Episode 242: It Shouldn’t Hurt to Nurse Your Baby with Lisa Paladino RN, CNM, IBCLC

Hi and welcome to episode 242 of the Untethered Podcast. Today we have Lisa Palladino rejoining us. Lisa was one of our initial first guests back way back when on this podcast. So Lisa is an IVCLC and a CNM and private practice in Staten Island, New York. She worked for 28 years at Staten Island University Hospital before establishing her private practice in 2015. At the hospital, she co founded and coordinated the Breastfeeding initiative and worked in collaboration with the New York City Department of Health on efforts towards achieving a baby friendly design nation. Currently, Lisa offers courses for parents professionals on the topic of breastfeeding and tongue tie. She produces the Tongue Tie Experts Podcast and provides education to parents and professionals through the Tongue Tie Experts brand on Facebook and Instagram. She is the author of the book It Shouldn't Hurt to nurse your baby Healing the six most common causes of nipple Pain. She loves to lecture and educate the world on the importance of breastfeeding for the health of infants and the developing airway. Personally, Lisa is happily married to her college sweetheart, has raised six seven children and is a proud grandma. She enjoys reading, watching the New York Mets, traveling, walking in nature and spending time with her two spoiled Shih Tzus. Quick Disclaimer all information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider. Welcome to the Untethered Podcast. I am your host, Holly Balkan. I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial Myofunctional Therapy, Airway Tether, Dural Tissue and Pediatric Feeding Therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener. As we jump into today's episode. Remember to listen with correct oral rest posture, tongue up, lips closed, teeth apart, breathe through your nose. Let's get started.

Foreign.

Lisa, welcome back to the podcast.

Thank you. It's so exciting to be here. So many episodes in. We've both done so much since our first interview together, right?

I know you were like one of my first guests on the podcast and I know we connected about doing another episode. I was like ah, this feels like it's Coming full circle. I love this.

Yeah. And, you know, we haven't really talked, but I've been watching all the wonderful things that you're doing with the podcast and your courses and all the education, and I feel like the way we, our attitudes towards our work seem to be aligned. From afar, I could tell that, you know, you're doing more than just your own clinical stuff. You're doing lots of empowering work for professionals, which is, you know, talks to my own heart. So thanks for all you do and thanks for having me here.

Well, that's so sweet. Thank you so much. I always appreciate, you know, a warm hug and nice words and, you know, I do it, a lot of it just I was actually talking to somebody the other day simply not just because of who I am as a person and the mission I've set forward, but I had my own child who really threw me deeper into this particular, you know, specialty arena. And, you know, it's having, being a mom going through it. I was like, I have the ability to get the education very easily because I already have a license that allows me to do that. And so if I can figure out how to, like, what I didn't know and impart that on others and share that with others, you know, and save them from a journey of excruciating, you know, pain and just trouble finding providers to help them and all, all those things, you know, I just know, like, there was no question about it. I was like, this is my new journey. And my own child just kind of shapeshifted that for me. So, yeah, yeah, yeah.

In my case, retrospectively, I went through this with my children, but didn't know what was going on. But there was such a dearth of information in my area. There weren't even IBCLCs at my hospital or in my local area. So it kind of fell on me with no choice when I was seeing people who, as I always say, my usual lactation tricks weren't helping. You know, doing all the things and it's not helping. There's gotta be something else. And, you know, as a midwife, I'm very non interventional. So when I was hearing about this tongue tie thing, just like many of the people listening must be like, what do you mean, why we need all these procedures? I was very skeptical at first because I think that the less we have to do, the better. However, there were some kids that made me go down this rabbit hole and say, what's going on? And after I sent the first baby and they came back and things improved, so much. That was it. You know, I was like, I have to do this. I have to teach. I have to learn all I can and start teaching other people so that I can have people to work with. So that, that's where. And, you know, the latest thing you talk about your, your child, I have a grandchild now, and he is, I'm going to do an episode one day just about him. His case study has been a journey, you know, continuing journey. So we, we learn and we apply. Right. And we go forward and teach.

Yeah, I mean, my, she's, she's been my best teacher and I'm very grateful because it made the journey with my second a lot easier when I was able to dive in and learn. And, you know, I didn't necessarily know everything. I wish I had known during her first two years of life, but we've since been able to, you know, work with her. And anyways, I share all about that on the podcast all the time. But, you know, I think it's, you know, I know one of the things that you, you really highlight, too, is the importance of considering the mom in this. Right. Especially with newborns and infants and when there's tongue ties involved. And so I would love for you to speak to that because, you know, I've been on this journey with both of my children. But share your, your.

Yeah, absolutely. First of all, the function of how an infant works at the breast. And you know, in general, we're talking about. Not more than in general. Specifically, we're talking about a breastfeeding baby. Bottle feeding. Yes, that mom should be considered as well. But when a, when a mom is breastfeeding, the function of the infant at the breast does not just depend on what's going on inside the infant's mouth. It has to do with what's going on for the mom, too. And many aspects of the mom, which we can get into. And there's a danger of forgetting about the mom. You know, this is more than a mouth. This is more than a body. And I've been to many conferences and especially lately, things have opened up and we're going back to conferences where there's multidisciplinary interdisciplinary learning, which is my favorite. And the last conference I was at, there was no, there was no mention of the mom at all. There was no, I was just a spectator. I wasn't lecturing. Right. There was no ibclc. Who was just an ibclc. Not. And when I say just an ibclc, meaning there were some dentists who had a dual Degree. There was some other professionals that were there that were, yes, I have lactation initials, but there was no standalone. This is what I do. I'm an ibclc, talking to the audience about what it's like from all sides of the breastfeeding diet, you know, and I like to talk about three patients. I consider them patients because of my mainstream medical upbringing and learning, you know, we learned about patient management. So I think about management of the mother, the baby, and then I consider the feeding like a patient. Right. So individually, those things and doing a subjective and objective evaluation assessment of those three patients. So when we don't consider the mom, we are missing a piece that is way more important than most people realize. So, yeah, so that. That's basically the. The motivation for my latest soapbox, so to speak. I love my money.

I love that. I mean, it's. I think back to the first pediatrician that I had with my first daughter. And one of the things I really appreciated about their office was that every time I was filling out, you know, questionnaires before each of our appointments and her, you know, at every single well check or anything, there was also questionnaires for mom. And it wasn't just one, it was usually like two. And I was like, huh? As a provider, like, this is. I really appreciate this because you are checking in on mom and you're hopefully going to flag anything that may also need to be addressed or any. Maybe some referrals that need may need to be made for mom or conversations that may need to be had. And so I really, you know, while they missed the tongue tie and the IBCLC was not trained in tethidural tissues in their office, I really did appreciate their approach on treating that dyad and the unit, the family unit in that sense, because they were saying, hey, mom, are you okay? How are you feeling? And, like, just through a series of questions, I think they would pick up on something.

It was probably the Edinburgh Postnatal.

Yeah, that was one of them. And there was something else that I think they had, like, created in house. And I think it was almost like a second means of, like, in case somebody is answering something the way they think they should answer it. We're going to ask it this way too, to see. And I was like. And that's what I really appreciated too, was like, they kind of could read between the lines because it's scary sometimes as a parent or a mother to admit to these things or to say, you know, well, my one job is to be a mom to this baby. To feed them, to keep them happy and clean and alive. And, you know, I don't want to fail as a parent. And if I answer this a certain way, that. Does that mean I'm failing? Right.

Were you being judged? Right. Yeah.

Pull out a questionnaire like this. So I thought that was very, very. I think.

I think that that's, you know, to be applauded. And unfortunately, I think that's rare. I mean, I never remember being asked anything beyond, you know, how's it going? Kind of. Kind of. Yeah. Yeah. So just to draw on that, you know, one of. One of the aspects of the assessment for mom that I do is asking questions around postpartum depression. But I also go back, and first of all, the first thing I'll ask a mom is, tell me your story. Tell me your pregnancy story, your birth story. You know, we bring all of that to the table as moms. What was it like for you and how do you feel about it now? Because almost no one will ask a mom, how do you feel about your birth experience? You know, how are you feeling now when you think about what happened to you in the delivery room? And more and more, sadly, more and more moms are checking off the box of birth trauma when they're doing my intake forms. And, I mean, I would say 95% classify their births as traumatic. Now, it might just be my particular location. I don't work as a midwife in the hospital that I worked at for a good reason because I wasn't supported to support mothers in the way that I wanted to. And I say that now six years out, almost seven years out, I'm comfortable saying that the reason why. And, you know, but I don't think it's just here. I think it's universal where post Covid, we lost a lot in the caring. And I mean, we know when we look at our, you know, infant mortality and maternal mortality and morbidity rates, not good in this country, you know, especially for black and brown women. So there's. There's trauma going on. There's a lot of interventions going on that new moms don't expect, and nobody's asking them about that. So what does that have to do with breastfeeding?

Well, I would consider my first birth a traumatic birth. And, you know, not my second was not my first was. And our feeding journey was really challenging. And it's definitely even impacted our. You know, I've talked in the past. I was talking to Taylor Kulik.

I don't know if you. Yes.

Yeah.

We've Done. Instagram lives together. Yeah.

And we were having this conversation. It just, like, hit me like a ton of bricks. And I was like, there's actually trauma around this.

Yes.

And the feeding journey. And I actually. And I also can see how that's impacted our relationship. Right. That we don't, you know, not that I don't love my child and she doesn't love me and we don't get along beautifully and, you know, people saw our family. Everything is amazing. But some of the ways she presents or, like, the way she seeks attention from me compared to my younger daughter, who had a beautiful breastfeeding journey because she was. Her tongue tie was released early on, and the birth was traumatic. I'm like, I can see and I've lived it firsthand. Exactly what you're saying. But nobody ever. No. I wasn't even told by my OB the extent of what happened at the end of the delivery. And I learned it from my mom, like, months after. And she's like, discuss this with you. And I was like, no, I don't even know. It's in my charts. Like, I just.

Right. Yeah.

Anyway, so, yeah, I mean, the.

The whole idea of, well, you have a healthy baby, you should be happy. Gaslighting is what we get. So, you know, I mean, I'm still working through birth trauma myself because I knew nothing about birth, and I was a labor and delivery nurse, and I knew nothing about what births should be. So it took to my third. I had a home birth for my third, and I healed some of the wounds from my first two births being taken care of as a nurse who worked in that labor and delivery unit. Can you imagine? I had trauma then. But anyway, that's a little, you know, little digression. But, yeah, so the trauma matters because, you know, here you are, you're a new mom. You're coming if you make it to the lactation consultant, because, you know, it's rare that you even get that far. You know, you decided you wanted to breastfeed. Everybody told you they supported breastfeeding. The baby comes now, you don't feel good. You're uncomfortable holding the baby. You feel like it should be working more than it's not. If you don't get 100% support and the right support in the hospital, you get confusing messages like, oh, it doesn't matter if you give a bottle or do this or do that or, you know, and I'm not anti supplementation. If it needs to be for medical reasons, it does. But your defenses are down. You're Physically exhausted. Even if you had the most beautiful birth in the world, you have just went through the most dramatic hormone shift that any human will ever go through. The time of immediate afterbirth, right? Everything shifts. So hormonally you're. That way you're probably anemic because we lose a lot of blood and most women are anemic before they give birth, which is another rabbit hole. So now you're anemic, you're depleted, you're either dehydrated or overfilled with fluids from IV fluids. You haven't slept, you have aches and pains, you are bleeding more than you've bled in your lifetime. Sounds fun, right? And now you're supposed to hold this baby and know what to do. And many of us come to our breastfeeding relationship never having seen a baby nurse, right? I mean, that's changing. But for most of us, it's still the case. And you know, it's hard, it's really hard. Now you get into the, well, you know, you're at the lactation consultant and oh my goodness, I had somebody the other day that brought three shopping bags full of lactation pillows, right? So like you have all these things you bought, all the things you think you need, you have the teas, you got the pillows, whatever, and still it's not working because nobody can tell you how to do this, right? So, you know, I'm always very gentle, especially on a first time moment, and take a breath before even if there is a tongue tie there. I try to do everything that I can to not have that be the problem that I'm presenting to them. Because here you are, all these things going on for yourself. And now I'm going to tell you there's something wrong with your baby that might need surgery. And no matter what we think about how easy a procedure is, that's all they hear. You mean my baby needs surgery? There's something wrong with my baby.

And then a lot of them will say, did I do something wrong in my pregnancy? They immediately go to like guilt, blame, Right? No.

Right? Yeah, yeah. So I try to downplay, not misdiagnose, not, don't assess. But I'll look at all the other things and I'll say, you know, does she know how to hold the baby? How's her milk supply? Does she have nipple pain that needs, you know, or nipple infections even that need to be healed before we even consider the tongue tie? There are some times when, and I'll judge this assessment depending on the situation where I'll say, you know what? There's no way this kid is going to nurse unless we do something. You know, there are those times, but I will always tell the parent, this is what I think it is. This is what might help. However, it might not be the be all or end all solution because we haven't fixed A, B and C yet. So your milk isn't in yet, or your milk is delayed, or you've been giving bottles and not pumping so you have no milk. And we can fix the tongue tie, but if you don't have milk, the baby's not going to nurse. We're looking at all of these things all at once, but mostly assessing how is she feeling about it, how is she, you know, and bottom line, what are her goals? Right? Because what my goal is for everybody, of course, is exclusive breastfeeding. But that might not be her goal. So maybe we can take some time and she can pump for a bit or whatever. The care plan is to make sure that she's ready and able to take on the idea that her baby needs a procedure. Right. And I always start with bodywork anyway, if it's available to the parent, whether, you know, physically, financially, whatever. Start with body work and giving them some tools to work through whatever it is that's impeding breastfeeding. Because honestly, tongue tie is one of the things. And when I first learned about tongue tie, everybody was going right away, I was like, oh, this is great. We found a solution. And now we're realizing that, you know, there is over diagnosis or over assessment, there is over treatment before we make sure that that's actually the problem, you know. Yeah, long winded answer.

But no, you're preaching to the choir here. I mean, I've also, I think, evolved, right. Over the past five to seven years or so. 8. And just from working with patients, from speaking with a lot of other providers in this space, you know, I think a lot of us are on the. On the same page here where we go, okay, we used to go, oh, this is. This is a solution. Okay, great, let's do something about it. And then we started to realize that the babies or the children, you know, other. The older patients I was even working with, those who had the best results, were they were prepared the procedure, if they even needed it, and. Right. So we always kind of had this, like, rule of thumb, unless it was like an emergent situation. Baby was maybe like on the verge of going on a feeding tube. They'd already had a whole bunch of other interventions. So they come to us kind of in the middle of all of this, that might be a very different scenario in terms of referring to a release provider faster. But we kind of had this, like, rule of thumb that we want to see you three to four times before we refer you, because sometimes it looks like tethered oral tissues. And then when you do go to another provider for bodywork, or you work with us, or we do some work in the mouth or, you know, you know, you're working with the IBCLC and they're giving you, they're teaching you how to breastfeed. They're also helping you if there's something preventing successful breastfeeding. You know, we're. We're collaborating. You would see. Oh, the baby's actually feeding really well now. Okay, don't touch. Like, the baby's feeling well. Mom is happy. Mom's goals are being met. Because that's another thing you said, too, is, what are mom's goals?

And right.

I have to admit, like, as when I was a younger clinician, you know, you come in and you're like, let's go. And I got. We're going to do this and this and this and. Right. And then I actually had some patients say to me, and it was actually, I think, more. Some of the adult patients that I was seeing in with Mayo, and they'd say, I don't. I don't want expansion. I don't want a tongue tie release. I just want to try to prevent this from getting worse. They're like, can you work with me? And I'm like, well, I'll do an assessment, and then we can have a conversation, and then we'll see if we feel like there's something we can do together. And I'm willing and happy to help you in whatever way that looks like for you. And I think that was very humbling and very eye opening, too. And I started to then go back and look at, you know, all of my other cases, whether they were infants or whatever age, and really make sure I was applying that same approach because. And, you know, I taught something almost a year. Well, almost a year ago now, almost 10 months ago, December, where I was. The whole talk was airway first. And so, you know, I was also sharing my airway journey. And everyone, you know, always says to me, well, Holly, like, what is your secret? Like, how do you connect so well with patients? How do you get them results? How do you move them from point A to point B? And I said, the number one thing you need to do, aside from assessing your way, is you need to ask them why they're there and you need to listen and you need to give space. Whether it's the patient or the parent or the mother, you know, or even sometimes a child depending on their age. Like we have to listen to what they're telling us because your agenda and that's not aligned with theirs, you're not helping them and we'll just refer them somewhere else.

Right. They're not going to reach their goals if you don't know what their goals are. And you know, so in, in my initial assessment I always in my note, make a list of the things that are problems. So whether it be there's nipple pain, there's reflux, you know, all the things that could be tongue tie related, baby's not gaining, I put the things in a list and then I keep, every time I speak to the parent, I refer back to that list and say, well, how's the pain? Has the reflux? Has. Because even when we have success, a lot of times we don't recognize it. So after release I've had parents sit in my office and say, you know, I thought it was going to improve everything, but it hasn't. And I'll say, well, you know, has the reflux, oh, he doesn't spit up anymore. But well then you know, like it's very hard to objectify how we, how we're doing. So I keep that very careful and that's something I evolved into, you know, later in my clinical practice because I just thought the success was breastfeeding. But it's not just breastfeeding and it's certainly not just weight gain. So yeah, I like to say, you know, show empowering, you know, the parents to see what they're doing is working because sometimes they feel like they're doing all these things that we tell them to do and nothing's really working. And a lot of times it is and they just don't realize it. You know, even in, even in milk supply cases, you know, I've had parents say, well I'm not, I'm not able to just feed at the breast, I still have to give bottles. And I'll say to them, well, when you first came to me, you were giving 20 ounces of bottles a day and now you're giving four. So look at how much you've improved, you know, and I think it's really important to keep that, that empowerment in the parents hands. And you know, we just, we keep like this underlying thing that I hear a lot when I talk to other professionals. And you kind of mentioned it, too. Is this of evolving of our knowledge? It's so important. You know, there are so many pros that just stay stagnant in what they learned in school. And how many times a day do you say, we just didn't learn this in school? Because I. I say it all day long in almost every conversation when I'm facing a parent and they're saying, why didn't so and so tell me this? Why couldn't so and so help me? Like, we just didn't learn this in school. But there's no excuse, but it's an explanation, you know? And also, my favorite quote from Maya Angelou is, when we know better, we do better. You know, you do the best you can until you know better. When you know better, you do better. And we're all evolving. You know, what we're doing today might be different. We might look back on this five years from now and say, what were we doing? Because we'll have new knowledge or new, hopefully new research that proves what we're doing is the right thing. Right?

Yeah, well, but I think that's also. It makes the best clinicians or the best medical professionals are those who are humbled, those who are willing to even like yourself to sit here and say, I may be doing something completely different five years from now. And that's okay. We're doing the best we can with the information and the experience we have now, with the understanding that that's going to continue to evolve. And it may look similar, it may look different. We don't know. Nobody has a crystal ball.

Right.

And I find that, you know, like you were saying to a lot of these families who are like, well, why are you the first person telling me this? I've been to five other people or why is mentioned this before, you know, so many of them turn to social media, which is just a whole nother rabbit hole of like, it's like, to some degree, I'm like, I don't want to say ignore Dr. Google and ignore social media, but also sometimes there's some really good information out there now that may actually be very educational too. Just kind of like getting through the noise and knowing what to trust or knowing what, you know, who to listen to, I think has become a really big challenge for parents.

Yeah. Yeah. And, you know, I think that we need to be able to explain to parents that there's good information, there's not so good information. But when they're being told different things by different providers, what I go back to is Instinct and especially maternal instinct. And I'll tell them. If I'm telling you what to do and you don't think it's the right thing, then don't listen to me. Because nobody knows your baby and your situation more than you do. So if I'm not saying the right thing or this isn't resonating with you, it doesn't feel right to you, then listen to the other people and no hard feelings from me. You know, I, I always tell people that if you don't follow my care plan, you can still come back to me because I respect that, you know, what's best for you at this time in your life. You know, maybe I've had people put off tongue tie release and treatment and, and everything when, when I'm like thinking to myself, oh, if they would just do it now, this is the right time. They really should, you know, they should do this, they should do that. But if they're, if it doesn't feel right to them, I have to respect that and I will, of course, respect that and take care of them in whatever stage they're at. You know, I think that's important. Like, our instinct matters and it's being like, bred out of us. Maternal instinct, you know, getting back to that birth trauma. You know, we're told that we don't know how to give birth. We need somebody else to tell us what position to be in. We need somebody else to, you know, tell us what tests we need during pregnancy and all the things. Right? Without. Without considering how it feels to us. And I know that when I was having babies, a lot of the stuff that was being done to me didn't feel right. And that's part of the reason why I became a midwife, because I knew there was a little bit more empowering way to give birth and what happened to me the first two times, you know, so I think that's very important. And, you know, in, in the fields of people that take care of lactating women or breastfeeding families, the only person really who can address the maternal side and the breastfeeding side is an ibclc. So, you know, I work very closely with slps and I have a team approach that I have wonderful professionals that I work with. But if they're seeing a baby and they can't help the baby and they haven't sent the baby the dyad to me, I usually tell them, please don't send them for release until we see them, you know, so it really, it's got to be the ibclc that's looking at the maternal side. There's real. I mean, with little exception, there is no one else that's. That's trained to do that, you know? Yeah.

I actually have patients who would fit this. This description where, you know, they only wanted to see me or this. You do the infant feeding. And I'm like, I have zero training in how to help you breastfeed or, you know, supplement with an sns. Like, I. I'm not trained in that. And then, you know, I have, like. I remember one family in particular, which the mom just kept pushing and pushing and pushing, and I had to almost start to, like, distance myself because I said, it's not that I don't want to help you, but you're asking me to do something that I'm not trained in.

That's right.

I'm not an ibclc. I have zero lactation credentials. I can work with your baby, but we need to also work. And then I've had other families, too, where there was lactation involved, and we were able to collaborate. And you're absolutely right that we have to take the dyad into consideration because they are one. They work like one unit. I mean, that's. Anyway, so. I know.

Yeah, it's beautiful. And when it works, I mean, I could. I just had a thread on my messages this week of someone who I saw. She went to the dentist. She went to my friend who's an SLP and does craniosacral work. Had the release came back to me. It was amazing. The baby was doing so well, transferred so much work, milk. She felt. The mom felt so empowered. We were all, like, giddy with how well it works because it's hard to get that team approach to actually happen because, again, moms are feeling so tired and overwhelmed. And to even make an appointment is hard. Yeah.

Whether you have the resources or not, it's definitely hard. And to find the team that gets it, too, is the other challenge. But, you know, one of the things, too, that you had mentioned earlier was a lot, and I know it's. You said it's changing, but a lot of women have never seen breastfeeding in real life before. And, you know, I think I was one of those people. I mean, I had kind of seen a little bit here and there. It was maybe not so successful because I was a feeding therapist and I wasn't even working with infants yet. It was maybe like. I remember I was working with a child who was autistic, and the family was maybe French Canadian. Mom Was still breastfeeding him at 4 because he really wouldn't eat a lot. And I know that's very normal in other parts of the world, not as normal in the US And I remember her talking to me about, you know, getting a lot of criticism even from therapists about still breastfeeding this child at four. And the child would say like two words. I won't repeat it because I don't identify who the child is, but basically words to this parent to basically tell mom, like, I want to breastfeed. Did not have a lot of language, did not eat a lot of solid foods at age 4. And, you know, probably blaming it on.

The breastfeeding because I've seen that they.

Were blamed, you know, if she would just stop breastfeeding. And I'm going, you guys realize this is normal in the rest of the world.

Right? Right.

Alternative, you know, universe here in the.

US and that kid might be failing if she wasn't breastfeeding.

Oh, for sure, for sure. I mean, and he, the child is doing fantastic now. He's much older. And, you know, it just, I think it was very eye opening for me because I was a new clinician at that point. I was only a couple of years out of school. And I'm sitting here and I'm just listening to this mom and I'm hearing her pain and I'm hearing her cry for help. And I'm going, why is nobody helping this parent? They're only criticizing her. They think they're helping, but they're doing the opposite. Showing up and forcing the child to stick some food in his mouth on a spoon is not helping anybody. And, you know, it just, it really opened my eyes to the lack of information surrounding breastfeeding in general. But then again, as you mentioned, I think so many of us, whether parents or professionals, really are not exposed to this until maybe we, you know, moms have their own children and decide they want to breastfeed.

Yeah. Well, I really applaud your awareness that you're not the person to help with breastfeeding, because I think it's even more dangerous when some people get a little knowledge, like they'll take a couple of hours of a course or whatever and think that, oh, well, now I know how to counsel breastfeeding moms. Well, counseling breastfeeding moms is a lot different than what an IBCLC does. So there's that too. And in my own experience, I took a myofunctional therapy course. I would never practice myofunctional therapy. I Mean, knock on something, I hope I. You know, unless I had more training, more experience, you know, shadowing someone, learning from someone. You know, I took a course that people are out there hanging shingles for, but I took it to learn what you do, not to do it myself. Right, right. So there are some people who are taking lactation courses to start to do it themselves. And, like, well, now I can help the mom, too. And not so much. Not so much. Unless, you know, you really.

Yeah.

In turn with someone and get practical clinical experience, you know, then we're doing disservice, you know, and then, you know, one of the things we talked about, that we would talk about is the under diagnosis and over diagnosis of tongue tie. And I think it's really important to address that issue about the breastfeeding population, because it's crazy. The world is crazy out there now. And the more, you know, we wanted it. We wanted tongue tied to be recognized. Yes. Right. But we also want to make sure that the tongue tie or the frenum is causing a problem, because you can have a frenum that looks like it's tied, but everything works well. Right. And I'll give you an example of that. I had a patient two weeks ago. When she messaged me, I was mad at her pediatrician because the message she told me was the pediatrician and the nurse in the hospital told me my baby has a tongue tie, but I should just watch and wait and see. So I automatically got my, like, what are they talking about? You know, I was all mad, all mad. I was all, like, ready to, like, see this baby, tell her how obvious the tie was and send her off. Right. I do the assessment. Yes. The baby's got a frenum that maybe it's a little restricted. Very restricted lip. Let's see how this baby breastfeeds. And mom was afraid to breastfeed because, number one, nobody showed her how to hold the baby. Right. And number two, she didn't think she had enough milk. But when she told me how much she was pumping and how much milk she was getting, I was extremely impressed. I'm saying, let's see what happens. Baby came on. I showed her how to position the baby. He transferred three and a half ounces in ten minutes. No pain.

Yeah, yeah. And yeah.

I mean, yeah, maybe there's a tie there. And then it's all. But. So imagine this is getting back to over diagnosis. Imagine that pediatrician had read something about tongue tie and said, oh, yeah, they're telling me I have to diagnose tongue tie now. Yeah, it's a tongue tie. Go get released now. We have a baby who had a release, who didn't need a release, who's gonna be traumatized. Mom had to go through all this stuff to do for this baby and get hands her baby off for a procedure when it wasn't needed. So I, you know, this was a reminder lesson for me personally that we can't assume anything. It's a good thing that pediatrician didn't over diagnose tongue tie.

Yeah, yeah.

Might not get it right with babies who need it, but at least this baby didn't have a procedure that was unnecessary. So on social, you know, I'm on social every week I do this thing called tongue tie Tuesday, you know, on Instagram and Facebook, because I feel like it's important to get out there and answer people's questions. And. And I get all kinds of stories from over diagnosis to under diagnosis. And in the over diagnosis, it's the re. The re releases that really, you know, hurt my soul. You know, we went back and we're thinking of going back a third time. Like, if it didn't work the second time. What are you doing to this poor baby?

Right.

And the trauma for the family? Yeah, yeah. No, I'm still missing ties.

Yeah. And sometimes in these cases, Right. That have had two releases and they are talking about going back for a third, I'm going, well, can you send me the evaluation that was done? And they're going, what evaluation? I'm like, the functional evaluation. I don't know. Maybe from the ibclc. I don't know.

Some.

Usually it's not there, right? It's not there. It hasn't been done. And I think that to everything that you're saying, you know, you're saying that we need these. These functional evaluations. We need to see how function is. Because, you know, that's always kind of been my. One of my platforms is. It does. Yes, form is important, but form does not lead to diagnosis on its own. And so if we see that there's a tie or we suspect there's a posterior hidden tie or whatever, I don't. I can't give you any information until I assess your child. I need to do a functional evaluation. And usually spoke to that too. With functional evaluation is also not just looking in the mouth and feeling in the mouth, which a lot of people fail to do, even go into mouth and feeding, but also talking to the parent and understanding the signs and symptoms present to understand it for both mom and baby. So even though I'm not a lactation consultant, I don't have, you know, credentials or training in that. I still, on our intakes, I ask about a lot of the same things that you do. I ask about the birth history. I ask about if there was any birth trauma. I asked about how delivery was. I asked about, you know, what a baby look like, how, you know, what are people telling you about? Like, what's the pediatrician saying? Because I want to know not only the words of, like the, the parents, the mom and what she's seeing or, you know, what their spouse may be seeing or the other caretakers, but I want to know also, what have you been told?

Right, right.

Has that shifted your beliefs? And so where are we right now? What are your goals? Like, let's move to what your goals were in the beginning.

Right.

Was your goals now?

Right.

Has someone else directed you to where you are now or is this where you want to be? You know, and so it's really interesting to see and have these conversations and then to do this functional eval and see feeding happen to then like you said, no, like this baby's feeding beautifully. And look, I don't know. Parents always say to me, well, should we just do it, like just in case?

Oh, yeah, yeah, yeah.

And I'm like, no, no, we're not. I'm like, none of us have a crystal ball. We have, you know, do I think that it could maybe cause issues down the road? I don't know. Maybe. But if you have a baby who is feeding well right now, this is not the time to do it because you're going to then lead to a baby who's no longer feeding well afterwards. You know, you know, there's going to be this whole roller coaster potentially. And why would we rock that boat? I always say, don't rock the boat. If things are going well, let's not rock the boat. And if something starts to present, we're here.

Plus, you know, if, if the downstream goal of all of this is airway, which I think we both believe it is, that baby breastfeeding is going to do so much to form the airway. So what? You know, if it's working, why play with it? And here's the other over diagnosis key that I see more and more on social media have people saying things like, no, I'm just going to get it done because I've heard it can cause speech problems. And you know, it's. It's like that little frenum that's going to cause the Speech problems is everything attached to it. Yeah, pun intended. So it's, it's scares me when I have, when I hear things like that because we never want to do a surgical procedure on someone for something that might be a problem in the future. You know, it just doesn't even make sense.

Right. Well, and the other, you know, side to that too is like psa. You release a tongue now and you don't do anything surrounding it to rehab it or to basically teach the baby how to function properly, how to get the tongue up to the palate, how to feed properly, how to breathe through the nose of the mouth closed. Right. We're just releasing these tongues in hopes that it's gonna. Their, their anatomy may have quote unquote changed a little bit, but the way in which they're using that anatomy is still the same.

Right? Especially. Yeah, especially for a bottle feeding baby. If a baby's exclusively bottle feeding, that's fine, that's your, your choice, whatever. But it doesn't make sense if a baby is successfully bottle feeding to release a tie and then just, just bottle feed and use a, you know, pacifier and whatever because the baby's not going to be using their tongue the way they need to and shaping that palate the way they need to, no matter. So the, the tongue is free. It doesn't matter. Really. Yeah, I mean, and that sounds a little bit fatalistic and whatever, but you know, why? Why? Unless there's something else going on, you know, in, in individually, you know, and I always take a very individualized approach to everything, but for the most part, in general, we shouldn't be doing procedures unless we're going to do everything around the procedure to optimize the result. And that leads me to my big drive to make sure that parents are prepared for the procedure. And I actually have a checklist that I've made and I think you're going to put that in the show notes about literally being prepared for the day of the procedure. So we talk all about, get the body work, do the exercises, all these things. However, there's practical stuff that addresses the mom's mental status, the actual physicalness. Like I go into, you know, make sure you have a meal prepared for that night or if you have other kids, have childcare ready, think about what you're going to use for analgesia. Don't go afterwards, you've got a crying baby in the car and now you're looking for cvs, you know, or. Right. So have everything, you know, and it's a list of things to have ready, because if we're ready, you're going to feel better as the parents. And this, you know, mom and dad will feel better as parents being prepared for it. The evening will go smoother. And I really do feel that how the evening post procedure goes has consequences. Because if you want that baby to nurse and you're in over, you know, cortisol overdrive, nothing is going to be nice. So, you know, we get prepared and the more we're prepared for what's going to happen, the smoother things go.

Yeah.

That being said, I don't want people to think it's a horrific thing that we have to go through. Sometimes this goes very smoothly and none of the preparation is even needed. But if we're ready, it's definitely a better chance, you know, And I, and you know, so, so the three pillars that I like to talk about when it comes to should we do the tongue tie procedure is, you know, functional assessment. Is it a tongue tie? Is the tongue tie causing the problem that we're trying to get rid of? And are we prepared in all dimensions for the procedure before we go for the procedure?

Yeah, no, I think that's beautiful. I mean, I think it's something that truly all of medicine really should be listening to this because, you know, I even, right, I had my, my septoplasty and turbine reduction, etc. April 2022, and my ENT prepared me so well. Like, I actually went in for a pre op appointment where I sat with one of the nurses for 30 minutes and we went through everything and she gave me, she gave me stapled pages of information with like, okay, this is what you need to do the week before, three days before, two days before, one day before, the day of the procedure. Here's what's going to happen afterwards. Here are the prescriptions. If you're going to take these that you're going to want to pick up beforehand. You know, all of these things, like, all these different considerations, here are the materials to have on hand so when you come home, right? And then so I, I was like, wow, I can see how this might be overwhelming for some people. And being an ADHD adult, I was like, I'm just, I'm gonna make myself a chart and I'm gonna, I'm gonna like, check the boxes. I'm like. Because I just know myself when I come home from a procedure. And you're like, out of it, like, right, right. So anyways, I made a chart. I showed them. They're like, can you do this for all of our patients. And then a family member also went to a different ENT for same procedure and got a one page handout and had zero information on how to care for the nose post op. And so I, you know, they were like, thank goodness like that you have this information and you have extra materials on hand. My auntie didn't tell me to do any of this. And I'm like, well, my ENT said like, for example, right. If you don't clean the nose around where they put the splints in, things get hard and crusty and it's very painful when they get taken out and everything. And she's like, I wish that everybody would follow the very simple instructions. It doesn't hurt. It keeps things clean. It makes it a much more enjoyable experience post op. And so I think this really goes hand in hand because there's different levels of information. And I love that you've created this resource for parents so they really can understand how to prep because it's not common, it's not common knowledge. It's also not enough. And we know we've had a lot of. I've had a lot of episodes and conversations recently around fight or flight, the nervous system and if that is where you know, the caregivers are functioning from and especially the mom, the breastfeeding individual baby's not going to relax and settle in after procedure.

Right. And you know, even with breastfeeding itself, the letdown reflex requires to calm that you're required to calm your nervous system. Because if we think about biologically, we're mammals and mammals are not wired to feed or eat when we are in danger.

Right.

So our physical response to anxiety is to put out hormones in our body that literally block the letdown reflex. So, you know, I tell people they should take three deep breaths and relax their shoulders on the exhale before latching their baby or as they're latching their baby or usually right after the baby latches because they always tense, especially if they've had painful latch.

That was me with my first. Yeah. I was away from her.

Yeah.

Which killed me because as like a speech pathologist, the communication and making eye contact with your baby as you latch them. I was in so much pain. I would look away because I didn't want her to see me.

Yeah. You know, but she's still feeling that. Right. So the deep breaths just to relax. But yeah, it's all, it's all tied in, no pun intended. It.

I mean this is, this is, I think, hopefully so helpful for Parents for professionals to hear a lot of this because, you know, I just, I think we have these conversations and bits and pieces, but I don't know that I've had this conversation with an IBCLC recently. And so I'm so excited that we were able to really dive into, you know, this topic and the functional evaluation that we need and the pre op and post op journey and what that should look like. And you know, again, even though there's so much information out there, I don't think that most are, are aware.

Right. And yeah. And even if for the professionals who are listening to your podcast, which I, I'm sure you have so many professionals who listen because you give so much great information. The checklist is something that you can download and give to your own patients if you find it helpful and useful. I'm all about sharing, so it really is, it's part of my professional course, but it's part of my professional course and my parent course because it's so helpful and I wanted to get into as many hands as possible. And I appreciate you letting me share that and having this conversation which has been wonderful.

Well, thank you for joining me. I, while we were talking, I went and downloaded it. So I have it in front of me and I just, I think it's a really, very easy to use, simple, like you've really simplified this for everybody, but very comprehensive at the same time type of resource that I think will be very beneficial. So thank you for sharing that and thank you for joining me today.

Oh, thank you. And hopefully you're going to come on my podcast soon.

Absolutely. So where. Tell us real quick where everybody can find you.

Okay. So Tongue Tie Experts brand both on Instagram and Facebook. I run a very well moderated Facebook group called Breastfeeding Tongue Tied Babies. I promise it's not like the wild west groups that some of us have been in and don't want to be a part of anymore. Very well moderated and on Instagram, Tongue Tie Experts and the Tongue Tie Experts podcast. And when I mention the name of my brand, I always like to explain that I am not saying I am the tongue tie expert. It's all of the people that come together to share their stories with me, whether professionals or parents, they're all the experts and we all deserve to be recognized. You know, if you're a parent who've been, who's been down this journey, then you are an expert, right?

Yeah.

So that's what's behind my name because it's not my ego.

I promise No, I don't think that came through at all today. I think everyone's gonna appreciate this information. Lisa, thank you again so, so very much. We'll make sure also that everything is linked below the episode so they can very easily click through and find you.

All right, thank you.

Thanks for listening to this podcast. If you found value in this episode and want to hear more of these Myotots, Airway and Feeding related episodes, be sure to leave a review on Apple Podcasts and share this episode on your social media platforms. You can access free resources and all I offer@halloweenbalkan.com or pop over to at Holly Balkan on Instagram to get all the latest updates.