Mary,
I work with a lot of TTd babies, too and I send every baby for bodywork before revision as well as post-revision. I think it's important to be honest with mothers and I tell them that the purpose of revision is to normalize function. There are three aspects to normalizing function. The first is bodywork, the second revision and aftercare and the third lactation support.  Without any one of the these components there is no reason to expect recovery. Releasing the tongue does not realease the fascial restrictions nor does it release birth trauma. This is why so many people think TT revisions fail. You would never undertake a surgical procedure that depends upon physical therapy if the patient refused to do the therapy. The same is true here. When you add the vacuum extraction (which is more likely to be a source of significant trauma than simply disorganizaton), this baby has little chance to regulate the nervous system, which in part depends upon release of fascial tension. My guess is this "alert baby who does not sleep" is stuck in a sympathetic state and will not be able to manage any organization until he can regulate transitioning between sympathetic and parasympathetic states. 


Jennifer Tow, IBCLC, USA & France
Intuitive Parenting Network, LLC



Date:    Tue, 6 May 2014 17:49:18 -0400
From:    "Mary Jozwiak BS, IBCLC, RLC" <[log in to unmask]>
Subject: Re: Resistant TT and Labial Frenulum case

No, no CST as of yet. It has been suggested. Mom is seriously overwhelmed with a 
very alert baby who doesn't sleep much, and intermittent severe nipple pain plus 
two surgical revisions.

A referral to several of the CSTs we work with will be offered tomorrow. 
(Included in original case presentation.)  I don't blame new parents, who don't 
have the same culture of those of us who are LCs to be given many suggestions 
for things to be done to/for their baby that many have never heard of before. 
There was some resistance to the DDS referral for the revisions (he had two on 
two separate occasions, the tight labial frenulum first and then a week later 
the posterior tongue tie) I have found over more than 20 years of practice that 
resistance met with too much force results in shut down of many clients. I want 
to keep the lines of communication open with this mom. 

I'm trying to respect this mom as much as possible. My intervention today most 
likely prevented baby from being put on a bottle for a week to "let the nipples 
heal." Mom is exhausted, near burn out and very frustrated. I have to tread 
lightly at this stage. 

Gently offering a CST referral will be done. Obviously, this baby is mildly 
disorganized due to the birth, the suction device used on his head, the deep 
suctioning of his airway etc during a difficult birth. I hope Mom will take the 
offer of a CST referral.

Thank you for weighing in. I appreciate it. 

Warmly,

Mary Jozwiak, IBCLC, RLC
Board Certified Lactation Consultant, Post Partum Doula 
Birthwaysinc. 
Chicago IL 









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