Posterior Tongue Tie

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It's 7.15, Sunday, Mothers Day and I am finally breastfeeding. No expressing, no bottles, no formula, no steriliser. Just me, her and the open road. A slight ache in my left breast reminds me that this achievement is the culmination of many small battles, won quietly, furiously in the past three and a half months since my baby, Lily was born. Who would have thought it would take so long to get here? Not me. But then I really hadn't a clue about breastfeeding before she was born.

But I'm used to long journeys. It took me many years to conceive and carry a baby to term. Like many others I thought of the birth as the destination point after a long hard struggle. Somewhere to unpack my heavy bags, settle and relax at last:" ah, my baby is here!" No longer any need to worry. Having read about the many wondrous benefits of breastmilk, I was fully committed to breastfeeding once she arrived. I had thought not once about the possibility of running into trouble.


At first, things seemed to go well, "Whatever you're doing, keep doing it" said the midwife. After days of palm sweating pain every time my baby girl latched, I felt encouraged. Oh god but it was agony! And my boobs! They were hard as rock! Hot cloths before feeding, cold cloths after…I spent hours in the shower massaging, squeezing, coaxing them and walked around the house holding them, one in each hand. Each feeding time, as her little mouth opened wide I'd bite on my finger to stop myself shouting with pain. So, yes, it was going well! Ha ha…


By the second week I knew something was really wrong. Feeding sessions were starting to take an hour each time, every other hour. My placid baby was turning fussy. I was exhausted and called a lactation consultant. She suggested expressing and topping up with formula. I had said I thought I had a latch problem, but by the time she came my baby was inconsolable, and was now screaming every time I put her near the breast. We worked on the latch but really it was pointless...she was refusing the breast and would have to be bottlefed. Day eight, defeated, confused, afraid, I bought a portable electric pump.

 Worse still, there was a bright red patch growing on my breast. By the following day my left breast was bright red, like a little teepee. I was shivering with fever and bent over double with pain. But worst of all, my milk just wasn’t flowing: I was spending forty minutes expressing, forty minutes sterilising, washing bottles, making up the formula top up, before starting again. It was exhausting, I felt dreadful and my baby was very unhappy. The midwife came back and found shed lost another 5%. She looked old, like a little wizened old man with wrinkly brow. I watched as my husband bottle-fed her across the room whilst I expressed. I couldn't stop crying. Even with all the pain, breastfeeding was better than this. I wanted it back, that closeness. It hurt like a breakup.

I realise now that this wrench of losing the breastfeeding relationship so early on is what motivated during the long months that followed. As family and friends looked on dumbfounded, I sat up night after night expressing to build my lactation in the hope that one day I would get that closeness back. Eventually, after countless hours I forgot what it was I was looking for and just focused instead on the benefits to her of getting breastmilk. But all along I knew that breastfeeding is much more than nutrition. It's nutrition, bonding and learning all in one. Babies need to suckle as well as eat. They need to be held. I consoled myself that I was giving her the best food, but in terms of comfort, she had to make do with a dummy. I'd often be expressing when she wanted to be held. I developed expressing 'nests' around the house and she and I would settle in for a good two hour session of bottle feeding, followed by expressing whilst she snoozed in the crook of my legs or on my lap.


I still tried latching her on but anyone who has ever had a baby will know that struggling with a young infant who's refusing the breast is deeply upsetting. Repeating this struggle eight times a day was making me depressed. At first I thought she had simply got a serious case of nipple confusion, brought about by the mastitis shutting down my milk production but a chance encounter with a second lactation consultant meant I was lucky enough to chance on a second opinion.


Sue Ayres is a rep for Medela and a lactation consultant. Once I knew I would be pumping night and day I decided to rent a hospital grade pump. Day fourteen, Sue came over and set up the pump, sitting with me whilst I used it the first time and massaging my breast where the mastitis was still obstinately lumpy. This was the first time anyone had ever touched my breast since having my baby. Suddenly I understood what everyone meant by breast massage...! It was a purposeful, focused and firm approach. She took my full history from giving birth onwards and looked in my baby's mouth.

Her diagnosis was posterior tongue tie. She suggested cutting the tie, saying this would give me and my baby the opportunity to get our breastfeeding relationship back. It was all very sudden and confusing. I didn't understand why the midwives hadn't recognised it. The thought of a simple solution to the exhausting struggle of expressing, and feeding was overwhelming. I got on the Internet and found MilkMatters.org. The testimonials by other mothers were unbelievably similar to my own experience. The list of symptoms was a page long and I could tick almost every one:clicky noises whilst feeding, nipple trauma, mastitis early on in mother, weight loss in baby, mammoth feeds, frequent feeds, snoring, it went on and on! Next I researched tongue tie cutting. If down very early, before a month old, posterior tongue tie is relatively painless and easy.


I went for a second opinion at the tongue tie clinic run at Hove Poly Clinic. Sitting there, topless in that cold room I was advised that my nipples were too large and to work (again!) on my latch...to put the baby on the breast at every feeding, etc etc. I pointed out that I had paid two lactation consultants and had, by now clocked up 50 attempts at latching my baby on to no avail. A support group, nineteen miles away in Haywards Heath  was offered, so I could get help working on my latch. I felt exhausted. I’d waited ten precious days to hear nothing new. 
When i spoke to Heidi, my friend running a Breastfeeding Support group, she explained that posterior tongue tie is still not recognised by many as a genuine problem. The professionals are locked into two poles: those for and against. Whilst the professionals battle it out, mothers and babies are left with nothing more than instinct: does this feel right to me? It did. Sue had trained at two clinics where mothers are queuing out the door to have posterior ties cut: Southampton and Kings. I decided to trust her.


We had Lily’s tie cut on Christmas Eve, when Lily was one month. The cut was a shock and she went into a two hourly feeding pattern for a couple of weeks. Things got harder before they got better...I felt terribly guilty, not knowing if it would work. Family had been less than convinced, the NHS consultant hadn’t agreed with the diagnosis, we were on our own. If it didn’t work, I would have put my child through an unnecessary procedure. I tried her on the breast again and again, she cried and cried. I gave up. If she was going to do it, she’s know when. I decided to just wait and see.

 

By now my lactation was becoming established. I’d cut out the formula and now I was building a good supply. An avid contributor to the Exclusive Pumpers group on the Baby Centre website, I compensated for my total ignorance at the beginning with an overdose of information on lactation, milk volume, milk storage. My NCT friends joked that I'd spent so much time reading up on lactation, I could start giving talks. When you’re expressing and feeding all night long there's not much to do but surf the net. I felt like I was living in another time zone: Tehran seemed about right. I’d go to bed at 7pm, get up at 11 and stay awake till 6am, expressing, feeding, resting a bit then again. We were in the 4-6 week growth spurt and Lily needed feeding every two hours. Sleep became a mirage, something I craved like water but I carried on, reading everything I could find about why breastmilk is so much better than formula. I kept going.


Three weeks after the tongue tie was cut I had my six week check up. My doctor asked about the feeding and I admitted that she still hadn't latched. She would hold my nipple in her mouth but still she didn't suck. "You can take a horse to water but you cant make it drink" I said ruefully and we both chuckled. "No miracle cure then" she said. As if on cue, the next day Lily found her own way to the nipple, latched on and started to suck. It had been so long since I last experienced breastfeeding that at first the sensation was unfamiliar to me, not least because it no longer hurt! The joy, the triumph was immense. It had all been worth it! I texted sue, Heidi and all the other great women who had given me their steadfast support through the past weeks to share my delight.

 

That was seven weeks ago and it is only now, today, Mothers day that I can truthfully say that I’m exclusively breastfeeding. Why? Well I lost a lot of confidence in breastfeeding at the beginning. After weeks of pumping I was afraid to just go with the breast and baby: what about all my carefully notated calculations on how much she was drinking? I was stuck in what Stephanie Casemore calls The Comfort of Numbers. I was afraid to go back to ten feeds a day. I was afraid of mastitis creeping back again. I was just afraid. So I kept breastfeeds to one or two a day. I did notice that my breasts started to feel much better after she started breastfeeding. All the lumpy soreness started to go away and they felt wonderfully soft and empty but it didn't occur to me that she might actually be better at emptying the breast than my trusty pump.

It took a third bout of mastitis that turning into an abscess before I learnt how to exclusively breastfeed: that exclusive breastfeeding is more than just meals. It’s an opportunity for the mother to slow down, and focus on your baby. This time the mastitis was worse than ever..pus, blood, the works! I was wailing in pain and wished above all else that I could just stop, right then and never squeeze another drop of milk from my breast. I was terrified by the accounts I'd read online of gaping seeping wounds not healing for months.

 

This was the point that friends and family started talking about formula. I started to feel isolated: was there something wrong with me? Why cant I quit? But my husband, who'd watched every sacrifice, every panic, stayed up all night with me during bouts of mastitis, bottle fed lily whist I got some sleep just said, " I think you should carry on for as long as you can manage it".

 

At the clinic a nice lady doctor gave me local and then put a needle into it and drained the pus. And the staff at the clinic encouraged me to keep going. It was like I’d got as far as base camp and everyone wanted to see me get to the top. They cheered me on and cheered me up. Just when I was well within my rights to give up, they suggested I take away the pump. I thought about how much better my breasts felt when I breastfed. I thought again about The Comfort of Numbers, of Sue's kind encouragement...maybe if i just let go, trust? The clinic's advice to me was also rest. And then rest more. So finally, three months after the birth, I called my mum and got her to come and take care of me.


Breastfeeding really started for real when I stopped looking at the clock, counting the millilitres and just looked at her sweet face. So what if we sit here all day? What else am I going to do? I realised this is it: this is what I always wanted and now here's my chance to have it. 

What have I learnt? That breastfeeding is an enormous luxury and a privilege. If it comes naturally to you…you are very lucky, appreciate it! If not, you can perhaps still do it but it will take focus, energy and the support and encouragement of not just professionals, but also family, good friends and your partner to see you through. I obviously had a rough start, but at each turn I trusted my instincts and kept going, not out of stubbornness (although that helped too!) but out of love. Those first few days, even with the pain, were such a special bond.

Now its just me, Lily and the open road. We've got months, or maybe even years ahead of us. Its Mother's Day, she's fourteen weeks and I'm finally doing it...I'm breastfeeding. And it feels great.

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