Breastfeeding

It Started With One Article

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The other night, as I was trying to wind down from a long day, I came across a Facebook post from KellyMom.com regarding an article. I didn’t have anything else to do, so I clicked on the link and started reading. It was an article discussing unexplained breastfeeding issues, tongue and lip ties, and trusting your mommy instincts. I thought it would be an interesting read, but OMGoodness it’s turned into something so much more than that.

When L was less than 24 hours old, he was (very quickly) checked for tongue tie because my nipples were cracked and blistering and I couldn’t remember that happening with G. The lactation consultant ruled out tongue tie, and that was that. She told me it had been a while since I nursed a newborn and it was something I would have to learn how do again. I felt comforted and agreed with her since I knew every baby is different and the breastfeeding experience could be too.

Though L has clearly been getting enough to eat (he’s moving into 18 month clothes and isn’t even 9 months yet) and was healthy and happy, his latch has never been great. First I figured it was because he was a preemie (they can struggle at first with latching and nursing). We just needed to practice and learn, I kept saying. L couldn’t handle my letdown, but since G also had that problem at first I knew I needed to wait it out and it would get better. Handling let down did get a lot better within the first few months, but L’s latch still hasn’t been what lactation consultants would consider ideal. I can tell it is shallower than it probably should be. His upper lip doesn’t flange as much as I remembered G’s doing. Nursing him hasn’t seemed as comfortable as I remembered it was with G, but it didn’t hurt so I’ve continued to readjust L when I can and bear with it.

Unfortunately, as I’ve discovered over the last couple of weeks, “bearing it” has meant clenching my teeth. Last week I actually started the process of getting a crown put on one of my teeth because I’ve cracked it from all the clenching and grinding I do. I do this at night too and hadn’t been wearing my night guard, but realizing I’ve been doing it while I’m nursing L doesn’t help either.

Anyway, I was reading the article and thinking, Okay, tongue ties, blah blah blah when I saw the picture of a baby with a lip tie and then I was like Holy shit, that looks like L’s mouth.

Lip Tie via The Milk Meg

Lip Tie. Photo credit: Meg Nagle, IBCLC (L was having nothing to do with me taking a picture of his lip tie)

This sent me into a Google frenzy. I was looking at pictures. I was reading more articles. I was reading blogs written by parents who have had their child’s lip and/or tongue ties fixed. The one thing that stood out was that they all — eventually– wound up at a dentist to have their child’s lip and/or tongue tie confirmed. The dentist. The one place you wouldn’t really think to go to if you’re having issues with your boobs and feeding your baby.

When I worked at an optometrist office, one of the things the owner would tell us over and over is that there is no better place to go when you’re having eye issues than an optometrist. They can diagnose diseases and have the equipment to do a thorough job. They can write prescriptions for medications. They aren’t just for eye exams, contacts, and glasses. This came to mind as I read articles and blogs about lip ties. The idea of going to the dentist if other doctors, pediatricians, and lactation consultants can’t figure out why breastfeeding isn’t going well made sense. Tongues, gums, and lips are in dentist territory.

I was reading during every quiet moment I had. The more I read the more I realized that maybe L’s lip tie was the source for some less-than-stellar things we’ve experienced since he was born:

  • Nursing hasn’t been painful, but hasn’t been comfortable. One blogger said it felt like her baby was pinching her nipple, and this is what I feel when L latches. I have had more bouts with sore nipples this time around than I did with G. One was so bad around the time L’s first teeth were coming in I was convinced I was getting thrush or mastasis.
  • L drools ALL! THE! TIME! I know babies are drool factories, but I honestly don’t remember it being so bad with G. The drool has caused a rash around L’s mouth that we haven’t been able to get rid of.
  • L had issues with reflux.

As soon as 8am came the next morning, I phoned the pediatric dentist G has been seeing to see if they could diagnose lip ties. The receptionist didn’t know what I was talking about, so she had to speak with the dentist to figure out what I was asking before making L an appointment for the next afternoon.

Hubby was skeptical of what I thought about L’s mouth. He had a lot of questions: What is a lip tie? How bad of a lip tie is it? Have you even been having issues nursing? What do they do to fix it? Is it necessary to fix it? Do they give the baby vicodin when it’s over?

I gave him the answers based on what I read, but he still didn’t look convinced this was something that would need fixing.

The dentist confirmed that L does have a lip tie, and if it’s causing discomfort during nursing it would be a good idea to have it fixed (this is called a revision or frenectomy). He said he could do it, but he’d have to put L under and there’d be stitches. I asked about the option of having it corrected with a laser because I didn’t want L sedated (also, I had read it was more precise, though I didn’t mention that). He said that would be best, but he didn’t have the capability for it. He referred me to an oral surgeon for a consult to see how they’d do the procedure, but his guess is that they’d want to do it the same way.

Since my research led me to the conclusion that having lip ties revised using a laser versus cutting was the best choice, I didn’t like this. That night I started figuring out where I could find a pediatric dentist who could perform lip ties with a laser. I found one — ONE! — in Ashburn, Virginia, two hours away. I debated with myself the rest of the night about whether or not I wanted to travel just for laser capabilities when dentists and oral surgeons closer to home could do it without one. I questioned Facebook, asking if anyone had good or bad things to say about this particular practice.

I decided it would be best to see if a frenectomy would be covered in the first place, so I called our dental insurance company. They should cover 50% of their contracted price with an in-network provider. The lady was nice enough to figure out which doctors at the practice participated with our insurance (one out of four).

Two friends responded to my Facebook query, saying they recently had their baby’s lip and tongue ties revised at this practice with positive results and experiences. This allowed me to move forward. I wanted the laser revision. So when I got home from pre-school drop off and settled L down for a nap, I called the office and made an appointment for a consultation. This office is the only one in the DC Metro area with laser capabilities and the receptionist told me they’ve had clients from as far as Virginia Beach see them. They even try and do the procedure the same day for out of town clients.

Awesome. My only question was, how much does it cost? This is how the receptionist broke it down for me:

  • Consult: $105, which gets deducted from the price of the procedure should you choose to have it done there.
  • Frenectomy: $760-$1600, depending on how extensive the problem is. 

I asked about insurance, because OMG possibly $1600 out of pocket?! We can’t afford that! Even $760 is too much. They said it was considered a medical procedure so they’d give me paperwork to file myself with my medical insurance.

After I calmed down from my $1600 mini heart attack, I got on the phone with our medical insurance company. Since I didn’t have the CPT code on hand, the customer service rep couldn’t give me a reliable answer on whether or not they’d cover a frenectomy. Basically, I was told “if she looked up the correct thing” it would be $250 as long as the provider is in-network.

I have a feeling this procedure at this dental office will be considered out-of-network and we don’t have any out-of-network benefits, so I’ve began questioning whether or not this needs to be done now or could wait until later. Or, should we just suck it up and have an in-network oral surgeon do it with a knife and know we’d only be $250 out of pocket.

Those mommy instincts tell me we should have this done, and should be done asap. It’s not just about seeing if we could fix a latch and drool issue (oh, and maybe my clenching issue). Lip ties can affect speech and overall dental health as the baby gets older. I don’t want to look back and feel guilty we didn’t suck it up and get this done to save some trouble (and maybe money) down the road.

Those mommy instincts also tell me the frenectomy needs to be done with a laser. The procedure takes less than 5 minutes. L would be sedated much longer than that if we went the “traditional” route. The laser is also more precise, lowering the chance of having to redo the procedure in the future, and is more hygienic.

I feel like Hubby is totally convinced this is something we need to worry about. I’m sure he isn’t happy about how quickly this escalated (within DAYS) — or even the fact that it started with me reading something random on the internet. I’m sure he’s even less pleased that I haven’t really consulted him on anything. I’ve just done what I’ve felt was right without consulting him beforehand. That’s not really a parenting partnership.

We’ll see what this second pediatric dentist has to say — both about the lip-tie and the cost! 

It’s been a weird week. I’ve had this stuck in my head for most of it:

Ron Burgundy Meme

Did any of your kids have a lip tie? Did you opt to have it corrected? What was your experience?




7 thoughts on “It Started With One Article

  1. A few thoughts…

    I’d totally get it done – follow your gut instincts. Money is tough though. So…

    1) Since there isn’t an in-network provider who can do the laser surgery anywhere near you, ask your insurance to grant an exception to have the provider be considered in-network. Those ARE possible – and may require you to do a ton of paperwork, but definitely push for one for better coverage.

    In order to request that you’ll need the specific CPT code though (which may vary depending upon the severity of the lip tie, but they should be able to give you a range of CPT codes based upon their assessment at the consult).

    I do pre-auth’s all the time at the medical office I work for — definitely keep pushing and fighting for it, and call back and talk to someone else if the first person is getting you nowhere.

    Here is ArchMama’s post on this regarding midwifery care – the same principle applies – http://archmama.wordpress.com/2013/02/02/home-birthin-my-bebe-part-four-health-insurance-and-home-birth/

    Also, I totally get just GOING for it once you knew something was wrong instead of consulting the spouse…I’m definitely guilty of the same. Oops. 🙁
    Josey recently posted…Supply Issues…My Profile

    1. OOoo! Thank you for the link and the advice! I’ll definitely try and look into that. Im also glad I’m not the only one guilty of not always consulting the spouse 😉

  2. I had oliver checked for lip tie at 4 months. My doctor said he has a more pronounced frenulum that ‘normal’ but that it wasn’t that bad. Thankfully his latch has improved as he gets older but if my pain had continued I would have pushed the issue.
    It would never have occurred to me to see a dentist! I feel like tongue and lip
    Ties are things they should automatically look for at birth. They are a very common source of breastfeeding problems and somewhat easily fixed!
    Good luck!
    Christina recently posted…Friday RamblingsMy Profile

  3. […] Finally. After six months of waiting for L’s first birthday to pass and one rescheduled appointment because he was too sick to be sedated, L had the frenectomy to correct his lip and tongue ties. […]

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