STOP! Don't rush into fixing that tongue tie.

I love talking breastfeeding and I really like talking the history of breastfeeding. When people find out I am an International Board Certified Lactation Consultant, they often respond with, “you’re a what?”. As I continue to explain what I do they say “seriously? People have trouble with breastfeeding? How is it that the human race has made it this far if it weren’t for breastfeeding?” Oh, goodness, what era do you want to talk about? I mean there is so much history about how breastfeeding can fail and what resolutions people had for that, depending on the era and the region.
​
We are part of another era and in the middle of history. I call the time before where we are  right now “Before Tongue Tie”. Really, as an IBCLC of just shy of a decade, I had MINIMAL education on tongue ties and their impact on breastfeeding. Like a dismel amount. Then several years ago, I attended a few conferences, online, in person, different geographical locations. Everyone was talking about tongue ties. I said to myself and to others:
“Can we not talk about anything else?”
“There is no way there are this many tongue ties”
“Did we even know anything about breastfeeding until now then, if tongue ties are to blame for everything?”

Tongue ties can cause a lot of issues but what should we address first; the tongue tie or the mess it makes? I have a few thoughts on the subject.

Really, I was thinking to myself, these people are INSANE. As a fellow insane person, I opened my mind and listened to what people had to say. I heard them out. I decided to change some things in my practice and assessments. I grew myself. I pushed myself to really learn more. Truth was, people were making history at that time. We were in it. It was a time of ah-ha moments all over the place. No one had all the answers about tongue tie and their related issues, but many had theories. 

They had different potential solutions. I come into all of this ready to learn and see if we can address some of the challenges that faced breastfeeding families that didn’t seem to have resolve. Much of what I was learning was that there was hope for these ongoing struggles that my previous education and training didn’t teach about.
​
I dove in. I recruited other professionals as supports. We networked. We shared experiences. We re-evaluated. We want the best for families.

My job as an IBCLC is not the same as those other supports and professionals but I want to share some of my learnings and reflections. I know tongue ties cause a lot of issues. I will not deny that, but I will say that just “getting it snipped” or getting into a dentist for a laser revision isn’t a guarantee things are going to be resolved.  

A really key piece I have acknowledged is how much better babies that are at an appropriate weight recover and catch on to breastfeeding post-revision compared to babies that are underweight or slow gaining, maybe gaining weight a little faster than what is called a slow gainer and who maybe is not getting much concern from anyone but still not growing on “their curve”. Doing a revision on these babies is something I really hesitate to do now and I won’t make a recommendation for revision until resolution has occurred in the weight department. This to me a really good reason to be working with an IBCLC before hand.  

Another really important part to working with an IBCLC is to assessing milk supply. Babies respond to flow and without that flow, they just won’t want to try and improve anything. Add in a tongue tie and they just don’t care to breastfeed nicely or at all. If supply is low, again even with a revision, they just are not happy breastfeeders. Both this scenario and the above one make people say “the tongue tie wasn’t the issue” and sometimes add in that “they did the procedure for nothing”. Being able to get moms working on supply, which in turn can help the weight gain issue, if it exists, helps ensure that once they get those two factors sorted out, they are ready for revision and have a good foundation to make the revision successful. The pieces fall into place nicely and almost predictably. It also helps me be able to tell a mom a timeline for “when will this all be better”. I can help them set up a plan so they can see a means to an end, rather than “just keep trying, it will click soon”.

There is also maternal pain that is often a concern and should be addressed INDEPENDENTLY of a revision. Sometimes tongue ties cause pain, damage & trauma to mothers breasts and can be resolved with a revision, but ideally more should be done to address this instead of just waiting for things to get better. When we deal with the breast/nipple independently, it makes the revision seem significantly more effective.
Babies can have other factors/stresses affecting and influencing breastfeeding that are often identified by IBCLC’s or professionals who assess physical factors, like Chiropractors or Osteopaths. I also find when we resolve these issues first, or at least start working on them, that things get back on track faster post-revision.       

Sometimes I am not consulted until after a procedure for a tongue tie has been performed. When I get called after, I can most certainly still help and we can get past these remaining pieces, it just is in reverse. What I find though, is it is all a lot more stressful for moms and families because they also have a cranky baby and after care exercises to get in, as well as possible pumping & supplementing, and perhaps appointments with the other professionals we work with. I personally think It is better when I can set up a plan in steps with one focus at a time. Once supply and weight is up, it is one less stress, so the family  can handle the stress of the aftercare and extra needs of the baby.

I am also aware that some parents would rather not go through a revision at all and this is where my “Before Tongue Tie” experience and knowledge comes in. I say to the parents and myself, “what would we have done BTT?” Are there strategies that would be useful and address the concerns? Sometimes there are solutions that the parents are 100% ok with and will get the baby fed and minimize concerns. Sometimes all of those are tried and the revision conversation might have to happen again. This is where knowing the risks to the situation and knowing what else to watch for is important.  

Tongue ties are a topic that people get really excited about from many different perspectives and I don't see that changing for awhile, but I wanted to raise the thought that we are in a place of breastfeeding right now that in the years to come will be a historical recollection. It might be known as something more eloquent than BTT but until then we can recall what it was like BTT. ​