So, hey – hi – I’m a mammal. And if you're reading this, chances are you’re a mammal, too. If you remember back to grade school, two characteristics mammals share are 1-they have hair, and 2-they feed their young milk obtained through mammary glands.
I checked -- I have both. How about you?
As mammals, we are further divided into three groups. Unsure about what type of mammal you are? This might help:
No matter what category you fit in as a mammal, you are biologically programmed to nurse your offspring (if you are female). While some mammals may not feel comfortable watching other mammals feed their young via mammary glands, it is an essential part of our make-up: Mammal young are fed milk from their mothers.
Why is it distressing for some to observe this normal act of feeding? In his classic, 1967 book, The Naked Ape, Desmond Morris writes:
So there he stands, our vertical, hunting, weapon-toting, territorial, neotenous, brainy, Naked Ape, a primate by ancestry and a carnivore by adoption, ready to conquer the world....For him, the main troubles will stem from the fact that his culturally operated advances will race ahead of any further genetic ones. His genes will lag behind, and he will be constantly reminded that, for all his environment-moulding achievements, he is still at heart a naked ape (48).
Meredith Small furthers this nature versus nurture argument in What's Love Got to Do With It? The Evolution of Human Mating: "Although our American and European culture has highlighted breasts as something sexual, the reaction...may be more culturally molded than based on a biological urge" (28).
You (general "you") see, as mammals, there is no need to be offended by the sight of a nursing baby -- it's just your (general "your") cultural beliefs and personal biases leading you (general "you") to feel how you (general "you") feel. I have learned, when it comes to communication and problem solving, when conflict arises, one examines who owns the conflict. Let's break it down:
Who has the problem? Not the Mammal or her Baby. So if you (general "you") are bothered by the sight of a baby feeding, YOU (oh, this is getting tiring! General "you") own the problem -- it's your (yes, still general -- but I'm about to get specific!) problem. Furthermore, our government in the US has provided protective laws in the case a baby may need to eat outside the home. This means, it is illegal to ask a mother to stop, go someplace more private, or leave an establishment if her baby is eating -- yes, even if it is bothering someone (show them this diagram and help them own their issues, to add to the rest of their baggage, I would guess).
So it is plain to see, if we need to normalize breastfeeding, we must also normalize hair, single-bone lower jaw, nucleus-less red blood cells, diaphragmatic separation of the abdominal and thoracic cavities -- and the list actually goes on. As we like to say (sing) in our family: "It's natural, it's nature, it's part of nature's natural process..." By virtue of just being a mammal, these characteristics and abilities are inherent to our design -- they're built-in -- so let's not waste another second asking people to accept what is already basic biology.
But you know who really needs to normalize breastfeeding? Birds. Think about it – they have neither hair nor mammary glands. As such, birds do not produce milk, nor do they feed milk to their babies. How will birds wanting to step out of the biological dictates of their class move past these cruel obstructions? How can they break through evolution's glass ceiling? I mean, they can already fly, and beaks are pretty sharp, but they still need our help.
We must work for change. Every bird should be free to move toward choosing to nurse her young -- through time (I don't know how much time, I am not a biologist), birds might become the missing link between traditional mammals (specifically prototheria) and avian (and if we really came from reptiles, there is a connection between birds and snakes, right? I've seen Jurassic Park, after all).
I BELIEVE WE CAN MAKE THIS HAPPEN!
Sign the petition contained within the "comments" section below. Let's make that robin's red breast into something more than just poetic decoration. And if you think this is a futile battle, watch this propaganda video for the cause.
Happy World Breastfeeding Week. Next year let's hope our feathered friends can join as well.
Download Your Free Business Card Template:
Look up your state's law and write it in the blank space. You could also print the law on the backside of this card. It is a bit snarky -- for a smoother option, try these instead.
If It Didn't Come from My Head, It Came from Here:
When wondering if your baby might have a tongue tie or lip tie, many questions arise. Shared here are some visible, physical features babies with Tethered Oral Tissue may manifest. In dialoguing with hundreds of moms, these seem to come up again and again. These tips can also be helpful for doulas and other first-responders helping breastfeeding moms in the early days.
Before we begin, a few notes:
Image 1: Lip blisters are often thought to be a normal part of nursing, but these can actually be a sign of something more. That cute little callus under your baby’s philtrum could show he has to compensate with extra lip-grip versus being able to stay latched to the breast via a well-moving tongue and lip combo.
An upper lip that doesn’t easily fan over the breast often folds (image 2) or tucks (image 3) during nursing. If baby has what I term “smeared lipstick mouth” after nursing, this shows the lip didn’t flange as it should. Of course this can be positional, as well; if this frequently occurs, even with increased attempts to improve baby’s latch, it can be something to super sleuth.
Image 2: Accordion fan of a tight lip – see that horizontal line under the nose? Instead of opening to the breast, the upper lip folds. The crease will show as a red line once baby unlatches, as in image 1.
Image 3: Another compensation for a tight upper lip is that it tucks inward. Some moms can manually turn out the lip by sweeping with a finger; other moms report the lip seems to turn into a tight band of tissue that is difficult to manipulate – it depends on the flexibility of each baby’s frenulum and lip.
Image 4: An easy way to get an idea of potential for tongue tie is to flip the upper lip and see how the frenulum attaches to the gums. This is less invasive than digitally checking your baby’s tongue. Many professionals agree, 90% of the time there is an upper lip tie, there is likely a posterior tongue tie. This can be a key in deciding how to proceed.
Figure 5: “Two-tone tongue” is a phrase Cathy Watson Genna shared with me when I mentioned something I noticed on my own baby. It is often mistaken for thrush, but often there is a line across the tongue, unlike thrush which can come in patches and doesn’t seem picky about where it develops. If the tongue has impairment in function, it doesn’t get the normal help shedding cells (think about a tongue scraper), and the white color reflects that.
Figure 6: Another low-hanging fruit feature is how a baby’s palate looks. When a baby cries, yawns, or is just hanging around, you can often take a peek to see his palate. Ideally, the palate is a horseshoe-shaped, wide surface, because proper swallowing and tongue movements shaped it before birth. Babies with restrictions often have vaulted palates – arch, bubble, channel, or otherwise, due to their inability to make these ideal movements.
Figure 7: I don’t know if there is a technical term for this, but many moms report their babies have “tongue dents.” These dents can occur as the tongue is being pulled by the underlying restrictions.
Figure 8: When crying, a baby’s tongue may curl or cup up. Again the force of the restriction is controlling the range of the tongue’s motion.
Figure 9: If you feel brave enough, and baby complies, you can try to feel for the frenulum yourself. Your baby may be upset by this, but as his parent, your fingers will be the most comforting to him – so if you are really wondering what’s going on, get in there and see for yourself. Place baby in your lap with his feet at your knees and come in from above his face. Gently use your index fingers to try and lift his tongue...and better if you have a partner ready to snap some pictures.
I don't claim to use proper terminology. I always welcome feedback and corrections. Find me on Facebook.
Much appreciation to Dra. Kelly Marques Oliveira, IBCLC, for translating this into Portuguese.
Tongue Tie Babies Support Group, on Facebook. A peer group with over 20,000 members. A great place to learn local option, ask all your questions, and get support from other families impacted by ties.
Advocates for Tongue Tie Education (ATTE) is a group for parents and professionals. Resources on their website include parent info sheets, educator packets, provider toolkit, and a tie gallery. They also have a Facebook group.
Catherine Watson Genna is a treasure trove of information. She is a woman with vast experience and an inquisitive mind, and she offers her knowledge on her website, in books and papers she authors, and in presentations that she travels around the world to share.
Dr. Bobby Ghaheri has been exploding with informative, relevant blog posts. He is not only an incredibly experienced ENT who performs revisions, he is also a father and husband whose introduction to the world of ties came through his wife and baby.
Dr. Larry Kotlow has a great site that can be a starting point for any parent looking for pictures and presentations.
Beverly Morgan is an IBCLC who wrote an exhaustive article full of tons of links, and she shares her own experience of revision as an adult.
Dr. Brian Palmer made extensive contributions to the world of breastfeeding and infant oral health. His website addresses ties, palate and jaw development, caries, and more.
International Lactation Consultant Association is the best place to find an IBCLC who can assess and evaluate a breastfeeding dyad's situation.
International Affiliation of Tongue-Tie Professionals (IATP) is the leading professional organization, and IATP offers resources for parents as well.
I cannot even pretend this was my original idea. I got this from Linda J. Smith's book, Coach's Notebook: Games and Strategies for Lactation Education. In "Who's Glad You're Breastfeeding," Smith offers a list of family and community members who see the benefits of breastfeeding.
I came across a pack of adorable thank-you cards at the Goodwill for $.99, so of course I picked them up with this activity in mind! I took 10 of Smith's suggestions and hand wrote thank-you notes for moms in the group to read out loud. As a modification, I had them withhold who the note was from and the rest of the group had to guess based on the information shared.
For example, the one I shared in the picture says:
"Dear Breastfeeding Mom,
Thank you for breastfeeding. Your child's athletic ability gets a boost from better eye-hand coordination and motor development.
Future Sport's Coach."
Smith has a list of 21 people "glad" a mom is breastfeeding, including her partner, her accountant, er dentist, her OB, her garbage collector, etc. After we read through the 10 I created, I asked what other benefits moms knew about that we hadn't covered. We also, tongue-in-cheek (but maybe not?) composed a letter from a mother-in-law to her breastfeeding daughter-in-law -- maybe as an attempt to imagine what we might appreciate hearing? Nevertheless, it was a fun group activity!
As part of another project for World Breastfeeding Week/Breastfeeding Awareness Month, I made business-card templates for the 50 US states; actually, I should say 49 US states plus Washington DC (Idaho does not have a law that gives a woman a right to breastfeed in public -- only one that may exempt her from jury duty).
Feel free to download and print, and of course share online and in real life! If you spot any errors, please let me know as I did a lot of this while entertaining/nursing my own busy toddler!
Today marks 33 years of the WHO code, or the International Code of Marketing of Breastmilk Substitutes. Social media outlets of all kinds are trying to inundate businesses today who choose not to comply with this code -- add your picture to show your support.
In my post about getting a breastpump, I mentioned the WHO-Code and different companies who are or are not in compliance with the code. But what is the Code? And who cares? Or should I say, WHO cares? Here is a break-down:
Everything that was decided was done so in order to protect breastfeeding and breastmilk. We know not everyone can breastfeed, and not everyone chooses to breastfeed. Formula isn't the subject up for debate -- it is a necessity in our world and it is the safest option we have for babies not receiving breastmilk. But the way formula companies advertise undermines breastfeeding.
For example, have you noticed advertising often depicts breastfeeding moms as lounging in their beds and their pajamas all day? Or surrounded by expensive-looking gourmet or "extra-healthy" food? The message is simple: To choose to breastfeed, you will be tied down to you home, your bed, your pajamas, and you baby -- and you must eat costly food to be healthy enough to nurse.
Moms depicted giving their babies bottles of formula, on the other hand, look put together, dressed professionally, ready to take on the world with their awake, alert babies. Or better yet, just a cute baby alone with her bottle, showing independence!
Celebrate the making of the WHO Code, and the businesses who choose to comply with it. When breastmilk is not the option, we know formula is available. Unethical marketing practices only serve to hurt moms and babies.
I met Falen through Tongue Tie Babies Support Group. When she suggested this post for Mother's Day I was thrilled, and I cried through the whole thing! Have your tissues handy! And all I can say to Falen and Dona is, thank you! Thank you! Thank you! For sharing this gift with us.
Falen: My Mother, My Doula
I knew I wanted a doula even before I became pregnant. The support that comes from being surrounded by a community of supportive women is unparalleled. But just who would that person be? Could that person be the one woman who has been there my entire life?
I knew my mother has long aspired to become a doula, to support mothers in birth. Not long after I told her we were expecting I asked the big question, will you be my doula? I was nervous and excited. She was too. She signed up for training right away.
The day of my son’s arrival finally came. I called her in the wee hours of the morning to let her know that this was the day. She drove three hours from her home to mine to be there for me. She came prepared, ready to put her newfound knowledge to work. I had been laboring for hours through the night by myself, pacing back and forth. It was so nice to have a familiar hand to hold to keep me grounded.
When I was ready to go to my birthing suite, to get the relief of the big Jacuzzi tub, she helped me call my midwife and made sure all of my bags were ready. She packed up the cars along with my husband and followed behind us as he drove us to the hospital.
When we arrive in our room, she carefully and quietly surveys the room to make sure my birth plan wishes are being honored. She assists me in communicating with the nurses as the contractions already a couple minutes apart come and go. We begin to move around the room with a rhythm. She follows me wherever I go. Holds my hand, offers her body for support. She runs her fingers through my hair or just sits quietly as I rest when my body allows.
As the day wears on I know she must be exhausted, her body must be tiring. But she never shows it. She just keeps offering herself to me. She supports me as only a mother can.
The following are the words I wrote about our experience just days after my son’s birth:
“How can someone perform so many roles and perform them so well, so seamlessly? Every touch radiated love and care. Every look raised my confidence. When I thought I couldn't possibly go any further, her presence told me I could. She did it. I can do it. She is here to support me in every moment. She is here through every contraction. She is here through every second of pure exhaustion. She is nervous and anxious but she never shows it. She is strong. She is strong for me. She labors with me. She pushes me through. She shares in my joy. She shares in my love. Our bond only grows stronger. I now know how she feels, what being a mother really means. It can't be described, only felt, only lived.”
I can’t imagine my son’s birth without her. I can’t imagine becoming a mother without my own by my side. It didn’t stop there, though. She stayed with me through the toughest time of my life. She had planned to stay a few days while we settled in to our new routine. But something wasn’t right. My son wasn’t nursing and he was losing weight rapidly.
She urged me to see a lactation consultant and went with me. At the consult he was weighed and I was told I should see his doctor immediately. The lactation consultant made an appointment for us and we went straight there. After the visit with a doctor we ended up in the NICU. They had to transport him to another hospital when he became unstable. My mother, my doula, held me up as I walked down the hallway and out the doors of the hospital without my son.
This was the hardest moment of my life. I felt like my everything had been ripped from me. She drove me to the NICU hospital and held me as we waited to see my son again. She held me in the NICU room as I stood there staring at my son hooked up to machines. She held me and her grandson while I struggled to nurse him. She was there through it all.
They made her leave after hours. But as soon as those visiting hours started she was there. Even waiting outside the door for the clock to strike so she could come give me the support I so desperately waited for through the long nights.
After we returned home so did she. I was so sad to see her go. But I knew with her encouragement and love that she had given me over the last few days that I could do it. I could be the mother I needed to be. And of course I could call on her during those quiet moments of doubt when only she would understand what I was going through. For only she was there to feel it all with me.
Dona: Mother, Nana, Doula
When my daughter asked me to be her Doula, I was so honored and excited. Not only was I going to be able to finally be a doula, something I had only dreamt of, I was going to be there to assist my daughter. I better get to work, I thought. I had to learn all I could. I wanted to be at my best, after all, this was MY daughter and MY grandson. To say I was overwhelmed is an understatement. I did my best to listen to my trainers. I also read every book I could get my hands on. One of the most important things I think I did was to talk to other Doulas and Midwives about their experience.
The day finally came. The three-hour drive in the wee hours of the morning was the longest ride of my life. I was on the hands-free phone with her most of the time, checking contractions, praying that it was God’s will for me to be there when she needed me. As I arrived, we went over her home plans and realized she was in active stage and could get some relief from the big Jacuzzi in the birthing suite, so off we all went. On the way to the hospital I thought, am I doing this right, am I saying the right things? As we arrived I went over her birth plan. Was the room dark enough, was it quiet enough? Making sure every support staff had copy of her plan.
Her labor was long and at sometimes it seemed that way. In other ways it seemed to go by so quickly. She received relief from the Jacuzzi. Finally I was able to see my daughter (yes, she is my daughter and client all at once, but my heart said daughter at this moment) calm and relaxed. I remember running my fingers through her hair as I did when she was young, thinking my baby is having her own baby. Holding her hand as we had millions of times before, but this time was different.
The hours went by and I assisted her in about every laboring/pushing position you could think of (if you’re a doula you know what I mean). She was exhausted, I was exhausted, but she pushed through. And then finally her baby crowned, and she pushed through the head. Part of her birth plan was that she had wanted to be able to touch the head and that she wanted her baby to hear her voice first. Her midwife placed her hand on the baby’s head and with a finger to my lips I reminded everyone to be silent (what my daughter didn’t know is, that she had pushed the baby's head all the way out and the baby was looking at us with great wonderment). It seemed like hours as we all waited patiently in silence. Then when she was ready, the last push, and he was here!
I can’t explain the emotions I was going through. The love that I had for my daughter at that moment was like no other time before, the bond that I already felt for my grandson, and the pure physical exhaustion. I was a Mother, a Nana, and a Doula.
Falen currently teaches full time. She aspires to become a lactation consultant after her challenges breastfeeding her son. "Like" her blog to follow her and read her musings and experiences.
Dona currently teaches full time while working toward becoming a certified birth and postpartum doula through DONA. She plans to help teen moms who would otherwise be unable to afford a doula. She serves the greater Detroit area. Contact her via email.
When I read this piece by Sejal, I was surprised by things I had never thought about before -- she makes some excellent points about how we care (or lack thereof) for our new moms in this culture. While reading, I longed to have the kind of nurturing of new moms she says is common in her culture. This loss is what inspired Sejal to work as a postpartum doula. Sejal saw a need, and she worked to fix it. I can't say how that touches me -- it is a reminder that we can all work for change, one at a time, and even though there seems to be so much to do, the moms, babies, and families we help will benefit from our heart and hands.
Mother-friendly Care Initiative
Postpartum period, the fourth trimester, maternity leave time, call it what you may but this is the most underestimated time for new mothers in America. We have made gender equality, marriage equality and other things a priority, but until we make the postpartum period a valuable commodity to be invested in we are not building a stronger future generation. I am a postpartum doula and I came to America and fell in love with this country.
My home country India, is where I learnt the basics of postpartum care growing up in a family of women taking care of each other during the time after the baby arrives. After years of helping my friends during their postpartum time I decided to make this passion of mine into something that could be used for helping moms who are not my friends and family. The amount of time needed to rest after giving birth cannot be generalized as each and every mother who has given birth recovers differently.
We have all the information on speeding up the postpartum recovery, but we fail to realize that it is a rebirth of the mother too. Baby steps are not just for baby but they should also be for the mom. The uterus, the vagina, the abdominal muscles, the breasts and the entire endocrine system go through a reorganization in the time following birth. All of these systems need time to heal and some more than others. Let us all unite to value the postpartum body and its recovery and help the new family have a wonderful time together. How do you get the rest when there are dishes to be done, laundry to be folded, house to be cleaned and baby to be fed? The postpartum doula will be there to help you with all of those and other things so you can have more time bonding with your baby and creating beautiful memories for your new family.
Sleep deprivation, stress from delivery, blood loss, pain associated with cesarean recovery, hormonal changes affecting the mood, and household chores are just a few challenges faced by a new mother. Add to that the worry that comes with taking care of this precious being who is solely dependant on the new mom is not a small challenge. The incidence of baby blues or postpartum depression in other cultures, including mine from India, are so less that it is sure in my mind that if women get the help at such an important transitional time as a new mother we could change the statistics in America too.
The dads need help too, and why not? There is enough research supporting that. ASKING FOR HELP does not make anyone weak, but on the contrary, it makes you see the REALITY and prove to yourself that you are HUMAN and we are a social being who needs people around us to help us.
I hope to work with families in empowering them to be stronger together by getting help at the right time. I strongly believe that it takes a village to raise a family and I would love to be a part of your village.
My postpartum doula career was inspired by a lactation consultant and the birth of my niece. My need to care for people has been fulfilled in this career. I come from a family of healthcare professionals like General Surgeons, Ob-Gyns, Pediatricians, Plastic surgeons and I grew up with babies being born around me. I am also very proud to be from India, a culture that is known worldwide for its heritage and hospitality. I feel that when you help a mom you are helping the entire family to grow and be empowered. With my education and interest I believe that I can be a part of the village that is needed to raise a child for a better future. I love to cook for my family, friends and even my clients. I love that food connects us all in one way or another. My primary goal as a postpartum doula is to empower new parents with all the skills that are needed to raise their child. I have also helped many of my friends during their postpartum recovery. To promote healing through evidence-based information and getting the family to be confident as caregivers is very important to me.
Back in June when we took Ezra to see Dr. Jesse, it was just my husband, Ezra, and I. I had this picture on my phone, and on a whim, I shared it with Dr. Jesse to show the array of palates and tongues we had left at home:
"You see this here?" he pointed to my (then) 13 year old's picture, "His tongue-tie is pulling his bottom two teeth in."
Now after my discovery of Ezra's mouth, and then our science project of comparing the other kids via pictures, I was amazed to see Jacob had a tongue-tie. He nursed with ease until the day he quit on his 4th birthday; well, I should say, after his stint in the NICU for 2 weeks, plus a couple of days figuring things out in our own time and space out of the hospital, he nursed with ease. I thought that was it, end of story -- nursing went well, so we didn't need to worry about it now. But I had before noticed in his otherwise lovely mouth of mostly-straight teeth, those two troublesome bottom guys...
In hindsight, a tongue like that could have caused a few issues we noticed earlier but were clueless about. Jacob was late to start solids. I offered him rice cereal at four months (it is important to know rice cereal isn't the best first food for babies, I was following mainstream guidelines and assuming since it was marketed for babies, it was best for babies; for more info about that, read here). He gagged so I figured he wasn't ready (again, I was uninformed and looking at the calendar and not the baby when determining if he was ready for food). I would wait a couple weeks and try again; same response with additional behaviors such as coughing, tongue thrust, clamping his mouth shut, and turning his head away. After a few more attempts, I lost interest and let my little sister (then 12 years old) eat it all. When Jacob was 9 months old (and still had no real solids experience) we were eating at our favourite Mexican restaurant. Jacob was large -- 9 pounds, 8 ounces at birth, 20 pounds at 4 months, 30 pounds by a year -- and because of that, we often placed him in the high chair while we dined to keep him at our level and engaged. He never acted interested in food, though. This particular night, he was madly waving his arms and shouting at us, so I offered him a bite of refried beans. Surprisingly, he took the food into his mouth, kept it in, swallowed, and wanted more! We were excited, but it still wasn't full-speed ahead with food -- he didn't really start eating food until about 14 months.
Tongue-tied babies can often be slow to eat solids or have other food issues, but I just assumed he wasn't ready and I didn't worry due to his size. I do believe Jacob limited himself to foods he could easily eat and swallow and this shaped his preferences -- he is still a picky eater, and I fully attribute that to his anatomical make-up and how he compensated to ensure he didn't choke or suffer other discomforts while eating.
The second sign of how he was being affected by his tongue was the fact that he had extensive decay on his top teeth, necessitating caps at 18 months old. Having a tongue that doesn't move in a full range can cause decay, as the tongue isn't able to move between the teeth and the lips up at the gumline to sweep food out. Coupled with an upper lip tie (restricted upper lip), pockets can form and food and bacteria can become trapped, thereby causing decay despite the best oral hygiene practices. Again, at the time we thought it was a fluke, genetic thing, especially since he hadn't started solids until later. Now I see it makes sense. In light of his history, I recently scoured all the pictures I have of him to try and find evidence of his tongue-tie as a baby -- this is all I have come up with:
Ties, like black holes, continue to exert that force on the mouth and the teeth if they aren't resolved or released; case-in-point: my husband's parents spent thousands of dollars on orthodontics for him, to only have his bottom teeth move once the braces came off and stopped holding the teeth in proper alignment. I could further prove this with a picture, but my husband doesn't readily allow me to share the inner workings of his body on the internet :).
We decided to take yet another trip to see Dr. Jesse and have Jacob's tie revised. We made an overnight trip out of it, with an adventure to the La Brea Tar Pits attached.
Dr. Jesse welcomed our whole entourage into the treatment room. While we waited, he ran in to get the laser and said, wheeling it away, "Someone has a canker sore that's needs zapping!" and left, happy to remove this thorn in a patient's mouth.
Dr. Jesse came back in to greet us, look in the other boys' mouths, and then get Jacob seated in the chair. He visually and digitally assessed Jacob's tongue function, saw there was no upper lip tie, and explained what he felt we should do for optimal restriction release. Jacob received a numbing shot that needed a few minutes to take effect, and we waited and chatted.
Since I held Ezra during the last procedure, it was Brad's turn to hold Jacob (just kidding -- Jacob is 6" tall and wears a 13 shoe). I did say that, though, and it got a good chuckle. What I intended to state was, since I held Ezra and wasn't able to watch the procedure in real time, I stood close to Dr. Jesse's shoulder to get full view of the lasering. It makes sense, but I wasn't quite prepared, that it took about 5 soild minutes to keep swiping the laser over, and over, and over the frenulum. Dr. Jesse would then readjust, regrip, and reapply the laser; soon I realized I didn't need to watch the whole thing. The other children were curious, and Dr. Jesse's assistant invited them over to both have a turn.
After the procedure, Dr. Jesse made sure all the boys (minus Ezra) received popsicles. We took care of the billing ($80), and bid Dr. Jesse farewell. We went in search of lunch and ended up at BJ's Brewhouse. Jacob ordered pizza and ate like a champ, mostly...but as he neared the end of his pizza, his eating got slower. Finally he pushed the last bit away and said he was done. I looked at him an realized he was white as a sheet! That's when it hit me: I should have given him ibuprofen before walking out of Dr. Jesse's office! I let the pain come at full-force as the numbing shot and laser affects wore off. I quickly offered him some analgesics and we hit the road toward LA.
We stayed in a hotel, and Jacob and I found a Target to get some provisions (popcorn, hot chocolate, snacks). I threw some Anbesol into the cart, hoping it might help. Jacob threw some popsicles in for good measure. Back at the room, we tried the Anbesol (it stung mightily -- he went and washed it out!), and he decided to keep up with the ibuprofen and popsicles. He had a hard time sleeping that night, but we were away from home, and the distractions were minimal.
The next morning his mouth really hurt, but he was able to drink some hot chocolate with his brothers:
We headed off for the day and had a great time at the tar pits. Jacob did experience pain intermittently, and we kept up with the ibuprofen (see a theme here?). For lunch we went to the Cheesecake Kitchen. Jacob ate a hamburger okay, and then the five of us shared three pieces of cheesecake (he had no trouble with that!).
For the next few days, his mouth hurt. Looking back now and reading other adults' accounts of their revisions, I wonder if we could have dissected a bit more what the pain felt like to get to the root of what might have been causing that sensation. As in childbirth, when you throw all the "pain" together in bucket, it is read as PAIN, but when you break down where the sensation is coming from it not only makes it easier to cope with, it helps us to know why it's there. I am sure he was feeling soreness at the site, but was he also feeling tenderness as his tongue moved in ways it never before was able? Was any of that the after-effects of tensing during the procedure, which caused lactic acid build up he was feeling now? Referred pain signals to areas that weren't even affected? All we knew was, he called it pain, and we treated it as such. There is science behind controlling pain for speedier healing, so I am not opposed to doing what works for him. Being that he is the size of a grown man, his frenulum was thicker and required more time to release.
I am trying to get him to write up his experience in his own words, but that may take some bribery on my part, or extra credit on his English teacher's part. But who knows, maybe it'll turn up and you can read how he felt about being tongue-tied and then released?
You know how they say, “Wear sunscreen? Well, let me be your cautionary person-writing-this-blog-post and say, up front, WEAR YOUR SUNSCREEN. On that note of “The more you know” (did you just hear the music?), let me also share that we need to watch our skin for more than just those changing moles we always hear about. Yesterday I had a Mohs procedure on a superficial basal cell carcinoma on my face (yes, skin cancer). My only clue this was something that needed attention was the fact that, all summer, I had this spot on my nose that would scab up for a week or so, and then heal. Scab, then heal. Scab, then heal. It was a shiny piece of flesh-colored skin that maybe looked a bit callused – no pigmentation, no mole appearance, just a regular area of skin that looked and behaved a little differently. A visit to my dermatologist revealed it was problematic, and that leads us to the Mohs procedure.
In order to fully get the root of the tumor, a Mohs surgery can be lengthy. The skin is numbed, the surgeon draws, and then they cut. They take that piece of tissue and essentially put a cross-hair on it,
mapped to match the area from where it was removed. This is examined to see if all the bad cells are gone (I never said I was an expert). If they see anything remaining on the sample, they know exactly where the offending tissue lies; my surgeon had to come back one more time in true, if-at-first-you-don’t-succeed fashion. There is a wait time of 30 minutes between each sample, which is why this isn’t generally an in-and-out procedure.
After this was all taken care of, I expected my doctor would just swab some antibiotic ointment and slap a cutesy Band-Aid on and that would be it. But I was wrong. I actually had to go to a different part of the building. “I’ll meet you over there, “ my handsome, thirty-something, Mediterranean (Middle-Eastern? Spanish? Who knows) hunky doctor said. Then a nurse walked me through some doors, shoved some things into my arms, and said, “Go ahead and put your clothes in the bag.” Um, what? I am just getting my nose bandaged!? What’s going on?
In the shock of suddenly realizing I needed to strip down, I couldn’t remember if the gown was to open in the front or the back. I tried it one way, spun it around, then twisted it back the first way. Finally with it half on, fabric clenched in my hands to cover my behind, I stuck my head out to call, “Hey, what’s the story on the gown? Open in the front or the back?” The back, definitely the back.
I continued with my booties and the ever-lovely surgical hair-net thing. I was placed in a bed and my nurse brought me a warm blanket -- other accoutrements included an automatic blood pressure cuff, and a pulse ox on my right index finger. My nurse sat and chatted with me for a bit, over such everyday topics as allergies to any drugs (none), was I supposed to take my bra off, because I did (there are so few places outside of one’s own home where I can do this, so why not? But no, it was not required), and the fact that we both were breastfeeding mothers (can’t remember how that came up).
I was actually wheeled, wheeled, I say! into the surgery (that sounds so Doc Martin, but unlike the European definition, this was the place in the surgery center where they do surgeries, not the office where docs do visits). When my doctor came in, I was kind enough to remind him that it had been a couple hours since last my nose was bee-stinged beyond feeling, so I would love some more drugs to numb that region. Here is the comment that started it all: “I think I have a pretty high pain tolerance, but I don’t want to feel this if I don’t have to.” His response was, “Oh, why do you think that?” I shared I had 4 babies with no pain meds. He and the two nurses all gasped. Oh, I had one more coming, “And the last one was born at home.” My nurse fainted to the floor.
Okay, not really. But I they were still abuzz with a lot of questions, that all sounded like “Why?” (Let me come down off my high-horse now.) “I wasn’t planning to have my first without pain meds. In fact, I said, ‘I have seen women give birth naturally, I think it’s pretty crazy; I am totally getting an epidural.’ Well fast-forward to an unneeded induction, and I wasn’t able to get an epidural. My fear of throwing up won out over my fear of having a baby, so I somehow was able to give birth to my first baby without an epidural or narcotics. It took some time to work through mentally, but eventually, I was happy about it.”
By this time in the surgery, my bed has been lifted up, the doctor has cleaned the left, upper quadrant of my face with iodine, my eyes stinging from the closeness of the fumes, and my face has been covered with a piece of paper with a circle cut out of it so only my nose is exposed.
I continued on…“With my second baby, I wondered what could birth be like if I actually planned to not use any medications? I got a midwife who delivered in the hospital, and I waited to go into labor on my own. Third baby, the same. Fourth baby, we moved here, there were no hospital-based midwives, so I found a licensed midwife who came to our home to help us have our baby there.”
“Why would someone choose to not have pain medications? It is painful to have a baby!” he stated, with much authority (at this point, I did question how he knew this, had he ever experienced it? To which he conceded, no, but he had seen it a lot). So I asked him this: “Why would someone choose to climb Mt Everest?”
“That’s different,” came his reply, “I can understand that. You want to see what you are able to
accomplish physically. You are challenging your body, working toward a goal...” My pulse-ox’d finger interrupted him, pressing, pressing on its imaginary quiz-show buzzer – or maybe it was my voice -- “DING DING DING! You got it!”
I couldn't see him because my face was covered, but his hands paused in their stitching. “I…could see that,” he came around, slowly. The hands resumed their stitching. “I am not sure what the big deal is about drug-free birth though. There is so much pressure to have a natural birth, but we don’t have the longitudal studies that show epidurals, or even c-sections, have life-long health risks.” On the spot, under the cover of plastic-y-paper, I couldn’t think of anything incredible to counter with. I did cite that babies born via cesarean birth have higher levels of allergies, and that was about all I could think of.
I joined him, then, because I do feel it’s the truth, “There is a lot of pressure for women to go all natural, I see that. It is very similar to the pressure we put on women to breastfeed -- ” Okay, this is when he cut me off!
“ – But those stats are there, we know breastfeeding is beneficial, we have that information.” Interesting! Super, hard-cord breastfeeding advocate, not so much on the normal birth platform! I decided, since I couldn’t present any compelling evidence-based studies or data from Cochrane, I would just keep it simple and stick with his line of thinking. “We are humans, though, and we know as mammals, breastmilk is the optimal, species-specific diet for our newborns.” He agreed. "Doesn’t it stand to reason, then, that vaginal birth, as unhindered as possible, is the norm for us as well? And even though we have the option for epidurals and cesarean births, that vaginal birth would provide the most optimal way for our babies to be born?” Honestly, I can’t remember what he said after that, only I know he wasn’t trying to refute anything.
The cover was lifted off my face and it was time for the nurses to step in and dress my wound. As he stepped back to let them take over, he asked, “Are you a medical professional?” I paused before my
answer, and then said, “No, I am a birth doula, a childbirth educator, and a La Leche League Leader.” He shook my hand, nodded his head to me, and then departed to fill out my discharge papers.
What fun! It made all those 5 bee stings to the nose worth it. I can actually say, due to that conversation, I rather enjoyed my day at the dermatologist. The staff was incredible and attentive (and I am assured my scar will be minimal). You never know where great birth conversations will happen! But the opportunity to have 20 minutes, one-on-one with a surgeon (albeit a derm surgeon), was pretty darn fun.
We decided to see Dr. James Jesse in San Bernardino, CA. It was a four hour drive for us, and to ease the stress of travel, Brad, Ezra, and I drove down the day before and stayed in a hotel.
During my Virtual Adventures in Tie-Land, I met a LLL Leader and IBCLC who lives about an hour south of me, Julie Huisjen. She was the one who really planted the idea of visiting Dr. Jesse and seeking laser revision for the ULT and PTT, as opposed to scissors for the PTT alone. As much as I didn’t want to travel that far, I came to the realization that a trip to Dr. Jesse was the way to go. As a bonus, Julie asked if she could come and observe the procedure, and I was pleased for the opportunity to meet her and have additional support.
Julie was waiting for us when we arrived at the office, and although we just met, I was grateful for her presence. When Dr. Jesse came to our room he was friendly and up-beat. He examined Ezra and agreed that we could benefit from having the ties revised. He explained the procedure, answered questions, and was appreciative of Julie’s and my breastfeeding background.
I sat in the dental chair with Ezra’s head on my left shoulder. I held my arms over Ezra’s chest, thereby pinning his arms but allowing his feet freedom to kick. Dr. Jesse numbed Ezra’s mouth, and then we sat and chatted for a few minutes to allow the anesthetic to take effect. Dr. Jesse was very personable with a great sense of humor. We asked to video the procedure and Dr. Jesse welcomed it -- that way I could watch it later.
Two assistants helped, one holding Ezra’s head behind us, and another to the right of us who was holding the spit-sucker (I am sure there is a technical term for that!). Once started, the actual procedure took less than 5 minutes. Ezra cried and moved a lot, but I knew he was probably more bothered by the restraining of his head than the laser surgery happening in his mouth. There was a little blood to be blotted with gauze, and that was it!
I sat up and looked at my fat-lipped baby as Dr. Jesse said, “From here on out things will get better.” I asked how soon I could nurse him, and smiling Dr. Jesse answered, “Moms like you nurse right away.” We tried, but Ezra’s numb mouth made latching difficult. I decided we would try again later. Dr. Jesse said babies cry for about 8 minutes post-revision, and then they are usually okay. We happened to have the appointment before lunch, and Dr. Jesse was kind enough to talk to us for another 30 or 40 minutes, generously sharing information, stories, and jokes.
We went to lunch and I nursed Ezra for the first time. I could already see a part of his upper lip turned out that I had never seen before – it wasn’t a huge flanging or anything, but it was something. I didn’t notice relief, though – if anything it felt a little tighter (read: worse).
Ezra was acting fine when we hit the road and headed for home. 30 minutes from home he began crying inconsolably. We stopped at Costco and I tried to nurse him in the car. He would attempt to latch, but then he acted like his mouth hurt (which I could believe!). I was worried about him not nursing, but they told me at the office he might not want to nurse too much in the first 24 hours, so it wasn’t a surprise. I decided at that point to give him Tylenol, we walked around Costco for about an hour, and then he settled down to nurse. I still couldn’t tell a difference in my pain level.
I gave him one more dose of Tylenol later that evening, and by the next afternoon, he seemed back to normal. Dr. Jesse’s office instructed us to stretch the upper lip and sweep under the tongue once every hour Ezra was awake. We went to a chiropractor the next day, and I have never seen Ezra so melty afterwards, if that’s a word.
Ezra’s “reflux” stopped almost overnight. He would still spit up, but it was nothing like it had been before. His clicking was mostly gone. That strange (cute) way he had of chewing up to latch on the nipple with a grimace on his face was gone, as was his way of sliding off the nipple while nursing. He seemed to be doing better, but I was still waiting…
Sometimes he didn’t mind the stretching, other times he hated it. One thing I figured out was to do the stretches as far away from a feeding session as I could, or we might have a hard time nursing afterwards.
One week passed and although Ezra seemed happy, I wasn't noticing anything much more than not having to hold the breast for him every time he nursed. I am so grateful for Tongue Tie Babies Support Group, there I received realistic ideas about how things might shape up for us over time. Although some women note instant relief after their babies' revisions, it seemed to me for every one who had that experience, there were 4 women who said it took many weeks for full effect. If I hadn't known that, I would have felt the surgery was a waste of time and money. So I kept up with the exercises and tried to encourage wider and deeper latching.
Speaking of money, in my haste to get this done I didn't ask Dr. Jesse's office the price of the procedure or what my insurance might cover. As Ezra was a newborn, I hadn't thought to sign him up on our dental plan, which would have covered the surgery. I was surprised to have to pay out-of-pocket for the surgery -- it was $400. I was happy to do it (although I will be even happier if our medical insurance reimburses us some!). Realistically, that is an affordable price for this procedure, in my opinion.
Two weeks passed and I wasn't feeling better. The nipple shape still showed some compression stripes after nursing. Before the revision, it was more painful to nurse on the left side; after the revision, it was more painful on the right side. This was not a miracle fix for me. Again, I was uplifted by the stories of other mothers; I tried to be patient, continued with the stretches, and kept correcting shallow latch-attempts.
Around three weeks, I started to feel a shift. One thing I have done since the very beginning with Ezra was talk him through our nursing sessions. Although this may seem silly, as in our family we already decided our dog is smarter than our baby (for now!), there is evidence that shows babies can learn when moms talk to them (parent–infant synchrony, or affect synchrony). The left brain is the technical, watch-the-clock, math side, while the right is the emotional, easy-breezy side. It isn't really possible to get our babies to learn algebra or memorize a linear sequence of events, but it is possible for babies to absorb behaviors and coping strategies connected and displayed by their mothers or other caregivers. It's like a baby's first positive self-talk -- I let him know, not only with words but also with emotions and facial/body language, how we can improve our relationship. It can't hurt, right? I am not attributing our breastfeeding success entirely to this concept, but I feel it certainly can't hurt!
How this looks: When Ezra would latch well, I would praise him and relax and smile. If his latch needed adjustment, I would say something like, "Okay, let's try that again. Open you mouth wider so it doesn't pinch."
The most fun for talking and nursing was in a laid-back position while I was on my bed. I would lie in bed and prop Ezra's upper half on my upper half, with his legs basically standing on the mattress. Babies have about 20 reflex responses that kick in when they are on their bellies as opposed to their backs, and one of these is called, aptly, "stepping." As Ezra would step to get closer to the nipple, reaching it chin first and then latching over the nipple with his upper jaw, his upper lip would naturally be in an ideal position to flange open. We were also en face, ready to engage and exchange smiles, head bobs, and happy eyes.
By four weeks (two days ago) I could safely say I believed we were cured. So inappropriate in an essay, but I feel that statement deserves a smiley face. This is where I go all Dorothy on you to figure out what I learned from my journey:
1. Find support. It wasn't until I connected with the Facebook group that I found experienced, real-life helpers in my area. Not only was this beneficial in assessing our situation, it also led me to the best practitioner for the job. If you haven't already met with an IBCLC experienced in ties, a group like Tongue Tie Babies Support would be a good place to ask for referrals in your area.
2. Get a second opinion -- and a third, and a fourth -- until you feel your gut agrees with what the professional is telling you. You have inner wisdom -- use it! Everything we are told is filtered through someone else's perception and experience. The first idea to pop into one practitioner's head may not be the same thing to pop into another's. In healthcare, the difference between wrong and right can sometimes be a simple difference of opinion.
3. Don't judge a book by its cover. And don't let your healthcare practitioner do the same. This means, the appearance of the tie/s shouldn't be more important than how the tie/s affect breastfeeding for mom and/or baby. The first doctor we saw (who was also an IBCLC) said Ezra's tongue-tie did not look severe, but due to the clicking, sliding, and pain, warranted treatment. If your practitioner doesn't value function over form, you may want to seek another opinion.
4. Continue to work with your baby patiently. It stands to reason the longer your baby has nursed with the tie/s, the more time he may need to get to a better place after revision. Resolution of the ties themselves is only the first part of the process; for continued progress, stretches help avoid reattachment that could come with normal healing. Your baby may also need to relearn how to breastfeed with this new and improved equipment, and that is where working with an experienced IBCLC can be integral, as well as getting bodywork done for your baby. I also chose to do tongue exercises with Ezra that are found in Breastfeeding Answers Made Simple: "Walking Back on the Tongue," and "Pushing the Tongue Down and Out."
5. Add your baby to your dental insurance. Or, be prepared ahead of time. It may just be me who makes that mistake ever, but still, I wish someone would have reminded me of that 4 weeks and, oh, 3 days ago. :)
♥ four young boys and a boy dog (offspring)