Tongue-tie and breastfeeding

The first issue I had to face was that my baby was born with a tongue-tie. This is a (often genetic) condition where the frenulum (the little piece of skin attaching the tongue to the bottom of the mouth) is too short and does not allow the baby to fully stick the tongue out. In severe cases, the tongue looks upside-down-heart-shaped and can prevent the person from being able to perform motions many of us take for granted, such as licking an ice-cream cone. In moderate and severe cases, the tongue-tie can interfere with breastfeeding by impeding the latch, and can lead to speech impediments later in life. In our case, the tongue-tie was moderate, but it did prevent the baby latching on correctly which lead to significant nipple soreness.

Tongue-tie can be fixed with a simple procedure: all that a doctor has to do is to clip the frenulum to allow for the tongue to extend further. The procedure is not painful as the part that needs to be clipped does not contain capillaries, and it takes less than a minute. Unfortunately, in Ontario, midwives do not have a right to perform this procedure (even though they can perform perineum stitching after labour which is much more involved), and doctors refuse to do it. Yes, you read that correctly. They can, the majority just chooses not to. One of the orthodontic surgeons, to whom we were referred as a specialist on the issue, told us that we should not do anything about the issue for a year! Add to this a virtual impossibility of finding a GP or a pediatrician for the baby (as most Ottawa doctors are not taking new patients), and you are stuck with a tongue-tied hungry baby who cannot effectively breastfeed.

I will spare you the detailed description of a range of emotions I went through while dealing with this frustrating artificial problem that could so easily be solved if people were reasonable. I had to pump first colostrum and then milk, and finger-feed the baby with a suringe. We got lucky: after a letter written by my midwife to a pediatrician at one of the hospitals, the hospital nurse called us (after we have called every place we could, had a lactation consultant visit, and went to a breastfeeding drop-in with a three-day old baby). She was very understanding since, as it happens, her baby had had a tongue-tie as well and she knew what we were going through, so she was able to get us an appointment the next day to see the pediatrician. The procedure did take less than a minute and the baby didn’t even cry – he was more uncomfortable with being held still than with the clipping itself. We were able to start breastfeeding effectively the same day. A video of a tongue tie release is available at Dr. Jack Newman’s site.

A tongue-tie can only be fixed by clipping. It is not painful and the baby can breastfeed right after the procedure. Without fixing the issue, the baby might not ever be able to latch correctly. Many doctors who are not educated about breastfeeding dismiss it as a minor issue easily fixable with bottle-feeding. Let them pump every two to three hours or feed their baby inferior food in the form of formula, and then maybe they will come to understand the issues involved. Alas, many are still ignorant of the issues surrounding the so-perceived feeding “choices”. If you find yourself in this frustrating situation, persevere to try finding a doctor to perform the procedure. Enlist the help of a lactation consultant if possible. I was told that some women drive to Toronto from Ottawa (5-6 hour drive) shortly after giving birth with a tiny infant, so they can get a tongue-tie clipped at the Jack Newman’s clinic, as that is easier than trying to find a doctor in Ottawa who would be able to do it without booking the appointment months in the future. Clearly, there is an issue here that needs resolution.

There is a comprehensive site at http://www.tonguetie.net/ that has loads of information on tongue-tie and its implications. Dispelling Breastfeeding Myths blog has another wonderful blog post on the politics of tongue tie.

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