My last 2 days have been on the other end of the tongue-tie spectrum 
from my prior (posterior tongue-tie) post.

My friend had a baby Sunday early morning in hospital--fabulous 
birth--no meds at all--fabulous CNM in attendence. Her sister was with 
her as labor support (former LLLL and bf peer counselor) and there was 
no separation. Baby attempted to bf, and was "at breast" a lot, but 
didn't stay latched at all. The sister got breast shells for the mom 
about 6 hours pp, as mom has very flat nipples. I saw the baby last 
evening--at about 16 hours pp. Mom had been given a pump and a nipple 
shield (with improper instruction on its use). The RN had also been 
trying to latch the baby by shoving his head on the breast--mom 
described her as very rough. We tried to latch the baby and I had an 
intuitive feeling that the flat nipples were a distractor from the real 
problem. When I looked in his mouth, the baby had an obvious tongue-tie 
(wonder how the nipple shield was supposed to help?).

I asked the nurse if we could get someone to look at him who could make 
a referral the the ENT for assessment and clipping on Monday (today). I 
also had to get larger flanges for the mom as the pump was causing her 
severe pain. It was very clear to me that this baby could not latch 
without clipping, so I told mom to keep baby close to breast, let him 
try if he wanted, let him lick, etc, but don't attempt to feed him 
until after she saw the ENT. We were hand-expressing and spoon-feeding 
colostrum when the NP came in to assess the baby based upon my request.

She had also seen the baby earlier in the day and not noticed the 
tongue-tie and was clealry annoyed that someone else was pointing it 
out. She down-played it, saying tongue-tie is rarely a problem, that 
referrals are rarely made anymore, since it doesn't affect speech, that 
baby had some extension (upon digital exam, I can assure you that if 
this baby had been able to latch, he would have torn the mother's 
nipples apart--there was no tongue extenstion whatsoever--all you could 
feel was his lower alveolar ridge) and mostly babies do just fine if 
you simply wait a few days (until they go to a bottle, no doubt!). She 
then turned to the mother and asked which hospital-based LC she would 
be seeing the next day--clearly indicating she did not approve of my 
involvement and expected a different opinion from the other LC. She 
then turned to the mother, who after the birth had signed a waiver 
refusing all newborn drug interventions and asked her if she had 
reconsidered. It was very clear to everyone that it was more important 
to her that this mother succumb to medical pressure to have these 
interventions than it was that the baby bf successfully. The mother 
said that she had been harrassed repeatedly during the day about this. 
After the NP left, we were able to speak to the midwife about the 
tongue-tie, who advocated for the family, at which point the NP told a 
whole new story about her support all along for making a referral to 
the ENT and how she could see that the tongue was a problem. At this 
point, both of the parents and the sister we very annoyed with the 
hospital staff for their rudeness, harrassment and outright lies.

This morning, the hospital LC saw the mom and agreed that the tongue 
needed assessment. I called the ENT myself and we were able to set up 
an appointment for the mom for tomorrow AM (he was in surgery all day 
today), so the mom was going to go home AMA today so she could make it 
for the appointment in the morning. Once the hospital staff became 
aware that the parents would go home early to get the procedure done, 
they managed to contact the doc themselves and get him in late tonight. 
After the ENT clipped the frenulum, the dad immediately noticed the 
difference upon finger-feeding the baby colostrum. I am confident this 
little guy will do fine once his mom's milk is abundant (so long as we 
can keep her areaola soft enough--I taught her RPS tonight should she 
need it overnight or in the AM).

What was so striking for me was the difference between the former 
client I posted about with tongue-tie whose baby was born at home and 
the situation with this mom. This mom is a friend and very willing to 
follow my guidance, yet she had to fight to do so every step of the 
way. The other mom is a client (albeit not a new relationship), yet 
without hospital interference, we werre able to act quickly and 
efficiently and without engaging in any adversarial relationships. The 
homebirth mom feels strong and supported and powerful. This mom feels 
harrassed, unsupported and invalidated. When I left tonight, she said 
to the dad, "we just need to get out of here so we can be the parents".

The good news is, the baby can now bf. The bad news is--the mother's 
beautiful, empowering birth was overshadowed by the kinds of 
territorialism, control and disrespect this family and I experienced in 
the hospital setting. I literally had a knot in my stomach all day 
long.  They will we home tomorrow--seeing the CST Thursday and 
everything is fine--but what about those families who don't have anyone 
to advocate for them?
Jennifer Tow, IBCLC, CT, USA
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