I hate when my Lactnet reading gets behind!  It takes me forever to
catch up, and I want to add to so many threads of discussion!

In my work I have seen far too many women with insufficient glandular
tissue. Perhaps in the past they would not have even tried to
breastfeed.  For some, in the past they would not have even had the
baby. Sometimes, rarely, I have seen some improvement.  My most recent
client is one of those moms.  I discussed her earlier when her babies
were first born.  She never gave up.  She continued to put babies to
breast with an SNS, sometimes without and just after a bottle, pumped,
took domperidone, used herbal galactagogues, everything you can think
of this, mom did.  Still for many weeks only an ounce of mlk between
both breasts and at the end of 24 hrs, only 10 ounces of milk
expressed to show for her work.  This with a hospital grade rented
pump when she would just get exhausted from the routine and switch to
pumping exclusively for a few days.  Now, at a little over three
months, she has milk. Still not enough for two, but much more than
before and nearly enough for one!  She is now producing about 16
ounces of milk!  Granted, not enough for twins, but for a mom with
breasts that were picture perfect for problems, this is amazing.
What's most interesting to her is the change in her breasts, one more
than the other, and that the storage capapcity seems to have altered.
She can now pump only 6 times a day and get the same amount of milk
she was getting when pumping closer to 12 times a day...and that
includes caring for twins.  Things we have changed also included
addressing her emotional state and encouraging her to walk daily and
take her Omegas (Thank you to Kathleen Kendall Tackett for sharing the
importance of such a simple change that makes such a huge difference!)
 So, now her babies are getting more of her milk, she can still not
always put them to breast due to the pain which I think is related to
the lack of elacsticity of her breasts.  There is almost zero
compressibility so they end up on the very tips of very small
nipples/areolas.  She may pump more often now that she feels she is
capable of production more than previously.  She is constantly trying
new things to get more breastmilk for her babies, while at the same
time trying to protect her own personal health and get enough rest,
eat, etc. which with two is not as easy when you have little help.

As for tongue ties, I do not believe the docs are
overdiagnosing...they mostly don't believe they are an issue unless
they are unable to bottle feed. Why are lactation consultants noticing
them?  Because we are being taught to learn more than turn the baby on
the side and wait for open wide.  Assymetrical latch is 'new' too.  I
still remember nose to breast and chin to chest and have plenty of old
handouts with pictures of latches with the nose smashed into the
breast....while we assured mothers babies could breathe that way.
Today we know it is more than position and wide open mouth, it is not
just the latch, it is the suckling!  A perfect looking mouth does not
mean no pain and lots of milk, so it is much more than a wide open
mouth.  I have so many moms swear they have a great latch because the
nurses all said so, but the stripe on her nipple that has now turned
into a gaping crack tell me that there is more to breastfeeding than
how it looks! Tongue tie is one piece of the picture.  Palate shapes
another.  Breast shape another, etc.  So, yes, we should look at the
entire picture, but just because other things are going on too, does
not mean that tongue tie is not the problem causing the cascade of
other issues.  Yes, some babies manage to do just fine with a tongue
tie and not all moms have nipple damage that makes them quit, but just
as many if not more do.

Perhaps we see more because more women are at least attempting to
breastfeed.  Perhaps some of those who have a baby with tongue tie and
sore nipples, quit before they call  us.  Regardless, I don't thing
tonge tie or reflux or anything else is over diagnosed. I think we are
learning more and becoming more aware of the reason for the problems
and trying to do something about it.  Years ago babies cried in pain
and no one called it reflux.  They still cried, they still hurt, it
just did not have a name.  Today, as more and more babies are put on
their backs to sleep right after eating, many are uncomfortable and
what they are experiencing is likely reflux.  Rather it needs
treatment or a change in position ca be debated, but their pain is
real.  Tongue ties have been around for years which is why we see it
in families, but breastfeeding was not a problem with them because
they were not breastfed.  We need to be aware that as more women
choose breastfeeding, we are likely to see concerns we did not see
much of in the past just because the numbers are growing.

As a profession I think we need to be very aware of the possible
causes of all the myriad of breastfeeding difficulties a mother may
encounter.  We need to do a better history, do a better assessment,
and pay attention. I don't think I see more tongue ties than in the
past because I am overusing new knowledge.  I see more subtle
differences, because I look for them.  I notice the shape of a palate
and how the shape of the nipple damage fits into that space. Knowing
lets me find a way to help mom compensate.  Sometimes breast shape
makes that easier than others.  Being aware, informing the mothers of
all the information I have is my responsibility. How she chooses to
handle it is hers.

Take care,
Pam MazzellaDiBosco, IBCLC, RLC

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