Untangling Tongue-Tie

theresa blog pic

Lactation consultants are very skilled at identifying the causes of infant latch difficulties, and helping moms find ways to breastfeed comfortably. Sometimes baby’s latch just needs some minor adjustments, or mom may need some additional physical supports to bring infant closer while baby learns to breastfeed. If you’re struggling with persistent nipple pain despite all your efforts to position baby carefully, the problem maybe that baby can’t improve his latch because his tongue movement is restricted by a frenulum, a band of tissue connecting his tongue to the floor of his mouth. The lingual (floor of mouth) and labial (upper lip) frenulum forms early in gestation, and most of the time recedes. However, in as many as 15 percent of babies, the frenulum does not recede enough to allow baby full tongue function. The resultant restricted tongue function, called tongue-tie or ankyloglossia, can cause a host of breastfeeding difficulties including nipple compression, pain and bleeding, poor emptying of the breast leading to very frequent feedings, low milk supply, slow weight gain, gastroesophageal reflux and lots of frustration for mom. Many babies with tongue restriction also have a band of tissue connecting the upper lip to their gum called an upper lip tie, which reduces baby’s ability to flange his upper lip during feeds, contributing to a restricted latch.

It’s important to know that healthcare providers are very unlikely to have had any specific education regarding the impact of infant tongue-tie on babies ability to latch and transfer milk effectively at the breast, or to know how to assess for tongue-tie. Lactation consultants have extensive education and background in infant tongue and upper lip restriction. Assessments include not just the appearance of baby’s tongue, but the function as well. We look (and feel for) the lingual frenulum under the mucosa and assess baby’s palate, which is often narrow with tongue-tie. We assess how well baby can use his tongue muscle while suckling and measure how much milk he transfers at the breast. If latch can be made comfortable, baby transfers milk well, and does not struggle with reflux, then a “watch and wait” approach can be taken. But it latch is painful and cannot be improved or milk transfer is poor, the infant with tongue-tie is referred for release of tongue-tie, called a frenotomy.

Dentists, periodontists, oral surgeons, and some ENT’s perform frenotomies. The procedure can be done with scissors, a quick procedure to cut or remove the frenulum, which releases the tongue and allows the full range of motion. Some use lasers, which have the benefit of minimizing the amount of bleeding during and after the procedure, provide a more aesthetically pleasing result with lip ties, and allow for a more complete release of tongue restriction. General anesthetic is not necessary. Many practitioners use a local topical anesthetic, which wears off quickly, to numb the area before the procedure. This allows baby to breastfeed shortly after the procedure, which is wonderful because breastfeeding reduces pain and anxiety in little ones. With a “newly mobile” tongue, many moms notice an immediate improvement in the depth and comfort of baby’s latch.

All babies have a “learning curve” after frenotomy, as they learn to use their tongue muscles effectively. If baby is still struggling with latch, the speech and language pathologist (SLP) can help babies improve tongue strength and coordination. A pediatric chiropractor can also be helpful in resolving oral facial tension, which can limit latch.

It’s important to work with an experienced lactation consultant before, and especially after a frenotomy to release tongue and lip-tie. They play key roles in maximizing infant latch, maintaining mom’s comfort and milk supply, and providing support to breastfeeding moms. Babies are born to breastfeed. If they are struggling to latch effectively, tongue-tie might be the reason why.


by Theresa Hardy, pediatric nurse practitioner/lactation consultant







A Mother’s Guide to Postpartum Relaxation

While teaching childbirth education classes, I frequently address the three crucial elements of relaxation: physical, mental and emotional. All three areas are important and should be addressed, if a woman is to achieve overall relaxation in labor and birth. “Environment” is a bonus consideration I add to assess a woman’s state of comfort and relaxation. After all, the atmosphere around her and whatever her senses are drinking in can (and will) have a direct impact on her physical, mental and emotional state.

You may be thinking, “That’s great for labor, Shannon, but what does this have to do with the postpartum period?” EVERYTHING. Let’s apply these simple principles of relaxation (used for labor and birth) to a woman’s postpartum period and get a picture of how they can influence a family’s early days together.

Physical Relaxation:

  • Take it easy and stay off of your feet, especially the first 3-5 days.  Whether baby emerged from your birth canal or from your abdomen, you JUST HAD A BABY. Cuddle up in bed with baby and stay there for awhile!
  • Channel your inner snail, go SLOWLY. Resist the urge to do too much, too soon. A wise careprovider once told me, “Do LESS than you think you can.” Newborn life is NOT a race to catch up to the rhythm you had before; parenting is a marathon, forging a completely new course. Be a snail.               snail
  • Allow time for your body to heal. Along with the learning curves of life with a newborn, you can expect the following from your body at a minimum: continued blood loss, sore bottom, achy muscles, afterbirth contractions, leaky boobs, tender or sore nipples. Depending on your body, healthy history and birth journey, you may have a more extensive recovery. Practice patience with this process.
  • Listen to your body’s signals; follow your “gut”. If something hurts, don’t push it. If you are feeling tuckered out, sit and rest (or better yet, sleep!). If you something feels off and you are concerned, call your careprovider. Don’t ignore messages from your body.
  • Eat nourishing foods and stay well-hydrated. Thought you only needed to eat well during pregnancy? Think again. Your postpartum body still needs a range of nutrients including plenty of protein, quality calories, calcium and iron.
  • Keep breathing. Riding the waves of newborn life can be challenging. Overwhelmed? Take a deep breath and re-oxygenate first.

Mental Relaxation:

  • Prepare for newborn life and have an idea of what to expect in this time together. Learn what is normal newborn behavior and what might be a deviation. Furthermore, become skilled in observing your newborn and following his or her cues to learn what is normal for your individual baby.
  • Adopt Elsa’s mantra: LET IT GO.                 frozen_elsa-1920x1080

Reduce life stressors as much as you can before baby arrives. Then, let go of what is not absolutely necessary to daily living in this sensitive and early period.

  • Play postpartum limbo — how LOW can you go?  Keep expectations of yourself very low. Think about how gentle you might be with others during this time of transition and growth. Then, regard yourself with those very same gentle thoughts and behavior. You would not expect much from a friend who just had a baby; don’t expect more from yourself.
  • Be open!  Don’t be afraid to learn and grow from this new experience. Surrender any pre-conceived notions of family life and embrace your own unique family dynamic. You do not have to have all the answers today.
  • Make a postpartum planMany birthing women take great care in creating a birth plan for the day of the big event (rightly so). However, do not neglect the life you will be living together after baby arrives.

Emotional Relaxation:

  • Bond with baby. While you should not feel pressured to instantly love your baby (not all women share that experience), do not be fearful of becoming attached to your baby. Allow yourself to gaze at their tiny features, marvel at this entirely separate person you had a hand in creating and soak up all the enjoyable moments you will share.
  • Reach out for help when needed.  Let’s be real: motherhood is tough. This is not a job for the faint of heart. It is OKAY and normal to feel overwhelmed or down. It is OKAY and normal to feel paralyzed at times. It is OKAY and normal to not know what to do at times. Be mindful of your feelings and when they start to feel too big, please reach out. Many women have walked this road; take strength from them.
  • Set up support network before baby arrives.  When there is a solid support system in place, you can devote yourself to settling in together and figuring out your unique rhythms. When the worry of meals is temporarily taken away, you can focus on growing love within your family unit.
  • Allow yourself to ride the postpartum feelings rollercoaster; know you are NOT alone!        roller coaster

Cry, as needed; it is a much-needed release of toxins, stress & feelings. However, don’t forget to laugh! Appreciate the humor that comes with the new bumps of parenting and family life. If you are having a difficult time laughing, watch this. You will not be disappointed. 🙂

  • Consider placenta encapsulationMany mothers have reported a variety of benefits, including improved moods and energy levels.

Environmental Factors:

  • Be exclusiveThat means, taking the leap and significantly limiting visitors in the first few days and weeks. I know, I know . . . EVERYONE wants to see your sweet, squishy baby and love on them! But even visits that are short, calm or relaxing require energy from you and your partner – energy you may need later when baby wakes up at night. Go green and be an energy-saver for your family!
  • Ask visitors to “ante up”.  Anyone who receives the awesome gift of baby glimpses, or snuggles, must “pay” a fee: completing a load of laundry, fixing a nourishing meal, walking pets, tidying up a room of the house, watering plants, providing non-judgmental listening of new mother & parents…you get the idea. Check out this helpful sign for postpartum families!
  • Set the stage.  Consider how the lighting, sights, sounds and scents of your home are affecting you. Reflect on what you find comforting and relaxing at that moment or in the days ahead. Do you need some sunshine? Open up the curtains. Need to relax and take a nap in some darkness? Need some quiet to re-charge? Or would some of your favorite, soothing music be better in that moment? Make the appropriate changes to your environment. Or better yet, ask your partner or support people around you to do it for you!
  • Call in reinforcements!  Consider hiring a postpartum doula to help manage daily life. In a town like CU, where a large portion of the population are “transplants”, many young families are left without adequate support from family or friends during the postpartum period. A postpartum doula can help ease your load.

This guide is by no means exhaustive. But hopefully, it can serve as a starting point. What is your current postpartum relaxation quotient (PPRQ – yep, I just made that acronym up!)? What relaxation areas do you struggle with most? What steps might you take now in order to achieve an even higher quotient later?

The challenge is on, mamas! Who will be victorious in this quest for the most relaxed postpartum period?

by Shannon Morber