Hi,

It happens that I experienced this first-hand recently. I gave birth  
to baby #3 and she had a type 4 posterior tongue-tie. Both my nipples  
had large scabs on them within 12 hours of her birth! Each feeding was  
an experience of toe-curling, excruciating pain for me, and this was  
after a beautiful, unmedicated home birth (1 hour from first  
contraction to delivery), with no mother-baby separation, no  
interventions or unnecessary procedures, plenty of time to self- 
attach, etc. etc.

Although she did lateralize somewhat, her tongue was very flat and  
didn't really come out over her gums. Dr. Betty Coryllos clipped it,  
as well as the labial frenulum, when baby was 3 days old. The baby was  
tightly swaddled and the assistant held her head while I held her body  
down and the dr lifted up the tongue with her "mickey mouse ears" as  
she calls them. ;) She examined the tongue, determined that there was  
a tongue-tie, and clipped it right then. She swabbed the frenulum with  
benzocaine before clipping. Baby did scream during the procedure and  
as her mother it was hard to watch (I cried a little, too), but I knew  
it was necessary to save our breastfeeding relationship. My husband  
left the room during the procedure as he tends to faint at the sight  
of blood.

The frenulum was very thick, definitely not the thin membrane you  
usually see. It almost looked like a braid to me--there seemed to be  
several "strands" of tissue crossing each other. I am not a  
professional (though I hope to become an IBCLC someday, which is why I  
lurk on this list), so I don't know if this is common or if I am  
describing it properly. Dr. Coryllos did comment to me on how thick it  
was, and there was quite a bit of blood, but the dr applied pressure  
for several minutes with a gauze pad while we sang to the baby and the  
bleeding stopped fairly quickly. We gave her tylenol every 4-6 hours  
for the next two days, as directed by the dr. She was pretty cranky  
the day after the clipping, but her tongue movement improved almost  
immediately. Huge, huge improvement in latch, although still not  
perfect due to other issues, but once my nipples healed, I could feed  
without feeling as though my nipples were caught in some kind of  
medieval torture device.

Baby was seen by her regular pediatrician 2 days after clipping. Ped  
was pretty surprised that I'd had it done since she hadn't noticed the  
tongue tie (and I didn't consult about it her first), but said that it  
was healing nicely. It was easy to see the clip because there was a  
grey diamond-shaped area under the baby's tongue. We saw Cathy Genna  
last week (about one month after the frenotomy) and she also said that  
it had healed very well.

I can't see why this would need general anesthesia. Doesn't anesthesia  
carry its own risks? When a baby has surgery and anesthesia, is the  
mother allowed to be present? As hard as it was to watch, I would much  
rather have my baby go through a procedure with me right there and  
able to nurse her immediately afterward. Even if you can nurse once  
the baby wakes up, it just seems longer and more complicated than it  
has to be.

Both Dr. Coryllos and Cathy Genna are amazing and I've never felt so  
lucky to live on Long Island! I hope the baby you referred is able to  
get treatment. I don't know what I would have done if I lived  
somewhere else and couldn't find a dr wiling to clip a type 4.

Jennifer Sokolow

On Jun 4, 2008, at 1:01 PM, Kerri Zandberg wrote:

> Hi,
>
> I have a question about clipping posterior tongue-tie - I am reading  
> chapter 9
> in "Supporting Sucking Skills in Breastfeeding Infants" by Catherine  
> Watson
> Genna - the description is great - but I'm always curious how is  
> this procedure
> done on a squirming infant?
>
> I have a local oral surgeon who clips straightforward stage 1 and 2  
> tongue-
> ties.....but he has never heard of staging....or posterior tongue- 
> tie......I just
> referred a baby for a stage 3/4.....and he feels it does not need
> clipping.......baby can't latch....doesn't have bad range of  
> motionside to
> side.....but has bunching when extends the tongue.....and can't  
> maintain
> extention  beyond the lower gum ridge.....I just spoke to another  
> oral surgeon
> and he doesn't even clip without general anasthesia!    I'm going to  
> speak with
> the one who clips and see if he is open to dialogue.....
>
> Kerri Zandberg, RN, BScN., IBCLC
>
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