I sat there with a new mother holding in my tears as she shared her story. Here she was with her 8 week old newborn, sitting on the couch wondering what to do next. She had already seen a handful of lactation consultants, midwives and a couple of doctors. Her nipples were red raw. Every single breastfeed was painful for her, and had been from the start. Her baby was growing, he was happy and content, she had enough milk…but she was struggling to stay afloat and ready to give up.
She was repeatedly told to use nipple shields. And yes, this can be a temporary solution for some women but being given a shield does not get to the underlying problem. She felt temporary relief but within a day or two of using the shield she was in pain again. WHY was this woman feeling pain? Why was she having such a prolonged period of painful breastfeeding? Using nipple shields does not actually help if there is no one actively trying to find the reason she was experiencing pain. Helping the mother latch her baby on without a shield is important BUT if the help with latching does not work then we must investigate further. NOT just put her back onto the nipple shields.
Everyone kept saying to her, “the latch looks good”. IT IS IRRELEVANT IF THE LATCH LOOKS GOOD TO SOMEONE BUT FEELS BAD TO YOU! As a mother, do not ignore your own instincts. As a health care provider DO NOT IGNORE THE MOTHER. She was told her baby’s latched “looked good”. Well who cares! She was in pain. That is what matters.
Upon observing her baby I noticed he latched on quite well and did not appear to have any obvious issues going on while breastfeeding. He was getting milk (I could see the pauses to swallow as he sucked and then swallowed the milk), the mother reported that yes, she felt as though he was getting milk while feeding and since he was growing and had heaps of wet and poop nappies we knew he was getting enough. He did not slide off the nipple or click while feeding which is an indicator of tongue and lip ties…BUT she was in pain. Now even with the shields she was experiencing some pain. This is where further investigation is needed.
I looked in her baby’s mouth and noticed that his tongue moved around quite easily BUT that is not an indication that he is tongue tie free. It is necessary to actually FEEL at the base of the tongue to see if you can assess if there is a posterior tongue tie. Sometimes we can see an obvious tie which is often referred to as “anterior” (towards the front) but there are many times where the tongue tie will actually be posterior (further back under the tongue) and might not even be noticed until you feel with your fingers on either side. This also allows you to get a better look. As I felt under his tongue and got a better looking feeling with my fingers, I strongly suspected a posterior tongue tie (PTT). When I placed my finger in her baby’s mouth, I also noticed that he did not suck my finger all the way back into his mouth (it was a very shallow suck) and his tongue hardly came forward when sucking. It was not only how it felt and looked to me, but also the mother’s experiences and history. It is looking at the whole picture. Not just one aspect of her experiences or the baby’s mouth. Not every “tight” tongue will need to be revised and not every painful breastfeed is a result of a tongue or lip tie.
Source: Dr. Kotlow
It’s important for us to stop focusing on whether it is, “anterior” or “posterior”. If your baby is tongue tied, they are tongue tied. Dr. Marjan Jones, a dentist from Enhanced Dentistry who has treated over 1,000 patients within the past couple of years has noticed (along with others who work in this field) that in almost every case an anterior tie will also have a posterior tie as well. Cutting the anterior is often not enough when dealing with tongue ties. In many cases a lip tie will also be present and must be assessed along with the tongue. Even if someone says your baby has a “mild” lip or tongue tie, if you are hurting or you have recurrent thrush, mastitis, blocked ducts or milk supply issues it is important to see if this “mild” tie is playing a part in why you are experiencing these ongoing issues. Your baby may also exhibit signs of reflux, food intolerance or allergies. These can also be symptoms of a baby with a tongue or lip tie. This is because your tongue is the first part of how you actually break down your foods. It’s a crucial part to digestion and how your food first makes it’s way into your gut.
Lip Tie. Photo credit: Meg Nagle, IBCLC
So what is this mother to do? It’s first important to rule out other causes of pain including (but not limited to) the mum having Raynaud’s disease or mastitis, or thrush in the baby’s mouth and/or on the mother’s nipples. It can take weeks and sometimes months to rule out possible reasons BUT assessing a baby’s mouth and the possibility of tongue and lip ties is CRUCIAL to investigating a mother’s pain while breastfeeding. If a mother has recurrent mastitis or thrush, it can in some cases to due to a baby with a tongue or lip tie as this affects how the baby can drain the breast. The photo to the left is of a baby I saw with a lip tie, HOWEVER he still had quite a bit of movement and I was able to help the mother find a comfortable position to breastfeed him in. He did not end up needing it revised. Again, it is always about looking at the whole picture. She ended up being able to breastfeed pain free without him needing surgery.
There are studies which show the positive outcomes when a baby’s tongue tie is released. A review of the literature surrounding tongue tie and breastfeeding from 2011 found that, “for most infants, frenotomy offers the best chance of improved and continued breastfeeding.” Another study from 2011 found that there was an, “immediate improvement in nipple-pain and breastfeeding scores, despite a placebo effect on nipple pain. This should provide convincing evidence for those seeking a frenotomy for infants with significant ankyloglossia.” One of the most recent studies on painful breastfeeding and frenotomy can be found here.
As this mother sat there crying I was feeling so frustrated that she was not referred to a specialist on revising tongue ties straight away from the beginning. I just wanted to wave a magical little booby wand to take all of her pain away. Unfortunately I cannot do that. But what I can do is continue to support her with this journey while bringing in other health care professionals along with way (such as an experienced dentist and chiropractor) so she can put herself and her baby in the best possible position to reach her breastfeeding goals.
*For those of you who are not planning on continuing to breastfeed it is still important to have a dentist assess your child’s tongue tie, as in some cases it will still need to be revised. Tongue and lip ties can lead to many possible challenges as your child grows including; orthodontic issues, tooth decay and sleep problems (Sleep apnea and tongue tie research). Click here for an excellent hand out from dentist Dr. Kotlow which lists the possible future problems it can lead to.
To the mothers out there who have seen person after person after person… DO NOT GIVE UP! If you would like to continue breastfeeding your baby seek help from an International Board Certified Lactation Consultant or other health care professional WITH EXPERIENCE diagnosing tongue and lip ties. Trust your instincts. If you feel as though something is going on with your baby, find a health care professional who listens to you and believes you. Trust your instincts as a mother. You know your baby best.
