I have often thought I need that wonderful old t-shirt, "Frankie say relax!", to wear when I am teaching classes or attending a birth. Could you imagine? I often joke that telling someone to relax is like telling someone to calm down -- it isn't helpful, it irritates people, and it often feels accusatory or as if someone overreacted to something. In labor we must learn when to actively relax, and when to work -- here Connie offers her thoughts on the subject.
If you were to believe the movies –- coping in labor means that you look like “The Buddha of Birth.” You sit in a lotus position, gently breathing, eyes closed. People in the birthing room often think that if the laboring person is doing well, they are completely quiet and deeply relaxed during each contraction.
While that might be nice, it is an unrealistic expectation of someone who is working hard! And that is what Labor is – Work! When I go to the gym, I see lots of people working hard. They don’t look relaxed at all. They make noises, move around and look to others for encouragement and assistance. Why do we expect less of a person giving birth?
Real coping in labor often looks and sounds like someone at the gym, especially during a contraction. But remember, a contraction lasts for about a minute. Then there will be several minutes that there is No Work to Be Done because the contraction is over. That is when we can relax!
Having a doula there to remind to you let go, release, and relax between contractions helps you to feel more in control. It allows you to rest and restore, so that when the next contraction comes, you have more energy to work with it -- more confidence and less fear.
It may help between contractions to think: “My forehead is relaxed. My shoulders are dropped. I sink down into my pillow. I am at rest.” Your support team can say these words to you to help you relax when you actually need to. In this way, then (if you want to be!) you can be “The Buddha of Birth”!
Connie Sultana is grateful to the 900 families that have taught her about relaxation in birth. Connie is a DONA Birth Doula Trainer, former member of the Board of Directors of DONA, a Lamaze Childbirth Educator and a trainer for Passion for Birth, a Lamaze Accredited Childbirth Educator Training. Learn more about her by visiting her website.
I have always loved music. I love when families incorporate music into their birth experiences. In fact, the other day I was at a postpartum visit where Mom and Grandma were asking all sorts of important questions about life with baby, and Dad interjected, seriously: "I have a question..." Long pause. "Should I be playing her country music around the clock now?" I laughed, and answered back with a question of my own, "Do you listen to country music? I wish I would have known that before I agreed to be your doula." They do listen to county music, and their baby's birth happened over the weekend of Stagecoach Festival, an important event in their lives as music lovers. As a Music Therapist and Birth Doula, Kate offers compelling reasons and creative ways to bring music to birth -- I know I can't wait to learn more.
Music is an accessible, adaptable, and valuable tool for comfort during birth because music is a whole-brain- whole body experience. A holistic resource like music can reach the many needs of a family in labor: physical, neurological, spiritual, emotional, social -- even environmental by shaping the birthing space. There are so many reasons music for birth is just.so.awesome! And the music we choose for birth can be really impactful and powerful. As leaders in health care, music therapists have demonstrated how accessible and enriching music can be for improving quality of life, rehabilitation and healing. As a doula and music therapist, I’m entrusted to bring the music to the birth environment and I use it as therapy -- a prompt for change, discovery and self-expression. To be clear, music therapy for birth comes in many forms. I use my voice, my body, and at times various instruments through live musical interactions whenever appropriate. Yet, most often during the labor and delivery stage, music enters the space as pre-recorded playlists. Music is more portable and higher quality than ever before. So every time my phone beeps or buzzes in the middle of the night, I make sure my speaker is charged, my client’s custom birth playlists are downloaded, and that I am ready to help deliver one of my favorite birth bag resources: the music.
So for the birth workers and parents out there who are considering using music as birth support, I’ll share my top three reasons why the music you choose in childbirth matters.
1. Music can support comfort and relaxation during birth to reduce pain perception, optimize hormone release and steady breathing. I was privileged to attend a birth where the mother, so calm and so peaceful, took deep, slow, controlled breaths and did not need to push her baby into this world. Instead, the power of her breathing and the rhythm of her pulsing contractions, very simply, very gently, guided her baby out. Her vocal and guttural instincts were validated through the singer and supported by her beautiful lyrical mantra. The rhythm of the music helped the mother’s body entrain and progress, to open and release her baby gently into this world. Music has been shown to support, entrain and influence many dimensions of childbirth. So if there is music out there that will support this, do you think there is music out there that might work against the birth process, making birth more painful, longer and unsteady? Most likely there is, but this will be different for every person. This is why it’s important that doulas and birthing families recognize how every song you plan to use makes the birthing team feel, move, breathe and think -- tall order and a big responsibly. It is important to know favorites and to know what music typically is not preferred. It’s also important to know the difference between just streaming any “birth” playlist, and using carefully chosen songs to purposefully impact birth.
2. Music supports ANY type of birth. Regardless of what type or style is preferred, music can be incorporated into any birth plan and pairs nicely will ALL childbirth techniques. I collaborate with couples to create the most customized and comfortable playlists for birth no matter what type of birth they have planned. Many of my tips for using music work no matter how families plan to birth; active breathing, passive hypnosis, partner supported, even planned surgical deliveries. Everyone’s birth rhythm is different. This is why the music should reflect the goals for birth and the stage of birth. Feel like movement will make a difference? You’ll need a steady rhythm or a beat. Need to sleep? Try a single instrument or vocal tone to help lull the brain to deep relaxation. Epic contractions? Why not try that romantic soundtrack for support of vocal moaning? As a music therapist, I provide guidance in making the best song choices from preferred and familiar music to shape birth playlists to suit birth plans and personalities while maximizing the therapeutic potential of the music to support birth at home, in hospitals or during cesarean sections. In fact, music in the operating room and a doula by your side can make cesarean births calmer, more memorable and family centered.
3. Music will create unforgettable bonds with baby before and at the time of birth. As a whole brain stimulus, music is a window into great realms of creativity, self-awareness and healing. I’ve witnessed families experience the importance of prenatal sound together in music, making art, moving through the stages of grief and life and love; all initiated by a song. At the moment of birth the music can become part of the baby’s and parents' permanent memory landscape, a neurological imprint if you will. A carefully chosen playlist of songs can help families revisit the memories at any time, rejoicing in the happiness or healing from difficulties that were faced in labor. Along with supporting the biological imperative of bonding after birth, music can also etch the vibrations of your family birth song in your minds and on your heart, forever. Parents are always reporting back to Creative Childbirth Concepts® that they continue to use their custom playlists as they transition into the reality of raising a baby. Together they continue to explore and use their favorite music as a resource for parenting. Parents report music was an integral part to their therapeutic prenatal preparation. Their music playlists were magical in how they connected them as a team, shaped their environment and created lifelong memories as a soundtrack to their birth. The music helped heal their past birth experiences. The music helped them anticipate their fears and anxiety and work through them by supporting imagery and reflection. The music was “theirs” and the music was therapeutic. It CHANGED their births. This is why I believe the music we choose for childbirth matters.
I believe in the power of music at the moment of birth. I believe in the power of music for supporting the prenatal experience. I believe in the power of music bonding, to process fears, to address anxieties. And I believe in you: I trust that those of you who use music, make music, and incorporate music into birth already are capable of making awesome choices and using intuition when working in the moment. I trust that those of you who are invested in learning more will seek knowledge and integrate it into the best music choices possible. But I also believe it’s important for you to know that there is a growing number of perinatal music therapists out there who are here to guide you whenever advice is needed. We really do want to help make birth better through music. Connect with me and I’ll share my favorite birthing music with you!
It’s your birth. Be Creative.™
Kate Taylor, MA, MTBC is a birth doula, board certified music therapist and owner of Creative Childbirth Concepts® in Chicago IL. Kate provides perinatal music therapy services and assists families through labor and delivery as a birth doula. Kate provides creative supervision for music therapists and mentors birth professionals around the globe. She is passionate about educating others about music for childbirth and helps empower families through music, movement and other creative arts during infertility, pregnancy, birth, even during new parenting adventures. Visit www.birthmusic.net for more information or connect on facebook with: Creative Childbirth Concepts® Music Therapy & Doula Services. In depth YouTube interviews, blog radio interviews, and audio podcasts of Kate are also available for you to learn more about her music therapy assisted childbirth practices, doula work and personal journey as a birth worker.
As I compose this, my washer is going full-steam-ahead with a vomit-covered, king-size comforter in it, my 8 year old lies on a well-protected couch (his bowl on the towel-covered ottoman), and Kipper -- a long ago forgotten, feel-good kid show -- streams on the TV.
My little guy is sick.
Standing vigil with him last night, I was reminded we can make our pain worse or we can make it better, and a lot of that power lies in our brains. Like many of us, he doesn't enjoy being sick. He tried to rest, but when his stomach started to rumble, he grew restless, rocking his legs back and forth with anxiety and anticipation. Not wanting to wash any more linens, I encouraged him to move to the bathroom, where he would pace back and forth in front of the toilet in his attempts to avoid the inevitable.
"I don't like to throw up," he said, tears sliding off his cheeks.
"I know." I gently rubbed his back. I wasn't sure how much of his pain was from his stomach, and how much was from his brain. Sure, he was coping, yet he was also masterfully avoiding his body's natural impulses to move through this illness. Fear -- he was scared.
"When you worry so much about being sick, it can make your body feel worse. I think if you can take deeper breaths and try to let your arms and legs be lazy and heavy, then you can really hear what your stomach is saying." We both sat on the edge of the bathtub as I mirrored the deeper breathing and lazy legs while continuing with my fingers on his back.
We repeated this ritual many times in the night, and a shift occurred: knowing he could calm parts of his body and mind led him to feel more secure in what was actually happening in his tummy. He was able to better feel the illness, as it would come and then go, and this helped him rest in-between.
See any similarities to labor here?
Really what this describes is the fear-tension-pain cycle. In my classes we demonstrate this with a very long piece of elastic tied in a knot -- like a very, very long piece (10 yards?). I offer it to three different participants, so when held, it makes a giant triangle in the middle of our classroom. I then assign each of the three to be either "fear," "tension," or "pain," and have them relax their arms so the elastic falls to the ground, and we read over a few situations. As one trigger point becomes activated, that person pulls back on his or her piece of the triangle, then the next trigger is activated, and we see the result when the third person has to hold his elastic tightly to prevent it slipping from his hands. As we get to the problem-solving part, that person relaxes his or her part of the triangle, until it is loose and dragging the floor again.
"Mary is laboring at home. During her contractions she leans over her dresser and her partner applies pressure to her lower back. She would say her pain level during contractions is a 3-4, and she feels she is coping well. Soon she reaches the point where it is time to go to the hospital. She and her partner gather their things and head to the car."
What's going on here? And how can we short-circuit the fear-tension-pain cycle? The biggest difference is, Mary's coping strategy has changed -- she is no longer upright and mobile, being comforted by her partner's hands. Now she is sitting, strapped into the car, and on her way to the hospital.
A change in the level of PAIN, brought TENSION to her body, and FEAR about the future. Mary's partner can help her through this verbally -- reminders to relax and release tension, seatbelt caused hindered mobility, labor not necessarily picking up but changing sensation from changing position, etc. Relaxing can reduce the TENSION, while knowing this information can speak to the FEAR, thus helping to change the intensity of the PAIN, interrupting the cycle.
Let's look at another situation (without the pictures -- as a side, I am currently reading Unfolding the Napkin, and I decided to follow the author's advice about processing visual information and creating my own pictures :)). Mary is now in the hospital. She is coping well by sitting on a birth ball and rocking through her contractions. She hears a scream down the hall and suddenly she has a FEAR response; consequently, she TENSES, and her PAIN increases. What can help here?
Address the FEAR with words. Remind the woman, just as she has a birth team taking care of her, the lady down the hall also has professionals aware of her situation. The screaming might not actually have anything to do with a level of pain or danger -- it may just be how that lady chooses to cope, maybe she is just a screamer? Hands-on touch can offer physical reminders to relieve TENSION in areas of her body, and her PAIN level can go back to where it was before her scare.
My little one is on the mend, the laundry is done, and I got a nap this afternoon. Watching him struggle was intense as a mom, just as it is when we are with laboring moms. It was an amazing tool to offer him, navigating through his own experience of the F-T-P cycle, by helping him recognize ways to make himself feel better in his body, by simply using his head.
I'm an educator that calls pain "pain." I think that is how most people perceive it. I used to feel the "p" word was bad, and I used all manner of euphemisms to avoid saying it. When you teach almost 2000 hours a year, you hear back from a lot of families. When more than one former student came back asking me why I didn't just call it "pain," I decided to adjust my viewpoint.
I do have an activity where I "break down the pain" into sensations, involving a bucket and water. The intent is to dissect each sensation, that when clustered together, we call "pain." I find it makes the physical sensations we experience more recognizable and less scary. But I digress!
I begin this activity before class, really, when I bring out the Hot Wheels track pieces absconded from my sons. When the first couple arrives, I ask them to put the track pieces together. Once finished, they are laid on the ground, the starting line by me, the finish line at the back of the classroom.
You would be surprised how happy it makes people feel to see Hot Wheels tracks and cars on the floor of the classroom where they are learning about how to have baby! This is generally class 3 of our 6, when we discuss pain theories and comfort measures. This is how I share the Gate Theory of Pain, essentially, that we can make pain worse (turn it on) or make it less (tune it down) by what we think, feel, and do.
To start, I lift up the end of the track near me, the starting line, and I let a few cars loose. Unobstructed, they zip down the track like greased lightning (hello, Grease fans!). Then I ask, "What have you heard about, in books or from your friends or family, that helps with labor pain?" People start shouting things out. "Water!" Okay, get your Post-It notes out and write "water" down on one. Choose a partner to come and place his or her shoe under the track, and stick the note on the shoe.
Ask again. "Massage!" Same thing. Have a partner come, place his or her shoe under the track at a different point, and slap that Post-It note on the shoe. How many people you have here depends on how long your track is. Pretty soon you have something that looks like this the top image, above (except I have them continue to stand while we do the next part -- I was home alone when I made the pictures here and I opted for empty shoes).
Now repeat the exercise with the cars. Start sending them down (I use 5-6 cars). Some will make it all the way to the end, some will slow, and some will get knocked off the track. What you will see, though, is that the undulations made by the shoes (interference, right? Comfort measures) will compete with the "sensation's" ability to get to the end (the brain). We can make sure the road is clear for those sensations to fly straight up and tell us we are in pain, thereby triggering the fear-tension-pain cycle, or we can "congest" those nerve pathways by throwing in other sensations to confuse our brains about what we are really feeling...enter comfort measures and emotional support! Voila.
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?
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. :)
So in April I had a baby -- a sweet, gorgeous, pink little baby. He is my fourth baby, fourth boy in fact -- and what a scrumptious, squishy baby he is. I love him. We named him Ezra.
Out in the world and on my chest, I soon began to see if he would nurse. And he did. Victoriously. I was happy, and he was happy. My midwife and I watched as his tongue passed his lower gum line and came out of his mouth, and we both hoorayed, "He's not tongue-tied!" I have not previously had a baby who was tongue-tied, but my sister has, and it was a lot of trouble to get diagnosed and treated.
Fast forward to day three: it's 10:00 at night. I am perched at my computer, Ezra screaming on my lap as I watch how-to-latch videos through tearful eyes. Each extra-pink nipple bears a horizontal stripe of raw, rubbed openness coupled with tiny scabs, and with every suck, I tighten and cringe and cry. I hate this. I label him. He is a bad nurser.
At this point in my life I have logged 11 years breastfeeding 3 different children. I have been a peer-breastfeeding counselor for 10 years. I have a pretty well-rounded knowledge of all-things-breastfeeding, both experiential and educational. I have helped countless women in similar situations figure out how to better nurse to ease or eliminate pain. And here I sit, alone at my computer, because he just can't do it right. Because he is a bad nurser.
Being new to the area, I don't have a clue who would be a good person to call for help. I left an army of good friends and trusted resources -- IBCLCs, LLL Leaders, midwives, doulas, and nurses -- years in the making. Okay, troubleshoot: I try dragging the nipple down his face and over his nose. I try teacup hold of the nipple. I try the "flipple." I try laid-back breastfeeding/biological nursing. I keep my finger taut to the nipple to try and push/shove it further back into his mouth. I try asymmetrical latch, symmetrical latch, sideways latch, and all-around-the-clock-face latch ("would you, could you in a tree?"). I even have my husband buy me a nipple shield and we try that (incidentally, that seemed to hurt even more, as Ezra couldn't latch to the shield so he would just chew my silicone-covered, damaged nipple). Nothing works, for weeks.
I was still in great pain, but the physical damage to my nipples was not getting worse, and that made me
hopeful. I found some Hydrogel Pads I had gotten as samples once, and they helped with the healing. I figured out by latching him in football hold, nursing sessions became bearable. We would also nurse lying down at night, turning on a small light to latch, stopping to make him try again when it was really, really painful (because it was never not painful). I kept looking for answers for my bad nurser.
Aside from the pain I was dealing with, Ezra gained weight exponentially; at one stretch between weigh-ins, he gained 38 ounces in 21 days. He did spit up a lot, like a lot A LOT -- overzealous amounts of milk, often flying out of his mouth in arching streams of stinky frothiness. Keeping the nipple in his mouth was difficult, as it would constantly slide out unless I held my breast in place. Once in a while when the nipple neared his lips, this disgusted look would appear on his face, as if I had presented him with something rotten and spoiled, and he would slowly chew his way up the nipple to latch. And as he nursed, he clicked like a horse trotting on pavement.
Armed with a digital camera, I took pictures of this baby every day for sport -- ahh, the joys of the Digital Age! When he was 3 weeks old I was scrolling through the latest batch, and suddenly, there it was: Ezra was crying, eyes shut, mouth open, with a tongue that curled and cupped up. Wait, I have seen that tongue before! That's a posterior tongue-tie (PTT)! Soon after birth I knew Ezra had a thick labial frenum (upper lip-tie, ULT), but I didn't feel this was the root of our pain; one of my other babies had one and it wasn't an issue, so I dismissed it without investigating the anatomy of his mouth any further. Once I saw this picture and that light went on, I began searching online, I posted the picture on Facebook to an IBCLC friend, and my thoughts about this baby shifted: Maybe he's not a bad nurser!?
I found Cathy Watson Genna's website incredibly helpful (http://www.cwgenna.com). We had met a few years before when she was a keynote at our local breastfeeding conference, and I decided to share this picture with her. She used the term "stingray tongue" to describe his posterior tongue-tie (PTT). From her site I found a link to practitioners around the country who diagnose and treat tongue-ties. I called to make an appointment at a clinic about 90 minutes away and was scheduled about 3 weeks out.
Although I have been working with breastfeeding moms for ten years, I had not heard the term "posterior tongue-tie" until about three years ago; even then, I had not helped a mom with a PTT -- it had all been hearing and reading others' experiences. When we spoke of tongue-ties, we meant anterior tongue-ties, the obvious tethered (often heart-shaped) tongue, easy to spot, that could be clipped in a simple office procedure. While lip-ties I was familiar with, there still wasn't a lot of focus on it other than just getting babies to flange their lips out to latch.
By the time we met with the doctor (pediatrician and IBCLC), I was certain Ezra had an ULT, PTT, and high-arch palate; all three of my suspicions were confirmed. This doctor agreed to fix (release or revise) the PTT but is not a believer in touching upper lip-ties. By using scissors, a diamond-shaped cut under the tongue would give it more mobility and hopefully make breastfeeding better for us. We had Ezra at home with a midwife, and as such, I chose to decline the Vitamin K shot. This doctor wanted him to have that shot first as PTTs tend to bleed more than anterior TTs. Ezra also had a cold with an impressive cough, so it was decided we would make an appointment to have the procedure done at a later date. I left satisfied with the diagnosis and proposed treatment.
While waiting Ezra's cold out, I was hooked into an amazing network of parents and professionals who have experience, knowledge, resources, and often a unique understanding of all-things-tied-in-the-mouth: Tongue Tie Babies Support Group on Facebook. There I have learned not many professionals know how to identify ties (especially PTTs); not many professionals believe in correcting ties, especially in infants; not many professionals believe ties can interfere with feeding, speech, digestion, etc. I have seen that many different kinds of professionals treat ties, from pediatricians to dentists to ENTs and GPs -- there isn't one kind of doctor who specializes in this area, it seems to be more about education and awareness than specific training that would come with a particular area of study. While some doctors fix ties with scissors, others prefer to use lasers. Some breastfeeding moms notice immediate relief and change, and others report it took weeks for things to feel better.
Having more information and more time to think, I began to second-guess taking Ezra back to the doctor we saw. It had been brought to my attention by many people that Vitamin K, at this point, is most likely unnecessary because of his age. And I learned I might have dismissed the role of Ezra's ULT a little too quickly; at the time I didn't think to ask about the Vitamin K and the ULT as I was a bit overwhelmed by my crying baby and the (unexpected, male, older) resident shadowing the doctor as she examined not only my baby, but also my breasts.
I found a second choice, three and a half hours away, where the treatment is done with a laser; not only could we get the PTT taken care of, we could also have the ULT revised as this doctor (a dentist) does both. I am not sure what to expect, but I am hopeful this is the right step for us...our appointment is next week.
This is long! Be warned!
I think when a person in is a position to serve a woman while she is in labor, that person should have required training every few years, like a recertification, on what it feels like to have a baby. I am not certain how this certification could be obtained, virtual reality plus some sort of pregnancy suit? Actually having a baby? I haven’t figured out the logistics, but I have recently had a recertification of my own, and that is called, my fourth child.
This fourth pregnancy was a surprise. Technically, I got pregnant at a time when no one would be able to get pregnant – only I guess more like I got pregnant at a time I felt I was highly, highly unlikely to get pregnant. My last menstrual period was June 10th. I did not get pregnant until July 13th at the earliest (a time when I was waiting for my period to start), to July 20-ish at the latest; looking at the date he was born now (April 6th), July 13th seems closer to the target date…we were on vacation.
I had lots of irritable contractions combined with irritable baby movements (probably more of the latter versus the former) that would happen around 10 pm to 1 am. The week before labor began I pretty much experienced these every night and I hated them. During these times, I would have waves of panic and anxiety about the reality of actually having to go through the birth process again, and I was always grateful when they were over and I could finally climb into bed.
Friday the 5th of April was pretty normal except I had two very serious bouts of grumpiness that made me feel deeply in touch with someone who was (hopefully!) going to start labor soon -- it was like total,
irrational, not-triggered-by-much anger that switched on so fast, I knew it was something else with some other root than just me being moody.
We had pizza for dinner, and like I had for the last week, I restrained myself from eating too much (“If labor starts tonight I don’t want to be too full,” was my rationale). I had two pieces and then cut myself
off. I took a little nap in bed, which I hoped would actually be “going to bed,” but I woke up at about midnight when I couldn’t ignore the antics of Wild Baby any longer. I watched TV a little and sat on the ball to try and bounce my guy into a calmer state. At 1 am I decided to watch the last episode of Mad Men on Netflix so I would be ready for the new season, with the intention of going to bed after that.
At 2 am, just when I was settling into sleep, I realized I was contracting, and these contractions felt different. They came 5-6 minutes apart, were totally manageable, and lasted about 40 seconds. I tried to sleep, but I was also mindful of needing to recognize true labor so I could get my sister and my mom on the road from two and a half hours away if this really were it.
Everyone was asleep, and as long as I was okay, I felt no need to wake them. I was feeling hungry, so I ate half a lemon Chobani (again, not wanting to eat a lot) in the morning quiet. I did call my sister at 3 am to let her know it was go-time. I labored longer, in the quiet of my living room, tending to small errands and tasks between contractions. At 4 am I woke Brad up to tell him I was in labor. He came out to the living room and asked, “What can I do?” and I immediately answered, “Take the recycling out, it’s driving me crazy and I have contemplated doing it myself for the last 2 hours.” I was hoping he would just lie back down on the couch and snooze a little, but he was up and ready to go.
I thought I would wait to call my midwife until 5 am, but at 4:30 my contractions began to get stronger and longer and closer together, just as they should, and I finally had some show. I phoned Linda to let her know I was in labor. She asked me a few questions, and then said she would be over soon. She lives about 40 minutes from us.
At 6 am, Linda arrived, and things were beginning to feel real. We had our tub set up in the dining room and I was feeling a pull to climb in, but I didn’t want to stall labor if I wasn’t that far along. I asked Linda to check me and she said I was 3 centimeters (“Not quite active labor!” I thought with a little disappointment), about 90% effaced, baby maybe at -2 station? I can’t remember that part. I mentioned I wanted to get in the tub, but I should probably try the shower instead (so gravity could keep helping my labor), and Linda agreed.
I got in the shower, and I really don’t know how long I was in there. The water felt great on my belly and during contractions I would swing from side to side so the water could fan over me. In between contractions I alternated putting my foot up on the side of the shower to lunge, in case my baby was posterior like his two brothers before him. Soon I found I had to vocalize during the contractions. I was in the bathroom alone and I had a lot of time to think. The thought that kept coming back to me was, “All is as it should be,” which was part of a prayer Brad had said earlier in the week when I was feeling really overcome with fear. I rubbed my belly and talked to the baby and told him to hurry, it all felt like it was happening in slow motion.
When I got out of the shower it was about 7 am and Linda checked me again. I was 5 centimeters. I went straight for the tub at that point, dropped my towel, and climbed in.
Jacob and Jonas were awake and had been for a while. Soon Isaac woke up and came straggling out of his bedroom in his standard sleeping attire – undies and a t-shirt. Brad told him we had company and he might want to put clothes on. Before Isaac woke up I remember Brad asking Jonas if he knew why Linda was at our house so early? Jonas admitted he didn’t, and we made a joke about Linda just coming for an early-morning visit. Brad then said, “Your mom is going to have the baby today.”
I looked to the tub for the relief it had brought in the past; with both Isaac and Jonas I got into the Jacuzzi tub at 5ish centimeters and after an hour was at 9ish centimeters, and I was hoping for the same, with the addition of having the baby in the water. After 30 or 40 minutes it seemed the tub wasn’t going to work as I had planned. I had intense pain in my lower abdomen to the point of not being able to sit in a relaxing position, so the whole time I was in the water I had to be on my hands and knees, and I didn’t want to stay that way much longer. Also, Brad started making pancakes in the kitchen.
At about 7:45 my mom, sister Shiela, and her two boys arrived. I headed to my bedroom, finished with the tub. Linda had set things up around the pool in preparation of a water birth, so some rearranging was in order, moving things to my room, getting equipment ready if needed. Once in my room it was just Linda, my mom, Shiela, and I. Brad had the boys going with pancakes and if they were making any noise, I sure didn’t hear it.
I asked someone to bring the piano bench into my room as I was laboring standing up, and I wanted to continue to lunge in case I had a malpositioned baby (which I don’t think he was, but I was a little gun
I think I had Linda check me again, and I think I was 7 centimeters? I am not really clear on this part. I wasn’t ready to sit down, so I continued to labor standing up. Shiela was a super doula – she would squeeze my hips during my contractions, and it brought so much relief! One thing I know about that double-hip squeeze is, it is hard to do when you have to press your arms together at the height of a woman’s hips – you get tired fast, and the laboring woman usually doesn’t want you to stop. If the
mom can get on her hands and knees on the floor, you can squeeze her hips with your own inner knees by straddling over her back, but I didn’t even want to try or offer that as I didn’t feel good in that position.
Over and over, a contraction would come, and I would tell Shiela, “Hips, hips, hips,” and she would start
In reality I have no idea what kind of time span this all happened in, I say over and over, but maybe it was only about 5 contractions? Or maybe it was 10?
I did finally sit on the bed for a bit. I remember taking my watch off and handing it to Shiela with the feeling that this was taking too long. I know for a fact I wasn’t looking at my watch or paying attention to how long it was taking in a linear fashion, but it was more some sort of symbolic resignation that I
would try to just flow with the timetable my body and baby presented even though I am as impatient as they come; in the last picture of me with my watch on, I see the time is 8:55 am.
I decided to visit the toilet. I spent a couple of contractions there, and Shiela was with me. She said my noises changed and she knew I was getting closer. As I sat laboring on the toilet, I opened the shower door next to me and contemplated getting back in -- I was looking for anything to comfort me at this point. Then I decided to see if I could feel anything inside of me, so with one finger about one knuckle in I was shocked to find something! “Is that a head?” I asked. But then I realized it was a bulging bag of water, with a head behind it. After all the years of hearing practitioners say, “I feel a bulging bag of water” (which I did remember Linda saying when she checked me last), I finally knew what that felt like and what it meant. I think I almost gingerly hopped off the toilet at that point, feeling remotivated.
I had one contraction standing up, with Shiela at my hips. Then I had another, and my water exploded all over the floor. There was a little meconium but Linda said it looked old and there was no reason for concern. I finally climbed into bed.
At this point I knew it would soon be time to push. I suddenly had the need for Brad to come and be with me, so I called to him and patted the side of the bed next to me, I just wanted him to sit with me and be near. Shiela was on the other side of me, and Linda was at the foot of the bed. My mom was by the door, ready with the camera, and the boys were in the living room playing Legos (again, I never heard anything from the boys, and there were 5 of them. Actually, I think after they ate pancakes they walked to the park with the dog to play for a bit. But I do know when the baby was born, they were playing Legos in the living room).
I did begin pushing at some point, and Linda said I still had a rim of cervix and she was going to try and move it, and I was totally fine with that because if anything was holding this baby up, I wanted it gone. So for a couple of contractions she worked on that and I guess it went away. I was pushing with such intensity but it felt fruitless. I truly felt nothing moving or changing and I imagined pushing forever
and not making any progress. It was at this point that I remember thinking, “I should have gone to the hospital so I could have the drugs!” (Interestingly enough, when I had my babies in the hospital, I never thought to ask for drugs, because I know if I had had the thought, I would have asked; maybe at home when it is not an option, my brain safely went there, just as a way to cope and vent.) Brad and Shiela were helping me pull my legs back during the pushing. Instead of rolling my chin to my chest, which I have helped women remember who-knows-how-many-times, I arched my head back against my pillows. I also had my body twisted in some way, crooked a little. Linda gently reminded me to get better aligned (with words and heart I could understand at that point), while giving me positive encouragement for this task I had to undertake.
Linda! What else could you want from a midwife? Really, not one thing. As a doula, I get really uncomfortable when people say, “Stacie, I couldn’t have done it without you.” Because, come on, you could have, and you would have. I don’t want anyone’s birth experience to have me entangled as an
essential ingredient; it should be all about the mom and her family, not me. But I have to concede that
when the right person is helping you with the right words and attitude and presence and spirit, it helps make the experience even more amazing, if that is possible. When you have the right midwife, the feeling is similar to being in your own home – the comforts of being in your own bed, using your own bathroom, lunging on your own piano bench – Linda was a natural extension of that. It felt right that she be here, in our home, unobtrusively watching over the birth of our baby.
The support Shiela gave me was also invaluable. Family members don’t always make the best doulas.
Shiela actually has taken a DONA-doula training, and that coupled with what she knows about me (just about everything), made her perfect for the job. She stayed by my side, she gave me verbal encouragement, she wished she could help me more. The truth of the matter is, only the mother can have the baby, but she doesn’t have to be alone while she is having her baby. I will forever treasure that my sister was there to support me during one of the most intense experiences of my life.
Pushing was hard, it was really hard – it seemed harder than it ever had been. I know I was lost in my head, and in there, the storm was raging. Every push came with screams, I hate to say it. I have never screamed with any of my other babies. And also, I cried, which was something new for me. In hindsight I probably could have pushed more effectively keeping those screams to myself, but they just came out. I know the boys didn’t appreciate the noise (although they all later admitted they weren’t scared), I am thankful my neighbors didn’t call the police, and the screaming is not my favorite thing about the birth video – oh well!
After so much pushing (again my sense of time is really off here), finally his head emerged. I felt his head with my hand, but it really didn’t mean anything to me, I just wanted the rest of him out! I pushed for one or two more contractions, maybe three, and then his shoulders popped and he tumbled out on a
wave of fluid and tons of baby poop. Linda helped bring him to my chest, all the while rubbing him and talking to him and watching him carefully. I was so relieved and instantly went from that person experiencing the very hard work of pushing toward a goal, to that mother experiencing her baby
for the first time. I was rubbing him and toweling him off and just taking him in, my body relieved of the burden with the prize in my arms. He was born at 9:42 am.
We all watched as he turned from purple-y to pink. His apgars were 8 and 9. Very soon after birth he wanted to nurse and he seemed to know just what he was doing. The boys peeked in one by one, only appearing mildy interested (we had two 13 year olds, two 11 year olds, and one 7 year old), and then backing out of the room again.
There were lots of things in the birth kit we didn’t use. My perineum didn’t need massaging, which Linda was prepared to do. We didn’t need the bulb syringe to suction the baby’s airways. There are lots of Chux pads that didn’t get used. Everything just happened easily and well, as it so often can when left to its own devices. I am sure the level of comfort and security factored into that for me as well. I am still struck by how ordinary things were and how extraordinary they were. Within a couple hours I was back in my shower. A little while later I threw a load of laundry in. My mom bought donuts and I happily ate three. Our new (nameless) baby was being admired and touched and held by his cousins and brothers and dad and aunt and grandma, while also nursing and visually taking in all he could. In many ways it was like a normal Saturday morning at home, but then, it was also like some rare, high holy day, calm with introspection, peace and joy.
Ezra Christian was 8 pounds, 1 ounce. There was much debate about his name – the other choices were Benjamin, Ruben, and Abraham. He was born on what we in the LDS religion believe to be Christ’s birthday, and also the day the LDS religion was restored; Christian is my brother’s middle name, and we
felt it appropriate for Ezra as well.
Moving through that birth, I didn’t feel alone. I remembered so many births and situations and strong mamas moving gracefully through this work. I could name each and every one that came to mind, but hey, this one’s my story. Just know if I have been with you for the birth of your baby, you were with me during mine in spirit and endurance and admiration. This has brought me so much more appreciation and compassion for birth and women while experiencing it – that’s why I feel there should be something birth workers can do every few years to get back in touch with what it can really be like to physically grow and have a baby. It changes you, and sometimes we forget that.
A while back I posted about my own experiences visiting the dentist. This experience involves my two-year-old.
♥ four young boys and a boy dog (offspring)