Friday, April 12, 2013

Successfully Breastfeeding After a Rough Start: Part 2

By Karolina Gonzalez, MAS

Last time, I shared the exciting news that my baby, David, was born and that my goal to breastfeed him exclusively was more difficult to achieve than I had expected.

After meeting with the lactation consultant on day 4 postpartum, I felt someone was actually supporting our breastfeeding goals. More than anything, her words were amazingly encouraging! I started using the breast pump to stimulate milk production and the nipple shields to be able to nurse the baby as often as he wanted to. However, two days later David’s weight gain didn’t improve at all.
On day 7, I noticed his tongue was not moving forward enough for him to effectively breastfeed. The tongue plays an important role in breastfeeding! In order to extract milk from the breast, the baby needs to move his tongue forward to cup the nipple and the areola. When he draws his tongue back, he presses the tissue against the roof of his mouth. This compresses the ducts behind the areola and allows the milk to move into the baby’s mouth. Babies with ankyloglossia, commonly known as tongue-tie, might have difficulty latching onto the breast and the mother may experience nipple pain and/or trauma. These conditions can lead to other breastfeeding problems, such as slow weight gain and/or failure to thrive in the baby and ultimately a poor maternal milk supply and untimely weaning (Ballard JL et al, 2002).

Everything indicated to me that some level of ankyloglossia could have been the cause for David’s low weight gain and constant fussiness, as well as my sore nipples and perceived low milk supply. Researchers have also reported that inadequate milk supply may be rooted in decreased ejection reflex as a result of maternal nipple pain or in suppressed lactation as a result of the infant’s inability to drain the breast (Ballard JL et al, 2002). I had already heard about that while pursuing my Master’s Degree in Maternal and Child Nutrition, but now looking back, I think sleep deprivation and pain prevented me to take that into consideration in the first place!

We left to the hospital again to discuss my observations with the lactation consultant. She agreed with me and scheduled a procedure to get his tongue clipped that same day. It was a fast and I think painless procedure, since the baby didn’t even cry! Right after that, I put him to the breast and everything was different! From then on his feedings were short but he seemed satisfied and not fussy anymore. This indicated to us that before having his tongue clipped, he needed to stay at the breast longer to get some milk. He was probably nursing more because his suck was less efficient. Over the next few days, my milk started flowing much more easily and breastfeeding was not painful at all! And the most important result was that, David achieved a normal rate of weight gain within 2 days after the procedure. Our efforts were definitely worthwhile! We were successfully breastfeeding!

I really hope sharing this experience will help those moms who want to breastfeed their babies to keep on trying despite the obstacles you might face at the beginning. For those moms-to-be who are still waiting for the baby, my advice would be to keep in mind all the resources you have at hand once you leave the hospital. And make sure those around you know about them, so they can act proactively when needed! Also, by clicking here, you can read some tips to get through your baby’s first week of breastfeeding...successfully, that we published some time ago.

Ballard JL, Auer CE, Khoury JC. Ankyloglossia: Assessment, Incidence, and Effect of Frenuloplasty on the Breastfeeding Dyad. Pediatrics. 2002;110:5, e63.
For more about tongue-tie, click here.

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