Sunday, August 9, 2009

Lingual Frenectomy

As my Twitter and Facebook friends already know, Madelynn was born tongue-tied like her older sister. Tongue-tie is when the frenulum, or the little flap of tissue that attaches the tongue to the bottom of the mouth, is too tight to allow for proper movement of the tongue. Usually, the frenulum is attached in the middle of the tongue but with tongue-tie it is often attached to the very tip of the tongue. It often causes the tongue to have a heart shape when it is extended, though it doesn't extend far. Tongue-tie can cause a few complications, such as difficulty with breastfeeding and speech defects. It can also cause some other issues that aren't as big of a deal, such as not being able to stick your tongue out, lick an ice cream cone, or french kiss.

As I said above, Mika was tongue-tied. We hadn't heard of it before our midwife noticed Mika's a couple of weeks after her birth. Doctors generally take a wait and see approach to tongue-tie, especially since the frenulum can stretch with time or rip as a result of a fall, releasing the tongue as a result. As it wasn't causing any problems with breasfeeding, we didn't worry about it. She also didn't have any speech problems. Thus, she is still tongue-tied to this day. We are waiting to see if she'll need it corrected for orthodontia, as is sometimes the case.

Then along came Madelynn. I recognized that she was tongue-tied within minutes of her birth. When they handed her to me, she was crying, giving me full view of her tongue. Initially, it looked more severely tied than Mika's was, so I pointed it out to the on call pediatrician that visited the next morning. Because her tongue reached over her gum line, he thought it would be ok.

Within a week of her birth, I started developing very sore nipples. I tried everything I knew to get her to open wider, but I only got more sore. Finally, I knew I had to do something. I contacted our pediatrician for an ENT referral (ENTs do frenectomies). The ENT that I've used before won't do it before 6 months, at which time a simple office procedure becomes an out patient surgical procedure with anesthesia. So, I called back for another ENT. I also called La Leche League for ideas and St. Joe's Lactation Consultants. I was hoping the latter two would know doctor's who have done it in the past. The LC might also verify that the tongue-tie was the issue, and give legitimacy to my request.

The receptionist for the second ENT told me that they took a limited number of patients for our insurance and that they were booked for a couple of months. She offered to ask the doctor, though. I was quite happy when she called back the next day with news that the doctor agreed to do it. We set the appointment for Friday. Meanwhile, the LLL contact turned up empty, but that was ok since I had an appointment. I also had an appointment set for the LC on Thursday.

At the LC appointment, the LC watched me nurse. She agreed that tongue-tie could very well be the issue, but that there was no way to know for sure until after it was clipped. What she also confirmed was that she was latching on correctly but did have a tendency to slip down, as I had noticed. We confirmed that she was getting enough milk by weighing her before and after nursing. Finally, the LC suggested that the fact I wasn't having oversupply issues like I normally do could be caused by her not nursing as efficiently as she could. Over time, this could lead to low supply. She also suggested that her marathon nursing sessions and wanting to nurse again right away could also be caused by not nursing efficiently because of the tongue-tie. So, basically, she confirmed that I should keep that ENT appointment.

So, we headed out to the ENT the next day. I was prepared for what would happen; there's a youtube video of it being done on a newborn that I had watched. It is 5 minutes long and most of that is the doctor explaining it. Our experience was MUCH easier than the video. After swaddling Madelynn to keep her hands out of the way (she likes to have her hands near her mouth), I held her in a cradle hold. While I held her, we woke her up; the doctor needed her to cry so he'd have access to the underside of her tongue. She barely cried enough to give him the access he needed. Then he snipped a tiny snip. She didn't increase the intensity of her cry at all. Then he snipped a bit more and called it good. There was a few drops of blood. I nursed her for maybe half a minute and she was back to sleep like nothing at happened.

Now, two days after the procedure, I can confidently say that our nursing troubles were definitely caused by her being tongue-tied. My sore nipple is healing and is barely noticeable. I can nurse without pain, and nursing feels like normal again. I had forgotten what normal breastfeeding feels like until this morning. I thought our nights were easy with Madelynn nursing only at bedtime, 2am, 4am, and then waking up around 7am. Now, she only wakes up once at 2am nd again at 7m for the day. Her daytime nursings have decreased dramatically. We haven't had a marathon nursing session in two days; instead of breastfeeding for 1-3 hours at a time, we're nursing more like 30 minutes at a time. She's going a lot longer between nursing, too. Finally, my supply is obviously increasing as I was a little bit engorged after having been nowhere near engorged since the first few days.

So, bottom line...tongue-tie really can affect breastfeeding.

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Mommy to One said...

Wow! That's wonderful that it made such a difference!

Jessica said...

Hi! My name is Jessica and I found your blog this weekend while googling HS information. We will begin our HS this fall and immediately became hooked on your site! I'm glad you have a solution to your breastfeeding challenges and congrats on the birth of a new baby girl!!

The Four Week Vegan said...

YAY - I am so glad that did the trick.

Twisted Cinderella said...

How wonderful that you are able to see such a big improvemnt!!