This post is the 57th in a series on Booby Traps, made possible by the generous support of Motherlove Herbal Company.
“Cry when you get the receptionist on the phone. Just tell her that you really need to see the doctor as soon as possible, and then start crying.”
That’s the advice I used to give mothers in my area who were having trouble getting an appointment to see the only doctor who would clip a tight frenulum (tongue tie). It wasn’t an attempt to deceive the doctor – these mothers had cried with me - but to help the mom convey how desperate she was to get care quickly.
And the fact that I felt mothers needed to resort to losing it on the phone is a sign of a problem. While health care providers have all heard of tongue tie (tight lingual frenulum, or ankyloglossia), getting one to recognize its impact on breastfeeding or – most importantly – finding a provider who can treat one in a timely manner can be very challenging. We wrote about this in 2010, and many of you responded with your stories: Booby Trap: Docs Who Won’t Snip Tongue-Tie, Thousands of Breastfeeding Moms & Babies Suffer.
In the case of mothers in my community, it could take over a week to get an appointment with the physician who, at the time, was the only one who would deal with a tongue tie.
I remember helping one mother who was in excruciating pain while breastfeeding her two week-old tongue tied baby. When she called the doctor’s office and heard that it would take over a week to get an appointment, she did a quick calculation:
A minimum of 8 feedings/day x 8 days of waiting for the appointment = 64 hideously painful feedings with a miserable baby. I quit.
She didn’t quit (I called and pleaded for an appointment the next day), and once her baby’s frenulum was clipped and her baby re-learned how to use his tongue breastfeeding was smooth sailing right into toddlerhood.
But what about moms who can’t find a doctor who will 1) acknowledge that a tight frenulum is causing breastfeeding difficulty, and 2) treat it with a fretonomy (if that’s what the parents choose)?
In the days before bottle feeding became the norm, fretonomy (clipping a tight frenulum) was done routinely. It fell out of favor starting in the 1940′s as bottle feeding became more common, according to Catherine Watson Genna, author of Supporting Sucking Skills in Breastfeeding Infants.
But it’s 2012. Forty years after breastfeeding rates began to climb. And we’re stuck searching and for providers who can help with a condition that affects up to 13% of all babies?
And it’s even more difficult to get care, or even acknowledgement, for a posterior tongue tie, which is less represented in the literature. In my area, mothers used to have to leave the state to get a posterior tongue tie treated – and pay for out out of pocket.
One hospital where I worked dealt with tongue ties which interfered with breastfeeding before families left the hospital. No one went home with breastfeeding problems related to a tongue tie unless they chose not to have it treated.
Another hospital where I worked didn’t treat tongue tie, and those mothers could spend weeks in pain, fighting the understandable urge to stop breastfeeding, until they could get appropriate diagnosis and care. Undoubtedly, some weaned long before they had planned. And as became painfully clear to me the more mothers I saw, the longer it took to get care, the longer the road to pain-free feeding because the babies had to re-learn how to breastfeed using the new range of motion of their tongues.
Just in case you need research to prove how big of an impact tongue ties have on breastfeeding (and if you had a baby with one I’m sure you don’t), research has shown that mothers with babies who have tongue ties are three times as likely as other mothers to wean in the first week.
A recent study has also proven, through a clever study design, that fretonomies do significantly reduce breastfeeding pain for mothers of tongue tied babies. In this study, published in Pediatrics last year, a group of babies who all had significant tongue ties and whose mothers were having breastfeeding pain were assigned to either have their frenula clipped or have a “sham procedure.” The result: The mothers in the “sham” group had no improvement in pain, the mothers in the “clipping” group did. In fact, by two weeks of age all but one of the mothers in the “sham” group had opted to have the procedure done.
I think that care for tongue tie is slowly improving. In my area there are now several providers who will treat tongue ties, and mothers no longer need to leave the state to get care for a posterior tongue tie. But until every moms has access to a provider who can swiftly diagnose and treat all forms of tongue tie, it remains a significant Booby Trap.
Here are a few of my favorite resources for moms on tongue tie and breastfeeding:
- Low Milk Supply’s list of Fretonomy Surgeons and Practitioners. I wish we didn’t need this but am very grateful that we have it. Note: you don’t necessarily need a surgeon – a pediatrician or family practice doctor can perform most fretonomies.
- The American Academy of Pediatrics’ newsletter on tongue tie and breastfeeding. Excellent reference with some good pictures. A good reference to share with skeptical providers.
- Catherine Watson Genna’s page of tongue tie pictures, “Is My Baby Tongue Tied?“
- I used to collect tongue tie breastfeeding stories so I could share them with other moms. They’re all published on the Motherwear Breastfeeding Blog: Danielle, Lisa, William’s mom, Allyson, and Amy (posterior tongue tie). They do a good job of describing what it was like to have their babies’ frenula clipped. Also see the Best for Babes 2010 post on tongue-tie and the stories in the comments.
- A recent podcast I did with Catherine Watson Genna on tongue tie and breastfeeding for Motherlove Herbal Company.
Tongue-tie doesn’t just interfere with breastfeeding, but can also cause speech impediments which are expensive, time-consuming to treat and can be emotionally damaging for children and a stress on families. It’s another example of where excellent breastfeeding care can save money, time and heartache.
Did you have trouble getting a tongue-tie treated?