New Cochrane Review shows that cutting tongue-ties does not improve breastfeeding

IMG_2179

I’ve written before that we’re in the midst of a curious epidemic of “broken” baby tongues.

Lactivists insist that women are mammals and mammals are “designed” for breastfeeding. They insist that breastmilk is the perfect food. They appear to believe that there is no such thing as not enough breastmilk. Simply put, no woman’s breasts are ever “broken”; if there’s a problem with breastfeeding it must be because … the baby’s tongue is broken (tongue-tie or ankyloglossia).

Should you really cut your baby’s tongue when bottles of pumped breastmilk or formula may solve the problem with far less pain?

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.

That has been confirmed in a variety of papers, but now The Cochrane Review has weighed in and they find that cutting babies’ tongues does not improve their ability to breastfeed.

Randomised, quasi-randomised controlled trials or cluster-randomised trials that compared frenotomy versus no frenotomy or freno- tomy versus sham procedure in newborn infants.

What did they find?

Five randomised trials met our inclusion criteria (n = 302). Three studies objectively measured infant breastfeeding using standardised assessment tools. Pooled analysis of two studies (n = 155) showed no change on a 10-point feeding scale following frenotomy (mean difference (MD) -0.1, 95% confidence interval (CI) -0.6 to 0.5 units on a 10-point feeding scale). A third study (n = 58) showed objective improvement on a 12-point feeding scale (MD 3.5, 95% CI 3.1 to 4.0 units of a 12-point feeding scale)… No study was able to report whether frenotomy led to long-term successful breastfeeding.

Yet frenotomy has become a big business.

Consider this study in British Columbia, Temporal trends in ankyloglossia and frenotomy in British Columbia, Canada, 2004-2013: a population-based study.

The population incidence of ankyloglossia increased by 70% (rate ratio 1.70, 95% confidence interval [CI] 1.44-2.01), from 5.0 per 1000 live births in 2004 to 8.4 per 1000 in 2013. During the same period, the population rate of frenotomy increased by 89% (95% CI 52%-134%), from 2.8 per 1000 live births in 2004 to 5.3 per 1000 in 2013. The 2 regional health authorities with the lowest population rates of frenotomy (1.5 and 1.8 per 1000 live births) had the lowest rates of ankyloglossia and the lowest rates of frenotomy among cases with ankyloglossia, whereas the 2 regional health authorities with the highest population rates of frenotomy (5.2 and 5.3 per 1000 live births) had high rates of ankyloglossia and the highest rates of frenotomy among cases of ankyloglossia.

They concluded:

Population rates of frenotomy in British Columbia exhibited a substantial spatial variation by regional health authority, as did rates of frenotomy among cases of ankyloglossia. This is concerning insofar as it reflects arbitrariness with regard to the diagnosis of ankyloglossia and in the use of a potentially unnecessary surgical procedure among newborns. The controversy with regard to the use of frenotomy has been framed as a conflict between lactation nurses, breastfeeding support groups and mothers who have experienced difficulties in breastfeeding versus pediatricians who are focused on the evidence for the efficacy of frenotomy. The latter position is also informed by a culture that has increasingly rejected minor surgical intervention (e.g., tonsillectomy, ear tubes) for babies and children with the understanding that most conditions improve spontaneously.

In other words, breastfeeding advocates are increasingly insisting that breastfeeding difficulties are due to tongue-tie and can be cured with painful surgery on babies while pediatricians can’t find evidence that such surgery actually works.

Mothers should be extremely dubious about any surgery recommended by the lactation industry. Instead of acknowledging that pain in breastfeeding is distressingly common and that breastfeeding may not be right for every mother and every infant, babies are being cut on the theory that breastfeeding is always perfect and, therefore, it is babies who are “broken.”

Only further research will answer these questions definitively, but until then mothers should seek second opinions on tongue tie surgery from someone other than lactation consultants and the doctors who perform the surgery.

Mothers should ask themselves if the benefits of breastfeeding outweigh the risks of surgery:

Should you really cut your baby’s tongue when bottles of pumped breastmilk or formula may solve the problem with far less pain?

  • mamajb

    Long-term effects of breastfeeding
    A SYSTEMATIC REVIEW

    “Building upon the strong evidence on the short-term effects of breastfeeding, the present review addresses its long-term consequences. Current evidence, mostly from HIGH INCOME COUNTRIES, suggests that occurrence of non-communicable diseases may be programmed by exposures occurring during
    gestation or in the first years of life (5–7). Early diets, including the type of milk received, is one of the key exposures that may influence the development of adult diseases.”

    http://apps.who.int/iris/bitstream/10665/79198/1/9789241505307_eng.pdf?ua=1

    • Nick Sanders

      That’s the preamble, not the conclusion. This, however, is from the actual conclusion:

      Because the meta-analyses are almost exclusively based on observational studies (see Chapter 2), the possibility of self-selection and residual confounding must be considered. Even when multiple studies show similar results, these studies may largely be subject to the same biases. In particular, most studies are derived from high-income settings where breastfeeding is more common among highly-educated, better-o mothers who are more health conscious, and whose o spring may be less likely to su er from the negative outcomes covered in the present review. The fact that estimates from high-quality studies, with tighter control of confounding, are less marked than those from all studies suggests that this may be the case.

      As is this:

      Interpreting the results of the present meta-analyses jointly with those of the two randomized trials, our conclusions are outlined below.

      Total cholesterol. There was no effect in the overall meta-analyses. In the 2007 review, there was a significant e ect among adults, which is no longer present in the updated analyses. The UK trial of preterm infants showed a small protective effect (3), while the Belarus trial did not report on this outcome. We conclude that breastfeeding does not seem to protect against total cholesterol levels.

      Blood pressure. The pooled estimate from the high-quality studies indicates a small reduction of less than 1 mmHg in systolic pressure among breastfed subjects, and no significant protection in terms of diastolic pressure. Residual confounding may be an important problem. The Belarus and UK preterm trials found no effect of breastfeeding (2,4). We conclude that the protective effect of breast- feeding, if any, is too small to be of public health significance.

      Diabetes. There was substantial protection in the pooled analyses, with a 34% reduction, but few studies are available and their results were considerably heterogeneous. Only two high-quality studies were identified, with conflicting results (one showing an increase and another a reduction among breastfed subjects). The randomized trials did not present any results on these outcomes. Our conclusion is that further studies are needed on this outcome.

      Overweight-obesity. In the pooled analyses of all studies, breastfeeding was associated with a 24% reduction in overweight and/or obesity, but the reduction was only 12% in the high-quality studies. Residual confounding may be still a ecting these results, because protection is not evident in studies from low and middle-income countries where the social patterning of breastfeeding is not clear cut. The Belarus trial did not nd an association (4). We conclude that breastfeeding may provide some protection against overweight or obesity, but residual confounding cannot be ruled out.

      Intelligence tests. Breastfeeding was associated with an increase in 3.5 points in normalized test scores in the pooled analyses of all studies, and 2.2 points when only the high-quality studies are in- cluded. The two randomized trials also found significant effects (1,5). We conclude that there is strong evidence of a causal effect of breastfeeding on IQ, although the magnitude of this effect seems to be modest.

      Emphasis mine.

      • Sarah

        Oh schnapp.

  • mamajb

    AND…
    Supplementary Feedings in the Healthy
    Term Breastfed Neonate, Revised 2017
    http://www.bfmed.org/Media/Files/Protocols/Protocol%203%20Supplementation%20English%20Version.pdf

    • Nick Sanders

      I cannot possibly take seriously anything that lists “Mother needs to rest or sleep” as a “risk of decreasing breastfeeding duration or exclusivity.” Anyone who could say that with a straight face has their head so far up their ass that they haven’t seen daylight in years.

      • Bombshellrisa

        Oh my pesky need to separate my child from my nipples so I can, you know, go to the bathroom or eat something.

        • Dr Kitty

          Our new disciplinary techique for our son involves a variation on “the naughty step”.
          We close the gates at the top and bottom of the stairs, sit him on the third step, tell him he’s naughty and leave him for 90 seconds.

          So far he’s taking it as a time trial for how many times he can go up and down the stairs and doesn’t seem at all bothered.

          However, it does allow us to us the bathroom, make tea and all the other necessities of life.

          • Who?

            And wears him out a little. It is amazing what you can achieve in 90 seconds, when sufficiently motivated.

      • myrewyn

        I wish some of the lactivists could see the force a mare uses to prevent her foal from nursing when she feels like doing something else for a while. Somehow the foals turn out fine.

        • Azuran

          ugh, all those hours I spent manually expressing milk from stupid, dangerous, badly raised mares during my horse rotation at school.
          Every freaking 2 hours………..Horses are just the worst.

          • myrewyn

            Horses pretty universally hate being milked. I’ve never met a mare who stands nicely for it. Well we milked a dead mare once — that was ok.

    • Who?

      What are the risks of ‘unnecessary supplementation’. And how is ‘unnecessary’ defined?

      • Nick Sanders

        The risk is the baby won’t be exclusively breast fed, and “unnecessary” is defined as “any supplementation where the mother isn’t dead with no wet nurses or milkbanks within one day’s flight by Concorde jet.”

        • Who?

          Pretty much what I thought then.

          Though surely ‘privately chartered Concorde jet’ should be specified, because if you’re not prepared to go hard to get breastmilk, then you’re just not trying.

          But that does lead to my follow up, about milk bank milk: if breast milk is made just for the baby, how is milk bank milk superior to formula? Apart from tiny dots who do seem to benefit from it.

      • mamajb

        I hope this will explain it much better than I can.

        http://drjaygordon.com/breastfeeding/supplement.html

        Written by [practicing] Dr. J. Gordon, FAAP, Dr. Gordon took a Senior Fellowship in Pediatric Nutrition at Sloan-Kettering Institute, and joined the teaching attending faculty at UCLA Medical Center and Cedars-Sinai Medical Center. In addition to his pediatric practice, he participates in the training of medical students and residents, and lectures all over the world

        This, I hope, can answer your second question. Please read down to the information on when supplementation is NOT indicated also:

        Academy of Breastfeeding Medicine Protocol
        http://www.bfmed.org/Media/Files/Protocols/Protocol%203%20English%20Supplementation.pdf

        POSSIBLE INDICATIONS FOR SUPPLEMENTATION IN TERM, HEALTHY INFANTS

        1. Infant indications
        a. Asymptomatic hypoglycemia documented by laboratory blood glucose measurement (not bedside screening
        methods) that is unresponsive to appropriate frequent breastfeeding. Symptomatic infants should be treated with
        intravenous glucose. (Please see ABM Hypoglycemia Protocol for more details)
        b. Clinical and laboratory evidence of significant dehydration (e.g., 10% weight loss, high sodium, poor feeding, lethargy, etc.) that is not improved after skilled assessment and proper management of breastfeeding
        c. Weight loss of 8–10% accompanied by delayed lactogenesis II (day 5 [120 hours] or later)
        d. Delayed bowel movements or continued meconium stools on day 5 (120 hours)
        e. Insufficient intake despite an adequate milk supply (poor milk transfer)
        f. Hyperbilirubinemia
        i. “Neonatal” jaundice associated with starvation where breastmilk intake is poor despite appropriate
        intervention (please see ABM Jaundice in the Breastfed Infant Protocol)
        ii. Breastmilk jaundice when levels reach 20–25 mg/dL (mol/L) in an otherwise thriving infant and where a
        diagnostic and/or therapeutic interruption of breastfeeding may be helpful
        g. When macronutrient supplementation is indicated

        2. Maternal indications
        a. Delayed lactogenesis II (day 3–5 or later [72–120 hours] and inadequate intake by the infant34
        i. Retained placenta (lactogenesis probably will occur after placental fragments are removed)
        ii. Sheehan’s syndrome (postpartum hemorrhage followed by absence of lactogenesis)
        iii. Primary glandular insufficiency, occurs in less than 5% of women (primary lactation failure), as evidenced by
        poor breast growth during pregnancy and minimal indications of lactogenesis
        b. Breast pathology or prior breast surgery resulting in poor milk production36
        c. Intolerable pain during feedings unrelieved by interventions

        Supplementation is NOT INDICATED, including:
        1. The sleepy infant with fewer than eight to 12 feedings in the first 24–48 hours with less than 7% weight loss and
        no signs of illness
        • Newborns are normally sleepy after an initial approximately 2-hour alert period after birth.27,28 They then have variable sleep–wake cycles, with an additional one or two wakeful periods in the next 10 hours whether
        fed or not.27
        • Careful attention to an infant’s early feeding cues, and
        gently rousing the infant to attempt breastfeeding every
        2–3 hours is more appropriate than automatic supplementation after 6, 8, 12, or even 24 hours.
        • The general rule in the first week is: “an awake baby is
        a hungry baby!”
        • Increased skin-on-skin time can encourage more frequent feeding.
        2. The healthy, term, appropriate for gestational age infant with bilirubin levels less than 18 mg/dL ( mol/L) after 72 hours of age when the baby is feeding well and stooling adequately and weight loss is less than 7%29
        3. The infant who is fussy at night or constantly feeding for several hours
        4. The tired or sleeping mother

        • myrewyn

          I don’t think you’ll find that Jay Gordon needs an introduction here.

          • Amazed

            Hehe, you’ve made it to his glorious participation in old threads, haven’t you? I regret to say we do know him quite well. Oh, and Dr Daniel Busy Flanders as well! I know you were around for this one.

          • Sarah

            He participated in old threads? Why have I not seen these? Someone link me, quickly!

          • Amazed

            It was in some of the old vaccine threads. Or perhaps breastfeeding threads. I can’t remember right now but I’m quite sure it was one or the other.

            I’m currently thinking of a man whose name resembles Gordon’s a bit. Fingers crossed for Turkey!

          • The Bofa on the Sofa

            Gordon used to pop in at Respectful Insolence in the past. In my interactions with him, I’ve come to regard him as a joke. Nothing he says is worth anything but a laugh.

          • Amazed

            I’ve seen him there as well and he terrifies me. He and Sears, both responsible for a death/epidemics, and still practicing. What the hell?

        • Who?

          Oh yes, Dr Gordon is well known to many here. He also is an anti-vax (or to spare his blushes, pro safe vax) campaigner and seller of alternative vax schedules, for which he takes payment in cash.

          Oh, and one ‘practises’ medicine, not ‘practices’.

          So now we have Dr G’s bona fides worked out.

          I don’t believe either list addresses the so-called risks of unnecessary supplementation, though I do note the possible indications and definite non-indications.

        • Amy Tuteur, MD

          Jay Gordon is an anti-vax quack.

          You are a perfect example of what is wrong with lactation consultants. You have no idea what the depth and breadth of the scientific literature shows; you only know what other lactation consultants have told you. As a result you spread harmful misinformation. The truth is that the short term benefits of breastfeeding in industrialized countries are trivial, the long term benefits are non-existent and the moralizing of breastfeed has nothing to do with its purported benefits and everything to With the monetization of breastfeeding support and products. Most of what passes for “knowledge” among lactation consultants is faulty marketing claims.

          The crap about the microbiome is typical. Do you know that infants raised in households with pets have a different microbiome than those raised without pets? That is just one indication that the infant microbiome is influenced by environment as much or more than by what a baby eats.

        • Amazed

          Dr Gordon? The very same one who cheered Christine Maggiore on when the loon breastfed her poor baby despite being HIV? This Dr Gordon?

          Of course, I am not even talking about his others quack qualifications that are well known to all us regulars here.

          It doesn’t reflect well on you to keep him as authority, mamajb. Who comes next? Andrew Fakefield?

          • Who?

            And now the reference to him has been mysteriously removed.

            I wonder if any of mamajb’s other words will quietly disappear?

          • Amazed

            I can still see it but it’s now awaiting moderatin.

            Weird.

          • myrewyn

            It’s “awaiting moderation” for me too. Does that mean someone flagged it?

          • AnnaPDE

            What a pity, because now I can’t reply to her directly.
            And I did want to point out that the “non-indications” in the last paragraph are a clear sign of how the mother’s and baby’s well-being is of absolutely zero priority in this whole protocol. Which is why it is total and utter bullshit, created by cruel, empathy-free idiots in order to push their pet ideology.
            Oh, and quack Gordon can fuck right off.

          • BeatriceC

            I haven’t refreshed the page in a few hours, so it’s still there for me. I screen capped it just for funsies.

          • Who?

            It was briefly removed, I think, then awaiting moderation when I got back. Screen caps are good.

    • maidmarian555

      It’s interesting that it claims that a Cochrane review supports rooming-in for new mums as apparently separating them from their babies will reduce breastfeeding rates. The actual conclusion drawn was that there is insufficient evidence to support (or indeed refute) this and that some decent trials need to be done. And frankly, it’s pretty curious that decent trials haven’t been done since the BFHI has been around for over 20 years insisting that mums aren’t allowed any sleep because breastfeeding…..

      http://www.cochrane.org/CD006641/PREG_rooming-new-mother-and-infant-versus-separate-care-increasing-duration-breastfeeding

  • mamajb
  • mamajb
    • Azuran

      PLEASE, all of those studies can be resumed by: breastfeeding vs formula feeding can change the mibrobiome, but we basically know nothing about the role of microbiome so we have no idea if it really means anything.
      Basically, we need more research.
      But seeing as no one is able to reliably tell who is breastfeed and who is not, the benefits are unlikely to be that extraordinary.
      Not everything that is statistically significant is also clinically significant.

      • mamajb

        I beg to differ. Actually we know quite a lot about our microbiome – especially when it comes to birth and breastfeeding. The project was launched back in 2008.
        That is not to say that there is much more to be learned.
        You may be interested in learning about what we do know:
        “Vaginal delivery and breastfeeding are evolutionarily adaptive for mammals and therefore are paramount to human newborn development and health. Common perinatal interventions like C-section, antibiotic use, and formula feeding alter the infant microbiome and may be major factors shaping a new microbiome”
        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464665/

        or you can watch…..
        https://www.youtube.com/watch?v=02GjzCMsiyg
        https://www.youtube.com/watch?v=edavYOlXCTI
        https://www.youtube.com/watch?v=iNdoxwLttKs
        https://www.youtube.com/watch?v=Zp_r6iV0V3A
        https://www.youtube.com/watch?v=o2XjA4wA4TI

        I know Dr. Amy has stated that the way we give birth doesn’t matter but, in reality, it does. You may want to check out an award winning documentary Microbirth. http://microbirth.com/the-film/

        • Who?

          Two things:

          Why assume the ‘natural’ microbiome ie vaginal delivery and breastfed baby, is superior.

          And: at what point does a cs to save someone’s life or brain, or formula supplementation rather than starvation or low calorie intake, become a fair choice?

          • mamajb

            I don’t assume anything. I was simply providing you with what is currently known via research.

            A medically necessary cesarean section, and medically necessary formula supplementation or feeding is ALWAYS a fair choice in the instance of saving lives. You know that!
            The issue is that about 50% of cesareans are considered to be medically unnecessary.
            http://www.huffingtonpost.com/2015/04/14/c-section-rate-recommendation_n_7058954.html

            http://www.consumerreports.org/doctors-hospitals/your-biggest-c-section-risk-may-be-your-hospital/

            Cesarean section is MAJOR ABDOMINAL SURGERY – with the associated, well documented, risks. Cesarean delivery is the most commonly performed major surgery in the United States! There are safe ways women can reduce the risks of having unnecessary cesareans.
            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3548444/

            According to new research published in the September issue of Obstetrics & Gynecology, the estimated maternal mortality rate for nearly all of the 48 states included in the analysis increased from 2000 to 2014.
            “Clearly at a time when the World Health Organization reports that 157 of 183 countries studied had decreases in maternal mortality between 2000 and 2013, the U.S. maternal mortality rate is moving in the wrong direction,” they state.

          • Who?

            If you don’t assume the microbiome from vaginal delivery and exclusive breast feeding is better, then why push either? Surely what suits mother best is the best?

            You’ve talked a bit over the last few days about breastmilk being perfect food, whatever you mean by that. How does that square with your view in this post that the outcome of exclusive breastfeeding, microbiome-wise, may not be better, just different?

          • Nick Sanders

            A baby transversing your vagina is a MAJOR PHYSIOLOGICAL EVENT – with the associated, well documented, risks.

          • Who?

            Is that what we call an inconvenient truth, do you think?

          • moto_librarian

            Just shut up. I don’t want to hear another fucking word about the “risks” of c-sections unless you are willing to also talk about the very real risks of vaginal birth. I’m feeling grouchy today because I’m really getting tired of dealing with bowel urgency/incontinence related to a rectocele and nerve damage caused by my totally natural childbirth. General anesthesia is riskier than a spinal, but that’s what I’ll be having when I have my repair done once I figure out when I can actually take off the 8 weeks from work required to heal from the surgery. In the meantime, I have to splint ever time I need to move my bowels, and carry baby wipes in my purse to clean up. This was from delivering a 6 lb., 4 oz., baby almost 8 years ago. If I had know that I would be dealing with this now, you bet your ass I would have had an elective c-section.

        • Azuran

          Damn, I guess I should have just let my baby stay stuck in my uterus until she died of infection due to my ruptured membrane. How can she ever have a normal life after being born by c-section, me getting antibiotics and her being combo fed until I had enough milk.

          Until you point to anyone who is able to tell me with any kind of reliability if a baby was born by c-section or received formula, then I stand my ground that it doesn’t matter enough to care about.

          • mamajb

            Are you serious???? Let your baby die because of uterine infection????
            Optimal birth is the birth that saves lives. One has to weigh risks and benefits in every situation.
            I don’t get the quarrelsome vibe on this site. I thought it was to share information.
            As I told “Who?”:
            A medically necessary cesarean section, and medically necessary formula supplementation or feeding is ALWAYS a fair choice in the instance of saving lives. You know that!
            The issue is that about 50% of cesareans are considered to be medically unnecessary.
            http://www.huffingtonpost.c

          • Azuran

            Man, you really suck a getting sarcasm.

            So, tell me, which 50% of cesareans are the unnecessary ones, which ones shouldn’t have been done? It’s entirely possible that if my OB had decided to try the forceps more than once, or tried the vacuum, he might have been able to pull my baby out. So was my c-section unnecessary?

            That’s the point, you CANT tell. We don’t have the tools to know. When you are faced with a risk of death or permanent damage, most people will chose a c-section. If you told 100 women they had a 1% chance of their baby dying if they tried vaginal birth, a large proportion of them would ask for a c-section. You could argue that only one of them ‘needed’ the c-section, but you don’t know which one it is. So when a c-section becomes safer than a vaginal birth, the proper thing to do is to recommend a c-section. Even if serious complications are unlikely.
            Same with formula supplementation. You’ll never know IF your baby absolutely needs supplementation until it has suffered damage. Considering the basically 0 risk of supplementing (which some studies even showed can raise the breastfeeding rate) it makes sense to recommend supplementation before a baby gets sick.

            Yea, it’s major abdominal surgery, I know, I’m still recuperating from mine. But: How many ‘unnecessary’ c-section is the life of 1 baby worth?

            The problem we have with you is that you are making argument that have no bearing in the real world.
            It’s useless to worry about the effect of c-sections on the microbiome when we don’t have a safe way to reduce the number of c-section.
            It’s equally as useless and hurtful to worry about the effect of formula on the microbiome considering that the effect of the microbiome are not well known and there is little that can really be done to raise the breastfeeding rate.

          • Who?

            As I kindly omitted to say the first time you put up the sad old trope about unnecessary cs, the fact is no one knows with any certainty what is unnecessary until it’s over. CS is a way to avoid possible or likely trouble. A CS rate that reflected CS done only when there is the absolute certainty of danger would lead to more dead and damaged mothers and babies.

            Which you at least have the grace to say would be a bad thing, unlike many who push vaginal birth and breastfeeding as ‘always best’.

          • Dr Kitty

            And?
            What if the woman prefers a medically unnecessary CS to a difficult labour and the kind of emergencies required to “prove” the necessity of a CS?

            That was my decision, to have two, planned pre labour CS with a predictable rate of predictable complications and the best chance of having two neurologically and physically intact children and an intact pelvic floor.

            I didn’t want to roll the dice.
            I didn’t want to experience labour, didn’t want to damage my genitals pushing a baby through my vagina, didn’t want multiple VEs in labour.

            So I didn’t have them. Maybe the CS were unnecessary- don’t know, don’t care. They were what I wanted.

          • Amazed

            Who told you that 50% of caesareans are unnecessary? An authority equal to Dr Gordon? Perhaps Dr Biter?

            Fuck HP, BTW. I am not surprised you’re so grossly deluded if you think reading HP is equal to “doing your own research”.

          • Sarah

            Her homeopath.

      • Empress of the Iguana People

        center4research? Does that strike anyone else as rather unprofessional?

  • mamajb

    This is the Authors Conclusion from the Cochrane Review – read it yourself:
    http://www.cochrane.org/CD011065/NEONATAL_surgical-release-tongue-tie-treatment-tongue-tie-young-babies

    “Authors’ conclusions:
    Frenotomy reduced breastfeeding mothers’ nipple pain in the short term.

    Investigators did not find a consistent positive effect on infant breastfeeding. Researchers reported no serious complications, but the total number of infants studied was small. The small number of trials along with methodological shortcomings limits the certainty of these findings.

    Further randomised controlled trials of high methodological quality are necessary to determine the effects of frenotomy.”

    This is MUCH DIFFERENT than what you are reporting Dr. Tuteur.

    My experience as a consultant — very few babies have a short enough frenulum to cause breastfeeding issues but those that do and have had it clipped suddenly nurse pain free. This is a boon to the mother that keeps her breastfeeding pain free. Another issue with a short frenulum, that is not treated, is speech pathology later on.

    • Amy Tuteur, MD

      You can eliminate maternal pain without causing the baby to suffer pain; it’s called bottle feeding.

      • mamajb

        You have stated that “Breastmilk is NOT the perfect food” – I am assuming you meant for human babies. I would love to see the research that states that cow milk based formula is superior to human milk for human babies.

        • Nick Sanders

          Why? How good formula is has no bearing on breastmilk being perfect or not.

          • mamajb

            Nick, my question was for Dr. Amy.
            Since research began on the qualities and components of breastmilk decades ago, it was found that human milk IS the perfect food for human babies. We know that formula does not compare. Yes, nutritionally, it passes the test but not for: Antibodies, Anti-Cancer (HAMLET), Growth Factors, Enzymes, Disease Fighting Stem Cells, Hormones, Anti-Viruses, Anti- Allergies, Anti-Parasites and more (according to every health organization in the world).
            I will await seeing the research that says it is not.

          • Who?

            Your claim is yours to prove. I await your studies with interest.

          • mamajb

            Do your own. You might learn something.

          • Sarah

            Well we aren’t learning anything from what you’re posting, that’s for good and certain.

          • momofone

            Please link us to your studies. We would be happy to read them.

          • mamajb

            I have been. Your not.

          • momofone

            Oh, I’m sorry. You said YOUR research, so I assumed you meant you had conducted the studies. You just meant you’ve read OTHER people’s research.

          • mamajb

            No, I am not a researcher. And I didn’t mean anything personal when I said “Your not”. I was referring to the group as a whole. I have provided a bunch of links to recent research here. If you are really interested, scroll through. You should find the links.

          • Heidi

            Huh, well breast milk has performed pretty poorly in developing countries where breastfeeding rates are the highest. These are countries with the highest infant and child mortality rates.

          • mamajb

            Heidi,
            Have you actually followed the World Health Organizations annual list of Maternal and Infant mortality rates? The United States is at the bottom for industrialized countries. It is not breastmilk that kills babies in these countries it is famine, disease and war. How can a dirt poor starving mother going to afford formula for one thing, and how can she mix it with dirty water??? TAKE A LOOK YOURSELF: https://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate

            Out of 225 world countries, the US ranks 169. There are 56 countries that are doing better than us. They are (in order of worst to best: United States, BOSNIA AND HERZEGOVINA, FAROE ISLANDS, GUAM, LATVIA, NEW CALEDONIA, NORTHERN MARIANA ISLANDS, SLOVAKIA, HUNGARY, FRENCH POLYNESIA, CANADA, GREECE, CUBA, POLAND, NEW ZEALAND, WALLIS AND FUTUNA, PORTUGAL, TAIWAN, SAN MARINO, AUSTRALIA, LIECHTENSTEIN, UNITED KINGDOM, ISLE OF MAN, EUROPEAN UNION, DENMARK, SLOVENIA, LITHUANIA, JERSEY, ESTONIA , IRELAND, SWITZERLAND, BELARUS, ANDORRA, NETHERLANDS, MALTA, ISRAEL, GERMANY, GUERNSEY, BELGIUM, ANGUILLA. AUSTRIA, LUXEMBOURG, ITALY, FRANCE, SPAIN, MACAU, KOREA, SOUTH, HONG KONG, CZECHIA, SWEDEN, BERMUDA, FINLAND, NORWAY, SINGAPORE, ICELAND, JAPAN, MONACO.
            https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html
            Despite being the richest country, I personally think it is unconscionable not to be in the #1 spot.
            Increased sustained breastfeeding rates could make a difference in all countries. And indeed, it does.
            UNICEF:
            “Proper feeding of infants and young children can increase their chances of survival. It can also promote optimal growth and development, especially in the critical window from birth to 2 years of age. Ideally, infants should be breastfed within one hour of birth, breastfed exclusively for the first six months of life and continue to be breastfed up to 2 years of age and beyond.”

            But, you have a computer, you can do your own research.

          • Azuran

            And the point is: If breastfeeding was as magical as you are saying, with all it’s ‘Antibodies, Anti-Cancer (HAMLET), Growth Factors, Enzymes, Disease
            Fighting Stem Cells, Hormones, Anti-Viruses, Anti- Allergies,
            Anti-Parasites and more’ Why are all these babies in the developing world still dying?
            The answer is simple: Because while it does have some benefits, they are far from as great as you claim and it’s not perfect. Meaning that many infants will die because their mothers are unable to breastfeed, or will get infection that breast milk couldn’t protect them against etc.

            Of course, breastfeeding is best when you don’t have access to clean water to make formula. No one is saying the opposite.
            But in first world country, where we have clean water, high quality food, proper sanitation, vaccination and great medical care, the effects of breastmilk are negligible. You can look up the variation in breastfeeding rates and infant mortality, you’ll see that there isn’t even a correlation.

          • mamajb

            There is nothing “magical” about breastmilk. It is simply species specific. You can do your own research but to save you some time and trouble, you might want to look at my comments to myrewyn and Heidi.

          • Azuran

            I have already looked at a lot of research and I’ve come to the conclusion that while breastfeeding can be awesome and does have some very small short term benefits. It’s really nothing special and in the long run will basically have no real significance in anyone’s life.

          • Heidi

            You’re dumb. I didn’t say breast milk killed.

            I’m not going to bother to repeat Azuran.

          • Heidi

            The EU isn’t a country. Not sure where you got your copy and paste from. You can do you’re research, though.

          • mamajb

            https://www.cia.gov/library… The link was at the end of my post.
            But you can find the same info on the World Health Organization site.

          • myrewyn

            Sooo, infants in poor countries are dying of famine, DISEASE, and war, despite a near 100% rate of being fed breast milk with all the anti disease properties you listed previously?

          • moto_librarian

            So prove to me that infants in the developed world are dying because they aren’t being breastfed. Give me specific diseases that could be prevented only by breastfeeding, not by vaccines.

          • Daleth

            Have you actually followed the World Health Organizations annual list of Maternal and Infant mortality rates? The United States is at the bottom for industrialized countries.

            Infant mortality has nothing to do with the safety of childbirth. Infant mortality measures deaths in the first year of life from all causes: SIDS, child abuse, car accidents, house fires, pertussis, etc.

            If you want to look at the safety of childbirth, look at the neonatal and perinatal mortality rates (deaths of newborns and of babies during labor). The US is among the best in the world on those numbers.

          • myrewyn

            Anti… parasite??

          • mamajb

            Yes, http://www.sciencedirect.com/science/article/pii/S2221169115300319
            “..in view of the overall nutritional and immunological impact of parasitic infections in the growing child, it is well to appreciate that there are fundamental differences in the composition of breast milk compared to formula milk contributing to a broad-based immune-nutritive anti-parasitic capacity. The high quality and efficiency of proteins in human milk of a well nourished mother are gold standards in infant feeding.”

            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3588117/
            “The most important conclusion of this study was that parasite-specific breast milk IgA was associated with protection of infants from E. histolytica and Cryptosporidium species infection. Our findings are consistent with passive immunity being transferred via breast milk IgA.
            … subsequent promotion of breastfeeding may be one way to protect infants in low-income countries from Cryptosporidium species and E. histolytica infection, and thereby reduce the global burden of diarrheal disease.”

            You have a computer, do your own research.

          • Nick Sanders

            Yeah, that means a whole hell of a lot in a first-world country…

          • Wasnomofear

            Did they consider that some, or all, of those parasites are environmental​? Like, formula, or rice cereal, being mixed with questionable water? Personally, I believe we should fix the water problem before pushing breastfeeding, when the majority of them are only using formula because breastfeeding didn’t work for them. Plus, then the whole population gets clean water, so everyone wins!

          • Azuran

            I think you missed the part where it said: Low-income country.
            Parasitic infection of babies isn’t a concern where I live since we have clean water.

          • Azuran

            Anti-parasites? Well I guess that cats didn’t get the memo since kitten are actually contaminated by parasites that their mother give them through their milk. And virtually ALL stray kitten will have parasites despite a 100% of them being fed their mother’s milk.
            Or is human milk the only perfect milk?

          • mamajb

            Cats????
            This is about human milk properties.
            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3588117/ Just one of many studies on the subject.
            No, human milk is not magic, it is not anti-parasitic for ALL parasites (as this particular study points out). BU/t, it is considered anti-parasitic.

          • Azuran

            And you think that humans are somehow special?
            Cat milk is just as ‘perfect’ for kittens as human milk is for human.

          • Nick Sanders

            I don’t care your question was “for”, you posted it in a public space, it’s up for grabs. Again, the quality of formula is completely unrelated to whether or not breastmilk is perfect.

            And for the record, it’s not. To quote the CDC:
            “breast milk alone does not provide infants with an adequate intake of vitamin D.”
            https://www.cdc.gov/breastfeeding/recommendations/vitamin_d.htm

          • mamajb

            Breastmilk has always been low in vit. D. That is because we used to get our vit. D from sun exposure – for millions of years.
            Now,we tend to keep out of the sun and use sunscreen. Therefore, the American Academy of Pediatrics recommends that all babies receive routine vitamin D supplementation (400 IU per day) due to decreased sunlight. The NIH recommends vit D supplements for ALL adults. Are you taking yours?
            The recommended daily allowance (RDA) is 600 IU for those 1-70 years of age and pregnant or breastfeeding women, and 800 IU for those over 71 years of age. An adequate blood level of vitamin D is 20 nanograms per milliliter, which can be achieved through daily skin exposure to sunlight.

            Factors that put your breastfed baby at risk for vitamin D deficiency (rickets) are:

            Baby has very little exposure to sunlight. For example: if you live in a far northern latitude, if you live in an urban area where tall buildings and pollution block sunlight, if baby is always completely covered and kept out of the sun, if baby is always inside during the day, or if you always apply high-SPF sunscreen.
            Both mother and baby have darker skin and thus require more sun exposure to generate an adequate amount of vitamin D. Again, this is a “not enough sunlight” issue – the darker your skin pigmentation, the greater the amount of sun exposure needed. There is not much information available on how much more sunlight is needed if you have medium or darker toned skin.
            Mother is deficient in vitamin D – there is increasing evidence in the last few years indicating that vitamin D deficiency is becoming more common in western countries. The amount of vitamin D in breastmilk depends upon mom’s vitamin D status. If baby gets enough sunlight, mom’s deficiency is unlikely to be a problem for baby. However, if baby is not producing enough vitamin D from sunlight exposure, then breastmilk will need to meet a larger percentage of baby’s vitamin D needs. If mom has minimal exposure to sunlight (see above examples) and is not consuming enough foods or supplements containing vitamin D, then she may be vitamin D deficient.

          • Nick Sanders

            And? I pointed out an imperfection, and it only takes one. All the copy-pasting in the world won’t change it.

          • myrewyn

            I like how breast milk can change to magically suit a particular baby through spit backwash, but hasn’t changed in “millions of years” to compensate for our vitamin D deficiency.

          • Sarah

            But it’s still perfect though.

          • KeeperOfTheBooks

            Yes, and for millions of years, assuming we didn’t die of smallpox/getting eaten by the local wildlife/an infected scratch, we got to die from melanoma due to all that lovely sun exposure.
            Me? I think my whiter-than-white self will be much happier in the long term on a Vitamin D supplement than with melanoma. Do note that I exercise outdoors for an hour 5-7 days/week, and live in the subtropics.

          • mamajb

            I take vit D too. I am not out in the sunlight as much as you are. I have nothing against vit. D for babies or adults.

          • Young CC Prof

            What substance in breast milk specifically fights allergies? How do maternal stem cells (not a genetic match to the baby) fight disease? How do the anti-cancer properties of HAMLET compare to BAMLET, found in cow’s milk, and for how long after the cessation of breastfeeding do the effects persist?

            If you’re going to make claims, you need to back them up.

          • mamajb

            Sorry, I am not a bio-chemist. Google any one of your questions (like I would have to) and get enlightened. Regarding BAMLET; it is found in raw cows milk. I hope no one would give an infant raw cows milk.
            HAMLET and BAMLET are affected by pasteurization. I could not find anything on BAMLET being found in infant formula.
            Some benefits of breastmilk end with weaning. However some benefits last a lifetime for both mother and baby.
            I think I have backed up my statements with links quite well – compared to most.
            Everything we have been discussing here is EASILY referenced and accessed on line.
            We don’t need access to a medical library anymore.
            I’m going to call it a day with this.

          • Nick Sanders

            If it’s so easy, you should do it.

          • mamajb

            Nick,
            I have been doing my research for many years. And, I do know a bio-chemist PhD that manages one of our countries biggest human milk banks in CA. So, I asked her about the BAMLET/HAMLET question – you will have to learn what that is on your own or ask Young CC Prof.
            Her response:
            One of the problems with BAMLET is that the results are not as effective as HAMLET. The alpha lactoalbumin is more effective in human milk. Researchers in pharma have been trying the BAMLET with limited results.

          • Nick Sanders
          • Sarah

            You’ve spent years researching and yet can’t answer those simple questions?

          • momofone

            But she knows a PhD!

        • Heidi_storage

          One could argue the superiority of formula; it is fortified with iron and Vitamin D, which are not plentiful in breastmilk. And for some children with severe protein allergies, amino acid formula is unquestionably the better choice.

        • Amy Tuteur, MD

          In order to be the perfect food, it would need to meet 3 criteria:

          1. Nutritionally complete
          2. Available in sufficient quantity
          3. Baby has to be able to access it.

          Breastmilk is NOT nutritionally complete; that’s why babies need vitamin supplements.

          Up to 15% of women don’t make enough breastmilk to fully nourish an infant.

          Infants with hypotonia, clefts and other disorders can’t access the milk.

          The benefits of breastfeeding in first world countries are trivial and it’s not clear how beneficial breastfeeding is in developing countries, either. Sure, it’s superior to formula prepared with contaminated water, but the fact is that many of the countries with the highest infant mortality rates have breastfeeding rates approaching 100%.

          Lactivists like to claim that breastfeeding saves lives, but those claims are based on theoretical models that assume causality. There is no real world data that shows that breastfeeding rates have any impact on infant mortality.

      • mamajb

        You have stated that “Breastmilk is NOT the perfect food” – I am assuming you meant for human babies. I would love to see the research that states that cow milk based formula is superior to human milk for human babies.

        • Empress of the Iguana People

          Don’t be fascitious; there’s no such thing as “perfect” food.

        • Sarah

          You confuse two separate things. It is possible for something not to be the perfect food for a particular group, whilst also being better for that group than another food.

          With that in mind, any research that proved breastmilk was superior to something else would not be evidence that it is perfect.

    • Empress of the Iguana People

      When my son accidently ripped open his tie, nursing hurt me just as bad as before and only bothered him while it was healing.

  • SF Mom & Psychologist

    Not the same, but my daughter had/has an overly attached upper frenulum (inside the upper lip). No effect on feeding, but when she was a baby, this resulted in a HUGE gap between her 2 front teeth (top), as the frenulum was attached all the way down between them. I got consults from 2 pediatric dentists and a ped ENT, and all recommended waiting. The “slick” dentist doing laser surgery was very alarmist and urged me to have it lasered ASAP. Over time, it has receded significantly on its own and no intervention was needed.

    • myrewyn

      Beware the “slick” medical professional…

      • MaineJen

        Worst therapist I’ve ever been to wore a 3 piece suit and had *actual* golf clubs in his consulting room.

  • Melly

    I’m late to the discussion, but my son actually had feeding issues related to tongue tie that improved once clipped.
    The paediatrician diagnosed the tie at birth, but said it wouldn’t need to be clipped unless it caused speech issues.
    I had tons of milk. So much that it felt like I had milk “left over” after every feed. LC said oversupply. He was jaundiced for weeks, LC said it was normal and not that bad. Milk leaked out the side of his mouth and soaked me at every feed. LC said my letdown was too forceful. He only pooped once a week. LC said some babies are like that, aren’t you lucky.
    My son could not coordinate suck-swallow, and no one took me seriously until he lost a full ounce of weight in one week at three months old. I made the decision to switch to bottles, but he couldn’t feed from a bottle either. Took him 10 minutes to drink an ounce.
    The first feed after his tie was clipped was the first time that there was no milk running down his cheek. He gained weight, and my “oversupply” disappeared. When he got chubby and healthy, I realized how sick he’d been.
    I asked the LC why no one told me the tongue tie could have been causing the feeding issues and she said, “Well, they don’t always cause feeding issues, and we don’t want to put ideas into moms’ heads”

    • AnnaPDE

      Yeah, that’s why my pediatrician didn’t tell us about the tie either — except she forgot to tell the midwives/LCs at the hospital about the “see” part of “wait and see”, because when the tie was causing massive pain and feeding problems, they all kept pretending really hard that it didn’t, despite explicit questions and pointing out the almost immobile tongue with frenulum reaching to the tip. When a different pediatrician saw my kid at three weeks (he hadn’t gained an ounce until then) he was pretty shocked by how this tie could have been overlooked, and the pediatric surgeon drove up from his parent’s place the next day to clip the tie, for no cost to us.
      Apparently there had been some conflict between doctors and LCs over who gets to diagnose tongue ties at that hospital, and the LCs were basically banned from even uttering the word. Our doctor later apologised that she hadn’t wanted my kid to get lasered if there wasn’t a good reason. I can understand where she was coming from, but the way she approached it was maximally stupid — our luck was that the “cut everything as deep as possible” super-popular laser dentist was closed over Christmas and New Year, while the hospital-associated specialist surgeon was nice enough to come in the day before NYE. Seems to me he was the better choice, as he did a very thorough exam and checked if there were any feeding issues to resolve in the first place, instead of just cutting away… and told us to use panadol, too, instead of trying to sell homeopathy like the laser dentist does.

  • The Bofa on the Sofa

    Here’s the part that has me just shaking my head:

    They deny that lactation failure is a problem, and send the message that everyone can breastfeed “with the right support.”

    Now this comes along. Basically, the message is “If you are having problems breastfeeding, it’s the baby’s fault.”

    I guess that’s better than admitting that women’s bodies might not always work perfectly. That would be insulting. But babies? Nah, they can be messed up….

    • Roadstergal

      See “Tongues, penises, and breasts” discussion, below. It is not anywhere near as sexy as the title suggests.

      • kilda

        basically, it’s all Bob’s fault.

      • The Bofa on the Sofa

        I’ve seen that, but it hasn’t addressed as much the issue that gets me here – the use of blaming the baby to avoid acknowledging the problem in the mother.

        • Roadstergal

          Fair point. And an interesting tie-in (ha) with today’s post. If the baby is ‘imperfect’, that comes back on the mom, by the NCB rules – so that might also put pressure on moms to ‘fix’ the thing that’s ‘wrong’ with the baby right away?

        • AnnaPDE

          Happens some of the time, but the kind of problem most people want to fix with TT is a painful camp-like latch that damages nipples, and difficulty swallowing, both of which are not that obviously the mother’s fault.
          Whereas the whole criticism of routine circ is that there isn’t a problem in the first place.

  • moto_librarian

    When our second child was born, I agreed to try breastfeeding again in the hopes that I would not experience primary lactation failure a second time (it was possible that the pph and complications during our first son’s delivery were responsible). The hospital LC told us that our second child had a tongue tie, and that clipping it would help with nursing. When our pediatrician came to round, we asked her to clip it. She did a very small clip, and told us that she would not do anything more other than refer us to a specialist. It was obvious that our doctor was not pleased with the LC, and told us that she would not be surprised if the LC complained that the revision was not extensive enough because she routinely recommended clipping. Of course my milk never came in (almost certainly due to IGT), and he wound up being bottle fed. Knowing what I know now, I would never agree to a clip unless our pediatrician felt that there was a real problem. This is ridiculous.

  • Petticoat Philosopher

    I recall that that terrifying mommy blogger who bragged about her children suffering for months with whooping cough was also obsessed with “lip ties,” which both she and her kids all had, apparently, and which she decided were all going to get cut–without any actual pain management, of course, since that would be medicine, which is evil. (There might have been some clove oil or something…) Is “lip tie” actually A Thing?

    • maidmarian555

      I just looked that up. Jesus that woman is insane. I’ve said elsewhere on the thread but I have a lip tie which has contributed to a gap in my teeth. I haven’t spoken to a dentist about it since I was in my teens but I was told at the time that snipping the tie alone wouldn’t fix the problem and I’d need braces. I have no idea if having it clipped as an infant would have made a difference. I can also see how a severe lip tie could potentially cause speech problems if it’s attached too far down on the lip but from the article, it sounds like that woman simply wanted to have her kids operated on. These are the reasons she gave for having it (both lip and tongue) done:

      “It inhibits movement of the tongue.

      It creates misalignment in incoming teeth.

      It creates dysfunction of jaw movement and therefore the skull and therefore the brain and ultimately the entirety of the nervous system including the viscosity and flow of the cerebrospinal fluid.

      It occurs in the location of the energetic wells for placement of the governing and central meridian lines, which means an interruption in proper flow of “chi.”

      Ties are considered “Midline Anomalies” Tongue and Upper Lip Ties are midline anomalies which occur along the vertical axis of the body. Midline anomalies can involve the brain, spine, heart, genitals and midline of the head and face.”

      I have to say I hadn’t noticed that my Chi had been interrupted (whatever that means) and would also question whether I’d been suffering from brain dysfunction my entire life without noticing……

      • kilda

        “It creates dysfunction of jaw movement and therefore the skull and therefore the brain and ultimately the entirety of the nervous system including the viscosity and flow of the cerebrospinal fluid.”

        Oh, for the love of God. I’m a neurologist, and that woman is an idiot. Consider for a moment that skull shape modification used to be a thing in some cultures and you can totally change the shape of an infant’s head without harming their brain development in the slightest. Somehow I doubt a hypothetical tiny alteration in jaw movement is going to cause a lifetime of neurologic issues.

        You might as well say putting a baseball hat on is going to hamper brain development.

        “It occurs in the location of the energetic wells for placement of the governing and central meridian lines, which means an interruption in proper flow of “chi.” ”

        aaaaaand she just got even dumber.

        • Heidi_storage

          Well, didn’t you know that hatting is evil and harmful to the baby? It’s because of something something bonding something, but I’m sure it also inhibits proper brain development.

          • The Bofa on the Sofa

            She’s a neurologist. OF COURSE she already knows that.

          • Heidi_storage

            Pfffft. Nonsense! These allopathic shills don’t know nothin’ but what Big Pharma tels them, because they haven’t done their RESEARCH.

          • The Bofa on the Sofa

            Oh she knows it, she is just keeping it quiet because it can’t be patented. It’s what they don’t you to know.

          • kilda

            actually it’s the Big Hat industry that I’m shilling for. don’t tell anyone.

          • Empress of the Iguana People

            Have you been talking to the Grand Duchess? She is quite sure that wearing a hat is evil. Chewing on them is okay, though.

      • Roadstergal

        “viscosity and flow of the cerebrospinal fluid”

        I have no tongue ties, so my CSF is 20W-50. Some poor bastard with a tie probably is out there running 0W-10, and is just not getting proper lubrication at high revs.

    • Nick Sanders

      If “tie” means “excessively short frenulum”, then it can be. I had one on my lower lip, that pulled my gums way down from my front two lower teeth. My dentist noticed it in my teens and snipped it. However, it was done under heavy anesthetic because he was sane. I don’t know exactly what it was, but I remember closing my eyes and watching colors pulse in time to the music he had playing.

      • Roadstergal

        When I’ve had that experience, it wasn’t the result of a dentist-administered drug…

      • Merrie

        Oh yeah, I had something similar too! I had it snipped by a dentist as an adult, I think with a numbing shot. It was causing some gum issues. I think at least one of my kids has similar, but right now one of them is asleep and the other is out of the house, so I can’t check.

      • Eater of Worlds

        That sounds like ketamine. Which I’ll be partaking of in a few more months. It can’t come soon enough (I get it legally and under a doctor’s supervision).

        • Nick Sanders

          It was actually two drugs. One I took 24 hours in advance: some really dark green liquid that I drank just a few milliliters of from a cough syrup dosage cup, like it barely came up to that little ring at the very bottom. The other was a shot into my gums shortly before the actual procedure.

          I don’t know what they were, but I didn’t feel the slightest bit of pain, but I could still feel the tugging and pulling of the blade, and I stayed fairly clear headed, except for the nice concentric rings of color when I closed my eyes.

          • Eater of Worlds

            Neither was ketamine then!

    • Heidi_storage

      Those poor children. I remember that nut; as far as I’m concerned, if her baby had died it would have been manslaughter. Not surprised she didn’t want any pain management for her children. Look, if the pediatrician/dentist say that we ought to clip our baby’s tongue and lips because of future dental or speech problems (not to mention that messed-up chi), we will definitely give the boy proper pain management because, y’know, we’re not monsters.

    • Empress of the Iguana People

      Clove, on a cut. Brrrr.
      Yes, lip ties are a thing. My son’s originally went all the way down his gums (he ripped it on an apple, so it’s shorter now). His ped confirmed it, but recommended not doing anything. (I was just curious when I asked about it so it was fine with me.)

  • Merrie

    Huh.

    So, with our first, breastfeeding was pretty painful for a while. It was theorized that she had a mild tongue tie that could be contributing. Our doctor declined to clip it and said she’d wait to see if she had trouble with solids or speech. Breastfeeding eventually got better and we never pursued the tongue tie angle further. She had no trouble with speech or solids.

    With our second, breastfeeding seemed to be going fine when he was brand new, but the hospital staffers said that he was mildly tongue tied and they could go ahead and clip it, it was a quick operation, it might cause a problem later if we didn’t… and I, thinking, well, if it is a problem later we may not be able to get our doctor to do it, went for it. It took two minutes and a q-tip and a snippy thing of whatever variety. He cried very briefly and that was it. I think that they might have given him a tiny bit of sugar water too. Later we got a bill for $250. I guess I (foolishly) assumed that it would be bundled in with the services we’d received at the hospital. My mistake.

    Also, he had an articulation delay at age 2. Coincidence? I don’t know. Maybe.

    Now I’m expecting our third. If they come around in the hospital to clip tongue ties, I expect to say NO THANKS! Unless he has a VERY obvious problem! Otherwise, we can just deal with it later if it does become a problem. We have a new doctor now (the other one retired), who says that if it needs to be done, there is another doc in his practice who can do it.

    I don’t know how common this syndrome is that I seem to run across on breastfeeding groups, of that baby with this crazy tie that only this one miraculous doctor can fix and after that happens everything is totally awesome. But my guess would be, not very common. I understand the frantic search for answers to bizarre problems but I wonder if this is really the right one in many cases.

    • Who?

      Over atAre They All Yours? There’s a side conversation going on about tongue tie. Appaz only certain doctors can spot it. Oh and cutting is so old school, you want laser.

      Classic quack right there.

      Mind you if the same dr offers vax he’s probably a charlatan.

      Sometimes my brain hurts.

      • AnnaPDE

        Laser and homeopathy, at the very least. For the “just imagined” pain during the stretches, which somehow are necessary for something that’s supposedly not even a real wound.

      • Eater of Worlds

        God, the father of that brood is horrifying. His wife isn’t much better. He threatened Obama and was investigated by the Secret Service.

  • StephanieA

    Its interesting because at my BFH, our LC’s are ALL about clipping ties. They do presentations on it and are always talking about how underdiagnosed it is. But my doctor, who practices at the hospital I work at, told me that she thinks its a rare baby that needs a tie clipped. She recommended not clipping my son’s, and I’m happy we didn’t because we ended up bottle feeding anyways.

  • StephanieA

    Pretty much all of my colleagues are dead set on breastfeeding (OB nurses). One of them had a really rough time nursing her second son- she had a rough delivery (but got her VBAC!) and was told he was tongue-tied. Neither her dental or medical insurance would cover the procedure, so she paid $700 out of pocket to clip the tongue tie. So much for breastfeeding being free.

  • Mel

    My last meeting with the LC I disliked involved her telling me that it was CRUCIAL that Spawn have his first three oral feeds from the breast.

    I shut that down.

    Then she mentioned that a lot of babies who have problems breast-feeding need a minor procedure to fix their tongue-tie.

    I looked at her and said, “Oh, hell no. First, he’s not tongue-tied at all. Second, even if he was, if he can drink from a bottle, he’s golden.”

    She skittered away soon after that.

    My irritation with her was mitigated by the fact that I’m pretty sure she’s afraid of micro-preemies.

    When Spawn was under 3 pounds, she never seemed to see him; I remember having her parachute in while I was doing skin-to-skin and start talking to me without ever referencing Spawn. I chalked it up to her having rather poor people skills all together.

    When Spawn got over three pounds and looked more like tiny term-baby, she suddenly noticed him when she saw me holding him. I found this more enjoyable and gave myself a pat on the back since I had been using task analysis to train her to ask about my son. (Once a teacher, always a teacher).

    When Spawn got over 5 pounds and looked like an actual baby, she started cooing and fussing over him. This is when I realized that I may have misjudged the situation and asked some of the moms who had little micro-preemies how she interacted with their babies.

    Working on a NICU floor when tiny babies scare you is a special form of hell….

    • Steph858

      I can’t understand why she would be scared of micro-preemies. I mean, I can understand how she might be scared of ‘breaking’ them – they look SO fragile – but if that were the case, she would surely only be scared of holding them, not scared of just *seeing* them. Maybe it was more a case of not wanting to try to cajole mothers of preemies to breastfeed since even she knew that none of them would be physically capable, so wait till they’re bigger and the mom can’t use “Oh, s/he’s too small, doesn’t have the strength,” as an ‘excuse’? If not that, then that’s a very strange phobia.

      • Mel

        A lot of people have a very visceral fear of micro-preemies. It’s not the same feeling as “OMG, spiders and snakes are terrifying” but more of a gut sense of unease or fatalism that served to prevent mothers and caregivers from getting too attached to a baby that had no chance of survival until so very recently. (I talked once to one of the longest serving nurses in the NICU ward who had been there since the NICU opened 44 years ago. When it opened, they couldn’t save babies who were 32 weeks gestation. 33 weekers had a chance, but no 32 weekers survived for the first few years of the unit. Now, 32 weeks is viewed as an uncomplicated NICU stay.)

        In the first few weeks after Spawn was born, I had to consciously work to bond with him because I had a deep gut reaction that there was no way he was going to live. Logically, I knew he had an excellent prognosis and was doing really well – but my body or subconscious mind couldn’t accept that a baby who was the size of a single-serve pop bottle would have any chance of surviving.

        The LC was pretty into cajoling micro-preemie moms into pumping and older preemie moms into breast feeding. She really had more of an issue with the presence of a micro-preemie in front of her.

        And, as I was typing this, I realized that there was another issue: the Small Baby Unit has the highest incidence of “really scary medical shit going down” of all the units on the floor. The two codes and most of the staff assists in the four months I was in the NICU with Spawn came from the SBU. The only baby who died without being critically ill before hand was in the SBU. Being in the SBU was basically a game of Russian roulette where the bullet was being present while a baby’s life was in danger

        • Sarah

          I can see how it would be difficult to establish bonding in those circumstances. There’s the weight of such a lot of human history bearing down on you. It can be difficult to get one’s head around how far medical science has come. Logic doesn’t always work when you’re recently postpartum even at the best of times. I can imagine having delivered at 26 weeks doesn’t do anything to enhance that.

        • Empress of the Iguana People

          It may be part of the reason why the NICU nurses enjoyed the 2 young giants when my girl was in. By ICU standards, they were practically all better when they came in. (Both just needed antibiotics and watching. Girlbard’s roomie ended up needing the full 7 day course while it turned out Girlbard only needed a couple days’ worth)

          • EmbraceYourInnerCrone

            Same with the reactions to my nephews baby boy 2 years ago. He ended up in NICU due to a very bad shoulder dystocia (weighed 10lb 11 oz or 4.8 kilograms) He looked like Godzilla next to all the preemies… I remember reading something years ago about how lots of cultures used to have a tradition of not naming babies until they were a year old. Many used nicknames that just meant “baby” or “little one”

        • mabelcruet

          I remember reading something about different cultural/tribal traditions regarding births and naming babies, and in some cultures babies aren’t considered as individual entities or given a name until they have survived a certain length of time. They aren’t considered wholly human until they’ve proved it by living a few days/weeks. Maybe your LC had some beliefs like this? Personally I’m terrified of micro-premies. I sometimes go to the unit to speak to neonatologists and whilst its lovely seeing the babies, I keep my hands firmly behind my back just in case, they all look so tiny and fragile and bruise at the drop of a hat-I’m scared of breaking them!

        • Steph858

          My reaction was kind of the other way around. My son was born at 34 weeks but with IUGR he was 1.5kg – the size of an average 31(?)-weeker. Since he’s my first (and currently only) child, I came to see him as normal and when I saw a term infant – well, they looked like giant toddlers to me. The best way I can describe the way I saw term babies is this:

          Whenever a ‘newborn’ baby is on TV, my mum will exclaim, “That’s not a newborn! S/he’s at least 6 months old!” Well, that’s how I felt whenever I saw a newborn term baby while visiting my son in NICU. I can see the evolutionary logic behind not seeing a preemie as a ‘real’ baby, and I’m usually quite logical as opposed to emotional so looking back I’m surprised I didn’t have that reaction. Though maybe that’s why: since I’m not very emotional, the logical part of me which said “He’ll be fine” overrode everything else.

          • Empress of the Iguana People

            *snicker* I’ve been seeing my girl as toddler size forever. (Really, who wears 18 month clothes at 8 months?)

  • Madtowngirl

    Yet again, I find myself wishing I had found your blog before I had my daughter. I had this done, because you know, there was no way I wasn’t producing milk (blood sugar tests, pumping nothing, and a hungry baby were not evidence enough I guess), it must have been the “tiny tongue tie” my newborn had. I regret that we went through with it. I had very little information about it, except that the lactation consultant told me I might “have to push the doctor to do it.” Of course, in hindsight this is a huge red flag, but in my sleep-deprived, vulnerable, desperate to quiet my screaming baby state, we agreed to it. My daughter had no complications, but I wish I hadn’t been pushed into making a decision like that without really knowing what we were doing.

    • Sheven

      Don’t feel bad. The whole point of studies and reviews like this are to figure out if there is a benefit to a procedure. You did what you could with the information you had at the time, which is all anyone can do.

    • Blair

      I have been talking about this epidemic of ankyloglossia for a while–more “cases” in the last 2-3 years than previous 20 combined. the LC tells the mom to “get their pediatrician to do it”, and then they are mad at me when I won’t do it, or shop for another pediatrician. It is actually easy to do in the office, and I have seen a couple babies in 20+ years of practice that the tip of the tongue was really glued to the gum line, and snipping the frenulum really helped

    • Tori

      You’re not alone. Similar situation- “tongue tie” wasn’t the reason I had no milk, but I was so desperate that I hoped it was.

    • Dell

      I know what you mean… I had my son’s cut twice because the pediatrician at his 1 week check said they didn’t cut it fully the first time in the hospital. I’d like to pretend that this means his was pretty bad, but I have no way of knowing because it was pushed to be done so quickly and I did not research this when I was 12 hours postpartum. Now sometimes it seems his tongue sticks out too much…

  • LovleAnjel

    So, lactivists insist that the rate of primary insufficient lactation is lower than 5%, or at least so rare that almost no one actually has it, but will insist that more babies have breastfeeding difficulties due to tongue tie than is possible with the <5% rate that it occurs.

  • OkayFine

    I’ve always been pretty skeptical about tongue ties and what having surgery does to help with the issue and still am. My 4th child had a slight lip and tongue tie but was gaining weight just fine. The issue was that he had so.much.gas when he ate. None of my others had that big of a problem. We waited for about 10 weeks to have it addressed because I kept thinking it would improve on its own. I was still very much on the fence about having it done but went ahead anyway. His gas issues went away over the next couple of days. I’m honestly not sure if it was just coincidental timing or if clipping the ties helped with the issue.

  • Heidi

    From a financial standpoint, I spent less than $850 on formula during the first year. And with the formula, I was 100% guaranteed the baby would be fed.

    • StephanieA

      Yes! I commented above that a friend paid $700 out of pocket to clip a tongue tie so she could continue breastfeeding. No thanks.

  • Heidi_storage

    So, hey. When kiddo was born, the docs and nurses said he had a lip-tie and tongue-tie. He breastfeeds just fine, but I don’t know whether it’s going to cause speech problems. I plan to bring it up at his 4-month checkup, but can the ped tell at that time whether it’ll be a problem? We’re pretty non-interventionist, but if he ought to have surgery I’d rather have it done sooner than later. How many ties actually cause speech problems, but not feeding problems?

    • Empress of the Iguana People

      My nephew’s “forked tongue” was serious enough that they cut it when he was a baby nearly a decade ago. (Not to aid bf’ing, this is the one whose mom started cancer treatment when he was 2 weeks old.)

      • Roadstergal

        I have a friend who has such a severe tongue-tie that she can poke just the very tip of it past her lips, and is still an accomplished choir singer and fluent in multiple languages (English isn’t her first, but you wouldn’t know that – or that she has anything wrong with her tongue – to talk to her). Which is to say, I dunno. 😀

        • Heidi_storage

          I dunno either, and it’s really hard to find information that seems to be unbiased. I suspect we’ll hold off; my older son had a lip tie (that the LCs wanted us to cut, so that he’d be able to breastfeed; the dentist said it might or might not help, so we didn’t do it), and he is an articulate and mostly-intelligible 2-year-old. Obviously, I’ll see what the doc says.

        • Eater of Worlds

          As a deaf person, people with really severe tongue ties are often impossible for me to lipread, because lipreading also involves watching where the tongue goes. If someone in your immediate family is deaf, uses lipreading and is going to interact with your child in a significant way, it could be something to consider. But that’s a pretty rare situation.

          I would notice that the tongue isn’t moving in a “normal” (average is a better word) way but the only one I’d ever consider asking to do it to as an adult would be my spouse and only if there was too much other issues with lipreading. Things like if my spouse had an upper lip that doesn’t move when they talk (some people’s upper lip just essentially straightens out to a line when they talk) or also had a lisp (and then I’d have them go to speech therapy to fix that) because a lifetime of struggling to communicate is relationship ending. Deaf/hearing relationships have a higher divorce rate than the average and if something that is relatively minor surgery would lower that frustration, yeah. But then, I’d give them a kidney or part of my liver if they needed it.

    • maidmarian555

      I have a fairly significant lip tie. It (fortunately) never caused me any speech issues but it has contributed to a gap in my front teeth. I was given the option to have it snipped and have braces fitted in my early teens but chose not to (I figured if a gap is good enough for Madonna, it was good enough for me).

      • fishcake

        Just realized my daughter probably has a lip tie, in addition to a tongue tie and a slight “forked tongue.” It doesn’t seem to be a problem. She speaks really well for a 2yo. I just love her gap-tooth smile!

    • BeatriceC

      I have a pretty significant tongue tie. It’s only a problem during dental work when it hurts when the dentist puts the little things for x-rays under my tongue, and when they run out of room for other equipment.

      • MI Dawn

        OMG. I HATE HATE HATE those xray things. It’s almost enough to make me swear off the dentist.

      • Gæst

        I have a small mouth for an adult, and the bite wings used to leave tears streaming down my eyes because they were just too big for me.

    • cookiebaker

      Most of my kids have a mild tongue tie. Out of the ones I breastfed, it generally didn’t cause problems. I did have to get them latched juuuuuust right or it’d pinch, but they nursed fine.

      Years later, my 10yo needed her lip tie cut because it caused an almost complete regression of her gums and she was at risk of losing two teeth. Grafting her gum onto the spot was expensive, but it fixed it and they cut the tie at the same time to prevent it happening again. I didn’t know she had a lower lip tie as an infant, but it would have been less damaging to have it cut earlier had I known.

  • MaineJen

    These are the same people who will freak out if you even mention “the c word” in the vicinity of a baby. (I’m not going to type it out because I don’t want to summon parachuters)

    • MI Dawn

      I was thinking the exact same thing, MaineJen. Deity forbid a parent does an elective operation on a baby’s genitals, but hey, let’s just perform a elective painful oral surgery on a baby who’s going to have to eat through the pain.

    • Empress of the Iguana People

      Sir K. Of Sishun is a mean meany-head but it no biggie about cutting a microscopic tie. o.O

    • Roadstergal

      Exactly this. It’s fine if you think one way or another about specific surgeries vs benefits for your children, but when you lie on the extreme end for the one with more consistently proven lifelong benefits, I find it interesting when you pivot 360 on this one.

      • kilda

        yep. Baby penises are made perfect, and breasts, breastmilk and vaginas are all made perfect, but baby tongues are just really badly designed. God was having an off day on those.

        • Roadstergal

          That is the most magnificent mental image I’ve had all day. God: “I’ve spent _hours_ on the breasts, penises, and vaginas! Bob can handle the tongues.”

          • Empress of the Iguana People

            well, that could be taken wrong, lol

          • fishcake

            You had one job, Bob!

    • AnnaPDE

      I agree on the part that they’re just as “Oh, it’s just a tiny snip” about the tongue as their penis snipping counterparts. I’m not sure what’s the point of pretending that surgery isn’t painful (especially in such sensitive spots) except when one doesn’t trust the validity of one’s motives for having it done in the first place. It’s scary that this denial goes as far that often in- and post-procedure pain relief is declared unnecessary. Those are the parents whose genitals and/or mouths I’d really like to cut with a sharp instrument, just so they understand what they’re doing to the kid.
      I’d like to point out though that most TT parents see their surgery as medically necessary. This might not quite be correct, from overblown hopes to shonky diagnoses to confused priorities. But it’s certainly different from cutting off a body part by default, without even a perceived medical reason.

      • MaineJen

        We got a parachuter anyway?

        I’d argue it’s very similar. Both are largely unnecessary procedures that some parents see as necessary, but have little to no effect on the child in the long term.

        And I think most babies who undergo the c word now have local anesthetic. (I cannot believe they ever did it without!) I doubt they do that for tongue-tie procedures.

        • AnnaPDE

          Where’d my reply go?

          No, not a parachuter, just a regular from a non-US place.

          Both procedures can be medically indicated, but I do think there are important differences. The most obvious being that tongue-tie clipping is in response to a problem (and it’s not the solution a lot of the time), routine circ doesn’t have a medical reason, just aesthetic preference and tradition.

          Interestingly, the parents’ way of handling the surgery when they’re not 100% sure they need it but still want it is scarily similar. And funnily enough, most non-laser TT specialized doctors are also the main circ providers around here… maybe they just like snipping bits skin off kids.

        • Eater of Worlds

          Well, it’s been shown that circumcised men are less likely to transmit HIV. My feeling though is that because I live in a society where access to sex education and condoms are easy as well as the use of them is encouraged, my hypothetical son’s risk of getting and transmitting HIV is going to be low. He can choose to circumcise himself if he wishes as an adult.

          http://healthland.time.com/2013/04/17/why-circumcision-lowers-risk-of-hiv/

          It’s kind of like how not breastfeeding in my country isn’t life or death for any child I might have… 😉 I know it’s not a direct comparison, but I have the luxury of it being a choice.

  • Empress of the Iguana People

    When my son managed to rip open his lip tie (burgling apples again) nursing was just as unpleasant as before for me