Ortho and Lactation Consultations

Nora had two appointments yesterday, ortho in the morning, and last night we met with a lactation consultant for help with breastfeeding.

Dr. Morcuende is the pediatric orthopedic surgeon at the University.  He reviewed Nora’s hip ultrasound following an examination, and thankfully he doesn’t believe she needs any treatment at this time.  He did confirm her right hip is immature, even for her corrected age, but he’s confident it will mature without the use of a harness.  We are following up with another ultrasound and exam the beginning of September to make sure she’s growing properly.  I made sure to ask that if for some reason her hip isn’t mature in September, there would still be time to correct, and he assured me there would be.  So for now, we wait, and pray.

I’m not sure I can say we were given as awesome of news at the lactation consult last night…

First though, let me say, the two ladies I met with were fantastic and extremely helpful.  Jennifer Pitkin, BS, IBCLC, RLC, and Kimberly Hendricks, who I believe is in training to become a certified lactation consultant, both from Mother and Child Midwifery, met me after hours last night at their clinic in Iowa City.  The first half hour was a lot of talking, they wanted to know about my pregnancy, her birth, her stay in the NICU, and how she’s been feeding since discharge home.  They did an oral exam, evaluated her mouth and suck pattern, and then watch her nurse to evaluate further.  They found a few things concerning during their evaluation…  I pasted their comments below, as they explain much better than I, but the gist of it seems to be that she has both an upper lip tie, and a posterior tongue tie.  The upper lip tie doesn’t actually seem to be an issue.  She normally tucks in her upper lip when nursing or with a bottle, but she can flair her upper lip with some help from me.  What she can’t do is raise the posterior portion of her tongue, or move her tongue from side to side.  They explained how babies tongues should flow in a wave formation when nursing, but since she can’t raise the posterior portion she can only move the front of her tongue up and down, thus basically chomping on my nipples, the cause of all my pain and soreness.  Oh, did I forget to mention that I’ve really, really been focusing on breastfeeding?  In the past 48 hours Nora has only had two bottles 😉  I’m proud of her, and me, but really, really discouraged as well.

So my pain…  Two pains actually.  I have been pumping between 30 and 35 ounces a day for the past 4+ months since Nora was born.  Nora doesn’t eat anywhere near that amount, so needless to say, just feeding her, and not pumping in between, well, its leaving me very full, and very uncomfortable.  As much as I hate pumping, I so want to pump to feel better.  But, several people have told me not to, or only pump for a few minutes, as my body needs to learn I don’t need to produce so much milk.  How long does it take for my body to adjust???

Than there is my nipple pain during feedings, and sharp shooting pains after feedings.  I don’t know how some people do this, with this much pain, for any length of time.  Its only been two days and I already want to go back to pumping.  I’ve been putting ointment on, but it doesn’t seem to be helping much.

At this point I’m very confused as to next steps.  The lactation consultant recommends a pediatric dentist in Dubuque, a girl I went to high school with…  Small world!  Problem though, we don’t have dental insurance again until August 1st when Eric starts work again.  Granted, that’s only a little over a week, but do I continue in pain for a week, knowing she is sucking wrong and damaging my breast tissue?  Or do I go back to pumping for now and try again after we talk to a specialist?  I feel like going back to pumping is undoing everything I’ve worked so hard at the past few days.  Eric also wondered if an Ear Nose and Throat specialist (ENT) would assist with lip and tongue ties… he emailed one he knows from the University, but I suspect they won’t use a laser like the pediatric dentist prefers.

I’m so confused.  How do you know who to trust to cut into your daughter’s mouth?  She’s already been through so much, breaks my heart to subject her to more.  But if we don’t correct her tongue, will she has issues with eating once we start on solids, or develop speech issues down the road?  Way too much to think about right now, when I’m supposed to be organizing this house for the movers!

Report:

Subjective/Relative History:
No abnormal breast history reported during pregnancy/lactation. Mother reported pain due to compressed nipples during nursing sessions.

Objective:
Mother: Normal breast anatomy. Sufficient supply due to previous pumping regimen. Worked with mother familiarize with correct positioning and latch techniques.
Infant: Inability to deeply latch. Infant showed symptoms of a class 3 maxillary frenulum (lip tie) which did NOT impact feeding when upper lip was manually flanged and III-IV anterior and posterior ankyloglossia (tongue tie). During infant oral evaluation, infant was able to extend tongue past alveolar ridge, had difficulty lateralizing tongue, was incapable of producing a moderate cup with finger, and frequently gagged. Infant utilized chomping motion rather than wavelike motion during oral evaluation.
At breast: Audible swallow. Tongue visible. Sliding down and chomping during nursing session.
Postfeed: n/a

Assessment:
Infant was incapable of initiating deep latch at breast due to inability to flange upper lip combined with an inability to produce adequate sucking motion at breast to deeply attach. Frequent sliding off of nipple and incorrect sucking pattern (chomping motion) have caused nipple tissue breakdown and compression stripes on mother’s nipples causing visible vasospasms.

Plan:
Mother will continue to nurse on demand, utilizing: exaggerated c-hold, manual flanging of upper lip, placing coconut oil directly on nipple to aid in healing. Mother has received instructions on suck training to reinforce correct wavelike sucking motion and will follow-up with progress by 7/27 with results. Mother is considering to have maxillary frenulum and posterior tongue tie revised by physician or dentist pending results of suck training progress, current care plan and physician’s recommendation. Mother was instructed to utilize tongue/lip tie stretches pre-feeding and suck training techniques after a nursing session to reduce compression of nipple and reinforcing wavelike motion to effectively drain the breast.

Follow up phone call will occur anytime mother has questions. In-person feeding consultation will be at mother’s request.

17 thoughts on “Ortho and Lactation Consultations

  1. I had both ties myself. I never got them corrected til much later in life (grade 4 for the tongue, and my upper when i was 26 – seems crazy I know!). My nephew got his corrected via laser and the recovery was super quick. If you can go that route, I think it’s a safe one. I wish I had mine done when I was a baby that way. Less pain and healing time.

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  2. Girl, get yourself a nipple shield! That can bridge the gap between now and when her tongue tie is better. That’s what worked for me after I had mastitis and before her tongue tie was better. I was about the give up after I had mastitis and it just kept hurting, but I used the shield for a couple weeks while Harriet did her therapy and then I withdrew the nipple shield and now all is well!!

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      1. Oh don’t look at a nipple shield as a failure!!! They are a god-send. Seriously! I use one and I’m so grateful they exist. I would not be breastfeeding right now if they didn’t, as we had a ton of issues establishing a deep latch and I’m a total wimp when it comes to boob pain. The one thing I would suggest is emailing to the lactation consultants to ask what size you need. I read somewhere all women need medium but my LC said that it’s absolutely not true and she has rarely seen anyone who needed that size. A correctly fitting nipple shield really makes a huge difference in comfort!

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  3. There is another blogger who’s baby just had one of the two laser surgeries you are talking about. I’ll try to remember who it was and send you a link to their blog as it might be helpful for you to connect with her.

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  4. Call the dentist now to set an appointment and to know what the wait will be. Everyone else above had great advice. You will get this figured out! PS: Good consults with both specialists and the LC report is sterling. Wish everyone seeing LC’s had such well qualified ones.

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  5. I’ve had a terrible, horible, awful time with nipple pain and injury. I also have Raynaud’s of the nipple (painful condition). What *saved* me were Silverette nipple cups. Look them up on amazon.com (they are prime!) and please order them post-haste. My nipples were completely healed after one week and I continue to wear them faithfully. 2 things: I wear pads in my bra to conceal the cups because they are quite obvious. Also, they collect milk in the tip, which I usually wipe out during feedings. Oh, and they leak when I sleep so I use thick washable nursing pads (and honestly I just wake up with a soaked nursing bra every day so I have a plethora of “sleep bras”). I hope you try the cups & find they help! Also it’s precious that they become jewelry after nursing (you send them in & the company will fashion a charm for you). XOXO

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  6. My kids always had theirs snipped with surgical scissors. It doesn’t actually bleed much. I was concerned because the laser is recommended but nobody around here uses one, but it was fine. So honestly, either way is probably no big deal. It’s such a minor procedure they do it in the office with just a little lidocaone!

    I personally would go with someone who can see you soon. If you keep nursing with a tongue and lip tie you risk nipple damage- well, you’re already having vasospasm, which is an indicator of chronic damage – and it can lead to chronic thrush and mastitis and which can be really hard to get rid of. That pain is an indication of damage! But the LCs sound very good and super helpful. I bet once you get this taken care of and your nipples heal some breastfeeding will be so much easier!

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