All Tied Up

During the hours after Etta's birth, she nursed quietly and slept peacefully.  Our midwife left just a few hours after her birth, leaving us to catch up on rest and bond as a family of four, knowing she would be back the next day to check on us.  That evening, as Etta let out one of her first real cries, I caught a glimpse of her little pink heart-shaped tongue.  Etta is tongue tied.

The heart shape; it sometimes looks even more pronounced.

I wasn't at all surprised to see the tip of Etta's tongue being pulled down by her tight frenulum.  My paternal grandfather, his three daughters including my mother, and one of my younger brothers were all tongue tied, and all but my brother had their tongues clipped.  When our midwife returned the next day, she confirmed that Etta is definitely tongue tied, but thought that between the strength of her latch and her ability to to reach her tongue beyond her gum line, that we would be okay nursing in the short term at least.  The midwife decided to return again on the third day to weigh Etta again, just to be sure she didn't lose more than 10% of her body weight.  By then, Etta was within the 10% weight loss allowed and my milk was already coming in, so we felt good about waiting until our one week appointment with the pediatrician.


Signs of tongue tie include Etta's heart-shaped tongue; difficulty latching, staying latched or a painful latch; slow weight gain; and recurrent clogged ducts and/or mastitis (especially if combined with slow weight gain).  When a newborn is tongue tied, her shorter tongue makes establishing an effective latch difficult or impossible, which in turn makes emptying the breast a challenge (making the mother prone to clogged ducts and mastitis).  With that in mind, I started several practices to make sure Etta would get as much milk as possible and gain as much as she could in her first week.  


First, I made sure Etta nursed at least every two hours- and often, Etta ensured she nursed at even shorter intervals.  Because she was drinking less at each feeding than she would have been with a great latch, those feedings needed to happen more often.  During nursing sessions, I used breast compressions to help Etta empty the breast (Dr. Jack Newman has a great video on breast compression technique, which you can use with any nursling, available on YouTube here).  To help establish a sufficient supply, I let Tye nurse often in place of pumping after nursing, which prevents a low supply that can accompany a poor latch.  


Using these techniques, Etta regained a good amount of the weight she lost after the birth by her one week appointment and weighed in at 6 pounds 8 ounces, close to the 6 pounds 13 ounces she weighed at birth.  By her two week appointment this past Thursday, Etta was up to 7 pounds even.  Although she wasn't worried about it, the pediatrician referred us to an Ear, Nose, and Throat specialist to look at the tongue tie because I expressed my concern at Etta's constant nursing, inability to clear the breast, and air intake during nursing causing extreme gassiness.  


Then, Thursday afternoon, I suddenly came down with mastitis.  I woke from a nap with a throbbing lump in my breast and within hours had a fever, chills, body aches, and a red, hot, swollen breast.  Thankfully, my mom is in town this week and was able to help entertain Tye and take care of me while I rested and tried a variety of natural remedies to take care of the infection.  By Saturday morning, with my regimen of raw garlic, increased vitamin C, topical applications of lavender essential oil, extra sleep, alternating heat and massage, and frequent nursing, my fever had broken.  I'm still keeping up everything I was doing because I still have a red, warm lump on my breast signaling at least a clogged duct, but now that the fever has lowered, I feel significantly better.  


At least, physically, I feel better.  Emotionally, I'm nervous about our appointment on Wednesday with the specialist.  I think Etta is a great candidate for a frenectomy, but I worry about the pain she'll experience and her- and my own- ability to cope with that.  Though my mom leaves town tomorrow, my dad will be here to help watch Tye during the appointment- something I'm extremely thankful for, since I don't think I could handle such an emotional appointment with Tye along, too (couldn't you just imagine the three of us all in tears, the doctor staring at us, speechless?).  


I'm hoping the frenectomy can be done quickly at the appointment Wednesday and that it provides a solution to Etta's weak latch, her constant nursing, and her gassiness, and that it prevents future bouts of mastitis.  Hopefully, the short-lived pain will be outweighed by the result of a happier baby, healthier mama, and easier nursing relationship.  Time, and likely a snip, will tell.  


Another great post on tongue tie, its symptoms and diagnosis, its affect on breastfeeding, and frenectomies was posted recently by Mommypotamus- a great read!  And Kellymom.com has great information available here.