What We Didn't Know About Tongue Ties

I did quite a bit of first-time-mom research in preparation for my daughter’s birth. I read a lot of articles and books, talked to a lot of people, and did my best to know everything I needed to know ahead of time. At the top of my baby-prep list was breastfeeding.

There was nothing I wanted more than to breastfeed my daughter. It was what I had been waiting for since before I had ever become pregnant! I wanted to be ready, and in all honesty, I was confident that I could figure it out. It was laughable to me that my OBGYN told me at seven weeks pregnant that I "probably" would be able to breastfeed, because there didn't seem to be anything inherently wrong with my breasts.

Oh, thank you,  Lady; I'm glad they're good enough to do what they were created to do in the first place.

After all, women had been breastfeeding their babies since the beginning of time. How could someone tell me that I couldn’t do it? I knew it could be very difficult. I told myself that I would push through anything that came up. I would face the hard. I would make it work, because it was too important not to.

Somehow, among all of my research, I never ran across the term “tongue tie." I had read about how to correctly latch a baby, and the different pitfalls which I might encounter, but that phrase simply never came up.

A fact that I find a little strange, as tongue ties are a fairly common problem, occurring in around 4.8 percent of babies born in the U.S. [2] This number is hard to nail down exactly, though, as many people go undiagnosed. It’s theorized that the number could actually be much higher than that.

In a normal tongue, the frenulum (the little band of tissue that connects the bottom of the tip of the tongue to the floor of the mouth) is long and thin enough that it allows movement for the tongue. A person with a tongue tie has an unusually short, thick frenulum, which restricts movement. Some people, with more severe tongue ties, can’t stick their tongues out of their mouths. Others may have trouble pronouncing certain sounds, or may have more dental problems, as the tongue can not sweep the inside of the mouth like it should.

In breastfeeding babies, tongue ties can cause problems with latching and efficiency. When a baby with a functioning tongue nurses, they use their little tongue to latch and suck. When a baby has a tongue tie, the frenulum restrains the tongue too much to effectively suck, and so the baby must resort to using her lips instead- something that is not only ineffective and exhausting for the baby, but also very painful for the mother.

Up until the 1940s, tongue ties were routinely cut after birth to help babies breastfeed easier. At the same time, breastfeeding rates went down, and because most babies were bottle fed, and mothers were not having the same problems they had with breastfeeding, the tongue tie was not considered to be a real medical problem anymore. Doctors began to consider clipping the tongue tie to be an unnecessary procedure, and even in the incidence that babies did have a tongue tie, they began to leave them unclipped. [1]

As it is now, babies born with tongue ties are often left untreated. The procedure (called a frenotomy) is usually a quick, simple procedure where they clip the frenulum. Some doctors refuse to do the surgery, because it is painful and considered by some to be unnecessary. On the flip side of the argument are those who say that, while the procedure is a little painful, the benefits of the baby being able to breastfeed and the avoidance of the long-term effects of a tongue tie outweigh the momentary pain.

Our Struggles with Breastfeeding 

Within the hour of her birth, my daughter latched and successfully.  I was ecstatic! We were doing it!

It wasn’t until my milk came in a couple of days later that I started noticing some problems. Something didn’t feel right. I didn’t know what right was, really, but I knew that, whatever it was...we didn't have it.

I would try to latch my daughter, and she would pop right off. It was like her little mouth just didn’t know how to stay on. And feeding by feeding, we both started to become more and more miserable. Feedings were not only long and frustrating, but they were becoming painful. And every time I nursed her, the pain got  more intense.

I had heard from many family members and friends that “breastfeeding just hurts,” and so I figured that something was wrong with me, and I just needed to push through it.

But it didn’t "just hurt." It wasn’t just sore or uncomfortable. It was excruciating.

It was me, sitting on our bed, sobbing while I was trying desperately to get my screaming newborn to latch on. It was me, trembling in pain when she finally did latch, and trying to convince myself to let her stay on, despite the pain, so that she would get something to eat. I remember telling my husband, “something is wrong. This can’t be how it’s supposed to be.”

Feedings lasted anywhere from one to two hours, and my daughter never seemed to be satisfied. She would only scream. I would beg with her to try.

"I know you're hungry," I would whisper to her, "I'm trying to feed you!"

I couldn't figure out what I was doing wrong. She would latch on, suck for a couple of seconds, and then scream again. I read and re-read articles on how to latch a newborn, trying to troubleshoot what I could not understand.

I was exhausted and frustrated. No one told me that breastfeeding was going to be like this. It was supposed to help the baby sleep. It never did. It was supposed to help us bond. I felt further and further from her. It was supposed to soothe the baby. It only made her cry.

My mind was, as it always is, the cruelest critic.

Failure!

This is what you were supposed to do, and you can’t even do that.

Your baby needs you, and you aren’t taking care of her.

You don’t know what you’re doing!

You’re a terrible mother.

How I wish I could go back in time and tell my inner committee to sit down and shut up!

When my daughter was a week old, our midwife came by the house for our one-week check-up. When she weighed the baby, we all realized that something was wrong. Breastfed babies are expected to lose up to 10 percent of their birth weight in the first week of life. My daughter had dropped past that, losing a pound- from 6 lbs 13 oz to 5 lbs 13 oz.

This was a problem. It wasn't the way it was supposed to be.

And as we discussed what was going on with our midwife, she made a connection. My husband has a tongue tie. We didn’t know much about it- only that he had one and that he had needed speech therapy as a child. What we didn’t know is that it is often genetic- and that it often causes problems breastfeeding. In fact, in a 2002 study, it was found that around 16 percent of babies experiencing difficulty with breastfeeding had a tongue tie. [1]

Our midwife was urgent to get me to pump and bottle feed our daughter, which the poor baby drank up as if she had never been fed. I suppose, to some extent, she hadn’t- not well, at least. Not to fullness. I remember how full her tummy was, and realizing that I had never seen it like that. I remember feeling how empty I felt after pumping, and realizing that I had never felt that before! She had been trying so hard to eat.

Another wave of guilt washed over me.

"I'm so sorry," I told her as I watched her guzzle down the milk from the bottle. "I'm so, so sorry."

Our midwife sent us to The Mama’hood in Denver to see Amanda Ogden, the lactation consultant who works there. I can not say enough good things about Amanda. I can’t say enough good things about The Mama’hood. What a blessing those people were in our lives and in the life of our daughter.

Amanda confirmed what our midwife suspected. Our daughter had the exact same tongue tie that my husband has- a very small, but tight, tongue tie that was keeping her from being able to latch and suck effectively.

Amanda told me some very crucial things when we met. First of all, she assured me that, despite common belief, breastfeeding is not supposed to hurt. If it’s hurting, something is wrong. If the pain is more than uncomfortable or sore, something is wrong. If the pain is a 10+, as I was experiencing, something is wrong.

Second, there were some signs that our daughter had a tongue tie all along, which we did not know to be on the lookout for at the time.

Some of the big ones were...
-her inability to stay latched on, making her re-latch over and over
-the clicking sound she made while latched
-the severe, stabbing pain while she was latched
-the blanching (white blotches where the nerves have been damaged) of my nipples after feedings
-the distorted shape of my nipples after feedings (lipstick shaped, rather than symmetrical)
-her failure to gain weight
-my loss of milk supply

She referred us to a dentist who was well versed in clipping tongue ties, and told me to rent a pump immediately ( I only had an older hand-me-down one that was not pumping enough), because my milk supply was plummeting very quickly.

We got our daughter in for her tongue tie procedure about a week after her diagnosis. I was expecting something like a miracle, I think. I was told that some babies, after the procedure, were able to immediately nurse with no pain. Others would need more time. On some level, I didn’t expect her to need more time. As it turned out, she did. I tried to suck up the disappointment and accept that nursing would be frustrating for a little longer.

Our struggle with breastfeeding certainly didn’t end there. To help with the pain and to help her latch more effectively, Amanda gave me a nipple shield to nurse with until my daughter’s tongue tie issue was resolved. When the pain had still not subsided by two weeks after the surgery, we brought her back in to get her tongue clipped again. Sometimes the frenulum can reattach after being clipped; hers had done just that. Slowly, after her tongue was clipped the second time, her latch became stronger, and I started trying to wean her off of the nipple shield.

It was then that we came across another problem- she refused to latch to me without the nipple shield. She didn’t recognize it as something she was supposed to latch to.

With the help of Amanda and the other lactation consultants at the Mama’hood, we began helping my daughter strengthen her tongue. And very slowly, over the course of about four months, we began weaning off the nipple shield.

And, gradually, it just started happening. She latched. It didn’t hurt. It just worked.
And we stopped needing the shield. We haven’t used it since.

Why it matters

Sometimes I wonder what would happened had we been given information other than what we were given. What if our midwife had told us that I needed to supplement with formula instead? Many doctors give that advice when babies are failing to gain weight. What if I was told to stop breastfeeding because my daughter had a poor latch, or because I was not making enough milk for her? Women are often told that these problems aren't fixable.

What if we hadn’t gotten the help that we had gotten?

I know life would have gone on, as it does for many mothers who have found themselves in those very situations.

But I can say almost certainly that we would not still be nursing today. I can say that I would not have been able to work through the months of tears and frustration to feel more confident and  more bonded to my daughter in the end. I am so glad that we had (and still have) the resources like my midwife, like Amanda, and like the dentist she referred us to. I am so thankful that we made it through that very rough start and came out stronger on the other side.

My hope for new mothers is that they know that a poor latch or early breastfeeding problems do not mean that they necessarily must quit nursing! My hope is that more mothers will seek out help from lactation consultants like Amanda, and will be able to breastfeed even through the obstacles that often come up. My hope is that they will find answers, as we did, and not feel stuck in a situation which they do not want to be in.

There are absolutely situations in which mothers simply must stop breastfeeding! And there are also situations in which it simply can never happen in the first place.

But for those mothers who feel forced into quitting by medical professionals or family members, or who simply lack the resources or information to know that they have other options, my heart hurts. I know how much breastfeeding can mean to mothers. I know how much it meant (and still means) to me and to my daughter. I know that, had I been told to stop breastfeeding, I would have been devastated. I know that there are many mothers who are told that they have no options, and are left carrying guilt that isn't theirs to carry.

For those mamas out there who understand that feeling, and who value breastfeeding the way that I do, I want to encourage you to push forward. Search out answers. And know that it is  possible to work through many of the breastfeeding challenges that many mothers are told aren't fixable. I hope that you will find answers and feel empowered by the choices you can make!

And for those mamas who have the kind of guilt that I carried around, whether from having difficulties with breastfeeding or from not being able to breastfeed, please forgive yourself (I'm speaking to myself here, too). Please don't carry around undue guilt. You don't deserve it.You are not a failure for not being able to breastfeed, in the same way that you are not a hero for being able to!

I so often thank God for giving me the ability to nurse my daughter, but I also pray that he will show me how to extend grace to myself if a time comes when I can not nurse anymore. I hope that, no matter what category you fall into, you will do the same!




[1] http://www.tonguetie.net/index.php?option=com_content&task=view&id=2
[2] http://www.sharecare.com/health/tooth-and-mouth-disorders/rate-of-incidence-for-ankyloglossia