A snip of the tongue


Ever since we went through the process of getting Andrew’s tongue tie assessed and snipped when he was nearly 10 weeks old, I have been very keen to share our story and spread the word about tongue tie in babies. In my experience, there is not much information about it from prominent sources such as antenatal info packs and classes, midwives and health visitors. I found I had to ask other mums I knew at our local breastfeeding support group, who had also had their baby’s tongue tie checked out, and do my own research online, to find out enough about it to make any decisions. So when I was given the chance to write a feature blog post for Wriggly Rascals on tongue-tie in newborns, I jumped at it…. and you can read it here.

If you’ve had experience of a newborn with tongue tie, please take a few minutes if you can to help out another mum trying to decide what to do about her baby’s tongue tie – here’s a Wriggly Rascals’ survey.

About Wriggly Rascals
Wriggly Rascals was set up by Shona Motherwell, a frustrated mum of twins Mhairi and Archie to get mums together to share pregnancy, baby and toddler advice via quick surveys to get the facts about what other mums do. Our mums pass on loads of great tips to mums who have asked for help. If you would like some advice, get in touch at www.wrigglyrascals.com



Mum-to-Mum sharing: at-breast supplementation

In this post I’d like to share my experience of using a little-known ingenious device for supplementing breast milk with formula milk. I haven’t met many mums who have used such a thing, and as far as I can see there isn’t much info out there about it compared to other breastfeeding-related ‘equipment’, so I’m hoping this will be a really informative post for anyone who this might be useful to.

Before I go any further though, let me first talk a bit about low milk supply and the possible need for supplementing with formula. Much of the useful information that I have taken in about breastfeeding has been through La Leche League (LLL), and, more specifically, the book published by the organisation called The Womanly Art of Breastfeeding (which I’ll call WAB for short). The information in this book was written by mums with years of breastfeeding experience, and is backed up by medical professionals and scientific research into various aspects of breastfeeding; plus it is constantly being updated (currently in its 8th edition).

A common anxiety that many mums-to-be and new mums have about breastfeeding is ‘will I (or do I) have enough milk?’ WAB’s answer is that most mums are able to make plenty of milk; some do have difficulty making enough, but often the reasons are fixable if the mum gets the right support and information at the right time. So what might cause a deficient milk supply? WAB puts it like this…. The baby might not be taking enough from the breast (leading to a declining supply because breastfeeding works on the principle of the more milk taken the more is produced); this could be due to issues such as position at the breast, the frequency and length of feedings (not often enough, too short), prematurity, tongue-tie, muscle weakness etc. Or mum might have hormonal issues which lead to lower milk supply, such as thyroid problems, polycystic ovary syndrome and other fertility issues, or structural issues with her breasts, such as previous surgery or insufficient milk-making tissue. There are many possible factors involved, and the combination of factors is different for each breastfeeding pair (mum and baby).

In the case of Andrew and I, there was a mixture of both mum and baby issues which lead to our supply problem (you can read our full story here, but I’ll summarise for you now). I don’t have a huge amount of milk-making tissue, which is evident from the shape and size of my breasts (it is important to note that small breasts does not automatically mean insufficient milk-making tissue, nor indeed does big breasts automatically mean loads of milk-making tissue – there could be lots of fat tissue too which doesn’t make milk; shape is also key in this. For more info, I’d recommend reading p381-382 of WAB or the LLL book Breastfeeding Mother’s Guide to Making More Milk). Also, Andrew was born with a tongue-tie. This was a particularly tricky one to spot, and we didn’t get an official diagnosis until he was nearly 10 weeks old, at which point it was snipped and this did make a difference to his weight gain (the indicator that he was getting more milk).

And finally, before I actually get on to at-breast supplementing after this important deviation into low milk supply, let me mention a few points (from WAB) that might explain why a mum thinks she isn’t making enough milk (when in fact she is). She might not realise that babies need to feed as often and for as long as they do (though they all differ in exact requirements) – what seems like all day every day canbe completely normal. She might have someone else asking her ‘are you sure your baby is getting enough?’ – that’s enough to make any new (or not so new!) mum doubt herself and her instincts. She might not be letting the baby lead the way by letting him/her feed whenever and for however long he/she wants to, and instead following a schedule imposed by herself or a parenting book.

Well done, you've found another scavenger hunt logo! Keep reading for more tips, blog links and chances to win some cool breastfeeding-related prizes!

If you along with your health professionals and breastfeeding supporters have ruled out all the potential causes of low milk supply (actual and perceived), and tried to fix any that could be at play, but baby is still not thriving as he/she should (usually indicated by poor weight gain, at least that’s what medical professionals look for, though there are other things like lethargy, dry mouth/eyes/skin, not reaching milestones), then supplementing baby’s milk intake is a necessity for his/her well-being.

At this point I would like to point out that, despite the impression that some people including medical professionals give, baby feeding does not have to be black and white: either you breast feed (exclusively) or you bottle feed. I successfully combined breastfeeding with formula supplements until Andrew was on a balanced and varied solid food diet, at which point I dropped the formula and continued to breast feed. Don’t let anyone tell you this isn’t possible!!! WAB also makes the same point. Another thing to point out is that there are ways in which mum can try and increase her supply as much as possible, for example by expressing milk to give to baby as well as feeding directly at the breast and taking herbal supplements (I won’t go into this here, but again I’d recommend WAB or Breastfeeding Mother’s Guide to Making More Milk).

One thing that helped us a lot with our supplementing (and increasing my supply as much as possible) was the at-breast supplementer that we were given (and then later bought one of our own) by our local hospital’s infant feeding specialist midwife when Andrew was admitted with dehydration and major weight loss at 6 days old. It’s called a ‘Supplemental Nursing System’, or SNS for short, by Medela. This ingenious device is quite simple really – it’s a bottle, into which formula or expressed breast milk is poured, which hangs around mum’s neck with a thin tube coming out of the bottom that mum sticks to her breast with tape so that the end of the tube sits just on the nipple; when baby sucks on the breast, he/she not only gets all the breast milk available, but also the milk in the bottle via the tube.

SNS (supplemental nursing system) - a bottle that hangs round mummy's neck by a cord, and out of the lid (which is at the bottom when hung) comes a length of thin tubing, which is taped for each feed to the breast, so that the loose end of the tube sits on the nipple. As baby sucks on the nipple, he gets all the mummy milk available, plus the formula in the bottle. Quite ingenious if you ask me!

The reason why I liked this was that Andrew was still breastfeeding all the time that he was also getting the top-up. He did have a bottle every now and then – basically when we were out somewhere that I couldn’t easily prepare and use the SNS – but I would always offer him both breasts first and then the bottle. He didn’t miss out on any of the milk that I was able to make, and I enjoyed the feeling of having him sucking from me and felt like I bonded very well with him in this way. I am convinced that without the SNS we would not still be breastfeeding today, at 16 months! So, ironically, it was a good thing that we went into hospital at 6 days old and were given very good advice by the feeding specialist.

Andrew (4 months) and mummy enjoying a feed, with the SNS around mummy's neck

Sure it was fiddly using the SNS to begin with, and it did take some time to get to know the best ways to use it. Here are some of the things I learnt about what worked for us:

  • If Andrew was very hungry by the time I got ready to feed him, it was sometimes easier to get him latched on first and then stick the tube in at the side of his mouth, rather than try and latch him on with the tube in place at the nipple, as this often ended up with him knocking it out the way during the latching process! Ideally I tried to feed him when he wasn’t already fussing, but this was sometimes impossible.
  • As he got older and I found I needed to support him less than in the early days, I found it easier to hold the bottle or put it down next to me instead of having it hanging round my neck which sometimes got in the way when he was bigger.
  • There are different thicknesses of tube, and working out which one was best at each stage was a process of trial and error: as he got older I thought it was logical to go for thicker tubing to get a faster flow which he could then cope with, but then I realised he got used to that and was more fussy about sucking from me without the SNS (i.e. without the artificial immediate let down of milk), and I reverted to the thinner tubes.

But these issues that we learnt to deal with were nothing compared to the help it gave us, and I would recommend it to anyone who is facing a situation of low supply and the need to top-up. Although we put formula in the SNS (because I was unable to express much with a pump or by hand), it is also possible to put expressed breast milk in it as a way of increasing supply – i.e. you express and baby feeds from you, to maximise the milk output from the breasts.

I’ve tried to remember all the information about low supply and supplementing that I think would be useful for others, but if you have any more specific question, please leave a comment and I’d be happy to tell you more about our experience. For a while I felt like a failure for not being able to produce enough milk and desperately wanted to be able to exclusively breastfeed, but I came (a) to realise that I’m not the only one who struggled with low supply, (b) to accept that this is just the way I and Andrew are (after lots of determined trying to increase supply and put everything right), and (c) to see myself as a breastfeeding mum who gave her baby a bit of calorific help from formula in the early months. Now that Andrew breastfeeds happily without top-ups, but of course a good diet, I’m so happy I persevered through feeling like a failure, because I know now that I most certainly am not! In fact the longer Andrew feeds, the more likely it is that I’ve developed more milk-making tissue to be able to feed the next newborn with less (or no) supplementing. Most of all, I hope that our story inspires others to not feel like a failure when breastfeeding is not going like it does in the textbooks – this is the real world.

Why not hop over to some other blogs and read other mums sharing their experiences? There are some links below, and more on the main website, where you can also find out more about the Keep Britain Breastfeeding Scavenger Hunt 2012. I’m sure there will be lots of other tips and stories to inspire and encourage. Don’t forget to enter the competition below to have a chance of winning the grand prize.

Bumps 2 Babies – The Beauty of Breastfeeding

Mama Geek – Getting Started with Breastfeeding – My Top Tips

Life, Love and Living with Boys – Breastfeeding Friendly Chester, An Update, A Guest Post AND a Competition! – A Babi-Mam Bib-Bob giveaway

Little Scribbles – Sharing

Breast 4 Babies – Ten Things your Midwife or Health Visitor Never Told Me about Breastfeeding and a BoobieMilk giveaway

Diary of The Milkshake Mummy – From One Breast Friend to Another

Blooming Lovely Jewellery has joined the Hunt with their beautiful Bola Pendants

a Rafflecopter giveaway

When tongue-tie is more than being stuck for words

Once again I seem to be blogging about the same topic twice in a few days (obviously not including pregnancy – the last time this happened swimming was the thing on my mind) This week it’s been breastfeeding, which I guess isn’t surprising given that I’m thinking ahead to a new baby. So, apologies if you’re not interested in hearing about breastfeeding, but here’s another thing that’s been on my mind.

We found out, the hard way, after nearly 10 weeks of Andrew struggling to gain weight as a newborn, that Andrew was born with a tongue-tie. ‘What’s that?’, you might say, or ‘I’ve heard of it – doesn’t it just mean when you’re put on the spot and can’t come up with the words to say?’ Personally I used to associate the term ‘tongue-tied’ with the (slightly geeky and cult) comedy series Red Dwarf (some of you may know what I mean; see here if you don’t!) Basically it means a tongue which is anchored to the floor of the mouth to a greater or lesser extent by a piece of skin called a frenulum. A more technical term for tongue-tie is anklyoglossia (anklyo – anchored; glossia – tongue). It is sometimes measured (roughly) as a percentage, so a 100% tongue-tie is where the frenulum goes all the way to the tip of the tongue, and in a 50% tongue-tie (for example) the frenulum goes about half way to the tip.

Example of a tongue-tie (about 80%) (yes, this is my mouth - the mouth of a breastfed baby all grown up) Note the frenulum, the thick piece of skin anchoring the tongue to the floor of the mouth behind the lower front teeth.
Example of a tongue without a tie (thanks to my lingually superior to me husband 😉 ) Note there is no frenulum anchoring the underside of the tongue to the floor of the mouth, so it is free to stick up this far.

‘What’s this got to do with breastfeeding?’, you might well ask. It shouldn’t be too hard to imagine that the physical state of the tongue can affect a baby’s sucking action, because that’s what they suck with. The problem with this for breastfeeding is that a tied tongue is unlikely to be very efficient at removing milk from the breast, and therefore the mum’s supply will suffer, because the process of breastfeeding is such that the more milk that gets removed by baby from the breast, the more the breast produces. Poor supply leads to less milk for baby, and so poor weight gain in the baby.

However, I should point out that it is not an absolute fact that all tongue-tied babies will have problems breastfeeding and gaining weight. I found out on the same day as we found out with Andrew that I have a severe tongue-tie (more severe than Andrew did), and yet I was exclusively breastfed as a baby and my mum had no major problems doing that. There are clearly many factors involved in each individual breastfeeding relationship between mum and baby, and what causes an issue in one may not cause an issue (or the same issue) in another. But my point is that tongue-tie CAN have a big effect on breastfeeding, as Andrew and I (as well as many others) can attest. For that reason, I’d like to do my bit to try and raise awareness of this.

In my experience, one of the most important places to start with raising awareness of tongue-tie is with medical professionals, believe it or not! Of course there are exceptions to every rule, and I’m sure there are doctors, midwives and health visitors who are very clued up on this, but that was not the case in our story. I won’t go into details of our tongue-tie story here, as you can read in a separate post that will follow this one, but we were wrongly advised by two GPs about what to do about tongue-tie. I understand that they are general practitioners, and so I wouldn’t expect them to know everything there is to know about tongue-tie, but I would expect them to refer us to a specialist, given the symptoms that we were displaying as a breastfeeding pair. In the case of these GPs (and others in Cambridge that I have heard about through mums having had similar experiences), the problem is their ignorance of the potential effects of tongue-tie on breastfeeding and, to some extent, ignorance of the importance of breastfeeding itself.

But it’s not really the fault of these individual medical professionals, rather a wider cultural issue resulting from the fact that breastfeeding lost its status as the norm of infant feeding to bottle feeding, though this is currently in the process of being reversed again. Tongue-tied babies can still suck a bottle teat and drink all the milk in the bottle (but they might be slower or messier than a non-tongue-tied baby). Knowledge about tongue-tie and how it potentially affects breastfeeding has dropped off the radar in the training of medical professionals, because it was not an issue for bottle fed babies. So it’s not surprising that our GPs weren’t clued up on tongue-tie – it was probably covered in just a line or two in their massive textbooks that they read once whilst cramming for exams! I read somewhere (but I can’t find it now I’ve come to write about this, so it might be an urban legend or old (mid!)wives’ tale) that midwives used to keep one of their little finger nails long and sharp so that they could inspect the baby’s tongue when it was born and sever the frenulum quickly using the nail if the tongue was tied.

Note the 'heart shape of this tied tongue - the frenulum is pulling it down in the centre when I try to lift up the tongue. Sorry for slight blur - it's actually really hard to take pictures of tongues as they are hard to keep still!

‘Wouldn’t that hurt the baby? Sounds a bit cruel to me?’, you might say. Actually in very young babies, the frenulum has little blood supply and nerve tissue, so they don’t feel much, if anything, when the frenulum is snipped. The younger the better, because as the baby grows, the more the frenulum develops blood supply and nerve tissue, and by the time you get to my age, it would be a major operation under general anaesthetic if I were to get my tongue-tie snipped (which I won’t because I don’t need to, thank you very much!) These days, when tongue tie is actually treated in babies, it’s done with a sterile pair of blunt surgical scissors, without any anaesthetic, not even local. ‘OK, that does sound cruel’, you might say. Well, it’s no more cruel than sticking a needle in their thigh for their immunisations. In fact in Andrew’s case, he cried less (loudly and long) for his tongue-tie snip than he did for any of his injections, and quickly calmed down whilst feeding from me, during which the action of sucking helped to close up the cut effectively. I’ve heard from other mums who had their baby’s tongue-tie snipped at just a few weeks old that the baby didn’t even wake up from their sleep when it was done. So overall I would say that the small amount of pain is nothing compared to the long term benefit of having an efficient tongue suck for breastfeeding, just like the short term pain of immunisations is nothing compared to the long term gain of not catching life-threatening illnesses. Both are choices that I as a parent have had to make on behalf of my child.

Look at how near the frenulum comes to the tip of the tongue! Sadly this is about as high as I can lift my tongue in my mouth when it's this far open, and I certainly can't stick it out very far at all.

With a second baby, I’m sure there are many examples of things that will be easier because we’ve encountered them before (of course there will be new things that didn’t crop up with the first too!) Tongue-tie is one thing that I will definitely be personally more aware of with our new baby than I was with Andrew. As I said, my experience of tongue-tie was once limited to a comedy series, so I can’t stand in my greenhouse and throw stones at people who don’t know about tongue-tie – I don’t fancy getting covered in smashed glass. What I do know is that this time I will be more persistent in getting specialist advice as soon as possible, because it is quite likely that this baby will also be tongue-tied to some extent, as it runs in families and mine is so bad, though thankfully Tom’s tongue is not tied at all. I will have more  knowledge myself to try and impart on anyone who is involved who does not seem to have it themselves. If we catch and snip a tongue-tie early this time, this might help to build up my supply more in the early days, and might mean I can breastfeed with less (or no) formula supplementation.

The follow-up post to this intro on tongue-tie contains the letter that I recently wrote to our GP practice, as feedback on our experience of advice on tongue-tie. I’ve anonymised it: my point is not to name and shame, as this practice is not alone in the way they deal with this condition. I thought it would be useful to share, to complete this bit on raising awareness of tongue-tie. In the meantime, I’ll leave you with a very helpful website, which (in its own words) aims to dispel the myths and reveal the facts about this little-understood condition, just in case you’re interested in finding out more: www.tonguetie.net (need I say more….)

The hardest but best thing I’ve achieved in my life

Starting this blog in December meant that the first month’s posts were predominantly Advent- and Christmas-related. So with the start of a new year, it’s time to introduce a few topics that are more on-going. A new year always makes me think back over the highs and lows of the previous year, and 2011 was for me an amazing year – the best so far I have to say, of course thanks to Andrew. I also think about what I’ve achieved in the year, and in 2011 came the hardest but best thing I’ve achieved in my life so far.

It must be the PhD, I hear you say? But wait, that was 2010, right? Up until 2011 I probably would have said it was my PhD. But then Andrew came along, and with him a very strong, instinctual desire to breastfeed no matter how many problems came our way when we tried to do it, a desire which wasn’t even present during pregnancy. 11 months later, and I believe that breastfeeding Andrew is my hardest but best achievement so far. I must acknowledge that I couldn’t have done it without the support of several people, in particular Tom (who made it clear every day that he would support me in whatever I decided to do about feeding), my parents (who gave us so much practical help around the flat so I could concentrate on feeding), and our friends who prayed for us all during the hard times.

Since I now feel very passionately about breastfeeding, I know this will feature quite a bit on this blog. I don’t want to give the impression that I’m one of those people who bang on about ‘breast is best’, full stop; you’ll see that from experience I know that breastfeeding is not black and white, but rather there are many, many shades of grey, with every mum and baby pair having their own breastfeeding relationship.

So to start with, I think it’s best if I share our breastfeeding story to date. This is in fact a bit of a cheat of a post, because I’m posting an article that I already wrote which is published in the latest issue of Breastfeeding Matters, the regular magazine of La Leche League (GB). I’ll say more about this organisation in future posts, but for now let me give you the background behind my passion for breastfeeding….

Breastfeeding Matters magazine - January/February 2012 (Do you recognise the handsome little fella on the front cover?! Photography credit: Mark Galloway aka Grandad!)

Making the most of what we have

It must have been around 30 weeks into my pregnancy, when I saw that the NHS-run antenatal classes we were about to attend had an optional breastfeeding workshop running one day quite soon. I’d thought that I’d like to breastfeed; my mum had breastfed my brother and me until around 8 months, and I’d read about the health benefits for baby. But I guess I always had it in the back of my mind that I had small breasts and so wouldn’t be surprised if I couldn’t. So I thought it was worth going to the workshop; after all, they would know if breast size would likely affect my ability to feed. Indeed it was helpful, and I came away with knowledge of latching baby on, feeding on demand, and various other important things. Most importantly in my mind, though, was the assurance that it is very rare that a woman cannot physically breastfeed, and small breasts certainly didn’t matter. Excellent, I thought.

Andrew arrived 4 days overdue (clearly he was waiting to share his birthday with his daddy!), in a much faster time than I’d expected for my first baby. At 7.30pm my waters suddenly broke, then my labour progressed very quickly, with Andrew arriving at 10.22pm. I had no pain relief, other than being in a pool for about an hour, but that seemed to slow me down, so the midwife suggested I get out, and he was delivered without complications soon after. She put him straight onto my tummy, and after just a few minutes, he lunged quite spectacularly across to my breast, latched on, and began sucking. Great, I thought, my baby knows what to do!

12 hours later we were home, and things went well for 3 days. I breastfed on demand, whilst my husband, Tom, and my parents did everything for me. On day 4, Andrew became very unsettled – he wanted to feed literally all the time, and when I desperately needed the toilet or a shower, Tom could do nothing to settle him for that short break from me. Although I’d heard that feeding constantly in the early days was normal, I wanted some reassurance that Andrew was OK. As my midwife was on annual leave until day 6, Tom, rang her team of colleagues, who advised us to go to a breastfeeding drop-in clinic (which was on day 5), where I explained Andrew’s unsettled situation, and that I didn’t feel any changes in my breasts, like my milk hadn’t come in. They assured me that it would, and advised us to have lots of skin-to-skin contact; they knew that my midwife would come tomorrow to assess Andrew. After another sleepless night, we were greeted at the door bright and early by the midwife. She looked him over and was happy with his appearance. But her expression turned more worried as she put him on the scales; she couldn’t quite believe it, and checked it again 3 times. He had lost nearly 20% of his birth weight. She sent us to A&E, as this was more than the normal post-birth weight loss.

I cried most of the rest of that day, sitting in hospital, watching them do all sorts of tests on my little baby, and thinking that I had failed as a mother already at less than a week. The doctor explained that he was dehydrated, so they would have to keep him in hospital and give him formula milk through a naso-gastric tube every 3 hours until he improved. We were lucky, though, that breastfeeding was not ruled out altogether by the doctor’s introduction of formula. First, he told me to continue breastfeeding as much as possible; second, the hospital’s infant feeding specialist came and looked at Andrew’s latch, which was good in her view, as well as my breasts, which she admitted were small, but she hand expressed something from them, albeit still colostrum at 6 days. As I was clearly physically and emotionally exhausted, she asked whether I wanted to carry on breastfeeding. Since Little Miss Determination should be my nickname, giving up on this was not an option for me, despite the exhaustion. Her suggestions were to use a supplementary nursing system (SNS) (see pictures below), and express with a pump between feeds, as these would make sure Andrew got as much breastmilk as possible and build up my supply. She’d even brought an SNS to the ward, and fitted it onto me for his next feed. Although this was a bit sneaky (because the doctors wanted him to be tube fed), it was the best thing that had happened for 3 days – Andrew fed amazingly well, latching on and draining the SNS of formula in no time, no problem. He had that lovely drunken full look, and I felt better already knowing that he was being nourished, but still getting whatever colostrum I had.

SNS (supplementary nursing system) - a bottle that hangs round mummy's neck by a cord, and out of the lid (which is at the botton when hung) comes a length of thin tubing, which is taped for each feed to the breast, so that the loose end of the tube sits on the nipple. As baby sucks on the nipple, he gets all the mummy milk available, plus the formula in the bottle. Quite ingenious if you ask me!
Andrew (4 months) and mummy enjoying a feed, with the SNS around mummy's neck

By the next day, his dehydration was back down to the higher end of normal. The question of discharge came up, and between discussions about his blood test results, Andrew yanked out his naso-gastric tube in a moment of arm flailing! It was as if he was telling the doctors: “I don’t need this tube, I can feed like a big boy, thank you very much! And now I’d like to go home, as would my mummy.” We were discharged that evening. Great, I thought, we were back on track with feeding.

Whilst my parents cooked us dinner, Tom and I set about sterilising the SNS in our microwave steriliser (which we’d been given before the birth along with an electric breast pump and bottles, as I thought I might need them when I returned to work). However, disaster struck, and the rubber band holding parts of the SNS together melted a hole through the plastic – it was no longer usable. It was Friday night, and despite my mum’s best efforts to google an SNS supplier, nowhere would deliver until at least Tuesday, plus we knew the infant feeding specialist was away for a few days. We had no alternative but to bottle-feed him some formula after he’d fed from me. That was it, I thought, he’d get nipple confusion and not stimulate my breasts enough to improve my milk supply.

After at least some hours sleep during the night, it occurred to me that we could contact La Leche League (LLL) Cambridge, as they might know where we could get an ‘emergency SNS’ at the weekend. I’d heard of LLL, as their website had come up whilst I’d googled breastfeeding in my antenatal research on the subject. Tom rang one of the contacts, Mary; not only did she know a lady who used to be a Medela rep and had an SNS for demonstration purposes, but she also offered to drop it round to us there and then. Within the hour we had an SNS, and Andrew and I were back in business as a breastfeeding pair, all thanks to Mary.

By day 14, Andrew had regained his birth weight. Also on that day I managed to squirt some milk into my eye whilst hand expressing, and the drops that followed were runnier and more opaque white than the creamy colostrum. What an amazing feeling, the almost 2 week wait had been worth it and finally my milk had come in, though not in great quantity.

Over the next month or so, Andrew started to settle into a daily rhythm of feeding, sleeping and being awake, whilst Tom and I tried to figure out how to manage the mixed breast/formula feeding. We wanted to make it as close to demand feeding as possible, though that seemed trickier with formula than if we could rely on breast milk alone. However, Andrew’s weight gain slowed down, and he gained only a few ounces maximum between each of his weekly weigh-ins, which our health visitor advised so we could keep an eye on him. We increased the formula supplement little by little each week as we didn’t want him to plateau on the baby-weight graph. Andrew and I also went along weekly to the breastfeeding drop-in clinic, as well as the fortnightly LLL meetings, to get support and remind myself why I was persevering when it was so easy to feel like there was no point giving him next to no breastmilk. During the clinic when Andrew was 8 weeks old, Mary (who volunteers there as well as LLL) was holding him; as he was showing off his wide smiles, Mary noticed that his tongue looked quite anchored towards the back, and it preferred to move to one side. She suggested that we could see a tongue-tie specialist, as she wasn’t an expert. I’d heard of tongue-tie, but nobody at the clinic or hospital had ever suspected it in Andrew, as I’d had no nipple damage and his latch seemed good from the outside.

We decided to get a private lactation consultant, Ann, who specialises in tongue-tie, after two GPs told me something along the lines of “oh well, you’ve breastfed for 8 weeks, that’s great; he’s on formula anyway, so there’s no point referring you to an NHS tongue-tie specialist if it’s a posterior tie and snipping it might not make a lot of difference”. Ann came to our flat when Andrew was 10 weeks old, and did a 3-hour assessment of his mouth and my breasts. Not only did she diagnose a 50% tongue-tie in Andrew (and incidentally an 80% tongue-tie in me, even though I was exclusively breast fed), but also breast hypoplasia in me. This is basically underdevelopment of the breasts, so there is insufficient glandular breast tissue. In LLL’s online article ‘Supporting Mothers with Mammary Hypoplasia’ (Cassar-Uhl, 2009), breasts are likened to a ‘milk factory’, and in the case of hypoplasia, the ‘“milk factory” is either missing key parts to its assembly line or is absent altogether’. In my case, there clearly was something happening in the assembly line, but perhaps there weren’t enough key parts to produce enough milk to satisfy Andrew’s growing appetite.

My breasts are small, I knew that, but this was the first time someone was totally up front with me – Ann said that their wide spacing and bulbous nipple and areola that merged into each other were signs that I had a medical condition which meant I was unlikely to produce enough milk, even if I tried really hard (which I felt I was!) She snipped Andrew’s tongue-tie, and showed me how to latch him on to make sure as much of my breast went into his mouth as possible. No wonder his latch had always been praised by others – my small nipple-cum-areola fitted into his small mouth no problem, so no darker skin was visible outside. After Ann left, I felt a sudden sense of built-up tension being released, and I slept for the rest of the evening after Tom got in (except when he woke me to feed Andrew before his bedtime).

For the next month or so, Andrew gained 7 or 8 ounces each week, and we went from weekly to monthly weigh-ins. I felt like I had more milk in terms of what I could express, though obviously I couldn’t see how much he could get out of me, but his sudden increase in weight gain suggested that it was more than previously. The snipped tongue-tie must have helped on a practical level, but I also think that the release of tension I’d experienced helped on an emotional level.

Now that Andrew is nearly 4 months old, I’d say that we’re making the most of what we have. I know my milk won’t be enough to drop the formula completely, and I’m coming to accept that there’s nothing I can do about my breasts, that’s just me. Don’t get me wrong, though, I still have days when I resent the faff of sterilisation and formula preparation, and wish I could just go out not worrying about how much milk to take. I see myself as a breastfeeding mum, who’s giving her baby all the goodies in breastmilk, with some extra calories in the formula milk (which at the end of the day isn’t awful – Tom was bottle fed and turned out alright, well, I married him!) Ann said I deserve a medal for persevering as long as I have given what was stacked against us; but I haven’t carried on for any prize other than seeing my son develop and grow after giving him the best possible start I can. Andrew has always been an alert, interested and bright little boy, even when he was admitted to hospital with dehydration – the doctor noted it on his discharge document. So even though he’s not exactly heavy for his age, we’re not worried about his development, and he’s reaching all the milestones as he should. And anyway, breastfeeding for us isn’t just about food for growth, it’s about the bonding and comfort we both get from being snuggled up close, which I wouldn’t change for anything right now, and (give or take the interesting distractions now that he’s getting older) I don’t think Andrew would either.


Since writing this piece when Andrew was nearly 4 months old, I’ve continued to breastfeed him, and he’s now over 11 months. If someone had have said to me at 11 weeks that I would still be breastfeeding at 11 months, I would not have believed them! My goal was to get to 6 months if possible, but when we got there, and he started eating solid food, I found I started to enjoy breastfeeding him even more. I think the reason is because I feel less pressure on myself now that I know milk isn’t his only source of energy. He loves his food, and will eat most things we offer him, shovelling it in messily with his hands and chewing away merrily. So I know that this food is complementing the goodies that he’s getting in my milk; more so than ever, breastfeeding is less about ‘feeding’ and more about snuggling up for quality time together, and me comforting him if he’s upset or calming him down if he’s agitated. He generally has one feed first thing in the morning, and one last thing before bedtime, though if he’s ill or upset, he sometimes wants more during the day or night.

There have been times over the past few months when I’ve worried that he was losing interest in me and my low milk supply, as he wanted fewer feeds. (One particular time turned out to be he start of a tummy bug, which Andrew and I only got mildly compared to Tom – probably due to the immunological help that we, the breastfeeding pair, give each other 😉 ). A LLL Cambridge leader, Justine, reassured me that this is quite normal at his age, even in babies whose mums haven’t had supply issues, as they start becoming independent, crawling off to explore the exciting world around them, and dropping feeds particularly during the day. This gave me confidence to carry on, and I’m happy to continue to meet his needs for as long as he would like me to, even if that means into toddlerhood.