Tongue Tied

Eleanor is 9 weeks old today and it feels like we are finally getting to a good nursing relationship.

My first Peace Corps assignment was to promote breastfeeding among women who had just delivered at the local maternity ward in our health clinic. The midwives and matrons laughed me out of the waiting room when I told them this so I turned to HIV prevention and sex ed at the high school instead. But I have a long history of believing that breastfeeding is best, and it's what I wanted for my baby when the time came.

Right after she was born our doula latched her on, and helped me out every day I was in the hospital. Another lactation consultant came to our house the day after we got home and had us get a pump from the hospital so that Josh could give Eleanor a bottle in the middle of the night and I could sleep a little longer.

The cracks started at some point; there were weeks of weeping and screaming at about half the feedings, exacerbated by lack of sleep. I went to two lactation groups a week once I got out of the house (week 3). I searched the internet endlessly for clues as to what might be causing the pain - thrush, tongue tie, lip tie, all of which were ruled out by our pediatrician. I reviewed videos and illustrations about latching. Nothing was helping. She would chomp vigorously on the nipple, click and lose suction, and the cracks remained.

Around week 5 or 6 the pain began to lessen from excruciating to very, very painful. I was getting more sleep, however, and it seemed like this might be manageable. Josh was upset at seeing me in pain and kept suggesting that I pump to put an end to the cycle, to let everything heal. I could only make it a couple days before I began to fear that giving her a bottle would just make things worse in the long run - she would forget how to latch, and I missed having her close. The logistics of pumping, feeding her, warming milk and washing up were too much for me. Breastfeeding was painful but at least it was simple.

I got another lactation consultant, an IBCLC with international certification, to take a look, and she broke it down for me. "It's some combination of flow and function," she said. Flow was the fact that my milk came out super fast, overwhelming her and causing her to chomp down in order not to choke. Function in that her tongue was a "little tight". I scheduled an appointment with an ENT who was known for doing tongue-tie cuts (most pediatricians don't believe that tongue-tie presents a problem); he clipped what he called a posterior tongue tie on June 20th. Things were a teeny bit better afterwards but I was still concerned that her lip, also tightly connected to her gum, was preventing her from getting a good latch. So we scheduled another appointment with Dr Kotlow in Albany, after much agonizing. Is this just elective surgery for no good purpose? Were we going to inflict serious pain on our tiny daughter with no result because the pediatricians were right? The day before we left I got mastitis, but it resolved in time for us to make the drive up to stay with the Ratners. It was a go. Nine days after her first surgery Dr Kotlow used a laser to fix her lip tie and to re-do her tongue tie, which had healed over because we hadn't done any stretches (following the ENT's directions).

Three days after the laser surgery as I fed her at a Wendy's on our way back to Philadelphia, I noticed that one side had healed up completely and we were having a pain-free nursing session. I felt like telling everyone I saw! But I refrained. The other side looked like it still had a ways to heal, but she was now sucking instead of chomping. The clicking hasn't gone away entirely but most of the time it's no longer the click-and-chomp. For the 10 days after the laser surgery we did stretching exercises 3 times a day and massaged the areas each time she nursed.

Bottom line - I won't ever really know if the surgery was the tipping point - it's possible that she is growing into her mouth and things would have gotten better without it. But it's hard to believe that, really. It finally feels like this is what she is supposed to be doing, rather than something that feels wrong. I had been living with the pain for so long that I was afraid I wouldn't ever know what breastfeeding was supposed to feel like. But this feels pretty good. Let's hope it continues that way!

Before surgery: