Tuesday, April 16, 2013

Triumphant Tuesday: Breastfeeding with Upper Labial Tie

Inside your mouth, there is a small fold of tissue which runs between your upper lip and gum (you can feel it with your tongue). This is called the maxillary labial frenum.  Most people have no significant frenum attachment, but sometimes this frenum attaches further down the gum, or runs between the front teeth and attaches behind them, causing restricted movement of the upper lip.  A baby with this condition may find it difficult to latch to the breast effectively. Once latched, his upper lip may be tucked inwards, resulting in a shallow latch causing pain for mom and insufficient milk intake for baby.

You are about to read the story of one such baby, Tom. He had an upper labial tie, and it was left undiagnosed until he was 20 months old! Yet he has never received a drop of formula. How did his mother assure this? Read on.


“Breastfeeding is definitely an emotive subject for me. I tried so hard to be successful.

Tough from Day 1

I couldn't get a good latch from the start. My son Tom was born 3 weeks early and weighed just under 6lb – he was tiny! He would never take enough breast into this mouth. We tried nipple shields yet I still ended up with huge cracks. I dreaded every feed and would be crying with the pain while he fed, which was never for less than 45 mins.


It’s hard to describe or compare the pain, it’s a bit like labour pain; like running a cheese grater over my breasts. It was a sharp, stabbing pain that didn’t stop. I dreaded feeding times. In between feedings my nipples would scab over a little and then it would start all over again! When the water hit my nipples in the shower it was really painful.

Patronising health professionals

I then saw numerous nurses, doctors, midwives, lactation consultants (travelling over 1500km one way! - 3 return trips). Everyone looked for tongue tie and high palate but not an upper labial tie. Many of the health professionals said that my nipple cracks were among the worst they had ever seen (I still have scars around the nipple 2 years later!)

The doctor I saw for my 6 week check up the hard work I’d been doing to breastfeed and said “you need a break too; it is ok to give him formula, even just one bottle a day – at night”. Undermining and not very helpful.

Mastitis

It wasn’t long before my badly cracked nipples led to mastitis. It started with a blocked duct which was a hard, aching lump. I massaged it for a few days and thought it had gone, but then my breast got a red warm area on it. Fortunately I promptly saw a Breast Surgeon who caught it early and prescribed Flucloxacillin.

We then started waking up near midnight to the sound of Tom (at 3 weeks old) vomiting and choking on the most vomit I’ve ever seen from such a tiny baby. It covered the entire inside of the bassinet and was a horrible yellowy colour. I figured out it was due to the just started Flucloxacillin.

But the fun and games were only just starting. I then got a staph infection in the nipple. Add to that vasospasm, 4 courses of antibiotics, topical antibiotic ointments and creams to be applied 3 times a day, then when that did not work to get rid of the staph - a long term course of antibiotics for 6 weeks. Thrush was always suspected but the lab results didn’t show it – we still treated my baby and myself for it anyway.

Pumping to the rescue!

To heal the cracks that had been there for weeks I was advised to pump to "rest my nipples" (Tom was 3 weeks old). Due to the staph the MASSIVE cracks never healed and I never could latch him on without extreme pain. So I only “breastfed” till he was 3 weeks old, and then pumped exclusively.

When I started pumping my nipples were still painful. It took a while sorting out the right size of breast shield/flange. The nurse gave me really large ones, as that is what they said my size was, but I was doing 40min long pumping sessions and it was taking forever to get the milk out. Plus the cracks were not healing and it may have even made them worse, since I had to have the pump on the highest setting! Here’s a photo of my "Strawberry milk". The cracks on my nipples would, every now and then, open up and bleed. Strawberry milk was the result. The milk in this photo had settled and separated. Of course I still fed it to Tom (even though my husband was hesitant) - I would never waste milk!



I later stitched to the standard size that comes with the pump and it was much better for getting the milk; I was able to use the pump at half the setting I was before which was better for the pain.

Pumping was relentless. I pumped 7/8 times a day whilst I persisted trying to latch Tom. I was glued to the pump for a total of 4 hours a day. I pumped in airport terminals, on planes, in moving vehicles, shopping centre breastfeeding rooms amongst other places. I definitely looked a sight, that’s for sure! I had a pumping bustier and a handsfree pump - the tiny Medela Freestyle. So I could walk around the house and get stuff done while pumping (although unfortunately, not eat - for some reason I always felt nauseated if I considered eating while pumping!) My family called me a cow.

I kept everything documented. Every ml that I pumped was recorded and the times, plus times and mls he ate. What I stored, when the stored milk was used I recorded it all!



This photo shows me finger feeding my breastmilk to Tom when he was 3 weeks old. We did this method of feeding for 2 months. It’s hard work, but the best method to use to avoid nipple confusion.





My routine looked like this: Tom would finger feed, taking 45 mins. Then I would settle him to sleep. Then I would have to be attached to the pump for 40 mins or so, then clean, pack and store the milk and parts – about at extra 10 to 15 mins. Plus all the recording milk amounts and working out his needs and what I needed to pump.


It was really stressful thinking about my supply in the early days! I was always worrying about Tom crying or needing me while I was hooked up to the pump. It was not too bad when he was little (he fit on my chest in between the shields or in my lap!) – but as he got older and bigger and could move around it got harder. Plus I couldn’t hold him as easily while attached to the pump. I used to get up in the morning (set my alarm) before I knew Tom would be awake, just so I could get in a peaceful/non stressful pumping session. The sessions that I had to do while he was awake were the worst/most stressful!

Unsupportive husband

My husband could see how hard it was on me and would say “You need a break – just put him on formula”. My parents and friends often said the same thing. It pissed me off! My husband already has 2 children from a previous relationship, who were both formula fed and his attitude/rationale was that they’re fine so formula is just another normal option to choose. It felt like he didn’t have the faith in me to feed Tom the way I was meant to. It actually strengthened my resolve to not turn to formula. I needed something to go my way (that I could succeed in) after Toms disappointing, traumatising birth.

However I admit, it was very tempting to take the easy route! Although I never bought a full can of formula – I bought a box of stick packs, about 6 feeds worth. Maybe I did that knowing that if I did have to resort to formula I didn’t want it to be permanent! Having formula in the house hindered me in that – I would think about how easy it would be to not be in any pain, not be feeding for 40mins/1hr per feed. I even got it out and sat it on the bench. I came SO close to making up a bottle!

But it also helped having it there because once I’d resisted using it once, it got easier and easier to keep resisting.

Nursing my sister's baby

When Tom was 10 months old I had tried breastfeeding my sister’s 4 month old daughter. It was completely pain free!! It felt different to ANY time I had ever breastfed Tom. It felt really nice and I could feel the milk being drawn out by her. This sent alarm bells ringing in my head.


I had for a while suspected Tom had an upper labial tie as his frenulum is quite large. When he was around 20 months and his 2 front top teeth had come through – he had a gap between them. We took him to a paediatric dentist, I had recently learnt of, who uses laser surgery. He confirmed my suspicions of the tie. I finally felt vindicated! It wasn’t me! And it SHOULD have been picked up by all of these people who examined me and him!

Despite all this - my gorgeous boy has never had a drop of formula pass his lips. There were times I wanted to give up and I still have the unopened formula in my pantry to prove it. But my wish to provide only the best for him has outweighed everything else.

Breastfeeding has cost me a lot more money than formula feeding ever would. But I'm so proud to say he's only ever had my breastmilk. I've even been able donate some of my freezer stash to a friend who could not pump the amounts I could.



This journey has been the Hardest experience I've ever had, but definitely the most rewarding! I wish more women would see pumping as an option if they “cannot” breastfeed. It was not easy and did come with its own set of challenges, problems and worries. Such as; the pump sometimes causing pain, bleeding cracks leading to “strawberry milk”, constantly worrying about supply (as we know pumps are not as effective as a baby for long term feeding), packing and storing milk, freezer space, using the milk before it went past use by date, planning days, outings and travel around pumping and keeping breastmilk cold, creating and maintaining a daily record of times pumped and amounts at each pump session and amount ingested my Tom at each feed (a LOT of paperwork!), and amounts wasted (warmed up for a feed but not drunk :(


I am extremely proud of myself and the effort I put into providing only the best for my son; that even in my darkest times I never “gave in” and went for the easy option of giving him formula. It still amazes me that he has NEVER had any formula.

Breastfeeding is the normal and best thing for babies. There are so many health and emotional benefits – I think many of which are yet to be discovered. Why would you want to put a man made, nutritionally inferior replacement into your baby, when the real thing is so readily available?

Mothers who don't try


Mothers who don’t even try: I think they are majorly uneducated and uninformed. It disgusts me! They obviously think that formula is as good as breastmilk! It annoys me that people wouldn’t educate themselves about something this important! Then of course bub doesn’t tolerate this or that formula or gets terribly constipated or sick from the formula. Not to mention that the bub gets sick a lot more often!

Then there are the women who say “I tried to breastfeed, but it didn’t work, etc, etc”. They piss me off just as much! It devalues my entire journey when they say that. I’ve NEVER personally met someone who had as many breastfeeding obstacles (blood in breastmilk – cause not detected, undiagnosed upper labial tie in baby, vasospasm/Reynaud’s phenomenon with tricolour nipple colour change, extremely deep nipple cracks, persistent long term staph infection in cracks, possible nipple thrush, blocked ducts, mastitis, 2 regular courses of antibiotics then 1 long term 6 week course, exclusively pumping, supply worries) as me, but I made it work! Surely most other people can too!”


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