You make me tongue-tied…Part II

Although Lactation Consultant No.1 had informed me I needed a whole new appointment to get Pip’s mouth checked, before we’d even started drinking our tea Lactation Consultant No.2 whipped on her rubber gloves and delved right in there – a process which took approximately 20 seconds. No.2’s hunch had been correct: Pip had a posterior tongue tie.

I won’t go into detail about what tongue tie is, as if you have been paying attention you should already know all about it thanks to Elly’s post on the topic!

Like Elphie, Pip’s tongue had been checked early on by the midwife and health visitor and we were assured that his was untied. It had therefore never really crossed my mind that my continuing issues with breastfeeding could have anything to do with that. However, it all started to make complete sense: as his tongue couldn’t extend over his lower gums and cushion my nipples, his gums had been repeatedly chafing against me which caused the soreness. The thing is, Pip had been latching on well in his own way and always opened his mouth wide, so people who had checked my breastfeeding had reassured me that it looked like we were doing it right! LC No.2 also noticed that when he cried (which surprisingly enough, happened shortly after she’d been poking around in his mouth with a rubber glove) he didn’t raise his tongue up which is apparently another sign – but I didn’t know this was something we were supposed to look out for. No-one told me his tongue was supposed to be so rock and roll!

tongue

Other symptoms we experienced were as follows (taken from the comprehensive Milk Matters list also linked to by Elly in her post):

  • Persistent very sore or damaged/blistered nipples
  • Compressed nipples (change in shape) and/or blanching after feeding
  • Excessive sucking need – baby wants to feed or suck very frequently/constantly.
  • Baby only swallows infrequently or swallows well for initial “milk ejection” (letdown), but then swallows become less frequent/sporadic.  In young babies this may result in falling asleep quickly at the breast.
  • Mammoth feeds – or falls asleep quickly and then wakes hungry as soon as breast/bottle is removed.
  • Very frequent feeds
  • Mastitis/blocked ducts
  • Tongue tremor whilst feeding
  • Unable to protrude tongue
  • Displays stressed body language when feeding – hands up near face, fingers splayed.
  • Restricted tongue elevation when crying.

We booked in for the procedure to take place the following week. Although LC No.2 and then the doctor at the clinic went through in detail all the alternatives we should consider (for example, expressing and bottle feeding; waiting until Pip’s mouth got bigger and hoping it would take care of itself), it was a no-brainer to go through with it. We decided continuing with breastfeeding was more important than a bit of temporary pain he might experience at the point of the snip. And there might not even be much pain: that membrane below the tongue apparently lacks many nerve endings and babies’ distress at the procedure may in fact be mainly due to their being held down and prodded.

We opted for a simple cutting procedure using special scissors. You can also choose the laser method which is available privately – we looked into this but decided to stick with LC No.2’s clinic as we felt comfortable with her. The doctor told us that there has been awareness of tongue tie and practice of its division for thousands of years (it’s easy to forget what people did and still do in the absence of formula); however, the NHS procedure has only been provided with NICE guidance since 2004.

At the clinic, we met another couple with their week-old baby. In their case, tongue tie had been diagnosed pretty much immediately at the hospital and the mother was told that therefore she “couldn’t breastfeed” which I found quite shocking! How many other new mums have been faced with this negative attitude when a simple procedure is all that is needed?! She had been expressing all week long and feeding her daughter solely with the bottle, hanging on until they could sort out the tie and commence breastfeeding. After both our babies had been snipped, we fed them in the same room with a dividing curtain (the dads were there too!) and it was impossible not to eavesdrop on her emotional first breastfeeding experience, latching on her baby and getting her milk flowing. Respect!

Fortunately they take the babies away to carry out the procedure but nonetheless it was pretty upsetting to hear the screams from next door and have Pip brought back to us with a little blood on his chin (Mr Cath claims to have never seen any blood but it was there!) but ultimately I think I probably cried more than him – he was just louder.

But then the miracle happened almost instantly. A whole new world of breastfeeding! That weekend, I used nipple shields for a couple more feeds to enable my nipples to heal completely, but after those first days following the procedure, I have put them away and never looked back. Breastfeeding feels so very different now – absolutely pain-free and comfortable! AMAZING.

One aspect of the tongue tie procedure we hadn’t anticipated, however, was the level of aftercare expected of us. Firstly and worstly, we were instructed to massage underneath Pip’s tongue – where the tie used to be – for 30 seconds, twice a day. The purpose of this is to prevent the tie from re-forming and keep the tongue as mobile as possible; as the doctor explained to us, this practice is considered a bit controversial because of the perceived cruelty to the baby and the lack of evidence to prove it actually works. In our notes from the clinic it was therefore labelled as “optional”. However, while we were there we met another couple who were returning for their baby’s second frenulotomy as the tongue tie had closed over again – the mother entreated us to do the massage as they hadn’t!

Therefore, after a couple of blissful days allowing the wound to heal a bit, Monday morning came around and I advanced on Pip, teething gel at the ready (the gel is supposed to numb the area so lessening the discomfort). I got my finger under his tongue but hadn’t even started massaging before the screams began – horrible! I physically couldn’t carry on… and called LC No.2 almost in tears, asking what to do and terrified I’d hurt Pip. She simply replied that I had to be brave! That statement being met with a quavering sigh, she then suggested that Dad take over the massage. Brilliant! So for the next week, Mr Cath massaged under Pip’s tongue with success. It is fascinating how differently mothers and fathers seem to cope with stressful situations like that. For me it was literally physical – my breasts started tingling and I couldn’t make my finger stay in his mouth. Mr Cath just merrily sang to Pip, applied the gel (still singing), massaged (singing through the screams), and brought him through to a weepy Cath ready to feed him (singing through the whimpers – the screaming never seemed to last long when he did it). It is the same when Pip is upset in general. For me it is how I’d imagine being stabbed through the heart but Mr Cath remains calm and unfazed.

Must work on my zen!

The second part of the aftercare was the instruction to breastfeed Pip every three hours, day and night. The purpose of this is to keep the tongue moving around, again preventing the tie from recurring. Bottle feeding was not allowed as this requires a different action. During the day? No problem. During the night? Argh! It was like having a newborn again, and what was particularly galling was that after dragging myself up in the courtesy of my alarm, Pip blissfully fed without ever even opening his eyes, then drifted off again seamlessly while in the meantime I was fully awake. At least the feeding itself went well! Then of course after I stopped having to feed through the night, Pip obligingly woke up naturally every 3-3.5 hours expecting to be fed (wouldn’t you?) – thank goodness things are finally getting back on track now a couple of weeks later.

Elly and Fred were not told to do any of this with Elphie, which is interesting. I guess the care must vary from clinic to clinic, which is typical in my experience. I’m sure Elly and I could write many a post on the contradictory advice we’ve received!

In any case, I’m so glad we stuck to the massage and frequent feeds, as the doctor and LC No.2 were really pleased when we returned for a check up a week later. LC No.2 told me that Pip was only the 14th baby this year that they have not had to re-snip (she could have said 40th – I was in too much shock to question it). I don’t know how many babies they see per year but say two a week, by October that would be at least 80 babies. Such an low success rate is astonishing really, and it makes me laugh that we weren’t told this when we first arrived at the clinic. I expect we would have needed a rethink after hearing that statistic!

The fact it wasn’t detected earlier is rather frustrating to say the least – but onwards and upwards, and as I’m hoping to breastfeed until Pip is at least one, it will all have been worth it. In the meantime I’m trying to tell as many people as possible about my experience so that when the time comes they can get their baby checked, and checked, and checked again – preferably at some point by a specialist.

The only negative? Now that Pip is feeding more efficiently, the feeds are much shorter so I have less time to write blog posts during them!

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