Why breastfeeding support is not a one-size-fits-all approach, and what to do about conflicting advice

New parents often receive a great deal of conflicting advice from health professionals they like and trust.

If you run into breastfeeding problems (and I can write those two words simply, but there is often profound distress, heartache, physical pain, and exhaustion lying behind them) you might be told that your baby has tethered oral tissues, needing surgical release.

Breastfeeding is something our forebears seem to have done easily for millennia, and it comes as a shock to find that it often doesn’t happen easily in the modern world. There are many reasons why this might be the case, but that doesn’t help a woman who feels like she is going under, with the baby screaming, the inability to get him or her onto the breast, the frequent pulling off, the frantic fussing, her own dreadful worry about her child’s weight gain and hydration. And then, the pain. She just needs help.

Classic tongue-tie has been overlooked for half a century or more, and may make breastfeeding impossible if it isn’t picked up. If the baby has a classic tongue-tie, it is a simple matter to have this snipped.

Otherwise, there are two main problems to sort out, and a range of other things about the breastfeedingand unsettled behaviours to discuss, and as soon as possible.

It’s important to have your baby fitting well into your breast and body, because fit and hold directly affects tongue function and oral tissues, causing tightness and disrupted tongue movement. Fit and hold can take quite a while to finesse, because your body and your baby’s body and mouth are so unique. Fitting you together in the best way takes a lot of experimentation through the days and nights with your baby. At Possums, we call our approach gestalt breastfeeding, since we have the view that there’s no point focussing on the tongue and oral tissues without understanding how they are affected by the whole of what the mother and baby are doing together. (‘Gestalt’ means a whole that is more than the sum of specific parts.) We have developed, out of years of work with breastfeeding pairs, a unique and systematic way of helping you with this. There is the problem of functional lactose overload, too - a bloated windy tummy and explosive frequent stools, which is often misdiagnosed as gastro-oesphageal reflux disease, or allergy, or tongue-tie, but which resolves with the right breastfeeding and fit-and-hold strategies. It’s also useful to understand the way a dialled-up sympathetic nervous system affects reflux and the way a baby cries.

What can you do when you receive conflicting advice, including the advice to get tethered oral tissues surgically released?

I recommend you find a second opinion, or as many opinions and information as you need, and weigh it up for yourself. You could give our gestalt breastfeeding a try, for even just a few days, before you go on to the deep laser or scissors cuts under the tongue and upper lip and subsequent wound stretching exercises. We know how difficult it is to receive conflicting advice, and regularly support parents on whatever journey they choose, frenectomy or otherwise. We are non-judgemental about the decisions you've already made, knowing how hard it is to when you've been told different things. In the end, our job is to support you, just where you are at now, and to help make the days with your new baby as manageable and as pleasurable as possible.

Please note: the baby at the breast in the accompanying image has fit and hold issues, which might lead to a diagnosis of tethered oral tissues. It is likely that this baby has difficulty getting on the breast, or pulls off the breast, back-arches, refluxes. This baby may also cry a lot. The mother may be experiencing nipple pain. At Possums, we can help you resolve these problems without surgery (unless there is a classic tongue-tie), by applying gestalt breastfeeding. Research demonstrates that our approach results in halved daily levels of cry-fuss behaviours.