Wiliam at 6 months showing off his tongue, with his father Alex

In April 2008 I had a phone call from Polly, who was having trouble with breastfeeding. Her first baby William was 12 weeks old and thriving, but she had never had a pain-free feed. Polly and her husband Alex are committed Christians and had been praying during the pregnancy for a trouble-free birth and breastfeeding, so this had been a puzzling as well as agonisingly painful time.

Polly had been told by midwives that her baby was attaching perfectly, but her pain and nipple damage persisted. At four weeks, her health visitor noticed that William was tongue-tied, and a week later the tie was partially divided. The doctor who did this said it was insignificant and didn't need snipping, but indicated that she would do so to keep Polly happy. There was no improvement, and Polly then saw a breastfeeding counsellor who helped her with various positions, but the pain did not ease. She found me on an online search for a lactation consultant, and was pleased to find that I lived only two miles away.

When I saw Polly and William, I noticed that he still had a tie under his tongue, and was not opening his mouth well. I had learned a lot about ankyloglossia (tongue-tie) while in post as Infant Feeding Adviser at St Peter's Hospital in Chertsey, and knew that the two things were likely to be connected, and could be the cause of Polly's pain. I made a referral to Mervyn Griffiths, consultant paediatric surgeon at Southampton General, and the UK's most experienced doctor in treating ankyloglossia. He found that William had an unusually tight, thick band at the base of his tongue, and divided it fully. Immediately, William started opening his mouth really widely, and we all hoped that the breastfeeding would now improve.

Polly kept in touch frequently after this. We were both surprised that William began waking at night and feeding very frequently. He had previously been sleeping through. As this is a more normal pattern for a young breastfed baby, I suggested that Polly try to stay with it for a while. However, every feed was still painful, as William was still not fully attached, and her nipples became ulcerated at times. She developed blocked nipple pores, blocked ducts and mastitis, and I visited to help her massage the blockages out. Her determination to keep William to breastmilk alone was put to the test when her breasts were too painful for him to feed directly, and she couldn't express enough to satisfy him during a bout of mastitis. She wrote about being in contact with another mother with similar problems:

I had suggested that cranial treatment might help William to attach more fully, and he had a few sessions of osteopathy and chiropractic to ensure there was no jaw stiffness or other problem left untreated. I was surprised and saddened that  this didn't make much difference. Polly asked her GP for a referral for speech and language therapy, as I told her this can be very helpful when babies have disorganised suck patterns, but she was advised instead to see an ENT (ear, nose and throat) consultant. This 'urgent appointment' took weeks to come through.

After a very difficult spell, William had a few formula feeds by bottle. However, Polly returned to breastfeeding as soon as possible. She emailed me to explain why:

Just to let you know I have decided to ditch the bottles, expressing and formula and go back to the breast feeding. This is because:-
1. I hated it.
2. He did the most disgusting, foul nappy in the chiropractors this morning, I nearly heaved, and I've got a nurse's stomach. That cannot be good for him
3. He has been a grumblebee and miserable since we started it
4. He started to refuse the breast even for comfort feeds, but would happily take a bottle, which scared me
5. I hated it.
6. Expressing every 4 hours made me feel like a cow.
7. I hated it
8. I have lost all my confidence, dread being left alone with him, and am convinced he doesn't like me, and that's only happened since we started it
9. It made me feel a complete failure as a woman and as a mother.
10. Did I mention I hated it? 

Amazing difference (with William) already, I even had a smile this pm! Still incredibly painful, but I have realised, I'd rather have the physical pain than the mental/emotional kind.

The worst difficulties were always after William's immunisations, so it was a great relief when the third lot were over.

At 16 weeks, Polly sent this:

Got William his first book today, and he loves it! Sat there with Alex turning the pages himself!  He has also developed an incredibly cute habit which almost (but not quite!) makes all the pain worthwhile - half way through a feed, he comes off, looks straight up at me, gives me a huge grin, 'chats' to me for a few minutes, then goes back to feeding! We are noticing changes in him on a daily basis now!

to be continued.....