When my daughter was born we had issues establishing breastfeeding. Feeding her was painful, and her weight gain was slow because she was tongue-tied. My memories of the early days of motherhood are still a haze to me, but by far one of my clearest (and saddest) memories was of looking at my perfect baby girl, willing her not to wake up. I couldn’t bear to feed her again. My nipples were bruised and cracked. I was on strong painkillers, because I had an emergency C-section, yet even with those, the pain far outweighed the wound I was recovering from. For various reasons, I was feeding my daughter for seven weeks before her tie was fully released and feeding started along the slow path to improvement. I won’t dwell too much on my story, perhaps I will tell it more fully one day on another blog. The purpose of this one is to share a few things I found helped me during the long weeks, plus a few things I have learned during my training in breastfeeding support.
There may be many reasons you are waiting to have a tongue tie division or indeed you may have decided the procedure isn’t the right decision for your family. Here are a few ideas and tips for you to consider.
Seek experienced feeding support whatever position you find yourself in. Find a lovely boob group too. Whatever happens on your breastfeeding journey, remember it is a journey. Sometimes a division isn’t an instant fix. Ongoing experienced support and moral support can be really helpful. Find a breastfeeding group here.
A breastfeeding counsellor or IBCLC can help you experiment with different positions. Some positions which work well for tied babies include laidback breastfeeding, the rugby hold, the straddle hold. Pay particular attention to the fundamentals of good attachment as this may be a harder to achieve with a tongue tied baby.
Get skin to skin! Skin to skin feeding can really help encourage a baby’s natural latching reflexes and has the added bonus of removing layers which separate you and the baby. It may just make that bit of difference.
Experiment with exaggerated latch techniques. These can be really helpful to encourage a deeper attachment. Options include tilting the nipple (“flipple”) or shaping the breast (“breast sandwich”).
It can be really helpful to use a couple of different positions while feeding when feeding is painful. This is because it stops the same part of the nipple being hurt and potentially damaged at every feed.
If baby struggles to transfer milk effectively while feeding
If feeds are very lengthy, painful or your breasts don’t feel relieved afterwards- there are a couple of things you can try. Breast compressions can improve milk transfer. Switch nursing can keep an ineffective feeder from falling asleep too soon at the breast and maximise milk intake. Combining both techniques can be particularly effective. Using both techniques during a feed might look like this; offer boob one, when the baby looks like their sucking is slowing (fluttering) or getting sleepy use compressions to speed up the milk flow again. You might find that sleepy baby springs awake again because babies often respond to milk flow! Once compressions become less effective, switch baby to side two and repeat. Once the same thing happens, then offer the first side again, and continue switching until baby signals they are done. You will ideally offer 4 sides minimum per feed.
Patience and support are important when feeding tied babies. Feeds may take longer than average and babies may feed more frequently to compensate. It can be helpful to reflect on your wider support network. Can someone help around the house or with other children while this is going on? Can your partner/family/friends offer any extra support?
Keep a close eye on nappy output and weight gain, and keep in contact with that experienced breastfeeding support I talked about earlier. An experienced supporter can help you to decide if your baby needs additional supplements of expressed milk and give you information about how best to do this while protecting your milk supply.
Sometimes the baby may be doing well but you may be struggling with engorged breasts, blocked ducts and even bouts of mastitis. If this is the case, firstly ouch, I am so sorry! One thing to consider may be expressing milk for a short amount of time after feeds to soften the breasts. This may also protect your long-term milk supply. If you need support with blocked ducts this factsheet might be useful.
“I can’t carry on! Feeding is too painful!”
Nipple shields are often considered by mothers in this situation. There can be some pitfalls to using shields, but if it is a choice between a shield or a bottle, a shield might be the better option. Ideally, shields need to be used with support from experienced breastfeeding support. Attention still needs paying to try to achieve a deep latch. Here is some more information to consider while using a shield.
I can empathise when mothers decide to use a bottle because they have tried so many options, and feeding is just too painful. Sometimes a mother may have nipple damage and just can’t bear feeding on demand at that time. I know how tough it is. If this is you remember to talk to your breastfeeding support person. In an ideal world you will still offer the breast for at least some feeds in a 24 hour period. As babies get bigger often latching can improve. It may also help with transition back to fully breastfeeding if this is what you want to do. Continuing to offer the breast, even if it is only a small amount to practise breastfeeding, protects your options down the line. If mixing breast with bottle, paced feeding techniques can be helpful to reduce the risks of bottle flow preferences. There are also alternatives to bottles, for example syringe or cup feeding.
If your baby is not breastfeeding much, or not at all, you may find the following information links useful:
Information on expressing: https://www.laleche.org.uk/expressing-your-milk/
Maintaining milk supply if the baby is not directly breastfeeding: https://kellymom.com/bf/got-milk/basics/maintainsupply-pump/
If using bottles or formula continuing to express when baby has a bottle can help support your milk production. Remember skin to skin is not only great for supply, but does good things for both of you, so keep baby close however you feed them. If you are using some formula it is important to prepare it safely.
If you have sore nipples but no open wounds, there is no evidence a cream is more helpful than using your own milk rubbed into the nipple.
If you have bruising, the usual treatment for bruising can be helpful such as cold compresses after feeds.
If you have open wounds, moist wound healing may be helpful. This is essentially treating a cracked nipple like a cracked lip and not allowing it to dry out. Cracks in nipples that dry out may split open again at every feed, and this can be very painful. Keeping the crack soft can help healing from the inside out. There is no evidence any one cream is better than another, some mums prefer a lanolin based cream but soft white paraffin (Vaseline) can be just as effective and cheaper. Do use a new pot though and not something that’s been knocking about in the medicine cabinet for donkeys years! Both of these options are safe to breastfeed with, no need to wash off. Just wipe any excess off before feeds.
While we are on the subject of washing, if you have cracked nipples it is essential the wound is kept clean to prevent infections. Some mums use a fragrance-free soap (some babies can be bothered by strong perfumes), others prefer a salt water rinse like the one suggested here.
It might be helpful to start feeds on the least sore or damaged side, babies tend to suck more vigorously at the start of a feed. If you do this, listen to your body to make sure the other breast is still adequately having milk removed, via expression if necessary, to help avoid any engorgement or loss of supply.
If you are in a lot of pain feeding here is information on analgesics which you can use to help.
When you have a long wait for a tongue tie division, I know it can feel impossible. Like an eternity. Those early weeks can feel like months even when things go smoothly. I can totally empathise how overwhelming it might feel. I can’t tell you whether to stick it out, or what is best for you but I can tell you that you are stronger than you know you are.
I remember one day being asked why I had persevered with breastfeeding for so many weeks despite painful challenges. This is something I’ve considered a lot because on that day I couldn’t give an answer. One thing I have come to understand is often it isn’t really about “the milk”, it is about an inner desire for this connection to our babies. Focusing on that can be more motivating than anything else. Try to remember why you started breastfeeding and why it is important to you. Encourage your partner to remind you of this. Hold on to any moments that are positive. Remember any breastfeeding you can do is significant. Setting small goals can be helpful- try to think about making it to the next day, or next week rather than longer term. This will all pass someday. By setting small goals one day you might suddenly realise you have stopped setting goals to get to next week and will know that the worst is behind you.
Whatever you decide to do, make sure you have support so you can talk it through and feel empowered to make decisions you feel at peace with. Finally, remember, there are lots of us out there to support you. You got this mama💚.
For more information and support:
Association of Tongue-tie Practioners for information about tongue tie
If you need support or someone to talk to fast about the issues you are having try the National Breastfeeding Helpline
Facebook tongue tie support group