helping and supporting me. La Leche League was my lifeline without which I would have quickly run out of energy and given up. But even though the tender encouragement of these nursing mothers kept me going, I still craved an explanation for my breastfeeding problems.
I mentioned Aleksander's feeding problems to our pediatrician and she immediately checked underneath his tongue. "He's tongue-tied!" she exclaimed. After examining him carefully for a few more seconds, she said, "No, he's fine." "Are you sure?" I asked, eager to find the reason for our latching problems. "Yes," she said firmly, showing me that his frenulum was not attached at the tip. "His tongue is fine."
Despite this final assurance, I turned to the Internet, searching for hours for information on tongue-tie. On the La Leche League International Web site, I came across an article called "Tongue-Tie and Breastfeeding" by Catherine Watson Genna, a lactation consultant in New York, USA. It described how the tongue is the major "player" in breastfeeding, and that tongue-tied infants may "fall off" the breast often during a feeding. They compensate for a shallow latch-on by "exerting positive pressure" with their jaws, which mothers report feels like "chewing or biting," and that the nipple is often compressed with a white band in the middle after feedings. All of these descriptions matched my problems precisely.
Another article by Catherine Watson Genna called "Congenital Tongue-Tie and Its Impact on Breastfeeding," written with pediatric surgeon, Dr. Elizabeth Coryllos, said that the tie didn't have to be at the tip in order to affect the latch-on; in fact, tongue-tie was likely to affect breastfeeding more severely if it were a posterior tie, with the frenulum attached tightly at the base of the tongue, far back from the tip. The article discussed treatment methods, the simplest and most commonly used being the frenotomy, "in which the frenulum is snipped with sterile scissors under a local anesthetic." This low-risk procedure was once common, but fell out of favor with the decline of breastfeeding in the 1940s and 50s.
I emailed Catherine Watson Genna for help and she confirmed from digital photos that Aleksander's tongue indeed looked "tied." At this point, breastfeeding was taking all of my energy. There was not much left of me for my three-year-old son, Nicklas, and even less for my husband. When my father offered to pay for my trip to New York, I agreed.
I worried about whether this was the right decision. Was I being selfish to go on this trip and consider a frenotomy for Aleksander? By a strange quirk of fate, our New York cousins, who invited me to stay with them, not only knew Catherine Watson Genna well, they lived virtually down the street from her. This serendipitous coincidence helped ease my fears. I now felt that I was meant to go.
In New York, I met Catherine and was immediately impressed by her eloquence and passionate dedication to babies. During our car ride to meet Dr. Coryllos, who would perform the surgery, Cathy explained how experts were just starting to use digital imaging technology to see what was actually going on inside the baby's mouth while breastfeeding, and how sometimes an incompatibility between baby's mouth and mother's breast can cause difficulties with latch-on.
Dr. Elizabeth Coryllos was another fascinating person to me: a woman who had attended medical school when it was still an old boys' club and frenotomies were not part of the curriculum -- she came to learn the procedure by chance. Since then, she has performed over 500 frenotomies to help tongue-tied infants and children, and in rare cases to correct speech problems so severe that the child could not speak beforehand.
I was nervous about the surgery, not wanting Aleksander to be in any pain, but was quickly put at ease. The area was numbed with anesthetic and the actual snip of his frenulum took only a minute. Aleksander cried initially but after a minute of comforting he was calm. After a few minutes he was smiling like crazy and charming everyone. Cathy had explained that there was no guarantee that the frenotomy would fix the latch-on, but that in most cases it did improve things significantly.
Although Aleksander was already three months old and was accustomed to using his tongue in a particular way, I could feel a difference in his latch-on immediately, though I was still in pain. I had always had the sensation during feedings that my nipple was being scraped with sandpaper and now that his tongue had more mobility he was "sanding" me even more.
Aleksander's frequent refusal to latch on was another obstacle. I soon found I could latch him on while he was asleep, one of the tricks of nursing non-latching babies. Though the frenotomy had not produced a sudden improvement in nursing, as it does for some mothers and babies, Aleksander's latch-on had improved enough that I could get him to nurse for all of his night feedings -- a major triumph in my eyes. I felt so close to my baby when he nursed. I breastfed him every night until he was eight months old when he became very congested with a cold and could not be coaxed to latch on no matter how I tried. I felt intense gratitude to those who had helped us achieve even that brief period of nursing. As we didn't plan on having any more children, I told myself that I had done my best, and what I had accomplished was enough.
Three years later, my husband and I were delighted to discover that we were expecting a third child. When Lukas was born, he seemed to have a strong latch-on from the first feeding, although it was somewhat painful. I thought, "Oh no, the same old chompy latch-on," but I remembered the adage that patience and persistence are the keys to solving breastfeeding problems. This time, the problems were more typical of early nursing: the latch-on only hurt for the first few seconds of a feeding, the baby was getting milk and growing well, and the discomfort grew better rather than worse over time. By the time Lukas was two weeks old, I was pretty sure things were improving. By two months we had breastfeeding down pat. I am now a nursing mother with no pain and much joy. Lukas is a healthy eight-month-old and we're enjoying our bond tremendously. And if Lukas starts to fuss, Aleksander kindly calls to me, "Mommy, Lukas wants some breast milk!" No problem.