How Can a Tight Frenula Affect Breastfeeding?

Tongue-ties and tight frenula are definitely a hot topic among breastfeeding moms and lactation consultants.  While I had never heard of these 6 and 7 years ago, when my kids were born, they are now the FIRST thing I check for during a lactation consultation when a mother is describing painful breastfeeding and pinched, damaged nipples.  And, while a tight frenulum is not always going to cause breastfeeding challenges, there are many breastfeeding mothers who are in excruciating pain even when their babies seem to have the ‘perfect’ latch.

 

So what are the signs of a tight frenulum, for both mom and baby? 

When should a baby’s parents consider clipping their baby’s tight frenulum? 

How can this surgery (frenotomy) improve breastfeeding?

 

A few weeks ago I had the esteemed pleasure of interviewing one of the top ENTs in San Diego about the effect of tight frenula on breastfeeding.  Dr. James Ochi, of Children’s ENT of San Diego answered all of these questions and more.  Plus, the three breastfeeding moms in the studio were able to share their experiences as mothers with tongue-tied babies.

 

Click here to listen to our episode Tight Frenula and Breastfeeding

 

Here are also a few of my favorite articles about breastfeeding and tight frenula:

AAP article: CONGENTIAL TONGUE-TIE AND ITS IMPACT ON BREASTFEEDING

La Leche League International: Tongue-Tie and Breastfeeding

Low Milk Supply: Tongue Tie and Suck Dysfunction

Entertaining a Toddler While Breastfeeding a Newborn

I cannot begin to tell you how excited we are about the 100 or so amazing questions submitted to our article, What Breastfeeding Topics Would You Like to Know More About?  From inquiries about breastfeeding after reduction surgery to dealing with a teething infant, our blog calendar is now FULL for the rest of the year, just answering your questions!  YAY!!! 

For the rest of the year, Thursday will be the day we delve into our readers’ questions, adding to our series, Help A Breastfeeding Mama Out!  We will also answer your questions on our ‘Ask the Experts’ segment on The Boob Group online radio show.

 

Here is our question of the week:

Dear SDBFC,
I would love to learn more about nursing a second baby with a toddler running around. I remember how hard it was with C and how it consumed everything for the first couple weeks getting my daughter to latch, and nurse, and stay awake to nurse...and I am due in October when C will be two and the thought of doing that with her running around terrifies me. Any tips?
 
Alicia

Does A Free Can of Formula Really Benefit Anyone?

Just last week, the American Academy of Pediatrics approved a resolution that advised pediatricians not to provide formula company gift bags, coupons, and industry-authored handouts to the parents of newborns and infants in office and clinic settings.

In their rationale, they explained that: Research has demonstrated that the free distribution of commercial materials, such as formula samples, diaper bags, formula coupons, or other gifts via commercial infant formula marketing implicitly endorses formula feeding and creates the impression that clinicians favor formula feeding over breastfeeding, and research demonstrates that this activity decreases exclusivity and duration of breastfeeding.

Enfamil bag with free formulaSo, how does this really affect both breastfeeding moms and formula-feeding moms? 

Does a can of free formula really benefit anyone?

How to Prepare for Breastfeeding Before Your Baby is Born

How to Prepare for Breastfeeding Before Your Baby is Born
Dear SDBFC,
What should a first-time expectant mother who wants to breastfeed expect at the (big, traditional) hospital in the way of breastfeeding support? It would be nice to know what we're allowed to expect/ ask for. Should the hospital lactation consultants be sufficient or should we plan on working with an independent LC right away? Is there anything we can do before birth to help ensure smoother breastfeeding?
Sincerely,
Jenny

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Dear Jenny,

That is an excellent question, and to be honest very difficult to answer.  The type of breastfeeding support you will find at a hospital will vary greatly depending on which part of the United States you live in, whether the hospital is Baby-Friendly, its yearly breastfeeding rates, if they have certified lactation consultants (IBCLCs) on staff, and if their postpartum nurses have had recent breastfeeding training.  One hopes that the hospital lactation consultants will be fabulous, but that may not always be the case.  Also, a new mom typically won’t even see a lactation consultant in the hospital unless she is high-risk for breastfeeding challenges or she asks for one directly.

Breastfeeding Expectations for the First Month

Do you remember what breastfeeding was like during those first few weeks after your baby was born? 

I personally remember feeling somewhat clumsy and awkward, as if my son and I were trying to master a new dance without stepping on each other’s toes.  Our rhythm was slightly off.   I constantly relied on my breastfeeding pillow and there was absolutely no dependable schedule.  I was forced to switch off my Type-A brain and learn to go with the flow, which was quite a challenge for me, to say the least!

Yet, as the months went by our breastfeeding relationship changed.  In most ways, it improved immensely, as I became a more confident mother and caregiver.  In other ways, different nuances surfaced, which taught me that breastfeeding, like parenting, is constantly in a state of motion and sometimes in need of modifications.

Partner Support: Can It Make or Break Your Breastfeeding Experience?

When Ben was born almost 7 years ago, I had no idea how much I would rely on my husband to be my pillar of support.  When I was gliding along my roller coaster of postpartum hormones, it was my husband who gave me space, as well as made sure I stayed somewhat sane.  He brought me water while I was nursing, ordered in dinner when we were too tired to cook, and made me laugh when I thought all I could do was cry.  He was also the person who got on the phone to call the lactation consultant when I had no idea why breastfeeding wasn’t going the way I have envisioned it. 

Breastfeeding was important to US and we knew we could make it work.

When Should I Introduce Solids While Breastfeeding?

Dear SDBFC,

Thanks for responding to this question on Facebook the other day, but I would love to hear more on this topic: does breast milk start losing its nutritional value after 6 months? If the pediatrician states solids (in particular enriched rice cereal) twice a day are needed, are there any alternate opinions? I'm curious if the WHO or LLL have any alternate evidence.

Sincerely,

Abby

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Dear Abby,

Thank you for your excellent questions.  Solids are a huge topic of discussion in our weekly breastfeeding support group and pretty much every pediatrician in town has a different philosophy.  Here’s what the official organizations recommend

Why Aren’t Moms Meeting Their Breastfeeding Goals?

In the Pediatrics research article, Baby-Friendly Hospital Practices and Meeting Exclusive Breastfeeding Intention, scheduled for publication in July 2012, the authors conclude that most moms will not meet their personal breastfeeding goals.  According to the Pediatrics study, more than 85% of the new moms in the study said they intended to breastfeed for three months or longer, but just 32.4% met their mark.

 

The study found that moms who were most likely to meet their goals:

  • Were married
  • Had given birth to other children
  • Started to breastfeed within an hour of birth
  • Had babies who were less likely to be given formula or pacifiers during the hospital stay

 

 Of these findings, breastfeeding exclusively while in the hospital, without giving supplemental formula, was the most significant factor in reaching breastfeeding goals.

So, what were the indicators that correlated with a mother to be less likely to meet her breastfeeding goals? 

  • Obesity
  • Smoking
  • Planning to breastfeed for longer durations

 

Still 32.4% of the moms in the study didn’t meet their goals of exclusively breastfeeding for 3 or more months.  The American Academy of Pediatric recommends exclusive breastfeeding for the first 6 months. 

We are failing our moms!  

Why is this happening?

Study after study has shown that new moms need breastfeeding support to be able to meet their personal breastfeeding goals.  (Cochrane meta-analysis)

So what does this breastfeedingsupport look like?

  • We need peer to peer support (like a support group) where we can learn from our friends and teach one another about the lost art of breastfeeding.
  • We need access to affordable and effective prenatal breastfeeding classes that are routinely promoted by our OBGYNs and midwives, so that we can increase our breastfeeding initiation rates. 
  • We need capable, caring lactation support in the hospital that can assist us when we need help and guidance, and recommend local breastfeeding support for when we leave.
  • We need hospital practices that support breastfeeding, like skin to skin in the first hour, even after a cesarean birth, and limited visiting hours.
  • We need access to affordable, on-going lactation support, from a trained certified lactation consultant (IBCLC) starting from day one until we decide to wean our baby.
  • We need our health insurance to cover the cost of qualified lactation services, just as they do with routine well-baby check-ups.
  • We need pediatricians to value breastfeeding and recognize that breastfeeding will protect their patients from so many preventable chronic illnesses.  So, when a concern arises about breastfeeding, we need them to immediately share with us breastfeeding resources in the community, both free and for payment.
  • Ideally, we need lactation consultants (IBCLCs) in our pediatricians’ offices so that when issues are brought to our attention at our appointments we can receive immediate and ongoing breastfeeding support and assistance.
  • Lastly, we need formula companies to stop sending free formula to every new mom.  If a mom needs or wants to use formula, she can get it at any local grocery store… no judgment!  Yet, let’s not make it so easy for new moms to succumb to self-doubt.  Do you know that the WebMD article, Most Moms Don't Meet Own Breastfeeding Goals, that first shared these findings from the Pediatrics' study happens to be placed RIGHT NEXT to a HUGE Similac formula advertisement.  Seriously???

 

Why do I think breastfeeding support for all moms is imperative?

As a married, breastfeeding in the first hour, and ‘no formula supplementation’ mama, it was the lack of community breastfeeding support that led to me not meeting my personal breastfeeding goals and that is something I will always regret.  When my milk was dwindling as my son turned 4 months old, it was never recommended by a health professional to see a lactation consultant to increase my supply.  Why was formula an acceptable substitute for my son in their eyes?  It doesn’t make sense to me.  Why didn't this doctor recommend that I see a lactation consultant?  

My story is not unique.  I meet women every day who feel guilty for not meeting their personal breastfeeding goals.  This doesn't have to continue!

Support, support, support!  It’s what we all deserve for ourselves and our babies!  We need to make this happen NOW!

 

How Can I Keep Up My Milk Supply While on a Business Trip?

Dear SDBFC,

Do you have tips on your first (business) trip without the baby when you're breastfeeding and have to pump (in my case, baby will be 9 mo.)? 

Thank you!

Kristi

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Dear Kristi,

Absolutely!  Taking a business trip, when you have a breastfeeding baby at home, doesn't have to be as daunting as it sounds.

Newborn Hands: Why are they always in the way while breastfeeding?

Oh, those sweet little newborn hands.  Such a love/hate relationship we breastfeeding mothers have with those hands.  We love to hold and kiss those sweet-smelling hands, yet when it’s time to breastfeed, those annoying little clawing paws won’t get out of the way!  The minute our breast is out and ready to feed, those newborn hands are like defensive linemen, blocking any entry into our baby’s pecking mouth.

So, what’s the deal with those hands?