We have had a blissful month since I posted last. Well, sort of. See, we learned a couple of weeks ago that not only does Hannah have an upper lip tie like her sister, but also a tongue tie.
While the early days breastfeeding Hannah has been easier than for Lily, it's a relative thing. I counted it as good that I only had abrasions on one side and I had them healed up within a week. My little porker at birth (>90th percentile in weight) had dropped down to around 58th percentile by her 1 month weight check. The pediatrician said not to freak out yet because the medical assistant at the 2 week weight check had messed up and weighed the baby while diapered, and if we assumed the diaper weighs a couple of ounces, Hannah would have been right at the bottom of normal weight gain for a breastfed baby. (Dude, I'm an engineer. I was sitting there not only mentally plotting her weight, but also figuring out what the rate of gain would look like - and it was trending down. Yes, I realize that I was basically differentiating my kid's growth curve. See kids, calculus really does have applications in daily life!)
So the ped said to just keep feeding on demand and maybe think about waking her up during her 5-6 hour overnight stretch, stuff like that. I went to a Milk Mates meeting a week later because I wanted to weigh her, and the IBCLC who runs the support group brings a scale. I was excited to see 8 oz in a week and was thinking that maybe we had turned a corner. After the meeting, the lactation consultant asked me how things were going. We were talking and I realized as I was telling her these things that the situation was really not optimal:
~ She was popping on and off the breast pretty much nonstop - All.Day.Long
~ She had started "clicking" (making a smacking sound) which actually means she was breaking the latch with every suck
~ Her rate of weight gain was consistently trending down, although thankfully still gaining
~ Nipple soreness and irritation not relieved by various creams intended for that purpose (not to mention the $30 Danish wool nursing pads)
~ The hallmark: flattened/creased "lipstick nipple", which I had the entire time Lily was nursing
Patrice heard this and put the pieces together, and asked if I wanted her to take a quick look at Hannah's mouth because a lip tie often means a tongue tie. She checked Hannah's mouth and bingo - tongue tie. She was leaving on vacation two days later but gave me names of some dentists who do laser revisions of these ties.
"Revision" is a nice euphemism for lasering or cutting the tissue away, usually with no local anesthesia in a baby this age. Part of me felt it was selfish to put Hannah through a painful procedure just for my benefit. After all, I nursed through nearly the same symptoms for TWO YEARS with Lily. But a few other lactation consultants who I'm acquainted with pointed out that for a lot of reasons it wasn't just for my benefit, it was in Hannah's best interests too.
I started making phone calls. Naturally none of the three recommended dentists in Connecticut were in-network for our dental insurance, and two of them wouldn't even submit the claim to our insurance for me. I'm not ashamed to say that money is a little tight right now and paying up-front for a procedure and maybe not getting much or anything in the way of reimbursement did not appeal. I called another recommended dentist in Albany, the guy who basically pioneered the use of lasers to treat tongue and upper lip ties in babies. He's been doing it for like 20 years now. I checked Cigna's website and magically, he's in-network. This prompted a call to his office, and it was confirmed that we would have a much lower out-of-pocket expense if we elected to have him do Hannah's revisions. So for the cost of a tank of gas we'd have less than 1/5th of the out of pocket cost and would be getting it done by the pioneer of this procedure? Sure, sign us up! The only kicker was that he was on vacation for a week, so we scheduled a visit for Monday the 5th.
Meanwhile we saw the nurse practitioner/IBCLC at the pediatrician's office, who has a reputation for being pretty conservative, and even she recommended a revision. She showed me that Hannah was basically gumming/chewing at the nipple rather than nursing correctly. It's likely that the only thing that kept the baby gaining was my strong milk supply and the fact that I was nursing on-demand, AND she was on the breast for most of my waking hours.
On August 5th, Hannah and I left bright and early to make the trip to Albany, which is around 2 hours. I learned the night before that Mark had been unable to get the day off to go with us, and I felt like it was too late to call my mother or any friends to come with me. I was so scared, and felt funny about being alone - there was no way I could have done this trip alone if she'd been my first baby. We had a pleasant and very scenic drive through the Berkshires and got to the dentist's office. He checked Hannah's mouth, said her ties were quite restrictive - especially the tongue - and he recommended revising both. I signed the consent forms and Hannah was whisked off for her date with the laser.
She was gone for less than 10 minutes, and I did cry. And I prayed that she would be OK and it wouldn't hurt her too much. Other families had arrived with babies for their revision appointments, and it appeared I was the only mom flying solo that day. The wait alone in the exam room sucked. I have no idea how parents of children with serious medical conditions do it - this was a simple procedure with absolutely no anesthesia and I was still a wreck. I was resolved not to be crying when she came back to me, though. THe dentist brought her back and had me nurse immediately. She was not crying when she came back to me, but it was obvious that she had been (whether from being swaddled or having fingers in her mouth or the pain of the procedure, I didn't want to know). He came back around 10 minutes later to show me how to do the post-surgery stretching exercises, and we were on our way.
We stopped for lunch and we got home around 3 hours after the procedure. At that point the natural numbing effect of the laser wore off and Happy Smiling Hannah turned into Insanely Screamy Hannah. I seriously started to wonder if the revision had been a good idea. I got her stripped down to a diaper for skin-to-skin and nursed her, which was the only thing that gave a temporary reprieve from screaming. I called the pediatrician to get the correct dosage of Tylenol and the nurse could barely hear me over the din. Mark got home and he went to get Lily from daycare and to pick up our CSA box, because Hannah and I couldn't leave the couch. Clearly, our plans to take Lily out to dinner for her birthday had to be changed.
Fortunately that afternoon and evening was the worst of it. I gave her a couple more doses of Tylenol in the days following and a week later, Hannah seems to be pretty much over it - except for when we do the stretching exercises. I'm worried that we may have a bit of reattachment of the tongue tie based on how it feels when I do the stretches/massage the surgical sites, but we'll see what happens as it continues to heal. She's already getting a deeper latch, is able to nurse for a full feeding without popping on and off constantly, and my soreness is diminishing. We've even had nursing sessions with no lipstick nipple! And having discrete nursing sessions versus being on and off the breast for a minute or two at a time is allowing me to actually get things done around the house.
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