tongue tie

Ry’s Lip & Tongue Ties

You may or may not have heard of a common condition among newborns called lip tie and tongue tie.  I did not think much of this topic until I had my own little girl born with both an LT (lip tie) and TT (tongue tie).  All I knew is that it could cause problems breast feeding and I did not want her to have it.

Upper Lip Tie

Upper Lip Tie

Posterior Tongue Tie

Posterior Tongue Tie

The Problem

The problem occurs when the baby is unable to create a proper suction on the nipple.  This hinders babe from getting enough milk in her tummy and hinders mom from producing enough milk. Often, LT and TT babies are able to get the foremilk but not the good, fatty hindmilk.

tongue-tieWhen my sweet Ryan Rachelle was born (on a Friday) she nursed like a champ.  If you read my blog on her birth story (click here to read) then you know that when she came out she immediately began to tug on my sports bra.  After her cord finished pulsating, was cut, and I was moved to the bed, she was brought back to me to nurse.  Before she had even been laid down she reached out, grabbed my boob, and shoved it in her mouth.  She knew where her milkies were and she wanted them!  I had the typical soreness, blisters, and cuts on my nipples as many moms experience when they start to breast feed.  I assumed all this was normal.  I just lathered up in coconut oil and went about my day as a new mommy.  That is, until we realized there was a slight problem. 

As standard procedure for our birth center, a midwife came to our home 48 hours after birth (Sunday) to check on mom and baby.  Thankfully, the midwife that made our visit is also a wonderful lactation consultant.  You’ll remember her as Teri, with the heavenly hands on my forehead while I was in labor.  During her visit she checked Ry’s weight, reflexes, and her mouth for ties.  She told me then that she might possibly have a LT & TT but it may not hinder her nursing and we should just keep an eye on it.  I didn’t think much of it.  She had lost weight but it was well within the normal amount for newborn babies. 

Teri checking for lip and tongue ties

Teri checking for lip and tongue ties

Weight check

Weight check

Foot prints

Foot prints

Several days later, our sweet girl still hadn’t pooped.  I contacted Teri.  She told me that if she hadn’t gone by Thursday around noon to give her a call.  In the meantime we were trying to stimulate her bowels by inserting a q-tip with coconut oil in Ry’s bum.  Ryan had just received his doctorate so I told him that he had to do it because he was a doctor.  Really, I just didn’t want her mad at me!  While it is completely normal for a breastfed baby to go a week without pooping, she hadn’t gone at all, with the exception of her initial meconium.  Thursday rolled around and we still had no poop.  Finally, around noon I emailed Teri, who had been waiting for my email, to inform her there had been no change.  She scheduled a lactation appointment the following day (Friday).  Ry was 1 week old. 

The Diagnosis

By now, my mom had gone back home and my husband was at work.  I went to the appointment alone.  Teri had me take Ry’s clothes off so that we could weigh her.  Then I was to nurse her and weigh her again so we could see how much milk she was able to drink.  I don’t remember the amount now but it wasn’t much.  I’m thinking it was less than an ounce.  My poor baby was hungry. 

I immediately started crying (keep in mind I was still on hormone overload).  I never expected to have a supply problem.  I am my mother made over and my mom had an abundance of milk!  Surely, I would too.  Teri officially told me that Ry did have a LT and TT and that if I wanted to continue to breast feed that it would be best to have them released in a procedure called a frenectomy.  She gave me a list of doctor’s names in the area and their various methods of treatment.  In the meantime, I would have to fight to increase my supply and supplement.

At this point, many doctors (dare I say, most) suggest (or force) formula.  Thankfully, Teri did not.  In fact, she taught me how to supplement with my own milk.  After each time I nursed, I had to pump for 15 minutes.  This was extremely frustrating as I was barely producing anything by pumping (I was thrilled the one time I got 30ml).  My mom and my husband had to constantly help me compress my breasts to try and get more milk out.   I tried everything from fenugreek, Mother’s Milk, and even beer (which I hate).  Nothing helped me produce more.  (I have since learned that my boobs just don’t respond well to a pump.  I still have to fight to get an ounce with a pump and I have PLENTY of milk for my girl.) We would then take that milk, put it into syringes, and attach a little tube to the end.  We would put that little tube in her mouth while she was nursing (so as not to cause any nipple confusion) and she would suck in the supplemented milk while latched to me.  Sometimes this didn’t work as well so we would use our fingers.  Every time she got the supplemented milk she would gulp and moan in satisfaction from getting her fill.

Ryan helping me supplement our sweet girl with my milk.

Ryan helping me supplement our sweet girl with my milk.

 The Frenectomy

Being a former laser technician and through much research I knew I would only have her ties released by laser.  I did not want them clipped.  When clipped they have a better chance to grow back, they bleed, and take longer to heal.  With a laser, there is little to no blood because the laser cauterizes as it treats.  It would be very quick and I could nurse immediately after to comfort my baby.  Teri had given us the name of Dr. Stacy Cole in Ft. Worth.  She said that he was one of the best in the nation.  There was no other option to me.  That’s who we were using. (Visit Dr. Cole’s website for more information and videos here.)

Through a series of events, we were able to get an appointment with Dr. Cole the following Tuesday.  My mom was back in town to help me by then, so she drove us to Ft. Worth.  Daddy had to work and was very unhappy about having to miss the appointment.  The last little leg of our journey Miss Ryan became very fussy.  We assumed she just wanted out of the car seat.  We were a little late due to getting lost, so when we finally arrived at the office mom ran inside to get us checked in.  When I went to get Ry out of the car I noticed a little brown mark beside her.  Then I leaned her forward.  She had FINALLY decided to poop.  Actually, explode is a better description.  I carried her car seat inside and told mom what had happened.  I had paperwork to fill out so Lovey (my mom’s grandma name) got to go to the bathroom to clean up the first poop explosion.  This is when I learned to carry more than a small travel pack of baby wipes in the diaper bag.

Dr. Cole was fabulous.  He came to the waiting room to introduce himself to us even though he was very busy.  When we were taken back to the procedure room, his nurse thoroughly explained the examination and procedure that was about to take place.  Again, being a former laser technician, I was very familiar with the laser they used to perform the procedure.  I was impressed with their obvious knowledge of their laser of choice, the procedure, and the safety precautions they used.  I was given the option to either hold my baby down myself or have the nurse hold her.  Someone just needed to be sure she didn’t wiggle her head around too much while there was a laser running.  I feared that I would want to rip my baby out of someone else’s hands were I watching, so I decided just to do it myself.  Each tie took less than 60 seconds to release.  There were tears but I was assured that the nerve endings in that area were not fully developed yet and therefore there was little to no pain.  The tears were from have strange fingers shoved in her mouth to keep it open.  Lovey was hiding on the other side of the room with tears.  My first tough mom moment was holding my baby down, and singing to her through tears, while someone stuck a laser in her mouth.  Honestly, the procedure looked a lot worse than it felt. The tongue tie was released first.  As soon as it was done I saw her tongue curl upwards while crying like it is supposed to do.    

Miss Ryan with all her safety gear on before her frenectomy.

Miss Ryan with all her safety gear on before her frenectomy.

All The Difference

Immediately following the release of her ties I was shown to a room with a rocking chair where I could nurse my little patient.  That nursing session changed everything!  There was no tenderness to me when she latched, and her top lip flanged up just like it was supposed to do.  She was totally calm.  There was some slight swelling but nothing major.  We put a bit of aloe under her tongue and under her lip a few times.  I was given a little plastic tongue depressor to use when she latched during the retraining process.  It was used to pull her upper lip out into a proper flange if she didn’t automatically do it on her own.  To this day when she gets a lazy latch I pull her top lip out and tell her that Mommy and Daddy paid for that lip to flange and she had better do it!

 My milk fully came in that night.  I was amazed.  Within one proper nursing session my milk came.  I will never forget the sweet sound of her gulps and moans of satisfaction while nursing from me and not a tube.  I believe I nursed through tears that night.  My baby was satisfied.     

It is funny to think about now, because we prayed and prayed for her to poop those first few days.  Once she had enough of mommy’s milk in her belly she pooped ALL THE TIME!  For months we easily had 6-8 poopies a day.  The Lord doth provide! 

I remember her first big poop after her procedure.  Ryan was outside working out.  I took off Ry’s diaper, saw the success, and ran out to get him.  I made him come inside to see it.  It sounds silly now, but we were so happy!  This told us that our girl was getting enough milk all on her own.

What if the ties are left untreated?

I have since learned that I have a lip and tongue tie, as well as my mother and father.  My ties were not as severe as Ry’s.  My mother, God bless her, continued to nurse me for 6 months through bleeding, blistered, and bruised nipples.  She said it was always excruciating.  But she didn’t know what lip and tongue ties were at the time.  Thankfully, I was still able to get enough milk from her, but at the cost of her poor boobies!  Through additional research I have learned that LT and TT can result in a slight speech impediment, mainly the pronunciation of Rs.  I had an awful time saying my Rs when I was little, and I learned my father did as well.  It is also possible, that if left untreated, a LT can lead to a gap between the front two teeth as well as decay of the teeth and gums.  All this being said, many people have ties that are never diagnosed or released.  If it doesn’t cause a problem with nursing or if that child is bottle fed, many choose to leave them alone.  Often, later in life a tie will rip or tear on its own. 

Give the gift of a Lactation Consultant!

Lip and/or tongue ties are increasingly common.  It is important to be aware of the condition, especially if you plan to nurse.  Many professionals don’t recognize the importance of ties and their effect on the nursing relationship.  I’ve found that lactation consultants tend to do a better job of examining and diagnosing them.  It seems almost everyone I know lately that isn’t into a crunchy lifestyle is being told that their new babies aren’t getting enough milk and need to be supplemented with formula.  In most cases, this leads to full time formula within a few weeks.  Of course there are legitimate supply issues where formula or another alternative is needed.  That’s not what I am referring to here.  (Side note: if you are in need of supplementing and using your own milk is not an option, I highly recommend looking into alternative options.  Donor breast milk, goat’s milk, or homemade formula are all great options.)   In the future, every one of my babies will have an appointment with a lactation consultant within days of birth.  I highly recommend it to anyone and everyone.