Saturday, September 15, 2012

Breastfeeding a Baby with Lip and Posterior Tongue Ties

Today I have a guest post from a mom, Diane Coombs of New Foundland, Canada, who shares her story on breastfeeding a baby with lip and tongue tie.

My baby girl is nine months old today! Our breastfeeding relationship got off to a rough start because of an undiagnosed posterior tongue tie and lip tie. The pediatrician in the hospital did not diagnose her, neither did our LC nor family doctor. I was told over and over it was 'poor latch' or thrush or 'lazy feeder.' All were incorrect.

Scarlett was gagging, coughing, extremely gassy, and she 'clicked' with each suck, my poor nipples were being crushed and so badly abraded my daughter would spit up blood after feeding. Nursing was making her so tired, she was sleeping through feeds to conserve calories, and was losing weight in a vicious cycle.

I researched what could be causing our issues, trusting my gut that there was something more wrong besides the diagnosis given. I went to a LLL meeting and met a mom whose story matched mine. She was unable to get her son treated locally so she went to see Dr. Kotlow, a pediatric dentist in Albany, NY - the leading expert in the field of tongue and lip tie. Immediately I got in touch with Dr. Kotlow. He diagnosed the problem via pictures I sent him, and I quickly booked our flight: 1500 miles from Eastern Canada to Albany. She was treated (laser revision) and immediately, she latched PERFECTLY!

I am not saying each baby with latch issues is tongue or lip tied, (and not every baby with a lip and/or tongue tie has trouble breastfeeding) but if you are having problems, and seem to have no answers - research it and see if tongue tie (especially POSTERIOR tongue tie) and/or lip tie is the issue. Here are some places to start:

The Hidden Causes of Feeding Problems?

Posterior Tongue Tie Information

Self Help for tongue tie and latch (photos and descriptions which may help you find tongue tie yourself, plus tips on improving latch)

Breastfeeding with an upper labial tie (lip tie)

Trouble Breastfeeding? Look in your baby's mouth. (Overcoming lip and tongue tie with an older baby)

To share with a reluctant provider: The American Academy of Pediatrics' newsletter on tongue tie and breastfeeding

The Myths About Painful Breastfeeding

Tongue Tie Photo Gallery

I hope you don't have to jump through as many hoops as we did, and I hope you have someone closer to you who is an expert in the field. See the list of frenotomy surgeons here to find one near you:

Cheers, and happy breastfeeding!

She's about 7.5 months here.

WARNING ON NEXT PIC: Post revision scar of the lip tie - might make some squeamish! Before's on the left, after's on the right. The whole look of her face changed! The before pics were takes two weeks before the after.

Her posterior tongue tie - very hard to diagnose unless you know what to look for.

Here is a video on finding a posterior tongue tie:

This is an excellent video on post-frenectomy exercises: Frenectomy Exercises with Melissa Cole of Luna Lactation

If you need help with breastfeeding, or suspect your baby has a tongue or lip tie, a Breastfeeding Counselor La Leche League LeaderNursing Mother’s Counsel or International Board Certified Lactation Consultant may be able to help.

Have you breastfed a baby with tongue and/or lip tie? Did you find the help you needed in your area?

Thursday, September 6, 2012

Good for the Whole Family

I’ve often heard moms say that they don’t have time to breastfeed because they have older children to take care of. They don’t have time to “sit around nursing all day”. So what if you do stop breastfeeding so that you can have more time to spend with your older children? What does that teach the older children? That baby’s needs don’t matter? That if something is inconvenient then you just switch to something easier, even if the inconvenient thing was better? The truth is kids are really inconvenient (not to mention loud, messy, and demanding). Why is breastfeeding so often at the top of the list of things to be tossed? I love how this mom points out, “Some portion of ‘The Family Schedule’ belongs to you (the nursing baby).”

I was there once. I was surprised when I heard myself think it. I considered not breastfeeding because it would take too much of my time and energy to do it. How could I, of all people, consider that as an option? My situation was a little different than most because my baby was a bit of a surprise and came to us through adoption, so I had no milk. I was needing to induce lactation.

Baby came home to us in July 2009 at 18 days old. My older kids, two boys, "Scootch", 7, and "Curly", 9, were on summer break from school. However, we had decided that when school began again in August they would not be going back. From now on we would be homeschooling. Several people asked me when we got the baby, “You’re not still going to try to homeschool are you?” The truth is the thought never crossed my mind not to. We had taken a long time to make this decision to homeschool. We had decided that this was what was best for our two boys. Now that we had a new baby girl the needs of my boys did not suddenly change. It was still best for them to stay home. The reverse was true as well. This baby needed to be breastfed, regardless of the schedules and needs of other family members.

Baby sister meets big brother 
When my boys were babies I took all of the time I needed to make breastfeeding work. Why should it be any different for this baby?

I had about 6 weeks of summer left and I started the process of relactating. It was so frustrating to have this baby and no milk! It took a lot of time. A few weeks into the school year and I was beginning to doubt that I could do it all. To make things even harder she was premature weighing 3 lbs 2.8 ounces at birth, and only 4 lbs 0 ounces when she came home. She had a weak suck and she could not draw milk through an at breast supplementer meaning I needed to spend even more time pumping and bottle feeding while practicing at the breast.

I confided in my good friend, “I don’t know if I can do it. I don’t have the time. How can I do a good job homeschooling the boys when I’m spending so much time with her trying to bring in a milk supply? All the time at the breast, pumping, mixing formula and preparing the bags for the Lact-Aid. Maybe I should just give up on the whole breastfeeding thing.”

My friend could see the bigger picture when I could not. “It is important to the boys too. Their sister is important to them. Let some of the school work and other things go.” That was over 3 years ago and I still remember her words. She is important to them.

Scootch and Baby sister

She was right. This tiny baby girl meant everything to the boys. They loved their little sister. This was just as good for them as it was for her. I couldn’t see it then, but three years later I can see it.

Curly and Baby sister
What did they learn by watching me work so hard to breastfeed her? First, they learned an awful lot about inducing lactation! They would watch me pump. When I first started to get drops of milk Scootch (7) walked up and saw the little bit of milk in the bottle. He started jumping up and down and called for his brother to come see, “She’s getting milk, she’s getting milk!” I had no idea they’d be so excited.

They watched me spend countless hours nursing their little sister. They watched as the bottles were replaced by the Lact-Aid, and then the formula supplements gradually went away altogether.

They learned that their little sister was important. That babies are important and that they deserve to have their needs met. They learned that nursing was important, even if you don’t make enough milk. They learned that everyone in the family is important, and that we do what we need to do to take care of each other. They’ve learned that family is more than just DNA.

We did school work while I wore baby sister in the Moby wrap. When she got bigger, they wanted to wear her in the back pack. They were learning how to love and care for a baby.

They wanted her to have the best, just like I did.

The fact that she was important to them was reason enough to spend the time and work hard for breastfeeding to work, even if it meant I had less time to spend doing certain things with them.

Letting her play with their Legos is proof of how much they love her!

One homeschool project was building a sled for little sister.

Now that she is three, she knows how to pester her big brothers, and she does! She can be the annoying little sister, but these boys love this little girl. They would do anything for her. Taking the time to bring in a milk supply and breastfeed her did not take away from them, instead it gave them, and all of us so much!

Then there is always this argument:

Tuesday, September 4, 2012

Increasing milk production and weaning from supplements

Before working to increase milk supply, make sure there is a true supply issue first! Take a look at these articles to first see if you have low milk production:

The golden rule of milk production: The more frequently and completely the breasts are drained, the more milk will be produced: How Mother’s Milk  is Made

Increasing milk production:

  • offer both breasts two times at every feeding
  • use breast compressions
  • nurse frequently (at least 12-14 times in 24 hours)
  • increase skin to skin contact
  • rest, and stay hydrated

What this process looks like:

Offer baby the first breast and allow him to nurse as long as he likes. When he starts to slow down on his sucking/swallowing start doing some breast compressionsWhen you squeeze your breast you should see baby respond with an increased sucking/swallowing. Baby has “finished” the first breast when breast compressions no longer get baby nursing more, baby falls asleep or lets go of the breast. When baby has finished the first breast offer the second breast. Repeat the above steps with breast two, (offer breast, use breast compressions and allow baby to finish the breast) then repeat the whole process again with both breasts. If baby is still hungry after taking both breasts two times, then you can continue the process, nursing on one side and then the other, until he is full and/or falls asleep.

Mom resting with baby after nursing with a starter SNS
When working to increase milk production, increase milk intake, or work to eliminate supplements, spending as much time as possible resting with baby skin-to-skin on your bare chest, encouraging frequent nursing, can make a big difference in a short amount of time. This can also be a chance for mom to rest, with baby napping on her bare chest. It can be a great time to have a movie marathon. If you have older children they can be movies to entertain them while you and baby rest and nurse.

Supplement in a way that supports breastfeeding:

Consider using an at breast supplementer instead of bottles for the supplemental milk. This will provide extra stimulation to your breasts and prevent a preference for bottles.

Lact-Aid at breast supplementer

If you are using bottles make sure you are giving them in a way that supports breastfeeding and minimizes flow preference. Bottle feeding in a way that supports breastfeeding includes:
  • Using a slow-flow soft bottle nipple that has a wide base and a shorter, round nipple (not the flatter, orthodontic kind).
  • Starting by resting the tip of the nipple on the baby's upper lip and allowing him to take it into his mouth himself, as if he were nursing.
  • Keeping the bottle only slightly tilted, with the baby in a more upright position, so he has to work to get the milk out. If you hold the bottle straight down, the milk will come out too fast, and he may feel overwhelmed by the flow (Kassing, 2002).
More information on bottle feeding in a way that supports breastfeeding: 

If you are currently supplementing with a bottle at every feeding, baby may expect that the time at the breast is always followed by a bottle. If you are using an at breast supplementer at every feeding, baby may expect the constant flow of milk from the tubing whenever he is at the breast. The first step towards eliminating supplements is to get baby comfortable with nursing without supplements at every feeding. Begin by encouraging comfort nursing between feedings, for at least a few days, before you begin to eliminate supplements. If baby is using a pacifier between feedings begin to replace the pacifier with your breast as much as possible.

The Finish at the Breast Method can be a great way to supplement with the bottle and encourage more breastfeeding. You may have heard to breastfeed first, then finish with the bottle if baby didn't get enough. Sometimes it works better to turn things around as described here. The "Finish at the Breast" Method of Bottle Supplementation

Nursing without supplementing

Weaning from supplements:

If baby is gaining weight on target and is showing signs of getting enough milk then you can safely begin to wean off of supplemental milk.

One way to do this is to start by eliminating the first supplemental feeding of the day. First determine what time in the morning you give the first supplement. Try eliminating that first supplement of the day. You may be able to eliminate it completely, or you may need to start by delaying it by about an hour or two.

Follow the steps above to nurse multiple times on each breast and use breast compressions. If baby is still having enough wet diapers (5 per day, plus at least 3 poops if baby is under 4-6 weeks old) then after a few days you can eliminate the next supplement of the day. Eventually you will get to where you are only giving one supplement in the evening and that will be the last one to drop.

Common Questions and Concerns:

I’m afraid to cut back on supplements, I ‘m worried my baby will starve!
Taking away one supplemental feeding will not cause your baby to starve or get dehydrated. You need for baby to be hungry enough to want to nurse more as that will increase your milk production. You can always go back to more supplemental milk if you realize you cut back too much too soon.

I tried eliminating the first time I usually supplement, but baby was screaming and refusing to nurse any more before it was time for the next supplement.
Go ahead and give the next supplement. You can simply delay the time of the first supplement instead of just eliminating it. If you were to delay that first supplement by one hour every day, by 24 days you would no longer be supplementing.

My baby seems hungry 10 minutes after taking both breasts. Does that mean it is time to give a supplement?
No. If baby is hungry again soon after nursing on both sides, offer both sides again. And again. Your breasts are never “empty”. As you continue to nurse, your body continues to produce milk.

How can I nurse so frequently? My breasts don’t have time to “fill up”.
Your breasts are never empty and don’t need time to “ill up”. The emptier the breast is, the faster it tries to refill - similar to an automatic icemaker. Emptier breasts make milk faster than fuller ones (How Mother’s Milk is Made).”

If I eat better and drink more water, will I make more milk?
“Research shows that the mother's diet, her fluid intake, and other factors have little influence on milk production. If the "milk removal" piece of the puzzle is in place, mothers make plenty of good milk regardless of dietary practices. If the "milk removal" part isn't there, nothing else can make up the difference (Smith, 2001).”
The more milk is removed the more milk you will produce. Pumping will remove more milk and help to increase your milk production. However, if you are nursing at least 12-14 times in 24 hours it will be hard to fit in pumping. Some thnigs to ask yourself include: Is it worth the additional stress? Would it be better to spend that time resting with your baby skin-to-skin? If you do pump, you can use it to replace any other milk you have been using to supplement.

Book: The Breastfeeding Mother's Guide to Making More Milk By West and Marasco

Bottles and At Breast Supplementers