Celine,
I see quite a few moms whose babies have tongue-ties and the mom has
been told off-handedly by a nurse or even another LC that it is
suspected, but there is no sense of urgency so it is ignored. Moms have
to be given the sense of how urgent it is to be treated, information
about treatment (I email Cathy Watson Genna/Betty Coryllos' article to
every client whose baby has a tongue-tie so that they can read it
themselves). I let parents know about the lack of education most peds
have on the subject and I facilitate an appointment with our ped who
clips ( I would say close to 100% of my clients will have the frenotomy
done). I never send babies to anyone else anymore, b/c many of the docs
who clip anterior ties don't even acknowledge posterior ties and there
may well be a pp tie that gets left and baby needs to be reclipped. I
just had one baby clipped for the third time (was the charm, though,
but poor little babe).
I will certainly give moms tips to stop-gap the pain, damage,
inefficiency at breast ( sometimes come off breast), but I also tell
them that resolution rarely happens w/o clipping. I do not think it is
acceptable for peds to be "not too willing to clip". Babies and moms
have a right to feed at breast and peds have an obligation to do
everything possible to make it happen. Since you know what the problem
is, there is no reason to look for anything else--the problem needs to
be solved and the frenulum needs to be clipped. I would, however get
this baby for CST, as her birth was absolutely brutal and I doubt it
can be true that she has adjusted to life outside the womb well at
all--her little body and psyche are holding too much trauma. Besides, I
believe babies with tt's needs structural work to release compensatory
behaviours. We will sometimes use finger-feeding, a pacifier or other
techniques to help babies learn to use their tongues, but I find the
CST does the trick for the most part.
Celine, looking at the bigger picture, I think this situation is such
a good example of how our language drives what we think of as normal
and how we define the infant's experience. What is an induction for
lack of progress? Gestation is its own progress! I saw a mom today
whose baby was born at 41+3--yes a midwife, of course and she kept
talking about how her baby was so late!!!! Look at how far we have
moved normal so quickly.
This is a baby who so badly needs regressive therapy--to self-attach.
I usually use the bath, but as more babies are born by cesarean, we
have to avoid the water for many. Baby wasn't having trouble tolerating
labor--baby was having trouble tolerating induction. And the epidural
and the morphine. Baby wasn't allowed to be STS or to nurse or to be
with her mother? There is no way that such an experience can cause any
outcome other than a desperate trauma that drives and thus integrates
compensatory behaviours. This baby's own inner guidance system was
completely annihilated and we wonder why she cannnot feed? Why she
might be upset, distressed, in a constant sympathetic state (thus not
interested in feeding), even angry? Life has not been good to this
little one so far.
Now baby is on a bottle and her entire experience of life is one in
which things have been done to her, completely negating her instincts,
her wiring, her right to be in control, to direct her own feeding and
thus the nature of her relationship with the world. How terribly
tragic. And we as a culture have named it all normal....
Jennifer Tow, IBCLC, CT. USA
Intuitive Parenting Network, LLC
"Subject: Clicking sound at the breast
First baby for this mom. Normal pregnancy without any complications.
Full term. Induction for lack of progress. Ended up with a c/s during
the middle of the night (something like 12 hours after induction
started) because baby was not tolerating labor. Epidural with Morphine
was used during labor.
Baby was born without any complications. Adjusted well to extra uterine
life. I am not sure if baby was allowed skin-to-skin and breastfeeding
in the first hour.
In the first 24 hours, baby never took breast. Too sleepy, not
interested. Tried several times without success. Baby was not put
skin-to-skin and baby was in the nursery because of protocol (all c/s
babies are in the nursery for first 24 hours unless dad or visitors are
with mom). Baby started turning jaundiced and was put under photo
therapy at a little over 24 hours old. Baby started to receive formula
via ff after attempts at the breast and breastfeeding was attempted
every 3 hours. No pacifiers or bottles were given to baby.
Baby started getting hungry and started to root for breast. From what
I was told, baby couldn't latch on to the breast and would push away
and scream at breast. They said she would pinch lips closed and refuse
to suck. A nipple
shield was tried without much success as baby would just suck on the
end of it. Suction was said to be more chewing than sucking.
When I saw this mom, she was over 48 hours pp. Baby was well awake and
rooting. She opened wide and did latch to the breast well but was
making these awful smacking loud noises sounding almost as if she was
smacking her
tongue from the roof of her mouth to the bottom of it. She was putting
no suction on the nipple and was on a few occasions hurting mom by
bitting down or clapping down on the nipple. Every once in a while, she
would get in a
few sucks but would go on to the same clicking noises. The sucks were
not very strong or adequate to remove milk. I did an oral exam and
found no abnormality except a short frenulum that seemed to be tied
rater in the back of the tongue. When attempting finger sucking, baby
could not extend tongue further than the lower lip. She would cup
finger with tongue but you had to try several time before she did it
right and even then, it wasn't a full cupping like other babies usually
do. Suction was good. Baby stayed calm while attempting to breastfeed
and did not push away from breast.
What I recommended this mom do is try baby at the bare breast for at
least a couple of minutes but not overly because nipples were starting
to get sore and baby was chewing them out. I said if baby wasn't
getting it after a few
minutes to finger feed baby while holding baby close to breast. Do lots
of skin-to-skin with baby and to pump after every attempt at the
breast. Tube at the breast didn't work either so that is why I
suggested ff. I also showed mom how to stimulate suck and how to try to
do suck training with baby to help with tongue extension and cupping. I
asked the nursery nurse to have peds look at the frenulum but I guess
she never did. I guess mom ended up giving up and offering bottle.
Did I miss anything? What else could I have done? Our peds aren't too
willing to clip frenulums....
Thanks for your imput!!!
Celine Cormier, RN, BN, IBCLC
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