As an IBCLC (Registered Lactation Consultant) about 30% of the moms I see complain of painful latch or prolonged feeding. Another 30% is for newborn poor weight gain and low milk supply. The remaining moms call for various concerns from breast refusal, nursing twins, chronic mastitis or plugged ducts, to introducing a bottle, toddler weaning to more significant issues of nursing a child with Turner’s syndrome, laryngomalacia, or prematurity.
About two-thirds of breastfeeding problems can be explained by a tongue and/or upper lip tie collectively known as tethered oral tissue (TOT). Once this determination has occurred a common but complicated question mothers’ often have is:
Sometimes, as lactation consultants, we are asked to use a magic wand to make everything magically better or use a crystal ball to predict if a procedure is actually going to fix the problem. Unfortunately, we have neither abilities. So, I do the next best thing…answer a question with a question. “If he/she were my child, would I consider doing the procedure?” Fortunately, I can speak from experience as I had to go through these same questions and emotions with my third child.
By the third day of life, my child had lost too much weight, wasn’t peeing, and feeding 18-20 times/day, but there was absolutely no pain when I nursed. There was an obvious attachment of the tongue about 3mm from the tip, with minimal elevation, and snap-back. I knew exactly what this meant for my child as I’ve assisted many physicians in a tongue tie release which gave me some peace about the procedure and I knew how long it would take to heal and what I could expect which again empowered me that I was doing the right thing. I never once thought that I was being selfish to have the procedure done. It wasn’t about me, it was about my baby. All we can do as parents is try to make the best decision for our children with accurate and up-to-date information and seek a medical professional that knows what he/she is doing. Either way, you should not live by regrets. So how do I end up answering this question?
When it comes to a tongue and/or upper lip tie release, there are three criteria that I go by:
1) Are the feedings causing persistent/chronic nipple pain/breakdown?
2) Is the infant not gaining weight normally? Staying below the 5th percentile?
3) Are the feedings prolonged, over 45minutes? Or feeding more than 12 times/day?
If the answer to any of the above questions are “yes” then it would be prudent for you to seriously consider the procedure. Why? Because there is a very real possibility that this can affect your milk supply and when your child continues to grow and expect more milk, the “wait-and-see” approach may prove to be devastating for the relationship later.
What you need to realize is that the milk glands that are working so hard to make milk will shut down if not properly drained on a regular basis and once they turn off, there is no turning them back on. So you need to be proactive in protecting your milk supply. So try to take your emotion out of this and think about the pros/cons of the procedure itself and keep realistic expectations. My goal for you is for you to be able to provide your breast milk to your child for as long as you both mutually desire and I’ll be here to help you navigate your emotions, but try to put yourself in your baby’s shoes…they deserve to be able to nurse a normal amount of times per day (8-12), in a normal amount of time (10-30 minutes), gain weight normally (1oz/day up to 3 months), and not have to struggle and work twice as hard to obtain their food. We’ve already established that your technique is good, your milk production is normal (for now), and if you want to wait one more week to see if there is more improvement, go for it. Her weight gain and attitude toward the breast will be the determining factor. I will support you in whatever decision you choose is best for you and your family. You are doing awesome as a mom. Keep up the good work.
Personally, I asked myself the same 3 questions with my son and answered yes to two of them and my milk supply was being affected so to get the tongue tie release was a no-brainer. After the procedure, my milk came in 2 days later, I had to supplement with formula to make sure he wouldn’t lose too much weight and maintain hydration and then everything was fine. I nursed him the longest out of my three children and had the best milk supply.
A lot of what we do as lactation consultants is stand side-by-side with our breastfeeding mom/baby throughout the up and downs of establishing a nursing relationship for many weeks. They can palpate the amount of energy and passion we invest in them. It can be very time consuming but rewarding at the same time. Many medical professionals cannot give the time required by a lot of these moms to help them make a decision and they will pose this same question to an ENT or Dentist.
What is my advice to you? Protecting the milk supply is key, along with normal weight gain, and pain-free/efficient nursing. The question should not be whether doing the procedure is selfish but “what is your breastfeeding goal and can this procedure help you achieve this outcome?” Advise them to find a support group and talk to other moms (Facebook has a great one, “Tongue Tie Support Group” page). Finally, send them back our way, we would be glad to do our bit and help out with any residual fears or concerns.
Jennifer C. de Franco, RN, IBCLC (RLC)
Premier Lactation Services, LLC
Serving Northern Virginia.