Dear Friends:

Esther asked about posterior tongue tie. After attending another fabulous
workshop led by Deborah Beckman OT/SLP, who developed the Beckman Oral Motor
Assessment and who is a passionate advocate for breastfeeding, she describes
posterior tongue bunching that is relieved by OT. So perhaps there aren't so
many posterior tongue ties as we thought, and we are suspecting tongue tie
and interpreting what we find incorrectly? What I got from her explains some
of why babies could need a frenulum clipped 3 or 4 times; it's because the
fundamental assessment is incomplete.

Someone asked me about the value of CST and frenotomy recently. My belief is
that the only folks in the US that have a comprehensive and thorough
education in the anatomy and physiology of infant suck are OTs. I know my
education as a lactation consultant has been in bits and pieces, with a book
here and a workshop there and my interest as the foundation for keeping my
heart open to new learning. Whereas the infant feeding specialists get a
wonderful framework from the get-go. I know that I didn't feel like a
lactation professional until after attending a Wolff and Glass 2-day
training and suddenly got the whole picture, and was led to come home and
shadow a infant feeding specialist for a while. That has gotten me to be
able to listen to a baby's throat during a swallow, and assess the vital
signs and know if it sounds right or not..........still a long way from
being able to diagnose and treat.

So my education in lactation has been hit or miss about the mechanics of
infant feeding. While CST training stresses the value of anatomy and
energetics (all very important) there isn't training on physiology and how
all the different systems work together. I didn't get enough basic education
in my 6 years of nursing education either that would enable me to diagnose
and treat babies with feeding problems either.

There are unique individuals whose dedication and interest and determination
has led them to a high level of professional practice, Cathy Watson Genna
being such a person. However, finding a local practitioner, whether it be a
LC or a DO or anyone else is again a hit or miss proposition. Whereas
starting with a specialist (OT/SLP)  in infant feeding who has a framework
of anatomy and physiology and how feeding mechanics are coordinated would be
my first choice of where to start with a baby having feeding problems.

As a LC, I can assist the mother to protect her milk supply and make sure
her baby gets nothing but her milk and help her with breastfeeding; as a CST
I can help a dyad resolve energetic issues (which often relieve mechanical
ones), increase comfort and commitment; as a nurse I can touch and do some
physical assessment............but to me the ones that can or could do all
of that are the Infant Feeding Specialists.

Induction always means a premature baby; if injury is added to that,
mothering is in trouble, as well as breastfeeding. In 2005, the March of
Dimes said that 25% of prematurity in the US is the result of medical
intervention. The mothers that deliver without pitocin are few and far
between. Pitocin is a synthetic HORMONE......and hormones affect every cell
in the body. There is a wonderful new paper published on-line in
Breastfeeding Medicine that showed mothers who had epidurals and pitocin had
lower levels of endogenous oxytocin on Day 2........and higher and faster
prolactin response. Does this mean mothers are set up for engorgement as a
result of induction? I believe so, particularly when mother and baby are
injured and then separated after delivery.

Mammals who are given epidurals and/or separated from their infants at birth
don't accept their babies, won't mother them. Humans are
mammals...............

Witness the success of skin to skin care, and biological nurturing. Doesn't
that come from honoring the mammal in us all??

What do you think?

warmly,
Nikki Lee RN, BSN, MS, IBCLC, CCE, CIMI
craniosacral therapy practitioner
www.breastfeedingalwaysbest.com
www.myspace.com/adonicalee

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