Understanding Tongue-Tie: Birth Onwards

Welcome to the first of a seven-part blog post series: Understanding Tongue Tie from Birth Onwards. Today, I’ll be guiding you through the modern birthing process, with the goal of fostering a deeper understanding of how induced labor affects infants in general and with some emphasis on tongue tied babies, thus empowering you to make more informed decisions early on and better treatment decisions overall.

The rise (and fall) of induced labor

There are good reasons to medically induce labor, especially when the pregnancy poses increased risk to the mother or her baby. Post-term pregnancies, for example, may benefit from induction as there can be increased risk for still birth. Evidence also suggest moms with pre-eclampsia benefit from induction past 37 weeks.

While the prevalence of induction had been steadily rising over the past two decades, in recent years the trend has seen a slight reversal. This is largely due to the overall decline in elective induction, which is where the mother requests to be induced even when it isn’t medically necessary. This trend is a net positive for newborns, as we discuss in greater detail below.

Natural vs. induced labor

When not medically necessary, it is recommended to avoid induced labor, and to let the birth happen naturally. There are many reasons why, but to get right to the point, I want to remind mothers of something that is not often remembered or even thought about. The birth process is a sphincteral process. As with all sphincter processes, there is a need for relaxation to occur, and there is often a “2 steps forward, 1 step backward” sort of process that is natural. Let me dive into this a bit deeper to help explain why it is so important for babies at birth.

A sphincter is a circular muscle which opens and closes in a wave-like process as to pass objects into, through, or outside of the body. Swallowing, digesting, passing food, and elimination are all common examples of sphincteral processes. Mechanically speaking, childbirth functions along the same principles–marked by alternating periods of relaxation and contraction in order to deliver the baby out of the mother’s uterus, through the birthing canal, and into the world.

In natural labor, the baby’s body makes “headway” upon contraction, and then retreats slightly. This forward backward motion of the baby allows for constant repositioning which better allows the head to turn and then the shoulders to clear the mother’s pelvic bone. In addition, this important, natural process functions to “turn-on” the baby’s autonomic nervous system in a way that is not well simulated after a c-section birth, and is often disrupted and dysfunctional in an induced birth. In an induced birth for example, the uterus contracts much more forcefully and more often, drastically increasing the periods of strain on the baby’s body while not allowing for sufficient recovery or natural turns.

To cope with this continuous strain, the baby’s connective tissues–their muscles and tendons, or “fasciae”–undergo a process known as “armoring”. Imagine a football player tensing their body to brace for an impact; the baby does the same while being pushed against the dilating cervix and then out of the vagina, but on an ongoing basis until delivery is complete. In addition, because hospitals are also business entities, there is frequently a tendency to “help” get the baby out quicker once it gets to a certain point. The help is in the form of forceps, vacuum or manual force. These forces do bring the baby out sooner but not without consequence immediately and later. An increase in shoulder dystocia and broken clavicles are 2 immediate results of such interventions and injury or facia trauma are things that may not be seen as quickly but can impact a baby significantly in more subtle ways. In a natural birth process mother’s are generally more relaxed and baby has time to make the needed turns and come out on their own, avoiding these traumas. What we need to remember is that almost 0% of medical doctors coming out of residency have seen a truly natural birth. They may see a mom who has labored almost completely elsewhere and then they get to “catch” the baby, but a majority of what they participate in and know as normal is induced birth’s, getting baby out quickly once it begins to crown and c-sections. They are trained that mom’s who are in labor but then stall need to be induced (which is common in sphincter process when anxiety sets in…aka walking into hospital at 8CM dilated then going back down to 2CM!) and that if labor isn’t “progressing” at a certain mark to surgically remove the baby. I don’t fault the doctors for doing what they know and are trained to do, but I think it is important to remember this is not natural and does have consequences to Mom and Baby.

Once born, natural, induced or c-section, the baby’s body has almost always already endured hours of armoring against unrelenting contractions, and enters the world in a state of extreme tension. Add to that that a majority of infants are then separated for a time from the mother for cleaning and inspecting. Left untreated, this wreaks absolute havoc on their entire system and often directly impacts their ability to breastfeed.

Effects of a traumatic birth

As mentioned above, induction denies babies the opportunity to shift positions in the womb prior to and during delivery. As the baby is continuously impacted against the mother’s uterine wall, cervix, and pelvic bone, its connective tissues begin to armor. Prolonged armoring in utero can “train” these fasciae to assume an unnatural default tension and shape. (For an incredible visualization of how the fasciae work, watch Strolling Under the Skin).

Two most commonly seen and known results of this armoring are conditions such as Torticollis, or “wry neck” and occipital compression. Both can significantly cause tension in the head and neck and negatively impact breathing and breastfeeding. Infants can also present with a highly constricted craniofacial complex. Left untreated, these issues can negatively impact neurological development and feeding as well as alter the growth of the face, jaws, and airway.

Tongue tie and its impact on breastfeeding

After delivering the baby, the natural first “reflex” is the crawl on the mother’s tummy up to the breast with the rooting reflex.

This often happens even with cord still attached. This is very natural and allows babies to open wide and have a great first latch and feed. The mother holds her infant skin-to-skin against her chest and baby is allowed to regulate after the trauma of birth. How often have you heard of hospital births allowing this to take place? Not only is it not common or even allowed sometimes, but research shows how medicines and inductions blunt the babies ability to have this first experience to get nursing off to the best start.

Even in the best circumstance, when a baby is allowed to crawl to the breast and latch, tongue tied babies will often latch, but it may not be comfortable or effective. An abnormal latch is often painful for the baby, mother, or both. Then tension in the body, especially head and neck limit the baby’s ability to open wide. In addition, the tensions, torsions and effects of the birth can directly affect cranial nerve function which affects the babies innervation and use of muscles associated with breathing and feeding. Restricted fasciae impede normal functionality of the muscles needed to latch and feed as already mentioned, so even absent pain, it can be difficult for babies to transfer the milk out of their mother’s breast, and sometimes this lack of transfer also causes an issue with the mom’s supply not coming in or being as robust. Sadly Moms aren’t given this information and so frequently think something is wrong with them when their supply isn’t coming in or as much as their baby needs.

Intervention begets intervention

Once Pitocin or another induction drug has been administered, the delivery is placed on a clock. After a certain window of time has elapsed, usually 24 hours, without a successful birth, clinicians will typically recommend a C-section. While C-sections have been shown to reduce infant mortality in their intended use-cases, the procedure does not come without its drawbacks.

Vaginal delivery equips a newborn’s microbiome with the initial culture it needs to thrive. Without this exposure (as is the case in C-section), children face increased risk for developing autoimmune and allergic diseases, and may experience respiratory complications as well. C-section babies are more likely to face complications breastfeeding, as well as increased rates of obesity and ADD. The process of delivering a baby through the birthing canal also offers a wealth of physical stimuli which are integral in helping the baby’s autonomic systems to “turn on” as mentioned before (and which are not easily approximated by artificial means).

What’s more, sadly hospitals are financially incentivized, as a business entity, to hurry deliveries along, placing significant psychological and physiological strain onto the mother. In stark contrast to midwife-led home births, hospitalized mothers have less to say on who comes and goes into the delivery room or how things will progress. This can make an already troubled delivery even worse, leading clinicians to elect for interventionist methods like induction, forceps delivery, and C-section.

A more holistic approach is needed

Throughout history as far back as antiquity, childbirth has been viewed as something rather miraculous and perhaps even beyond the full scope of human reckoning. As such, midwives have traditionally concerned themselves primarily with facilitating the natural birthing process, letting the mother’s body take the lead.

Today, virtually every aspect of pregnancy up to delivery is subject to clinician oversight and control, for better and worse. Across the myriad medical disciplines, research and development have surged to produce the most sophisticated body of knowledge we’ve ever possessed on human physiology. On the whole, however, the practice of medicine has not moved towards a holistic paradigm in managing this incredible complexity.

Instead, the focus of well-meaning clinicians has tended towards solving highly granular issues at the expense of the bigger picture. The most common modalities are thus prescriptive and largely interventionist in nature. Such methods are typically quite successful within their intended use-cases, but may inadvertently trigger other problems to crop up elsewhere in the patient.

Unfortunately, this is tragically evident in our handling of childbirth. This observation is not meant to denigrate the advances of modern medicine, which have ushered in an era of plummeting mortality rates among both mother and child alike world-wide. Sadly however in the US we have one of the highest maternal mortality rates of any developed country. The US is 3 times higher in this alarming statistic than in neighboring Canada and 6 times higher than some European countries. This illustrates the need for humility enough to admit that our understanding of pregnancy and birth is inadequate in the medical area, and to serve as the basis for developing a more nuanced, holistic approach.

How to get the support you need

Pregnancy and the birth that follows are not “one-and-done” processes. What’s more, no single clinician holds every answer to the question “how do I give my baby the best start in life?” For this reason, I am a staunch advocate for assembling a team of knowledgeable providers who can help you address the nuanced requirements of your newborn’s emergence into the world, especially if they suffer from tongue tie.

In the coming weeks, I will be sharing a blog post detailing the role each of the following personnel plays in treating infant tongue tie:

  • Internationally Board Certified Lactation Consultant (IBCLC) – Pre-frenectomy
  • Internationally Board Certified Lactation Consultant (IBCLC) – Post-frenectomy
  • Bodyworkers such as Osteopaths, Chiropractors and Occupational Therapists
  • Functionalist Medicine Pediatricians

Finally, I will conclude the series with a post on Tummy Time, “container babies”, and the Back to Sleep initiative. Taken together, this body of information should go a long way towards guiding your pregnancy and birth in a healthier direction for you and your baby.

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