I’m sharing this because there are lots of things and issues about nursing that aren’t well known. The major problems are, well, major. It’s also totally possible to have a minor issue that can be the start of a long slow slide into problem land, which is where we landed at 5 and a half months.
There was never really a question that we would breastfeed, or that we would breastfeed until our son was finished (assuming of course that there were no issues that 100% prevented us). Silas was born and everything seemed fine. However, given that he’s our first I had NO basis to know what a good latch felt like or what nursing would be like.
A little background is that we ended up with a vacuum extraction with epidural (because of a giant head and stalled labour during pushing!) and I was hospitalized for a blood transfusion after hemorrhaging. I’m mentioning this because the former can impact a baby’s latch (because of headache / tension in the head) and the later can impact the mother’s milk coming in due to stress.
After Silas arrived everything seemed to be trucking along. Sure, I had minor nipple soreness and vasospasm (which was awesome when you add a cold Canadian winter to the mix). It mildly annoying, but not so bad that I ever really thought about it as being bad. Silas also had some clicking and gas at let down, which got better as he got older so again I didn’t think too much of it.
Around his second-third month we had a brief phase of bright green poops. I did some research and it was likely one of two things – diary intolerance or a foremilk/hindmilk imbalance. We decided to try treating for a foremilk/hindmilk imbalance by block feeding first (as it was easier to test that solution than to cut out diary for 4+ weeks and hope for the best). A few days of block feeding seemed to do the trick and everything went back to normal.
After the next few months we had a slow increase in fussiness at the breast (pulling off and fussing), nipple pain, and vasospasm. We also had slow-ish weight gain. However, we also had the stomach flu in the middle which made it hard to differentiate if the slow weight gain was because of the flu or because of feeding issues.
At 4 months our doctor wanted to keep an eye on his weight. We went back at 5 months, and while he’d gained a pound, my mom-radar was sure that something was up. I had done some research into tongue ties (aka, something came through one of my multiple feeds and caught my eye) and thought that there might be a chance that Silas had one as his tongue ‘cupped’ when he cried. Also, papa had both his upper lip tie and tongue tie cut and they can run in the family. The doctor did a quick finger sweep and said that everything looked okay – however a finger sweep generally only catches anterior tongue ties and not posterior tongue ties (and especially not posterior submucosal tongue ties!).
Some background is that tongue ties generally cause a poor latch because the baby doesn’t have full use of their tongue. Breastfeeding is a supply-demand process. A poor or shallow latch can mean that the breast isn’t fully emptied in a nursing session, which the body interprets as the breast making ‘too much milk’ and so signals are sent which cause the body to down-regulate milk production. This can quickly create a negative feedback loop with the end result that your supply can drop. When I switched the block feeding I accelerated this process because we were feeding from one breast over several sessions (i.e. the other breast would get fuller but not be emptied so the body would signal it to produce less milk). Note that not all cases of tongue tie will result in a drop in supply, but it is totally possible! A risk is that if the infant gets frustrated at the breast (with low flow/low supply) and so nurses less, they too can contribute to the negative feedback loop and further decreasing supply.
I was worried that we’d get stuck in the negative feedback loop and that it would result in Silas getting so frustrated that he’d self wean in the next few months (worst case scenario). Given that I want to nurse until he’s finished, this was scary for me. Stress also doesn’t help with supply or flow. Oh life, how you challenge us – insert brain jumping to irrational worst case scenarios “yes body, please relax even though you’re freaked the fuck out about this issue that may result in your baby starving”. (Silas was never at risk of starving, so don’t freak out.)
At this point we’d seen a lovely IBCLC who had diagnosed a submucosal posterior tongue tie and given us some good advice on helping improve our latch and my intuition was telling me that our doctor was wrong. We managed to finagle a referral to the Newman Breastfeeding Clinic to have Silas checked out.
Dr. Newman did a cursory check on our first visit and recommended Domperidone (a medication whose off-label use can increase milk supply). I was nervous about this solution as increasing my supply would help with fussing at the breast as the flow and let down would be faster and stronger. This might not help in the long term, as if there is a physical problem with the latch the body will eventually revert back to the negative feedback cycle creating a loop of needing more Domperidone to further increase my supply, and so on. It was basically half a solution.
On my own, we went to see a craniosacral therapist to see if by releasing some tension in Silas’ head/neck his latch would begin to improve. We were very lucky and happened to be there on a day when their staff IBCLC was there. She did another exam and also agreed that we have a tongue tie. She recommended a specific doctor at the Newman Clinic, who we made an appointment to see. We also saw an osteopath, again to help with alignment and releasing tension. Together, the two treatments allowed the beginning of a better latch as seen by a decrease in vasospasm. However, it still wasn’t perfect as the latch was shallow (aka, slipping off the nipple).
We went back to the Newman Clinic last Thursday. The doctor we saw this time was very thorough in her examination and saw the tongue tie. After almost a month of dragging the two (and sometimes three) of us around the city for various appointments, this was such a relief! It wasn’t the most extreme tie, but I asked for them to cut it anyway. Breastfeeding is a relationship with two people, the mother and the infant, and both parties need to contribute to make it succeed.
I had a talk with Silas before they did the snip. I told him that being a parent is difficult. You make decisions on behalf of someone else and you hope to hell that you make the best decision. I apologized for making a decision that would end in him feeling pain and told him that I hoped that it would help things be better down the road.
Hearing Silas cry when the tie was cut was heartbreaking. Seeing his mouth be bloody right after was so sad (the bleeding did stop really quickly!). Seeing him be fussy because his mouth is sore is difficult.
There’s still the possibility that it will reattach (damn you oral tissue for healing so well!), but as of right now the initial snip was totally worth it.
The first time he latched after the clip and every time since, it has been totally pain free. Even though my nipples never cracked, bled, or were excruciating - every single time he latched there was a niggling little pain that was so constant I’d mostly tuned it out. In fact, now nursing is pleasant. With the addition of Domperidone and a faster flow of milk. Silas had also gained 10oz in 16 days, actually gaining on his growth curve. This is amazing because my gut was telling me that before he was getting enough milk (as seen by some weight gain), but not enough to be fully satiated and totally happy with his feeds.
We didn’t have extreme symptoms and it wasn’t an extreme posterior tongue tie, but having it clipped made a big difference to our nursing relationship. The caveat is that not all revisions will see improvements. I still think that it is worth trying, especially given the other potential benefits (fewer dental cavities, better speech, and even the potential to be able to stick your tongue out far enough to french kiss when he’s older!).
I’m glad that I stuck with my intuition and chased down the system until we got confirmation and a solution. I’m gutted that I risked our nursing relationship in the process and that I contributed to the problem by block feeding. I’m sad that I might be on Domperidone for the rest of our nursing relationship. And I’m sad that being on Domperidone means that I won’t be able to be a breast milk donor.
I’m glad that I get the chance to continue to take way too many photos of my little man nursing. I love you littlest man and am so glad that we’ve been able to build this bond. We’ve learned that sometimes you have to work for the important things and about the comfort that comes from being cuddled close.