I don't want a mother to feel guilty, but I do want her to recognize her feelings about her situation. Feelings are not negative. Feelings are just feeling.  And we need to feel to work through the struggles. 

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.
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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. ​

This week husband of Florence Leung released an emotional statement about postpartum anxiety & depression after losing his wife two months ago. He also commented about the pressure to breastfeed in the same comments. I commend him for speaking up, being brave, being seen, wanting to improve other peoples situations & for encouraging all new moms experiencing low mood or anxiety or depression to seek help. He added that these mothers are not alone and that they are not bad mothers. I agree and know he is correct. I don't believe there are bad mothers. I know mothers feel alone and isolated. Too many mothers feel this way. They are alone but not alone at the same time. When we pull in the breastfeeding component it gets super confusing and conflicting and very, very emotional. There are so many versions of how breastfeeding plays into postpartum anxiety and depression. Part of it is emotional and the feeling part of our brains and body and some of it is biological and chemically controlled in our brains and bodies (hormones are so complex). Some of this is controllable, in the sense that we can just change our outlook and start to feel better, and much of it less controllable and sort it feels like it is happening TO the mother. It really feels like a loss of control. ​

​If the baby cannot function fully at the breast no amount of time at the breast is going to drive supply. At the same time, we also learnt the breast doesn’t function like we thought it did. The new science tells us we make more milk by emptying the breast more, NOT by letting it get full and empty every 4 hours. Hold on, what? But babies don’t like when the breast isn't full, they scream and protest or fall asleep. They are happy when it is full, let-downs come easy and milk leaks into their mouths. We now understand this all as a compensation for babies inability to function and realize that this routine of feeding can, in fact, cause (secondary) low milk supply down the weeks of feeding. If we address the babies issues, we can have proper feeding, proper demand and proper long term supply. We are starting to make progress with this and changing the idea of low supply. 

What i am not seeing is a change is how we see the idea of oversupply or overactive let down. If the idea of low supply is often being perceived incorrectly should we not consider the idea of overactive let down or oversupply isn't a true phenomena either? Could oversupply also point back to the baby? Is this another function consideration?  I certainly think so. I would like to ask that we consider the let down and supply as normal flow, but, too fast for that particular infant. The infant, for varying reasons (and an assessment would be needed to determine the reason) is having a hard time controlling the flow of the milk. They choke, cough, sputter, leak milk, etc. They might have fast feeds, gain well and seem to adapt to this "overactive let down". As time goes on, supply decreases (we respond saying milk supply is now regulated as nothing was wrong anyway) and soon, the same mom with overactive let down, is saying she has low supply. WHY? Because the baby could not feed correctly from the beginning. They had difficulty at the breast, relied on that fast letdown and now without correct feeding behaviours, just like the low supply moms I talk about above, the demand is not there and so the supply goes down. 

Something else we now know, that we used to say the opposite of, is that a hungry baby will cry and a content baby cannot be hungry, Regardless of weight gain plateauing on the curve, being slow gaining, so long as baby seemed content, no one worried. What we know how is that as milk supply goes down, appetite of the baby goes down. That appetite is the demand we need! So without the demand, we again will have no supply. This is quite a different tale than has been told in history! 

Let's keep chatting! If you think you need some hep navigating your breast-feeding I am happy to book a time to see you and your little one. 

​Do you know what can mimic a tongue tie? Terrible breastfeeding technique can. The number one cause of many breastfeeding concerns or issues is positioning and latch. A good latch is vital to milk transfer. Good supply is dependent on milk transfer. Weight gain, pees and poops are dependent on supply. Swing back full circle to latch and latch is dependant on good positioning. This is true in the majority of cases. Add in that good positioning and latch should also make things easy, comfortable and pain free for mother. It should also make things easy, comfortable and effective for baby. 

When we see concerns with breastfeeding we must start with full maternal and infant assessment. This cannot be skipped. This includes a history on the birth and the start of breastfeeding, how feeding has been going, any know medical issues that contribute to breastfeeding concerns with mom and baby, a feeding assessment including positioning and latch, and structural exams of both mom and baby.

​Sometimes we have breastfeeding issues and concerns that are easy resolved by refining breastfeeding techniques. It can be that simple. Sometimes you will get breast-feeding technique (position and latch) perfect but there is still lots of trouble. We have pain, we have inadequate transfer, we have low weight, low pees and poops, etc. These are times we need to look further. There can be lots of reasons for this but today I am going to highlight tongue ties. 

Tongue tie or poor breastfeeding technique? 

I am all for fixing tongue ties. If they are a problem they are better resolved than to be “pushed on through”. However,  I am more if favour of through assessment of breastfeeding & comprehensive follow up if a procedure is deemed warranted which is why I am drawing attention to this point today. 

Assessment of breastfeeding MUST include watching a feed amongst structurally examination of mothers and babies. And we have to address position and latch. The sooner we do this, the better. Why? Because if we have position and latch causing pain and damage, it is hard to tell if position changes are helping the pain or not. If we have damage and trauma, even a good latch will hurt until that is healed. So, then if look at a baby and see what visually looks like a tongue tie, we start to get blurred lines. The simple presence of a frenum is not a tongue tie. Diagnosing a tongue tie requires more than just looking. It is an assessment of function. Now when we are dealing with breastfeeding infants that function includes transfer of milk, weight gain, position needs, maternal comfort, visual of babies like folds in the lips, blanching of the frenum, blisters in the lips, etc. The people that can assist us in revision of ties are doctors and dentists and I am grateful to have them as part of our team. 

But, let me ask you how many doctors and dentists are watching feeds? How many would know how to throughly assess a breastfeeding session? How many know what to look for structurally in a mother? And throughly for an infant? 

Doctors and dentists that we rely on in resolution of breastfeeding concerns by revising tongue ties are typically only looking for a tongue tie as the reason to why you are presenting themselves to them. Their brains are actually wired to look for a possible intervention to try and resolve the issues based upon their skill level, experience and ability to help. 

Have you heard this quote before? “If you hear hooves behind you, don’t expect to see a zebra when you turn around. Chances are it’s a horse.” 

This means, first look for the simplest, common explanation to the problem presenting first. Once we have done this, then yes, we should go ahead and look for rarer & more problematic causes. In the medical community this is know as differential diagnosis.

How do you know what is causing your breastfeeding issues? 

The most important key is to telling the difference between the horses and zebras. You cannot do this without a through evaluation, by a skilled practitioner. In the case of breastfeeding, these practitioners are International Board Certified Lactation Consultants. We have to be cautious of not assigning more importance to one element of breastfeeding than another, just because we think it is important or because we think the title of a certain practitioner is important or because that person thinks they are so important. There is another term for this which is “availability heuristic”. It is a bias towards things which you deem as more important because you readily recall it so deem it more probable. So, as someone looking at tongue ties most of the time this is front and centre in their minds. So, it is likely a dentist or doctor would go to tongue ties as a common cause of breastfeeding issues.  As IBCLC’s we start at the basics, with the most common explanation of position and latch and move from there. The differential diagnosis mentioned about is what an IBCLC would do. This is why an IBCLC should be a first stop and why I think referrals for revisions of tongue ties should not be done without an IBCLC assessment. 

I bring this up because I am seeing moms & babies after tongue tie revisions who I didn’t see before. I don't know what the baby looked like before but more importantly what I am seeing a little more frequently than what I would like is bad breastfeeding technique. I cannot help but wonder, if we had just corrected positioning, would that have been enough. Did we have a true tie or did we have symptoms of bad technique that are also symptoms of tongue tie. Looking back at the information presented above about assessments, evaluations, horses and zebras & availability heuristic people you can see where my concern is warranted. 

Where do you go from here for support in resolving breastfeeding concerns?
 
Be wise in your selection of care providers when you are struggling with breastfeeding. Step #1 should be an assessment with a skilled IBCLC. From there we will make all appropriate referrals to other members of our team that assist with getting breastfeeding back on track. If you are in Regina or in the Regina area, I would be happy to help you navigate your breast-feeding challenges. You can give me a call or easily book online.

Nipples sore? 


Sore nipples can be one of the more common breast-feeding challenges. You certainly are not alone in this, however, you don't need to remain sore, or worse yet, in pain. Pain at any point is your bodies way of telling you something is wrong and you need to pay attention to yourself. 


What causes soreness and pain? 


Most commonly it is because of trouble with positioning and latch, creating friction, and proceeding them to soreness, cracks, blisters, bleeding and sometimes infections and even lose of skin. 


What can be done? Here are a few quick ideas. 


Most importantly, check your position and your comfort. One of my rules is to make sure mom is comfortable first. Ideally, mothers are slightly reclined, arms and shoulders lose and down, and her neck has the ability to be relaxed. With this, mothers can then bring baby to them. You don't want to try to take your breast to baby. Baby can be front-to-front with mom, being supported by mother’s arms, and mother’s arms can be supported with pillows. Use gravity to help baby get on the breast deeper, rather than sitting upright and having gravity pull baby down or away from the breast. 


If we still have discomfort, we need to check baby’s latch. A good latch is vital to comfort but also to long term duration of breastfeeding. A good latch is key to effective feeding which is essential for adequate milk supply. You might need to ask someone for help with checking the latch. If someone tells you it looks good, but you have pain during or after a feed, you need to ask someone else. 


If position changes do not help with latching issues and soreness and pain are still prevailing sometimes we need to look farther into reasons and makes plans. Sometimes we can use a nipple shield to help protect the nipple and help baby to latch. It is important to get good help if needing a shield. There are important things to watch for such as fitting, proper placement, adequate milk transfer, babies output and weight gain. This is very important to know and recognize however; nipple shields are a Band-aid solution. They are not an answer, they are simply a tool to help keep the baby breastfeeding, at the breast, rather than quitting breast-feeding or going to pumping and feeding another way. It is a short term tool that needs a bigger plan. 


Throw away the lanolin! For years we were told Lanolin was fabulous and all new mothers needed it. But the new research shows us, doing nothing is actually more effective than lanolin and in fact lanolin can delay healing, making things even worse for a longer period of time. Mor effectively you can apply breastmilk to the nipple or coconut oil or calendula if you want to try something else. 


Do not let you nipples be wet and cold at the same time. Again, we were told for years that we should let the nipples air dry. But for mother’s with very sore, damaged nipples, the cool air can cause more harm. It is a good idea to apply heat while the nipple dries. Something like a rice sock or heating pad after baby unlatches, or even when getting out of the shower or bath, can help. This helps bring blood flow to the nipple that previously was restricted. 


Soreness and pain are not considered normal for breastfeeding at any time or for any length of time. If basic positioning and latch changes do not help, it is worth having someone skilled come and have a look. They can help assess and evaluate what might be happening and help you make a plan to further overcome the struggles. 
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Ladies (& partners and support people), you need to know that there are resources out there to help you, when you need it, where you need it and that will consider YOUR goals. I can come to your home, I can come to see you at the hospital, you can come to my office. If you feel like you are not getting the support you need, when you need it, don't throw in the towel on breastfeeding. There are always options. 

Breastfeeding can take some time to get established. It is a learned behaviour by both mother and baby, and each baby a woman has is a new learning experience. With that said, time is also precious when trying to get breastfeeding established. Some things are normal learning curve experiences and some things are not normal and should be addressed as soon as possible. Mother's almost always know when something is not correct.

I spoke with a mother earlier this week who knew something wasn't right. She asked for a referral to a lactation consultant and was denied. She continued to ask as the days went on and was told repeatedly that what she was experiencing was normal and wasn't yet at the point of needing a lactation consultant. Her frustration was to the point that she was ready to throw in the towel on breastfeeding. She spoke to a friend who informed her that there are private IBCLC's who she could see and who would be able to see her sooner than later and that before she quit breastfeeding she should call me. 

This mother took the advice of the friend and gave me a call. I was able to listen to her breastfeeding story to date,  do an assessment on her and baby, figure out what her goals for breastfeeding were and prioritize the concerns she had about breastfeeding. Sometimes it is about addressing one big issue, like the amount of pain a mother is having, and then moving forward with other plans and goals. Breaking it down into manageable bits and pieces can make the big picture seem far less daunting. Let's not worry about breastfeeding until baby is one year, if we are not even sure we are going to make one week with the amount of pain we have. Maybe we should look at how to get rid of the pain, and see how week two goes…sounds far less scary than pain for a year. 

Disclaimer: I am not a mental health care professional or provider. If you think you are suffering from any sort of mental illness I recommend seeking medical attention as needed. I will also add in that I do take mental health concerns seriously and this blog post in not intended to down play medical concerns. 




Before you diagnose yourself with depression or low self-esteem, first make sure that you are not, in fact, just surrounded by assholes. - William Gibson 

When I first came across this quote, I immediately identified to it as an adult, as an individual and as I related to other adults. More and more I have been thinking about this in the context of my work, my work with new families, young babies and children & different relationships forming in homes. 

The rate of postpartum mood disorders is on the rise. Baby blues, anxiety, depression and psychosis are a very real reality for many new mothers and fathers. We mostly see it in the context of mothers but more and more research shows our fathers are impacted by mood disorders as well. 

Let’s, however, just step back for a minute and think about the above quote. “Before you diagnose yourself with depression or low self-esteem, first make sure that you are not, in fact, just surrounded by assholes.” I don’t want to be rude but let’s face it, babies are assholes, toddlers are assholes and kids can remain like that as they grow up. They certainly don't mean to be but they are incompetent & demanding, they can be obnoxious and rude, they interrupt your every meal and all your sleep. You can’t even think about peeing without baby waking up and crying, let along move an inch to try to get up and pee.  They need to be fed constantly, hanging off your breast, YOUR breast no longer belongs to you. When they are not feeding, they need you to hold them or they will turn the reddest of red and blow horrible smoke from their ears. They pee and poop ALL.THE.TIME.  Rudely, they sometimes don't even wait for the new diaper to get on before they shit all over you or shower you in pee. You imagine stuffing that thing back inside you, because as awful as it was to have that watermelon come out the lemon, they are way easier to take care on the inside, right? Well, too bad, there is no turning back. There is only moving forward with this asshole in your life. 

By now you know I am not serious in calling babies assholes, but you can see my point. Life is HARD with a new little person to care for. The real assholes of the world are hard enough to put up with, but now you have to put up with the smallest of them all, ALL the time, because YOU created it after all, YOU wanted this. Now you have to do it when you have zero sleep, zero nutrition and probably zero clue how to actually take care of this baby - I can guarantee you it did not come with a manual. Add in some hormones and everyone’s opinion of what you should be doing and it is easy to see why one would end up with signs and symptoms of a mood disorder or postpartum depression. 

So, how about we get serious about what we can do about this baby and get through what will be one of the most challenging times of your life. 

Self-care is big. You don't want to lose yourself in this. Having a baby WILL change you, but doesn’t need to consume you. What do YOU need? What does your partner need? Make a plan to have that happen. 15 minutes in the shower, making two sandwiches instead of one when your partner leaves for work, tea out with friends.  Asking friends to bring you food when they come visit the baby. By the way, when they come visit, the asshole will switch personalities and put his nice guy face on.  Have someone come help with light house work and laundry once a week. It’s the small things that make a massive impact. 

Communication is huge. Tell each other how you are feeling about the changes in life and the new demands. If you are reading this before having your baby, start that conversation now. Brainstorm the different ways to achieve self-care that will work after baby. Be open and flexible in changing those plans, if needed. Just talk to each other and others about what is happening in your new world. Just keep the conversations going. And find others who will listen to you both. Just someone who will let you get it out. I promise, they won't mind. 

Support. SUPPORT. SUPPORT.  This is a must. You need to build a team of support people. Before baby is ideal but may not have happened and you may now just be building a support team. Who are we talking about? Family, friends, community resources - your health care providers, doula’s, peer support groups. Everyone’s team is going to look different depending on the needs they have. What is important to know is that support is going to make one of the largest impacts in how you feel about everything and how stable your mood will be, how you will interpret your experiences and what the outcome of the situation is. It is important to identify your needs and equip yourself with the tools to get there. It is vital to know what your support options are because without options you have no choices. So, start now by identifying your needs and making a list of supports. If you get lost and have a need but don't know how to get the support you need to have that need met, please ask! I am here to help in this time of transition in your life.

You are a new breastfeeding mother. It has been about ten days and your cracked bleeding nipples aren't healing & you have started to have a burning sensation with deep throbbing pain in your breast. It sometimes lasts for a few minutes, but sometimes hours. The beginning of feeds are terrible and even between feeds you are getting electrical shock like feelings in the breast. If this is you, you are like many other mothers and like many other mothers you may have been told you have thrush. You are given a prescription for nystatin for you and baby. You treat for two weeks and symptoms get mildly better, but it isn't going away. Baby has no symptoms but your pain just won't knock it off. You get Nystatin for a couple more weeks, cut out all sugars, start washing your nipples with grape seed extract and the pain in still persistent. Maybe you have had APNO cream & some Diflucan in there, as well. Still no success. 

How about I suggest to you that if you have thrown every thrush treatment at your nipples and you're not seeing results, that it isn't really thrush you are trying to treat? 

Thrush is very commonly diagnosed, rather misdiagnosed. I do not think that it is as common as we are being led to believe it is. I know you are asking me, "if it isn't thrush than what is it?"

I would say in more likelihood than not, it is vasospasms. Vado-Whats? What are those? The simple answer is that the blood vessels in the are contracting and becoming smaller in diameter - called vasospasms. This can happen for a variety of reason and for some people it can be very painful and occur in various parts of the body, including the nipple in breastfeeding mothers. 

There are risk factors for vasospasms including but not
limited to : 

• Poor latch, position or clenching during feeds
• Nipple cracks or trauma, especially severe or reoccurring trauma 
• Exposure to cold temperatures
• Periods of severe emotional stress
• Cigarette smoking or second-hand smoke
• Caffeine intake 

What are some more symptoms and how would you suspect you have vasospasms? 

• Nipple/breast pain
• This pain might be a burning sensation, throbbing, pins & needle-like, deep into the breast, and/or numbing.
• The pain can last from seconds to hours, and come during or in between feeds.
• The pain may get worse when the nipples are exposed to cold, i.e. when you step outside in cold weather, or when you get out of a hot shower.

• When you are having the pain, your nipples will usually change color to pale/white, blue/purple, or dark red. These color changes are a sign that your blood vessels are contracting or spasming. 

What can you do about vasospasms? 

1. Most importantly, make sure your baby has a good latch and you are pain free during feeds. If you are in pain or are unsure about the latch, get help as soon as you can. I suggest booking an appointment with an IBCLC. Getting the latch and pain resolved is key to stopping and healing your vasospasms. 
2. Use heat! Stay warm and keep your nipples warm. During episodes of pain and after feeds, use a warm compresses or your own arm or hand to warm the nipple. Always have heat on the nipple while wet. 
3. Avoid smoking and second hand smoke.
4. Decrease caffeine intake. 

It is important to seek professional help as soon as possible if this problem is persistent. They can help assess the cause and come up with some remedies for you. They can also explain the use of vitamins, minerals and omega fatty acids (important for healing). There are also prescription medications available, if warranted, and your IBCLC and physician can help accommodate that. 

You do not need to suffer through the pain or end breastfeeding for this to resolve. If you would like to keep breastfeeding, without pain, book an appointment and we can get you back on track.