It’s official: the third trimester has arrived!
With 10 weeks to go until baby number three is due to make their appearance the countdown is on and I’m starting to think about the practical side of things, like breastfeeding.
Regular readers will know I breastfed both BB and Little B until they were almost two (it turns out there’s lots of things they don’t tell you about extended breastfeeding).
They both had their first feed within half an hour of being born and I loved feeding both of them. In fact I was so distraught when I stopped feeding BB I wrote a poem about it.
But that’s where the similarities end. Both were very different experiences and I’ve no doubt it will be different third time around too.
My breastfeeding hopes…and fears
I always planned to breastfeed and with BB it couldn’t have been any easier.
We’d been on an NCT course where we were shown a video of how newborn babies naturally root and latch on to the breast, and I couldn’t wait to have that experience too.
The reality was somewhat different though. Before I knew what was happening the midwife had one of my boobs in one hand and BB’s head in the other and she clamped her on for her first feed – that’s the only way to describe it. There was none of the natural rooting and instinctive opening of her mouth I’d imagined.
Nevertheless she took to it like a duck to water and she was 21 months old when she had her final feed.
I was determined I wouldn’t be manhandled like that for the first feed the second time around, so I didn’t give the midwife the chance and waited until she was out of the room to latch Little B on for the first time.
He happily took what was offered him and it was everything I’d hoped it would be – and wish it had been with BB. That appeared to be that. Except it turned out it wasn’t.
It transpired Little B had tongue tie, meaning his tongue was anchored to the bottom of his mouth in a way it shouldn’t have been, which basically meant he couldn’t latch on properly.
This was diagnosed in the hospital when he was born, but they didn’t have the ‘facilities’ to deal with it – ie have it corrected by snipping the piece of skin anchoring his tongue to the bottom of his mouth – and we had be referred to a different hospital – 10 days later.
The midwife asked me at the time if that was ‘ok’, but it quickly transpired that it absolutely wasn’t ok and I realised the very fact she asked me meant it wasn’t.
Breastfeeding a baby with tongue tie is painful. Ouch ouch ouch ouch ouch painful. So painful it left me in tears, with cracked and bleeding nipples (sorry if that’s TMI!), engorged boobs and dreading the next feed.
Within 24 hours I was on the phone to the health visitor begging for help, and although she came to see me the very same day and showed me different positions to make feeding easier there was essentially nothing to be done until Little B’s tongue could be released.
I simply had to grin and bear it. Needless to say not much grinning went on – just grimacing.
This time though I have a feeling things will be different. I’m hugely excited to be working with breastfeeding experts Medela as one of their Medela Mums (I’ll be charting the highs and lows – there are bound to be some – of our breastfeeding journey in a bid to offer support – and hopefully entertainment – to other breastfeeding mums out there) meaning I’ve also got Medela’s in-house lactation consultant Sioned Hilton to call on.
Sioned’s going to be on hand if I need her and I’ve taken the opportunity ask her about breastfeeding a baby with tongue tie, and for her top tips. Here’s what she has to say.
Q. What exactly is tongue-tie?
A. Tongue tie (ankyloglossia) occurs when the frenulum (a cord like structure that connects the floor of the mouth and stretches to the underside of the tongue) is very short, thick, tight or broad and affects the ability of the tongue to have free movement required for sucking, feeding, eating and has associated challenges with speech.
Unfortunately, they don’t all look alike and some babies have greater difficulties dependent upon the grade of the restriction and health professionals may grade it into classifications following an assessment. They vary in appearance and position in the base of the mouth. Some babies are very restricted with a ‘v’ or heart shape tongue at a very early embryonic stage, others are very thick white and vascular. Sometimes a tongue tie can run in families and the incident is more in boys than girls.
Most tongue ties are now assessed following mums’ experiences of feeding challenges especially when breastfeeding – mums may feedback sore and painful feeding that is not resolved with position and improved latch. Engorgement and mastitis are difficulties due to ineffective feeding by the baby and the infant may have poor or slow weight gain after birth and first few weeks.
Q. Can I still breastfeed if my baby has tongue tie?
A. Yes, you can but you do need to have early intervention to support comfortable feeding and optimum milk supply. When your baby is born your midwife or paediatrician will do a full health assessment and this too should include examination of your baby’s mouth to exclude any oral anomalies such as a cleft. Occasionally a tongue tie may not be picked up because your baby will not lift his tongue, be asleep, or not be crying when you can see the tongue and mouth capabilities. If you have had a previous baby with a tongue tie you can ask them to look closely.
Continue to initiate breastfeeding within the first few hours of birth, trying different positions – a good position to use with a baby that is tongue tied is a laid back position (biological nursing) so that the nipple falls deeper into the baby’s mouth. If you are experiencing challenges with feeding you will need to get a referral to a breastfeeding specialist so that they can assess everything, observing a feed, offer suggestions, support to sustain your milk supply, feeding devices to give top up of expressed milk and a referral to get the tongue tie released and support after.
Ideally this should be as soon after birth and before three weeks to support optimum feeding and protect mothers milk supply. A delay in seeking specialist consultation can lead to baby learning abnormal sucking patterns, having difficultly removing milk from the breast, poor weight gain and nipple and breast pain in mum that may lead to mum exploring the options of stopping breastfeeding.
Q. What are your top tips for mums breastfeeding a baby with tongue tie?
- Get specialist support early – if it hurts keep on asking for help
- Get a referral by your GP to get a tongue tie feeding assessment – there may be a waiting list
- NHS NICE guidelines are useful to support your discussion with your GP for a specialist referral
- Be prepared to feed often – frequent emptying of both breasts will help your milk production long term so when baby is ready to nurse the milk is there
- Be prepared for nipple pain and keep nipples in tip top condition with using a little expressed milk and apply nipple cream to help with sore tender nipples
- If you have tried different positions and latch continues to be challenging, you could consider using a nipple shield to help with breastfeeding until your baby has surgery to snip the skin
- Support lactation if baby isn’t feeding well by expressing after each feed
- If you need to supplement you can use your expressed milk and can use a supplementary nursing system to help top up whilst you have the baby on the breast
- Rarely, a fibrous tongue tie that has been released with surgery can reconnect when healing – this is why follow up is really important
- Some babies will continue to have feeding challenges even after surgery – however you can continue to breastfeed and compliment with expressed milk with a feeding device so that you both enjoy and benefit from not only health benefits but that lovely time together
- Be realistic – it is tough, you are tender, tired and uncertain, keep asking for support and help from your partner, family members and health professionals. You may get negative comments from those who see you both struggle – don’t take it personally, they just don’t know how to help and ease the problem and may suggest other feeding options
- Be strong – weigh everything up, get specialist support and take each feed a day at a time
They say forewarned is forearmed, and I definitely feel forearmed this time.
If tongue tie happens to me again I’ll refuse to leave the hospital until it’s corrected. Surely there must be someone in the building who can deal with it.
Do you have experience of breastfeeding, or breastfeeding a baby with tongue tie? How was it for you?
I’m thrilled to be working with Medela as a Medela Mum sharing my third breastfeeding journey. How it pans out remains to be seen, but watch this space!
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