 I have known Jessica for over a decade, and she has been an excellent source of information through the years. We have had parallel lives in opposite sides of the country, right down to our tongue tied first babies. Moving in the circle of birth support, breastfeeding help, and the intense caring that comes with walking beside a family while they struggle -- these are not new concept to doulas. It is no surprise that Jessica brings all the best elements of doulas into the world of lactation and tongue tie. I’ve been a doula-ing most of life, long before I was a professional birth, then postpartum, doula. How is that? Well, the term doula may have started with birth, but the role, the intention, is really about continuous support. We now have postpartum doulas and bereavement doulas. There are even end of life doulas. To doula is to be someone well-informed about an experience another person is having and to offer continuous support. It’s about meeting that other person where they are and offering to be fully present with them as they experience intense feelings, sensations, and processes. It means to be open and supportive of their loved ones as they work to balance their own needs and that of the primary person in this particular journey.
These are intense experiences through which I offered continuous support for people involved -- I met them where they were and included as much information as I could in how the process might be eased for them. I offered guidance in what choices they had to make. In each experience there was struggle and joy and pain, humor and grief. Things that might be petty to others were looming, and things that might overwhelm another were handled with resilience. This brings me to where I am now in my life and career. I call myself a tongue tie doula. What does that mean? It makes sense to start with the literal. Tongue Tie is the common term for the medical condition ankyloglossia. It’s where the lingual frenulum (band of tissue that connects the tongue to the floor of the mouth) is restricted of function through being too far forward, too short, or lacking elasticity -- or some combination of these.  One might wonder how a person might be a doula for a medical condition? In the same way a birth doula supports a person or people experiencing birth, a tongue tie doula supports a person or people experiencing tongue tie. This role has formed as I found my private practice as an IBCLC merge with my experience as a birth doula. In May of 2005 I gave birth to my second child. I was already working in lactation and quite committed to breastfeeding. It was a long and very painful process for both of us to find a somewhat normal breastfeeding relationship. Despite being surrounded by world class support, most of my son’s early days are a fog of pain and confusion for me. He was six weeks old before I found out, be it through lucky coincidence or kismet, that he had a posterior tongue tie. From there, I learned. Then I taught. The doula in me began to appreciate that resolving tongue tie, even in a baby, is most often not an event; it’s a process. It’s one that is usually emotional, often painful, and frequently fairly complicated. I would hold people’s hands, both literally and metaphorically, as they made hard choices, moved with their baby through the procedure to release oral restrictions, supported their baby in recovery and healing, and dealt with their own needs throughout. People who’d had a birth doula would often say, “It’s like you were a doula for the revision!” Many professionals within the tongue tie community who are experts in tongue tie have a plethora of knowledge. Many provide excellent recommendation, tools, and protocols for the process of gaining function from oral restrictions. The doula factor adds continuous support. There are amazing midwives and doctors who provide excellent, thoughtful, family-centered birth care. They are not doulas because they do not offer fully present continuous support. I know midwives who also work as doulas outside of their midwife roles and they will tell you that the roles are not the same. As a doula who is also a midwife, they may have a lot of information with which to guide families, but the difference comes in the emotional, fully present support that accompanies that information. As a tongue tie doula, my role is like this. Just as many IBCLCs are exceptionally educated about tethered oral tissues (TOTs), I provide referrals, recommendations, tools, and protocols to families as they work to help their baby obtain full oral function. My role goes one step further, however. I also provide emotional support before, often during, and after the release procedure. I meet them where they are when they struggle with choosing a direction in which to go, as far as medical procedures and various therapies, especially in the face of frequently contradicting recommendations. I hold space as they grieve the newborn and breastfeeding experiences they had envisioned or vent about how hard the whole process is. Am I the only tongue tie doula out there? Far from it. I know amazing people and professionals in many fields who are tongue tie doulas. Some don’t even know it. Many don’t appreciate the nuances of the care they provide as they see the bigger picture of people’s lives and families as a unit. Many tongue tie doulas are creating bigger-picture care plans never knowing that this perspective is often neglected in the lives of the families they serve. My fellow tongue tie doulas, whatever title they may be using, are the ones holding mothers as they cry, and sitting with fathers as they rage, and empathizing with babies as they struggle to learn a skill they were meant to learn before ever breathing air. Always on the cutting edge of care, we work to support evolution toward improvement. We never settle for accepting an unmet need. And we always, always know that at the end of the day, the parents and babies are the real heroes. Because doula-ing is not about the medical condition. It’s about the human condition.  Jessica Altemara has been an IBLCLC in private practice for 7 years. She officially became a birth doula in 2004 after being surrounded by birth and breastfeeding her whole life due to a mother who was an IBCLC, doula, and L&D RN. She's passionate about staying on the cutting edge of care in her own practice and in the information she shares with her clients about practices in general; valuing a functional medicine mindset. Jessica offers in-person and online education not only to parents but also to professionals. She's a mother of 4, ages 13-3, in Chapel Hill, NC where she and her husband enjoy the dramatic mixture of technology and nature the area provides.
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 Tori is the mother of three boys, a La Leche League Leader, and a birth doula. Her baby, Otto, was born in September, 2015 -- he had ties, but no one really knew until his weight dropped in response to his decreased desire to eat. In Tori's words, she documents their journey, and how hard it was to find help while her baby was struggling to eat and grow.
"Here's a timeline of our journey to the breast. Born Sept 21 2015, weighing 9lb 3oz, noisy latch, unsettled baby, needy baby. Jan 2016- weight arrested at 13lb 4oz (in hindsight, because milk supply tanked and no longer fueled by postpartum hormones, looking for adequate sucking to maintain it, baby not sucking adequately or very long per feeding). He would pull off at letdown, refused to latch deeply and the bottom lip never flanged like it's supposed to. Feb 2016- weight unchanged for 1 month, I started pumping, building back my supply and trying every way under the sun to supplement. SNS, Haberman feeder, syringe, 8 different types and flows of bottles, all with little success. Syringe was best because required no sucking and because of severe posterior tongue tie he was unable to suck properly. In Feb I saw our Ped, LC, and Speech Pathologist. All 3 professionals examined his mouth and stated that tongue tie was not present, because he could thrust his tongue out of his mouth. I mentioned posterior tongue tie with all 3 professionals and was told in so many words, 'it's not real.'  I had 2 meetings with speech pathologist who encouraged me to spoon feed him and use Haberman feeder to help avoid mouth aversion. She refereed us to Children's Hospital to have a barium swallow study done to watch on X Ray my baby swallowing, mainly to check for silent aspiration which can over time cause pneumonia. The soonest they could get my baby in was April 7th, 2016, 2 months from the time the study was requested. Over this month my frustration and desperation grew to a crippling degree. I didn't sleep, I was spoon, syringe, bottle, breast feeding around the clock. My baby was fussy but never showed signs of dehydration that I was told to look for (soft spot sunken, dry lips, listlessness, dark urine, few diapers). He had normal large stools and urinated clearish non-smelly urine 12 times per day. At urging of Speech Path, I started keeping a detailed log of every single bit he would eat. I did this for 5 days, it varied from 14 oz to 20 oz, guessing with how much transferred during breastfeeding. March 4th 2016- I took him for another weight check with Ped. Still no weight gain. 2nd month. I lost it in the office. She offered to draw labs on him and I said yes. Labs showed a drop in blood sodium levels. March 6th- we repeat labs at emergency room and sent to Childrens because of sodium. By this time I had connected finally with dentist who does posterior tongue tie revision. It's $500, and our insurance was not accepted, so I had been trying for several weeks to get an appointment and gather the money to pay for it. I wanted to revise him before our hospital stay, but both Drs agreed he was too sick. So we put it off until after the stay. March 7th- after 6 hours of stress for my exhausted baby, with multiple more lab and urine draws, Children's finally placed a feeding tube in my baby. We fed him through a tube down his nose, 2 oz every 2 hours for 3 days. His weight gain was on average 15 grams per day. They were also supplementing his sodium and watching it closely to make sure it was rising, and it was. March 8th- Barium swallow study performed and severe tongue restriction and silent aspiration of syringe feeding observed. March 9th- I was persistent enough to get an ENT doctor in my hospital room to revise his tongue. This doctor used a long metal tool to lift my baby's tongue deeply and revealed a frenulum far back under his tongue that no one had ever laid eyes on before. The ENT doc cut this about 1/2 inch long piece of skin and handed my baby to me. My baby IMMEDIATELY latched differently than he ever had, drained my entire breast, which he never had done, and we only did one feeding through the tube that day as he learned to use his newly released tongue. ENT doctor exclaimed 'Oh, that released a lot,' when he did it, in surprise. March 10th- morning weight gain was 130 grams after breastfeeding all night. March 11th- consulted with speech path, ped doc and ENT about stretching his tongue to keep revision from re-adhering and all told me not to, but because of my own research I did it anyways. March 13th- constant weight gain of on average 120 grams per day and maintained sodium levels, so we went home. I'm attaching two pictures, that were taken 9 days apart. The first one is the day of the lab draw and the 2nd one is the day of hospital release.  I believe sodium levels were low because my baby was starving, not unlike someone with anorexia. I received consults from endocrinologists, geneticists, nephrologists (kidney doctor), lactation consultants, urologists and speech pathologists during our hospital stay. The doctors didn't think sodium was low because of his lack of feeding but were searching for other causes. They did an ultrasound on his kidneys and discovered they were enlarged, but recommended just watching them every few months to ensure they don't get worse. It's my opinion that the kidney issue is unrelated to the sodium levels, but there are still some tests out on his hormones that will answer that for sure (adrenal hormones). I urge you to educate yourself, if you work with moms and babies, and stop telling mothers that posterior tongue tie isn't real, and to start learning how to clinically recognize it. My case was typical yet on the extreme side, and my baby and I were made to suffer because it went untreated. I'm personally feeling a huge amount of guilt, and the months leading up to our hospital stay were traumatic for us both. I share this with you in love and kindness and hope you will learn and grow as I have." I am grateful to Tori and her willingness to share her story. Tori and Otto were let down by many health professionals -- any one's education or awareness could have quickly changed the course of events before hospitalization was needed. Tori has chosen to contact these health professionals, not to stir angry feelings or place blame, but to simply ask them to learn more, so they can help the next family and prevent complicated issues like she and Otto faced.
 I once had a life-size, cardboard cut-out of Captain Jean-Luc Picard. I was 18, in college, and I spent every night at 11pm watching reruns of "Star Trek: The Next Generation" (or "TNG," as we Trekkies call it) at someone's house -- it capped off every day. For reals, I wish I had a picture of me with my paper Picard -- Flat Stanley's got nothing on Jean-Luc. When I first started with TNG, I was immediately pulled in by Wesley Crusher. Wil Wheaton had been a favorite of mine since the summer I watched "Stand by Me," 500 times between 7th and 8th grades. So imagine my surprise and sorrow, in the 13th episode of the first season, Datalore, when Captain Picard yelled, "Shut up, Wesley!" to my favorite teen in space. In this scene, it can be heard uttered by three different people, including his mom, Dr. Beverly Crusher: I love to make memes -- they are a fun way of offering a small spark which might ignite one's full curiosity.
For this meme, I extrapolated what I knew of Wesley and what people think of him -- both on and off the screen (the characters and the fans). Although brilliant, he didn't always escape the naivety of childhood -- hence his smiling face and eagerness to believe the professional who states, under no circumstances, can a tongue tie affect breastfeeding. Of course the insinuation here is, the professional hasn't been trained to properly assess, is likely choosing one or two pet methods of "examining" a tongue tie (one being simply looking at it, the other perhaps seeing it extend over the gum line), to decide -- despite the mother's and baby's issues -- it isn't the tongue's fault. If you are told your baby has a tie but it isn't causing your feeding issues, you may want to seek out a professional who knows proper assessment and evaluation requires more than just taking a peek into the baby's mouth. The best list I can suggest is held within the files of Tongue Tie Babies Support Group on Facebook. These are often called preferred providers, but that term is inaccurate; these are professionals who have received enormous amounts of positive feedback from families. TTBSG goes on to research these providers in-depth before choosing whom to add to the master list. This doesn't mean there aren't other capable providers out there -- in fact, if you know of someone who is not on the list, contact an admin to let them know. And if you still don't see someone near you (and by near, let me share we traveled 4 hours away to see a listed provider, and I am counting that as "near"), be sure to see if there is a local state/region tongue tie group for your area. With the addition of these smaller, more specific groups, families have more precise information to share, and often they know of providers who haven't gone through the review process to be added to the TTBSG file. There are often suggestions for IBCLCs, body workers, and other professionals who can help you with the assortment of problems that surround tongue tie. UPDATE 12-30-15: TTBSG will no longer be maintaining and updating this list of providers. Instead, ATTE will be responsible for keeping lists of local providers in the State/Region groups. I am so grateful in my area we have an incredible dentist in Bakersfield who treats tongue and lip ties -- thus eliminating the lengthy travel some families have to make (she wasn't offering this service back when we had our baby treated). Dr. Dana Yeoman has studied under two excellent doctors experienced in tongue tie issues and utilizes that knowledge to help families in the Central Valley. The addition of the face-smacking captains is just a bonus.  On December 4th, 2014, I had my posterior tongue tie released by laser. I am not ready to get into the whole nitty-gritty story right now -- I am hoping for some better results in the future. I did want to address something amazing I am happy about, though: my tongue finally found its home. All my life I struggled to know how my tongue was supposed to fit in my mouth. It felt big, unelegant, cumbersome. I never knew where to put it to make things feel together. I sucked my thumb until I was 8 years old. I started seeing a speech therapist before I quit sucking my thumb to address issues with "thertain thounds." Dr. Peachy (and I can't remember if that is how his name was spelled -- that's how we said it; I checked with my mom and she can't remember his proper name either) tried many strategies to get me to stop this thumb-sucking. We put that tape you use on hair (do they even make that anymore?) around my thumb, stained yellow with food coloring; if I sucked my thumb, my mouth would be yellow when I woke in the morning. Once he helped me scrape the dirt out from under my fingernails and we put in on a cracker -- he then invited me to eat! I cannot remember if I put the saltine in my mouth or not -- it obviously didn't make me stop putting my thumb in my mouth. Dr. Peachy also made a big deal about where my tongue was supposed to rest, and how I should swallow. I had tongue thrust, and the natural resting position that felt good was between my teeth. I had an open bite (although future braces closed that) from the tongue thrust, and he was helping me learn my way out of bad habits. He had this stuff that seemed like a thin spot of gelatin; he affixed it to the roof of my mouth and told me this is where my tongue should go. At rest, at play, before and after swallows -- this was "my spot."  At some point I learned to speak more clearly and stopped speech therapy. I even grew out of thumb-sucking, and as I said before, I am pretty certain it had nothing to do with any of Dr. Peachy's interventions -- I think I just was finished. All my life I have had this feeling my tongue wasn't right for my mouth -- somehow, I was given a tongue a few sizes too big. I had anxiety about where "my spot" was. I was always trying to remember to put my tongue on "my spot." What this meant was, taking my tongue from its position between my teeth, and putting the tip to "my spot."  Fast-forward many years, and learning the oldest and youngest of my four children have Tethered Oral Tissue-issues -- somewhere along the way, an amazing IBCLC and mentor, Norma Ritter, suggests I look in my mouth, and she bets I have restrictions of my own. I was doubtful. "No," I told her, "I know I am fine." Months later, I decide to look and see, and what do I find? What looks like a posterior tongue tie! I have this confirmed casually by a few other professional acquaintances and friends, and I start to put together symptoms I deal with, like debilitating tension headaches, clenching and grinding of my teeth, tapping of my teeth, and mandibular tori, to name a few, or four. I make an appointment for treatment with an area dentist. Five days after this release, I was lying on my bed, nursing my toddler. No one was home, it was quiet, and again, I was trying to find "my spot." Through the years I have developed different ways to do this. Sometimes I lift my tongue to the roof of my mouth and start to "click," but instead I leave my tongue there and close my mouth; another trick is to say "ehnnnn," like the letter "n." I tried to map my palate so I could just know by the ridges where "my spot" was, but the topography still was not enough, in 30-ish years of knowing this, to help me out...so it always requires thought and action. Again, I was trying to locate "my spot," and while I was figuring this out, the back of my tongue lifted to my palate and I found the tip of my tongue was not pressed against my palate, but resting right at "my spot." This may sound unremarkable, but for me, it was nothing short of inventive! I had just made a discovery, and all the lightbulbs in my brain flashed at the same time and gave me the realization, "This is it!!! This is what Dr. Peachy was talking about! This is 'my spot'! MY SPOT!!!" And I sat there, marveling at how all my life I was misunderstanding what my tongue was supposed to do once it got to "my spot." Miscommunication perhaps -- heck, maybe Dr. Peachy didn't realize I was curling my tongue up to my palate -- but I was struck by something else...by a feeling.  If you ever sucked your thumb, maybe you remember what was so awesome about it, or maybe you don't. But we have sensors in our bodies called mechanoreceptors -- I learned this in my Lamaze training. Pressure to these mechanoreceptors can bring feelings of comfort or calm -- I would even say joy (and I'm not a scientist, and I don't feel like researching this -- so call it anecdata if you will...because I will). Some places we have these are in our hands, in our lips, and in our mouths. Think about that -- we hold hands, we kiss, we eat food, and all these activities bring us little rushes of endorphins. When a baby sucks his thumb, he is directly providing the stimulation feeding would or should bring; in my case, with a vaulted palate, feeding may not have given me these warm-fuzzies (and in fact, my mother tried to nurse me and it didn't work out), so I got creative and figured out, on my own, how to get my endorphin-fill. Another mentor and friend, Michale Fetzik of The Myofunctional Center, shared that thumb-suckers are smart, because they figure out how to make up for this loss.
So, back to me and this new feeling -- I suddenly was a small child again, filled with the comforting sensations of sucking my thumb...and this all came because my tongue finally found its home in my mouth, resting along my palate. I am not a science journal writer, and I don't want to be a science journal writer -- currently my 22 month old clings to my left leg, and thank goodness for automatic saving, because I inadvertently closed this page and had to retype this sentence (but everything else was still here!). I am just a mom who is noticing things and trying to help others who may be noticing things as well. But now I have to nurse my baby to sleep. And while I'm at it, I'm going to practice hitting the spot. 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. Additional ResourcesTongue 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.  In April I gave a presentation to a group of healthcare professionals on the topic of tongue-tie. It was important for me to see where moms were getting the initial idea there might be a tie -- the diagnosing and treating was not part of this poll. What impressed me about this is, moms are generally the ones who figure this out. There is wisdom in mothering! Before the first book was written or the first study published, there were mothers -- sharing stories, knowledge, and experience with the next generations. That has not changed simply because information is easier to access. Follow your instincts!   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.  Yesterday I decided to check in my 14 year old's mouth again to see if any changes had come from his frenotomy back in September. His teeth don't look that different, but in person, I can tell there was a larger space at the gumline than there is now. The tongue extension right after the procedure speaks volumes, though. This was a child who breastfed easily until he was 4 years old, but I believe he had a host of other issues, including delayed ability to eat solids, extreme pickiness that still affects him today (it makes sense to me that he ate what his mouth could handle, so certain textures and foods were avoided), and caps on many teeth at 18 months of age, and of course the eventual pulling of his teeth in.
 Did you know upper-lip ties are frequently present when there is a tongue tie? And either or both may make breastfeeding difficult? If you suspect a tongue-tie, flip the lip! The presence of a thick labial frenulum could indicate the need to check under the tongue.
-For real-life help, contact an IBCLC in your area who has experience with lip and tongue restrictions, for a thorough history and assessment. -Want virtual support and help? Visit Tongue Tie Babies Support Group. -To see how upper lip ties look, check out Dr. Kotlow's handy chart (scroll to page 22). -Don't miss Dr. Ghaheri's excellent article explaining how upper lip ties can affect breastfeeding.  The upper lip ideally fans out over the breast in order to help the baby grasp and latch deeply. Have you thought about that before? Babies hold the breast with only their mouths, although they often place their cute little hands on either side while nursing -- but those hands aren't holding the breast, their mouths are. Lip ties frequently come with tongue ties, and if you have been told your baby has one, make sure your provider knows how to check for the other. The baby pictured here was not able to nurse despite his mama's best efforts (she extended pumped for him), and at almost 2 years of age, his lip tie was noticed. For more information on upper lip ties: Advocates for Tongue-Tie Education's Fast Facts Tell Me About Tongue Ties! Breastfeeding USA Diagnosing and Understanding the Maxillary Lip-tie as it Relates to Breastfeeding, Dr. Lawrence Kotlow
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Stacie Bingham, LCCE, CD(DONA), CBS(LER)Calm, comfortable Lamaze education & experienced support for pregnancy, birth, & breastfeeding serving Bakersfield, Delano, Hanford, Porterville, Tehachapi, Tulare, Visalia + the World
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