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.

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

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!

A few days later she wrote:

I have to keep reminding myself, this is only a storm, and it will pass eventually, even if only because he is weaned! Although not so easy this morning - up a lot in the night, and wanted to feed every hour to an hour and a half since he woke up. And he feeds properly, not just comfort sucking. Then cries cos he's tired and wants to go to sleep and can't. There have been several rants about God this morning, I'm afraid. Not proud of myself, but there you go, my nipples hurt.

The next week, after Polly had had a really rough time, I was surprised to get this:

Hello Auntie Alison,
The reason I was a bit grizzly yesterday when you came to play is that I wasn't very well. Mummy was getting me ready this afternoon to go into Guildford with daddy (I had a lazy morning in my pyjamas!) when she noticed a rash on my tummy and legs. So she took me to the surgery where she used to work, and a very nice lady Dr looked me all over, and said I had a virus, with a sore throat and a viral rash. so mummy has been carrying me in the sling a lot, and giving me lots of her lovely mummy milk to help me feel better. Oh, and some Calpol too!
Hope you don't catch it!
Love William xxxx

Things continued to be difficult and at 4 months, Polly and Alex began asking me about weaning foods. We discussed the pros and cons of starting early - the recommendation is to wait until babies are developmentally ready to start taking solids (not puree), which is around 6 months. A few days after that, this email came:

Another bad night with William - up every two hours, and decided to stay up between 4.30 and 6.30. My nipples are in shreds!  I read the stuff you sent - a bit concerned that they state early weaning won't make any difference to sleep, as that is our main reason for doing it! And I so wanted to wait. But then I thought, maybe by trying to wait, thinking it's in his best interests, I'm actually making him suffer, because he can't get the creamier milk, and is hungry. Today I bought a clear, see through dummy, because I want to know if he is hungry when he wakes, or if he is just wanted the comfort. It also has the benefit, because it's clear, of showing what he is doing with his tongue when he sucks! we also gave him some organic pear blended with EBM this evening as we had our dinner, after his feed. He seemed to enjoy it - he didn't push it out with his tongue, and had about 6/7 baby teaspoons. He went down to sleep easier, and seemed to suck better off the right, after sucking on the dummy. I'm not holding my breath though, I still think he'll be awake by 9. There aint that many calories in 6 baby spoons of pureed pear!

Over the next weeks of weaning, the discussions continued. Polly kept to fruit and vegetables, knowing to keep gluten products until after 6 months. William still wanted a lot of breastfeeding, but gradually things became easier. He had a check-up from a speech and language therapist who specialises in baby's feeding problems, and she gave helpful advice about encouraging William to use his tongue well.

At nearly five months, I chuckled over this email:

Big cuteness alert - yesterday his carrot and broccoli was too hot, so I was blowing on it to cool it down before he ate it. This morning in bed, he obviously thought my milk was a bit warm, he'd have a couple of suckles, spit it out, and then started blowing on my nipple, in exactly the same way! Then he'd look at me sideways and grin! He was doing it for about 5 minutes!

With the family's permission, I have included this (slightly amended) in the update of my book Fit to Bust.

Over the next few months, weaning became easier, and William began to sleep more at night. His teeth came through, always with some tears on both sides, but breastfeeding became a little less painful when he wasn't teething. At nearly 6 months, William sent me another message:

Hello Auntie Alison,
I got a tooth through properly today! I was visiting my little cousin (she is only 3 weeks old, and I hadn't met her), when mummy thought I might be in pain (she's very clever - because I was!) Luckily she had some teething granules in her bag, so she gave me some, and then she gave me my MAMS gum massager. I had a good chomp on that, when suddenly my gum split and a little tooth popped through! Mummy noticed some blood in my mouth. I tried to be ever so brave Auntie Alison, but it did make me cry a little bit. I've had lots of nasty things happen in my mouth! Thankfully, because mummy noticed as soon as it happened, she gave me lots of my lovely mummy milk. It took all the pain away, and was so comforting. Mummy was telling me that if it hadn't been for you helping her, I wouldn't still be having any lovely milk. So I wanted to say THANKYOU! I love my milk - it always tastes different, but it's always sweet and warm. And I love being so close to mummy, and the smell and feel of her soft skin - I am very grateful to you. Mummy said it will make me grow up to be clever, and I won't get lots of nasty illnesses. Mummy said she still can't actually see my tooth, but I was chomping on her finger in the bath, and she could feel it!
I am really looking forward to seeing you again soon!
Lots of love from William xxxx 

Update January 2010
When William was half-way through his second year, his breastfeeding came to an end as Polly was well into another pregnancy. Thomas was born in the autumn. After a few weeks we realised that he too was tongue-tied, though not as severely as William. The tie was divided by the Southampton team, but Thomas still has problems with his tongue movement and feeding remains a painful challenge for Polly. Thomas is now having 'suck training' with advice from Catherine Watson Genna, IBCLC, in the USA. I am so thankful that I am able to help Thomas, Polly and Alex continue to do what they really want to do. We don't understand why breastfeeding is so difficult in this family, but believe that God knows the reason!