When Two Communities Collide

I live in 2 primary communities in my life:  the Lactation Community and the LGBTQ Community.  For me these two communities overlap quite a bit as I am a VERY OUT Lesbian IBCLC.  Anyone who knows me knows I have a wife who I love and adore with all my heart and soul.  I see no reason to hide it and I hope that it gives others in the LGBTQ community who happen to also be in the Lactation Community the ability to be out as well – but not all are for their own personal and valid reasons. 

But what happens when these two communities collide?  Well, it HAS happened to me a few times as I have written about in this blog before.  Frankly, I can handle it.  Don’t like that I am Lesbian?  Move along and take your prejudice with you thank you very much.  But what about others?  Others in the lactation community who are NOT out and collide with another in the lactation community who is LGBTQ-Phobic?  What do they do?

I was at a well-known conference this past week for lactation consultants.  Honestly it was great!  Lots of wonderful people, lots of hugs and kisses (good thing my wife is NOT the jealous type!) and lots of community.  I personally had no issues with anyone who had their own personal issues with my LGBTQ community…but another wonderful woman did…

Without going into all the details because they are not mine to share I will say this:  Someone in the Lactation Community made an assumption about another person (I will call her Mary).  This person assumed that ‘Mary’ had the same (negative) opinion of the LGBTQ community and made a very transphobic comment to her.  ‘Mary’ is not OUT to the lactation community (yet?).  This hateful, deeply offensive and hurtful comment shocked ‘Mary’ – she was deeply upset and frankly the rest of the conference was marred for her.  And when the other 4 of us in the LGBTQ community (who are also in the Lactation Community) discovered what happened – it marred the conference for us in many ways as well. This is unacceptable.

Out of nearly 200 attendees only 5 of us were also members of the LGBTQ community.  5.  Let that sink in.  Talk about being a minority.  And while it is a strong possibility that the majority of the other 195 attendees are LGBTQ supporters, it is clear that at least one was not.  And that one deeply offended US.  And she had NO CLUE that she had done so by making a (very wrong) assumption.

So – what do we do as a community?  As a member of the LGBTQ community I am speaking up here on my blog and to anyone who is willing to listen and learn:  Check your assumptions AT THE DOOR.  Check your privilege AT THE DOOR.  Do NOT assume that another person you talk to feels the same way you do – about ANYTHING.  And most importantly do not assume they are NOT members of the LGBTQ community.  You just never know where we might show up. And there is no way to know 100% if the person you are speaking to is a member of the LGBTQ community…or not. 

As a member of the Lactation Community – I say the same damn thing.  Check yourself and your assumptions and your privilege.  As professionals we are supposed to present ourselves as such – and when one of us makes an LGBTQ-phobic comment it makes the rest of us look bad.  While I am hopeful that the person who deeply offended ‘Mary’ and our LGBTQ community did not intend to do so on purpose, I can't help but be angry that neither did she ‘check herself’ before she made an inappropriate comment.

Let me make this clear:  We are Here.  We are Queer.  We are Lesbian.  We are Transgender.  We are Gay.  We are Bisexual.  We are IN the Lactation Community and WE are Here to STAY.  So – if you cannot find it in your heart to accept others and not judge them for being different than you, at least have the common courtesy to keep your discriminatory and assumptive opinions to yourself. And if you are an Ally – and you support the LGBTQ community please – make it known somehow…stand up for us when you can.  WE in the LGBTQ community appreciate it. 

Thank you.

Speaking as a Lesbian...

I just did my first big conference this March – as the General Speaker.  I was asked to present my Structure and Function program (assessing infant structure in relation to breastfeeding challenges) and to present on Counseling Same Sex Couples and LGBTQ Culture.  Speaking about Structure and Function is easy for me.  LGBTQ?  That’s a little different.

I am a Lesbian.  I have 3 kids, a Wife and I own my own business as a private practice Lactation Consultant.  I am also Out.  Not in your face Out, but I have no problem (most of the time) talking about my wife and kids and letting people know if they have questions about working with LGBTQ parents and families to ask me.  LGBTQ Issues are coming out into the forefront in a big way right now – we are making strides with equality in some areas while atrocities committed against us in other areas are making headlines and countries are being taken to task for it.  So, when I was asked to speak about my community – I was honored.

Let me set the scene for you:  Out Lesbian living in California (relatively safe), out on Facebook and professional groups online (relatively safe), being asked to speak in the Deep South…what is known as The Bible Belt…in Louisiana…safe??  To say my wife was concerned about my flying into and speaking in that environment is an understatement.  To say I was mostly unprepared (read naïve) for what would come is also an understatement.

You see – I live my life as if being gay is no big deal – because to me it isn’t.  Am I very much aware of the issues my LGBTQ family around the world deals with day to day?  Absolutely.  Have I dealt with such issues myself?  Yes.  But, frankly, I have it really good where I live and I feel ‘relatively’ safe.  And people I come into contact with daily in my professional world don’t give a care that I am gay, in fact they generally appreciate that I am as Out as I am and come to me fairly often with questions and ask for input – which I am more than honored to give.  But I was asked to speak in an area that is not known to be LGBTQ friendly.  We, as a community, are lacking in equal rights, civil rights and face discrimination on a regular basis in the Deep South.  Now, don’t get me wrong, there are MANY people there who are progressive and accepting and absolutely LGBTQ Allies fighting beside Us for equal rights for all.  But – there are, without question, those who are not. 

My trip out I had a seatmate (a 21 yr old young man) who made it clear he hated ‘faggots’. 

I needed to work on my LGBTQ presentations on the trip out but did not because, frankly, it just wasn't safe for me to do so sitting next to a young man who talked about putting the guy who called him a ‘faggot’ into the hospital.  This to me was, scary.  Who I am was clearly a threat to this person who, since he did not know I was lesbian, had no problem talking to me assuming that I had a husband back at home.  No I did not correct him on that.  Why not?  Think about it.  

On my way home, I sat with a preacher man whose church is welcoming, affirming and now is honored to have LGBTQ preachers.  Talk about opposites...and it occurred to me that this is the world we live in - and it is frustrating and contradictory - and something no one should have to live with...the fear of just being yourself, never sure if you will be safe or not.

At the conference I came out to 150 people I did not know – and who did not know me.  And while it may have looked easy to those watching me speak, coming out the way I did was NOT easy. But I needed to put a face to the topic – and that face was ME, my family and my LGBTQ community.  During my last session it was made very clear to me and the group by one individual that she was highly offended at my presentations and made no bones about saying so – repeatedly – to many others – including the conference programmer who was accused of having an ‘agenda’ – to which she replied yes she did have an agenda:  To Educate.

Now, while I have no problem being who I am, knowing that there are others who will take great personal offense at my being open about my life and world makes it an emotional challenge to 'put it all out there for strangers' to see. Being out on FB with people I like and know is one thing...going in to a room full of strangers is something completely different.  And something I wasn’t fully prepared for.

The backlash was intense.  Apparently 2 sessions on LGBTQ Issues is just Too Much Gay for Some People’s Day.  The point was missed, by some, that we all need to learn about LGBTQ Culture and Counseling just as we need to learn about other Cultures, how to counsel appropriately and how to work with that culture without inadvertently offending.  Rather the point on how the LGBTQ community is regularly treated (blown off, discriminated against, marginalized, oppressed…) was made loud and clear.   The backlash was present during the presentation, after the presentation (that day) and even several days after the conference was over.  Apparently the organizers received some ‘unpleasant evaluations’ and were told I was an incredibly unprofessional speaker…because I talked about LGBTQ Issues – because I put it ‘in their faces’ – because I was open about my being a ‘lesbian’.  I was told they didn’t ‘need’ the information I was providing…I’d have to disagree with that.  And perhaps my laid back style of teaching/speaking isn’t what they are used to…I use slang terms, humor and talk to people as if I am talking to my friends. 

Frankly, the fact that this conference had the vagina to actually ask me to speak on LGBTQ topics in the Deep South speaks volumes to me.  The fact that some were quite rude and disrespectful to me and to them was surprising to me and hurt.  The fact that many others, however, were angry at how I was treated was amazing!  So many people came to me later, in person, via email, via Facebook messages saying Thank You for what I presented – how they were so angry with the person who was rude to me, how the information I shared was helping them already to understand how better to work with and communicate with LGBTQ families.  To me this is amazing – and I am humbled and honored.  I have been told that I made an impact that I may not even be aware of…that I have educated on topics that are desperately needed and the resources I provided will help them help the LGBTQ community far better than they have been.  I have been told by many now, that I made people think about stuff they don’t want to think about.  That I challenged them in a manner they are most uncomfortable with.  That whether or not they wanted to be educated on this topic – They WERE. 

THIS is overwhelming to me!

I simply went to speak on a topic near and dear to me.  Though I know there are those who don’t like the LGBTQ community, and I have been treated rudely by others because I am Lesbian I did NOT for one second expect to be treated like that by other lactation professionals – my colleagues.  That shocked me.  It just didn't occur to me that I would be treated like that.  I know – I am naïve.  I know this about myself.  I expect others to be polite, respectful – as I would be to them.  I am just me, trying to educate people in the best way I know how on a topic that is very much needed.  

Will I speak on these topics again live?  Sure.  

Will I change the way I present my topics?  Nope.  

Will I change my speaking style?  Nope.  

Will I change me to make others more comfortable?  HELL NO.  

Will I continue to do my best to educate others who want that education?  Absolutely.  

Will it challenge some to think a little and others to think a lot?  I sure hope so. 

The LGBTQ Community is not going away – in fact we are coming out more and more and as Lactation Professionals it is our JOB to be as educated as possible in working with the LGBTQ Community, myself included.  And frankly, who better to educate the Lactation Community about the LGBTQ Community than a Lesbian Lactation Consultant?

Breastfeeding Trauma: How I want to help and how you can too

In 1994 I gave birth to my 2nd son and thought, since I was an experienced breastfeeding mom, I'd have no problems.  I was wrong.  Not only was I wrong - I was REALLY WRONG.  What followed was nearly 4 months of an incredibly difficult situation that gave me a career as an IBCLC - but also gave me severe sleep deprivation, severe postpartum depression and a delay in my bond with my baby.   (see my story here - Why am I an IBCLC) 

I have worked with breastfeeding mama's and their babies since January of 1995 when I first started my training working for WIC as a Peer Counselor and becoming a Certified Lactation Educator.  (About Jaye)  In the beginning, most of my clients had very basic challenges which were easily corrected with simple latch and positioning help, milk supply support and basic counseling.  But, over the years, as my practice grew and my skills improved, I started seeing more and more complicated cases.  (My Services)

The babies I work with are struggling to breastfeed (tight muscles and/or tongue-tie).  They are often high needs, difficult to feed and/or need body work (which can get expensive adding in a financial stress to the mix).   Their mamas are struggling emotionally with the stress of pumping, nursing and bottle-feeding.  They are often exhausted from sleep deprivation, emotionally stressed and battling postpartum depression and dealing with injured nipples, painful breastfeeding (if there is breastfeeding), mastitis, plugged ducts and thrush.   

Any Mother who has struggled with breastfeeding knows that the emotional toll can be considerable.  Sleep deprivation and postpartum depression are common.  Emotional disconnect from baby due to severe breastfeeding challenges is more common than one would like to know.  It is a very difficult time for a mama when she has intense struggles to do something that should come so easily - and is instead fraught with pain, frustration, fear and emotional overload.  The emotional fallout can take months and even years to recover from, cropping up as intense fear and dread with the next baby, praying that they will not again go through the difficulties they went through last time with many fighting between just bottlefeeding and taking the risk and giving breastfeeding a try.   Many mothers describe those emotions as akin to PTSD - and I understand that all too well having faced those intense fears myself with the birth of my third son.

To add insult to injury, many of them (myself included during my struggles) are told by well meaning family, friends and HCPs to 'just get over it - it's just breastfeeding,' and  'just give the baby a bottle, formula is just as good as breastfeeding,'  and comments such as, 'I don't know why you are so worked up over this' are common.   Those who have not gone through this type of experience truly cannot understand or appreciate the depth of pain comments like these cause.

The level of counseling I do with these amazing women has gone from  basic breastfeeding support to considerable emotional support - helping them stay calm, find peace (if at all possible) in difficult decisions, get through each day, one at at time - sometimes one feeding at a time.  They know I am available to them any day of the week.  I have talked more mama's off a proverbial ledge than I can count.   Actual lactation education/help has gradually become a secondary aspect to the care I routinely provide.  Currently, the emotional support I provide is fully 50% or more of my work with struggling mama's.

When I work with a mama in a tough situation like this (which is often) I always recommend counseling to assist with the emotional distress that results from the challenges they are dealing with.  Counseling can be very effective if the counselor is familiar with the nature of the struggles that Mama is going through.  Understanding Mama-Guilt is especially important as learning to reconnect with one's baby can be especially painful as there is a lot of mama-guilt just from being disconnected in the first place.  But, my Mama's often tell me that their counselor, who is great with other issues, doesn't seem to be grasp the seriousness of this particular issue.  Rather, many mamas are told it's just not a big deal - not every woman can breastfeed.  In essence - they are blown off - and they do not get the help they often desperately need.

For women who have had serious birth trauma, there are counselors who specialize in birth trauma issues and emotional healing.  I want to be that person who does the same thing for mamas who have suffered Breastfeeding Trauma.  I currently offer a lot of 'hand-holding' and emotional support, doing my best to help mamas 'hang in there' while they work through their breastfeeding challenges.  But, for me, this is not enough. 

I watch and listen as they struggle with not only their own emotional stress, but the emotional disconnect or distance from their baby that breaks their hearts - and mine.  While I personally understand how it feels, and can relate and empathize with them, I do not yet have the skills needed to assist these mamas at the level they need and I want.  I want to help them heal not only themselves but also their relationship with their baby if it too has suffered.  Or better yet - be better able to assist in NOT letting that happen in the first place. 

My goal is to get specialized education that will facilitate what I already do with these amazing Mamas but take it a step or three further.   But education is expensive and I need help.  So I am appealing to you for help.  My goal is to be able to offer not only in person help, but long distance help as well.  I know it is needed - I want to provide it. 
 
To see how you can help please go to my website and take a look at the fund raiser I am holding.  If you are a Mother who could have benefited from (or could benefit from) this type of specific counseling, please feel free to share your story so that others can understand why it is so important to have someone who can do more than just hold you hand.  While it is an honor - a huge honor - to help the many, many women I have been privileged to work with - I am left with a sense of wanting to be able to offer more to them...they deserve it.  I will deeply appreciate any help given to fulfill that goal.

Warmly,
Jaye Simpson, CLE, IBCLC, RLC, CIIM, BC 
Breastfeeding Network

Your Care Provider did what? When to file a Complaint and Why…

You have put your trust in your care provider – whether that person is a Dr. a Dentist or, in my field, an IBCLC.   You think you are getting good care, but something doesn’t feel right.  And you realize that not only have you not received good care – you (or your child) have actually been harmed in some way.  What do you do?

In my field I often talk to parents about poor care they have received from other practitioners.  They are angry, hurt and confused.  They don’t understand why their care provider would ‘do that’ to them.  In one case a mom and baby came to me 8 wks postpartum and the baby was 3 ounces above birth weight.  The Pediatrician had told mother he was fine because he was gaining – just gaining slowly.  No – he wasn’t fine.  In another case, a mother was treated horribly (witnessed by her partner and doula) by an OB/GYN during her delivery.  The treatment bordered on malpractice.  She was traumatized, baby had been injured – parents did not know what to do.  In yet another case, an outpatient-clinic IBCLC sent a baby home below birth-weight at 2 weeks of age and told mom there was nothing that could be done to resolve the baby’s anterior tongue-tie and significant torticollis and to just feed him a bottle of formula.  Another mom was told by her IBCLC that If she didn’t do the recommended treatment she was a bad mother.  And lastly another parent told me of how she had pre-paid for a consult with another IBCLC and yet, while her money is gone, no consult ever happened and the IBCLC in question refused to respond to her many emails.  These are just a few instances - I know of many more.  In each of these cases I told the parents the same thing I tell any person who has been treated poorly or harmed by their care provider:  FILE a Formal Complaint.  

All of the above examples are clear cases that warrant a formal complaint being filed.   As humans we have the right to expect our care providers will do what is best for us, treat us with respect and work to protect our health.  When they don’t we actually DO have options.  The trick is to actually follow through.  

Many parents are just wiped out, exhausted, dealing with a new baby and dealing with potential fallout from poor care by a provider.   They feel they just don’t have the energy it takes to file that complaint.  I get it – I really do.   18 yrs ago an IBCLC acted quite unethically with me and I was disgusted – but I was exhausted and working to try and get my breastfeeding challenges worked out.  My primary IBCLC was a God-Send – this other one?  Not so much.  But I didn’t know I could file a complaint against her.  And even if I had, I don’t know that I would have because of my state of exhaustion and lack of support at home.  Her unethical actions still haunt me (they taught me what NOT to do as an IBCLC!), and it is too late for me to file that complaint.  However, I wish I had known that I could have…because had I done that there is the good chance that she would have been disciplined, re-educated or even perhaps stripped of her IBCLC Credential…something!  As it was – I did nothing and her behavior continued – for years.

I knew there were procedures for filing complaints against other practitioners, and as I got into the field I learned that there was also a process for filing a complaint with the IBLCE (International Board of Lactation Consultant Examiners).  The IBLCE is the Governing Body for IBCLCs.  They tell us what our Scope of Practice is (we can and cannot do), and what our Code of Ethics and Code of Professional Conduct are.  And when those are violated it’s a problem – for everyone.   

So, I started encouraging moms to FILE when they had cause.  Some did, but most didn’t because they were too hurt (betrayed) by the care provider, too tired, too busy.  They didn’t think their words would be enough to make a change happen.  I get it, I really do.  But at some point we need to stand up for ourselves and our children and take a stand that will help us and help others.  If we know others who have been harmed by a particular provider, we can work to support each other as we file our complaints.   One thing we know is that when we have been harmed, if we have the support to, and knowledge how, to stand up for ourselves it can be very healing!  And the other thing we know is that Change does not happen if no one speaks up!  This Blog Post is to help YOU out there who have been harmed stand up for yourself and your babies and file that complaint when you have cause.  

Many moms fear retaliation from a disgruntled care provider, and I understand that too.  (Believe me I will get a lot of anger and probably some hate mail over this post!)  But I believe that if we can set that aside for just a moment (and know that if retaliation does occur we have options there too) we can heal ourselves, and help others in the process.  We must recognize that if a care provider is hurting us, they surely have or will hurt someone else.  If no one stands up to stop it, it just continues.   Taking back our personal power from someone who harmed us is amazing!  Yes – I have done that – and it WAS amazingly healing!  

So – what do we do?

When our Dr. hurts us we can file a complaint with the medical board.  Google ‘file a medical complaint’ and you will find links for each state and how to file.  Same thing with a Dentist, Chiropractor, Massage Therapist, Midwife and even hairdresser – a Google search will bring the information up easily enough.  If you search for “Association breastfeeding complaints procedure” you will find links to file complaints against lactation professionals in other countries.  Google ‘complaints IBCLC” and you will find what you need as well if you have been harmed or treated inappropriately by an IBCLC. 

My parting comment is this:  Regarding ANY care provider – if you or your child has been harmed or think you have been harmed, been treated inappropriately, unethically, etc., investigate and make sure you have cause – and if you do - file that complaint.  Don’t just let it go; don’t fear retaliation to the point that it stops you from taking a stand for yourself.  (Blocking people via internet is surprisingly easy!)  Protect yourselves and help protect others…we all benefit with that. 

Take back your power…

Tongue Tie – Gentleness and Compassion for the Baby - Part 2

To recap - we are talking about babies who become orally aversive due to tongue-tie after care.  Why does this happen?

First:  There is no judgment here – none at all.  As a mom with a baby who was tongue-tied and struggled for months to get breastfeeding right, I understand the desperation to have it just WORK once and for all.  Some moms struggle for so long, weeks and even months in pain, pumping and trying to breastfeed.  They are so desperate, and understandably so, to fix their breastfeeding problems and get that baby breastfeeding once and for all.  Sometimes they inadvertently create this problem of oral aversion with aggressive stretching.  This absolutely does not happen on purpose of course, though sadly it is happening and the truth is it does not need to. 

I have heard some moms state that the baby cries when the diaper is changed and it’s no big deal, and this crying during aggressive stretching is just like that.  Well, no it isn’t.  A diaper change doesn’t cause the baby pain.  And I have heard others say that it HAS to be done this way in order to make sure that frenulum doesn’t reattach.  Well, no, it doesn’t – it can be done gently and still be effective.   

I have spoken with moms who had significant mom guilt when they realized that their actions (aggressive stretching) had caused their baby’s emotional trauma and oral aversion.  These moms were devastated that, in their attempt to help their child – they hurt their child.  The fact is, as I see it, and those moms too, this is avoidable.  
 

Stretching consists of lifting/stretching or massaging the underside of baby’s tongue in order to keep the tissues mobile and from healing closed and causing lack of tongue mobility (which is why we did the frenotomy in the first place, right?).  However, there are various thoughts on this process, how it should be done, how often and to what extent.  Some recommend using a tongue blade (wooden tongue depressor), or just your fingers.  Some recommend massaging the tongue, some recommend stretching.  Some recommend breaking the wound open at least a few times per day to prevent scarring down or reattachment.  Some recommend these procedures not be done at all while others recommend 5-8 times or more per 24 hours or prior to every feeding.

As a Lactation Consultant who specializes in tongue-tie I would not recommend anything other than using your finger to do the stretches, unless you have been specifically taught by the Dr. who did the procedure how to properly use the tongue blade.  Stretching the wound is uncomfortable for the baby at best, and can be painful at worst.  It is the rare baby who can handle the stretching/massage with a smile – at least initially.  

So let’s talk about how to do this in the most baby friendly manner.  These are my own recommendations to my clients.

Tongue massage/stretching should be an in and out fast procedure. Gently slide your finger under the tongue and massage the incision site as such: from bottom:  massage up the tongue, then back down 2 - 3 times using gentle but firm pressure - then get out of the mouth.  This is 3-4 second procedure at most. If you are doing the stretch, you can use the Kotlow method of coming under the baby's tongue from behind: Baby is laying on his back with his head close to you, you gently slide two fingers under the tongue and lift the tongue up with a gentle push back - hold for count of 3 and then get out of the baby's mouth.  I recommend 2-5 times per day for at least 2 weeks, and strongly encourage some sort of complimentary body work.  And check in with your LC or Dr. to evaluate how the healing process is going.

These stretches/massages should be kept as enjoyable as possible for baby. The last thing we want is for baby to fight, scream and cry inconsolably when we are trying to help them.  It is one thing for them to fuss and complain - it is quite another if they are screaming.  Also, I do not recommend purposefully breaking open the wound several times per day because 1) it is painful for the baby and 2) it is painful for the baby.  Breaking open a wound repeatedly slows down healing, causes emotional and physical trauma and should not be needed in order for the wound to heal properly.  If the wound breaks open on its own without extreme pressure that is different - doing it in purpose should not be needed.

If there is fighting and screaming happening with stretches and massage - then we should take a look at WHY.  If stretches are being done to the point of doing them for minutes rather than seconds – Stop.  It should be seconds.  Doing the stretches for minutes will cause baby much pain and discomfort.  If baby is screaming and crying for an extended period afterwards – as in more than a minute or two – too much is being done. This type of overdoing can actually cause oral/feeding aversion, whether it is breast or bottle.  

Anything we do in the mouth MUST be done with respect and as much gentleness as possible.  And while these stretches are important, we can do them in a manner that does NOT potentially cause other issues.

You can do these gentle stretches when baby is asleep, awake and relaxed, just before feeding, or after feeding. If you do 2 reps of the stretch and baby is getting mad - STOP. Don't push the issue at that time. There will be a later time (half hour?) where you can finish. Keep this time and activity as happy and as relaxed as you can.  Make funny faces, sing, or make funny noises!  Talk to your baby in an encouraging and supportive tone.  Whether you do these exercises twice a day or 8 times a day they can be done in a gentle and respectful manner and still be effective.  Using pain relief is a good idea as well.  Talk to your Dr. or IBCLC about pain relief measures (acetaminophen, ibuprofen, homeopathics…).  Get that bodywork to help baby’s body move and groove the way it needs to help that tongue move the way it should.  

Finally, many moms have told me that they would rather deal with some breastfeeding discomfort, pump and bottle feed, or just bottle feed formula than to cause their babies the kind of pain they see happening with others or that they themselves have inadvertently caused.  And you know what?  I agree with them – 100%.  And frankly, it is my professional opinion that, if it requires hurting the baby repeatedly, to the point of causing oral aversion, in order to make breastfeeding work, then perhaps we should reconsider that.  

Is the causing of injury, emotional and physical trauma worth breastfeeding?  I don’t happen to think so.   

And I implore you to put yourself in the baby's shoes...how would you feel and what would you ask for in this situation?    

Gentleness and compassion for the baby while working with tongue-tie…it can be done. 

Tongue Tie – Gentleness and Compassion for the Baby - Part 1

Lately I am getting more and more emails, private messages and phone calls from mothers and professionals regarding tongue-tie.  The concerns are the same and actually kind of frightening and sad at the same time.  I will discuss these shortly in Part 2 but first let’s lay some groundwork so we all understand what we are talking about.

What is tongue-tie?

From TongueTie.net

The ‘lingual frenum' (or lingual frenulum) is the cord that stretches from under the tongue to the floor of the mouth. 

‘Tongue tie', ‘Ankyloglossia' or ‘short frenum' are the terms used when the lingual frenum is short and restricts the mobility of the tongue.  

Tongue-ties can cause all sorts of problems or none at all.  If there are problems with breastfeeding (or feeding in general) and tongue-tie is determined to be the cause, a frenotomy is usually recommended.  A frenotomy is also known as:  Clipping, revision, or frenulectomy depending on who you are speaking with.  I have heard all of the above.  

Clipping simply means the frenulum is snipped (ether by a scissors or laser) – kind of like snipping a string in two.  It is generally painless for the baby and bleeding is typically minimal.  Only rarely and in extreme cases will a baby need general anesthesia to have a frenotomy done.  Most all frenotomies can be done with the child awake with little to no anesthetic.  Babies typically are angrier because someone has their fingers in their mouth than they are about the actual procedure – which is generally very fast.  And as soon as the procedure is done, baby can breastfeed which will help calm the baby and encourage proper tongue motion and mobility.  Follow-up with bodywork, such as Chiropractic, Bowen, an Osteopath or Cranio Sacral Therapy is strongly recommended.

There can be long term consequences of not having a tongue-tie that is causing problems clipped.  Speech issues (lisping), sleep apnea, snoring are just a few long term possible challenges.  However, if there are no feeding issues with a tongue-tie and parents are unsure about clipping, the decision to clip or not needs to be discussed with someone who is knowledgeable about tongue-ties and their potential long term effects.  Sometimes it is simply a 'wait and see' situation.  Many babies have been tongue-tied and gone on to breastfeed just fine (or with minimal discomfort to mom) and there were no long term consequences observed.  

However, just because there are times when there doesn’t seem to be an issue, we still need to monitor baby’s weight gain and moms milk supply.  It can be difficult at times to know for sure that baby is transferring milk well on his own or if he is getting milk primarily because of mom’s healthy let-down reflex.  If baby in unable to transfer milk well on his own, mom will notice a decrease in her supply at some point in time.   If that happens other steps will need to be taken to preserve the supply and baby’s intake.  At this point a frenotomy may definitely be in order.  As long as the parents are aware of the risks and know what to watch for, how they choose to handle their situation is entirely up to them.

 

If parents decide to proceed with a frenotomy they should be well informed, by their Lactation Consultant (IBCLC) and the Dr. doing the frenotomy of the procedure itself as not all Dr.’s do frenotomies the same way.  Aftercare exercises and possibly needed pain relief for the baby will need to be discussed.

The aftercare exercises are where we start running into trouble and are the point of this article.  Many LC’s and Dr.’s recommend stretching of the tongue to prevent the wound from healing ‘down’ or the frenulum from ‘reattaching’.  Other exercises may also be discussed to work with tongue mobility.  I am focusing on the stretching because it seems to be the biggest issue. 

What I and many other IBCLC’s are hearing and seeing is increasing cases of oral aversion in babies directly caused by excessive/aggressive stretching of the frenotomy site.  Frenotomy wounds are being stretched open, to the point of bleeding, repeatedly each day causing baby pain and distress, day after day, for up to weeks on end.  Babies are being reported crying for hours after stretching exercises and even closing their little mouths up tight when they see a finger coming towards them.  Some babies even learn to recognize the ‘stretching position’ and begin to protest and cry immediately when placed in that position.   Sometimes breastfeeding does not get better, and in fact sometimes gets worse, and in some cases ends completely as the baby flat out refuses to nurse due to oral aversion.  What that means is baby is so averse to having anything in the mouth because of trauma that they refuse to nurse or eat, and/or scream anytime the breast, a bottle or finger approaches the mouth.  

So why is this happening?   See Part 2 for the rest of this story...

Breastfeeding Support...exclusion or inclusion?

One would think (or at least hope) in 2012 that people would be accepted for who they are and respected for what they can offer and/or want to offer to help other people.  But clearly this is not the case and I find it very, very sad.  It is also not the case in the world of breastfeeding and I find that just as sad and disheartening.

In today’s world we are finding more diversity in people, cultures, belief systems and families.  People are freer now (but not in all areas) to be who they are and to express themselves in the way that feels best for them.  Gender roles and identity are becoming more blurred in many areas of the world.  We find ourselves with humans who identify with all sorts of various gender roles and identities including but not limited to: straight, gay, lesbian, bi-sexual, pan-sexual, transgendered, queer, Cis-gendered (identifying with the body one was born into), androgynous, and many more.  There is acceptance in some areas and not in others.

We find such a diversity in families that is amazing to me.  We have the male/female couples, and same sex couples as well as a cis-females partnering with a transman, or a transman in a gay relationship – and with the wide range of gender identities the combinations are nearly endless, and beautiful.  People loving each other for who they are – I think that is amazing.  My own family is part of this diversity and I love that!

Along with those couples often come children.  With children come pregnancy, birthing, breastfeeding and parenting.  For opposite sex couples babies are for the most part easy to come by unless there are significant fertility issues.  Adoption for any couple can be a challenge, time consuming and costly financially.  For same-sex couples babies are not quite easy to come by.  Donor eggs or sperm is generally required depending on the couple, however a transman in a gay relationship may be able to carry his own child with his partner. 

Once the child is born, many parents want to breastfeed their baby if at all possible.  This is not always easy for a variety of reasons.  Many women nowadays are having milk supply issues due to Insufficient Glandular Tissue (IGT) or hormonal interference.  Transmen have likely had their breasts removed (top surgery) and have very little breast tissue left. And while for many of these people they will produce milk, they may very well not produce enough to meet their child's needs.  In these cases supplementation is required.  How that supplementation is managed can range from breast and bottle, pumping and bottle feeding, breastfeeding using an at-breast supplementer and many other combinations as well.  None of these are particularly easy and come with their own set of challenges; however they are very effective (and necessary) ways to feed the baby.  What the parents choose is a very personal and important matter.

Recently there has been a lot of publicity about a certain transman, named Trevor MacDonald, who birthed and is currently breastfeeding his son. You can read his story here.  Milk Junkies  Trevor is an amazing man, a leader in breastfeeding culture in his own right and is making a huge difference in the world right now opening the eyes of people who may or may not want their eyes opened.   He applied to La Leche League (LLL) to become a La Leche Leader (LLLL) with the support of the LLL group he was regularly attending.  His application was denied because Trevor identifies as a man and LLL states they are a woman to woman support organization.  Regardless of the fact that he is a breastfeeding parent, he is not welcome to be a LLL Leader; however he is welcome to be a LLL member (which he is).  

When this all came out I was surprised at the reactions that came along with it.  While there were many people who were disappointed in LLL International’s denial of Trevor’s application, and implored LLLI to ‘come into the 21^st Century’, and be inclusive of all breastfeeding parents, there were many others who felt that not only was LLLI’s denial appropriate but they felt it with such righteousness and anger that it truly shocked me.  And that some of these people were NOT from the straight community really surprised me.  

Many of the comments I have read over the past couple weeks from people who vehemently stand by LLLI’s decision to deny Trevor (or any breastfeeding male) the opportunity to support other breastfeeding parents have been far short of  respectful.  They have been downright mean, insulting, and judgmental and have made statements about not only Trevor but anyone in his position.  The assumptions and misinformation was staggering.  People have made statements about Trevor and his situation that were quite inaccurate – and generally not nice.  With all of that I am left wondering: Why are people being so rude?

I truly believe it is far past the time for us to behave in this manner.  This is the 21^st Century after all.  Where is the ‘accept and be accepted’ aspect we should have for each other as humans?  It does happen in bits and pieces here and there and that is wonderful.  But isn’t it time for this acceptance to be all encompassing?  Especially when we are talking about breastfeeding our children and raising our children to love and accept others for who they are?   Aren't we supposed to treat others with respect and common courtesy?  What are we teaching our children when we react with such anger and vitriol towards people who are not exactly like us?  How can we expect the world to be a better place if we don't teach our children through our example?

Parents of all genders, identities, nationalities NEED support whether it be pregnancy, breastfeeding or parenting…we ALL need that support!  Breastfeeding support can be difficult to come by in many areas, and finding people who have been through breastfeeding challenges that parents are going through, who are also breastfeeding counselors/consultants, can be challenging.  Understanding the blessings and difficulties that breastfeeding a baby brings is an important part (in my professional opinion) of being able to relate to and help other breastfeeding parents.  We need the many people who are in different but similar situations as much as we need your average everyday mom who has a breastfeeding challenge.  Why are we not begging these people to join with us in supporting breastfeeding Parents?  Not just breastfeeding moms...but also breastfeeding dads.

So, why is it OK to be exclusionary – You can be a leader/counselor for our organization but only if you are a woman.  This is NOT OK with me, personally, and I know many others who feel the same way.  Why can we not be inclusive?  Is it really so difficult to welcome any breastfeeding parent (male or female) into the 'group', give them the education and get them out there to support ALL breastfeeding Parents?  I don't think so.

I tell you what I really hope for - is that someday ANYONE of ANY gender who breastfeeds can apply for and become a breastfeeding counselor whether with LLLI or Breastfeeding USA. It is time to stop the segregation. Women and Men have glandular tissue. They both can and do breastfeed.  And maybe someday acceptance will be universal and those who counsel and support breastfeeding parents will not be limited to being specifically women...maybe we will find a way to be inclusive rather than exclusionary of those who don’t necessarily fit society's typical model of a breastfeeding parent.  

 Maybe.