Episode 65: What to Do Before Treating Your Baby’s Ties

Jacqueline Kincer

Welcome back to Breastfeeding Talk: Milk, Motherhood, Mindset. I’m your host, Jacqueline Kincer. Today’s episode is long overdue. I’m coming back to you after an extended break period, which I’ll just say, I personally really needed. There’s been a lot of big changes happening at Holistic Lactation. If you haven’t been following along, you might not know. I don’t post everything that’s going on within the company on Instagram either. I’ll just take a couple of minutes at the intro of this episode just to fill you in on things.

So last year, we brought on some team members to be other lactation consultants to do one on one appointments with clients, and they’re phenomenal. We have Cait Ahern, who is an absolute badass if I can say so. She is a whiz at all things ties. She is like my double and I just absolutely love her, and so do clients. We’ve gotten so much amazing feedback. Every time a client books an appointment with us, and they do their appointment with someone on the team, they actually get a really in-depth survey afterwards. I do that survey because I want to know, are there things we could be doing better? Did you get the results that you had hoped for? The feedback from everyone on the team has been incredible.

We’ve got Gina Nigro who is doing amazing things with the team. She’s a really seasoned lactation consultant. She is our eldest member of the team, and in a good way, because she is just so great at connecting with moms. She’s lived in the US for years, but now she’s actually in Spain. She has a really interesting international perspective. She’s very multicultural, and she speaks Spanish fluently. So if anyone needs Spanish help, Gina is absolutely the one to book with. I just love her approach because it’s different. She brings something to the team that I probably wouldn’t bring myself necessarily. So, I love her. She’s also really used to working with clients who have babies with ties, but don’t have anyone even remotely close to them that would be a good option for releasing the ties surgically. She is really great at persevering through breastfeeding in spite of ties and not getting them treated. So I just feel incredibly blessed to have them.

But besides them, we have other team members that aren’t seeing clients as well. So I’m just really thrilled to have an incredible group of women, a group of moms who are all working to support breastfeeding moms. It’s just been an honor and a blessing to have them. It’s also been a lot of growing pains for me running this ship, show ship, whatever you want to call it, because it’s a lot. That’s why it took a moment to step back from podcasting, but behind the scenes, there’s a lot going on, and I want to share a couple of big updates with you.

One is that The Nurture Collective, the long awaited membership program that I’ve been talking about for years is finally almost here. We are putting the finishing touches on it literally as I speak and it is going to be launched at the end of May 2022. I’m recording this, today is Tuesday, May 3 and we are going to be opening the doors giving early access to anyone who is on the waitlist on May 31. You’ll be the first to get in, there’s a special bonus for you too if you are on the waitlist and you end up signing up for it. We’re going to give everyone else the next few days to explore what it is. We’re going to be going live on Instagram before that time to share with you a preview so to speak of what it’s really like inside of The Nurture Collective and what we’re doing in there.

Essentially what it is, is there’s a course aspect to it. All of the modules are essentially based on the age of your baby. So, pregnancy, newborn stage, one to three months, one to six months, six months to a year, and then a year plus. And then within those different stages, we’re talking about ways to troubleshoot things like low milk supply, food intolerances, ties, mastitis, clogged ducts, oversupply, pumping issues, bottle feeding, you name it, and there’s some extra goodies in there as well. We have a full on breastfeeding buyer’s guide. If you’re looking for any particular products, the ones that we recommend, and why they’re so amazing, we have these incredible written resources for you. I honestly would have to just visually show it to you to really paint the picture because it’s so much more than just information. It’s in depth information. It’s how to, it’s step by step, how to tackle certain problems, certain struggles you might be encountering, but also telling you, hey, here’s what’s normal. And here’s what’s not, but it matters what stage of breastfeeding you’re in. Right? It matters. If you’re pumping, it matters. If you’re nursing, it matters. If you have a two day old versus a two month old, things are different depending on your circumstances.

It’s more than just a course, because you have access to all of that content at any time. So you can access that you can DIY things, and you can really get some trusted, in depth, evidence based information to support you and breastfeeding your baby. But then we also have a community within that. So that community is going to be me and Kate primarily in there as well as some others. And it’s a support group of sorts.

So if you have questions about the content, questions about what’s going on for you with lactation and breastfeeding, you post in there, and you get access to us. And we are there to support you, as well as the other members. And then we’re bringing in guest experts on a monthly basis as well. They’ll be addressing other topics that are more in depth and answering your questions. It’s different from a podcast episode in the sense that whatever you hear on the podcast here is great. And a lot of it is in depth. But we’re going deeper in The Nurture Collective, and you’re getting a q&a, you’re getting a back and forth. It’s not a one sided conversation that you’re just passively listening to like you are here on the show. So anyway, it’s amazing, I can’t say enough good things about it. If you want to add yourself to the waitlist, you can do that by going to the nurture collective.co. So that’s dot c o, you can add yourself to the waitlist there right now. So anybody on the waitlist, again, gets early access, and you got a special surprise as well, as I thank you for being on the waitlist and being one of the first people to sign up.

So that aside, another thing I’d like to share with you is that for a long time, now it’s been over a year, we’ve had the advanced lactation formula supplements, that’s a supplement for supporting and increasing milk supply. It’s full of five amazing organic herbs or herbal extracts that are really targeted based on my years of clinical experience of a lot of research, of trial and error of hearing from clients, what works for them, what doesn’t, and that products been out it’s been doing great moms love it, they’re seeing excellent increases in their supply, especially when nothing else has worked. So that’s been super exciting.

But we’re bringing another product to the market. And this is another herbal supplement. And it’s really designed for preventing, but also treating clogged ducts or plugged ducts as some people call them and mastitis. I’m not going to share with you the exact ingredients just yet not even gonna share the exact name with you just yet. But production time is probably about 12 weeks from now. We will start taking pre-orders a week or two before it’s actually in our warehouse. So when we actually know, hey, it’s done, it’s going to get sent to us stored in our warehouse, it’s going to be stocked on shelves there and ready to ship to customers will start taking pre orders and we’ll be offering that at a discount. So that’ll be super exciting.

And then shortly after that, we’ll get it up on Amazon, Walmart.com, but it’ll be first available on our site. So we’re really excited to bring that to you guys. It’s a lot more powerful and it’s a lot better for you than something like sunflower lecithin. So it does not contain any lecithin, which often causes a lot of digestive distress. And it’s really something that a lot of moms report not liking, taking you have to take it at a really, really high dose in order to get a therapeutic effect. So we are giving you some more pure ingredients, a combination of ingredients that combat inflammation, but also infection. So I’m just super thrilled to bring that one to the market.

There’s more in the pipeline, but at least that one’s in production. So now I can start talking about it. So anyway, those are the updates. That’s pretty much all I have in terms of what’s been happening over here at Holistic Lactation. But let’s dive into today’s episode.

So today, we’re gonna be talking about what options you have before treating ties. Tongue ties, or lip ties, buckle ties, whatever. And honestly, this episode title or this topic is kind of a misnomer, because you might be doing things other than doing a surgical release of oral ties, but you’re still treating the ties, if that makes sense. I’ll be talking about that.

I’m really passionate about this topic, because ties are my jam. Ties are absolutely the thing that I’ve chosen to specialize in. And it’s not that I don’t have great in depth, knowledge and all of the other topics regarding breastfeeding and lactation, and oral function and all of that I do. But ties are personal to me in a lot of ways. And it’s become personal in terms of my journey as a parent and my own children. But also, I just see how so many parents don’t get the validation, the proper diagnosis, the proper assessment of their baby, and they don’t know early enough on that their baby has oral ties, and that these are challenges. And so by the time they finally figure it out, by the time they find someone like us, there’s already this snowball effect of problems.

It just is heartbreaking, because a lot of times parents will convince themselves that it’s something they’re doing wrong, something’s wrong with their body. Why are they in pain, something’s wrong with their nipples, they have a defect. And the whole time, it’s like, no, your baby is the one with a congenital defect, and it’s totally fixable. But unfortunately, they’ve been led down this path of being medically gaslighted, of essentially just feeling like, you know, there’s just no hope. And breastfeeding is not meant to work out. And all this discouragement and all this anxiety and stress and all these things. And it’s heartbreaking.

It’s heart wrenching to witness that now, it’s also on the flip side of that incredibly rewarding to be able to help that family and finally get them the answers they’ve been searching for so long for and turn things around and make breastfeeding better. So let’s talk about how that happens. So the way that we want to address ties, and I know doesn’t always happen like this, but I’m going to talk to you about what would happen in a perfect world. And then we’re in talk about how you can work around those things, and why there might be exceptions to that sometimes. So in a perfect world, you start with an IBCLC.

Now, I would love it if everybody, breastfeeding problems or not, saw an IBCLC after they have their baby. More than once. And the reason for that is, it’s obviously great to get that help right away after you give birth, whether that’s hospital home birth center, wherever you’re giving birth, because you need help with that initial latch. If you’ve never had a baby before, you’ve never breastfed before, even if you have this baby is different. And it’s a long time ago, you know, at least nine months ago, right? So you forget. So getting that initial help with latching knowing that your baby’s getting enough milk, that proper education, good lactation practices, good breastfeeding management, that is so important. Because if you don’t get off to a good start, it’s really hard to try and recover that leader.

Now it can be recovered, obviously. But then right after the birth, you’re only making colostrum. Right, you’re new at this, your baby’s fresh, they just came out of the womb, they’re still kind of curled up in that balloon like position, they have a lot of unwinding to do. There’s a lot of changes that will be happening over the next few days, like your milk transitioning. So once you start making copious amounts of breast milk, that changes the mechanics of breastfeeding, that changes how nursing is going. And we also want to make sure that you actually are transitioning to make those copious amounts of milk. If you’re not and not doing it by a certain timeline, we want to see like, why is that happening? And what can we do to speed that up, because there’s a lot of different factors.

So seeing someone at that point would also be beneficial. And then ideally, in the next week or two after that would be great, because now you’ve got a milk supply, hopefully, right. And if you don’t, that’s something that needs to be worked on. And then you are nursing this baby kind of getting into a rhythm, but you still want to make sure everything’s going really well, that you’re mastering a lot of these things so that you’re rockin and rollin with breastfeeding, that you’re getting really well established, because we don’t want to have breastfeeding be the central focus of postpartum life for all time. Now, is it going to be that focus, especially in the first couple of weeks, and really the first month? Absolutely, yes, your baby’s gonna be nursing around the clock. Who are we kidding? And I know there are always new people that will say that’s not true. And you know, that’s great that your baby has the ability to go longer stretches without needing to nurse. That’s not true for most newborns. Just to go over what’s real and what’s not.

But we want things to be really well established. Now, there’s a lot of limitations of this kind of care, a lot of people don’t know where to find a good IBCLC. They don’t feel like they have one locally, they don’t know that virtual options like us, Hint hint, wink wink, exist. Or they have an IBCLC and they’re just not very good. That happens more often than not unfortunately, or they see someone who’s not an IBCLC, and is not qualified to give them that level of care. So they’re working with a CLC, a CBS, someone like that when they really should have been working with an IBCLC. So just knowing that difference, and I do have an entire podcast episode devoted to The Alphabet Soup of Lactation Land, so I’ll link that in the show notes for you, that way you can understand the differences.

It’s really, really important that if you’re experiencing breastfeeding problems, which most parents do, that you get that support that you need. Now in relation to ties, here’s the deal, right. So first, you want to have breastfeeding assessed and have breastfeeding optimized and improved, and have that lactation consultant do the assessment for the oral ties.

So why is it that very few IBCLC’s are actually trained properly, to do an assessment of oral ties, this does not mean that you should avoid seeing an IBCLC altogether. But what it does mean is that if you suspect that your baby could have oral ties, or you want to have your baby checked for these, you’ve got to do the groundwork to find a lactation consultant that is skilled in assessing for and working with oral ties, because it’s not just enough to look in a baby’s mouth and say, yes, they’re tied, that lactation consultant needs to know how to fix that. Okay, thanks.

Because I mean, a diagnosis, a lot of different professions could give you a diagnosis by looking at the structure of something. But truly, ties are a functional assessment. They’re a functional diagnosis. And what I mean by that is, you have to look at how that restrictive from the tie itself, whether that’s a tongue tie a lip tie a buckle tie, you have to look at how that functions in real life, you look at the structure of it, you feel the tension in it, but you also observe how it affects or redirects in a negative way, the motion of the oral cavity. So what I mean by that is, let’s say we’re talking about a tongue tie. Okay?

So if the tongue tie is so significant, that the baby cannot move their tongue properly to extract the milk from the breast to swallow the milk, any functional swallow way, because there’s absolutely dysfunctional swallows happening, right, then that means that tongue tie is impairing function. So we’re looking for the functional impact. Now, let’s say the baby has a tongue tie. But they’re able to obtain, let’s say, 80% of the range of motion that they should have. There’s not really any major problems or red flags. Now, it becomes a cost benefit decision where your provider is kind of playing out in their mind and saying, Well, what are the risks of the procedure? One is the babies and pain. Two is it’s a lot of work to do the aftercare for the wound, and the oral rehab work and anything else that’s needed for this particular baby, you know, three, is this baby able to functionally breastfeed well enough that we can avoid some of the major concerns that breastfeeding can be maintained that this family is going to meet their breastfeeding goals.

Okay, if that’s the case, then maybe treatment isn’t warranted. Right. But that’s a decision that is arrived at between your lactation consultant, and any other providers on this team of people that you might be working with when it comes to ties and yourself. So also, you know, think about a lip tie, for instance, right? So if the upper lip is crawled under at every single feed, despite trying to revert that lip manually by pulling on it, or repositioning it, because the lip tie is so significant, well, we’re never gonna get functional breastfeeding. And you’re going to get some issues that are going on with oral development, and just overall oral function, very likely to have nursing pain, that sort of thing.

It takes the IBCLC to do a functional assessment to observe breastfeeding, to intervene and make changes to breastfeeding to see if those create enough improvement, right. So whether that’s latch positioning, some other techniques that’s going on during the feeding, can we optimize that and get the improvement and results that we want, then after that intervention happens and we see what the mother and baby are capable of, and even sometimes giving them time to implement these things over and over again throughout several feedings over the next several days. If not enough improvement is seen.

And we can tell that then the oral ties are restrictive enough that we’re maxed out, we’ve reached essentially maximum medical improvement. There’s nothing else we can do at this point. Because the tires are impeding full function, they’re causing a significant enough problem that without treating them, we cannot say that breastfeeding is going to continue to go well, or get any better. That’s the point where you and your lactation consultant decide, okay, yes, let’s go get a consultation with the dentist with whoever is going to be the person that’s treating the ties surgically. Right, and then explore getting those released. The other thing that sometimes factors in and I will be really honest about this, I don’t think it needs to factor in all the time. But I do think a lot of the time it’s really helpful is bodywork. But just like lactation consultants, a lot of body workers are not skilled enough to work with one infant, two ties, and three, a lot of them just, you know, offer a lot of fluff. And that’s very true in my own profession.

So it is true in every profession, right? I mean, you could have a plumber come to your house that charges you $600 and replaces a gasket on something, and you know, like, doesn’t really do anything for you, you could have another plumber, who brings some diagnostic tools with them, you know, finds out that Oh, my goodness, you actually have a crack in this pipe. And that’s why that’s going on and finds the root cause and fixes that issue. And at the end of the day, you know, saves you money, because you know, has prevented a water leak damaging your drywall and creating a mold issue. In every profession, there’s the good and the bad. And unfortunately, the top tier are the minority, the really, really good ones are in the minority. And it just is the way it is. We’re not unique as lactation consultants, party workers aren’t unique. People who treat ties aren’t unique. It’s a very small subset of each of these professions that knows what the heck they’re doing.

It’s really important that you work with those people if you’re going to pursue treatments, because if you’re not, well, then why even bother, right? But if you are going to have a surgical procedure done on your baby, to surgically release those ties, you pretty much want to make sure you’re working with the best. I mean, we’re talking about your infant here. We’re talking about making or breaking, feeding, breathing, speech, sleep, I mean ties affect so much. If you’re going to go to somebody who does a half assed or subpar job, or doesn’t take you seriously enough, or doesn’t know how to do a proper functional release, then you’re doing you and your baby a massive disservice. And you’re going through something traumatic and painful and expensive, for really little or no result, possibly making things worse. So it’s really, really important that you choose that provider carefully.

Why do you want to work with the IBCLC, because we know who those providers are? Right, we have direct clinical experience, and we can tell you, that is the person to see, and that is the person to avoid, because we see the clinical outcomes. A lot of times the doctors who are releasing ties, maybe only follow up with you once, maybe they don’t ever potentially, but we are following up with you. We are the ones who are seeing how breastfeeding is improving how the wound is healing, we are working for you most times, several weeks after that procedure to make sure everything is fully resolved, and that breastfeeding, bottle feeding whatever it is, is going well again, are going well for the first time in a lot of cases, right? So it’s really important that you have that guidance.

The IBCLC kind of acts like the glue, if you will, and we act like the consultant and the counselor for you because we’re navigating you and your baby’s movement throughout the entire treatment team. And we’re trimming the fluff. So for instance, if your baby has torticollis, let’s say, yes, they need bodywork. And it would be really great to work on that before they get the surgical release. Because if your baby has torticollis, and you go and get a tongue tie release, potentially that tongue tie release, or even that tongue in front of will have some asymmetry to it because the tongue is connected to the neck. Right? All of these things are connected to one another, intention in one area creates tension and others.

So if you’re not addressing all the surrounding tension outside of the ties, and you go get your baby’s ties treated, and that does release a lot of tension, right. But it’s not going to necessarily fix that torticollis, it’s not going to fix the other tension that’s going on. So you still have a baby that’s struggling to open wide or get a good latch because they’ve got another issue that’s impacting breastfeeding. So the IBCLC is really great at timing it for you, essentially, when to get the release, when to get bodywork. If that’s needed. Do you need it before the procedure do you need it after now the bodyworker themselves is also going to give you their own professional guidance and timeline. And I can’t say that I know exactly what that is. Because I don’t do that work, right.

But I can at least recognize, ‘Hey, it’s time to refer to this person’ because that’s outside of my scope. And I can tell this is something that would be beneficial to your infant, right. Just like I can say, ‘Hey, I don’t treat ties’. I don’t have a laser. I don’t have scissors. It’s not in my area. I don’t have those kinds of privileges. I’ve got to refer you to someone that does that. Now what we would love is IBCLCs if that was reciprocated for us now bodyworkers. Entire lease providers do often reciprocate and recognize the need for our profession. But it is very lacking in terms of let’s say pediatrics, where they tend to not refer to lactation consultants. And so it’s unfortunate because you’re sort of left without options, right, you have to find all this stuff out on your own.

That’s why you’re listening to this podcast right now figuring out for yourself. So there’s a lot of things that can be done before you treat the ties and may need to be done like a really good skilled IBCLC is going to give you oral exercises, to optimize your baby’s oral function to strengthen their muscles to prepare them for a surgical release, they’re going to refer your baby for body work, if they need it, they’re going to maximize and optimize the potential of breastfeeding, of bottle feeding, of pumping, have all of those other things that are going to be really, really important outside of the ties themselves, and they’re going to give you a plan to improve or maintain where you’re at until you can get those ties surgically released. Then you’re going to go get those ties released, right, your lactation consultant should want to follow up with you sometime in that first week after the procedure.

A lot of us want to do it three days after no later than five days after the reason for that is one, you’ve got to make sure that you know how to do that wound aftercare properly. If you don’t, the wound will very likely reattach you will have poor healing, you will have negative outcomes. So don’t put your baby through a surgical procedure and not not commit to all of the aftercare. It’s kind of like, it’s kind of like getting a new replacement surgery and then just never doing PT afterwards, you’re not going to get great results, right, your surgeon generally doesn’t even want to do the procedure on you unless you are committed to seeing physical therapy after. So think of an ibclc as a little bit of physical therapy in terms of managing that wound care, but also oral exercises.

So just because you’ve gotten their baby’s oral ties released does not mean that your baby automatically knows how to move their muscles how to address the mechanics of breastfeeding, because they’ve never been able to do it that way before, they’ve literally never been able to move their tongue or their lips, or their mouth or their whole oral structure. In this way, this is all brand new for them. So there’s some aspect of baby’s brains being hardwired for this, and they will know what to do to some extent. But on the other flip side of that is they will often have muscle memory and ingrained motor neuron patterns for certain movements. So if your baby was chomping at the breast a lot previously, that tromping doesn’t necessarily go away just because they got their tongue tie released.

So there are ways that your lactation consultants can teach you to do oral exercises to observe whether or not those are the appropriate exercises for your baby, observe you doing them making sure that that’s going well, it’s creating an improvement. And generally you start seeing an improvement, even within a day, certainly within three days. And if those are the correct oral exercises, now, the ones that your lactation gives you are for short term use, right. They’ll be tailored specifically to you and your baby and their needs, right, you’ll be doing those exercises. And then once a certain level of improvement is achieved, now we can work on the next issue that’s going on, and phase out those exercises, maybe phase in some new ones. And then finally bring you to the point of graduation, so to speak, where hey, you don’t need to do anything else, your baby’s mouth, everything’s good, just keep breastfeeding, maybe there’s still some wound care that needs to be addressed.

But knowing when to taper off of those things and stop doing that treatment plan is equally as important as knowing what to do and when to start those things. Now a lot of parents think that they can hack the system by going on YouTube and watching suck training videos. I want to tell you right now that suck training is but one tool in the toolbox. And it’s not something that we actually find we need to use very often. Okay, suck training is overrated, it is overused. Now, it might be used to refer to generalized oral exercises, but oral exercises. Again, suck training is a subset of oral exercises. It is a type of oral exercise that you can do with the baby to improve their oral function. There are many, many others. And if you don’t know what you’re doing, if you’re just willy nilly putting your finger on your baby’s mouth and doing some exercises that you watch on YouTube, how on earth do you even know if those are gonna be beneficial? How do you know your baby needed those to begin with?

How do you know that you’re not doing something that your baby didn’t need? And you end up creating an oral aversion or you just don’t see any improvement? So what I hear from parents a lot of times is they’ll say things like, ‘Well I’ve done it all, and there’s been no difference’. Well, if you’re not trained to do this work, I don’t want to discount your expertise as being the mother of your child. But if you’re not meant to do this work, you don’t have the clinical thought process, so to speak, to look at your child objectively, and say, ‘This is what they need, and this is how I will know when it’s working. This is how I know when it’s not, and this is how I’ll know when to do something different.’ That’s very, very difficult to do.

I will tell you, even as a lactation consultant with my second child, I hired an IBCLC because I was too close to the situation. And I actually have a whole podcast episode about this. It’s my second breastfeeding journey. And I’ll link that up in the show notes for you if you’re interested in that, because I do talk about it. But I was in denial that she even had ties. I didn’t get her ties released until she was six weeks old. Now, that’s something that I quote unquote, “should have known” being a lactation consultant, but I didn’t, because I was too close to the situation. And quite honestly, I worked with two lactation consultants. I worked with two different body workers. I worked with an occupational therapist, and we had an acupuncturist. I worked with a myofunctional therapist. I did a lot of things, because I just couldn’t do it myself. I was too close to the situation, and I could not tell what my baby needed, and only getting objective help from those outside providers was able to make a difference.

So I would just say to you, I know that you’re very intuitive, as a mom, I know that you know a lot, but you also don’t know what you don’t know. And this isn’t some sort of pitch like, ‘Hey, hire us and pay us a bunch of money’, that’s not it. But what I am saying is, when it comes to treating ties, there’s a lot more than just the procedure. So that’s really the point that I want to drive home.

Now you can do things instead of treating the ties, right, there’s compensation that can be done. And maybe that helps you achieve your breastfeeding goals. Because ultimately, at the end of the day, you as the parent get to decide what happens to your baby. And you get to decide whether or not you’re going to go forth with a procedure. So you sure as heck want to make sure that you’ve got breastfeeding going really well, right, because if you don’t, well, in the end, what I mean, you can only do so much, right. So if you don’t have a good latch technique, or even if you have the best latch technique, but your baby’s just physically incapable of latching, well, maybe it’s time to look at something like a nipple shield. But then be aware that every time you use a nipple shield, the best practice is to pump after that, in order to maintain milk supply.

Now, if you have an oversupply, that’s not going to be a problem for you necessarily, right.

So all of these decisions are very individual. There are rules, but within those rules, there are subsets, and there’s branches and forks. So like normally, I would say best practice was a nipple shield, like I just gave as an example is to pump after every feeding, because there’s less breast stimulation, there’s less milk removal. So you want to do that to maintain your milk supply. Now, if your baby isn’t able to get all they need at the breast, not only are you pumping, but now you’re also having to offer a bottle or an SNS or some other way to supplement your baby without additional milk. So it’s a catch 22. But maybe you’re one of those oversupply moms, it’s actually calming down your oversupply, your baby’s able to get all the milk they need at the breast, you don’t need to pump afterwards. All of that, potentially that is fine for you.

The problem with the nipple shield, though, is that it never promotes good oral mechanics. It promotes a shallow latch, it promotes more bottle feeding mechanics and breastfeeding mechanics. And they’re very different skill sets. So if you’re wanting to improve your baby’s oral function, and a nipple shield is not the way to do that. So if you’re trying to think of ways, you know, how can I manage things, instead of getting the ties released? Well, there are ways you can manage that. And then it’s also kind of a personal decision as to what you can tolerate. So let’s say breastfeeding is painful. No matter what you do, you’re experiencing nursing pain. You have a choice, you can continue to endure that you can exclusively pump, you can try a nipple shield, and if that helps you or you can get the ties treated. And those are really your only options. I mean, you can wean and give formula. So there’s a fifth option, right? So those are really your only options. It’s up to you to decide which one you think is best.

So when you work with an IBCLC, when you work with a body worker, you work with a surgical release provider for ties, you know any of these professionals, ultimately, we’re giving you our best clinical advice based on the goals that you’ve given us. Right. And so from there, now it’s up to you to take that information and decide what do I want to do with this? And it’s up to you to ask us questions to say, ‘Well, what happens if I don’t do X, Y, and Z?’, or ‘What are the risks of doing ABC?’. Right, and exploring that conversation with us because we absolutely love answering your questions. I do. You know, I don’t want to overwhelm anybody with a lot of information that they can’t receive all at the same time. Right. That’s why we don’t do three hour appointments. We, ideally, try to break it up into multiple appointments. Because one, you can only do so much at once. Right to it’s typically a staged approach. So you start doing some things, let’s see the level of improvement you get there. Now we can take away some things we can add on some others, right? If we just give you the entirety of everything you’re going to need to know for the next year, oh, my goodness, how are you even going to know where to start?

Right. So think of your lactation consultant as a project manager in some ways, because we’re kind of giving you a schedule, we’re breaking things down into easy, doable steps. And we’re saying, These are the things that you really need to focus on right now. These are things you might want to think about later. But we don’t need to address those today. And then this is what to expect going forward. And this is how to know when there’s other problems, and you need to reach back out for help. So those are really common themes of any appointment, at least with us and other great colleagues that I know. So we typically work in the same way, same style, if that makes sense.

So I will say, if you go and get your baby’s tongue tie released, and you have not seen a lactation consultant who’s skilled in this, you have not seen a body worker, chances are you’ll see some improvement. Okay, assuming that you’ve gone to a provider that does a proper release of all of the ties will fully release them, teach you the proper aftercare, all of that. Let’s say you’ve got the procedure piece down, you should ideally see some improvement. Great. But the maintenance of that improvement beyond the first couple of days post op, make sure that that’s happening, right? It’s never too late either. So if you’re like, ‘Oh, shoot, I’m listening to this episode, and I never even worked with anybody’. That’s okay. That’s all right. We see people that have gotten the babies twice treated, and they’re not seeing improvement all the time. And then they work with us, and they finally get that improvement.

So you want to make sure that the healing hasn’t gone wrong, that the baby’s ties have reattached. That you haven’t disrupted that old muscle memory, that old motor learning pattern that your baby has, and that they’re doing things in a new functional way. All of that stuff is important, you can always work on that later as well. So just something to think about is you don’t have to work with us.

First, I think you’re set up for success. If you do, I think that there’s less of a promise that you’re set up for success if you wait till afterwards, for sure. But if you’re thinking, ‘Well, the baby’s ties are really severe, I need to get those treated first’, maybe that’s the case. And then you can get the other pieces of help afterwards. I will say it’s very, very rare. And I’ve seen it a handful of times, and I’ve worked really closely with tongue tie providers as well, you know, I’ve assisted with the procedure and things. And oftentimes, these are people that aren’t even my clients, right. And so they’re going to get this procedure done. And you’re seeing improvement with things. Some babies, especially if they don’t have ingrained muscle patterns, if they’re younger, let’s say can go get those ties released and do great right out of the gate. And we really don’t need to do a lot of other things, because we got it treated early on enough. So that can be a huge godsend. And that can be amazing.

But like I said earlier on in the episode, a lot of the times early diagnosis and assessment isn’t done. And it’s not until later that you’re learning, ‘Oh, my goodness, the ties are an issue’. My baby has ties. And now we’re going to do something about it. And your babies, you know, one month, two month, three months, eight months, 13 months, whatever, right. So when you get treated really early on your chances of just the procedure being needed for success are really great, especially if you’ve already gotten breastfeeding off to a pretty decent start. And you know, what you’re doing in terms of latching and milk supply and all of those sorts of things. So I’m not saying you always need a lactation consultant, or you always need a body worker. And I’m not saying you always need to treat the ties, right. It’s always a very individual decision. I can say that much. And it’s always weighing the risks and the benefits.

Now the benefit of having someone like a lactation consultant to walk through this with you is to have that really professional skilled discussion to determine what is the best path forward, right? Because we can’t tell you until we look at what’s going on. So you can’t send me a text message and ask, ‘Should I get my baby’s ties treated or not?’, because I’m like, ‘Whoa, whoa, whoa, hold on. First of all, what does it look like in your baby’s mouth? What does it look like when your baby is breastfeeding? What is your medical history? What’s your baby’s medical history? What was the birth like? How’s breastfeeding been going since birth? How many diapers a day are they having? What’s their week?’. I mean, I have 1000 other questions that I need to ask you before I can even begin to think about if your baby has ties and should they be treated? So I think that people don’t understand there’s actually a lot that goes into this.

Now we can cover a lot in a really short period of time. It’s not like you need multiple appointments to decide if you need to treat baby’s ties. Sometimes in rare cases, that is the case. But most of the time we can tell you in one appointment Anybody who’s good at their craft will be able to do the same. So I’m not just speaking for myself when I’m talking to you about this. This is really how an ibclc thinks and works when they’re skilled with ties. And I don’t want to say that there are very, very few of us. But when you look at the worldwide population of lactation consultants, yes, we’re definitely the minority. Now, there’s a growing interest and growing group on getting that additional training. And there’s actually quite a few of us. So one of the sites I would encourage you to look at is, if you don’t want to work with me or my team, that’s totally fine. Or if you want in person support, I would absolutely suggest that you use the directory on ibclcmasterclass.com. And I will link that up for you in the show notes.

That is an excellent directory to find people all over the world who have gotten additional training, especially in ties and oral function. Now, just because someone has not attended the ibclc masterclass program does not mean that they’re not qualified to help you. So it’s just one avenue, one directory that I know that is fairly large, where you can find that expertise. But really, what you should be doing is looking at this person’s website, checking out their social media, seeing if this is something that they’re talking about? Do they know about ties? Are they vocal about it? Because quite honestly, if they’re not, they’re probably not super skilled in that area. So if you have to ask like, if you contact me, you’re like, Hey, I didn’t see anywhere that you work with babies with ties, do you do that, unless they’re in the middle of like a website remodel or something, or they don’t have social media, I would say, that’s probably not someone that you want to necessarily work with.

Now, that being said, I do think that there’s always people learning and I think that sometimes you’re gonna find providers who they’re not, they’re more of a provider, they’re less of a business owner, they’re not always thinking about the public facing stuff. They’re so engrossed in the work that they’re doing with families. So they don’t always put things out there publicly, necessarily. They just don’t have time. It’s not in their wheelhouse. It’s just not what they’re interested in doing. So, if you find someone that you think might be good, reach out to them and ask, but also ask your community, right? Ask your friends, ask your extended family, ask your health care providers, do they have recommendations for someone for you to work with, if you find, let’s say, a dentist or some other type of doctor that surgically releases ties, ask them for a list of referrals to lactation consultants. So there’s a lot of things that you can do to try to find those resources, no matter what country you’re in, no matter what area, rural, suburban, urban, that you live in.

And again, certain things obviously, you can’t virtually get the tie surgically released. But certain things like lactation can be done virtually. And to some extent, bodywork can be done virtually as well. So you can work one on one with a physical therapist, or, you know, let’s say an occupational therapist, and learn those things they can teach you, they can do it on video, they can observe you with your baby and teach you how to do things at home. Because truly any good body worker is going to give you things to do at home anyway, just like a lactation consultant, we’re not there for every time you’re going to latch and nurse your baby, or every time we’re going to pump, right, you’ve got to take what we teach you and implement it on your own at home. Just know that right? So you can access a lot of services virtually, which is great. I mean, because we are still in a pandemic, it’s crazy, cases are rising again, what the heck is happening out there, folks. But a lot of you just don’t have good local options. And then a lot of you are just like, ‘Forget this, I don’t wanna leave the house if I can do it from home, this is way easier’. I don’t blame you. I mean, with video now, and technology that we have, through messaging, sending videos, photos, back and forth live video, there’s so many ways that you can be really well supported in your journey that oftentimes even feels more supportive than in person care, because as opposed to seeing someone in person, just kind of one and done. And that’s it, you tend to get more support. When you work with someone virtually you have a greater level of access to that person or that team to ask questions to get the follow up care and all of that.

So in summary, I just wanted to reiterate that there’s a lot of things that you can do before treating ties to understand whether or not your baby has ties, whether or not they’re worth being treated. Perhaps some of those interventions can improve things to the point of not needing to treat those ties. And then on the flip side of that, there’s things to do afterwards as well. So getting the procedure is really the smallest sort of timeframe in terms of how long it actually takes or what have you. It often feels like the biggest piece of it all because it’s scary because it’s a surgery. I mean surgery, take that term loosely, right I mean, it is a surgical procedure. Aegir to remove the restrictive collagen bands of the front of this form the tie, but it’s not like we’re talking about putting anybody under doing sutures or you know, any of that kind of stuff, right? Like it’s what can we compare that to? Oh, gosh, it’s like saying that getting Botox injected in your forehead is a medical procedure. Technically it is. Right, but it’s not a spine surgery. So you know, there’s different types of surgeries. Right.

But technically releasing ties is a surgery. You know, that word scares people, but I would say just, you know, try to destigmatize that we’re trying to remove the fear from that, because, you know, we’re just calling it like it is, right, we’re just using this as a medical term without any sort of connotation. So just being accurate in the vocabulary, if you will. But there are things that you need to do outside of that procedure before and after, that are really, really important to ensuring the success of it, or are really, really important to help you avoid needing to do the procedure to begin with. So just a lot of things to consider. And really, I just wanted to have this as a conversation, a conversation of setting some really good expectations for people setting just some really great ideas in your mind. If you’re thinking, Oh, my goodness, I think my baby has ties, or I’m looking at getting the ties released. But I don’t know where to find help, or I’m not sure what to do next, or do I actually have to do this.

These are a lot of questions that are circulating in the minds of parents, and just having a conversation about this, guiding you through thinking through a lot of these different concepts, but also giving you the professional guidance and insight into all the things that need to be done that go into this whole process of a baby having ties, it’s a lot, but it becomes a lot less when you have guided professional support along the way. So that’s my message for you. And I appreciate you listening, I would encourage you to check out the show notes. If you love the show. We’re back, having regular episodes every week. Make sure you subscribe to Breastfeeding Talk wherever you listen to the show. And please please if you find these episodes helpful, share, take a screenshot, post it on your Instagram, tag us, let us know, share with your friends. If you have any interest in being on the show, whether it’s to share your own personal story, or maybe you’re an expert, a professional that’s listening, you’d like to share some insight with our audience. Definitely reach out to us at podcast@holisticlactation.com. So thank you again for listening. I will see you all on the next episode.