 Healing relationships has been a highlight of my many years of general practice. The fulfilling moments of being able to help alleviate some of the barriers to a truly harmonic mother and baby relationship composes a large proportion of this collective treasure of my years. My own involvement in treating oral restrictions has been a big part of this experience in seeing breastfeeding relationships healed of dysfunction.
We are made from and of relationships. The foundation of all that is unique in each of us starts from that unique experience of being nurtured by our mother. The breast and its function is truly sacred and sustaining in every sense of the word, far beyond nutrition, from the tiniest baby to the robust child. For all of us our unique mother-baby beginnings have shaped us and defined our future health through the multitude of repercussions of having been breastfed or not in our basic nurturing relationship. The realists among us are only too aware of the influences which threaten the harmony of this breastfeeding mother and baby, such as, labour and delivery trauma, mother-baby separation, pain, lactation failure and oral anatomy. Oral restriction, including but not limited to tongue tie or “Ankyloglossia” and its impact on breastfeeding is now known to be a treatable cause for such interference. The development of a tongue restriction dates back to 12 weeks in utero when the final separation of the tongue from the floor of the mouth is thought to occur. When this separation is less than complete a degree of impairment results. A baby is born with the tongue configured with or without restriction. Babies with oral restrictions can exhibit a degree of suboptimal range of motion of their tongues and other oral structures. The skill of assessing the impact of any potential restriction is knowing how it is affecting breastfeeding, being aware of any other potential issues regarding tongue and oral functions which need to be considered and how such restriction might be best remedied as part of a plan of action for such an infant. The spontaneous resolution of restriction of tongue or other oral tissues does not occur - it is a matter of releasing such tissue by one of a variety of tools available. Those who do frenotomies or other oral releases choose their instrument according to their profession and experience – choosing from scissors, scalpel, electrocautery or laser – as a means of producing the best improvement in range of motion of the tongue and other oral structures with enduring enhanced function but primum non nocere – first do no harm. A procedure of releasing oral restrictions should always having as its companion the skill of those who put it all back together – namely the lactation consultant who can gently re-align the breastfeeding relationship and a body worker to focus on the infant’s need to harmonize behaviour in their new oral environs. However, in my experience, the key to optimal resolution of restriction and movement lies with the mother. Her willingness to be patient and persistent, to assist her baby to go beyond the pre-established behaviour and to reach the functional potential is dependent on her belief that the anatomical limits of her baby can be permanently altered through better movement and built upon by some degree of manipulation of these oral structures, thus encouraging optimal feeding behaviour to emerge and to endure. The joy of renewal of the breastfeeding relationship is celebrated. Complete resolution of breastfeeding difficulties by release of oral restrictions is never guaranteed and the dedicated professional will grieve as much as the mother if premature weaning occurs. When a suboptimal result occurs often there is no specific reason and certainly no culprit. However, having a supportive lactation consultant is invaluable in encouraging the mother to develop a creative strategy to approach the many aspects of the breastfeeding relationship - through continued breastfeeding even when discouraged. I have shared my journey of 19 years with colleagues around the world – physicians, surgeons, dentists, lactation consultants, midwives, speech language therapists, body workers and many more members of diverse health care professions who work tirelessly for mothers and babies. It is always a pleasure to meet and get to know such a colleague as Effath Yasmin. Her genuine respect and concern for the breastfeeding relationship shared by mothers and babies coupled with her skill as both a lactation consultant and as a cranial-sacral therapist, has made her a valued member of the international community of professionals involved in the management of oral restrictions. No matter how great our diversity may be those of us who have the honour of working with mothers and babies share an immense respect for and commitment to every mother and baby and their achievement of the normal and fundamental human relationship – breastfeeding. To quote Canadian academic and environmental activist Dr David Suzuki: “A baby nursing at their mother’s breast…is an undeniable affirmation of our rootedness in nature.” Yvonne LeFort MD FRNZCGP FCFP(Canada) FABM IBCLC Family Physician and Breastfeeding Medicine Specialist Milford Breastfeeding Clinic Auckland New Zealand Dr Yvonne LeFort is an MD and practices as a Family Physician and Breastfeeding Medicine Specialist & Medical Director at Milford Breastfeeding Clinic, Auckland, New Zealand.
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