Duo Ventures

Wednesday, August 24, 2016

The Nursing Chronicles Part 3: Tongue & Lip Tie + Frenulectomy

Over the last two weeks, I've been detailing my breastfeeding experience as part of my Nursing Chronicles series.  I left off last week in Part 2 where it was confirmed by our second lactation consultant that Sami had both a tongue and a lip tie.  Thanks to that at-home lactation visit, we were finally encouraged to book an appointment with an ENT to have his ties revised.  If you'd like to start at the beginning of our journey, you can check out Part 1.

Prior to having Sami, I had never even heard of a tongue tie & had absolutely no idea how it might impact breastfeeding.  The Mayo Clinic defines a tongue tie (ankyloglossia) as:
"A condition present at birth that restricts the tongue's range of motion.  With tongue-tie, an unusually short, thick or tight band of tissue (lingual frenulum) tethers the bottom of the tongue's tip to the floor of the mouth.  A person who has tongue-tie might have difficulty sticking out his or her tongue. Tongue-tie can also affect the way a child eats, speaks and swallows, as well as interfere with breast-feeding.  Sometimes tongue-tie may not cause problems. Some cases may require a simple surgical procedure for correction."
Before I get into the specifics of the frenulectomy (also known as a frenectomy or frenotomy), I'd like to touch on the symptoms that we experienced as a result of Sami's tongue & lip ties.  Of course, looking back it all makes perfect sense.  Unfortunately, we didn't put it all together until Sami was over 2 months old.  I'd also like to point out that the presence or absence of these particular side effects do not necessarily mean your baby may or may not have a tie.  I am not a medical professional - these are simply the specific combination of symptoms that we experienced.


falling asleep while nursing:  This is something that happened frequently from the very beginning.  Sami was constantly falling asleep while breastfeeding.  While some babies can sleep & nurse simultaneously, Sami would always stop nursing as he nodded off to sleep.  It completely makes sense now, seeing as the extra effort he had to exert in order to stay latched probably exhausted him to the point of falling asleep.

shallow latch + popping off + clicking noises:  If you've read my last two posts, you'll know that we struggled with a poor latch from the start.  Knowing what we know now, it's clear that he was never really able to get a very good latch or extend his tongue out far enough, and the clicking noises were a result of that poor suction.  Kelly Bonyata (BS, IBCLCA) explains it further on KellyMom.com:
"A baby with tongue tie may be unable to keep the tongue extended for the relatively prolonged job of nursing, and thus the tongue will “snap back” when baby can no longer keep it in place. When he pulls the tongue back, suction is broken and you hear a click."
pinched or flattened nipples:  Again, this is something I never really noticed until it was brought to my attention.  Since Sami couldn't achieve a deep latch, he would essentially gum my nipples, creating a flattened or pinched nipple after he was done breastfeeding.

painful nursing + damaged nipples + persistent thrush:  Many women will experience some form of pain and/or nipple damage at the onset of breastfeeding, including cracks, fissures, or bleeding.  In my case, however, the damage never seemed to heal fully & the pain never got more manageable.  I believe that Sami first developed oral thrush as a result of the antibiotics I had to take for the mastitis infection - however, I think that our inability to get rid of the thrush was probably in part due to my chronic nipple damage.

blocked ducts + mastitis:  Due to his ties, Sami may not have been draining my breast as effectively as he could have, which ultimately led to a clogged duct.  Within a day, the clogged duct turned into full on mastitis.

tongue mobility + forked/heart shaped tongue:  A common misconception is that babies with tongue ties will not be able to stick out their tongue.  While there are certainly instances where this occurs, it doesn't mean your baby doesn't have a tongue tie if they can stick their tongue out.  In the photo below, you can see that while Sami can stick his tongue out, a "heart" or "forked" shape is created due to the tie restricting the tip of his tongue:

upper lip blisters:  Another symptom Sami experienced were persistent upper lip blisters.  Again, just because your baby develops a blister does not necessarily mean they have a lip tie, as many newborns will develop them during the first few weeks as they adjust to breastfeeding.  However, if your baby consistently develops them it can be a good indication of an upper lip tie.  Since the lip tie prevents the baby from making a proper flange with their upper lip, they may suck more vigorously in an effort to make up for their inability to get a proper deep latch.
Hindsight is 20/20 as they say, but it still seems crazy to me that I didn't put it all together sooner.  All of our symptoms were ultimately caused by a shallow poor latch, which was simply a result of his ties.


Per the recommendation of the LC, we made an appointment with an ENT when Sami was just over 2 months old.  Here he is on our way to to have the procedure done:
The first thing the doctor did was have Nader hold Sami face up across his legs so he could examine his mouth.  The doctor explained how there are several different types of tongue ties & Sami happened to have a type II tie.  The doctor also confirmed that he had an upper lip tie as well.  Apparently, if you have a tongue tie the chances are very high that you will also have a lip tie.  He suggested that we revise both of them at the same time.  There are 2 different types of revisions - laser & the traditional scissor cutting.  The ENT we went to ended up revising Sami's ties with the scissors.

Before the doctor could cut the ties, they needed to numb Sami first.  They had Nader hold him while they gave him 2 shots.  Sami screamed & cried so hard that I started crying myself.  After they finished with the shots, I held him for a few minutes to calm him down.  Thankfully, he stopped crying within a minute or two.  I honestly think it's always worse for the parents than the kids.

Next, they had us swaddle him before they took him to the operating room for the procedure.  Once we had him calm & swaddled Nader took Sami into the room by himself.  I was doing everything I could just to keep myself together & couldn't bring myself to watch, so I stayed in the exam room.

Nader said that they had him hold Sami's head while they used a metal clamp to isolate the tongue tie & then cut it with the scissors.  Next, they cut his lip tie.  Of course, I could hear Sami crying from the exam room.  I just tried to remember that he wasn't crying from pain since he was numb, but rather from the shock of it all.  There aren't many blood vessels located in the frenulum, so there was very minimal bleeding.

They immediately brought him back into the exam room & had me breastfeed him.  Prior to the procedure, I had read stories about how women felt an immediate improvement with zero pain after the procedure.  I have to be honest and say it wasn't completely pain free for me righ
t away.   There was, however, a definite improvement with his latch - it did not feel as shallow as it normally did.  I still had pain, but that very well could have been due to the thrush & not the latch any longer - it's hard to say exactly.  It's also important to note that some babies need to essentially re-learn how to latch & suck after a tongue or lip tie revision.

Sami was perfectly fine on the way home.  The only thing we needed to do post-procedure was periodically stretch his upper lip in an effort to make sure that it did not reattach.  Like I mentioned earlier, there was a clear improvement in my pain level.  Looking back, I think any residual pain I was still experiencing was most likely due to the thrush.

On that note, I'm going to wrap up Part 3 & continue with Part 4 where I'll explain how we finally got rid of the thrush & experienced pain free nursing for the first time ever!

Thanks for reading!


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