Low supply & tongue tie through exclusive breastfeeding with bottle refusal! Chelsea's Story

AHHHH - The elusive tongue and lip tie. This is a case where the baby was really struggling to feed, and the tongue tie was not super obvious. Bottle feeding and pumping were extremely important to make sure the baby was getting enough milk to gain well and for mother to establish her milk supply until the baby was able to feed from the breast on her own. In this case, supplements of expressed milk were managed appropriately until Molly was able to feed well on her own. Molly went on to the breast full time and ended up refusing bottles, dispelling the myth that introducing bottles will ruin breastfeeding!

I met Chelsea and Molly Rose after they had been seen by many health care providers and were eventually directed to have the tongue and lip evaluated. I met the family a few days before the lip and tongue release. Chelsea was working on getting her milk in with the breast pump. I assessed Molly's ability to breastfeed and before the procedure she was only able to get less than 1/2 oz while breastfeeding. In this case "just keep breastfeeding and working on the latch" would have been detrimental to breastfeeding long term. Chelsea continued to work on latching but continued to pump over the weekend until the procedure on Monday. After the procedure, the latch dramatically improved but there was still work to be done. Molly was getting MOST of the feeding by breast now and just needed an extra 1/2 oz to complete the feeding and continue to gain well. I continued to monitor Molly Rose's breastfeeding ability and she progressed very quickly. When we saw that she could complete all her feedings at the breast, we pulled the bottle supplements and the pumping and let her fly! She went on to get LOTS of milk from the breast - so much she was gaining a pound a week and now she's refusing bottles!

Sometimes families need bottles and the pump and a good care plan to get through very serious complications in the first few weeks. I do not think babies are not confused by nipples. I think they are usually struggling to feed and when given a method that works - many will make a choice for survival. Many mothers need to pump in the beginning while trouble shooting latch issues. The baby is not always better than the breast pump. Women will lose their milk or the latch if they do not have the proper care plan in place. It takes lots of one-on-one time and many appointments to evaluate, assess, plan - re-evaluate, assess, and plan to get mom and baby where they want to be. Here is Chelsea and Molly Rose's breastfeeding journey....

Molly Rose was born on the morning of December 3^rd after a very long, and hard labor by emergency C-section. She was very punctual like her mamma with my water breaking on her due date of December 2^nd. Molly was perfect at 8lb 4 oz and a very tall 22.5 inches. With my delivery not going as planned and a lot of complications, our breastfeeding journey started out a little rocky. 

I had always known that I wanted to breastfeed, and did everything I could to prepare prior to Molly’s arrival. I took classes, read books, and spoke with many of my friends who had different feeding journeys with their children. Naively I believed I was prepared for breastfeeding my baby, but then again you know what they say about plans. 

Molly had a rough time latching right from the beginning. She wasn’t getting a wide latch and her jaw always seemed very tight to me so when I would try to widen her latch by pulling her chin, I always felt like I was going to hurt her. With a shallow latch I was in so much pain with my nipples swollen and bleeding in the hospital. Molly was checked out first by the lactation specialist in the hospital on December 4^th, and I specifically had her look for a lip and tongue tie. The lactation consultant said she didn’t have a problem and to keep working on the latch. By day two in the hospital Molly was already losing a good amount of weight and was crying a lot so we gave her a little bit of formula to supplement and she took the bottle sucking it down right away. She was then seen by the pediatrician in the hospital and again I asked about a tongue tie and was told she did not have one. She was still not latching well, and I was still in so much pain. 

We took our beautiful baby home on December 5^th and had an appointment to see our pediatrician on the 6^th.  We were still working very hard on latching around 8 times a day, but at the appointment we found out that she had lost over 10% of her birth weight and we would have to come back in 2 days later for a weight check. We went home and supplemented with formula while still trying to latch her as much as possible. At this point my milk was still not in, and latching consisted of her trying to feed with a very shallow latch, me crying in pain and frustration and Molly crying in frustration and hunger. At the weight check we saw the lactation consultant at our pediatrician office. Molly had gained a little weight because of the formula, but we were still struggling with my milk and her latch.  The lactation nurse evaluated her and her latch telling us she didn’t think it was a tongue tie and to just keep working on widening her latch. She also told me to start pumping in between latching to try to get my milk to come in. Between her latching wrong, and me pumping every 2 hours I was miserable, but I was not ready to give up. The nurse said to see how it goes and if we needed to come back in 2 days come back.  We went back in 2 days later, and nothing had really changed.  She started us on the tube feeding where you string a feeding tube attached to a syringe on top of the nipple after she latches and so she is latching trying to get my milk in but getting the food out of the syringe.  That lasted about 2 feedings because it was impossible to do by myself at home, and my husband was back at work at this point. 

I could have never prepared for going into week 3 of my baby’s life with my milk still not fully in and her still not able to latch correctly.  I was sad and frustrated and felt like I had failed.  We went back into the lactation nurse and I was defeated about to just concede and exclusively pump to get her whatever breast milk I could and supplement with formula when she took another look another look in Molly’s mouth and paused a little.  Now at this point Molly had been seen by 3 pediatricians, and 2 lactation consultants multiple times and each time was evaluated for a tongue tie at my request.  The lactation nurse, who had seen Molly 4 times prior to this visit, turned to me and said she was second guessing her initial thought about her having a tongue tie.  We talked about it and she said we should go have her looked at by the ENT at Dupont.  We called and made an appointment for the next day. 

We took Molly in to the Wilmington Dupont Hospital at 9am the following day.  She was seen by the nurse practitioner, and we were told that she had about a 50% tie.  We were presented with the option to have it clipped right then and there knowing it could fix her latch or it could have no change or not do anything and see if it got better on its own. If nothing changed, we could bring her back and get it clipped.  We decided if there was a chance of improvement then we should do it.  I was a mess, but Molly was a champ! It was very quick, blead very little, and she cried for about 15 seconds and sucked down a bottle right after.  When we got home it was an immediate positive change.  Her latch was SOOOOO MUCH BETTER!!! It was a dream she was latching and eating, and my milk came in almost right away. 

Molly is now in the 85^th percentile for weight and has been a wonderful eater.  Our biggest problem now is she doesn’t want to take a bottle only wants the boob, but after our crazy hard journey ill take that any day.  My advice for new mammas starting their breastfeeding journey is this: 

1. Every journey is very different and don’t compare. 

2.  Keep persisting, feed your baby obviously however you can, but don’t give up if you want to breast feed there is most likely a way to make it work if you keep trying. 

3. If you think there is something wrong and you think there might be a tie keep asking about it.  Doctors are not always correct, and ties are not always cut and dry.  You are the biggest advocate for you and your babied feeding journey and continuing to ask can not hurt.