Thursday, December 27, 2018

TONGUE-TIE CLIPS: CONSULT WITH AN IBCLC PRIOR TO RELEASE!

There are still so many ENTs and dentists who perform tongue-tie releases with no preparation, no IBCLC referral and no follow-up in place. When I post on social media about how essential integrative care is, I am told I don't understand the costs involved. When no referral is required, parents are misled into believing the release is a silver bullet. It is not.
The assumption that practitioners ourselves don't understand the difficulty in paying for medical care, is completely false. My family has gone without medical insurance for more years than we've had it, and for the most part, it's been useless anyway, as it covers nothing we need and deductibles are $8-10,000. We all deal with the reality of our profit-driven system, one that ensures only insurance companies come out on top.
That doesn't change what is necessary if our goal is function. I see far too many dyads suffering the consequences of a surgical procedure that can't possibly deliver on expectations, because the release itself cannot resolve issues. The release only allows the bodywork and the lactation support to be effective. No other surgical procedure is performed with such frequency, yet primed to fail due to inadequate preparation and follow-up. 
There are FB groups for families who regret releasing ties. There are many health care providers concerned about babies being released with poor outcomes. This is a legitimate and growing problem that needs to be addressed. 
In my practice I frequently see families who have paid $600-1600 for releases yet their babies still cannot nurse effectively, if at all. Those parents are then forced to pay for my time, often more than they would have if I had seen them in the beginning, in addition to more bodywork than they would have otherwise, and often another release with a different provider, because they saw the wrong release provider the first time...someone who was willing to release without preparation and follow-up.

While it was once very difficult to find skilled IBCLCs, it's become much easier as so many of us work remotely. I see as many as 80% of my clients on-line. Many other IBCLCs now do as well. The trick is to find someone skilled in functional assessment and habilitation, who also collaborates with other providers. That way, you have access by referral to competent bodyworkers as well. Ask questions about their education specific to oral anatomy and function, whether they collaborate and how they prepare for and follow-up after the release. In my practice I teach clients oral exercises that will provide neuro-muscular preparation for babies (this is not simply "suck-training", which many babies don't need at all). Click here for a list of IBCLCs who have taken a three day MasterClass that includes learning these exercises. 
The cost of health care in the US is outrageous. The poor quality of care for the price is even more so. Unfortunately, that doesn't change physiology. The release alone fails over and over again, because the release cannot resolve the full-body issues that stem from the restrictions. The first step, whether or not your baby is nursing, is an IBCLC who can guide you with a functional assessment, coordinate with your other providers and optimize a functional outcome.


TONGUE-TIE CLIPS: REATTACHMENT

Many parents mistakenly believe their babies' ties have reattached when in fact they have simply not had adequate lactation and bodywork support to eliminate compensations. When feeding is compensatory, the new frenum is frequently just as short as the previous one, but it has not "reattached". A new frenum is normal, but mobility is necessary to ensure it is long and functional, rather than short and restricted.
Examples of compensatory breastfeeding:Many babies feed in a way that may not cause damage to the mother, but is passive, relying on a robust milk supply, tandem nursing or pumping as they cannot drive a supply themselves. Other babies may manage to drive supply, but are structurally compromised, and come to the breast in a flexed position that mothers tend to inadvertently compensate for (frequently by side-lying, but it can be done in other positions as well). These babies often look like they have their shoulders up to their ears or they have no neck. Nursing passively or in this flexed position that limits range of motion will often cause the new frenum to be as short as the previous one. Placing babies in containers for long periods of time can have the same result. 

This is why it's important that parents work w an IBCLC who understands whole body function and knows how to "see" babies structurally and functionally, as well as how to communicate and collaborate with the bodyworker and release provider. And why both an IBCLC and skilled bodyworker are necessary pre and post-release.