by Bethany
I had planned to have a drug-free water birth at The Birth Cottage, a freestanding birth center in Milford New Hampshire. I had watched documentaries such as “The Business of Being Born,” “Gentle Birth Choices,” and “Orgasmic Birth,” and therefore was very well-informed of what goes on in many hospital settings. I didn’t trust hospitals and knew I wanted my baby to be born in a safe environment where the baby would remain with me and not be separated after birth, and where I wasn’t at risk of having unnecessary surgery. I had taken childbirth classes in the Bradley Method to prepare for a drug-free birth, during which we read about the many possible dangers to the baby of drugs during labor. I had interviewed and chosen a doula to provide labor support. I even chose to go to a birth center in New Hampshire, rather than having a home birth in Massachusetts where I live, because the laws regarding midwifery are different in New Hampshire and I knew that should I need to transfer to a medical facility, a New Hampshire midwife would get a lot more respect at a New Hampshire hospital than a Mass. midwife at a Mass. hospital. Midwives are actually licensed by the state of New Hampshire, and therefore are acknowledged providers there.
My pregnancy was pretty uneventful. I had the normal (statistically-speaking, possibly not biologically-speaking) inconveniences, like fatigue, and mild swelling towards the very end. I had very little nausea. I became a very picky eater and experienced aversions to many foods a lot of the time, and other times only had a taste for specific foods, but I never craved anything crazy like pickles and ice cream ;). My weight gain was what most providers would consider within healthy limits. I declined the test for gestational diabetes, but didn’t show any symptoms of that. Towards the end of the pregnancy I had some back pain, and used massage therapy to help alleviate that.
The midwives at the Birth Cottage were wonderful and never gave me much reason to be scared, which I appreciated. Unlike any doctors I had seen, they gave me plenty of notice about tests that would be available to me at certain points in the pregnancy, so that I could do my own research and decide whether I’d like to have the tests or not. They spent 30 minutes or more with me at each appointment, answered any questions I had, and never gave me a hard time if I chose to decline a test or procedure. I really appreciated the sense of respect for my autonomy and intelligence that I felt from them.
My August 10 due date came and went. 5 days later, I experienced contractions at night, which didn’t have any clear pattern and subsided by morning. This pattern went on every night, and by the weekend, they were increasingly painful and becoming closer together. My doula came to our house and provided support while I had strong contractions that I felt in my back. They again subsided by morning.
I learned that this pattern of contractions was called “prodromal labor” – where women can have pretty strong contractions that aren’t close together enough to “affect cervical change.” I was very discouraged and became increasingly frightened of the pain that seemed like it could go on for days and days. I also didn’t get much sleep on those nights. I had suddenly become painfully aware that for all the intellectual preparation I had done to prepare for childbirth, none of that prepared me for the emotional fear I had of the experience. I did some self-discovery with Elchanan and while it always helped in the moment, the fear would always take over again later.
By August 21, my midwife, Autumn, called me and told me that she wanted to send me for a non-stress test and a biophysical profile, routine tests in this country for women who go past their due dates. I consented to go for these tests, because in the state of New Hampshire, if a woman under midwifery care reaches the 42 week mark, her midwife is required to consult with a physician. It can be a lot easier for the physician to give the woman the go-ahead to “keep going” if there are test results in hand that say everything is fine. She told me to go for the tests, and then come to the birth center to discuss the results and our options.
So, my husband drove me to a hospital for the tests and to the birth center to talk to Autumn. Autumn told me that while the test results showed that the baby was not in any immediate danger, they had some concern over my exhaustion over the past week and how that could affect my birth. She calmly presented four different options to us (which I very much appreciated, since I know many ob-gyns simply tell the patient that they must have an induction at that point). Our options were:
- wait and see, knowing that I could wait another 2 or 3 or more days, and possibly be even more exhausted than I was.
- try a more “natural” method of induction at the birth center. She told me though, that that would mean castor oil, which almost always makes women feel pretty sick, and therefore she had reservations about using that method with an already exhausted mom.
- go to a hospital for a induction
- go to a hospital to receive a narcotic for what the doctors called “therapeutic sleep”
Hospitals? We hadn’t researched any of the local hospitals, but I trusted Autumn completely and asked her where she recommended we go if we did choose the hospital route. She told us the pros and cons of some of the more local hospitals, and then said that her favorite hospital was Cheshire Medical Center, a community hospital in Keene, NH (about an hour away from the birth center and 2 hours away from our home). Cheshire had nurse-midwives on call six days a weeks, so unless I went on a Sunday, I would have a midwife and not an ob-gyn, unless there was an emergency during my labor. She said that the postpartum care was also very family centered there.
I was devastated that my wishes for our birth were not to be, but I knew in my heart that going to Cheshire for an induction was probably the “lesser of the evils” and the right thing to do. If I had tried to go through with the out-of-hospital birth, and needed to transfer in an emergency, I’d almost certainly end up at a more typical hospital in Nashua and not be too happy about the outcome. I cried at the loss of the birth I wanted. Autumn told us to take our time, think things over, and let us know that we were free to use the phone, the computer, anything we wanted to do some research; she had plenty of paperwork to finish up and would be able to stay as long as we needed. I was touched by her sensitivity to our situation, knowing that it was unlikely any doctor would give us that same level of consideration.
Once our decision was made, Autumn called Cheshire and asked when we could come in. “7 am tomorrow morning” was the answer. She faxed my records to the hospital. My husband and I drove out to Keene that night and stayed in a hotel, since we were already halfway there and it was far from home. I don’t think I slept at all that night, between the contractions and the fear I felt. I shook uncontrollably. The contractions became closer together, and we went in at 5 a.m. instead of 7.
Autumn met us at the hospital. I was introduced to Carmen, our nurse (Cheshire provides one-on-one nursing care during labor and delivery, rather than one nurse in charge of several rooms like at many urban hospitals). Carmen looked over my records and my birth plan and asked me “what is the most important thing to you on your birth plan?” I responded “what happens after the birth. I’d like the baby to be placed immediately on my chest with the umbilical cord intact until it stops pulsing. I’d like all examinations to take place with the baby on me unless there is an emergency.” Carmen said “that is what we do anyway here.” My husband and I breathed a sigh of relief, knowing that we would not have to fight for our wishes to be honored. They asked if I was interested in using a tub for labor, and when I said yes, they gave me the room with the tub.
I only remember bits and pieces of the rest of it. I hated having IV needles in my hand. The pitocin made me feel sick, and I was already exhausted. As I had requested on my birth plan, no hospital staff offered me any pain medication or epidural anesthesia unless I asked for it. I requested them both by the end of the day. I know that pitocin-induced contractions tend to be much more painful than natural labor contractions, but since I have no basis for comparison, I’ll have to take everybody’s word for it. I felt “violated” and “traumatized” by the contractions and laboring in the tub didn’t seem to help at all. The medication helped me sleep. When I had the epidural, they put an oxygen mask over my face. It was probably the oxygen, but when I woke up I felt great! I was told that I was almost fully dilated. There was only one intervention that I felt the staff pushed on me that I didn’t want, and it happened at this point. The midwife on call told me that from what the monitors said, it seemed like the baby’s heart rate during contractions was almost identical to my heart rate, and they were concerned about whether the monitor was picking up the correct one. She wanted me to turn onto my side to encourage the last lip of cervix to move, but when I turned onto that side, the monitor did not pick up the baby’s heart rate at all from that position. She wanted me to consent to having a small monitor implanted into the baby’s scalp, for accuracy. I asked what that meant, exactly. She told me that a small monitor is actually screwed into the baby’s scalp. I thought that sounded pretty dangerous. I turned to my doula and asked her if she had seen that done. “Yes,” she told me. I asked her if she had ever seen anything go wrong with that. She told me that, yes, she had. I told the midwife that since there was no emergency and they were only requesting the monitor because they wanted me to get into a certain position, I wasn’t going to have that. We could wait longer for full dilation; the baby was fine. I was sure of it.
Sure enough, I was fully dilated within the hour. I had enough feeling in my legs that I was able to move around while pushing. I could squat, get on all fours, etc. I requested that the lights be kept dimmed for pushing so the baby wouldn’t be born into a brightly lit room, and they complied. I vaguely remember that towards the end of the pushing hearing things like “heart rate dipping” and they were really encouraging me to push. I think a shoulder may have been stuck and the midwife might have had to help him out a bit. After 2 hours of pushing, Asher was born. As promised, he was put directly on my chest while they took his vital signs. He attempted to latch and nurse but I didn’t feel much from it and I knew it couldn’t have been effective. They called an OB-gyn in to stitch up my tear. After a while, the cord was cut and the baby handed to my husband while I was cleaned up. A nurse came into the room and asked “just to confirm, you want no eye ointment, no vitamin K shot, no hep-B vaccine, and no circumcision, correct?” We breathed another sigh of relief, having been expecting to have to watch the hospital staff like hawks lest they follow through on their routine protocols before reading or remembering our birth plan.
After weighing and measuring Asher (9 lbs, 3 oz, 21 inches long), the three of us went to our room, a family-style room with a double bed. I don’t remember too much after this other than Asher screaming whenever he was handled at all, and being unable to get him to nurse. The only time he calmed down and slept seemed to be when we wore him in a sling, which, luckily, we had packed for the hospital.
Lactation consultants came in several times per day. Asher would try to nurse and then end up crying and crying. We thought it was perhaps because my nipples were on the flat side, especially with my breasts being bloated from IV fluids. He couldn’t cry and suck at the same time, we told him. As if a baby needed to be told how to nurse! After the first day, when Asher still didn’t nurse successfully, we tried with a nipple shield, still unsuccessfully. A very kind lactation consultant brought me a breast pump and showed me how to pump and finger feed him using a syringe. I was heartbroken that I couldn’t breastfeed Asher at the time. A pumping schedule seemed grueling – there wasn’t enough time to shower, eat, and sleep between pumpings, let alone hold Asher or snuggle him. Asher cried all the time. My husband changed diapers and wore him in a baby carrier while I pumped. “You’re a special baby,” he told Asher. “You’re nice and safe.”
On Sunday, one of the nurses mentioned that they were talking about not discharging Asher yet, since he couldn’t nurse. I told them that he absolutely needed him to be discharged with me, and that we had support we could call on at home. The midwives from the Birth Cottage would be following up with us, and we had the numbers for La Leche League leaders already written down. They asked me if I wanted some formula to take with us to use until my milk came in. I told them “no, thank you.” With a rental breast pump, we left right after he ate, thinking he’d sleep for the entire two hour drive home.
Nope! He woke up about 45 minutes away. We stopped at a baby store and tried to nurse him. Still wouldn’t nurse. It was either bring the pump in and pump, or keep going until we made it home. We changed his diaper and it seemed to momentarily calm him down. We kept going. He woke up again and screamed before we made it home. When we got home, my first thought was “I cannot bring a screaming baby into the house – it will traumatize the cats.” I took Asher onto the porch and attempted to nurse him. It seemed like he latched (although now that I know what nursing actually feels like, I don’t think he really did). He attempted to nurse for about 20 minutes on each side, though I’m not sure if he got anything. Then he cried again. I had Andrew bring me a bag of cat treats, and walked in the door with a screaming Asher in one hand, and a bag of cat treats in the other. The cats went straight for the treats and seemed indifferent to the crying baby.
Back to pumping.
My in-laws arrived the next morning to help me out. Andrew needed to go to work that day, but would have the rest of the week off. Andrew was not breastfed, and I knew my in-laws had never been around a breastfeeding mother or baby. Before they came, I warned them that there would be plenty of, um, exposure, as I had not yet mastered nursing, let alone using a cover while I pumped or attempted to nurse Asher. When they arrived, I showed my father in law how to wear Asher in a baby carrier. They held and wore and walked Asher around while I pumped, fed, ate, attempted to nap. I had left the hospital with instructions not to overexert, and to do nothing but feed the baby and lounge with the baby. The lounging part was definitely missing here. I barely held Asher at all, or I would fall behind on pumping or self-care – which I did anyway, but it would have been even more so. I was incredibly thirsty from all the IV fluids, and sucked down literally gallons of water as I pumped.
Later that day, my mother asked if we wanted her to come up next week, since Andrew would have the rest of the week off. I told her that no, we needed her now. She came up the next afternoon (Tuesday). I pumped, Andrew diapered and soothed, and my mother cooked and cleaned and did laundry. 2 midwives (Allison, and Beth, a student) from the birth cottage came over that afternoon for a home visit. They checked us over, watched us feed Asher, held and rocked him while I pumped and he screamed, fixed me some food. They weighed Asher and found that he had lost slightly more than the recommended 10% of body weight after birth, and while they acknowledged that I had had a lot of IV fluids and Asher’s birth weight was possibly artificially high because of it, they told me that the pediatrician might be concerned, and they knew I needed some help to get breastfeeding underway. They told me about a small gadget I could buy called a Latch Assist, which might help with the flat nipple thing. They called every drugstore in the area to find out if they carried this thing. They encouraged us to call a lactation consultant and held Asher while I made the phone call to a lactation consultant, Lynda, who did home visits.
Lynda came the next morning (Wednesday), armed with a very exact scale which she balanced to a precise zero on our kitchen table. We weighed Asher before and after feedings. She had me get in bed with Asher and we tried to latch him on. Still no success. Nipple shield. Still no success. She advised us to buy an Avent bottle to use instead of finger-feeding him. He was swallowing a lot of air with the finger-feeding, and “I want him to get the connection of “suck/swallow/full-belly.” She told me to use the bottles exclusively for one day, as she wanted us to take a break from the stress of unsuccessful feeding. Then she would come back the day after tomorrow (Friday) and we would try to latch him on again.
My mother went to the store and bought the bottles.We bottle fed him for the rest of the day and the next day. On Thursday, Allison from the Birth Cottage called and said that Autumn wanted to come see me for a home visit on Friday. I think they must have told her that I didn’t seem to be doing so well. In fact, I wasn’t, and I needed all the support that I could get, so I gratefully agreed. Autumn, Allison, and Beth came over on Friday morning. Asher had started to put on some weight again. While they were there, he kept rooting at the breast. I said to them “see? he definitely WANTS to nurse.” They agreed.
Lynda came back that afternoon and we tried to latch Asher on again. No luck on the bare breast, but he did take the nipple shield this time. Success! He took the whole feeding, and nursed from the nipple shield all afternoon. Hooray for no more round-the-clock pumping. Hooray for getting to hold Asher more. Lynda told me that the idea was to wean Asher off the shield eventually. She instructed us to log all of his nursings, wet diapers, and soiled diapers to make sure he was getting enough. She would come back on Tuesday to see how we were doing. She called us every day to check in every day until then.
On Tuesday when Lynda came back, Asher had almost returned to his birth weight. He also had twice as many wet and soiled diapers as the minimum they were looking for, so we were given the green light to stop logging these things. Still no success getting him off the shield. She came back a couple times over the next few weeks. We tried to get him off the nipple shield with no success. When Asher was about 1 month old, he seemed to latch onto the breast on his own (I now know that this was not an effective latch, rather just taking the breast in his mouth and gumming a little). Lynda came back and we tried to entice him to feed. He gummed for about 6 minutes, then cried and wouldn’t stop. We tried squirting a little breastmilk into his mouth with a pipette, and he still cried and wouldn’t return to the breast without the shield. Lynda gave me instructions to do that a couple times a day. I tried once, but didn’t have the heart to continue. It didn’t feel right and I was afraid I would be giving him a negative association with the breast. Squirting the milk in his mouth didn’t entice him to suck; it only made him cry harder.
We went to various moms’ groups and parenting groups. I talked with other moms who had started with nipple shields and managed to transition off them. I always got the same advice: just start with the shield, then take it off partway through the feeding. Didn’t seem to work with Asher, and that didn’t add up, to me. Asher seemed otherwise healthy, active, and bright. Why couldn’t he “get” nursing, something all babies are designed to do?
A friend had suggested that some babies might not want to latch on to their mothers if their diet was causing some body odors they didn’t like. It seemed worth trying (since nothing else had worked so far), so I eliminated spices and dairy products from my diet. As the weeks went by and I observed Asher, I didn’t think that was the issue though. I had a very good sense of smell following birth, and I noticed when people had bad breath (garlic or the like). They would smile at Asher, and he didn’t seem to react to the smell at all, smiling back at everyone equally. Even with my simpler diet, he seemed to always be rooting for the shield and becoming frantic if he didn’t find it, almost as if he didn’t “know” that one could eat without the shield. While it made sense to me that this might be the issue for some babies, it didn’t seem “right” for us – my diet was healthier than that of many nursing mothers, whose babies latched on just fine!
Asher seemed to get happier as the weeks went by, and I didn’t push the breast without the shield again. One Friday when Asher was 10 weeks old, I took him to a mom’s group at the Birth Cottage for the first time. For some reason, Asher was pretty fussy that day. One of the other mothers, Laura, noticed that we were having “issues” latching on and asked if I needed help with anything. “No thanks,” I told her. “It’s just this nipple shield. Some days we just have trouble getting it together.” She asked why we were using a shield, and I explained that it was because Asher wouldn’t latch. She asked more questions, and then said that he sounded just like her son, until they worked with an amazing lactation consultant. I could clearly see that her son was nursing just fine. “Has he been checked for tongue tie?” Laura asked.
“Yes,” I said.
“Who checked him?”
“Pediatricians, lactation consultants.”
“Well, I’m going to write down our lactation consultant’s name. I really think you should at least contact her. She might have some resources that could be of help.”
Later in the afternoon, after Asher pulled off the shield for probably the 20th time that day, I decided to contact the lactation consultant, Celina Dykstra, even though I didn’t have high hopes. We had already been seen by two lactation consultants in the hospital and one at home, after all.
When I called Celina, she spent about 30 minutes talking with me over the phone and asked if he had been checked for a posterior tongue tie and also a lip tie on his upper lip. I had never heard of a lip tie and she said she’d e-mail me some information about this. She said that can create problems with a shallow latch and babies who have this usually get very frustrated trying to nurse effectively. She says the only thing she has really seen to correct poor latch due to tongue tie and lip tie is to have it revised.
I asked if that is something that the pediatrician does, and she said that many pediatricians are not skilled in identifying it and correcting it, and that there was a pediatric dentist in Albany NY who did the procedure with lasers.
She also asked me questions about his feeding habits, and when I mentioned that he does seem to spit up a lot, she said that reflux is pretty common in babies who nurse with a shield, as they tend to swallow a lot of air as a result of breaking the latch more easily. She also acknowledged his resistance as a real thing that was occurring and suggested other things to help with his resistance to latching, such as lots of skin to skin contact, holding him between the bare breasts a lot, etc, to help him learn that it is a safe place; looking into chiropractic or cranio-sacral therapy to release any tension that might be there, etc.Overall, I was impressed by how thorough she was in her questions and how she connected the dots between his habits and symptoms.
She promised to e-mail me some links, and told me that I could look over the information, and if I thought I might like to work with her, we could schedule a time. I checked my e-mail later and found information and instructions for checking for a posterior tongue tie and lip tie. I had trouble checking his tongue….but I checked his upper lip and he had a very thick tie! I felt relieved. Not that he had a lip tie, of course, but that, maybe there was an explanation for why a bright, vigorous baby couldn’t do the one thing that babies must do.
I discussed it with Andrew and we decided that, yes, we should have Celina come work with us. I left her a voicemail the next day (Saturday) saying that we’d like to schedule a consultation and asking her what she felt the next step should be. She left a voicemail for us in response, recommending we take Asher to a chiropractor with pediatric experience as soon as possible (preferably Monday or Tuesday morning), and that she would come work with us the next day.
I didn’t know anything about chiropractic for babies, but I trusted that Celina could help us and since she had pinpointed the issue when nobody else could, I decided that I would do whatever she recommended, without question. I called Dr. Carolin Kohler-Dameron, the chiropractor recommended by the Birth Cottage and some of the other mothers in the group there. I left a voicemail explaining that we needed to come in ASAP. Then on Monday morning, I had Asher dressed and ready and called her office at 9 a.m. as soon as it opened. The receptionist told me that she had just heard my voicemail, and was trying to move some things around that morning so she could see Asher. “Dr. Carolin likes to see the infants who are having problems right away. Let me see what I can do and I will call you back in 5 minutes.” Five minutes later, she called and told me that Asher could be squeezed in as soon as I could get him there. We got right in the car and made the 45 minute trip.
In the office, Dr. Carolin told me a little bit about chiropractic and how working with babies is different from working with adults. She explained that sometimes in the womb or during the birth, when there is a lot of pressure on the baby’s head and neck, the pressure on their spine could cause some pain or restriction of movement. She asked questions about our birth, and about Asher now. Does he prefer to nurse on one side over the other? She looked at me holding him and said “he looks very rigid. Does he always hold himself very stiff like that?” I didn’t know how to answer that – Asher being my first baby, I had no idea how babies usually held themselves. “Does he ever snuggle?” she asked. I didn’t think so…
She held Asher in a way that I see many people try to hold him, in a way that many babies like to be held. He cried. “He doesn’t like to be held like that,” I told her. She put him back over her shoulder and said “he may be uncomfortable. Does he cry in his carseat?” Yes, I told her. “Only when it is moving?” No, I told her; all the time. She explained that some babies cry in their carseats because they are physically uncomfortable.
She told me that after Asher was adjusted, here were some things I might expect: he might sleep for a long time (don’t wake him up to feed – it tends to be a good, healing, restorative sleep). He might have a big bowel movement. I might see a change in personality if he was more comfortable now. Okay, then.
She examined and adjusted Asher, though I couldn’t tell the difference between examination and adjustment, as her movements were that gentle and subtle. It only took a couple minutes, and she handed him back to me and told me to bring him back on Thursday. I paid the receptionist and put him in his carseat, fully expecting him to scream while I packed up the diaper bag and put on my shoes and coat.
To my surprise, he didn’t scream – he just hung out there and even smiled at me while I got ready to leave. I noticed how I had braced myself for the scream, and it never came – he was relaxed. Interesting.
I put him in the carseat a couple more times during the day and he never screamed. He even quietly played on the floor while I ate my lunch. He hung out in my lap happily after nursing – something he’d never done. He felt a bit “floppier,” not so “stiff as a board.” In the evening, I called Dr. Carolin’s office and let them know how different he was. “Where did you stash my baby?” I felt happy for Asher but also a little disconcerted – I had spent 10 weeks learning how to relate to a different baby than he had suddenly become. I felt like I didn’t know him or his cues at all. I noticed how tense I had become, trying to do everything quickly so as not to elicit screams of protest from Asher (eating, going to the bathroom, getting dressed, etc). Now I was still tense, I noticed, but Asher no longer was.
When Andrew came home, I told him what had happened, and warned him that Asher “handles differently, now.” Andrew agreed – Asher felt “goopier.” When Asher fell asleep that night, it seemed deeper, and Andrew and I looked at him. I told Andrew “I feel like I don’t know him anymore.” Andrew smiled and said “this is who he is meant to be.”
The next morning Celina came to our house and worked with us for several hours, observing him feeding in several positions and on several sides. Asher was happy and friendly with her. She confirmed that Asher had a posterior tongue tie and a lip tie. She analyzed his suck: in order to compensate for not being able to use his tongue correctly, Asher had resorted to “chomping” and then using pure suction to bring the milk far enough into the back of his mouth to swallow. She told me that this would have been very painful for me if Asher had somehow managed to latch without the nipple shield, so in a way, it was a blessing that I had it when I did. I agreed – if it weren’t for the shield, we’d still be pumping, so I was indeed grateful.
We called Dr. Kotlow’s office to schedule his revision. Celina told me that the babies who do best usually have chiropractic and craniosacral work done within 48 hours before and after the procedure. She told me about a Dr. Vallone, from Connecticut, who had written articles for La Leche League and was well-known for working with tongue-tied babies. We looked up Dr. Vallone and saw that she was only a few miles away from my in-laws. So I called Dr. Vallone’s office and scheduled an appointment for before and one for after Asher’s revision.
Over the next couple weeks I felt a great sense of anticipation, but also some doubt, too. What if I put my son through the revision and he wouldn’t breastfeed because he had become accustomed to the shield? To play devil’s advocate, I wondered, “couldn’t he just nurse with the nipple shield?” I asked many people for their opinions. Even if he didn’t learn to breastfeed, a tongue tie might mean a speech difficulty later. Or dental problems, so I read. Why put my child through the potential awkwardness of a speech difficulty? Yes, we would have the revision. I knew in my heart though, that I would be heartbroken if he wouldn’t breastfeed even after the surgery, so I tried to temper my anticipation so I wouldn’t get my hopes up too high.
In the meantime, we continued to bring Asher for chiropractic twice weekly with Dr. Carolin. After about a week, she noticed that I seemed more relaxed than I had the first time I brought him in. I agreed. Asher felt more like a happy baby most of the time, and less like a ticking time bomb. He still cried when he was tired, but that was about it now.
On the Sunday before Thanksgiving, we packed up and drove down to my in-laws in Connecticut, where we would stay for the week so Asher could have his pre- and post-revision care on Monday and Friday. On Monday morning, we took Asher to Dr. Vallone. She did a thorough evaluation, and was very informative: since Asher had been nursing improperly, it had caused some musculoskeletal imbalances to develop, causing the base of his skull to be fixed in a position that was slightly off and therefore creating a “chin-to-chest” posture. This could prove problematic later if it worsened, compromising his airways, his digestion, etc. Dr. Vallone explained and reassured me that there were other reasons that tongue tie warranted revision other than breastfeeding: motility and resultant gut health (maturation of the lining of the gut, inflammation, establishing normal flora, etc), aspiration, failure to protect his airway or eustachian tubes sinus health and development, dentition (decay, teeth not fitting requiring extractions and orthodontics secondary to failure to spread the maxilla and allow the hard palate to descend or mandible) and possible speech deficits. She told us that in her opinion, Asher was clearly receiving excellent chiropractic care from Dr. Carolin, but until he had the revision and the cause of the movement issues was removed, that care was simply keeping him comfortable and would not be enough on its own. When she heard about his temperament, she said that it sounded like that of a starving baby. I told her that Asher definitely got all the food he needed; he was growing well and his diaper output was good. She explained that she didn’t mean that he was literally starving, but that when a baby couldn’t eat properly, he was constantly living with a low- or high-grade fear of starving. A baby is primally driven to “breastfeed or die,” and when something prevents that, they are literally frightened that they will starve. She prepared a homeopathic remedy to give Asher before and after his surgery for pain relief, inflammation reduction, healing promotion, and anxiety and fear alleviation.
The next day (Tuesday morning, November 20), we made the two-hour drive to Albany with Asher. Celina had advised me to bring a pump with me, as some babies don’t nurse well immediately after the procedure and I would want to pump to relieve any sense of fullness and avoid potential supply problems later. We brought Asher into Dr. Kotlow’s office, which looked like a regular dentist’s office. Dr. Kotlow was quick and to the point – he examined him and said “yes, he has a posterior tongue tie…” and as he looked under his upper lip “and a BIG lip tie.” In the interests of informed consent, he put on a very detailed video about the procedure and the necessary aftercare we would have to give Asher, and left the room for a while. When he returned, he asked if we had any questions and took Asher for the procedure.
A few minutes later, I heard Asher crying as Dr. Kotlow brought him back to us and instructed me to put him to the breast. We used the nipple shield, and in a couple minutes, he calmed down enough to nurse. Dr. Kotlow showed us how to stretch the revision sites and instructed us to do this 2-3 times daily for 10-14 days, and to bring him for craniosacral threrapy within the next couple days to help restore some movement. He said “I know you are following up with Sharon [Dr. Vallone], so I’m not going to talk too much – you are in good hands with her. If you have any questions, send a text message to my cell phone.” Since we had no further questions at the time, we said our goodbyes.
Asher took a very deep nap, and we got on the road. Celina was right – he didn’t want to nurse for a while, and I pumped in the car and once back at my in-laws. When Asher woke up, he was very fussy, as we expected – we were sure his mouth must hurt. We gave the homeopathics as directed, and when it had been almost 5 hours since he had nursed, Celina told me to try giving him a little bit of expressed milk with a spoon – often, just a little taste of milk will remind the baby to nurse. It worked, and he nursed well. He continued to be fussy all evening, and he kept stiffening up, so before bed, I gave him a small dose of baby motrin to help him sleep.
Asher slept well, and by the morning (Wednesday), he seemed to be acting completely normally (which, by now, meant “pretty happy and calm”). Of course, he hated when we did the stretches three times a day, but other than that, he seemed to be his normal self. He still only nursed with the nipple shield, and I didn’t want to push the breast without the shield while he may have still had that discomfort, so I only offered it here and there.
We enjoyed our Thanksgiving, and on Friday took Asher to Dr. Vallone. Andrew expressed some concern that the tongue tie may have been reattaching and she confirmed that it did look to be the case. She manually detached it again and gave us some pointers on how to do the stretches. She did some work on Asher and watched us nurse. She suggested offering the breast without the shield when Asher was relaxed and not too hungry. We could start a feeding with the shield, then once he got some milk in his belly, burp him, and then try offering without the shield. I told her that I wasn’t feeling hopeful at the moment, since every time I had offered the breast in the past, he simply rooted for the shield and got mad if he couldn’t find it. What she told me really helped my mindset: “Don’t think of it as ‘rooting for the shield’ and not the breast. Think of it as ‘he couldn’t use his tongue properly to draw the nipple out, so he was rooting for something big.'” That made me feel a lot better. We drove home that afternoon.
Over the next couple days, I spent a lot of time with Asher nursing lying down, giving him lots of exposure to the breast. On Saturday night, when he was in a smiley, snuggly mood, I offered the breast, and he latched on for about 15-20 seconds. That was very exciting!
On Sunday, in the early afternoon, I offered the breast again, and he latched on! I told Andrew to come take the nipple shield out of my hand, without making any sudden movements. Asher nursed for 4 minutes without the shield, and then cried a bit, and I put the shield back on.
Then, that evening, around 8 p.m., I noticed Asher was in a happy, snuggly mood again, so I offered the breast – and he took an entire feeding in bed without the shield! He nursed for about 20 minutes or so. About an hour later, we did the stretches for him. He always screamed during the stretches, and we put him to the breast right afterwards. He latched on again and took another feeding! I thought to myself “he is going to go the whole night without the shield!”
And he did! I had my husband get up and turn on the light so I could see in order to latch him on during the night. Asher went the whole night without the shield, 5 days after his revision, 1 day before his 3-month birthday! I said the shehechyanu, which is a Hebrew blessing that means “Blessed are you, Lord our God, ruler of the universe, who has given us life, sustained us, and enabled us to reach this day.” It felt truly fitting, especially the “sustained us” part. I thought about how difficult things felt when we couldn’t nurse properly, when we were pumping and finger feeding, when Asher and I were both miserable, and how, in those moments, I understood exactly why women give up on breastfeeding. Yet, we stayed the course, and I’m while I don’t consider myself a religious person, God or the universe or whatever higher power sustained us, enabling us to reach this day.
I was so excited, and I also knew that we didn’t yet know if Asher would nurse without the shield in other positions, out of the house, etc. The next morning, Celina came back, and we were so excited to tell her that Asher had nursed through the entire night without the shield. Asher smiled at her to confirm his happiness. We sat on the couch to nurse, and Asher latched on, and nursed, but he popped off and cried often. It turns out that Asher was not used to such a strong let-down (so much milk coming into his mouth so fast now!), since the shield had buffered it before. Celina gave me some tips to help ease this for him, and also told me that, for now, while he gets used to it, he might want to nurse lying in bed as much as possible, since the gravity wouldn’t be pulling the milk out as quickly as when I was sitting up. So we went upstairs for his next feeding so I could nurse lying in bed. In the meantime, she confirmed that his tongue was much more mobile, and his sucking action felt normal. He now took the normal 1-2 sucks to every swallow, instead of his previous 5-6 sucks to every swallow (translation – he didn’t have to work nearly as hard to get the milk, and was much more efficient now!). After another feeding lying in bed, Asher gave me a huge smile. We thanked Celina, and for most of the rest of the day, just lounged around and nursed – it seemed to be all Asher wanted to do! Every time we nursed, he gave me a huge smile afterwards – he was just so happy to be off the shield and nursing normally!
In addition to the job, I felt absolved of guilt, like a huge weight had been lifted off my shoulders. For the first 3 months of Asher’s life, when Asher couldn’t nurse normally, I had questioned whether I was to blame. We had had a medicated birth. Had we, in doing so, missed our opportunity for Asher to latch on normally? Had he developed a preference for the shield? Had I eaten too many spices, I even questioned? The flip side of the empowered birth movement is that when something goes wrong, it can be all too easy for a mama to question whether she alone is to blame. I now knew that, no, none of these were the reason Asher couldn’t nurse. I felt satisfied in our parenting, knowing that we had absolutely done the right thing for Asher by having the revision, with absolutely no second thoughts. He was happier, and so was I. He even sleeps better now! For the first three months of his life, if I so much as got up to go to the bathroom in the middle of the night, he would squirm and fuss. Now, he sleeps right through it. I like to think he feels safer, now that he knows he can breastfeed correctly. His whole biology is calmer as he is no longer “in survival mode,” so to speak.
When I was pregnant and mothers would tell me how their babies wouldn’t latch, I would silently judge them a little and think they hadn’t tried hard enough. After going through all of this with Asher, I really do understand why mothers give up. It was the hardest thing I ever went through in my life, and if I hadn’t luckily stumbled on a person in my community with the right information when he was 2 months old, we might still be having latching issues. It would have been all too easy never to stumble upon the right information. And it would be even easier, in the plethora of helpful and unhelpful information out there, to not recognize the helpful information for what it was and ignore it. I’d like to encourage all mothers whose babies have trouble latching to keep seeking until they find. I read in La Leche League’s “the Womanly Art of Breastfeeding” that “if we can teach a tiger to jump through hoops, which they are not designed to do, we can certainly teach a baby to breastfeed, which he IS designed to do.” Don’t give up – the benefits are all worth it, and the hard part is all behind us now. I feel more proud of this accomplishment than anything I’ve accomplished in my entire life, knowing that I did the right thing for my baby and myself.
Even so, I don’t mean to minimize the struggles of other mothers who are seemingly left with no viable choice but to supplement with formula or quit breastfeeding entirely. We had a lot going for us that I think most mothers don’t have in the United States today. We were in a hospital with good lactation support, who got me pumping right away and often, so I never had a milk supply problem, even though many mothers of tongue tied babies do, since ample milk supply is based on frequent milk removal. We had plenty of help at home in the weeks after Asher’s birth, so I could focus all of my attention on pumping and feeding. I had supportive family. Even those in the family who had never breastfed never once said to me “why are you putting yourself through this? Why not just give him formula?” They simply got me water when I was pumping as fast as I could suck it down, and held Asher while he cried. The Birth Cottage midwives followed up with me at home twice in our first week, and over the phone as much as I needed when I was depressed and at the end of my rope and this poor baby was STILL crying. I don’t think the majority of OB-gyns would have done the same. So, even though we struggled, we had a lot of support that most mothers and babies just don’t have. It really does take a village, and it would have been that much harder without that kind of support in the early days. Even with that support, there were days when things felt impossible. So my heart goes out to all mothers who want to breastfeed but don’t have any hope that it can work out.
If I can be of any help to a mother going through the same thing, I would love for them to contact me so I can refer them to some proper support. Even if they’ve worked with lactation consultants before, I’ve learned firsthand that not all of them have experience with this kind of tongue tie. There IS someone out there who can help!
Thank you for reading my story. If it has helped you in some way, or if I can be of any help, please drop me a line and let me know. https://www.facebook.com/profile.php?id=546844183
Bethany
For those who suspect tongue tie / lip tie you can join this Facebook Tongue Tie Babies Support Group: https://www.facebook.com/groups/tonguetiebabies/
