Breastfeeding and the curious epidemic of “broken” baby tongues

Tint newborn baby crying after bath in a blue towel

Am I the only one to have noticed this irony?

Lactivists insist that women are mammals and mammals are “designed” for breastfeeding. They insist that breastmilk is the perfect food; in order for it to be the perfect food, it would have to be highly nutritious, always available in the amounts needed, and the baby always able to access it easily from the breast. They appear to believe that there is no such thing as not enough breastmilk (“nurse more! and pump when you’re not nursing!”) and no such thing as pain when breastfeeding (“it’s your fault; you’re not doing it right!”). Simply put, no woman’s breasts are ever “broken”; if there’s a problem with breastfeeding it must be because of the mother’s laziness.

If pediatricians and ENT specialists think it’s a fad, who’s making the diagnoses? Mothers and lactation consultants.

Yet at least 5% of women don’t produce enough breastmilk to completely nourish a baby; many women find breastfeeding painful, and they have raw bleeding nipples to show for it; and many babies are screaming with hunger because they can’t extract enough milk from the breast.

What’s the problem? It’s the baby’s fault! Their tongues are “broken”!

There appears to be a veritable epidemic of “broken” baby tongues, known colloquially as tongue-tie and scientifically as ankyloglossia.

According to lactation consultant Nancy Mohrbacher:

What started as a problem for a small percentage of babies seems now to be an epidemic. Health-care providers report increasing numbers of breastfeeding mothers self-diagnosing tongue and lip ties in their babies, often based on online information, and asking for a tongue- or lip-tie revision, a minor office procedure to release the tie…

What is tongue-tie?

If you look carefully at the photo above, you will see that underneath the infant’s tongue there is a small vertical membrane that connects the tongue to the floor of the mouth. Tongue tie occurs when the membrane (the frenulum) is abnormally shortened and or thickened, restricting the movement of the tongue itself. Since the motion of the infant tongue is critical in breastfeeding, it’s easy to see how tongue-tie can cause problems breastfeeding.

The epidemic of tongue tie is surprising since the natural incidence of tongue-tie has been estimated as 1.7-4.8%

But releasing (snipping) the tongue tie is big business. The surgical fee for frenectomy/frenotomy is $850. I presume that $850 is what the doctor bills; what he or she is actually paid probably varies by insurance company.

How effective is surgery for tongue-tie in reducing breastfeeding problems?

Not very.

A recent review of the literature published in the journal Pediatrics, Treatment of Ankyloglossia and Breastfeeding Outcomes: A Systematic Review, found:

Twenty-nine studies reported breastfeeding effectiveness outcomes (5 randomized controlled trials [RCTs], 1 retrospective cohort, and 23 case series). Four RCTs reported improvements in breastfeeding efficacy by using either maternally reported or observer ratings, whereas 2 RCTs found no improvement with observer ratings. Although mothers consistently reported improved effectiveness after frenotomy, outcome measures were heterogeneous and short-term. Based on current literature, the strength of the evidence (confidence in the estimate of effect) for this issue is low. (my emphasis)

Indeed:

A minority of surveyed pediatricians (10%) and otolaryngologists (30%) believe ankyloglossia commonly affects feeding, whereas 69% of lactation consultants feel that it frequently causes breastfeeding problems.

So, according to the scientific literature, the incidence of tongue-tie is small (less than 5%), it does not necessarily lead to breastfeeding difficulties, and there is little evidence that surgical treatment of tongue tie improves breastfeeding difficulties.

Why has there been a dramatic increase in the diagnosis of tongue-tie and a dramatic increase in expensive surgery to correct it?

Dr. Bobby Ghaheri insists that Diagnosing Tongue-Tie In A Baby Is Not A Fad:

One of the most frequent things I hear is that primary care providers say something to the effect of “Oh, diagnosing tongue-tie is just a fad” or “This tongue-tie business is just something new that some people are doing”.

So if pediatricians and ENT specialists think it’s a fad, who’s making the diagnoses? Mothers and lactation consultants.

Why?

I have a theory:

Breastfeeding is supposed to be perfect, yet it is clear that many babies and mothers aren’t doing well with exclusive breastfeeding. The obvious conclusion is that breastfeeding is not perfect, and may not even be a healthy choice for some babies. That simple, obvious conclusion leads to cognitive dissonance in the lactation industry and among lactivists themselves. For them, breastfeeding must be perfect; therefore, it is babies who are “broken.”

Curiously, the same people who insist that women are perfectly designed to breastfeed can’t explain why so many babies aren’t perfectly designed to breastfeed, and why they apparently need surgery to treat with breastfeeding problems.

How ironic!

  • MZB

    Gluten-free food is a fad too. Lots of people avoid gluten even though they don’t need to. It’s annoying. However, there are people who are real celiacs. I think it is similar with tongue tie–it’s a fad and more people are having it cut than need to; however, some kids really do have a membrane attached too tightly which is inhibiting tongue mobility. The fad is ruining everything for the celiacs and the tongue tied–nobody believes their medical issue is real anymore.

  • PrimaryCareDoc

    Dr. Ghaheri has shown up in the sOB Facebook comments.

  • Who?

    Over at Are athey All Yours? Zu is having the baby’s tongue tie revised at 3 months because it is preventing her moving enough milk to grow. This is after having it sorted out once already, and despite her der brother being miserable for a week after his second procedure.

    And the little one gets adjusted for free at the chiro until she’s a year old.

  • militarymommy

    My baby couldn’t latch, and I refused to to an unproven medical procedure. Switched her to formula with no guilt involved, and she developed normally in all aspects, including speaking. And no, I never tried pumping because that seemed foolish to waste all that time that I’d rather be holding my baby. It’s not like breastmilk is as amazing as certain people claim.

  • indigosky

    I know too many women who thinks vaccines are poison and circumcision is child abuse, because children are perfect and deserve consent. Yet they have no issue trying to force doctors to cut off part of their baby’s mouth and starve them to make them breastfeed. Gotta love the hypocrites.

  • Brooke

    Breastfeeding shouldn’t hurt and shouldn’t cause bleeding cracked nipples. It doesn’t mean that the mother is lazy, it means that she needs help or practice getting the latch and positioning correct. I did. Even though I breastfed my first kid for 3 years. I still needed a refresher course so to speak. No one is saying that breastfeeding is uncomplicated or easy to get right. Or that every mother/baby pair can get it right. The thing is, in earlier human history if a mother couldn’t establish nursing or had inverted nipples or whatever, someone would step in and wet nurse that child. If a child had a severe lip or tongue tip a mother would hand express and feed that child with a cup. Today breastfeeding in public is taboo, I would say most women probably have not seen, especially up close, another woman breastfeeding. They don’t know what a good latch or good positioning looks like, they don’t have another woman to feed their child if they don’t produce enough milk so have to use formula/plus again there’s a cultural taboo against a woman whose not the child’s mother breastfeeding him or her. I’m wondering how if only 5% of women cannot produce enough milk why do so few women make it to the first year of breastfeeding? Its not because women are incapable of producing milk or babies are incapable of breastfeeding. Its because we don’t have a breastfeeding friendly culture, even if breast is best is on billboards and buses, that hasn’t translated into changing the culture or even women getting basic things like longer maternity leave.

    • Amy Tuteur, MD

      Why do you care? Why do you think the way another woman feeds her child is your business?

      • Brooke

        I never said wet nursing was a perfect system. Looking at western cultures in modern history isn’t ideal either for exploring global norms in infant feeding.

        Dr.Amy why are you so obsessed with the way in which women give birth, feed and raise their children? Your blog posts go well beyond just educating people but often shame and ridicule people for making different choices in an extremely personal and hostile way.

        • Amy Tuteur, MD

          My goal, the goal of nearly all physicians, is to provide accurate information so women can make informed decisions. I trust women to decide for themselves what is good for their families.

          I had four vaginal births, two without pain relief, breastfed all my children and followed many of practices of attachment parenting BUT that doesn’t make me a better mother than other mothers. I don’t need to have my own choices mirrored back to me in order to feel good about my choices.

        • Cartman36

          You said that if breastfeeding didn’t work “someone would step in” and wet nurse and that just isn’t true. Also, there is not one set of “global norms in infant feeding”. Every society and culture (12 – 16k according to the book anthropology of childhood) that exists or has ever existed had their own set of norms and practices surrounding child rearing including feeding that was based on their cultural practices, food and resources that were available at the time, religious beliefs etc. it’s frustrating to see people insist that everything was perfect prior to the introduction of formula which is just not true.

          • Dr Kitty

            Extended breast feeding is also one of the few reasonably effective woman controlled options for family spacing that was available prior to modern contraception.

            The rhythm method and withdrawal methods only work if the male partner is on board.
            If he isn’t, and if your culture says that his word is final when it comes to sexual matters, then breastfeeding your toddler is probably the only thing you can hope to do to prevent a pregnancy.

            That gets overlooked a lot.

          • Cartman36

            That is true. Sarah Hrdy talked a lot about that in her booo Mother Nature as well. My biggest take away from the book was that life was pretty darn hard for everyone but especially the mother of young children prior to birth control and other modern conveniences like a Walgreens on every corner (I’m in the US. This is a drug store chain that if they don’t sell it, you don’t need it 🙂

          • Roadstergal

            It’s my go-to stop for prescription refills, flu shots, film development, batteries, little packages of chopped pineapple and basic wraps, really cheap wine, frozen pizza, dog treats, pink hair dye, gummi worms, Halloween costumes, Ace bandages, canes, flip-flops, anti-inflammatories, and if I wanted it, every goddam supplement known to man.

          • Cartman36

            I love Walgreens. I could spend hours in there. I’m a big fan of CVS as well because they let you stack coupons and you can get Pampers for cheaper than the Walmart brand if you have the right coupons.

        • momofone

          Brooke, Dr. Tuteur isn’t the one who comes across as obsessed with how women birth, feed, and raise their children. In fact, I wonder if that isn’t what rankles for you; she doesn’t say one way is better, she says they’re equally legitimate ways to birth/feed/etc. You seem to be hung up on making breastfeeding The Best. I’ve never seen a comment from you that didn’t promote breastfeeding or some specific parenting practice. If you aren’t obsessed with promoting one option over another, why are you doing it?

          • corblimeybot

            Right. The only reason to act like Brooke, is because you can’t stand it when people don’t kiss your ass for your choices all the time. If other choices are legitimate, then Brooke can’t go on. So she has to make sure other women know she is better.

            Brooke won’t be a young mother forever, and the internet never forgets. I wonder how her behavior will seem to her with the benefit of a few more decades experience. Or how it will seem to her kids when they inevitably internet-snoop on mom. Will she keep this up long after everyone else in her life has moved on?

          • Sarah

            Slagging off an obstetrician for having an unusually high level of interest in birth also seems to be missing the point rather. What next, railing against mechanics because there’s more to life than cars? Throwing a wobbler in a shoe shop because they only know how to measure feet?

          • N

            And what about teachers actually interested in their students progresses, wouldn’t that be a shame? Or veterinarians who like animals?

        • Sarah

          Have you of all people seriously just complained that Dr Amy (AN OBSTETRICIAN so, you know, INTERESTED IN BIRTH) is obsessed with the way women give birth and feed their kids? Oh the ironing!

    • Cartman36

      It really grinds my gears when people bring up wet nursing as if it was a perfect system. Sarah Hrdy who wrote Mother Nature: A History of Mothers, Infants, and Natural Selection, touched some on wet nursing and it was NOT the perfect system that lactivists like to pretend it was. Throughout history and before formula and our modern child welfare system, many women who couldn’t feed or provide for their babies simply abandoned them including just leaving them alone on a hillside. People who found and took in abandoned babies who were unable to find a wiling wet nurse often feed them supplements such as cows milk from a cup or rag and many children died of starvation and disease. Also, the infants of wet nurses suffered as the wet nurse needed the money made from wet nursing but didn’t always have the supply to feed the child she was being paid to feed and her own. Sarah Hrdy’s book is very eye opening to the realities of mothering prior to modern conveniences.

      Suzanne Barston, in her book, Bottled Up, made an excellent point to counter the “breastfeeding is natural” argument. To paraphrase, she says that humans have been using our enormous and complex brains to change our lot in life for thousands of years. Formula is completely natural in the sense that it is another example of humans seeing a problem with our natural situation and finding an efficient and easy way to fix it.

      And to second Dr. Amy’s comment below, its not our business or concern how other women feed their babies.

      • Azuran

        And really, even if wet nursing was perfect. It no longer is the case.
        Sure, when we lived in small villages, 100% of women where stay at home mom and had babies all the time, finding a wet nurse and making arrangement was probably somewhat easier.
        But what am I supposed to do in today’s reality? In my family, I have 1 cousin who is pregnant at the same time as me. She lives 6 hours away. None of my friends are currently pregnant or breastfeeding. I have two coworker who are also pregnant, and could still be breastfeeding by the time I have my own baby. At best it’s a 20 minutes drive both way to get to their houses, which I should do every 2-3 hours? And even at night?
        Of better yet, find a total stranger on the internet and have her come live in my house with her own baby? Or just give her my baby and pick it up when it’s weaned?

        • Cartman36

          You make points that are valid today and were valid in the past as well. Lactivists love to point to wet nursing in history without ever talking about any of the issues surrounding it. I believe it’s called the naturalistic fallacy. Even when humans lived in small villages or communities there would be a limited number of other lactacting women and then those women would have to agree to it. In an atmosphere of extremely limited resources, even within families it was likely difficult to convince another lactacting mother to move or share resources fror her children with others.

          To each their own but with the availability, safety, and convenience of formula, I don’t understand why anyone today would use milk from someone else.

          • N

            Around where I live (not US, not UK), LC and LLL-people don’t even think about recommending wet nursing. It is too dangerous. If the mother who wants to breastfeed does not provide enough “liquid gold”, formula is the first and only choice to supplement. We even tell mothers to talk to their pediatrician about what kind of formula to choose. Never ever wet nursing. Nor buying breastmilk from strangers on the internet! No!No!No!

          • Cartman36

            Yes, I mentioned on another of Dr. Amy’s posts that I had a doctor, who when I mentioned I would supplement from birth with my second as I did with my first, suggested that I could get breastmilk from a friend that I “trust”. I was horrified and she is no longer my doctor. How a physician, wouldn’t recommend my child share a comb for fear of lice could suggest that i feed my newborn a bodily fluid from someone else instead of formula is beyond me.

          • N

            You can never trust anyone 100%. I would not even let my sister wet nurse my baby. Never, ever! No, that is not true, in an end-of-world-scenario, like mad max, I would probably encourage wet-nursing if possible. 🙂

          • AnnaPDE

            It’s kind of funny that all those potentially disease-ridden strangers are allowed to expose their own newborns to all their horrible germs though… and they probably see you (and me and everyone else) as potential sources of infection for their kid. Hell, how can anyone even trust themselves to be perfectly healthy, without constant testing? (Which, btw, is exactly how formula was pushed in the 70s in Germany: That breastmilk is full of germs and pollutants and therefore unsafe for babies.) Conversely, blood and milk testing makes sure that a potential milk donor is actually safe.
            The ewww-bodily-fluids paranoia is running a bit high IMO.

          • N

            Milk from a milk bank, I trust that it is safe. But there are no milk banks here.
            I needed lots of blood transfusions a couple of years ago. I got it in a hospital and trusted it was tested and save. Never ever would I buy blood from a donor in the internet, or from a friend or family member without the hospital between us to test it, if it is save. Why would I do it with milk for my baby.

          • AnnaPDE

            Of course you wouldn’t trust a random stranger on the internet. But say a good friend who’s had a baby recently and gone through the same extensive testing as you have? (I had a buttload of tests ordered at the beginning of the pregnancy and then again shortly before birth – apparently that’s standard practice around here.) Clearly it’s a matter of being able to rule out risks, and possibly doing some extra testing beforehand. Which is exactly why I think that safe wet nursing and milk sharing are utterly impracticable for most people.

          • Who?

            We are all potential carriers of disease-and if someone has risk factors they are aware of they can choose how to respond to those. As we know, people are within their rights to refuse vaccination for their own children. Which would be riskier for the child’s health I wonder?

            I take it you’ld be fine with unprotected sex with a stranger if you’ld be fine with the concept of feeding your child that person’s breastmilk?

          • AnnaPDE

            The fact that we all could, in principle, carry diseases does not mean one can’t be reasonably certain about a specific person not being one of them. As in, for example, most people are with long-term partners (at least if you trust them to be monogamous). Or blood banks with donors after testing samples. Or someone you know very well, know to be looking after their health and to have had recent tests – e.g. I’d have no issues for my kid to have breastmilk from my cousin who has a baby of the same age. Obviously I wouldn’t have sex with her for a lot of reasons, but none of those is risk of disease.

          • Heidi

            I could trust a friend to be monogamous, but you also have to trust her spouse, and not just to be monogamous but also to not be an IV drug user. I’ve been around long enough to know that I don’t know what people do in their private time! I don’t think it’s being paranoid to refuse non-milk bank milk in the least, even from trusted friends and family members.

          • AnnaPDE

            By the same token, how can you trust yourself – given you never know what your spouse is up to? After all, most people don’t know right away when they’re being cheated on.

          • Irène Delse

            Well, at least, if your spouse is the child’s other parent, they have powerful reasons to be wary of catching and transmitting diseases. A friend’s spouse wouldn’t be in that position.

          • AnnaPDE

            They would be wary of transmitting that same disease to their own kid though – after all, the donor isn’t lactating for no reason. But then, you’d think that most people would like to avoid catching STIs altogether just for their own sake, and reality doesn’t bear out that assumption.

          • Who?

            So a man who would cheat on his spouse and bring home an std is going to be all sentimental about his child’s heallth?

          • Who?

            Sorry this one was for Anna-tiny phone keys!

          • Heidi

            If someone told me they weren’t breastfeeding because they didn’t trust their spouse, I would not think they were being overly paranoid.

          • Cartman36

            I’m not going to debate anyone on hypotheticals or what ifs. However, I would like to point out two facts that lactivists like to either gloss over or pretend they don’t exist. 1. Millions of children have contracted HIV and other communicable diseases via breastfeeding. This is a real problem in Africa. 2. Millions of mothers are faced with the horrifying choice to either breastfeed their child knowing they have or are likely to test positive for HIV or risk the child suffering due to a lack of formula or clean water / supplies to prepare formula. It’s a slap in the face to these women for those of us in developed countries to pretend like we have a clue what’s it’s like to have to make a choice like that.

            AnnaPDE you know darn well no one hear is arguing against breastfeeding because your spouse “might” cheat on you. The point I and others were making was that wet nursing had real challenges in history as it does today that lactivists gloss over. Wet nursing and utilizing milk from a licensed milk bank are NOT the same thing. Blood testing and pasteurization make donor milk from licensed milk banks safe but it is not a reasonable alternate for many families due to the cost. Fifth grade sex Ed tells us all that wet nursing or purchasing breast milk online, does run the risk of exposing the child to communicable diseases.

          • AnnaPDE

            Ok, that first argument is completely analogous to “dieting to stay slim in the West is a slap in the face of starving people”. Yes, the situation in many African countries is awful, with no feasible option for many mothers, and absolutely not comparable to places like the US. These countries weren’t the subject of this discussion.
            For the second argument, that’s not what I criticised – I have repeatedly stated that wet nursing or milk sharing is not a simple or practical thing to do safely. Which obviously rules out random internet strangers. But the way this has been generalised to include any and all situations is overblown IMO (specifically, “not even my sister, except maybe in a mad maximum scenario”, when the same argument applies to all BF), and I stand by that point.

            And re milk bank: IMO the little available milk bank milk should go those preemies who actually need it.

          • Roadstergal

            The issue is that it’s a risk/benefit tradeoff.
            Giving a kid a blood transfusion has more risks than not doing it, no matter how good the disease screening. You obviously only do it if _not_ doing it has a worse prognosis.

            Breastfeeding a baby your own milk has risks, and breastfeeding a baby someone else’s milk carries even more risk. Most women who breastfeed take some care to make the milk as safe as possible (not all, though – eg, the pot-smoking breastfeeders in Oregon), and there are benefits involved for women who want to breastfeed (convenience, closeness/joy if the BF gives them that, etc.).

            However, the only benefits for someone else breastfeeding your child are the falsely trumped-up benefits of ‘a skinny smart beautiful perfect hypoallergenic child’, and therefore, given that there is a much easier and far safer alternative available, it’s all risk with no benefit.

          • AnnaPDE

            I agree it’s pretty pointless when there’s formula, I just dislike the massive overstatement of a fairly controllable risk.

          • Roadstergal

            I think having formula available changes the whole scenario. It’s like how opposed I am to acupuncture because of the data showing that the weak placebo effects are evoked just as well with sham acupuncture that doesn’t pierce the skin. For me, that suddenly made acupuncture risks 100% unacceptable. People like to point out that the risk of, frex, HepB or a collapsed lung from an acupuncture needle is low – but it’s not 0, it has happened and could still happen. For me, in the absence of benefit, the risk is now unacceptable.

            There’s no benefit of wet nursing in the developed world with access to formula and clean water. Therefore, the risk is unacceptable.

          • Cartman36

            Obviously we are going to have to agree to disagree. However, I stand by my points. You claim that the risks of wet nursing are overblown and they are not. If someone chooses to engage in wet nursing or buying milk from strangers in developed countries rather than use the formula readily available at any corner store and their child contracts a disease they will be at fault. And yes, I think you prattling on about how “your spouse could cheat on you” so the risks of wet nursing are “overblown” is offensive to women who are struggling with the HIV epidemic in third world countries and for whom this is not a hypothetical. You have far more choices that they ever will. As the notorious RBG says, it’s a sad state that only women of means have choice when it comes to reproductive issues.

          • AnnaPDE

            I’m “prattling on” because I’m pointing out the hole in a pretty contrived argument. One that reminds me oddly of lactivists’ hypothetical scenarios how formula could still be contaminated even in developed countries with clean water, kettles and fridges, thus devising ever more inconvenient preparation regimes. (And really, where did I advocate to buy.milk online from strangers? I was talking about people who know each other very well and get tested.)
            And please, why are you trying to put anything into my mouth about encouraging wet-nursing in places with high HIV prevalence?
            Anyway, let’s disagree. 🙂

          • Roadstergal

            A spouse can even have unprotected promiscuity and/or IV drug use or other risky behaviors in their past, that they want to bury, and be carrying something they didn’t know about.

            I don’t think it’s unreasonable to find it an unacceptable risk, because the risk from formula is basically zero.

          • kilda

            Before we could screen blood for HIV, some people chose to have family members donate blood for them, rather than use anonymous donor blood, on the theory that it was safer because you knew your family members wouldn’t have HIV. IIRC, studies showed this was actually higher risk than using regular blood bank blood. Believe it or not, you don’t actually know what your family members, or friends are up to in their private lives and what risk factors they may carry.

          • An Actual Attorney

            Does anyone remember the study about diseases in milk donated to milk banks? IIRC, it was pre-screened women who were donating to a hospital bank for preemies. So, about as altruistic and motivated as could be. And the numbers were, to me, uncomfortably high. On the phone now, so it’s hard to find.

          • D/

            Maybe this one?
            Results: Of 1091 potential donors, 3.3% were positive on screening serology, including 6 syphilis, 17 hepatitis B, 3 hepatitis C, 6 HTLV and 4 HIV.

            http://fn.bmj.com/content/95/2/F118.short

          • An Actual Attorney

            I think that was the one. Thanks.

          • PrimaryCareDoc

            Every week I have at least one patient in my exam room crying and requesting STD testing because they’ve found out their spouse was unfaithful.

            This is NOT a rare occurrence.

            All of these patients were blindsided. Not a single one has every said, “Meh, I always knew he was a player.”

          • AnnaPDE

            That’s my point. By this logic of whom one trusts, no one should be feeding their bodily fluids to their own baby. Which I think we can agree is overkill.

          • Who?

            I’d suggest it is irresponsible to feed your child milk that you wouldn’t consume yourself.

            Would you drink your cousin’s breastmilk?

          • demodocus

            i wouldn’t drink my own, either, but that’s because i dislike sugary drinks

          • Roadstergal

            What about in a White Russian? Vodka kills germs. 😀

          • Azuran

            I wouldn’t even drink my own…….because ewww. (I know it’s not really logical, bu still, ewww)

          • AnnaPDE

            To make a point, yep. For taste, no, my own is yucky tasting enough.

          • corblimeybot

            You think it’s paranoid to not let your child drink untested bodily fluids from someone whose history you cannot fully know? So you’d be okay with your kid drinking a bottle of that same person’s blood, right? And a bottle of blood from the person that person has sex with, yes?

          • AnnaPDE

            Why untested? By all means do make sure that person is tested.
            I still wouldn’t feed their blood to my kid because he’s not a vampire and would probably throw up (at least that’s what my own swallowed blood does to me after a nosebleed).

        • Sarah

          Wet nursing is also rather incompatible with modern knowledge about diseases passed through bodily fluids, and with modern employment rights.

          We now know that nasties can be transmitted through breastmilk. We didn’t previously, and obviously HIV is a relatively new concern. I dislike the use by one commenter of the term ‘overblown’ wrt fears in this respect: that is a matter for the individual parents.

          If I were employing a wet nurse in modern day UK, I would have to pay her minimum wage and provide paid holiday, adequate health and safety arrangements etc. Which is as it should be, of course. I would hope all of us would agree on that point. But very few people can afford paid 24/7 domestic help, which is what a traditional wet nurse would be. That wasn’t such a concern in the bad old days when you could pay whatever pennies you liked because there were plenty where that came from, and didn’t have to give any fucks if the wet nurse’s own baby ended up starving. This of course is all progress, but makes using a wet nurse a less feasible proposition for most people.

          I also, again quite rightly, wouldn’t be able to place limitations on who she has unprotected sex with while she’s wet nursing my child. But of course, although I could require her to be tested prior to commencing employment, and most women will have accepted HIV tests and more during pregnancy, that tells us nothing about what behaviours her sexual partner/s since then might have engaged in. Naturally this is an unacceptable level of risk to some of us, now we have both an understanding of what that risk actually is and a viable alternative.

    • Box of Salt

      “Today breastfeeding in public is taboo”
      Nonsense. Not where I live – So Cal.

      • demodocus

        Nor in my area in Ohio.

    • Sarah

      Could it not also be because lots of women don’t actually want to?

    • Who?

      Worst word in the world=should. Judgemental nonsense usually follows.

      As you display.

      • demodocus

        frequently

    • Roadstergal

      “Today breastfeeding in public is taboo,”

      Nope, breastfeeding in public is a bigger deal than things that actually matter – like vaccinating – in my area.

      • corblimeybot

        I get that some people are mean to women who breastfeed in public, but it sure didn’t happen to me. No one ever said anything about it.

        (I also didn’t have to deal with any of those insufferable creeps who approach breastfeeding women to congratulate them, thank goodness.)

        • demodocus

          i got one or two of those, and they are creepy.

          • Heidi_storage

            Yeah; I’d just finished pumping one time at the zoo (in a bathroom), and this lady comes up to me and starts talking about what a wonderful thing I’m doing for my baby and good for me. She meant well, of course, but it made me rather uncomfortable.

        • Roadstergal

          I appreciate that it can happen, but to be fair, you don’t have to be breastfeeding in public to have people talk shit at you. Just be a woman in public. :p

          • Maud Pie

            So true. I had to talk my baby for a blood draw (hypothyroidism concern, ultimately ruled out) just after I started supplementing with formula in conjunction with pumping and supplemental feeding system. I took out her bottle, and sure enough some jerk hollared across the waiting room “you’re supposed to breastfeed.”

          • MaineJen

            Ugh…just…no. Did you at least get to show him/her the one finger salute?

          • Roadstergal

            “You’re supposed to mind your own fucking business”?

          • Charybdis

            “Sorry, I JUST had the nipples tattooed onto my reconstructed breasts and, although the look like a million bucks, they DON’T WORK THAT WAY! And I refuse to starve my kid, so here we are with a bottle. Why do you care?” might be my first comeback…

          • Hmm….

            “WOW! You can tell the difference between expressed breastmilk and formula? Come and give my sister/best friend/cousin/ advice on how to tell if it’s expressed breastmilk or formula. She’s convinced the daycare are sneaking her kid formula.”

            Yeah. This is one of the many many many reasons why I’m not a parent.

          • Roadstergal

            You know, ever since I’ve been hanging out on SkOB, I’ve gotten a lot more sensitive to birth/feeding woo in pop culture. I remember stumbling over childbirth and breastfeeding woo in the otherwise great Breaking Bad, and just the other night, they were playing Raising Arizona on TV, which I had never seen all of the way through. Yes, the ‘you should be breast-feeding’ was done by the two ‘bad guys,’ but still, it didn’t really play off as a bad thing, which irritated me.

            (There was also poly-shaming, which annoyed me.)

        • Dr Kitty

          Me either.
          NIP very definitely isn’t common here, I don’t use a cover and I still didn’t have so much as a single comment despite feeding both of mine until they were over a year.

          My resting bitch face and IDGAF aura probably kept the weirdos away.

  • Lucy

    I’ve seen a few kids who nursed until about the age of two- they were pretty darn whiny and immature compared to their weened peers. That being said, I think this author is spot on: breast is best, but breast is not best if you both are struggling and your child isn’t gaining appropriately; supplementation plus breast may be the best strategy for some moms, and some may not be able to nurse much at all (there is a such thing as breasts that don’t make hardly any milk . I talked to some lactation consultants and found them to be unqualified quacks. No wonder we have an increase in “diagnosis” of tongue tie by these non-professionals. One told me “your body won’t respond to the metal of a pump” (that my supply would decrease if I pumped; she was very old and I guess didn’t know that pumps are made of plastic mostly). Another told me that I “wasn’t nursing often enough” when I put my son on the breast every 3 hours. She thought he should be on twice that often, at a minimum. How did she “calculate” those times? Why, she compared it to how she nursed her own baby, of course! The total quackery of the LC “profession” is astonishing; it amounts to a cult following more than a profession.

  • Hannah

    This is anecdata, but I had months of agonizing feeding with nipple damage and vasospasms until my daughter had a ‘moderate’ posterior tongue tie snipped by the head of Pediatric ENT at Oakland Childrens’ Hospital (Dr Wesman). He charged his regular consult fee (I think it was like $125) and feeding went from sheer agony to merely uncomfortable within the first feed, and comfortable within a week.

    Her tongue was heart shaped whenever she cried and from the first day I told lactation consultants it hurt and that I felt her doing something weird with her mouth. Just as a flipside, I think this is a fad of sorts in lactation communities but there are situations where it is a real issue. The irony is that if the tie is posterior, LCs miss it and tell mothers to ignore the pain.

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  • I’m late to this discussion, which is too bad. I’m a pediatrician who performs frenotomy on newborns. I’d like to make a few points:

    The systematic review in the OP criticized the quality of the evidence, and called for longer-term followup, and I certainly don’t disagree with that. However, in their own words, “The good-quality RCTs were relatively consistent in demonstrating improvement in breastfeeding effectiveness immediately or within 5 days of frenotomy compared with sham or no intervention, respectively.7–9” Lacking perfect evidence doesn’t mean we ought to disregard what evidence we do have.

    I agree that ankyloglossia is overdiagnosed– I estimate 1/2 of the newborns specifically referred to me for a clip don’t have ankyloglossia at all. It is not a subtle diagnosis, when present. I agree many in the lactating support community seem to be overcalling this, at least in my community (Atlanta).

    In my experience, having done dozens (maybe hundreds) of these, I have found that IF nursing is going poorly AND baby has a true tongue tie (truly limiting movement) AND the tongue is tied by a thin, see-though membrane, I can snip that in less time than it takes to get consent. Then mom nurses, and 9 out of 10 times it goes well. I used to call all of the moms a few days later, just to see, and feedback was overwhelmingly positive.

    I also don’t charge nearly $850. I’m in the wrong specialty….

    • Amy Tuteur, MD

      Thanks so much for your perspective!

    • Young CC Prof

      Good to know! What bugs me about Ghaheri is that apparently he diagnoses it in almost every baby sent to him. Unless patients are being really well-screened by the referring practitioners, which his obviously aren’t, a specialist should be telling some patients, “Nope, not the problem, try something else, sorry.”

  • Courtney84

    I had a tongue tie and a lip tie lasered on my three week old yesterday. I knew from the first time she latched something was not right. Her ties were pretty obvious, and her latch is dramatically improved but there are still some difficulties. She also seems to be dairy sensitive/intolerant/allergic so I am motivated to avoid formula as it makes her wail inconsolably for hours and Alimentum is $$$. I will say it makes me nervous that her dentist recommended chiropractic/CST to resolve body tension. We aren’t doing that.

    • Mishimoo

      Awww damn! Hope things gets easier for you both soon.

    • Tosca

      Her dentist recommended…time to find a new dentist. Chiropractic is quackery, useless at best and dangerous at worst. For a health care professional to RECOMMEND it for a newborn is unconscionable.

      • Joy

        I have never heard of a dentist, or midwife, that released a tt that didn’t. I also gave a Prince type side eye and backed away.

    • Angharad

      Food intolerances are no fun! Soy formula is typically about the same price as cow’s milk formula, in my experience, if it’s just dairy that’s the problem. I hope things get better quickly!

    • Lancelot Gobbo

      Why does a three week old need a dentist at all?

  • Toni

    My daughter has a moderate tongue tie. It affects speech. But it didn’t affect breast feeding, interestingly. She nursed happily for a year. Her doctor wanted to snip it when she was tiny “in case” it affected nursing but she was a few months old and it hadn’t so I didn’t see the point. Though since it affects speech now, 9 years later, I kind of wish I’d let him do it. He didn’t mention speech as a possible problem at all 😛

    • Toni

      When I say it affect speech, I mean it affects HOW she speaks. She had no delays. She started talking at 9 months and hasn’t shut up since. haha.

  • Joy

    My baby had a tongue tie. We got it snipped at 4 weeks because she still wasn’t back to birth weight with combo feeding. She wasn’t able to feed well from a bottle and was still taking twoish hours to feed at three months. So, we paid privately in the UK to have her tongue and lip tie lasered. She did take a bottle much better immediately after. The dentist even said that not every baby would be able to ebf afterwards. I think for us it was worth it, but I am not objective. I wouldn’t recommend it to anyone particularly. If you spend any time on tt FB groups you will learn that, with no exaggeration, even if your 18 month old has been gaining weight just fine but is now weaning, it is a tt issue. That if you don’t get it fixed it will cause a. reflux b. migraines c. eating issues e. speech delays d. muscle problems e. back issues I think that in extreme cases, some of these might be problems. I can see how not being able to move your tongue from side to side can cause eating difficulties, but I think these are the minority of tt cases. But not, of course, according to the message boards. It is not uncommon to have babies on their fourth or fifth revisions. If my baby had been able to take a bottle well, then I don’t think I would have done it.

    • demodocus

      Someone thinks their 18 month old wants to stop nursing because of a tongue tie? oh for pete’s sake. That is not a nursing strike, that’s the kid saying she’s done with this!

      • Joy

        If you spend too much time on FB you hear a lot of women being told that they should basically cut out all food and drinks to force the baby (toddler at that point really) back on the breast. Because it is all about self-weaning! Or something…..

        • demodocus

          that is disturbing.

          • Joy

            Well, almost no child would self wean before two, so clearly they aren’t weaning. I try to bring balance to the group.

          • Young CC Prof

            I’ve read a lot of their pieces about “natural” weaning age, and what they seem to be missing is that nature doesn’t include grocery stores. A hunter-gatherer toddler with an irregular and/or monotonous food supply is probably going to nurse more than a modern toddler getting balanced meals four times a day.

          • N

            My almost 2 years old must think that we are hunter-gatherers with an irregular and/or monotonous food supply. There are moments where he wants to breastfeed all the time. As I don’t want that anymore, he is not a newborn anymore, I offer him food instead of my breast, as soon as he starts to clusterfeed. And, oh miracle! He accepts foods like bananas, oatmeal, bread and cheese (well, he eats the cheese and leaves the bread),… It’s just that he has not realised yet, that there IS food and that he can ask for it.

        • Wren

          That was the final thing that pushed me out of the mommy woo. My son quit out of the blue at 9 months. I did everything I could, but I wasn’t going to starve him just so he would nurse. I mean, I rented a great pump, saw a couple of lactation counsellors, called a few more, moved him back into my bed (which meant we put the mattress on the floor as our bed is quite high) to try to get him to nurse at night, tried just about every bottle on the market that was meant to be “more like a breast” and made myself crazy. He would only take a bottle at night, so it was like we had a newborn, getting up to eat repeatedly at night. The one thing I would not do was starve him until he went back to the breast. It was repeatedly advised by the crazies at mothering.com, but I will say was never advised by a lactation consultant.

          • Heidi

            My little one started refusing the bottle at about 9 months, too. I don’t know if it was as the result of teething or just being done with drinking his meals, but my bad, just don’t feed him solids advice came from his less than helpful pediatrician. We think we’ll switch doctors soon. We threw out bottle after bottle and we formula feed so it was literally pouring money down the sink. He’s such a diverse eater, though, that I am not too concerned.

        • N

          ??? Wouldn’t it be wiser the other way round? A toddler that only wants to drink milk and refuses all other foods – cut down a bit with milk and try to make him eat other things? I always thought, a one-year-old that still refuses to eat could still be acceptable BUT could also be a sign of low iron. So talk to your ped about it.
          And I thought I was a lactivist, I must be wrong, because I don’t like the idea of wet-nursing, of forcing toddlers back to the breast through starvation, and advise mothers on many accounts to talk to their pediatrician…

      • magenta

        My insane SIL kept forcing the breast, but my niece at almost 2 years soon learned that biting upset Mommy, and biting real hard constantly would finally stop her from being forced to breastfeed. And she even would bite when not breastfeeding, just walk up to SIL and bite her hard through her shirt. Never did that to any other woman, even when I would hold her and I have huge boobs. Amazingly, the biting stopped after SIL stopped forcing the boob. My niece is a genius.

        • demodocus

          ouch.

    • Hannah

      OMG those Back To Breast and TT groups are scary! Women desperately trying to get ’28 month olds’ back on the breast. Nuts.

  • CanDoc

    How fascinating. I do release tongue ties when requested by our local (hospital-based, nurse-run) lactation clinic, probably for about 2-3% of our newborns. It seems to make a difference for about 1/3 of those babies in terms of latch quality – but many of those moms are ready to switch to formula and be done with the whole racket by the time I see them (and by this time they’ve slept 23 hours in 7 nights, are stressed out, exhausted, pumping at all hours, and I don’t blame them one bit). But I don’t make $850… I make just under 1/10th that much (I bill about $74 for the consult and procedure), and it takes me away from my office, usually at an odd hour, and is a total nuisance that I’d be just as happy to avoid. Am very eager to appraise this review with our clinic and see if it changes our practice, thanks!

  • Hilary

    Very interesting. When my son was struggling with breastfeeding several mothers were very insistent that I should get him examined for a tongue tie. When I pointed out that his tongue appeared completely normal and that none of the specialist doctors he’s seen at the universtity children’s hospital thought he had a tongue tie, I was told that only doctors specially trained in tongue ties can be trusted to find them and was told to look up Dr. Ghaheri’s work. I thought it seemed fishy, so I ignored their (no doubt well-intended) advice, and we now know my son’s difficulties were caused by a combination of silent reflux (dxed by upper GI series), mild dysphagia, and impaired oral motor planning.

    • The Bofa on the Sofa

      When I pointed out that his tongue appeared completely normal and that none of the specialist doctors he’s seen at the universtity children’s hospital thought he had a tongue tie, I was told that only doctors specially trained in tongue ties can be trusted to find them and was told to look up Dr. Ghaheri’s work. I thought it seemed fishy,

      Yeah, good spot.

      The comparisons to chiropractors grows. It’s like diagnosing subluxations.

      • Hilary

        I was also told chiropractic would fix his GERD and to try cranial sacral therapy for his hypoxemia. FWIW I went to a chiropractor for about a year and it helped tremendously, but that was for an actual injury that showed up on x-rays and I was very very careful in choosing the chiropractor. When I asked *how* chiropractic treatment would affect reflux, I was just told, “Well, it worked for my kid and for so-and-so’s kid.” Call me crazy, but I like to have an explanation for how and why something works before testing it on my medically complicated child.

        • Young CC Prof

          The funny thing about infant reflux is that it tends to go away on its own. The baby’s digestive tract matures, he spends more time sitting up and less time eating, and the esophageal sphincter starts working properly all by itself.

          (There are of course exceptions, but that’s the normal course of infant reflux.)

        • The Bofa on the Sofa

          FWIW I went to a chiropractor for about a year and it helped tremendously, but that was for an actual injury that showed up on x-rays and I was very very careful in choosing the chiropractor.

          Bofa’s Law

          Actually, this is why I think the chiropractor is such a good comparison. There are undoubtedly times when tongue-tie needs to be treated. But when you end up resorting to “Not all tongue-tie surgeries are bad”, that’s just Bofa’s Law in practice

          • D/

            According the International Association of Tongue Tie Professionals (of which a great number of members are chiropractors and “body workers”) the philosophy and approach is …

            IATP members remain dedicated to two main principles: the prevention of later-in-life problems due to untreated tongue-tie, and the education of all based on both current research and solid clinical evidence.

            From FAQ:
            “The negative impact of tongue-tie varies from person to person. For some, the impact is very slight; for others the impact can be substantial and affect their daily quality of life. The problem is that it is impossible to predict which babies will experience the worst problems as they grow up. Most knowledgeable health practitioners recommend treating tongue-tie during early infancy to prevent problems from developing.”
            http://tonguetieprofessionals.org/about/

  • SarahSD

    The day my baby was born, I noticed that her tongue was completely heart-shaped. I had not been studying breastfeeding blogs, but planned to nurse, and somewhere I must have read or heard about tongue tie, because I remember asking the nurse, “is she tongue tied?” and was told that yes, this was a “classic”, very tight tongue tie. I asked if it would cause nursing problems and they said maybe, maybe not – to wait and see how she did and that we could ask the pediatrician to evaluate her at her ~1 week checkup. At first it seemed fine – her latch was fine in terms of extracting milk. But after a couple of days the “clamping” that she needed to do in order to get the milk out was bruising my nipples to the point of tears each time she nursed. I brought her to her appointment at 10 days or so and asked whether the Ped could do the procedure and what the pros and cons were (I was super nervous about cutting my baby, and what if it made things worse, or she didn’t want to nurse at all?). She performed the frenulectomy right there, the baby cried for 2 seconds, I nursed her immediately and felt an immediate difference. I’m very glad for the procedure because I wanted to nurse and this let us continue, which we both ultimately enjoyed. I have also since been surprised by the large number of mothers in my ‘groups’ saying their babies have tongue and lip ties, repeated revisions, and expensive laser wielding specialists. Based on both wholly anecdotal experiences, I’ll buy that it’s become a fad, but I also think that it can be a real diagnosis that may be really helped by the procedure.

  • Toni35

    IME a huge part of the lactavist mentality is the notion that ‘it doesn’t hurt if you are doing it right’. Well, for the first 2-3 weeks of breastfeeding, even if everything is going well, it fucking hurts. I say this as someone who nursed 3 children to age 2, and is currently nursing a 4 week old. With my first child I thought something might be wrong because the pain with latch on was not only present, but worse than I would have expected. Ironically enough, a breastfeeding book provided by Similac (in a dreaded “gift bag” – this was back when hospitals weren’t worried about pandering to the lactavists and being baby “friendly”) informed me that it is normal to have some pain with latch on in the first couple of weeks, but so long as it wasn’t severe and the nipple wasn’t damaged (it wasn’t), it didn’t last the entire feeding (it didn’t), and didn’t continue beyond the first couple of weeks (it didn’t) that it was normal and would subside as my breasts and nipples got used to breastfeeding (and toughened up). Basically, barring any signs of milk transfer issues or damage to the nipples, the pain would resolve itself. That advice probably spared me 100s of dollars in LC fees for a “problem” that really wasn’t a problem at all; and it may have spared my children a needless surgical procedure to boot.

    Why aren’t lactavists more honest about the pain that many (dare I say most) woman experience in those first few weeks? First I think they believe that women would stop bfing, or never bother bfing, if told the truth – which is extremely insulting. When I found out that the pain had an endpoint and should not be a problem after the first couple of weeks, I was more than willing to continue on. Four times! And like clockwork, all four times, the pain went away sometime during the baby’s second week of life. The ultimate irony is that by hiding this little bit of info (and preventing the formula companies from getting the info to new mothers because – gasp – a sample can of formula was included in the gift bag that had this particular book) new moms who experience the same thing I (and many other) mothers went thru won’t know that a certain amount of pain in the early days is perfectly normal and will pass. So instead of doing what I did and assessing the situation (no damage to the nipples, baby is clearly getting enough to eat, I just have some pain – I’ll wait a couple weeks and see if it subsides because I’d like to make this whole bfing thing work, if I can) more and more women are rushing off to LCs because something must be “wrong” (remember, ‘unless something is wrong it’s not supposed to hurt’).

    That brings you to the second thing – you have all these women seeking help from LCs because ‘something must be wrong – I thought it wasn’t supposed to hurt’, but you don’t have the LCs sharing the info that a certain amount of pain is pretty gosh darn normal in the first couple of weeks and if baby’s latch looks good, there is no nipple damage, and baby is getting enough to eat, you simply have to wait it out. Why? Because if that became common knowledge, women wouldn’t bother going to LCs to be told that. And LCs might lose out on an awful lot of income, because most of the time this “problem” isn’t a problem at all. But, if you pay someone hundreds of dollars for a consult, you don’t want to be told ‘this too shall pass’. I wonder if LCs aren’t suggesting tongue tie in these cases, simply because the pain is normal but they can’t admit *that* (see my first point), however, they feel the need to offer the woman some kind of “reason” for the pain, and the babies are, unfortunately, and easy “target”. And so women go to their child’s doc, insisting (as the lactavists have told them) that bfing shouldn’t hurt, their LC said they were latching correctly, but their baby might have a tongue or lip tie. If the doc disagrees, she is bfing “unfriendly”, and mom finds a doc that will perform the procedure. Hence the rise in diagnosis and procedures to correct tongue tie. Just my take on it.

    • Elaine

      I agree with all of this.

      I didn’t hear until my first child was several months old that moms with flat nipples (which I also didn’t know I had until after having babies) are likely to have more breast pain with nursing and have it last longer. My daughter was literally breaking adhesions in my breast tissue when she nursed. No wonder it hurt so much. The good news is eventually it did pass and when it came time to nurse my second baby it didn’t hurt to speak of, since the first had already effected the necessary remodeling of my body.

      We also had a debate regarding a possible tongue tie with her but never got it resolved; our doc said she’d rather wait and see if it impacted her ability to eat solids or talk. It did not affect either of those things. Then when we had our second, they told us in the hospital that he had a mild tongue tie that might or might not affect breastfeeding (he was breastfeeding fine, mind), that they could revise right then and there, easy procedure, blah blah blah. We decided to go for it just in case and ended up getting a bill for $250. I wasn’t thrilled. I felt like they led me to believe it was part of the services provided in the hospital post-birth. If we hadn’t had it clipped he probably wouldn’t have had any problems.

  • Dr Kitty

    Also OT

    I’ve been thinking about the “just stick a boob in their mouth” school of parenting that Milk Meg et al seem so fond of.

    I mean, that works for infants, but it is hardly appropriate for older babies and toddlers.

    If tirednesss/ hunger /boredom/sleepiness /sadness/frustration/ a little pain/ a lot of pain is ALL met with the same maternal response (“here honey, have a boobie”), I’m not sure that these children are being taught how to manage and appropriately respond to their own emotions and life’s challenges.

    Sometimes good parenting, even of toddlers, involves telling the kid that sometimes life doesn’t go the way they want, and they have to find a way to manage their feelings about that. Also, small children react the way you react- we all know that.
    If you respond to a tumble with “Fall down, go boom! Back up again” your child will usually smile and happily pick themselves up, but “oh no! Poor baby! Are you hurt? That looked sore” will lead to floods of tears and prolonged cuddling.
    If every minor tumble gets the same maternal response as a broken bone, you’re in trouble.

    A one note maternal response to all of life’s little trials doesn’t seem to me to be responsive, helpful or smart.
    Once the child is weaned from the breast (at what, 3,4,6?) it’s a bit late to expect them to suddenly know how to manage all their feelings and respond to your social cues.

    Am I making sense?

    • Chi

      That makes perfect sense. To me at least. Mind you I subscribe to the school of thought where allowing even an infant to comfort suck means that they want mum and only mum when they need comfort, thus it’s even harder for her to find space for herself.

      Using multiple tools to teach children how to self-soothe is a much better idea, at least to me. I know some people don’t believe in pacifiers, but I would much rather give a pacifier to comfort them rather than a cracked, bleeding, sore boob that can barely handle feeding, let alone excessive comfort suckling.

      And I feel you’re right about offering a boob every time they fall down, because then every bad thing that happens will be (at least in my view) blown completely out of proportion and they most definitely will struggle to handle bad situations when they no longer have the comfort of mum’s breast. Most likely they’ll take to thumb sucking which is really bad for their teeth.

      Plus then there’s the whole eating when they’re upset thing. Personally I think that contributes to obesity in later life because of that early association between food and comfort. If that makes sense?

      • Wren

        I would argue in my daughter’s case there is not an association between food and comfort, primarily because she had long since moved to solid food rather than nursing for nutrition long before weaning. I would think it was the same for most later weaned children.

        • Kelly

          We were making the mistake at throwing food at my second child every time she cried. I realized how bad it was getting around the time she turned one. So, we had to break the habit. It was easier at that age and I did not want her growing up eating for comfort and having bad food associations. Now, if I could stop them both from sucking their thumbs it would be great. I have tried some things but I think I have just decided to not fight it and pay for the dental contraption that will stick them when they try. Even I don’t agree with my method but sometimes, you have to choose your battles and I just can’t fight it right now. I may regret it later.

          • Wren

            Choose your battles. It’s an important part of my parenting philosophy. It sits right next to do what works for your family.

          • Kelly

            I agree on that but I feel like I should battle the thumb sucking because I know it will cause more harm in the long run. I thought I saw my third child on the ultrasound sucking her thumb already. I just need to remind myself on why I made this decision for when I look back and tell myself that I should have done better.

        • Chi

          I think it’s more when there’s extended nursing into toddlerhood and they ARE being nursed every time they get upset. I think that might be where that problem association could be made.

          But then not all kids are wired the same way, so some will make bad associations, some won’t. I think it might be something worth studying, but confounding factors would be a bitch to try and eliminate.

          • Wren

            I think it’s a stretch to argue it causes obesity, given the high rates among those who were never breastfed. I think the way solid food is handled through childhood has a much bigger impact than nursing an upset toddler.
            My son kept his pacifier for at least as long as his sister nursed, and a certain cuddly toy. He requires neither now at 9 and doesn’t use either sucking on something or holding a cuddly toy to deal with his emotions now.

      • Amy M

        Anecdotal I know, but my children weren’t breastfed. We did use pacifiers as a soothing tool. Shortly before they turned 3, we thought it was time to get rid of the pacifiers (which were only used at bedtime by then anyway). There was no fuss about this, but that night (not exaggerating), they took up thumb-sucking instead. They still suck their thumbs, at 6, because I don’t know how to break the habit. They don’t do it all day—mostly when falling asleep and occasionally when very upset. I’m not thrilled about all this, (and if anyone has any suggestions, I’m open), but yeah, if a kid really wants to suck something for comfort, he’ll find a way.

        • Ceridwen

          We’re having trouble ditching the paci for this reason (my daughter is 2.5). If we restrict it too much she resorts to sucking on her fingers/thumb when upset or attempting to fall asleep. So we’re slowly working on introducing other self-soothing measures while increasingly limiting the paci. I’m hoping it will ultimately prevent her just switching to her thumb when we ditch the paci altogether, but that remains to be seen.

          • Chi

            Yeah I’ll admit my daughter uses a paci to sleep. But we’re limiting the use to JUST naps and bedtime. She also has a security blanket which hopefully will be sufficient when we finally ditch the paci. But one thing I always say is that each and every child is different and what works for one child will totally NOT work for another.

          • Tosca

            My solution with my daughter was to allow her a dummy (as we call them in Oz) all she wanted – but ONLY in her cot. If she wanted to be out and about – no dummy. If she wanted the dummy – into the cot. It was a tough fight for a few days, but she soon realised I was serious.

            The solution meant she never took to sucking her thumb, as she could have a dummy if she really wanted one.

          • MLE

            That’s so smart!

          • KeeperOfTheBooks

            While DD was ridiculously easy to de-paci (like, got bored with it at about 6 months and never took to sucking her fingers instead, either), I seriously doubt I’ll always be that lucky with future kids. I’m making a note of this idea for precisely that scenario.

        • I sucked my thumb until I as probably 8 or 9, having tried to quit but it was something I had done since I was a newborn and couldn’t give it up.

          What made me quit was an early visit to the orthodontist who would give me braces, and being shown a device similar to the one in this picture, only installed on a cast of a real kid’s mouth and not just a photo. I was told I would need one installed if I didn’t quit. I quit immediately.

          • Who?

            My daughter stopped sucking her pointer and middle finger for exactly that reason.

        • D/

          No suggestions and likely no comfort for you either.

          By about three my youngest had gotten down to just a bedtime paci (from a 3 pack a day habit up until two). After a random little conversation about babies she decided pacifiers weren’t for “big girls”, chucked it in the trash and would never touch one again. Within 24 hours she was sucking on half of her lower lip (and not just at night). I tried to convince her to take the paci back, but she’d spit her lip out, say “oh no, those are for babies” and immediately suck that lip back in. She kept at it until it was eventually so swollen and stretched out it looked like something from an elastic man at a carnival.

          She eventually mostly stopped, but never completely … She’s a grown woman, and I always know when she really needs a nap more than the movie we’re watching or if she concentrating especially hard 🙂

          • KeeperOfTheBooks

            FWIW, I sucked my thumb until I was 5 or 6, and when I finally stopped, I switched to pulling on my ears until they looked giant, red, and swollen most of the time.
            It’s still my “tell” if I’m tired or stressed…

        • indigosky

          Agreed. I went from a pacifier to my thumb to my hair.

    • Wren

      That makes perfect sense to me. Weaning my youngest at 35 months was easy. For both of us, learning how to comfort her without that option was a major struggle. It wasn’t the only one I employed by that age, but it was always there and was an easy option, especially when the problem was partially tiredness on either side. Losing it was hard.

    • Who?

      It also subtly-or not so subtly-means every upset is mum’s to fix, perhaps with her breast, perhaps in some other way, and if she can’t fix it, the problem becomes intractable.

      That’s a lot of responsibility on mum, and as you point out is no way to help a child learn to manage their pain/fear/disappointment.

    • KeeperOfTheBooks

      I just about died laughing when I overheard my (very conservative, not-at-all-familiar-with-pop-culture) mother-in-law singing “shake it off! Shake it off!” a la Taylor Swift to my DD when DD took her fifty-seventh tumble of the day. Between Abuelita singing something goofy at her and Mommy going into fits from laughing so hard, DD had no trouble at all shaking it off and going on with her playing…

      • Hannah

        Hahaha, we do that too! I love me some Tay Tay.

  • Dr Kitty

    OT: https://www.rcog.org.uk/eachbabycounts

    Guys, have you seen this?

    RCOG is logging all cases of term babies with severe disabilities due to intrapartum issues, with a plan to do a nationwide root cause analysis and a goal to reduce the numbers affected by 50%.

    I have the distinct feeling that one of the outcomes is going to be an evidence based pushback against a low intervention, intermittent monitoring and home birth based model of care for low risk pregnancies.

    This is the BEST thing that RCOG have done in ages.

    • Sarah

      I hadn’t. Really glad they’re doing this.

    • Roadstergal

      That’s amazing. I hope it gets done with a minimum of political interference.

      • Dr Kitty

        From what I can tell, the data gathering will be simple and compulsory, and because the focus has been on learning lessons from mistakes and improving outcomes (coincidentally reducing costs of providing 24hr care to affected children, and possibly reducing indemnity fees by reducing risk) there hasn’t been any pushback from RCM or government.

        That might change once the data gathering stops and the root cause analysis starts showing certain recurrent patterns of systems failures that I think we might all be able to predict.

        For example, I think it is reasonable to think that the findings are going to suggest that risks are underestimated, monitoring during labour was inadequate, problems were not identified in a timely manner, obstetricians were not involved early and interventions were not implemented quickly enough in a significant proportion of cases.

    • CanDoc

      Wow, I’m SO excited about this initiative!
      I think women are going to have to make a choice:
      1) Low-intervention care for low-risk women, with fewer cesarean sections but slightly more bad outcomes for babies. Some women will say, well, I’m almost guaranteed to have a good outcome, so it’s worth it; OR
      2) High-surveillance care for low-risk women, with higher numbers of cesarean sections, forceps, episiotomies, etc, but slightly fewer bad outcomes for babies. Some women will say, I don’t want to take ANY chances with my baby, so it’s worth it.
      I don’t think that there’s a morally superior choice, but I think women are going to be forced to deal with the consequences of which choice they make.

  • Mishimoo

    My youngest has an upper lip tie, so I asked a surgeon about it. He checked it, noted that it was flexible, and said to feed however I am comfortable. (Which meant lying on my side to get a good latch) His opinion was frustration at people demanding to have bits in their babies mouths snipped since it does cause pain and doesn’t make much of a difference, especially when there is a perfectly good alternative available (formula). He then followed up with something along the lines of: “My daughter breastfed her son to 14 months or so, so I’m not against breastfeeding. I just don’t like doing something that seems faddish since it does hurt.”

    • Ceridwen

      My daughter has a relatively tight upper lip tie. Never affected breastfeeding. I never had nipple pain, she never had issues getting enough milk (rather the opposite at times), and she gained well. As she got older and we started brushing her teeth we did encounter some problems, because the normal toothbrushes we were using were stiff enough to hurt her where the lip tie was, and even to make her bleed there if we were not extremely careful. We were considering whether to get it snipped, but found a type of toothbrush that doesn’t cause this issue and it no longer seems it will be necessary. Even if we do end up deciding to do it though, I’m comfortable with having waited to see if it would actually cause a problem that warranted snipping the tie, especially since the procedure is not painless and the chance of it reattaching is relatively high.

      Multiple people advised me that I should get it snipped just because, despite the lack of feeding problems. I don’t understand that logic. It was like maybe they thought I was lying about not having breastfeeding issues or had them and was just too stupid to notice.

      • Mishimoo

        Oh yes, on brushing teeth!! It helps that we have an extra soft toothbrush and if I let him do the upper middle ones, he lets me do the rest of his mouth without complaints and disappears to brush at random intervals throughout the day (he’s only 2).

  • Onandoff

    My baby had a very obvious tongue-tie. She also had a very difficult time eating. She produced very little suction when she tried to latch on and had a hard time swallowing. Breastfeeding was very stressful for her, but I had a vigorous let-down and she continued to gain weight and I had no pain. Nonetheless, around 6 weeks I asked about a revision. She had a very tight tie and there was no push back about this. I had the procedure done and she was visibly distressed, upset and in pain. Nursing her afterwards, I could tell there was no difference. Her latch was exactly the same. Over time, my flow slowed, she became a stronger feeder; but it was months after the procedure was done.

    I don’t know how I feel about having it done. I wanted to make breastfeeding more pleasant for her, but failed. She was distressed by the procedure. I hate this “tiny cut” mentality so prevalent among lactivists. It was not tiny in her case. There is no evidence that the tie would have cause issues later in life. I don’t think she’s scarred for life, but I do regret buying into this mentality that it’s not a big deal and that it will solve all problems.

  • Helena Handbasket

    The most obvious explanation for the rise in diagnosis and treatment of ankyloglossia? More women who want to breastfeed are feeling empowered to persevere through breastfeeding difficulties. They are refusing to have their concerns dismissed, they’re seeking second opinions, they are taking ownership of their health and their child’s health instead of waiting for doctors to tell them what to do.

    Breastfeeding is not ‘supposed to be perfect’, it’s a learned skill. Every woman’s physiology and circumstances are unique and sometimes babies are born with congenital abnormalities which make breastfeeding difficult. Do we mock mothers who seek to breastfeed babies with cleft palate, or the specialists who help them do it? Do we belittle women who want to breastfeed their Down Syndrome baby? There didn’t used to be much evidence about or support for breastfeeding those ‘broken’ babies, either.

    Tongue tie is not the cause of all breastfeeding difficulties and not all tongue ties will affect a baby’s ability to breastfeed. There is not sufficient empirical evidence to dismiss this issue – what on earth is the value in publicly lynching people who are in the process of getting the very evidence we need to understand it? And it is utterly ludicrous to make an issue of the fact that Dr Ghaheri is charging money to perform a medical procedure. Would you work for free?

    If it’s such a problem that mothers are turning to the experience of other mothers or peer breastfeeding educators or lactation consultants, how about fighting to make sure that so many women don’t feel like that’s their only option? Why not push for better research or better education amongst health professionals about these kinds of issues? Is a constructive approach really that hard to attempt?

    • Amy Tuteur, MD

      But the existing evidence shows that it DOESN’T work. The American Academy of Pediatrics and the American Academy of Family Practice don’t recommend it. Thousands of babies are having their tongues cut and the only thing we know for sure is that those who cut them profit from it.

      • Helena Handbasket

        The existing evidence is insufficient. Of course the American Academy of Pediatrics and American Academy of Family Practice don’t ‘recommend’ it, why would they until there is a better body of evidence?
        To gripe about people ‘profiting from’ diagnosing and treating ties is pretty ridiculous. Or should medical professionals not be compensated for doing their jobs? And let’s not forget the women and babies who profit from having physiological barriers to breastfeeding dealt with. Or perhaps we should pretend that the thousands of mothers and babies who have experienced an improvement upon tongue tie release don’t exist.

        • Amy Tuteur, MD

          I’m not complaining because they profit from it. I’m pointing out that the ONLY people who recommend it are the people who profit from it.

          • Helena Handbasket

            You’re confusing ‘recommending’ with ‘performing’. Patient choice, Amy. Stop trying to limit it.

          • Linden

            The patient in this case is the child.
            Should we not question whether a medical procedure has any merit? Are you going to cover your ears and go “Patient choice”, when it comes to useless or even dangerous procedures? Chelation therapy for autism, for example, should we just let it go, let children suffer in the name of “patient choice”?

          • Helena handbasket

            It’s not that simple. If the procedure is being undertaken for
            breastfeeding reasons, The ‘patient’ is a mother-baby dyad. The child’s oral issues have direct impact on the physiology of the lactating mother.

          • Who?

            Only if she continues to breastfeed. The mother, at that moment, has a choice-subject the child to an unproven, possibly painful intervention, or feed the child with a safe, healthy alternative to breast milk straight from the breast.

          • Helena Handbasket

            That choice still affects her body! Suppressing lactation in order to wean to formula is hardly insignificant and can also involve pain. The choice is a mother’s to make on behalf of her and her child.

          • Linden

            If it is so difficult for the mother, she can go right on and pump, until her children are at uni, if she so wishes.
            Having only recently totally stopped breastfeeding my 13 month old, I understand the physical and emotional response to stopping, I really do. The emotional aspect especially took me by surprise. But this is not the baby’s problem, it is the mother’s.

          • Megan

            Sure, but the burden of proof still lies with proving frenectomy provides benefit before we just start doing it routinely. Why would you subject your child to a painful procedure when the literature doesn’t support it? The literature suggests many times the procedure doesn’t help and is unnecessary and it is unclear how to differentiate who will be helped by it and who will not. Moms deserve to know that information when they make their choice too. I am a mom who chose frenotomy for my baby and I deeply regret it. It didn’t help, caused her pain and cost us a lot of time, money and frustration. It should not be promoted as this miracle cure like it is.

          • KeeperOfTheBooks

            Ridiculously enough, suppressing lactation was, in my case, by far less painful than anything else associated with breastfeeding. Uncomfortable, certainly, but quite manageable with a good dose of ibuprofen, lots of strong sage tea to reduce my supply, and a couple of ice packs in a sports bra. Unlike, say, latching. Or feeding. Or mastitis for the second time. Or a plugged duct for the who-knows-what time. Or the breast abscess I was insane enough to lance myself because if I left DD long enough to get it taken care of, it might–horrors!–interfere with our breastfeeding. Etc.
            Lastly, I’d far rather be uncomfortable than let my child suffer pain. If it was a question of cutting a tongue tie or giving my kid formula, the formula would win, hands-down.
            ETA: And of course, pumping and bottlefeeding may be an option for those mom/babies for whom it works.

          • LovleAnjel

            Anecdata #2 – suppressing lactation was a relief compared to BF. BFing caused me searing pain and caused blood blisters on my nipples. I’ll take a week of soreness over that any time.

          • Taysha

            I find it notably interesting you equate “safe, healthy alternative to breast milk straight from the breast” with suppression of lactation. EBF is readily available and there are multiple pumps available to ensure it works, as well as laws to protect pumping at work (for working mothers).

            Who didn’t say anything about suppressing lactation. She simply said not feeding the child straight from the breast. I thought the final goal was to have a child who drank breastmilk as the best food available. The argument is not HOW they drink it.

            But then LCs make no money.

          • Hannah

            I am about as anti-lactivist as they come but exclusive pumping is no joke and not a solution for a lot of mothers. We had my daughter’s tie cut at 16w and I was able to breastfeed comfortably until this day at nearly fifteen months (we are down to one feed and will wean completely shortly). Exclusive pumping nearly broke me.

            I knew something was off with my daughter’s feeding from day one. Everyone missed it including the people I paid to help me figure it out. I am more pissed with the lactation ‘professionals’ who repeatedly missed the issue despite my clear description of the issue and told me that it would stop hurting eventually or to just put heat on my nipples for months on end.

            Basically, I do think TT is blamed a lot but as someone for whom a posterior tie as diagnosed by a head of pediatric ENT was the issue, it isn’t helpful to fob every women off and tell her that EP or FF is the solution, either. That just makes anti-lactivists look shit, too.

          • Taysha

            I exclusive pumped. I know how much of a not-joke it is.

            My children didn’t have tongue or lip ties, so even attempting to fix a TT to allow breastfeeding would have been useless.

            TT exists, in some cases it is a major impediment and it needs to be resolved (I know only one child with severe TT and the treatment included a lot of speech therapy).

            Making everything a “breastfeed or bust” is not going to help anyone. There are many other reasons why breastfeeding can fail that don’t include imaginary TTs, or the complete removal of lactation. The black-and-white dichotomy of thought is dangerous.

          • Hannah

            We are on the same page. I am still angry at the pressure I felt and the misinformation I received from lactation consultants (and, frankly, some pediatric staff). Breastfeed or bust is bullshit, no doubt. Time over, I wouldn’t do what I did e.g. EPing. On the flipside, I am happy that I did get an answer to what the issue was.

            However, and this is a big however, I remain uncomfortable with the idea that every mother who pushes for a closer look to be given to their babies’ mouths be written off as imagining things.

          • SporkParade

            Ooh, I should try that one. “Hey, sweetie. I’m sick of taking hormonal contraceptives, so I’ve scheduled you for a vasectomy. Wai, what’s wrong? It’s not like *you* are the patient. The patient is the husband-wife dyad!”

          • Linden

            No, the patient is the baby. S/he is the one you’re subjecting to a possibly useless treatment.

          • Cobalt

            Where does she say patients shouldn’t have access to the procedure?

            All I see is a call to stop recommending the procedure for profit, and instead use consistent, quality, proven diagnostic criteria.

      • Annie Schimpff VerSteeg Ibclc

        For goodness sake, they aren’t having their TONGUES cut, they are having a thin band of tissue called a frenulum cut to help with tongue mobility.
        Evertime you did a delivery or a c-section you profited from it. Not every c-section was warranted or have you never made a mistake? Ever lost a baby or a woman giving birth?

        • Amy Tuteur, MD

          No, I worked for a salary. I made no extra money for anything.

        • PrimaryCareDoc

          Again, I can’t help but think about circumcision and intactivists when I see this comment. Substitute this- “For goodness sake, they’re not having their PENISES cut, they are having a thin piece of tissue called the foreskin cut which helps reduce the risk of HIV and other infections.”

          • Bugsy

            My thoughts exactly.

          • Joy

            And the argument about not needing any pain killer for tongue tie is that they rarely ever cry! See it doesn’t hurt. Yet when talking about circumcision, they don’t cry because it is so painful that the babies have to shut down and not cry to block out the pain.

    • yentavegan

      Truth? The first few weeks of breastfeeding hurts. Even when baby has a “good” latch. IBCLC’s charge money. They are motivated to justify their fee by finding something wrong that needs fixing. Hence the rise in tongue-tie diagnosis.

    • Cobalt

      “More women who want to breastfeed are feeling empowered to persevere through breastfeeding difficulties. They are refusing to have their concerns dismissed, they’re seeking second opinions, they are taking ownership of their health and their child’s health instead of waiting for doctors to tell them what to do.”

      I think it’s more like:
      More women who want to do what’s best for their own babies are feeling pressured to persevere through breastfeeding difficulties. They are being refused accurate information about their concerns, they’re getting trapped in echo chambers where only one opinion is allowed, they are losing ownership of their choices about their health and their child’s health through public “advocacy” instead of receiving accurate advice on the options they can pursue and being allowed to choose freely what they would like to do.

  • Annie Schimpff VerSteeg Ibclc

    This whole thing makes me laugh. If you don’t want to breastfeed, don’t.
    I have never criticized a person because they chose formula, a c-section or an induction.
    I’m here to help which is clearly not what any of you want!
    You all remind me of Donald Trump.
    I am a mother, grandmother, IBCLC, woman, friend and a bleeding heart liberal. I am proud of each and every moniker.
    I came here to have an open and honest discussion about who I am and what I do. I have been called names and shut out at every sentence.
    You will have to find someone else to trash now!
    Have a great day.
    Annie

    • moto_librarian

      Just be sure to stick the flounce.

    • Cobalt

      Does Donald Trump ask you for evidence to back up your claims?

    • Taysha

      You came here to tell us all how bad Dr. Amy was and how you were glad she wasn’t practicing because she’s a meany. We can read your posts, you know.
      You also came to tell us you have diagnosed hundreds of babies with TT even though you have no medical license, and that you believe TT to be responsible for things such as suck/swallow and reflux, despite being shown they were not.
      You also took the time to call us all angry and attempt to make several women here feel bad by using the “maybe you’re just mad you didn’t reach your goals” which is an asshole way to imply we weren’t able to follow through or were somehow not “women enough”
      You came here to validate yourself and you got pissy none of us fell for it.
      You’re not a hero.
      You’re a bully with no arguments.

      • Cobalt

        A bully in a room full of unreliable (non)victims who have discarded vulnerability and desperation in favor of rational choice.

        It must be hard to suddenly have to actually justify ideology with facts, but I’m sure she’s doing her best.

      • Annie Schimpff VerSteeg Ibclc

        I never said I have diagnosed hundreds of TTs. It is out of my SOP.
        I never want anyone to feel bad about their choices. I do my best to smooth over the rough spots with the WOMEN I work with.
        I don’t need validation.
        I saw plenty of bullies here today.
        I am happy with who I am and how I’ve handled today.

        • Taysha

          You shouldn’t be, you’ve been a disaster. Allow me to remind you of a few things you’ve said:

          “Perhaps you are angry by the message so want to attack the messenger?”

          Nice dig! didn’t take. You still haven’t produced evidence.

          “The mouth has very little risk of infection.” Well that’s idiotic.

          “Reflux is about gastric juices. The inability of a bay to suck swallow properly, on a breast or a bottle inhibits the gastric juices from being released.
          Often times, reflux is resolved when proper suck/swallow is achieved.” I can’t even with this statement. All problems are magically cured by breastfeeding (not even milk, just the feeding) is probably the best example of illusory thinking we ever see. And your statement is wrong.

          “Taysha, you seem very angry. The evidence is everywhere. Obviously your breastfeeding
          goals were not met or weren’t important that doesn’t give you the right to criticize me for wanting to do my job or for women who seek a different outcome.”

          If you don’t want to make anyone feel bad, WHAT THE FRESH HELL IS THIS STATEMENT?

          OBVIOUSLY my goals weren’t met and you just want to help other women not meet with my sad, sad fate. Can you get any more insulting and patronizing than this? This is the ultimate statement of passive aggressive bullying, whereas my asking you to offer clear evidence not seated on magical thinking is met with I am just disgruntled I was never able to magically thing. Which goes hand in hand with I am bitter and don’t want others to succeed.
          THIS is what bullies do. This is how they torture new mothers.
          You walked into the wrong forum, dove.

        • moto_librarian

          I thought you were leaving? Don’t announce that you’re done with us and then keep coming back to complain. It’s tiresome, and it gets our hopes up.

        • PrimaryCareDoc

          Bullies. Again, someone with an opinion that is not congruent with yours is not a bully.

          Are you being forced to be on this website? Is there a power differential that is oppressing you? Are you unable to turn off your computer and walk away?

          Unless you answered “yes” to those questions, you are not being “bullied.”

        • Jenny_from_da_Bloc

          The good o’ “you’re a bully” card to try and validate your opinions, instead of using factual evidence does not add credence to what you are claiming. Everyone is a bully who disagrees. No one person here is forcing you to post on this site. If you can’t take the heat, don’t jump in the fire.

    • Megan

      Most of us just respectfully asked that you back up your claims with evidence. You showed yourself to be unable to do so. That’s all. No one here ever asked for help. It’s arrogant to assume we want help. You came on here to “educate” us only to find that we are pretty well versed in the literature and won’t just take your claims at face value.

      • Annie Schimpff VerSteeg Ibclc

        Actually, you aren’t all that well versed. But it was fun.

        • momofone

          You’ve been given ample opportunity to point out in what specific ways posters are “not that well versed,” but have yet to produce evidence.

          • Megan

            Who needs science when you have the sheer will of ideology?

        • Taysha

          But you didn’t come here to insult.

          Pro-tip – you aren’t well versed, either.

        • Megan

          You’re welcome to demonstrate how I’m not well versed by citing some evidence contrary to what I’ve said. I’ve been nothing but respectful to you, only ever asking that you provide evidence for your claims. You are still free to do so.

    • Gene

      You may be a mother, grandmother, woman, and liberal, but NONE of those are particularly relevant to assisting a new mother with lactation or diagnosing a baby with tongue tie. And after your repeated factual incorrect medical statements (tongue tie causes reflux, etc) and complete lack of response when those errors were pointed out speaks volumes to your lack of knowledge. You may have practiced for decades and sat for an exam, but that means nothing if you are, as a supposed professional, giving parents blatantly false information.

    • yentavegan

      For the record, I was disappointed to find that your avatar is not a representation of you.

      • Annie Schimpff VerSteeg Ibclc

        It is a representation of me because to me, BLACK LIVES MATTER.

        • Mishimoo

          And yet, instead of having an avatar that has text saying as much, you have decided to objectify a mother and child and double-down on your ‘right’ to do so when called on the appropriative/fetishistic nature of your actions.

          • Annie Schimpff VerSteeg Ibclc

            In the photo, it says, “BLACK LIVES MATTER” right across the diaper.
            Credit is given to the photographer.
            Fetish????????

          • Taysha

            Appropriation.

          • Mishimoo

            Yes, fetish. One you’re still defending even though you know as well as I do that it is impossible to see the message across the diaper unless one clicks on your photo to go to your profile. Instead, most people would only see the small image of a mother breastfeeding an infant, neither of which are you.

        • Cobalt

          Your justification for appropriating this woman’s image is that you are impersonating them in order to show how much you care about their racial group, which has historically been reduced to voiceless bodies through systematic impression and exploitation.

          Really? Do you have no capacity for reflection on how your self serving assumptions relate to the actual human beings around you?

      • Taysha

        I’m adding appropriation to her list of sins.

    • Sue

      Annie SvS comes to Amy’s blog, and says things like:
      “I’m so happy to hear you are retired.”
      and
      “Please, you seem a part of the ‘old boys club’ not a modern day feminist”
      and then
      “I came here to have an open and honest discussion about who I am and what I do. I have been called names and shut out at every sentence.”

      Can a person REALLY lack insight so much?

      “You will have to find someone else to trash now!”
      We didn’t find you, Annie. You found us. You said silly stuff. We responded.

    • Sarah

      But you can’t help when you have no idea what you’re talking about. That’s when you become a hindrance.

  • Minnie

    My mother-in-law told me my husband had tongue-tie as a baby (to the point where he had it fixed, yet had to go through speech therapy til he was 6), so it was something to look out for when I had my son. He wasn’t. He was just lazy about latching, then refused to open his mouth to latch and got stressed out about it at the month point. Still, I had so many people ask me if he had tongue tie and was I sure he didn’t, etc. And this is something that ran in our genetics. It amazed me how people heard about it as a thing to fix and all is well. I had a very pro-breastfeeding, helpful nurse at the hospital who was best at getting my son to latch, even though he preferred the bottle and I wasn’t going to deprive him of that. I had no pain breastfeeding, but after a month I didn’t see the point of stressing him out or trying to pry his mouth open to breastfeed. I still had people asking me if he had tongue-tie.

    On a different note, it has been a learning curve as someone who is very used to living and let live, and do the same to me to have so many opinions thrown my way now that I’m a mom. It’s as if everyone now gets a say about my body and baby. When I was first pregnant I was googling to find random information on the growth rate, further information on tests I was doing, etc. mainly due to curiosity. I happened on this website and I am quite thankful. I may not feel as strongly about certain things, had a good experience at a baby-friendly hospital and so forth, but it was a breath of fresh air finding this site. Most were very woo-focused and quite forceful in that. A lot of people like to tone-police Dr. Amy, but if you don’t subscribe to a lot of those philosophies the niceties/”mama” togetherness is dropped and it is pretty belittling at its best, and misleading at its worst. So just wanted to say I still check up here and thanks for this site.

    • SporkParade

      “It’s as if everyone now gets a say about my body and baby.” This was, hands-down, the worst part of becoming a mom for me. Women’s bodies are public property, and “natural” parenting is just the latest manifestation of this. That’s why I love this site.

  • Amy Tuteur, MD

    I confess I was rather startled by Dr. Bobby Ghaheri’s insinuation, without any evidence, that I am being paid off for pointing out that the benefits of breastfeeding in first world countries is trivial.

    Then it occurred to me that the problem isn’t my income, but his income. By his own omission, 90% of his practice is breastfeeding issues. That’s a lot of money for appointments and a lot of money for procedures.

    When I pointed out to Dr. Ghaheri on Twitter that most studies find little evidence that surgery for tongue-tie is effective and most professional societies (including the American Academy of Pediatrics, the American Academy of Family Practice) don’t recommend it, he insisted that they “don’t get it” and noted that the American Academy of Tongue-tie Professionals does endorse surgery.

    Perhaps Dr. Ghaheri assumed that what I write about breastfeeding must be about my income, because what he writes about breastfeeding is responsible for his income.

    • Megan

      And frenectomy is big business. Where I went, our “consult” consisted of us watching a video, he came in and said “any questions?,” answered questions, whisked my daughter to the laser suite for the procedure, we breastfed immediately afterwards, he came in and demonstrated aftercare briefly and we were done. We were in and out the door in about 30 minutes. As a physician, I asked him about the laser and how many he could do a day and he usually does about 4 an hour (staggering them) and charges $600 each. His laser cost over $100k but that wouldn’t take too long to make back. I don’t doubt that the procedure is helpful for some babies but it felt like a bit of a patient mill while I was there. Lots of other babies getting it done.

      • Cobalt

        Well, if $250 of each procedure goes towards paying off the laser, and he does 4 per hour, 5 hours a day, that’s $1000 per hour, $5000 per day, and the laser is paid off in less than a month.

        Even if only $50 per procedure goes towards paying it off, you’re still looking at only 6 months (less with interest free financing) before it’s paid off. Still only doing procedures 5 hours a day, too.

        I’m in the wrong business.

        • Megan

          I know…I picked the wrong specialty! If only Medicaid paid that well…

    • The Bofa on the Sofa

      Before you posted this, I was going to comment that it has been odd how, despite having the parachuters come in to defend the practice, no one has actually addressed the content of the post, which talked about how there’s no evidence for the effectiveness. No one has talked about limitations of the study, for example. All we get are comments about how the “evidence is everywhere” and personal anecdotes, descending to the depth of it being a cure for things for which it is anatomically impossible to solve. As I hinted earlier, it’s descended basically to the level of chiropractors,*** accupuncturists or other snake oil salesman. But this “Society of Tongue-Tie Professionals” crack seals it – this is a bunch of crap, going beyond the lunacy of chiros and accupuncture, and basically dropping to the level of the Big Foot and Flat Earth Societies and the Association of Paranormal Investigators.

      We’re talking Ear Candling, Cupping and homeopathy here. Complete quackery.

      ***Before anyone says, “But not all chiros are bad” I will just say one thing: Bofa’s Law.

      • Cobalt

        Have they ever actually addressed the concerns or calls for evidence in the post instead of jumping straight to defense of the practice on grounds that boil down to “because I said so”?

        • The Bofa on the Sofa

          “The evidence is everywhere”

          • Roadstergal

            “I believe you’ll find that I said so.”

          • The Bofa on the Sofa

            Now we have, “The studies haven’t been good enough to show the benefits. My personal experience…”

            Which puts them right in the same realm as “vaccines cause autism.”

            It’s the Jay Gordon approach.

    • Sue

      As I said on twitter, his website says he practises “Breastfeeding Medicine”. Nope – he’s an ENT surgeon with 2 daughters who apparently had feeding difficulties, and he’s done a lay course.

      Give the man a knife, he cuts.

      • Cobalt

        I thought only OBs were cut happy scalpel junkies out to crank out as many incisions as possible.

        I wonder if Dr. Ghaheri plays golf.

        • Bugsy

          Good point. I personally wonder what percentage of tongue tie activists are anti-circumcision…

      • Annie Schimpff VerSteeg Ibclc

        He uses a laser

        • The Bofa on the Sofa

          Is it mounted on a shark?

          “All I ask for are sharks with friggin lasers on their heads!” – Dr Evil

          (“I didn’t go to 8 years of Evil Medical School to be called ‘Mister'”)

          • moto_librarian

            I just snorted.

          • Kq

            Thanks, I almost choked to death just now…

    • Bugsy

      Hmm, what percentage of lactation consultants are male? I’m no prude, but I would feel uncomfortable having a male lactation consultant…even more so than having a male OB/GYN. Go figure.

      • KeeperOfTheBooks

        While you should, of course, use a provider you feel comfortable with, you might be surprised. I felt deeply uncomfortable with even the idea of a male OB/GYN, but went to one to get my initial tests/ultrasound done before transferring to a CNM practice, as they couldn’t fit me in for several months. I liked the guy so much at that first visit that I stuck with him, which believe me was a massive surprise to someone with serious trust issues when it comes to men.
        Oddly enough, when he retires, though, I will probably go with a female doctor, unless he refers me to a male doctor who I like as much. As for a male LC…that makes me cringe a bit. I know intellectually that for a professional nurse, say, it wouldn’t be a turn-on, but somehow I can’t wrap my head around being okay with it. Perhaps it’s more me than them; I’m not sure.

        • Bugsy

          That’s what’s interesting to me – I’d actually have no problem having a male OB/GYN (even though I do have a slight preference for a female). One of the docs I saw at my practice with my first son was a guy, and I was actually hoping he was the doc on duty…he was great!

          It’s more the idea of the male LC that troubles me…given that he likely has no and never will have first-hand experience with breastfeeding, nor with boobs physically attached to his own body. I didn’t state it complete well in my first post…darn pregnancy brain.

          • Gene

            I hate things like this. It’s like saying a man can’t be a good OB because he doesn’t have a uterus, a woman can’t be a urologist because she doesn’t have a penis (though urologists do more than just penises, obviously), and someone without kids can’t be a good pediatrician.

          • Medwife

            Yes. I was a midwife before I was ever pregnant, and while I’m sure it has impacted aspects of my bedside manner, it didn’t alter my professional skills.

          • Bugsy

            That’s not what I’m saying at all. From an emotional and personal standpoint, I am uncomfortable with the idea of having a male lactation consultant. There certainly could be some; I just have no experience with them and would prefer mine to be female.

            That being said, as I stated, I’ve had great experiences with male OB/GYNs. I don’t care if my docs are male or female as long as they’re competent, and whether a paediatrician is a parent is irrelevant to whether I hire him/her for her medical decisions.

            The entire point of my post was that I haven’t personally met any male lactation consultants and would be uncomfortable with males advising me on the subject of breastfeeding. I suspect there are quite a few other moms out there who would feel the same way. If this seems sexist, c’est la vie.

          • Hannah

            I feel the same way. I also wanted a female OBGYN. I was non-negotiable about it. I don’t go to male doctors if I can avoid it because I feel uncomfortable talking to them about female issues. It’s not about being sexist, it’s a personal preference, for a variety of emotional reasons.

            Our pediatrician is male, and I like him, but my preference was a pediatrician who has children and he does. It wasn’t about professional skills for me, it was about bedside manner and to have someone who I have personal common ground with.

          • KeeperOfTheBooks

            It’s weird. On the one hand, I get that men can be very good OB/GYNs without giving birth or having periods, and I can accept on an intellectual level the idea of a professional male nurse who had extensive training in breastfeeding helping a mom learn how to nurse, but I’m still okay with the former and squicked out emotionally at the latter. Perhaps because lactation isn’t a life-or-death thing in the first world, it’s a more relaxed setting than giving birth, it’s less urgent, even if it feels so urgent at the time…? I wonder if because even if not meant that way at all by the practitioner, it might smack of paternalism–being told by a man to nurse my baby, and not just that but HOW to?
            Weird, like I said. *shrugs*
            One thing I will say: female lactivists are quite awful enough. Having a man come into my hospital room to grab my breasts without permission, imply that only bad moms formula feed or need a rest, and so on…? Oh my gosh. Can you imagine how triggering that would be for women who’ve had bad experiences with men in the past?

          • Bugsy

            Completely agree!

    • American Academy of Tongue-tie Professionals

      There actually is such an organization???? Tell me this is a joke.

      • Ash

        I googled. it appears to be a real group.

        • Does it admit Tongue-TieD Professionals?

          Just think of the membership I could recruit if I started an American Academy of Left-handed Redheaded Professionals! Oh wait, I think that something similar appears in a Sherlock Holmes story [The Red-Headed League]

          Thank heaven the NFL season begins next week. I’m going crazy [or crazier]

        • The Bofa on the Sofa

          “real group” means nothing. There is a society of accupuncturists, chiropractors and homeopaths. Doesn’t make any of them anything other than the crap they are.

          As I noted yesterday, there is a real Big Foot Society, Flat Earth Society, and the Association of Paranormal Investigators.

          • Cobalt

            The manure pile behind our barn is real, too.

  • nomofear

    I’d just like to ask the people who have had breastfeeding issues if anyone ever referred them/their children to occupational therapy. My first daughter would take an hour and a half to eat, and then want to eat again an hour later, and my nips never healed, but she was gaining weight like a champ, and her latch looked fine, so every consultant I desperately asked – and paid – shrugged and said eh, here’s some salve? Finally, at eight weeks, I met with a different one to talk about pumping – I’d given up on my bloody nips – but the moment she saw them, she freaked. “At eight weeks they look like that? Something’s not right!” I cried tears of relief, she checked for my daughter’s chew reflex, found it practically nonexistent, said there’s the problem, here’s a referral to a children’s occupational therapist. We went once, got some exercises, did them a few times a day for a couple weeks, and everything resolved.

    So, I wonder how many of these poor babies are victims of general lack of knowledge in the lac industry. Perhaps also in pediatrics, since it seems like it’d be nice if mouth reflexes were checked as a standard practice.

    • Taysha

      I wonder how many mothers don’t ask their pediatricians and choose to ask lactation consultants under the banner of “peds don’t know” or “peds don’t specialize in breastfeeding” that is usually flown high by the lactivists

      • nomofear

        Oh yeah, our current group has a lac consultant on staff, so they tend to defer to her. Luckily I haven’t had any issues with my second baby, though I did get her ped to refer to a feeding specialist (not a lac consultant), because she won’t take any artificial nipple and I wanted to be sure she didn’t have some kind of issue like big sis did. Bonus, the ped didn’t even try to get me to bring baby to the lac consultant first, either. (The lac consultant is an Ina May fan, so I try to avoid her.)

      • yentavegan

        You have hit the nail on the head. I can not tell you how many times I am in discussion with IBCLC’s and LC’s crowd sourcing maladies in either the baby or the mother that is outside our scope! I remind my co-lactavists to have the mother in question call the doctor..but then I get a chorus of “doctor’s don”t know.”

    • Young CC Prof

      My son had some sort of problem with his nursing related reflexes that was pretty obvious, but no one said anything about it. Most babies turn and latch when something brushes their cheek, mine shook his head vigorously from side to side, which made it almost impossible to get him latched. The hospital LC seemed to think that she’d won by getting him to lick a drop of colostrum one time, she then disappeared in a cloud of excessive perfume.

      We eventually handled it by bottle feeding, but I do wonder if there was another solution.

      • nomofear

        Cloud of excessive perfume! 🙂

        I just try to get this question out into the ether. After we found out that these simple exercises were also likely to have prevented speech impediments and eating issues in my older daughter, I started wondering if this was a bigger problem than we realize.

        • fiftyfifty1

          ” After we found out that these simple exercises were also likely to have prevented speech impediments and eating issues in my older daughter,”

          Or not. We have no science to back any of this up. No idea of what a newborns “chew reflex” should look like or proof that OT exercises can create a reflex where there wasn’t one before. The very definition or a reflex is something that isn’t taught/learned. And we have no proof that any of this matters in the long run.

          My opinion is a lot of this stuff is just developmental. A lot of newborns are neurologically very clumsy and discoordinated, and what fixes it nothing more than time.

          • Megan

            I agree with you. I think the problem is that women are scared to supplement while waiting for these issues to work out because they are told that supplementing is evil, will ruin your supply, your baby’s microbiome and that EBF is the holy grail of good motherhood. I also think some of what we call reflux and colic is developmental too, (which doesn’t make dealing with it any easier, I understand.) Not that real breastfeeding problems and GI issues don’t exist, but that for a lot of them, the pressure to breastfeed and just the difficulty of getting through the first three months makes people feel this urgency to “just do something.”

          • Bugsy

            Nicely stated.

          • KeeperOfTheBooks

            And throw in “never getting a freaking break.” If your kid is colicky and you’re supposed to comfort by offering the breast, you can’t really get a break from the screaming. Which no doubt stresses most moms out, and babies do pick up on stress. Not that I’m suggesting for a second that mom’s stress is responsible for a colicky baby, but that it can contribute to more crying because “mom’s angry and stressed and tearful and I don’t understand anything except that means I should be scared and unsettled, too.”

          • Cobalt

            I have unfortunately extensive experience with colicky babies. Anything that hampers the primary caregiver(s) ability to take a break is senselessly cruel at best, and possibly very dangerous.

            Incessant screaming can do serious psychological damage to the helpless listener, especially if they are supposed to “fix” it, and their infant is at stake. It is torturous for many. That pressure should not be discounted, minimized, or lied about.

          • KeeperOfTheBooks

            Yep. I have no idea if DD was colicky, or just a fussy baby, or if I was doing something wrong, or if I just wasn’t used to babies as a first-time mom, but she certainly seemed to scream a LOT compared to any newborn I saw before or since, and oftentimes nothing would comfort her. I was home alone with her all day, no family or friends in the area, and I remember several times sitting on the floor near her and scream/sobbing myself “leave me alone! Just leave me alone for an hour! Please!” I felt like I couldn’t take it another minute.
            Not one of my finer parenting moments, but thank God I never did snap.

          • Cobalt

            It’s serious. Parents are human. Humans have limits. I’m not excusing abuse (taking the frustration out on the baby is unacceptable, period). I am absolutely advocating for better understanding, support, and respite care for parents who have infants that are overwhelming.

          • Taysha

            I read some time ago that people were proposing colic to be related to infant migraines (in which case I totes understand). I don’t know if it was looked at in depth though.

    • Cobalt

      My last baby had an adequate but not great latch at birth. The hospital LC watched a few latches and diagnosed him with what boiled down to “not intrinsically motivated to open his mouth wide enough”. She recommended touching his lips and chin to trigger him to open his mouth but not giving him the nipple until he was opened wide (and to flare his top lip out once latched if he didn’t do it himself). We were repeat the exercise as often as we reasonably could to strengthen his muscles and response and see how it went.

      He was latching like a champ with no assistance whatsoever a week later. Five minute consult, no surgery, instructions to call if any trouble (there was none). We’ve passed the year mark and are still breastfeeding just fine.

    • Kelly

      Yay for OTs! I may be a bit biased as my husband is one but I am glad that it was so simple. It makes me wonder if my second daughter could have been helped in that way. (He does not work with peds at all. It was his least favorite subject in school.)

  • SL27

    Our pediatrician diagnosed my daughter with tongue tie on the day she was born, but told us we could wait on the procedure to see if it actually affected her in any way. She nursed great, and at 2 is a very talkative toddler with no apparent speech impediment because of it. So no procedure for us. This is how it is supposed to be, only recommending procedures if they will actually do something. And yeah, it sounds like lactivists are just trying to blame something other than breasts.

    • Annie Schimpff VerSteeg Ibclc

      I am a Lactation Consultant not a lactivist.

      • Zornorph

        There’s a difference?

        • Karen in SC

          Zorn, your son is so cute!

      • SL27

        I wasn’t referring to you specifically. But the definition of a lactivist is someone who promotes breast feeding over formula feeding, so you most likely are one.

        Also, the lactation consultant at the hospital did tell us to fix the tongue tie anyway, going against the pediatrician’s recommendation. I’m glad we listened to him.

        • Annie Schimpff VerSteeg Ibclc

          I am not a lactivist.
          I will be the first to break out the formula.

  • Elisabetta Aurora

    Aren’t midwives able to perform the procedure? I am originally from Oregon and I remember a mom telling me that her midwife did it. If so, that would explain why lactivists are pushing it.

    • Maya Manship

      Umm, I think that procedure qualifies as surgery. Wouldn’t a midwife performing surgery come under practicing medicine without a license?

      • Ash

        https://www.youtube.com/watch?v=OEWyaVUL-co

        Here’s a UK midwife doing it.

        • toni

          ooh that made me wince. I can’t believe a frenulum has no nerve endings.. I cut mine on a potato chip once and it hurt! Is a circ really that much worse?

          • Wren

            I can only speak anecdotally, but my son’s did not appear to be very sensitive and when it snapped (we know exactly when) he didn’t cry or anything. Perhaps it depends on the tie?

          • Megan

            You should see the video from our surgeon for the aftercare. The baby’s screaming has conveniently been muted out.

          • SporkParade

            Circ is probably better because you can use topical anesthetics.

        • Daleth

          That’s the UK, where many midwives are employed by the NHS, all of them are real midwives (equivalent to a US CNM), and they may well have the legal ability to do simple procedures like this that they wouldn’t likely have in the US.

          • Wren

            I haven’t researched it for tiny babies, but I know on older kids midwives cannot do it in the UK. It’s a hospital event then.

        • Sue

          What a happy, healthy-looking ten-weeker! The MW says “I’m surprised you managed to feed so well!”…but cuts it anyway. Why? Because she can? Same as Ghaheri, but likely at a fraction of the cost!

        • Maya Manship

          I should have been more specific. I didn’t mean the real ones like the CNMs here in the States or the ones in England…or the rest of the world. I was talking about all the pretend ones that made up their credentials. Totally my bad.

    • Life Tip

      Oh god. Please tell me CPM or random birth junkie/direct entry midwives are performing this procedure on tiny babies in the U. S. That would be horrifying.

      • PrimaryCareDoc

        I’m pretty sure they are.

      • Cobalt

        I’ve read about a CPM that keeps one of her pinky finger nails long and sharp to “sweep” the baby’s mouth with at every birth. Her clients don’t have breastfeeding problems.

        Not sane.

        • Young CC Prof

          Paging Dr. Bear?

          • demodocus

            I have to giggle; we recently gave our boy a stuffed elephant he promptly named Dr. Bear.

          • Monkey Professor for a Head

            Dara O’Briain reference? I approve!

        • Megan

          I’ve read this too and just don’t understand how you could ever get your fingernail sharp enough. I couldn’t even keep my daughters already open frenotomy site from reattaching with my fingernails. I wonder if this story is really true.

          • Cobalt

            The midwife may be lying about her practice. Considering the content and purpose of the lie, it doesn’t say anything good about CPMs.

        • Who?

          That’s assault, probably aggravated. Horrible.

        • KeeperOfTheBooks

          If you’ll excuse me, I’m going to vomit now.

        • Roadstergal

          I didn’t know Wolverine moonlighted as a midwife.

    • Bombshellrisa
  • MichelleJo

    I’d only ever heard of tongue tie being used to describe shyness or stage fright, until a couple of years ago, when every day there seemed to be another baby diagnosed and ‘treated’ for it. Strangely, they all seemed to be patients of the same Doctor, an MD turned ‘holistic’. I have always kept miles away from him but of course didn’t voice an opinion. I kept quiet as others waxed lyrical about him. After all, what could be wrong with a medically trained doctor incorporating ‘other forms of medicine’? Sorry, don’t trust these guys, and now he’s proven himself. Mutilating babies wholesale, without anaesthetic. Arrests please. But his patients will never have it.

  • Trixie

    Bobby Ghaheri has a nice little business slicing and dicing his way through the baby tongues of Oregon. No wonder he feels threatened by you.

  • I

    Yippee! You breast-fed your infants! That makes you an expert on all the breastfeeding related. NOT!
    What you really should be focusing on is the unnecessary and harmful c-section rate. That right there is the biggest disgrace of all when it comes to the mother baby dyad. I can only imagine how many needless c-sections you did in your career…. Every one of which I’m sure you find someway to foolishly justify.

    • Taysha

      Mine was totes justified. I like being alive.

      The living crotch trophies are a bonus.

      • Charybdis

        I loved my CS. Best way to have a baby in my opinion. Mine was scheduled and it was wonderful. I wasn’t worn out after hours of labor and pushing. I can’t imagine that scenario; being exhausted and possibly sleep deprived, THEN having the CS. But what do I know..CS and formula feeder here.

        • Cartman36

          I like to say I gave birth the way God intended…strapped to a gurney, numb from the breastbone down. 🙂

          • KeeperOfTheBooks

            Shades of Blanche Devereaux? “I had my babies the way God intended, honey: numb from the neck down.”

          • Cartman36

            Exactly! Daphne in Frazier said something similar

    • Wren

      How do you define a needless C-section?

      • mythsayer

        It’s impossible to define of course 🙂 in my opinion, every CS is necessary.

        I asked for mine because I was terrified of labor. As in, pure terror. Panic attacks at the thought of it. I was terrified of having an epi that didn’t work and of tearing. ESPECIALLY of tearing. I was beyond relieved when I asked for a CS and my doctor said yes (apparently he wanted me to have one but didn’t know how to broach the subject with me…he was Japanese and I japan if he assays CS, Japanese women say okay…but the Americans get all mean and argue…so he was scared to bring it up).

        So in my case, my doctor had medical reasons for wanting me to have a CS, but my reasons were mental. And I think that’s just as valid. Heck, it’s no less valid than the women who want to stay home to be “comfortable.” That’s what makes me mad…apparently they have a right to take risks with thei baby for their comfort, but I don’t, even though my comfort means having a CS. Maybe I should write an article on that point….. The hypocrisy is mind blowing.

        • Wren

          I’m pretty sure that the only way to determine a “medically necessary” C-section is if the baby comes out dead or seriously disabled. If it works to prevent those, then clearly the baby is fine and it wasn’t needed, right?
          I have no problem with maternal request C-sections, but I’m guessing those are always “needless” according to this type.

          • mythsayer

            That’s what they argue, yeah. If baby is fine after CS, they claim it was unnecessary.

            And yeah they have issues with requested ones. But like I said, if they have the right to risk home birth solely for comfort, they can hardly argue that my request is unreasonable, right? Because it was made for my comfort! I’m going to start throwing this back in their faces when they bring it up.

          • The Bofa on the Sofa

            That’s what they argue, yeah. If baby is fine after CS, they claim it was unnecessary.

            It’s bullshit, of course, but yes, that’s what they claim.

            You CANNOT know that the baby would have been fine without the c-section. Not “don’t know” but CANNOT.

          • Sarah

            It’s funny how uninteresting some things become in a c-section. My second c-section was planned as a precautionary measure. I was actually really bummed about it, because I was trying hard to be “crunchy” (I have since reformed). But I happened to glance at my discharge papers to see that the cord had wrapped around his neck. No one mentioned it to me after the fact. I might have even missed it on the paperwork if I had read too quickly before signing.

            I’m not saying it would have been impossible for me to deliver him safely. I know that depends on several issues. Just the fact that it was such a nonissue because of the c-section, and there was no way we could have known had we attempted a VBAC.

          • The Bofa on the Sofa

            Exactly. If you take precautions to prevent an emergency, just because everything goes without a hitch doesn’t mean it wouldn’t have been an emergency if you hadn’t taken the precaution.

      • Young CC Prof

        One performed on someone who is not pregnant.

        • Taysha

          ^^ for the win. Right there.

        • Sarah

          “I’m sorry. It appears that you just ate at Taco Bell.”

          • Roadstergal

            A happily childless friend of mine sent me a picture of a Standard Smiling Woman getting an ultrasound from a Standard Smiling Tech, with a big hurking burrito showing on the screen.

        • araikwao

          Oh, I have a story about that..

    • momofone

      C-section was the best thing that could’ve happened for this mother-baby dyad. As in, because of it, my son was, you know, alive to nurse.

      • Roadstergal

        I’m no certified LC, so I’m just guessing, but I bet they latch so much better when they’re alive!
        Also, too – the chances of bits of retained placenta are way way lower with a C-section, so every lactivist should demand a C-section in order to maximize her chances of successfully breastfeeding. :p

    • moto_librarian

      Please show us the peer-reviewed literature that demonstrates that we have an “unnecessary and harmful” c-section rate.

    • yentavegan

      Please ….take the time to actually read up on this issue. I would have both my c/sec’s again . I have living breathing healthy children and a really cool scar.

      • Sarah

        I’m glad that I was able to give birth to two healthy children. Heck, I’m just glad I got to live after the first one was born. Medical interventions like accurate testing for pre eclampsia and c-section saved me complications from seizures and worse.

        I love participating in these boards, but the ableism coming from so many of the dissenters is starting to wreck my hope for humanity.

        • yentavegan

          Healthy is a relative term. They are healthy even though they are classified by the school district and have certain quirks that others label as challenges..

    • Trixie

      Actually she’s written that her primary cesarean rate was 12%. But, nice try.

    • Fool on the Hill

      I loved all three of my c sections. The first was for breech presentation, the second two by my choice. I chose a csection for the breech and not to VBAC because I will always choose to assume the greater risk for myself rather than shunting it off on my child who has no say. The second reason why I choose not to VBAC was because my first child is profoundly disabled due to a genetic condition. I see how she suffers every day of her life because of it. Already having a child with a disability made me completely unable to take any risk that my subsequent children would have any preventable disabilities. The biggest disgrace in this country is not the c section rate; it is the epidemic of selfish mothers who put their innocent, helpless, children at risk in order to satisfy their bizarre need to bolster their self esteem by pushing a baby out of their vaginas. HBAC, high risk VBAC, VBAC after many c sections and home birthers I’m looking at you. Birth is but a moment. DIsabilities are for a lifetime. NO amount of rare is rare enough if your child is the one suffering the complications. Lastly, I am so endlessly glad I choose a c section for my first born because now I don’t have to be haunted by the question of whether or not my birth preferences made her condition worse. All of these women bitching and moaning about their less than ideal birth experiences disgust me and make me sick. Talk about a lack of perspective. Talk about first world problems. Here’s my suggestion. Get your heads out of your self absorbed asses and be grateful that you live in a time and place that can prevent most deaths and disabilities during or as a consequence of birth. C sections are harmful? No, birth choices made to satisfy a woman’s vanity is harmful. Revolting. Absolutely utterly revolting selfishness.

    • samantha

      I loved my C-Section. Very low key and relaxed, I was pretty much back to normal one week after surgery. Popped baby on boob right after she was out of by body and went on to EBF for three months until I went back to work, then a combo pump/nurse for another 16 months. I luckily worked in a private office so i could pump during the day while still working. If we ever decide to have another, I’ll be doing another C-Section.

      • mythsayer

        Right? They are awesome! They way I figure it, ripping down there would have hurt like a mo fo for weeks, especially when going to the bathroom. No thank you. I’d rather deal with surgery recovery. I’ve had 6 surgeries in my life, four of them abdominal, so I knew what I was doing. I had gastric bypass. Having a CS couldn’t be much worse than having my stomach rearranged, I figured. And yes, it did hurt quite a bit for the first five days…more than I was expecting. But it was fine overall and is always planned on having a tummy tuck after I had my baby, so didn’t care about the scar. And now I have a TT scar, a super flat tummy with no extra skin (from my weight loss), and a perfect nether region. Fine by me 🙂

        • samantha

          That and we were *ahem* back in the saddle after three weeks due to no damage down below.

          • swbarnes2

            Umm, I think that’s generally not recommended, because your uterus is still healing from where the placenta detached.

          • Medwife

            Very individual. If bleeding has stopped and both people are in the mood (and somehow have the energy for it), no real reason not to. But CONDOMS PLEASE.

      • LibrarianSarah

        I don’t remember my c-section but I hear that is pretty normal. My mom says I came out crying and kicking my legs like a champ though.

    • mythsayer

      YOU are now discussing things you know nothing about.

      I ASKED for my CS, and it was my right to do so. Know why? My body, my right. Sound familiar? You probably use that same statement when justifying the horrifying death and injury rates during home births. The fact that you could possibly support something so obviously dangerous while decrying CS’s, which absolutely SAVE LIVES, is hilarious.

      Some of us don’t want to experience labor. Some of us don’t want to have our nether regions ripped to shreds.

      I LOVED my CS. Best thing ever. And my doctor said yes to my request but no to every other person who asked for one…I found it later I had quite a few good reasons for having a CS. It just so happened that my request and my doctor’s opinion were on the same page.

      Oh…and it was in japan. With a Japanese doctor. Who gets paid the same amount for most births…a fraction of what they are paid here. Lower CS rate overall. So you can’t claim he did it for money. He did it because he thought it was best for me. So shut up. Seriously. Shut.up.

    • Sarah

      I think you’ll find most of us on this blog are very, very pro MRCS. If you’re going to hang around here and whine about section rates, prepare to get your arse handed to you.

    • Fallow

      You going to reply to a single one of these comments you got, or are you one of those drive-by commenters who shits rage, and then runs away so they don’t have to hear how bad it smells?

    • Cartman36

      Has it occurred to you that women and their doctors opt for a c-section because it is what is best for them and their baby and that the national or world C-section rate is IRRELEVANT to an individual woman’s care? I had a c-section because I was not going to allow my unborn child to continue to suffer heart decels. I don’t care what the c-section rate is for my doctor, my hospital or the state I gave birth in because ALL THAT MATTERS is my son was born healthy.

      You are not going to find support here for bashing c-sections.

    • Dr Kitty

      Boo!

      I had two elective CS at 39weeks. Totally “unnecessary” by your metric, but very much wanted. Never laboured for a second.
      Breast fed kiddo #1 until she was over a year. That child never had a single bottle of formula.
      Kiddo #2 is only 9 days old, but so far, breastfeeding happily.

      I got my dream birth experiences, easy recoveries, happy, thriving babies and straightforward breastfeeding.

      I didn’t have to risk:
      my pelvic floor and continence
      my future sexual pleasure
      uterine rupture
      hypoxic ischaemic encephalopathy
      Shoulder dystocia
      Cord prolapse
      Meconium aspiration
      GBS infection
      Or any of the other fun complications of vaginal childbirth.

      I got all the fun of babies, without hours of painful labour, the way I see it, I win!
      No regrets here.

    • Jenny_from_da_Bloc

      Some women prefer a c-section over vaginal births. Ever c-section performed is warranted for one reason or another. Foolish in your opinion, but the holy grail vaginal birth is not appropriate for every woman and baby. I had 2 elective c-sections and not one problems after either birth. There is no optimal c-section rate and there shouldn’t be one either. C-sections are not harmful and are not unnecessary and claiming otherwise is what causes harm to women who need or want a cesarean.

      • Roadstergal

        And it harms the babies who need a C-Section, when their mums have been scared into refusing them by the propaganda.

  • yentavegan

    I have been assisting mothers as a volunteer peer counselor since 1988. For the first 15 years or so no mother ever had a “tongue -tied” infant that was somehow missed by the pediatrician. Infants who are tongue tied can and do breastfeed and all things being equal can latch effectively. Some mothers put up with chewed up bleeding stumps of nipples until the baby’s mouth grows, stretches and the latch self corrects. Other mothers say the pain is not worth it and fix the problem by transitioning to bottles. In all my years I have never recommended fixing/clipping a tongue tie to correct a latch issue.

    • Annie Schimpff VerSteeg Ibclc

      Nobody is calling you out for using the term mother?

      • Wren

        Why would anyone be called out for using mother?

        • SporkParade

          Our LC friend is feeling put out the rather large number of commenters on this site who find the use of the term “mama” by people other than their own children to be infantilizing and degrading.

          • Wren

            I did get that part, but no one ever complained about the use of mother.

          • SporkParade

            She thinks she’s being ironic.

          • Life Tip

            Or obtuse.

      • yentavegan

        I am a mother to mother volunteer. That is the scope of my expertise.

  • Zornorph

    All those lactivists who want you to get a tongue snip would be horrified if you circumcised your son. Because, you evil person, you mutilated your baby after God made him perfect!

    • ladyloki

      I never thought about this, but you are 100% right! Nice catch, I think this needs to be the featured comment.

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    • Annie Schimpff VerSteeg Ibclc

      Why did you circumcise?
      Was it medically necessary?
      Was it for cosmetic reasons?
      Did you ask your baby how he felt about it?

      • Megan

        Why did you do frenotomy?
        Was it medically necessary?
        Was it for selfish reasons? (I ask this because looking back on my fierce desire to breastfeed despite signs pointing to it not working, I realized it was more about me than my baby’s needs.)
        Did you ask the baby how he/she felt about it?

        Below, I and someone else detailed for you the benefits of circumcision. I do not believe it should be routine but the benefits are enough that it should be a choice for the parents. Can you provide us with a literature review showing the clinical improvements experienced by babies after frentotomy and what the benefits of it are, in particular the lasting benefits, (not just “we fed better immediately afterwards”)? I don’t understand how you can argue for frenotomy but against circumcision. It makes no sense. Formula is a perfectly healthy way to feed a baby and the best science on breastfeeding shows the benefits to be small in developed countries with clean water. Can you actually address these questions with citations to back you up?

        • Cobalt

          “I do not believe it should be routine but the benefits are enough that it should be a choice for the parents.”

          That’s exactly it. For the majority of babies that have the procedure, the benefits are underwhelming or strictly for the parents. The benefits, however limited in first world countries, do exist, though, and so it should be a protected choice. Just like breastfeeding.

          A little integrity in the answer to “Do marginal health benefits justify access to very low risk surgery?” would be nice.

        • Annie Schimpff VerSteeg Ibclc

          Feed the baby,
          You will never see a baby under my care feel the pain of hunger. EVER.

      • Roadstergal

        Funny, I’ve been dying for you to give me the answers to the first two when it comes to tongue ties. For all of your commenting, I still don’t know how you diagnose them. That should be a simple comment, surely?

      • Zornorph

        Genesis 17:11
        No
        No
        Yes; he said ‘ah’.

        • Annie Schimpff VerSteeg Ibclc

          Religion is different than cosmetic.
          Are we still stoning women who take a job?

          • Zornorph

            Well, I’m beginning to suspect you’re stoned, all right.

          • Annie Schimpff VerSteeg Ibclc

            Not stoned…. Not drunk. Just thinking about Leviticus.

          • Zornorph

            I prefer to think about The Song of Songs.

      • moto_librarian

        Why did the LC recommend that we have our baby’s tongue clipped, given that she knew I had probable IGT?
        Given that my pediatrician disagreed with her diagnosis of the severity, was it really medically necessary?
        How did my son feel about it?

        See, we can play this game all day.

      • Taysha

        I didn’t. I’m not a doctor.
        HIPAA
        HIPAA
        It’d be akin to asking my cat her deep thoughts on Nietzsche.

        • Zornorph

          Just don’t as your cat her deep thoughts on Schrödinger; she might just die.

          • An Actual Attorney

            My cat stopped at Newtonian physics for just this reason.

      • Gene

        1. I don’t anymore (no longer part of my practice), but previously did when parents requested it.
        2. Some were
        3. Some were
        4. No, much like I don’t ask the baby how he or she feels about getting a shot, an IV, a catherterizec urine sample, a lumbar puncture, a dislocation reduction, suturing, or any other procedures on my long list of things that will cause a baby pain.

  • Annie Schimpff VerSteeg Ibclc

    I’m so happy to hear you are retired. I think it’s interesting that as OG/GYN you consider yourself an expert in breastfeeding. Do you have this same attitude towards Piediatric Cardiologists too? Neonatologists? Do you argue with them about how they practice their skills?
    Everyday I’m IN the trenches with mamas and babies who’s lives are changed by a frenotomy. A simple 45 second procedure and mom and baby are able to meet their goals. Isn’t that empowering? Isn’t that what we are supposed to do, help each other?
    Please, you seem a part of the ‘old boys club’ not a modern day feminist. So sad.
    Annie VerSteeg IBCLC

    • Taysha

      Have you had your frenulum snipped?
      It’s UNHOLY PAIN FOR DAYS

      But you go on with yourself. Only boobing matters, right?

      • Annie Schimpff VerSteeg Ibclc

        No, I’m not saying only Breastfeeding matters. I’m saying, if it is a goal, we need to help!

        • Taysha

          I’m saying newborns don’t have goals except for pooping and eating.
          Support breastfeeding by performing surgery on children. Great. If breast milk is what matters, why not pump and feed instead of hurting children?
          and you said “Please, you seem a part of the ‘old boys club’ not a modern day feminist. So sad.”
          NOTHING about supporting breastfeeding.

          Go snip your frenulum (harmless according to you) and get back to us when you can talk again.

          • Daleth

            If breast milk is what matters, why not pump and feed instead of hurting children?

            EXACTLY.

          • Annie Schimpff VerSteeg Ibclc

            I’ll totally help a mommy do that too.

          • momofone

            Are you just constitutionally incapable of referring to grown women as grown women?

          • Annie Schimpff VerSteeg Ibclc

            Grown women. When grown women give birth, they become mothers also known as moms, mommies, mamas.
            The best day in my life was when I went from Ms to mama!
            Soon, I’ll be grandma and I will be equally proud of that label too.

          • NoLongerCrunching

            Would you like your doctor to call you grandma?

          • Annie Schimpff VerSteeg Ibclc

            AGAIN, I do not call my clients ‘Mama’ I call them by their given names. A woman who has given birth is a mother.

          • Taysha

            a MOTHER. Not a mama, a mommy or whatever dismissive, infantile term you want to use.
            And they are women above all.

          • PrimaryCareDoc

            You’ve called then “mamas” here several times. It’s demeaning. It’s infantilizing. It doesn’t matter that you’re not doing it to their face.

          • PrimaryCareDoc

            Please. Should I start calling my female patients who have had babies, “mama?” Of course not.

          • Wren

            You still have kids, even if they are grown. I guess we should all refer to you as Mama from now on.
            It could get a little confusing if we are all “Mama”, “Mummy” or “Mommy”, but as that is our primary identity rather than just a part of our identity, we should indeed all be referred to in that way.

          • The Bofa on the Sofa

            Grown women. When grown women give birth, they become mothers also known as moms, mommies, mamas.

            When my older son was young, he called his mom “Baba”. We’ll still refer to her as Baba on occasion, or maybe “BabaLoo”

            So can I start referring to mothers as “BabaLoos”?

          • Annie Schimpff VerSteeg Ibclc

            I suppose if you want to, but the proper term is mother.

          • Eater of Worlds

            Congrats, you finally stopped using mama and accepted the right term, not the infantilizing one.

          • Medwife

            That’s funny, in Hindi and Swahili “baba” means “father”.

          • Amazed

            Here and in Russia, “baba” means “grandmother”.

          • Wren

            How about a mother?

          • Annie Schimpff VerSteeg Ibclc

            I’ll help a mother do that too. Or a woman or anyone of the female body.
            Sorry my vernacular was insulting to you! My grown kids call me mama!

          • Taysha

            We’re not your kids.

            Neither are your clients.
            Business 101

          • Annie Schimpff VerSteeg Ibclc

            Thanks! I never called you mama. I was referring to a certain type of woman. The ones who have given birth.
            FYI I call all of my clients by their names.
            As a definition, I use the word mama, mommy or mother, meaning they have given birth.

          • PrimaryCareDoc

            Oh my god. Please stop.

          • Taysha

            She can’t.

            I’m kinda amused by it all, she’s not answering any questions other than calling several of us angry.

          • Wren

            I have given birth. I have 2 kids in fact. I still prefer to be addressed and referred to as an adult woman, not a “mama”, “Mommy”, “mummy” or any other cutesy name for mother by anyone but my children, and occasionally my husband in the context of a family discussion with the kids present.

          • Annie Schimpff VerSteeg Ibclc

            I call my clients that I work with by their given name.
            As a whole, the population I work with are mothers, in that they have given birth.
            I work with mothers and babies. WTF is wrong with that as a description?

          • demodocus

            Those are your kids. Was it acceptable for their teachers to call you Mama, or did you prefer your actual name?

          • Annie Schimpff VerSteeg Ibclc

            I told you, I refer to women who give birth as mothers when I see them as a client I call them by their names.

          • demodocus

            actually, you told someone else. But you are still calling them mamas behind their backs. Mama may be culturally appropriate where you live, but mother is more appropriate for many other cultures for anyone but your offspring to use.

          • Daleth

            Why wouldn’t you suggest to all moms that they do that instead of subjecting their baby to a painful operation?

          • Annie Schimpff VerSteeg Ibclc

            Because it isn’t a painful operation.

          • Taysha

            I couldn’t talk for 3 days without crying after mine. you have stories in this very thread of children SCREAMING. YOU yourself used analgesics.

            Not painful. Right. Pull the other one, it has bells.

          • Daleth

            Have you tried clipping your own frenulum? Try it and get back to me on how painful it is.

            Doctors used to say circumcision didn’t hurt babies, and a few troglodytes still swear by that. Of course, it’s totally untrue and is why local anesthetic is routinely used for it these days.

          • Annie Schimpff VerSteeg Ibclc

            Inability to suck/swallow, reflux, colic, and hunger are all very physically painful. These cause a bay to suffer.
            If the mom wants to pump and feed I will support her in that too. If she wants to wean I will help with that.
            I will not let a baby suffer. EVER.

          • PrimaryCareDoc

            Except when you’re encouraging a surgical procedure on their tongue with no evidence that it provides a benefit.

          • Annie Schimpff VerSteeg Ibclc

            I’ve seen the results! It does provide a benefit. It’s a 45 second procedure. I’ve witnessed many many of them on babies from 3 days to 4 months. The proof is in how these babies are after the procedure. It’s pretty amazing.
            I was a skeptic once!

          • Taysha

            Where is your data published? I’m sure it’s a fascinating read.

          • Annie Schimpff VerSteeg Ibclc

            The data is everywhere. And your data? And your credentials? Just curious?

          • Wren

            The data is everywhere?
            Is it actually, you know, collected into an actual study?

          • moto_librarian

            If its everywhere, posting a few links shouldn’t be too difficult.

          • Taysha

            my credentials are “I can read scientific papers” and if you claim to have all this evidence, do compile it.

            I would expect at least a 90% power on a sample exceeding 200 in order to do solid stats.

          • Roadstergal

            “And your data?”

            As I mentioned above, it’s just a little ways down this thread, a nice little review article that Dr T posted. It’d be nice if you could get to those questions. I mean, a professional like you should have very firm diagnosis criteria to share with us.

          • Amy Tuteur, MD

            I really doesn’t matter what you’ve seen. It matters what the scientific evidence shows.

          • Annie Schimpff VerSteeg Ibclc

            Show me the SCIENCE that shows it does not work.

          • Taysha

            No dear. When YOU make the argument it does, the onus is on YOU to show that it, indeed, does.

            I don’t have to disprove anything. As long as you can’t prove your statements they have already been disproven for me.

          • Megan

            That’s not how it works. We don’t just do random surgical procedures that can cause pain and harm and say, “well, we’ll see if it works later.” You have to justify the procedure before you do it. Isn’t that what all you people say about “unecessareans?”
            Is it really so unreasonable that before we put our babies through a painful procedure with painful aftercare that we demand proof of lasting benefits??
            I was one of your miracle stories initially. Right after the procedure my daughter was a breastfeeding champ! But it lasted a week. We had it opened again (the doc ripped it open while she screamed in my lap) and same thing: It lasted a week before reattaching again. After that I said screw it and we started pumping and supplementing. I never went back to my LC because there was nothing else to try at that point. Isn’t it possible that you don’t ever really see the long term followup of all the patients who get it done? Is it really so hard to admit that it may not be a panacea for everyone??

          • Annie Schimpff VerSteeg Ibclc

            I do see them long term. I don’t do or recommend the painful aftercare. I make sure, long term, that breastfeeding is going well and use that as the aftercare.
            I have stated on this page, many times, I will happily help a woman EP and bottle feed or wean.
            It isn’t for everyone.
            Pain wise, how does it compare to circumcision? The most common excuse I hear for that is “I want him to look like his daddy”. It does not change cancer outcomes. It is purely cosmetic.

          • Taysha

            Pain management.
            And you have no say in anyone’s medical decisions. They are private, remember?

          • Megan

            Actually, there are studies showing reduction in transmission of HIV and HPV as well as reduced rates of penile cancer with circumcision. These benefits may not be huge (and I would never recommend circumcision be routine, but only a choice if the parents want it) but can you assert, with evidence to back you up, that frenotomy is any better? Especially when the benefits of breastfeeding are trivial in developed countries with reliable access to clean water?
            Every LLL meeting I went to was rife with moms basically “willing” their babies to have a tongue tie because they thought if it was fixed that would solve all their breastfeeding woes. I think part of this stems from how often moms get blamed for their breastfeeding difficulties (“You just aren’t trying hard enough/nursing enough/pumping enough”) so they are thankful when there is a possible reason breastfeeding might not be working that can’t be attributed to them.

          • Annie Schimpff VerSteeg Ibclc

            That is just BS and you know it.
            Remember the wonder drug thalidomide?

          • Roadstergal

            The drug that the FDA blocked from licensure and sale in the US due to insufficient testing, particularly in pregnant women? Yes, that was a triumph of science, and of women in science, as Dr Kelsey was instrumental in the outcome.

          • Megan

            What exactly is BS? And what on earth does thalidomide have to do with circumcision or frenotomy?

          • LibrarianSarah

            You mean the drug that the FDA never cleared for use in pregnant women and is one of the few successful treatments of multiple myloma a very deadly form of cancer.

          • Captain Obvious

            AAP still believes circumcision benefits:
            For the new policy statement, researchers formed a task force in 2007 to review evidence from 1,000 studies that took place between 1995 and 2010. They found that the procedure had preventive benefits, including a major risk reduction for male urinary tract infections – especially during the first year of life – and a lower risk of cancer, and heterosexual acquisition of HIV and other sexually transmitted diseases. Specifically, risk for herpes was 28 to 34 percent lower for circumcised men and risk for HPV was reduced by 30 to 40 percent.

            A 2014 review found that the benefits of circumcising a boy outweigh the risks of doing so by at least 100 to 1.

            Decrease HIV RR 2.3-4.5
            Decrease HSV, syphilis, chancroid.
            Decrease non-ulcerative STD.
            Decrease UTI, 2.15% v 0.22%
            UTI risks bacteremia, renal scarring, meningitis and death. Also long term HTN, hyposthenuria, proteinuria, and chronic renal failure.
            Decrease penile cancer.
            R/T circumcision and hygiene.
            Israel +/+ 0.1/100,000
            Denmark -/+ 1/100,000
            Paraguay -/- 4.2/100,000
            Decrease Phimosis, Paraphimosis.
            Decrease Balanitis, Balanoposthitis. (old men going for circumcisions when they can’t clean as well as they used to)
            Decrease cervical cancer in partner

          • Amy Tuteur, MD

            That’s a logical fallacy known as the “argument from ignorance.” Thanks for demonstrating it!

          • PrimaryCareDoc

            You can’t prove a negative. Go on, keep showing us that you have no education in the scientific method.

          • PrimaryCareDoc

            No. Your anecdotal observations count for nothing. Nothing. I also “saw” the benefit of kyphoplasty for vertebral compression fracture…until the literature showed that it was no better than placebo. Now I don’t order it any more, and my patient’s outcomes haven’t changed.

            That’s the difference between a real doctor and a fake “practitioner.” A real doctor changes practices based on best evidence.

          • Taysha

            no, no, dear. reflux has nothing to do with lip/tongue tie. It has to do with the maturity of the pyloric valve and it’s resolved, usually, with a month of zantac.

            Been there and all that.

            Inability to suck/swallow denotes MUCH bigger problems than tongue tie. And hunger is fixed with a bottle of “put inyour favorite whitish looking thing”

          • Annie Schimpff VerSteeg Ibclc

            Dear doctor Tasha,
            There is no proof a month of Zantac has no long lasting harm.
            Reflux is about gastric juices. The inability of a bay to suck swallow properly, on a breast or a bottle inhibits the gastric juices from being released.
            Often times, reflux is resolved when proper suck/swallow is achieved.

          • Taysha

            No dear. Reflux is only about gastric juices in the fact that the pyloric valve does not close correctly and thus they climb up the esophagus.

            It’s resolved by proper suck/swallow because proper suck/swallow is achieved with time, which is what cures early reflux in infants.

            Your physiology-fu is somewhat weak, dove.

          • Annie Schimpff VerSteeg Ibclc

            Fu and dove?
            Taysha, you seem very angry. The evidence is everywhere. Obviously your breastfeeding goals were not met or weren’t important that doesn’t give you the right to criticize me for wanting to do my job or for women who seek a different outcome.
            Different isn’t bad. It’s ok. We all have our own goals.

          • Wren

            Dove is evidence of anger?

          • Roadstergal

            She seems to be overdiagnosing anger in this thread with the same vim she brings to overdiagnosing tongue ties.

          • Taysha

            Angry womyn with frooty colored hair here. Rar.

            heh.

          • Roadstergal

            “I am woman, hear me ask for peer-reviewed studies with acceptable methodology.”

          • Taysha

            Allow me to girlcrush you, Roadster =)

          • Roadstergal

            *blush*

          • Sarah

            Read Organized Analytical References!

          • Nick Sanders

            Marry me.

          • Taysha

            Lay off, Nick, I saw her first! 😉

          • LibrarianSarah

            With sample sizes too big to ignore?

          • LibrarianSarah

            I prefer…

            “Don’t make me ask for peer-reviewed studies with acceptable methodology. You won’t like me when I’m asking for peer reviewed studies with acceptable methodology.”

          • Annie Schimpff VerSteeg Ibclc

            I don’t overdiagnose TTs.
            I do work everyday. I’ve been working for 20 years.
            I’m really proud of my work, my parenting and my goals.

          • Taysha

            Do you practice regular audits of your work and clients to determine if you overdiagnose TTs? Actually curious, because most hospitals have routine audits to make sure they are doing well.

          • Roadstergal

            You say that, but you won’t even provide us with your criteria for diagnosis – or any studies showing that there even _are_ standard criteria, or that they have relevance to desired downstream outcomes.

          • Taysha

            Aw, concern troll is concerned about my trolling her with kindness.

            Dove, my goals were healthy children. Met and exceeded. The fact that you know nothing of physiology and are attributing a weak valve (well known development) to a tongue tie and the lack of ever present breastfeeding is ridiculous for someone with your ‘expertise’

            I can criticize your uneducated suggestion that children be hurt for the sake of hooking up to a boob.

          • Taysha

            And you must be old and probably not well-versed in the field if you don’t know how the -fu works.

          • Annie Schimpff VerSteeg Ibclc

            You mean as in FUCK YOU? I just didn’t think the children would come here to play school yard bully.

          • Taysha

            HA. No dear. I mean as in Kung Fu

            But thank you for that lovely insight into your mind.

          • PrimaryCareDoc

            Proof. Where’s your proof that frenotomy has any benefit for reflux or colic?

          • mythsayer

            You know, I thought you were reasonable until you brought this up. My daughter didn’t have a tongue tie and had horrible reflux. Zantac helps neutralize the acid…it doesn’t actually stop the reflux. Babies have to how out of gmhaving reflux. It’s not related to suck/swallow, no matter how much you’d like it to be.

            Based on your logic, If babies without ties have reflux, what exactly are they supposed to do for relief?????

            Zantac didn’t hurt my daughter at all. You are seriously arguing that because there’s no proof it DOESN’T cause harm…it shouldn’t be used? I’m assuming you take no medication at all then, correct?

          • Annie Schimpff VerSteeg Ibclc

            Zantac is an acid blocker.
            I’m not saying it shouldn’t be used. It certainly can and does help.
            I’m saying reflux is a symptom that deserves further investigation to get to the etiology.

          • Gene

            Sure. But tongue tie has absolutely nothing to do with it.

          • Gene

            Suck has nothing to do with reflux. Almost every baby refluxes to some degree, as would you if you lay on your back and drank milk all day. As babies mature and they become less floppy (and sit upright), their reflux tends to improve. Zantac works by reducing the acidity of the stomach and causing the liquid that does back flow into the esophagus to be more neutral and less irritating to the epithelial lining.

            When suck/swallow is more coordinated, you reduce problems with aspiration. Not reflux.

          • Gene

            Quick anatomical clarification: esophageal sphincter, not pyloris.

          • Taysha

            Many thanks. =)

          • yentavegan

            So glad you brought this up. Infants with an inabilty to suck/swallow are not cured by clipping the tongue tie. The tongue tie is a symptoms of an underlying glitch. Convincing/brainwashing a mother to shlepp her underfed infant to a far away doctor to clip the tie as the panacea is cruel.

          • Annie Schimpff VerSteeg Ibclc

            I would feed an underfed baby!

        • Annie Schimpff VerSteeg Ibclc

          I have had a frenotomy! I’ve never been circumsised.

          • Taysha

            Were you conscious at the time? Because I had it as an adult, and I can tell you it’s not something I’ll ever do to my children. Because it effing hurts like a mofo.

          • Annie Schimpff VerSteeg Ibclc

            I was conscious, it did hurt but I was 58 so was dealing with a newly released muscle that had never been used properly and the long term adult benefits far outweighed the pain I experienced and managed with Tylenol.

          • PrimaryCareDoc

            I’m truly curious as to what adult benefits you derived from a frenotomy. The ability to roll your “r’s”? The ability to whistle and blow bubbles from chewing gum?

          • Annie Schimpff VerSteeg Ibclc

            Well, I got to discontinue using a CPAP and no longer had acid reflux at night. I sleep way better.
            I already know how to blow bubbles, whistle and can roll most of my r’s.

          • PrimaryCareDoc

            Interesting. I can’t find a single article that shows a relationship between tongue tie and either OSA or reflux. I can’t even think how physiologically a frenotomy would impact either of those conditions.

          • mythsayer

            Ummm….reflux? How the hell can a tongue tie have anything to do with reflux????

          • Taysha

            I believe you about “this much”

          • Annie Schimpff VerSteeg Ibclc

            I believe in your knowledge about the same. What is your speciality that you so quickly criticize mine?

          • Taysha

            Science.

          • Annie Schimpff VerSteeg Ibclc

            You are a scientist? Wow, cool, what field? Where did you go to school? Where do you work now?
            How old are your kids?
            Way to go.

          • Taysha

            My, you sound angry. Maybe you regret your choices in life

            And all going well, thank you. Do you think I give my information over the internet? This is still the internet.

          • Annie Schimpff VerSteeg Ibclc

            LOL, enough said! You just totally outed yourself.
            My life choices have been amazing and rewarding.
            Hope the same is true for you.

          • Taysha

            Outed myself as what? A normal professional with 13 publications (3 more in the running) who doesn’t need to put her credentials in her name?

        • Daleth

          If I have a goal of giving birth to my baby unassisted in the middle of the street, do you need to help me achieve that?

          If I have a goal of feeding my baby RC Cola right from the soda bottle, do you need to help me achieve that?

          My point here is that before helping someone achieve their goals, surely you evaluate whether a goal is reasonable, and whether it is worthwhile in light of the costs and harm needed to achieve it (cutting a baby’s frenulum, causing it days of pain and putting it at risk of infection is harm).

          • MLE

            RC Cola? Dr. Pepper all the way!

          • Annie Schimpff VerSteeg Ibclc

            I certainly assess their goals!
            And certainly if your goal was to feed your baby RC cola, I would assist in changing that goal.
            The mouth has very little risk of infection. Frenotomy is not like wisdom teeth.
            Plus, you know, breast milk is filled with good antibodies against infection.
            Are you saying all people who work towards their reasonable breastfeeding goals are bad and stupid?
            Am I bad and stupid because I believe, as does the AAP, that breastmilk is best when it’s possible?

          • PrimaryCareDoc

            The mouth has very little risk of infection? What planet are you living on?

          • Nick Sanders

            I literally said “on what planet” out loud after reading that post.

          • Megan

            I was also about to type something similar…

          • Annie Schimpff VerSteeg Ibclc

            This planet.

          • Roadstergal

            “Plus, you know, breast milk is filled with good antibodies against infection.”

            Breast milk has varying quantities of IgA, which is a mucosal-specific antibody with low effector function. When the mucosal barrier is compromised (say, by an incision), they’re not going to be terribly helpful. Breast milk is not ‘filled with good antibodies against infection.’

          • Taysha

            No, you’re bad and stupid for recommending painful surgical procedures in the unholy name of the boob.
            Also, for using the expression “filled with good antibodies against infection”

        • momofone

          Sometimes helping someone assess whether something is a REALISTIC goal is the most helpful thing we can do.

          • Sarah

            I know there’s talk of a lot of LCs working outside of their scope in these discussions but the LC that works at my kids’ pediatrician’s office is incredible. She told me that it was likely I may never produce enough milk but “that was okay” and “didn’t mean that I couldn’t have a breastfeeding relationship with my children.” Basically, she accepted my plan to put them to the breast as long as they were willing and not to fret about giving them however much formula was necessary for them to thrive. I really owe a lot to her.

            I know we’re not discussing IGT here, but it would help if LCs saw the goal of “thriving children” and “happy mothers” more often than breastfeeding for x amount of days. Maybe then we wouldn’t have to discuss unnecessary surgeries.

          • Annie Schimpff VerSteeg Ibclc

            I’m glad your LC was helpful. There is a huge difference between IGT and TT. I wouldn’t be recommending a frenotomy to a woman who has given birth and has IGT.

          • Taysha

            Goes back to: what are your guidelines for recommending frenectomy?
            Also, do you have a medical degree for that recommendation, or does it fall under practicing without a license?

          • fiftyfifty1

            ” She told me that it was likely I may never produce enough milk but “that was okay” and “didn’t mean that I couldn’t have a breastfeeding relationship with my children.” ”
            Am I the only one who is put off by the term ” have a breastfeeding relationship”? Why not just say breastfeed? I think it’s because lactivists are invested in promoting the idea that there is something special in the relationship between a mom and breastfed baby that cannot be replicated between a mom and bottlefed baby. It is the same as what MilkMeg did when she asked women to share positive stories about “mothering through breastfeeding”. It’s a putdown of formula feeders.

          • Sarah

            I can see what you mean, but in this case I didn’t feel put out by it in any way. She is also a little older, so I’m not sure if that has any influence on her phrasing. Optimistic, think-the-best-about-people person that I am, I think she would have been find using “breastfeeding” and “bonding” interchangeably. She had no qualms about my formula supplementation and even offered me samples then and there.

          • Gene

            I think “breastfeeding relationship” is weird as well. My kids get fed, I use my breasts to make milk for them. My kids don’t have a “relationship” with my breasts. They have a relationship with ME!

          • Annie Schimpff VerSteeg Ibclc

            You are so right. I will help with that too.
            I’m the first in line to feed a hungry baby.

      • Charybdis

        Is proper, effective pain relief provided before the frenulum gets snipped or do they just “snip it right quick”? This is what the intactavists scream about…no pain relief for a cruel, irrelevant procedure that has minimal benefits (according to them). I can’t imagine going to that extreme (demanding the procedure if it is not clearly a tongue tie) on the off chance that it would *maybe* improve breastfeeding if there was an issue that wasn’t helped by practical help (different holds/positions, checking the latch, basic stuff like that).
        I also can’t imagine being so enamored of breastfeeding that I would subject myself to the merry-go-round of interventions that often are pushed as necessary to establish, maintain and prolong breastfeeding. Though I surmise that interventions NOT suggested by a doctor are somehow not considered interventions. It becomes “practical help” and therefore more acceptable to those steeped in the woo.

        • moto_librarian

          My son had no analgesia prior to the revision.

        • Taysha

          I honestly don’t know, but if Annie is going on about a 45 second thing, I’m going to say it’s a quick snip
          The dentist takes longer than 45 seconds to dull my kids for an in-depth exam

        • Wren

          I know in the NHS it’s a quick snip for little babies, but by a year it would have been much more involved, with proper pain relief.

        • Megan

          My daughter had no analgesia. They said that “she wouldn’t remember it anyway” and it was “just a quick zap with the laser.”

    • DaisyGrrl

      Are you seriously comparing IBCLC skills and training to those of neonatologists and pediatric cardiologists? Seriously?

      • PrimaryCareDoc

        I’m sure she is. After all, she helps “mamas.”

      • Annie Schimpff VerSteeg Ibclc

        Of course I’m not comparing myself to either of those. We are all specialists in our respective fields. I do not argue with either of those because my speciality is breastfeeding. I RESPECT their opinion in their field and wish my 20 years of being in the trenches would garner the same respect.

        • Roadstergal

          “Of course I’m not comparing myself to either of those. We are all specialists in our respective fields.”

          The second sentence contradicts the first, you do realize?

        • moto_librarian

          Dr. Amy breastfed all four of her children! I’m betting that she’s pretty damned familiar with a range of issues related to nursing. The question is whether or not tongue tie is being overdiagnosed. I tend to think that it is.

        • Azuran

          Sorry hun, 20 years as a lactation consultant does not deserve the same respect as 20 years as a cardiologist.
          Just because you have letters after your name doesn’t make you a ‘specialist’

    • Roadstergal

      According to the Canadian pediatric paper below, “Criteria used to diagnose ankyloglossia show considerable variation, and there is no accepted standard.” So, I’m curious, how do you diagnose a tongue tie? And how do you justify your enthusiasm for the release surgery in light of the lack of good data on objective benefits?

      Also, for FSM’s sake, please take a minute to proofread your post before clicking Post. A spelling or grammar error here and there is one thing, but when your post reads like it was written by an overenthusiastic 3rd grader, it doesn’t help your credibility (and it makes my head hurt).

      • Annie Schimpff VerSteeg Ibclc

        Thanks for the compliments. Perhaps you are angry by the message so want to attack the messenger?
        I’ll do whatever it takes to help a mama and baby reach their goals. If that, in the end, means a referral for a frenotomy, I will refer for that.
        I generally spend 2 hours at my initial visit. I watch a feed, I hear the mama. I see and examine the baby and we create a plan of care from there.
        Hope your head feels better soon.

        • Taysha

          For the love of god, if you’re going to accuse someone of being in the “good old boys” club and being against feminism, stop referring to women as “mama”
          It’s infantilizing in the extreme.

          • Annie Schimpff VerSteeg Ibclc

            A woman who gives birth, is, by definition, a mother.
            AKA, mama, mommy, ma.
            I am referring to to a woman who gave birth.
            When I see them as clients, I call them by their names as I do their baby.

          • FEDUP MD

            You don’t seem to get it.

            We don’t like being indirectly referred to as mamas, even if you don’t call it to our faces. It is overly familiar and when used by a stranger, infantilizing.

          • Annie Schimpff VerSteeg Ibclc

            I have news for you, once you give birth, you ARE a mother. You know how many women would give their right arm for that title?

          • Zornorph

            There are plenty of women who have not had a baby transit their vagina who are also entitled to the title ‘mother’.

          • Annie Schimpff VerSteeg Ibclc

            Did I say anything about transiting vagina?

          • FEDUP MD

            As a survivor of infertility, with multiple miscarriages, I probably know better than you, yes.

            But if you cannot tell the difference between the word “mother” which is a typical English noun versus the diminutive and intimate name of “mama,” I am not sure what to tell you, other than to get a better dictionary.

            Also, I presume you call all fathers “dada” as well.

            My kids call me Mama. I am extremely uncomfortable with anyone other than them referring to me by that name. The same way my husband has pet/private names for me as well, but if you started referring to me as “sweetie” or such I would be upset as well.

          • Annie Schimpff VerSteeg Ibclc

            I’m not goingto try and one up you in the fertility department, suffice it to say I have walked that path. It was long and hard.
            I apologize everyone got their panties in a bunch over me referring to mothers as mamas. I used a more familiar term. My bad.
            I too dislike being called sweetie, honey or mama by perfect strangers.
            I get it… My bad.
            Can we move on now, PLEASE?

        • Roadstergal

          Why on earth do you think I’m angry? I asked two questions, neither of which you answered, and asked you to write a little more clearly. If you can’t do the latter, at least give the former a shot.

        • PrimaryCareDoc

          Please, stop calling grown women “mama.” Please. Show some respect for your clients.

          • Annie Schimpff VerSteeg Ibclc

            I call women who have given birth mamas. As clients I call them by their NAMES.
            A woman who has given birth is a mother by definition.

          • PrimaryCareDoc

            You just don’t get it.

          • Fallow

            I fucking HATE it when people who are not my child call me “mama”. I have a goddamned name. By definition I’m also an aunt and a sister, but no weirdos go around calling me “auntie” or “sis” just because I meet a technical definition of a role.

            You need to ASK women if they WANT to be called “mama” before you do it. I find it belittling. But I never correct the providers who do it, because it’s easier to just let it slide than argue about it. But rest assured, I hate it and I am not the only one.

          • Erin

            A thousand times this. One of the midwives in the hospital where I had my son insisted on calling everyone “Mum” and by the time they discharged me I’d come close to throttling her several times. In her case I’m pretty sure it was laziness but still it’s patronizing, annoying and downright rude, especially since the hospital made a point of asking it’s patients to refer to the midwives by their given names rather than their job title.

          • Annie Schimpff VerSteeg Ibclc

            I refer to women who have given birth as mamas. If some one asks me what my job is I say, “I’m a Lactation Consultant” if the go on to ask what I do, I say “I help new mamas with their babies”.
            I CALL MY CLIENTS BY THEIR NAMES. CAN YOU ALL READ THAT PLEASE?
            I don’t walk into someone’s house and say, “Hi Mama” I say, “Hi Susan”.
            Do you get it now?
            PS, I know many many women who’d give their right arm to become mothers but for one reason or another are unable to.
            It’s not an insult, it’s a descriptor.

          • momofone

            I was one of those women, and spent many years and a lot of heartache trying to have a child. I still am absolutely turned off by being referred to as a “mama,” except by him. I am a mother, or Firstname, or Ms. Lastname. The word itself certainly isn’t an insult, but its use by someone other than my son is overly familiar and inappropriate.

          • Bugsy

            Well-said. I was also thinking that while I was struggling with infertility, the last thing I would have wanted was to hear women referring to each other as “mamas.” It just would have been a complete reminder of the secret club that I was unable to join naturally. No, thanks.

          • Annie Schimpff VerSteeg Ibclc

            I don’t call people anything but their name. My work is centered around mothers and babies

          • momofone

            Then why the insistence on referring to them here as “mamas”?

          • fiftyfifty1

            “I refer to women who have given birth as mamas.”

            Fair enough. Just as long as you consistently refer to the men who fathered their babies as dadas.

          • Annie Schimpff VerSteeg Ibclc

            Ok. I do that too.

        • Daleth

          What goals of the baby do you help with? How do you know what goals the baby has?

          Mine were primarily focused on eating, sleeping, cuddling, and having clean diapers in those early months. Correct me if I’m wrong but I believe that’s pretty typical of babies. I don’t recall them caring how I fed them, so long as I fed them when they were hungry and provided enough food to make them feel full.

          • Annie Schimpff VerSteeg Ibclc

            Yes, those are my goals.
            Happy, healthy baby.

          • Daleth

            Happy baby, unless you diagnose a tongue tie and mom wants (or you guide mom into wanting) to cut it, in which case baby becomes temporarily unhappy, because it hurts.

            Why again do you not gently suggest that mom switch to pumping and bottle-feeding, so as not to subject her baby to unnecessary pain and risk of infection? (BTW, the mouth is one of the dirtiest parts of the body, and is not, as you claim, a low infection risk–to the contrary, it’s dirty enough that human bites that break the skin are infection risks for the person who got bitten.)

        • Megan

          So if a baby isn’t thrivng and mom is obviously stressed from her trials with breastfeeding you will tell her that the best science shows breastfeeding has trivial benefits in developed countries with access to clean water and that she and her baby should consider switching to formula (and by the way of course you’d also say she’s also a great mom no matter how she feeds her baby), right?

          Sometimes that’s what it takes…

          • Taysha

            Noo. She’ll recommend cutting the tongue on the baby, adding all sorts of herbs and pumping after every feed because breastfeeding is always amazingly easy

            met her type before.

          • The Bofa on the Sofa

            met her type before

            Yeah, they’re called chiropractors.

          • Annie Schimpff VerSteeg Ibclc

            I’m not a chiro.

          • The Bofa on the Sofa

            You can’t read, either.

          • Annie Schimpff VerSteeg Ibclc

            TASHA, as I said before, I never recommend triple feeding, EVER.
            The cases I see are never easy. Women don’t call me unless they are having problems.
            I have never recommended cutting a tongue but the frenulum. It’s a 45 second procedure like getting your ears pierced.
            You have me all wrong.

          • Taysha

            Dear, my name is TaYsha. If you can’t even bother to get that right, I’m not impressed by the letters behind your name (I have 6, btw).
            I have you all wrong? You have so far accused me of insulting you to cover up your lack of knowledge of popular terms, accused me of “outing myself’ as a non professional because i won’t smear my qualifications all over the internet, been tremendously patronizing to me and, short of a head pat, been terribly passive aggressive.

            A 45 second procedure that hurts like a mofo for which no anesthesia is provided (ear piercing is a false equivalency, btw, as there are a lot more nerves and blood vessels in the mouth than the ear). A procedure that when YOU had it you had a regiment of analgesics, that I’m pretty damned certain you don’t offer to the babies you encourage. A procedure that has been mentioned BEFORE as not being related to breastfeeding (children with/without TT being able/not able to breastfeed in random patterns).

            You have tried to associate TT to reflux and a variety of other events that are mildly reminiscent of snake oil selling. So no. I’m pretty sure i have you all right.

          • Annie Schimpff VerSteeg Ibclc

            I would not say trivial because clearly that isn’t true…. But I’d be the first in line to help her with switching and make sure she feels good about the switch.

          • Roadstergal

            “I would not say trivial because clearly that isn’t true…. ”

            It clearly is true. If those letters after your name don’t mean that you stay up to date on the science, what do they mean?

            You still haven’t told us how you diagnose a tongue tie. I’m keenly interested.

          • Annie Schimpff VerSteeg Ibclc

            Well, I check the mothers nipples, watch her feed, make necessary position adjustments and do a full oral exam on the baby. I look for lift and thrust and lateral movement. I check to see if there is a frenulum in the way. I check to see the baby’s ability to suck, check the palate and re-evaluate.

          • Gene

            And that takes two hours? That takes me 10-15 minutes at most. And that’s with a full history and complete physical exam.

        • momofone

          Would it be too much to ask to call them mothers? The only person with “mama” rights is my son.

          • demodocus

            Professionalism counts.

        • Fool on the Hill

          Love the passive aggressive patting yourself on the back. That kind of non response proves that you can’t make a credible response. We all thank you for courteously outing yourself as inept. By the way, I utilized the services of a lactation consult for my first, who is neurologically devastated, and for my third who was a preemie due to preeclampsia. Really glad I got the competent consultant I did, as in one who worked in conjunction with and respect for the opinions of our doctors and not an arrogant consultant puffed up with her own self perceived superiority like you.

        • demodocus

          Weird. My son’s male ped and the practice’s grandmotherly nurse helped me figure out what was up in 2 10 minute visits

          • Taysha

            They don’t charge by the hour. Salaried people don’t usually waste time.

          • demodocus

            Actually, the second was more like 20 minutes, because I was crying so much. Dr. A wanted to make sure I was more or less ok, just having baby blues and not PPD. And give DH and I the warning symptoms of PPD again.

        • Medwife

          Wait, so you don’t diagnose TT because it’s out of your scope to do so, but you refer for frenotomy?

          • Annie Schimpff VerSteeg Ibclc

            I refer for evaluation to the head ENT here at Rady’s Childrens’ Hospital.

    • Zornorph

      You are ‘in the trenches’. Yeah, because breastfeeding is totally like war.

      • yentavegan

        I was just thinking about you! So glad to see you here and posting.

        • Zornorph

          Thanks – life has been busy (in a really GOOD way!) and I’ve not been here as much, but I still check in from time to time. 🙂

          • attitude devant

            Don’t be a stranger! We miss you! Your furbaby AND your baby baby are totes adorbs.

      • LibrarianSarah

        Well trench warfare was primarily used in World War I which was pretty much the most pointless war in the history of wars so in that respect the metaphor works.

      • Annie Schimpff VerSteeg Ibclc

        I’m sorry, let me rephrase that.
        Everyday I see women and their infants who are having a breastfeeding problem. Nobody comes to me because breastfeeding is going well.
        I spend at least 2 hours with the woman and her baby. When was the last time your ped or OB/GYN did that?

        • Zornorph

          I’m a single dad; I didn’t have a need for anybody to talk to me about breastfeeding. My Ped – who is quite the chatterbox – spends a fair amount of time going over things with me at Kiddo’s appointments. I’ve never felt rushed out of there at all.

        • Life Tip

          I’d be really irritated if I had to chat with my pedi or OB for two hours. Unless there’s some sort of medical procedure being done, I certainly don’t want a two hour appointment. Ain’t nobody got time for that.

        • Megan

          Well considering they aren’t paid by the hour like a LC…

          Plus there wouldn’t be enough docs to go around!!

          • Annie Schimpff VerSteeg Ibclc

            I am not paid by the hour.
            You are grasping at straws.
            You wouldn’t have enjoyed a little TLC after giving birth?

          • Megan

            Sure but I can get that for free from my family and friends. Why would I pay a LC for TLC?

          • Who?

            Paying for tlc.

            There’s a name for that. Though I’m pretty sure in that case the client touches the worker’s breasts, not the other way round.

          • Annie Schimpff VerSteeg Ibclc

            Well, that was cute.

    • Megan

      My life and my baby’s life was changed by our frenotomy. We had $600 less in the bank, cruel aftercare to do for weeks that made my daughter scream and a trip to Albany and back. Then it reattached and we trudged back to Albany again. And it reattached again.

      The thing in our lives that didn’t change after the frenotomy? Our ability to breastfeed. We still couldn’t because it kept reattaching. It lasted a week. I now deeply regret the pain I put my daughter through to fix her tongue tie. I should’ve just switched to formula, especially since breastfeeding just isn’t as magical as it’s made out to be.

    • Amy Tuteur, MD

      There’s a reason why scientific research is so important: it’s because people “in the trenches” can be blinded by their own prejudices and economic self interest. Obstetricians “in the trenches” thought that episiotomy prevented perinatal tears. Research showed that it didn’t. Should we go back to routine episiotomies because obstetricians “in the trenches” thought they worked?

      • Annie Schimpff VerSteeg Ibclc

        You were ‘in the trenches’ for years. You breastfed 4 kids. You were an OB/GYN. You didn’t see your patients postpartum like a ped does. Isn’t there a difference between an OG/GYN and a ped?
        Because you breastfed 4 kids, you aren’t an expert on breastfeeding, but the deliveries you have done make you and expert in YOUR field.

        Nitpickers and naysayers parse words.
        I have a ton of respect for professionals.

        • Taysha

          you seem to only respect people who sing your praises and nod their heads at you.

        • SporkParade

          Why don’t OB/GYNs see their patients postpartum? I thought the six-week visit was standard in most places with good medical care.

          • KarenJJ

            Plus there’s all that GYN stuff that patients need post their need for obstetric care..

    • yugaya

      How many years of real education does it take to become an IBCLC? Is it as many as it takes to become an OB, or a pediatric cardiologist or a neonatologist? Do you have to be among best students in your country to qualify into IBCLC university just like kids in my country have to be among top high school graduates to get a place at medical university? Because you know, you sure are placing you and your qualifications among theirs and making it sound like your opinion on anything is as valid as that of a real medical professional. It is not. Never will be.

    • demodocus

      Breastfeeding is like knitting. A complete novice has trouble at first and needs the help of someone both experienced and able to explain it. This experience can be developed within the year. For some novices, it never clicks or they find they dislike knitting or they develop a bad case of arthritis so they find another hobby. For some, the skein of yarn was too small and they’ll need to supplement with another. You can poke yourself pretty badly with needles and even give yourself a rope burn. Oh, sure, there are knitting classes, but they aren’t strictly necessary.
      It’s silly to equate helping new mothers and babies figure out nursing an ob pretending to be a cardiologist. The training in the former can happen in a few weeks, half of which can be just out of one baby-how-to book. The latter, not so much.
      P.S. I’m a self-taught knitter, but I’m *not* going to a self-taught medical doctor.

      • Annie Schimpff VerSteeg Ibclc

        I knit too.
        I went to school at UCSD to become an IBCLC, I sat a 7 hour exam. I sat it again at 10 years.
        When I got my IBCLC, We were required 5000 hours of experience (it’s less now).
        It is a little different than knitting or breastfeeding two children. Both good skills but they don’t make me an expert!

        • demodocus

          So you’re the Alice Starmore and Kaffe Fasset of breastfeeding. I had about that much experience in order to teach. and people are always decrying teachers as know-nothings.

          • Michele

            > So you’re the Alice Starmore and Kaffe Fasset of breastfeeding.
            <3 this

        • moto_librarian

          I sat an 8 hour exam to get my M.A. in musicology. It’s all part of the routine.

          • Annie Schimpff VerSteeg Ibclc

            And I’ll bet you love it when, say, an English major argues with you about musicology because they once listened to an album.

          • moto_librarian

            Actually, I enjoy discussing music with pretty much anyone. When you really think about it, the controversies in musicology are absurd to the vast majority of the populace. I believe that the arts and humanities are important, but we aren’t curing cancer. I am also willing to change my perspective based on new evidence, something that you appear in able of doing.

          • Who?

            The difference between your hobby and Annie’s?

            No one gets cut.

        • fiftyfifty1

          I sat a 7 hour exam to even GET INTO medical school.

          • Megan

            Yes and just think, 5000 hours experience is less than one year of time we spent in residency!

          • Gene

            With duty hour restrictions, 80hrs/wk for 50 weeks (two week vacations are pretty common), each year of residency is about 4000 hours. Not including self study, prepping for step 3 of the usmle, board exams, etc. This is for the US, of course.

          • Megan

            Those restrictions werent in place when I was an intern. Or rather I shod say, they were implemented at the tail end.

          • Gene

            They started right before I did internship. I vividly remember those 36 hour surgery and OB/Gyn shifts Q3. Some med schools don’t even have call rooms for their students since they don’t spend the night. We had rooms with 10-12 bunk beds for all of us.

            Honestly’ though, I’m MUCH happier in my little shift only world!

          • Megan

            Yes I definitely do not miss those days! Though I did learn a lot…and fast!!

          • PrimaryCareDoc

            Yup. And show me a program that actually sticks to duty hour restrictions and I’ll show you a unicorn. We all fudged our hours during my residency. No one wants their program on probation.

        • D/

          I’ve sat for the IBCLE exam twice as well, initially and at 10 years. I did spend 7 hours the first time, but that was including an hour and a half drive each way to get to the exam site.

          Not to quibble, but it’s a 175 question 4 hour exam … not easy, but I’ve certainly taken harder.

  • Taysha

    Having been on the receiving end of a frenulum self-snip, I would never do that to my kids. It was horribly painful

    (don’t ask, it was one of those “you don’t want to explain this to the paramedics” things)

    • Eater of Worlds

      I did it to myself as a kid. It was awful.

  • Zoey

    Among the crunchy parenting crowd I used to associate with, it wasn’t just tongue ties that were potentially an issue with breastfeeding. If your baby wasn’t gaining weight, transferring milk, or even just occasionally fussy, it was always recommended having them evaluated for ties. Even if your baby had no visible tongue tie, they might still have a harder to diagnose posterior tongue tie (that coincidentally only 1 dentist in our city could diagnose or release), or even a lip tie. Just about everyone that asked if their baby had some sort of tie ended up going to this dentist to find one and then have it released.

  • Wren

    My son was diagnosed, by a doctor, with a tongue-tie after he quit breastfeeding. It apparently had an unusual presentation, not the usual heart shape tip of the tongue. It did break on it’s own (with some help from us and the love of ice cream) the day before a consultation with a paediatrician at the hospital at 1 year. He said it had clearly just done it and said he would have clipped it because it had affected speech at that point. My son did have years of speech therapy later on, some of which was attributed to his early tongue tie.
    Anecdotally, feeding my daughter (who did not have a tie) was much easier than my son and I had less pain. She also has not needed speech therapy.
    We did find out after my son was diagnosed that both of our mothers had been born with a tongue-tie, clipped in the hospital at birth. I know my mother was not breastfed, so it wasn’t clipped for that reason.

    • NoLongerCrunching

      There are true tongue ties that do affect breastfeeding. However what with all the overdiagnosing by LC, pediatricians are loads to believe us, which is quite understandable.

      • Wren

        In my son’s case, he never breastfed without a tie so I can’t say for sure it would have made a difference, but I can say feeding my non-tied daughter was sooo much easier and less painful.
        At this point in his life, I’m much more concerned about the impact it had on his speech (though that is largely dealt with) than on breastfeeding.

  • Amy

    So if the overdiagnosis is a fad, and it’s being driven by mothers and lactation consultants with help from Google University, why are so many doctors saying yes to the surgery?

    • PrimaryCareDoc

      $$$$$$

      Plenty of doctors are motivated by money.

      • Wren

        I can see that in the US, but I don’t think that $$$$$$ (or £££££) is the issue here on the NHS. I don’t know if the number of surgeries has increased here, but I seem to hear about it more.

        • Daleth

          Does the NHS provide tongue-tie surgery?

          • PrimaryCareDoc

            That’s a good question. I have a sneaking suspicion that this diagnosis and treatment is sought out by the upper middle class with money to spend by going private.

            But I’m also talking out of my butt and I actually know very little about the NHS, so take my opinion with a grain of salt.

          • Daleth

            Quick google search tells me it costs about £150 when done privately, is typically done without anesthetic (poor baby!) and the one poster who clearly said she had it done on the NHS “had to push” for it and apparently got it because it was a genetic thing (her husband had it too) that impacted speech.
            http://community.babycentre.co.uk/post/a17451035/frenectomy

          • Wren

            Yes it does. My son almost had it done in 2006. The tie split on it’s own the day before he was evaluated for it and the doctor made it clear he would have done it, and that we should have him referred back if it re-attached.

            By the time my son was evaluated, it was affecting speech sounds (he wasn’t properly speaking yet) and at least some of his later speech problems were attributed to spending the first year of his life with a tie. He was in speech from 4 to 9.

          • Joy

            Yes, but it does almost no posterior ties and no lip ties unless the child is older and it is affecting their teeth.

      • NoLongerCrunching

        I used to have a magnet on my car advertising my LC services. I actually had an ENT come up to me at a gas station to ask me to refer patients to him. Spam much?

    • Megan

      At $600 a pop, I can see why you might be willing to do them… Gotta pay for that expensive laser.

  • Riverside

    My youngest had a tongue tie. And more than one midline birth defect. His tongue tie ripped a permanent fork into his tongue after my pediatrician refused to cut it. The ENT had to put him under because he was too old for office patient procedure.
    Nursing was going well before the cut. Maybe 70th percentile before surgery on weight. After surgery he hit 95th percentile on weight. Treating tongue tie is important for speech problems, which plague my whole family. The backlash to lactivist diagnosis is hurting children who could benefit from tongue tie release surgery.

    • Cobalt

      Ties that are actually impacting development should be treated. That is indisputable.

      The issue is that incidence of actual ties requiring treatment seems to come in faddish waves and clusters, which suggests that they are not actually ties. And, as you pointed out, this interferes with getting treatment for kids with legitimate problems.

      Just another way lactivist enthusiasm hurts babies.

      • Young CC Prof

        Exactly. I definitely believe that some babies have tongue ties that cause problems, but when there is an enormous variation in the rate of diagnosis for no apparent biological or selection-bias reason, there may be something wrong with the way some practitioners are diagnosing it.

  • Ashley Pickett

    You might find it interesting to know that in Ontario, Canada peads get paid $12 by provincial health care for releasing tongue ties. $12. Without the monetary motivation that you speak of, our doctors still put themselves into the position of releasing ties when babies are having trouble breast-feeding and there is a restricted tot – because almost always it leads to better outcomes. I invite you to come to is in Toronto, and spend a few days in our clinic. Watch is evaluate breast-feeding, try to latch not-yet-latching babies, and try to help mom’s resolve their pain – and then watch what happens when the physician releases those ties and immediately afterwards, we can get those babies to latch, or hear mom’s often report that there’s no pain at all.

    From your perspective, it does seem pretty questionable. But that sentiment would make sense, coming from anybody who doesn’t actually have any experience in this area. Breastfeeding is as natural as birth – and we all know that not all moms could safely have a homebirth with water, rainbows and dolphins.. That with some intervention, sometimes surgical interventions, we can help moms meet their goals of delivering their babies safely in hospital. I believe the same to be true with breastfeeding. Often it goes well. Often it needs some support with latch techniques or drugs to increase milk flow. And sometimes there is a surgical intervention. I’m actually surprised that your stance on this is so different than your opinions of birth and it’s common interventions.

    I really do invite you to come and gather some real information, and gather some real experience witnessing the before and after, see you can make a properly informed article about what you referred to as “just a fad”.

    • Megan

      I had the same experience. It helped our breastfeeding for a week, then reattached. It was released again with the same outcome. I am not he only one to have this same experience. If there is data that shows lasting improvements from the procedure, I would be interested to see it. I don’t think its always the miracle cure it’s presented as though I’m sure some babies with severe ties do benefit. Also, the aftercare was downright cruel and I will never put another child of mine through it again.

      • Annie Schimpff VerSteeg Ibclc

        I don’t promote that painful aftercare. I’ve seen many frenotomies produce great and lasting results.
        Sadly, I have seen the results you have had too. I do not recommend second releases.
        I do recommend maintaining a milk supply and feeding the baby by whatever means work.
        I NEVER recommend triple feeding.
        I actually pretty good at my job.

        • Megan

          It doesn’t matter if you promote aftercare or not. My daughter’s surgeon did. My LC (wisely) suggested I follow his advice since he did the procedure. Why would you contradict the doctor who did the procedure? He’s done thousands. And while I don’t necessarily agree with his practices, surely you wouldn’t say you have more experience with it than him?

    • moto_librarian

      But how many babies actually have tongue ties? I don’t think that anyone is questioning that some babies really do have ties, but it’s the constant go-to among LCs here. The hospital LC said that our second child had a tie. His pediatrician took a look and did a very small revision, but she was skeptical that it was even necessary. She also said not to let the LC convince us that he needed anything else done because there was a pattern of aggressive clipping going on at that hospital. Given that this is a highly-regarded tertiary medical center, I think there is indeed cause for concern. Given that my milk failed to come in, I wish we hadn’t done anything at all.

      • Ashley Pickett

        Yes we see this often in the community -. A “very small” revision would be considered incomplete and I would not suspect it to help most of the issues we see. I’m sorry you didn’t have the complete revision.

        I also believe this very issue informs the research. Some of the studies I’ve read discuss an anterior clip, but without providing posterior mobility the “outcoms” wouldnt be dramatic. It’s too bad.

        • moto_librarian

          I am not the least bit sorry that we followed the guidance of our pediatrician rather than a hospital LC. this would be the same LC who already knew that I probably had IGT. I was willing to try nursing a second time on the off chance that the pph during my first delivery was what had prevented my milk from coming in. We put our son through this for nothing, and I wish that we hadn’t.

    • Amy Tuteur, MD

      The Canadian Pediatric Society does not agree, Ashley:

      http://www.cps.ca/documents/position/ankyloglossia-breastfeeding

      • Ashley Pickett

        I know. But in sure they’ll come around.

        • Glittercrush

          Are you serious? You are presented with the evidence you scream for then turn around and dismiss it because it doesn’t fit your view? Incredible.

          • Ashley

            That sure is a lot of words that I did not say. I haven’t screamed for anything nor have I dismissed anything. The CPS has a position paper. I have my own position.

            I’m not here to defend my position, or to change anyone’s minds. My comment was an invitation for this OB to come and see for herself, what I do know to be true. Her position isn’t informed by the reality of our daily practice. Evidence based includes our experiential And anecdotal information. I don’t claim to be science-based… Everything we do in medicine began before we had research on it. I see this daily, and will continue to support my clients in theI goals.

          • moto_librarian

            Your own pediatricians disagree with you! Has it occurred to you that your daily practice may be faulty?

          • PrimaryCareDoc

            That’s great. You don’t claim to be science-based. That’s exactly who I want making a medical recommendation for my kid.

          • Glittercrush

            You are right. I misread your post. You didn’t ask for evidence or anything like that. My mind must have been mixing up several comments at once. However, your clinic is not the only source of truth when it comes to this issue. Dr. Amy found other evidence that actually supported her position. And you dismissed it with a “they will come around”. Plus your last sentence makes no sense. What do you mean when you say “Everything we do in medicine began before we had research on it”? Sure, at some point centuries ago things were done without much research because we had no choice. But in medicine as we know it now each new procedure, medication, or recommendation is thoroughly and rigorously evaluated for safety before being introduced to the public at large. Anything less than that is unethical.

        • Roadstergal

          Did you actually read the paper? Do you have actual data that contradicts their analysis?

          I’m particularly interested in this. “Criteria used to diagnose ankyloglossia show considerable variation, and there is no accepted standard. The lack of a consistent definition further fuels controversy regarding this condition and its clinical significance.” If there’s a lack of consistent definition, how can you do a proper study to show benefit?

        • mythsayer

          So you know better than doctors?

    • mythsayer

      How long are you watching them for? Seems like most agree there is a short term benefit for about a week. Are you watching them longer than that? Do you have some perfect record after this surgery where every baby can EBF into toddlerhood after getting tongue snipped?

      • Annie Schimpff VerSteeg Ibclc

        Many of my clients keep in touch for over a year.

      • Ashley

        I typically follow up for 3 weeks in person, and then moms come to my drop in monthly as long as they would like to. Sometimes, the initial Reattachment is addressed at the 1 week follow up. Most often, positive effects continue for the duration of breastfeeding. Often, the effects continue after proper soft issue support (comparable to seeing a physiotherapist after a cast is removed) and then effects are dramatic and lasting. And then, as with any surgical intervention, there are the families who don’t see enough improvement or see the initial improvement regress. Reattachment is an issue, and a tough one – the mouth is a uniquely hard place to control wound healing. Hope that helps 🙂

    • fiftyfifty1

      “I really do invite you to come and gather some real information,”

      Or how about you gather it and publish it in a peer reviewed paper which should be easy enough if what you describe in your practice is true.

  • T

    Continue on with spreading misinformation and bad advice. And feel free to continue with pulling the most irrelevant and insignificant studies to back up your nonsense. Most of us know you don’t give a rats ass about new mothers, new babies, or what’s best for them. There’s not many people who take anything you post seriously, anyways.

    • Megan

      If you have other studies you can cite to show frenectomy is associated with clinically meaningful improvements in outcomes I’m sure we’d all be interested to see it.

      That would be the easiest and best way to show how ignorant Dr. Amy is of the topic.

    • moto_librarian

      And yet you’re here to offer comment…

  • Amy M

    So whenever a woman gets the “but less than 5% of women can’t produce milk, so low supply can’t possibly be your issue”, she can toss back “Well, less than 5% of babies actually have tongue-tie, so that can’t be the issue either!.”

    • Life Tip

      Or you could point out how many babies actually make up that 5%. People in general are not good with statistics. They think, well 5 is a pretty low number so I guess it’s unlikely….

      • Roadstergal

        Ben Goldacre mentioned in Bad Science that people do better with frequencies (x in y) than percentages. I mentioned something a little while back to a friend that was 5% (I can’t even remember what it was), and she shrugged – until I rephrased it as 1 in 20… 5% is very frequent!

        • Life Tip

          Yes. There would regularly be at least 20 moms with babies in a LLL meeting when I attended. 1 in 20 puts things in a better perspective.

          • Cobalt

            20 kids is a kindergarten class.

    • AirPlant

      I do not understand the whole 5% thing. I assume it is 5% cannot and will never be able to maintain a full supply, but that does not take into account women who get a good start but lose their supply down the road for whatever reason. It seems like people treat 5% as the maximum number of genuine supply issues but from my perspective it feels like the floor. Breastfeeding, as with anything will have a certain amount of dropout over time (the mom can breastfeed fine, but can’t pump, the mom develops severe mastitis and is hospitalized, the infant loses interest after solids are introduced, or any other reason). In what universe does this data indicate that supply issues would be rare?

      • Amy M

        I agree. And there’s a ton of reasons why a woman might not produce a full supply—like she makes some milk, but not enough to satisfy the baby. My understanding is that various disorders the mom could have (thyroid, pcos), pph, or even medication the mom takes, can contribute to decreased supply.

        • AirPlant

          Right? It isn’t like anybody would even consider 1:20 to be all that rare, and that is only the first line of supply problems that a woman can encounter. I really doesn’t help your month four supply problems to know that you had an oversupply for the entirety of month one and it certainly doesn’t make your supply issue go away to know that you were not part of that 5% initially.

          • Daleth

            Can you imagine if there were a disease that affected 5%/1 in 20 people?! Anything that common that had bad effects would be considered a public health emergency. Even diabetes, our current public health emergency, only affects like 1/100 people in the US.

          • AirPlant

            I am a natural redhead. I laugh in the face of 1:20 being irrelevant and rare.

        • mythsayer

          That was me. I think it’s because I had gastric bypass 6 years before. I was able to maintain a healthy pregnancy but I only gained 20 pounds and she only weighed 6 lbs 5 oz at 39 weeks, 4 days. But we were still both healthy during the pregnancy. But no matter what I did, there was never enough milk (huge shame as she ended up on prescription formula bc she was allergic even to alimentum…). She even refused to touch the bottle for 2 full weeks when she was 10 weeks old bc she had chicken pox and she spent that time attached to me almost all the time. I figured after that, there’d be enough milk. There wasn’t. So it was never gonna happen.

      • Are you nuts

        Not to mention, 5% is 1 in 20. That’s a lot!!!!

  • nikkilee

    Breastfeeding is not perfect. No human activity is perfect. Tongue tie has been a common anatomical variation for millennia. Some babies are have such tongue restrictions that they can’t bottle-feed well, although this is less common than breastfeeding difficulties with a tie. The bottle-fed kids thrived but then they had speech difficulties and more cavities. http://tonguetie.net/background/

  • mythsayer

    That is a pretty good irony. Let’s ignore doctors for everything until we need them to snip the baby’s tongue. Surgery is bad. Unless you have self-diagnosed. They are so damn stupid…I can’t even…

    • Roadstergal

      I’m reminded of the comments some have made about the Venn overlap between lactivists and intactivists, and the irony that those who believe snipping one bit of skin for moderate benefit is abuse, while snipping another bit of skin to enable the moderate benefit of breast milk is totally necessary. Now it seems uncertain that the latter even works that way…

  • The Bofa on the Sofa

    If babies have always have tongue tie (“it’s not a fad”) and if tongue tie prevents breastfeeding, then we would not be here as humans, because of evolution.

    Right?

    Interesting how the “if we couldn’t breastfeed we wouldn’t survive” claim works for shaming mothers, but doesn’t apply to babies.

  • PNP in Tennessee

    Dr. Amy, I’d encourage you to read up on MTHFR gene mutations. Consider also folic acid additives into our food versus natural folate in real food.

    Also you may want to review your usage of “your” vs. “you’re”

    • moto_librarian

      How is this applicable to breastfeeding?

      • Mel

        Because it spells out an insult about having sex with a mother.

        • moto_librarian

          I see that there may be a correlation with neural tube defects, and maybe cleft lip and palate. Obviously, cleft lip and palate present real feeding problems for infants, but I don’t see anything related to breast feeding.

          • Sarah

            No correlation. I’ve done a lit review for the paper I wrote. It’s a complete beat up. WIll post paper here when it comes out

          • moto_librarian

            Awesome!

        • Cobalt

          My first thought! They’re getting bolder every year.

          The next fad will be Seepyem Kashezin supplements, or Payelseesmoor syndrome.

      • PNP in Tennessee

        It is applicable to breastfeeding because MTHFR is a gene that is used in the processing of amino acids and vitamins. Mutations in this gene in a mother are well known to cause midline defects in infants (one of which would be tongue tie). Women with MTHFR gene mutations need to be supplemented with true folate rather than folic acid, but folic acid is what is present in most prenatal vitamins. There is evidence that increased MTHFR gene mutations paired with increased intake of folic acid during pregnancy is responsible for an increase in the incidence of tongue tie. Tongue tie affects breastfeeding. So, that’s how this is applicable to breastfeeding.

        • moto_librarian

          So how common is this, actually? And why am I not seeing any references to tongue tie specifically? I find it telling that a number of holistic practitioners have interest in this particular genetic mutation….

          • PNP in Tennessee

            From what I have read, the carrier frequency of the gene mutation is 31% to 39% for 1 mutated gene and 9%-17% for both genes to be mutated among the white North American population. So not terribly uncommon.

          • moto_librarian

            But where’s the proof that it causes tongue tie in the peer-reviewed literature? Cleft palate and cleft lip are referenced, but not ties.

          • PrimaryCareDoc

            There is no proof. MTHFR is the ultimate fad diagnosis, beloved of naturopaths, chiropractors, and midwives.

          • moto_librarian

            That is what I figured, PrimaryCareDoc.

          • Joy

            I think it is the new black mould and/or hypoglycaemia in non-diabetics.

        • moto_librarian

          Also, aren’t you the same person who told us that only 1 in 1000 women actually have low supply? Given my experience with LCs in the state of Tennessee, you seem fairly representative of the problems with the profession.

        • Megan

          I’d like to see your citation. My LC me told this to me too. Incidentally, I was on 800mcg of folate (not folic acid) well prior to conception and that never prevented my daughter’s tongue tie.

        • Sarah

          NOPE. Just submitted a paper about how useless the MTHFR gene polymorphisms are clinically. Waiting on publication. and mutation in MTHFR are NOT known to cause midline defects- 60-70% of the population carry one of the two common polymorphisms.

        • Medwife

          I could fertilize a field with your comment. The only MTHFR mutation myth you forgot was the link to autism.

          • Joy

            Your forgot that MTHFR causes Down’s Syndrome. That one is out there as well.

    • Mel

      A) Stop being a twit. If you’ve know of an actual paper, cite it.

      B) There is no usage of “yours” “your” or “you’re” in this article.

      • Life Tip

        Actually, there is. But it’s used correctly.

        Grammar Tip: It’s your fault (possessive)
        You’re not doing it right! (Contraction of you + are)

        • PNP in Tennessee

          heeeeeeellllo, straight from first paragraph: “nurse more! and pump when *your* not nursing!” (emphasis mine, of course)

    • Amy M

      http://www.mayoclinic.org/drugs-supplements/folate/background/hrb-20059475

      According to that, folic acid supplements increase the amount of folate in the blood, so what difference does it make?

    • Joy

      Except the same tongue tie issues are cropping up in the UK. Where they don’t add folic acid to foods and most women don’t take folic acid before going to see the midwife until, at the earliest, eight weeks. The US isn’t the only country in the world.

  • Ariel Brewer Louis

    You’re ignorance is staggering.

    • moto_librarian

      Said by someone who doesn’t know the difference between “your” and “you’re.”

      Delicious.

      • Ariel Brewer Louis

        Hmm. Having a PhD I most certainly know the difference but my cell phone my not, though who really cares? Personal attacks which are irrelevant to the topic at hand are surely signs of insecurity.

        • moto_librarian

          As someone with a PhD you should know that we expect something better than an ad hominem. Back up your statement, please.

          • mythsayer

            This is exactly what I was about to say.

        • Megan

          Kind of like when you say “Your ignorance is staggering” and nothing else?

        • Life Tip

          Well, you just called author ignorant with no mention of the topic at all. So…

        • Mel

          There’s an irony in the fact that you have another spelling/auto-correct error in your statement about why auto-correct errors aren’t a big deal.

          Plus, Ph.D = knowing the difference in usage of “your” and “you’re” is complete bullshit unless your Ph.D is in English. I’ve seen many horrific spelling errors made by Ph.D’s in a wide area.

        • mythsayer

          Pot call kettle black.

    • Life Tip

      And yet you have nothing with which to back that statement up?

      Join the club.

    • Mel

      Intriguing answer.

      As a teacher, I’d like to point out that “you’re” is a contraction of “you are”. Since you are stating that Dr. Tutuer’s ignorance of breastfeeding challenges is staggering, you want “your”.

      As a point of interest, no one my age (35 ish) had tongues snipped regularly, but many were breast-fed. This might be because options were given like pumping or latch shields instead of insisting that all babies need to have their lips attached to a mother’s nipple.

      • PNP in Tennessee

        I suspect the commenter is mocking Dr. Amy’s misuse of “your” and “you’re” in the first paragraph of this post.

        Also, “many” infants 35 years ago were NOT breastfed, in fact, that is around the time when breastfeeding rates were incredibly low.

      • Wren

        I don’t know how many tongues were snipped 35 years ago, but anecdotally I can tell you they were doing at least a few in both England and the US in 1948, as both my mother and my mother-in-law had it done.

    • Roadstergal

      This may very well be the perfect comment. 😀

  • tsm

    so, we had my son’s released at three months because he couldn’t stick
    his tongue out– his tongue looked somewhere between heart-shaped and
    forked– and the pedi said it would almost certainly cause speech issues
    later in life. oddly, he didn’t have problems breastfeeding–quite the
    opposite, he liked to eat so much he would overfill and (cheerfully)
    spit up, and i never had the hint of a sore nipple, from day 1 on. so i
    wonder how much tongue ties *actually* affect b/f. my daughter has a
    perfect frenulum, and little miss gave me raw nipples the first two
    weeks (and still does, sometimes). So…I feel like some of the tongue-tie anxiety is b/s.

    • tsm

      on the other end of things, a friend of mine with chronically low supply is now on her second baby, and has had both of their tongues released–on one girl, they re-did the release after it didn’t “take”!–supposedly there were lip ties and such, although they could always stick their tongues out, etc. i think it may just have to do with low supply, but the lactation consultation tells her otherwise. oh, and for people who don’t know–the recovery for a frenotomy isn’t terrible, but it isn’t fun for baby or parents. You have to rub the incision site under their tongue 10-12 times a day so it heals correctly. It’s awful. Now that he’s 3.5 and can stick his tongue out (ice cream! popsicles! making faces at mommy!) and talk like a champ I’m glad we did it…but yeah. Awful.

  • Mel

    We’ve been feeding calves on the farm for decades. The number of calves who have an actual anatomical problem that prevents feeding is less than 1 per 1,000 births or 0.01%.

    Now, over 50% are horrific at feeding at first. They don’t know how to correctly shape their tongue around the nipple. They feel that their snout should point down towards the ground while attached to a bottle. They feel the nipple should point out of their mouth. Calves are born nose-first, so if the delivery was slow, it’s not uncommon for the roof of the mouth to be swollen which messes with their ability to extract milk. That passes in a day or two and if the calf is visibly hungry but can’t feed, we can give them a tube feeding until the swelling goes down. Plus, unlike human babies, calves are born with an instinct to stand while feeding. This means that a calf whose legs are weak at birth (called “knuckling over” because they stand on their pasterns instead of the hooves) can be so focused on trying to stand that they can’t focus on feeding at the same time.

    So, making an assumption, there are probably a lot of human babies who need a few days….or a week…..to figure out that whole nursing thing. I’m also going to assume that since calves will attempt to get milk out of anything that is at all similar to a nipple that a human baby might need to feed from the easier bottle than a breast at first.

    Point of interest – we’ve never needed to do surgery to get a calf to feed….so I’m guessing that other-wise visibly healthy tongue-tied babies are around, but really rare. Our calves with anatomical problems that make feeding harder generally have other issues – issues that are generally incompatible with a long, healthy cow life…..

    • Tiffany Aching

      But those calves surely live in a culture that bashes breastfeeding and denies female’s amazing abilities. I see no other explanation at their difficulty to grasp the amazingly perfect and natural act of latching.

    • Annie Schimpff VerSteeg Ibclc

      Any of the calves ever die or need artificial feeding? At what day are they weaned?