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 *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome