Pregnant women and their partners settle into their seats as I announce we are going to watch a movie. The lights go down as the movie starts up, and we see our heroine navigating a convertible, wind having its way with her hair, along a curvy road with a cliff below.  What, you didn't see this movie in your childbirth class?  Are you ready to know what in the world that clip from a Hollywood blockbuster has to do with birth? 

An iatrogenic effect is a care-giver caused illness or issue. So, our leading lady was out for a Sunday drive, enjoying herself, when Cruise's character begins the chase. During this pursuit she almost slams into a truck, spins-out, and ends up perilously perched on a precipice. But wait, what happens next? She is rescued by none other than the person who put her in danger to begin with. Will she walk away from this incident blaming him for the accident, or will she remember him as the person who saved her life? 

It is not unusual to hear women share, "Thank goodness we were in the hospital! They saved my life! They saved my baby's life!" In casual conversation this makes birth sound very scary. With  knowledge of the potential risks of a specific intervention and keenly-tuned ears, frequently one can pick up on the events that may have turned that situation into an emergency. For example, let's look at an intervention that happens hundreds of times daily in hospitals the country over: artificial rupture of membranes (AROM, or breaking the water). 

The most common reason to break the water is to "speed-up labor." In some situations, AROM is done to more accurately monitor the baby's heart rate  and the contraction strength via internal instruments. It can absolutely be a part of the epidural routine (give epidural--->break water--->insert internal monitors--->begin pitocin). Let's look at it alone, though -- just having the water broken.

It seems harmless enough, right? No IV or medications required. The only instrument involved is an amnihook. By simple insertion, the hook tears the amniotic sac and the water is broken. The baby here is almost ready for birth -- see the cervix is wide open as the bag bulges over the baby's head? A baby this low is less likely to have an issue than a baby who isn't in such a snug-to-the-cervix position. Sometimes as the water flows out, baby's cord sweeps down a bit and becomes pinched between baby and the uterine wall. The baby's heart rate drops, and mom would be given oxygen and rolled into different positions to try and ease that pinching pressure off the cord. If there is a side she can lie on where baby looks good, then mom holds that position; if baby doesn't like the lack of fluid and continues to have heart decelerations, sometimes this can require immediate action -- a cesarean birth. 

In a situation like this, it is unlikely the woman would be told AROM contributed to baby's decels.  Assessing mom and baby's immediate needs and working to resolve the issue is where the focus needs to be. In the midst of the crisis and machines and noises and scrub-donned staff, the family is terrified. When mom and baby are finally safely reunited, and the collective sigh of relief is made, often it's the medical establishment that gets the award and eternal praise for navigating everyone through this dangerous situation. Tom Cruise reached through the car hanging off the cliff and pulled the heroine to safety.

Here are some facts about AROM:

• Amniotomy does not shorten labor length and is associated with increase risk of cesarean birth (Lee et al. 2010; Fok 2005; Goffinet 1997) 
• AROM increases risk of infection (Busowski et al. 1995)
• Stalled or slow labors often respond to position changes, movement, and hydration (Lawrence et al. 2009)
• Pain levels can increase, most likely due to the loss of the cushion of fluid (Barrett et al. 1992; Lupton 1992; Inch 1985) 

Of course interventions have their place, it would be irresponsible to say they are never needed. There is also overwhelming evidence that shows us, when mom and baby are doing okay, it's best to support their unique labor by allowing them to work together in their own time.

Click here to learn more about the risks of interventions, why they might be needed, and how to keep labor as normal as possible in the midst of an intervention. And to see more of the video clips I use -- stay tuned! 

A couple months ago, Ezra popped up with abnormally pink circles on his cheeks. I knew he had an orange popsicle from a nice lady at church who doesn't really speak English (and I don't really speak Spanish) about 2-3 days prior -- being a 4th child, we are pretty relaxed about food -- but I wasn't sure it was related. There were no other symptoms or issues, the spots never got any bigger nor were they streaky, they were flat, not warm to the touch, just two round rosy spots. After a  couple weeks or so, the spots went away.

Maybe a month later, my mom came to visit.  My mom is a popsicle junkie -- she eats many every day.  Wanting to share the calories, maybe, she offered some of a red popsicle to her 10th grandson (no grand daughters!).  Again, 2 or 3 days later, Ezra turned up with those spots!  This time I was more concerned. I linked it to the popsicle, but I thought it might be more about the food dyes -- maybe this was an allergic reaction? Contact allergic reaction? My mom had been visiting over a weekend, and it was the following Saturday that I most worried -- I contemplated taking Ezra to Prompt Care -- I thought I might have felt a lump under one of the spots.  This time they did feel a bit warm, although he had no fever or any other indicators that something was wrong.

I called our insurance advice line.  After going through the symptoms, the nurse said we should take him in.  Seeing his behavior was normal and Prompt Care was 30 miles plus 20 bucks away (on a very busy Saturday afternoon), I chose to watch and wait.  Oh yeah, and put in a call to a friend who is a nurse practitioner.  I texted her the picture and we did some trouble-shooting over the phone.  No new detergents, no new skin or bath products, no illnesses, no known allergies, and no new foods (really, no food yet), but for the popsicles.  Together we both felt settled on a bit of a reaction to the dye, although there were no other spots on his body.

I thought the whole thing so strange -- how long it took for the spots to pop up after exposure, and then the length it took for them to leave (2-3 weeks). I belong to a message board with brilliant (mostly) women, some of whom I have "known" since my oldest was a baby.  I decided to share these strange symptoms to see if anyone had any good ideas. It took 12 replies to my post before a mom chimed in with this: 

"It is called Popsicle panniculitis.
http://www.pediatricsconsultant360.com/content/popsicle-panniculitis 
It is benign." 

Okay, she also happens to be a pediatrician, and she later shared she has no experience with it, she had just recently read a journal article about it. Still, another participant posted, "I love us," in response to how many times we are able to help each other out with these kinds of questions, offering mother-to-mother support for issues related to kids, and person-to-person support where we can share our different skills, expertise, and experience. I also sent the link on to my NP friend as I was amazed this really was "something."

Popsicle Panniculitis is common when parents or caregivers give teething babies something cold to soothe sore gums. It is harmless and will resolve on its own. It is thought to occur more frequently in babies due to the higher level of saturated fatty acids in their subcutaneous fat versus the higher levels of unsaturated fatty acids in the same tissue of adults.  

Ezra is working on his top four teeth and I had the fleeting thought to let him suck on a popsicle -- but since he has been happy and drooly, I decided we will stay away from marring his face, at least until the Christmas card pictures are taken!    

Did you know a parent or caregiver can pass the bacteria that causes cavities to their babies?  As I feed Ezra more of what I am eating, I realize we end up sharing the spoon. If I have untreated caries in my mouth, I can pass the Strep mutans (believed to be the primary bacteria that causes cavities) to Ezra and colonize his mouth and teeth so he could potentially "catch" cavities from me.  

We know Strep mutans are not present in babies' mouths at birth. "Research shows that caries can be infectious.  When an infant is born, its mouth is basically sterile.  It does not
have decay-causing bacteria in its mouth.  The decay-causing bacteria is 'acquired' or 'inoculated' at some point in its life.  It may be the timing and amount of the inoculation that determines the risk of decay. The infant could be inoculated by Strep mutans in many different ways -i.e.- kissing, using same spoon, etc.  Once exposed to Strep mutans, the critical issue then becomes how often the infant is exposed to sugar.  Frequency of exposure to sugar is more important than the amount of sugar.  A low bacteria count with many sugar exposures can be just as cariogenic as a high bacteria count and less sugar exposure." The late Dr. Brian Palmer was a leading researcher on breastfeeding and oral development and health, and that quote was his, taken from a presentation on his website. 

Dr. Palmer also showed us breastmilk is anticariogenic in nature -- meaning breastmilk alone will never cause decay.  Now as soon as you add a Goldfish cracker or a slip of dried seaweed -- anything that has carbs in it -- you have the makings for caries.  But his research showed teeth soaked in breastmilk did not decay. This is important in light of night-nursing.  When babies start to get active and busy, they often shift the majority of their eating from the daytime to the nighttime (we call this reverse-cycling), yet night-nursing is often blamed for infant caries.  Wiping the teeth with a clean cloth at night is something some parents do, but admittedly not every parent is awake or aware enough to see this through.  Others choose to brush their babies' teeth after dinner and only allow breastmilk or water until morning.  Whatever you choose, it is important to be mindful that as soon as your baby's teeth erupt, it is time to start taking care of them.

As parents there are things we can do to help improve our babies' dental health: 

• Ensure your own mouth is in tip-top shape and role-model good oral hygiene habits.  I did last visit the dentist in March, a month before Ezra was born, and my mouth was deemed cavity-free -- I am overdue to go back, but with a baby in my care during common office hours, I keep delaying my visit!
• If you have active caries or current mouth pain, think twice before exchanging slobbery kisses, sharing spoons, or "degerming" the fallen pacifier with a pop into your own mouth before offering it to your baby...same holds true for anyone in close contact with your baby. You can pass those Strep mutans right to your baby and that begins the infection, essentially.
• Practice good eating habits.  What the research tells us is, it isn't the amount of sugar we eat, it is the frequency of sugar.  My husband shared with pride how he could make his Halloween candy last a year when he was a kid.  In my family we were allowed to gobble all of our candy up in the matter of a few days. Everything equal as far as daily brushing routines, who has the increase risk of cavities?
• Know your family history.  Did you have an aunt who had an enamel deficiency? Be suspicious for any kind of enamel anomaly or peculiar periodontal paradox plaguing your predecessors (oh my, I had to!).  
• Along those lines, if you already know someone in your family dealt with tongue or lip ties, be aware there is a possibility your baby may be affected. Some terms you may hear at family gatherings that can hint to tie issues include: "small upper palate" (palate expander needed), "large lower jaw," "high palate;" perhaps someone had to have a frenectomy to remove  a space between the upper two front teeth (a diastema).  Any of these could allude to a tie issue. If your baby has an upper-lip-tie or a tongue-tie, consider revision.  I learned this the hard way 13 years ago with my oldest son.  He had his four top teeth capped at 18 months due to restrictions in his mouth -- at the time my husband and I had no idea why that decay occurred.  Since then we learned upper-lip-ties can hold bacteria and food in pockets close to the teeth, and a tongue-tie can limit the tongue's ability to sweep out that debris.  Often with a tight upper-lip-tie, it is hard to brush the area because of the thickness of the frenulum and the pain it can bring the chid. Dr. Palmer's website also has information on frenulums.  

There is other very interesting information at Dr. Palmer's site on additional reasons decay can occur in children, including major maternal illness or stress during pregnancy -- certainly worth a read if you feel that might fit your situation. 

There is much joy in feeding that little baby of yours "real food" once they can really go for it.  With a little bit of knowledge, and a tiny toothbrush, you have the tools to help protect those teethies while also building lifelong habits of proper dental hygiene.

Through Tongue Tie Babies Support Group, I "met" Jen, and then we were able to meet in real life.  While Ezra and I struggled with common tongue-tie issues related to excessive weight gain, reflux, "oversupply," and all with a happy baby, Jen and Christian were at the other end, experiencing intense colic, nursing around the clock, failure-to-thrive, reflux, and diminished milk supply.  I asked her to share her story, and it is extreme.  I am grateful for her willingness to upturn all of these feelings and emotions, and I know she does it to help other families. 

Even though it has already been six months since we went through our revisions, I still find it hard to think about what my son Christian and I went through with his undiagnosed tongue and lip ties. I should include my husband, Scott, in that statement as well, as he had to be there for all of the problems we were dealing with. He spent his time home with us soothing a screaming baby -- a baby who we thought had reflux, gas, and colic. He helped me cut out every offensive food in my diet that could have been making him sick (according to all of our baby books and the websites I read, Christian was probably upset all the time because of my diet, the gas that infants naturally have, and because he was just a “colicky” baby). For his first two months of life, we spent 8-10 hours a day laying on the couch nursing. He would fall asleep a few minutes in, and I would try to get up to do something around the house or grab a bite to eat. As soon as I moved, he would scream until I nursed him again. I would see a little heart-shape at the end of his tongue and a piece of tissue going halfway up his tongue that I thought was suspicious, but I didn’t think too much of it.

Let me backtrack. I was supposed to have Christian in a birth center until we had complications three days into my labor. He went from the right position to the wrong position and I couldn’t dilate due to horrible back labor. I was not planning on spending time in a hospital, but during our overnight stay I must have called the nurses every hour to help me with breastfeeding a baby that couldn’t latch well from the get-go. I was told that not being able to latch was normal and we both had a lot to learn with each other. The advice didn’t sit well with me because it seemed extremely hard to breastfeed him. A nurse supplied me with a nipple shield and we “kind of nursed.” It still hurt, but I had a tool that helped a little. 
 
I left the hospital with my baby and my shield promising to appear at our pediatric follow-up the next day. When Christian was weighed, we saw that he went from 8lbs 5oz to 7lbs 12oz overnight. The doctor didn’t seem concerned and arranged for us to come back a few days later -- he was barely at 8lbs at that visit. She said that since he was gaining weight, even though not quickly enough, she wasn’t too worried and I should just come back in for our two month appointment. She chalked up the weight loss as being a normal symptom of jaundice and that some time in the sun and feeding him constantly would clear him of it.

We spent the next seven weeks nursing all day and all night. I had bruised nipples and the baby had blistered lips. I had heavy letdowns in the morning and he would spit up most of what he drank. I was irritable, frustrated, and would spend the five minutes a day I had alone crying in the shower. My husband learned all kinds of tricks to calm the baby, although now I’m realizing that we made him cry it out and he just gave up and slept because he realized he wouldn’t get any food. That’s my best guess, anyway. I don’t think our gas moves were helping him. Being new parents, we figured that we had to work out the gas and when he would fall asleep we figured we did our hard jobs as parents. We had no idea how hungry he was.

When two months rolled around, Christian looked really thin and I started to worry about him. His head was huge, his arms were tiny, and I could see his ribs clearly. My best friend said he didn’t look any bigger (but I didn’t notice how skeletal he was until I looked at pictures I had taken). She noticed him falling asleep while eating and thought he didn’t have a deep latch. 

I heard of a breastfeeding group that was part of a local hospital and I decided to go in for support to figure things out. The first time I went, the lactation consultants thought he was a newborn. When they saw him eat, then told me that he was just a lazy baby and they see lazy babies all the time. I was told to constantly make him uncomfortable so that he would
eat. They said he was “happy to starve” and he “circled the drain” -- whatever that meant. Basically, they told me that he preferred just to eat enough to be comfortable and then go to sleep (from my own research, I found that he was working so hard at eating that he fell asleep out of exhaustion). No mom wants to hear these words about their child and instinctually, the situation didn’t sit right with me. I showed her the ties and wanted her confirmation that they weren’t normal (at that point I read a little about posterior tongue tie and upper lip tie in the Facebook Tongue Tie Babies Support Group) and she told me that they were normal, they see them all the time, and that they would stretch. She told me that my bruises were normal and his lip blisters were normal. I wanted her to tell me what my gut was telling me: the ties were the problem. Instead, the baby was blamed. Unfortunately, he was diagnosed failure-to-thrive by the lactation consultant who told me to go see the pediatrician right away or else they would make sure he would be admitted to the hospital. I was told to take fenugreek, pump, and give him as much formula as he would take.

When we went to his pediatrician, she told me that he was fine, not yet failure-to-thrive, and I probably just didn’t make enough milk for him. I pointed out his posterior tongue tie and upper lip tie and she said that those are normal and they would stretch in time. Both pediatrician and lactation consultant agreed I should rent a hospital-grade pump and pump/bottle feed for every single feeding. The lactation consultant sent me home with a case of formula since I probably didn’t have enough milk for him and by that point, she was right. We had two months of bad latching and breastfeeding and my milk supply, although there, was hardly established. I went through the next month pumping, bottle feeding, and “sneaking in” breastfeeding sessions to make sure we kept our closeness and he didn’t decide the bottle would be better for him. 

As if pumping, bottle feeding, charting weight and diapers (we bought an infant scale and weighed him six times a day) weren’t enough, there was a huge strain on me feeling like a failure. I could not wrap my mind around my baby being lazy and happy to starve. My instincts were telling me that this baby would do anything he could to survive, and that something had to be an issue. I originally found out about the Tongue Tie Babies Support group through another breastfeeding site where many of the moms were also telling me that all of these things were normal and that we would just work through them. I was told to take fenugreek, eat oatmeal, have a beer, drink a ton of water, and try all kinds of positions. Where some of these things helped a little, I thought they were more like bandages and not cures. After reading through most of the posts, I came across one from a mom who described my story exactly: feeding the baby all day, baby falling asleep, waking up crying, gas, colic, reflux, failure-to-thrive. 

She spent the next few hours communicating with me back and forth and encouraging me to go to the support group. There, other parents were telling me almost the same exact story. When I asked why I was told it was my fault or my baby’s fault, they explained that doctors and lactation consultants usually aren’t taught these things in school. I read Dr. Kotlow’s breastfeeding publication and looked through all of the articles I could get my hands on. Finally, the mom who originally linked me with the group told me to go see Dr. James Jesse who only lives an hour away. I made an appointment for the first available opening which was a week away. When I went to tell my midwife, she told me to see someone closer to us and although I agreed, I kept my appointment with Dr. Jesse.

When I saw the pediatrician who clips lip ties, she told me that his tongue tie was very minor and although she would clip it, it probably wasn’t really causing us that many problems. She said his upper lip tie was “too thick” to clip and that I should just wait until he broke it on his own or was old enough to go under general anesthesia and could have it stitched. She watched him eat a bottle and told me that I could just bottle feed him, but I probably just wanted the closeness. As a mother determined to breastfeed, yes, I wanted closeness. I wanted so much more than that. Her lack of knowledge and incomplete revision (both of not revising the upper lip tie and also not cutting enough of the tongue tie) discouraged me but the support group assured me that Dr. Jesse would take care of both issues. When I called his office to confirm, the receptionist said that there wasn’t a tongue or lip tie Dr. Jesse couldn’t take care of.

I took Christian into see Dr. Jesse and within ten minutes he was diagnosed and revised via laser. I couldn’t believe the difference I saw in his mouth, and although he had a hard time breastfeeding right away, he ended up napping which gave me time to allow him to heal. 
 
Our story didn’t end with the revision. After a traumatic birth and two months of bad and overcompensating latch, we had Christian go through craniosacral therapy and chiropractic adjustments. After working with him on his latch and suck, we finally have a good, pain-free breastfeeding relationship. Sometimes I think his suction is a little too good -- creating quite a seal when he latches. I never saw or felt that before when he had posterior tongue and lip tie! After trying an SNS for feedings, I couldn’t really get the hang of it and decided to opt for bottle feedings for supplementing. Some women can boost their milk supply up in big ways after revisions, but mine never quite got to where it needed to be. He wasn’t gaining enough weight still and so I had friends who donated over 150oz of breastmilk to me and we found a formula that he liked. I have to say my milk supply did increase a lot, and with that I have been able to go from supplementing 15-20oz a day to 0-6oz a day, depending on Christian’s needs. He has been gaining weight steadily and his gas and reflux have not been an issue since his revisions. I haven’t worried about the types of foods I eat, nor would I label him colicky. We even took a trip to Colorado for a friend’s wedding when he was three months old and he was not the same frantic baby he was at one or two months old. I enjoyed his first laugh without looking at the fragile, skeletal sweetheart that I would have done anything for.

Even though he is currently behind in weight (tenth percentile), he is healthy, happy, growing, and meeting major milestones. I am just following his lead in providing for him, and it is working out well without a lot of stress. We know that one day this will really be behind us with Christian. We know that we will take our next babies in for revisions as early as a day post-birth if they have ties, and chances are, they will. When I went back to visit the lactation consultant I worked with, she didn’t seem to want to listen to our story, but I plan on going back in with information and resources hoping that she and her colleagues will see this common problem that many moms face and learn the ways they can support them so that no baby will ever be called lazy again. Because of our experience, I want to save other moms the pain of going through what we went through with an issue that is so easily diagnosable and treatable. I hope that my friends can learn from our experience and realize that with their similar issues, their doctor may not have all the answers. I am also thankful that I was proactive in preventing adult issues with tongue and lip tie such as speech problems, digestive issues, tooth decay, and other symptoms that I struggle with as an adult as I have an undiagnosed posterior tongue tie myself. 
 
Even though having a baby diagnosed as failure-to-thrive is devastating, I am thankful for going through the extreme end of the issues because I can use our experience to help other mothers who are struggling. I don’t regret the revisions at all, and would do it all again in a heartbeat knowing that it is fully benefitting Christian.