It is very frustrating to new mothers to have a baby still not nurse well after a frenotomy. Sometimes a tongue tie is diagnosed in the hospital and the infant frenulum is 'released' in the nursery. Other times a baby has a frenotomy done later after struggling with breastfeeding for days, weeks or occasionally months. While most of the time improvement is immediate, other times, there is slow or marginal improvement - occasionally, none at all. Some parents consider having their baby’s frenotomy redone on advice of their pediatrician or other health care professional. Other mothers, frustrated with d continued pumping, slow weight gain or extreme pain during nursing, finally give up breastfeeding. If you are one of the many mothers who are struggling to nurse a tongue-tied baby or infant who is still nursing poorly post-frenotomy there are other things you can try if you are not ready to 'throw in the towel'.
Milk Production is the most important element when trying to help a baby nurse post frenotomy because the best help to encourage a baby to latch and nurse well is good milk flow. Babies love flow! Make sure your milk production has not fallen behind your infant’s needs. The amount of milk your baby needs changes as he grows. A better milk flow will ease the transition back to the breast, and nurse well at the breast. Milk flow is affected by your supply, so the more milk you have the better the flow. While it is tempting to use the often less-effective 'free pump' from your insurance company, renting a hospital grade pump can boost a greater supply than using a battery/electric pump. Those pumps are fine for maintaining an existing supply, however not efficient for increasing your current milk supply.
Cranial Sacral Therapy (also known as CST) is a gentle, non-invasive form of bodywork that focuses on the bones of the head, spinal column and sacrum. Some babies are not just struggling with tongue tie. Some infants have birth trauma from a rapid birth, C-section, forceps or vacuum extraction. I have seen clients whose baby had a frenulum that was mid-line on the tongue, who were unaware that in most infants, this was considered tongue-tied. The presence of a short or midline frenulum does not always indicate a tongue-tie. Sometimes when babies are having trouble breastfeeding, it is more than one factor contributing to their problem. Craniosacral Therapy works by easing tightness in the baby’s mouth, head and neck to help with more successful breastfeeding by waking up under-used muscles in neck and face and easing tightness in over-used areas that are too tight or strained, from over-compensation.
Finger feeding offers a reward, and an incentive to continue sucking. It also helps you to 'feel' it when the baby is not using his tongue correctly. For example, some mothers experience a lot of pain during nursing before and still have pain after the frenotomy. A common reason is that baby is holding his tongue humped into the back of his mouth and not allowing it to gently cup under the breast tissue. So mothers feel gums pressing down on their nipple tissue during nursing. This is very painful. The constant clamping or friction can cause blanching (nipple turning white) and a beveled or lipstick shape to the nipple.
'Bottle first' method works by giving the baby a method they are familiar with and using food to help them relax, and be more open to trying the breast. Very hungry babies resist new methods of feeding. Humans have a low tolerance for change during hunger or frustration. That improves when baby 'feels safe' due to his continued weight increase and freedom from hunger over a period of time. It always best to first use a familiar, comfortable feeding method before trying any new arrangement. When your baby begins to relax and approach fullness, you can then introduce the newer method of feeding (the breast). Your focus is more on feeding baby until satiety, he is no longer frantic to eat, and more content - happier, but not asleep or so full that he is in a 'milk coma'. He falls asleep at the breast!
Skin to Skin therapy to encourage self-attachment. Skin to skin therapy is a biological norm that is overlooked in our modern society. Babies spend almost no time on their mother’s chest and are always overdressed. Allowing baby to nestle next to your naked breast or just on your chest, you are triggering instinctual biological patterns that help them smell, lick, crawl to the breast and begin to latch. Be patient, it may not happen immediately. Please don’t get discouraged if it takes hours (or a few feedings) for your baby to show interest in your breast.
Supplementing at the breast using a supplemental nursing system (SNS) or Lact-Aid, uses extra milk flow to coax the baby back to breast with an easy meal. The flow can be gradually decreased over a few days or week and the supplementer can be discontinued. It is best to have the help of a lactation consultant if you want to try a nursing supplementer.
If you are interested in any of these alternative treatments for tongue tie, find an IBCLC in your area. They are the gold standard in lactation care. Many areas have private practice lactation consultants who do home visits. They can work with you one on one in the stress free environment of your home to help problem solve to assess what is really going on. They can also point you to reputable providers in your area such as CST therapists, speech therapists or even providers to redo the frenotomy if it is truly necessary. They can also teach you many different techniques to improve latching and breastfeeding, including the few mentioned above to help your baby back to breast. When looking for a lactation consultant make sure she has experience with tongue-tied babies and post frenotomy care.