The lactation consultant stared down at my chest and declared, “Yep, she’s gonna have to grow into them.” ‘Them’ being my nipples. I cringed.
I’d never really contemplated the size of my nipples up until my breastfeeding woes began. They were bigger than most, perhaps the size of a nickel on a lily pad, but not so big they couldn't fit into my newborn's mouth. Yet, she wasn't gaining weight. Days before I had made the hard decision of having my daughter’s tongue-tie clipped. Most people think of tongue-tie as a moment when you have a hard time speaking due to love or embarrassment, but tongue-tie or ankyloglossia is a common condition that makes breastfeeding difficult and painful. Basically, there is a piece of skin or frenulum that connects your tongue to the bottom of your mouth. If the frenulum is too tight or short, it’s referred to as tongue-tie. The American Academy of Otolaryngology – Head and Neck Surgery states that tongue-tie is often missed and can lead to mothers abandoning breastfeeding completely. The reason is that babies with a tongue-tie cannot stretch their tongues out and over their gums to draw more of the areola into the mouth. This ensures the baby will suck more milk. Instead, they end up rooting on the nipple, causing pain for the mother and not receiving enough milk. Well, that certainly was the case for me. Here are few tips that can help you and your baby get through tongue-tie and quite possibly succeed.
1 | Check for tongue-tie in the hospital
It’s becoming more of a common practice to check for tongue-tie in the first few days of a baby’s life, but my daughter’s tongue-tie wasn’t discovered until I insisted they check before we left the hospital. I had a terrible time breastfeeding with my son and wanted to avoid repeating the same mistakes. Breastfeeding with my daughter seemed to be going fine. She was latching nicely, and there wasn’t any pain. Still, I was shell-shocked from my first experience and mistrusted everyone. I’m glad I did because I would have left believing we were breastfeeding without any problems. Checking for tongue-tie is a simple procedure but needs to be done properly. Request that your pediatrician or lactation consultant checks during the first routine examination.
2 | Clip Earlier Rather than Later
Now, this advice is controversial. For some, clipping a tongue-tie is unnecessary, like having your son circumcised. It makes sense – you don’t want your baby to experience pain unless it’s needed. Also, some small risks are associated with a frenotomy. Some of the risks include: pain, bleeding, and possibly infection. If you and your doctor decide clipping is best for you, then have it done as soon as possible. If left untreated the tongue-tie could cause extreme frustration for the baby and failure for the mom. Another important factor to consider is that the earlier the tongue-tie is discovered and clipped, the easier breastfeeding will be for you and your baby. Best-selling author and pediatrician Dr. Sears gives some great reasons for clipping it immediately. The doctor clipped my daughter's at two weeks, which may seem early, but we were already two weeks behind in breastfeeding and struggled to catch up. Remember, clipping the tongue-tie should be a decision you make with your doctor.
3 | Don’t attend the procedure
Most doctors will ask if you want to be in the room during the procedure. Don’t. Seeing your baby in pain and blood coming out of their mouth will be one of your first low points as a mother. It’s understandable to want to attend to comfort them (I naively thought, if my baby is in pain, I need to be too), but this won’t be the case. A nurse holds the baby while the doctor makes the small cut. Once the procedure is finished your baby is brought to you for breastfeeding. This is when you can really comfort your baby. Once Leah was back in my arms and firmly attached to my breast, I felt a shuddering sigh as she snuggled in. I then sighed with her. It was over; at least for now.
4 | Clipping the tongue-tie will not fix the problem immediately
According to the Journal of Human Lactation, “within 24 hours 80% were feeding better." Even though this is true, it might take some time for the baby to relearn how to suck or root. Babies’ practice the rooting motion in utero with a tongue-tie, so once the tongue-tie is eliminated, they have to relearn how to nurse without the restriction. The mother and baby now learn together. How long this takes is individual. Relearning how to suck might take a week or it might take a few months. It took my baby 10 weeks to relearn how to breastfeed. I scoured every website and forum I could find to determine an average time, but the answers varied from immediately all the way up to six months. It's really hard to pinpoint the exact timing because every baby and situation is different. In the interim, the mother might need to supplement with a bottle to ensure healthy weight gain and to pump to keep up her milk supply.
5 | Do the recommended tongue exercises as much as possible
To help ensure that the frenulum doesn’t reattach, they recommend daily tongue-tie exercises. Fortunately, informative videos can help you with this. My doctor also recommended that I rub the clipped area a few times a day with a clean finger. You have to press down and rub back and forth so that any reattachment doesn’t occur. Honestly, I was guilty of skipping this because, with everything else I had going on, I would forget. I think deep down I didn't want to cause her any more pain. When you rub the sensitive area, you have to do it hard, and I found it difficult to do this repeatedly. A lactation consultant showed me once, and she made my baby bleed accidentally. Afterward, she told me that I needed to do it hard; otherwise it was pointless.
6 | Join a breastfeeding support group
Most hospitals have a weekly group that you can join for free. If you live in a larger city, there will be a breastfeeding support group almost any day of the week. One place to start is your local La Leche League.For some, joining a group can seem daunting, while for others it's a natural fit. Wherever you fall on the spectrum, find one and go as early as possible and as often as possible until you’re breastfeeding full-time. At the meetings is a board-certified lactation consultant, who will be able to help you latch properly and answer all of your questions. At first, I hated the lactation consultant who told me my nipples were too big. The consultant is usually a fit woman in her 50s. Think Jillian Michaels on steroids, but she’s there to help you. Also usually another mother is crying or looking so miserable that you’re suddenly thankful that you only have your problems to deal with. During the breastfeeding support group, you’ll weigh the baby, then breastfeed the baby, then follow with another weigh-in to track how much they’ve transferred. The scale used for the weigh-ins goes to the grams and ounces, so it’s pretty accurate. Another benefit is that you connect with other moms and realize that you’re not alone. If an in-person group is not your thing, consider joining a Facebook support group for tongue-tie. I found that very helpful.
7 | Don’t put so much pressure on yourself to be perfect.
Lactation consultants and doctors are there to help, but they aren’t there with you in the middle of the night when you are trying to comfort a screaming baby who won’t latch and who is turning red from frustration and hunger. They aren’t with you when, after you get through the pain of a bad latch, you have to supplement with a bottle, then pump to keep up your supply, only to do it all over again once the cycle is completed. They aren't feeling the mixed emotions of wanting what is best for your baby yet wanting to sleep; wanting to enjoy being a mom yet wanting it all to be over with. The best advice I received and followed is: nurse when you can, supplement when needed, and pump when convenient. Research has shown that the ideal of breastfeeding and what actually occurs are quite different. Women are put under a lot of pressure to breastfeed exclusively; if they don’t, they are made to feel they have failed. They're told they haven’t just failed themselves but their babies as well, possibly making them less healthy and smart. Don't give into this overwhelming pressure. Decide what you can do, based on your situation, and know that it is good enough.
8 | Remember Everything is Temporary
In the first few weeks after a baby is born, time seems to stretch and speed up making your sense of reality alter. One week with a newborn seems like a blink yet a year. One week struggling with breastfeeding seems like you’ve aged 20 years and you’ll never sleep again. I found my first gray hair after struggling to breastfeed for a week. It’s important to remember that everything changes and that the struggle is temporary. Every day you and your baby are changing. Just when you think you can’t make it through one more day breastfeeding, you do and just as suddenly you’ll be successful. As soon as I gave myself permission to do only what I could and acknowledged that this moment would not last forever, my daughter grew into my nipple. I began to hear what sounded like slurps and gulps. My little angel became like a beer-bong guzzler. Intuitively, I knew she was getting more milk. It did take 10 weeks, but to get there, I allowed myself to understand that the struggle would end. Just breathe and remember the frequently quoted mantra, "This too shall pass."