Episode 312

often say that after a few days or a long weekend of being off work and not holding a newborn, I get pretty antsy by Sunday night feeling like – oooh,  I really need to hold and cuddle a baby.  For me, Monday often means, yeah, I get to hold a baby, rather than the ughhhh it’s Monday and I have a whole week of work ahead of me.

The very first mom I saw this week was fairly new to this town as she had just moved to the Phoenix area from Tuscon, AZ  Back home, she had a wonderful network of friends and moms who shared her attachment parenting lifestyle. Sarah had only been here for 7 weeks before giving birth to her 3rd baby, a beautiful baby girl named Jessica.  Not having a support system and giving birth 6 weeks early to a 4 1/2 pound baby has been very difficult for her.  She went into labor when she woke up in the middle of the night went to the bathroom and as she sat on the toilet she felt a pop.  It being her third baby, she recognized immediately what happened and yet, at the same time her brain fought to deny this event.

As she attempted to dry herself off and the water kept running down her legs, she gave in and woke her husband up. The plan was to have given birth at the birthing center and premature rupture of the membranes meant that she would be transferred to the care of a midwifery team at the local hospital her birthing center had a relationship with.

Her husband took the information over the phone, and put her other 2 kids in the car and then helped his wife get into the car.  Sarah was quite fortunate as her midwife and her doula was able to meet her at the hospital and the doula was put to the task of watching the 2 kids, until she got settled in a room and they were able to be with their mom and dad.  Not an optimal situation, if you were not planning for this, however, birth is like this.. no guarantees and you just don’t know how things are going to unfold.

Her baby was born vaginally and after about 10 minutes on moms chest, was moved to the warm crib and then was quickly brought to the NICU.  Jessica actually did quite well needed some minimal care in the NICU and then was able to go back to moms room in about 24 hours.  Unfortunately during the time in the NICU, the staff convinced both parents that their baby needed to have formula because Jessica needed to sleep and baby needed to eat.  Not really knowing what they could do to advocate for themselves, they agreed and the baby was fed 4 bottles of formula until she came to moms room.  Sarah had given birth at birthing centers twice before and breastfeeding went fairly smooth for her from the beginning and she never supplemented with formula.  In fact, once she had her first, she decided to take a leave from her job and stay home with her baby.  Neither of her 2 babies ever had bottles and she never pumped and she breastfed her babies –  1 for 18 months and 1 for 2 years.

Mom and baby were discharged on Day 3 and Sarah continued the hard work of getting her baby to breastfeed.  She contacted me for help when Sarah was about 3 weeks old and in her words – she had had enough   With 2 other kids, she just could not spend hours each day trying to get her little girl to breastfeed.  her supply was low because she was not pumping enough.  She was trying so hard at breastfeeding and because she did not pump before, she was not really clear about the reason for regular pumping while working on breastfeeding.

She only gave her baby the milk from the bottle she pumped and since she was only pumping about twice a day, and since her baby was not really breastfeeding really well, her baby was just at birth weight at 3 weeks and 2 days when I met with her.

Sarah said to me that she had been on her Facebook group and had been given  many suggestions from friends on how to proceed and while she did find some things helped a bit, nothing really solved her problem.  As I was weighed her baby, she asked about tongue tie.  She said she had checked and didn’t think she was and she asked her Dr. and they didn’t think she was, but wanted me to check.

After about 5 minutes, Jessica appeared to peter out and not do much sucking at all.  On Sarah’s end, she was to tell me when she thought Jessica was done.  20 minutes later, she said:  there she’s done.  So, we took her off, weighed her and in all that time, she transferred about 1/4 of an ounce.  Sarah’s habit was to wait until her baby was just not sucking at all and appeared to have gone to sleep.  then she would switch sides and repeat.  So, this is what we did and after both sides and about 35 minutes of breastfeeding, her baby only transferred about 3/4 of an ounce.  Jessica actually did better on the second side, the side that Sarah says is “always full.”

I explained to her how much Jessica should be getting at this age and weight and compared that to what she transferred at breast.  Sarah is beginning to understand why her baby is gaining so slowly.  I also explained to her that a baby that is not getting enough, lacks the energy to go on and put forth the energy to breastfeed so it becomes a vicious cycle.

We worked together, at the bare breast, I gave her some adjustments to make and she was easily able to follow my verbal lead and helped Jessica achieve a deeper latch, which will help her do better at breast than she had been doing, but this is far from the full fix that is needed.  I spent some time explaining normal nutritive sucking behavior and it soon became clear that Jessica was becoming quite fatigued and was just not going to be able to get a full feeding at breast.

I also pointed out to Sarah that her baby has an upper tip tie with the tissue being so deeply embedded into the upper gums and I can see where the frenulum literally wraps around to the hard palate.

It is very unusual for me to see this degree of severity and not cause any breastfeeding problems.  It is also very unusual for me to see this degree of  upper lip tie severity and not observe a lovely little short lingual frenulum also.  However, this was the case for Jessica.  I, of course, referred her to a tie specialist for a complete evaluation and I was quite curious to find out if perhaps I was missing something.  The answer – even this provider was quite surprised to find an upper lip tie and no lingual tie.

How did this impact breastfeeding for Sarah?  Well, in order to have a good seal around the breast tissue, which is just one of the many things that need to happen when breastfeeding, the upper lip needs to flange outward.  Jessica’s frenulum was causing her upper lip to pucker inward rather than flange outward  Without a proper seal on the breast, well this just throws off the mechanics of breastfeeding and the result of the oral cavity cannot function the way it needs to in order to transfer the milk from the breast.  babies  keep slipping off the breast, appear to be losing the latch, when they in fact probably don’t have a good latch to begin with and become fatigued and take in a lot of excess air during feeding times.

At first, when I suggested that she pump and offer some milk in a bottle, Sarah felt that Jessica was full so why bother?  I asked her if she could just try.  She agreed, pumped 1 1/2 oz in 15 minutes and when offered this in a bottle with paced feeding, Jessica eagerly drank it all and while not frantic, was easily looking for more.  Jessica warmed up an ounce of milk from a previous pumping and Jessica took all of this.  At this point, she appeared calm, content, awake, alert and looking around.  There was no more arms and legs moving about, no more head going from side to side, wide eyed and searching.  She was at peace and according to Jessica, handled the diaper change nicely as usually after a feeding she cries through the whole diaper change.  Seeing her behavior served as a good reminder to Sarah at how babies look like when they have had a good feeding.  She had just kept telling herself that she had a fussy baby.

Jessica had the revision and Sarah spent the next several weeks, breastfeeding, pumping and bottlefeeding and healing from the revision and thankfully gaining weight the whole time.  At 2 months old, Jessica was gaining very well and was now exclusively breastfeeding.

As you know, I love sharing other moms stories because we can all learn from them.  What do I want you to take away from Sarah’s experience?  Be open to asking for help with breastfeeding from experts in the field.  I often say that friends and family and even physicians will be of some help, however, if intuitively you feel like you need experts eyes on you and your baby, seek help.  One of the things that just drives me insane is when moms discontinue breastfeeding without getting help that goes beyond asking other for advice.  Just like any other medical/health issue, a good, comprehensive evaluation is of utmost importance.  For a majority of moms and babies this often helps you turn the corner and go on to enjoying a happy breastfeeding relationship.  I also wanted to share this story with you so you can now that those lovely upper labial ties can sometimes be the main cause of your breastfeeding challenges.