Thursday, August 3, 2017

My Breastfeeding Journey: Twins and Tongue Tie

I started writing this story in February of 2016 right after my babies turned one… I finished it World Breastfeeding Week 2017, just after my sweet toddlers turned 2.5.

In February of 2016 I started with this introduction:

In order to write this story I had to find time when both teething, nursing stuffy nosed breastfeeding boys were asleep and turn on my now defunct windows phone (my best friend through the entire pregnancy and first year of mommyhood). Like the rest of the world I remember some details and have truly forgotten others and the timeline of events of our first year exclusively breastfeeding twins.

In August of 2017 I finished writing the story after a marvelous day at the beach during our summer break in Massachusetts. I finished it while my two active toddlers were watching their favorite videos while they fought the dreaded night sleep.

How much things have changed, and how much things change when you are a breastfeeding momma.

My twin boys were born vaginally at 39 4/7 weeks with an amazing OB and birth team that included great friends, a fabulous doula, and one special OB tech in the OR who silently cheered me on from across the room and was my focus as I pushed my babies out.

Samuel arrived first, 7lb 4oz, Sydney second, 5lb 9oz. It was a good but challenging birth for all and after some quick assessment by the birth team both went to breast in the delivery room without any challenge or concerns. I was then wheeled out back to my room with both babies on me. We rolled into out room and the boys met their support, village, aunties and grandparents.

Both breastfed well in that early time after birth. My epidural had only been running for about 6 hours prior to their birth and the pitocin prior to birth was limited greatly, nothing post delivery was given by IV.

The rest is a fog..but what I do remember is…

Samuel breastfed like a champ that first 24 hours. Sydney just seemed to have trouble finding the latch. I let them both crawl to breast multiple times and with time and practice Sydney crawled his way to a good latch around 12 hours of age.

I looked closely at both of their tongues and thought…oh geez we got ties….but nothing that can be clipped….and moved on through the day or night or whatever time it was. The twin zone had begun.

Both boys had great output in the first 24 hours, no concerns for rising bili levels, jaundice and we were discharged around 30 hours postpartum. I remember leaving the hospital and turning to my mom and saying.. ‘I feel like we just robbed a bank! I just had term twins, vaginally, with a discharge just after 24 hours in Las Vegas! Amazing!’ I was so happy to be headed home with these bundles of joy.

That first night home….

Soreness and lots of it. I grabbed those nipple shields right when I got home and I didn’t look back. This girl was not gonna go the way of bleeding blistered nipples…no thank you!

The interesting part that follows is…

I remember Sydney as my piranha baby and throughout that first year of life he had less gain and had to work harder for that flow and weight gain when breastfeeding.

My texts from that first week tell another story for the early days. At 2 days of age after my first at home picture post, my pediatric dentist notices a nipple shield on both babies. I respond Samuel is a piranha and Sydney is off the shield. Interesting as this is totally opposite of what I remember. But the text is the truth, right? The texts continue as I assess and reassess. Samuel has his first chiropractic appointment around 5 days old, as I note how tight he is, and he has surgery for an inguinal hernia coming up on day 7. At 6 days of age I note a posterior tie in Samuel, no observation concerns for Sydney. At 3 weeks of age the boys are actively going to CST. We have their first pediatric dentist visit at 3 weeks. Following my protocol and practice, which has now changed thanks to these two beautiful babies, I agree to postpone revision despite my pain and the breastfeeding challenges and continue with the CST and revisit in a few weeks. At this point Samuel is still on the shield, a week later I am able to wean him but as is common with posteriorly tied infants he is leaking milk out the side of his mouth while feeding without the shield.

At 4 weeks, the pain is still present. Sydney is now notably more painful than Samuel. At 5 weeks I reach out to a colleague who gives me the standard advice of trying to latch both babies deeper and keep them latched deeper without the shield. I try this, 72 hours off the shield for both.

My memory of this 72 hours is clear as it ever can be. I remember almost every day around 4 or 5 pm being sore and irritated and feeling just plain old defeated. I reached a point of feeling like the hope wasn’t there, the pain was irritating, intolerable, and interruptive. I wanted to just feed my babies and enjoy this time and not worry about when that evil soreness was going to return. I also seemed to notice around this time that I was chasing supply. Sydney was not gaining like Samuel was and tandem seemed to help him get the letdown, the flow, better. Frustration doesn’t begin to describe where I was at during this time. I stopped the CST somewhere around this time since it wasn’t getting better and the trip was taking a toll emotionally and physically on all of us. The IBCLC curse, it had arrived.  Placenta pills and village support to the rescue and a deep breath.

For the next few weeks, I keep breastfeeding with and without the shield. I keep watching for letdowns and feeding often and focusing on supply. At almost 2 months of age I notice Sydney is not gaining as well as Samuel and the pain when he feeds is starting to limit the time I allow him to stay at the breast. We return to the chiropractor and start again. I assess Sydney noting his suck is not appropriate- a bite with no forward movement. I also note he needs Samuel on to transfer well. I am still compressing throughout feeds and tandem feeding through the night. I am going as far as clearing Sydney’s nose to make sure he is feeding well. After our CST visit that day, amazing improvement in Sydney. He can breastfeed! But, this is short lived and the old piranha baby returns shortly after this visit. I continue the CST and the pattern continues. I keep doing what I need to do, but things aren’t changing.

At almost 3 months of age, I notice Sydney is minimum gaining, 5oz a week, is fussy at the breast, popping on and off and just plain not enjoying breastfeeding and neither am I (okay I admitted it). Despite how much I am not enjoying this process, I am still on the fence about revision. I have no one to talk to in my black hole, or my cliff, or my island, or whatever you want to call it. I do the best I can do and call a colleague. I talk to her by facetime. She watches me feed my baby, we talk, we try a few things, she gives me some exercises and it feels better. Relief! The magic bullet! The breastfeeding fairy! She explains, as I have to so many clients, that revision is necessary. These exercises are important and are helping but they are not fixing the root cause. I do as she has told me and things stay better post exercises for the next 24 hours. I talk with her again 24 hours after our first chat and ask if I really need to do the revision, she encourages me to revise. The exercises aren’t the answer, revision is.

A few days later both boys are revised, lip and tongue. It was amazing and felt so much better afterwards! We left the pediatric dentist, got food, I breastfed again- in my car as I had been doing for months already- and then went to CST. From this day forward things got infinitely better! I became less frustrated. Samuel fed better all the time, Sydney took some time but in 4-6 weeks he was feeding better and feeling better at the breast. I was overfull 24 hours post revision! The soup, the oatmeal, the golacta, the brewers yeast (yuck), the shakes, the chicken… they had all worked but now I could relax, enjoy and feed my babies. This is what breastfeeding is supposed to be, and so it was.

We made our way through that first year with ups and downs and weight checks at home biweekly and then weekly as all who have a history of dealing with tongue tie often do. Teething brought on biting and irritation with feeding for both. Sydney oscillated between feeding well and needing encouragement. But this was a journey, our journey, and as a family we made it. At 26 months and a few weeks, after an amazing breastfeeding path, weaning arrived and our new journey as a family of sleeping through the night toddlers arrived.

In the end, no matter how much you know or think or feel, having someone else coach you and guide you to a better you, a better family, a better journey is so very important in this motherhood journey. My biggest take away, don’t be afraid to reach out and ask for help because that special person is waiting for that call and what they have to say may change your journey and many others.



Thank you to EVERYONE who supported me and us as a family on this amazing journey. Thank you to my beautiful boys for pushing me to keep searching for better answers, better solutions, and better options for them and for other breastfeeding/chest feeding moms and babies. 

Lisa Weinshenker, RN, IBCLC
Breastfeeding and Babies, Yeah!
www.breastfeedinglv.com