Family Ties

Disclaimer: This post contains a lengthy discussion of breastfeeding. If that's not something you want to read about then just scroll through quickly and look at the cute pictures.

Before Isaac was born, having him be exclusively breastfed was already important to me. I watched videos, attended a class, talked to friends, read every book that I could on breastfeeding, and eagerly anticipated it. I knew that I wanted to be skin-to-skin with him for at least the first hour so that I could have that very important first nursing and bonding experience immediately after birth. When the time came, and I was holding my minutes-old son on my chest that magical moment that I had so greatly looked forward to came and went with no nursing. We tried several times but his mouth would just slide right off as though he was trying to drink a milkshake from a straw after getting a mouthful of Novocain. And the same thing happened over and over again during our next 36 hours in the hospital. Finally, one of the nurses brought me a pump so that Isaac could get some food in his belly. I had no idea this would become our routine for the next two weeks: pump, pull the pumped milk into a syringe, feed Isaac by syringe, burp Isaac, clean pump, bottles and syringe, store leftover milk, repeat every 2 hours. Every minute that he wasn't being syringed full of milk was spent skin-to-skin with me. I became an expert at eating, drinking, typing and sleeping with him on my chest.

Piled on top of normal parental sleep deprivation and postpartum hormones was the thought that I would never get to enjoy breastfeeding my child and it was my fault. Surely I was doing something wrong. There must be something wrong with my body. He didn't want nurse from me.

That first magical moment came when he was nearly two weeks old, and I couldn't bring myself to break what was a terrible and painful latch in order to try to adjust his mouth. He had worked too hard for too long so I just let him be.

We saw lactation consultants who offered a variety of tips and techniques and told me not to worry because I was still several steps away from my son being a formula-fed baby. This provided little comfort. We saw a pediatrician who told us that he was born with a recessed chin that, as it grew, would become better suited for nursing. We saw another pediatrician who told us that he had a borderline tongue-tie and that we could get it clipped, but it probably wasn't necessary because as his mouth grew it would stretch and loosen. Because he was gaining weight well and because we are relatively non-interventionist when it comes to Isaac and scalpels, we opted let things be.

The "recessed chin"

And his chin did grow as did his mouth, but nursing did not get much easier. There were still so many unknowns and frustrations. As a first time mom, I didn't know why he couldn't latch, why when he finally did he would pop on and off, why he constantly bit and scraped once he sprouted teeth, why this loving, bonding time with my baby was so painful. 

Fast forward to this week: I am only able to nurse him on one side and having to pump and give bottles on the other due to the toll that his "unorthodox" latch has taken on my body. Things have gotten progressively worse over the last 2 months, and I am having thoughts of weaning so we make yet another appointment with a new lactation consultant on Wednesday. She takes us through the ropes of how to teach him not to bite and proper latch techniques and she also takes a look inside of his mouth. "Tongue-tied" she says, as well as a lip tie and a very high palate - all things which have complicated our breastfeeding relationship. We explain what we had been told before and she tells us that both looked very tight and we should have them looked at and also recommends two dentists (not ENTs) in the area who do a new type of frenectomy (the removal of the tongue and lip-ties or getting a "frenny clip", as Joe calls it). Once home, I make an appointment for Friday and read up on this new procedure.

Here's what I learned: the traditional scissor method employed by ENT docs snips the tissue to free the lip or tongue while this new method completely removes the tissue with an infrared dental laser, requires no anesthesia, and is done in a way so that the baby can nurse immediately afterward. The doctor who has pioneered this technique is Dr. Kotlow in NY and he has trained two Tarrant County dentists (Drs. Oser and Cole) how to do the procedure. Prior to that, our lactation consultant would recommend that families fly up to NYC to have Dr. Kotlow do their frenectomy.

So Friday we're at Dr. Oser's office and this is the one day a week that they do all of the frenectomies. I sat with the other moms, all of whom had babies who were mere days old, including one 12 hour-old. It was the first time that Isaac seemed like a giant. I watched the tiny wiggles of the sleeping newborns as my behemoth grunted and inchwormed his way across the waiting room floor and it ate at me that we didn't do this 6 months ago, that I wasn't one of the brand new moms with a brand new baby about to get a brand new mouth. My son has been nursing about every 3 hours for his entire life. Could he unlearn the only way he knows how to eat? Was it too late? Or worse, was the doctor going to say that it's borderline and send us away leaving me with no hope of an improved latch for Isaac?

After a quick look in Isaac's mouth Dr. Oser said that Isaac had a class 4 tongue-tie and a class 4 lip tie. Classes are assessed according to the length of the tip of the tongue/lip to the attachment of the frenum. In the case of the tongue, a measurement of over 16mm is "clinically acceptable". Isaac's was less than 3mm. The doctor suggested that despite its severity, it's possible that his tongue-tie went undiagnosed because it didn't present itself like a traditional tongue tie. He asked if we wanted to have the procedure done today. I answered with an emphatic "yes!"

Looking back through old pictures, these were as good a glance at the inside of his mouth as I could get. Isaac at 2 months.

Note the thick piece of skin between his lip and gum.

The hardest part was walking away from Isaac at that moment. I asked, but I wasn't allowed to be with him during the surgery. I signed papers, handed him to a nurse and walked out. I walked out into the waiting room, and once there was greeted again by brand new babies followed by the distant cries of my son and decided that I hadn't walked far enough. So I walked out the front door and into the parking lot where I stood and cried and watched cars drive by.

After the longest 10 minutes, Dr. Oser popped his head outside with Isaac in his arms, and the comic relief of my boy's face interrupted my pity party. He had raccoon eyes like a student after chemistry class from where they had to put goggles on him to protect his eyes from the laser, his hair was terribly rumpled, and he had the familiar crust of dried Tylenol around his mouth from where he had surely spit it back out into the face of whomever dared to dose him with something that was not suitable to his sophisticated palate.

Post-frenectomy swollen upper lip

The doc explained that everything went great and showed me some mouth exercises I needed to do with him to keep it from growing back together in the next few weeks. Then, the breastfeeding specialist came in and suggested we give it a go, and there in my arms I witness the most beautiful, deep latch I had ever experienced. Not only was there no pain, there was almost no sensation at all. It was if Isaac had been trying to play hockey with track spikes and someone just gave him newly sharpened skates. It was smooth and effortless and it has only gotten better.

Although I am immensely relieved that our problem seems to be solved, I'm still mulling over several things. Mostly, how I ignored my motherly instinct that was telling me that something was truly wrong and that I couldn't fix it with a little determination and elbow grease. How I wasn't truly an advocate for what was best for Isaac. I didn't speak up and stand my ground, and because of that he had to endure what was surely a very difficult and frustrating way to get food.

But this is just something that I'll have to deal with. At the end of the day, being a mom is a lot of hard work and we don't make it easier on each other as mothers by being judgmental of one another or constantly questioning ourselves. There is more than one right way to do most things and every parent has to make difficult daily decisions that impact their child. I am in that club now and I've made some decisions about my son, my body, my parenting style, etc that aren't shared by everyone. That being said, the one thing I will forever defend and promote is breastfeeding. Moms, if at all possible, breastfeed your babies. Despite all of the problems we've had, despite the plugged ducts, the oversupply issues, the bleeding, the tears, my favorite thing about motherhood has been my breastfeeding relationship with Isaac.

Leaving aside all of the ridiculously indisputable research on how it's the best thing that can go in your baby's body, it's also the most amazing bond and connection. At the end of every exhausting day I get to hold him, rock him, listen to his sighs and study his face in a way that no one else will get to do. Maybe it comes down to selfishness. I am an unabashed Isaac hog, which makes me love the hours and hours of cuddling I have with him that no one else gets. Many people get to enjoy the roly poly active daytime little boy who gives a smile with ease and loves to play, but only I know Isaac at 4am. Only I know the steadiness of his breath, stillness of his hand as it rests on my chest and the distinct feeling of his body getting heavier in my arms as he falls asleep with the greatest full-bellied contentment. I am the exclusive owner of those nighttime rendezvous, and while my body tells me that what I really want is sleep, my heart cherishes our one-on-one time.

I have already felt time passing too quickly and I know that some day I will go into his room while he's sleeping and watch him, wishing that he would wake up and want me to rock him. But tonight I get to hold him, get to rock him, get to nurse him back to sleep and be thankful that Isaac and I are not done writing the story of our breastfeeding journey.