Ep 39 Timing of Release

In this episode, Katie Oshita discusses the all important phrase of "timing of release" and what it means.  Why does it matter when the tongue tie release is done?  What is meant by pre-release and post-release therapy?  What is the difference between active wound care and oral exercises or oral habilitation?  And rhythmic movements?  Listen as Katie addresses these and deciding on her own timing of release when getting a functional frenuplasty as an adult (at 44 years old).  If you have wondered what happens while "waiting" for a tongue tie release then this episode is for you.

Podcast host: Katie Oshita, RN, BSN, IBCLC has over 22 years of experience working in Maternal-Infant Medicine.  Katie is a telehealth lactation consultant believing that clients anywhere in the world deserve the best care possible for their needs.  Being an expert on TOTs, Katie helps families everywhere navigate breastfeeding struggles, especially when related to tongue tie or low supply.  Katie is also passionate about finding the root cause of symptoms, using Functional Medicine practices to help client not just survive, but truly thrive. Email katie@cuddlesandmilk.com or www.cuddlesandmilk.com

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Disclaimer, this content is meant for information only and not as a diagnosis or medical treatment for any condition. If you or a loved one needs help, please seek out a qualified medical professional for assistance. Welcome to the podcast. I'm your host, Katie Osha, BSN, RN, IBCLC, and Infant Feeding Specialist. Quench your thirst for knowledge and travel with me across the nation to discover, learn, collaborate, and better serve clients from all over the globe. Let's ride and thrive together. Thanks for joining me today on the podcast. Today it's just me, Katie Oshta, and I want to talk to you about some really important tongue tie stuff to not just to the other providers out there who might not know some of this, but also to parents, if any parents are listening. But there is a really important concept that not everyone truly understands, and that's the timing of release. Okay. And I want to start by saying there is no tongue tie emergency ever. Okay. It is not an emergency to get a tongue tie release. The minute you figure out what's wrong with your baby, whether it's been two days, two weeks, or two months, it is not an emergency. You don't need to Google and find the first or best provider you think or the most popular and book an appointment and take their first availability. Again, not an emergency. Okay. What is an urgent thing that does need to be figured out is how to manage these problems, right? So the reason that I find people will say that they need the first available appointment, or even sometimes I've met dentists who say they keep that first appointment of the morning open for emergencies, for tongue tie emergencies. And I'm like, okay, again, there's no tongue tie emergency. But um, you know, I really think that the the times that people get really frantic for that release is when baby is really not gaining weight. We're in that first two weeks and they feel like that's what's holding it back. Or mom's in a ton of pain, right? That's a really common one. Mom's got really shredded nipples, and someone mentioned, you know, baby's probably got a tongue cut, you should probably get that looked at. And so mom's in pain, has bleeding nipples. Of course, they want it better and they want it better now. Okay. The problem is doing that release right then might get them one or two feeds that are better, might not, and most likely after that will get worse because that baby and family weren't ready for release. Okay. So when we talk about timing of release, what does that even really mean? Like, what does timing of release mean? And I will say that it's about being prepared, it's about having the best result, and it's about really just being ready and understanding what we're doing. So the other problem with going in from Google is that these parents who just look up a release provider and schedule an appointment and go in, they really don't know what they're getting into. And it's quite a detriment to them and their baby. They don't understand that the effects of the pain. They don't understand wound healing and contraction periods. They don't understand that there's even going to be active wound care afterwards and what that's going to look like with a baby. And so they tend to get really shell-shocked, right? They tend to come out of that appointment going, oh my God, I don't know what happened. My baby was just released. I don't know what to do. I'm totally freaking out, right? And then they're just really hoping it's going to get better, but they don't really have any plan or any way of making it better, right? Besides doing that release. So I've had quite a few clients. This is part of why I'm doing this podcast today. I've had about four clients in the last month that went to a release provide. So they were struggling at various ages in the first um two months of life. They were struggling and took a while to figure out what was going on. They were told frequently the breastfeeding parent knew or had a suspicion of tongue tie. Quite a few of them have mentioned to me, you know, well, all the symptoms seemed to fit. You know, the baby was clicking, they had white stuff on their tongue, my nipples were lipstick shaped, they were really gassy. But every time they asked, they were told, no, their baby doesn't have a tongue tie. And then they were finally told, yes, your baby does, by someone, some, you know, moderately knowledgeable provider. But unfortunately, that provider suggested going for a tongue tie release immediately. And then it didn't seem to do anything, but they were waiting for it to get better. And all four of these clients I've had the last month reached out to me between four and five weeks post-brenectomy when the release provider told them, well, it should be better. I don't know why it's not. So I guess you can find an IBCLC. And it's really unfortunate, really, really unfortunate. I wish that I had met them pre-release, right? Or even day of release. Like there's so much more I could have done at that point than a month after. But sometimes, you know, we we do the best we can and we move forward. And that's why I want to get this information out there. So when I talk to release providers like Dennis, they're like, how can you make someone wait when their nipples are bleeding? That's just cruel. And I'm like, well, it's really not, because we're not gonna let them just sit there with their nipples bleeding. So let's go back to that for a sex. For the maternal pain issue, we just need to go in and stop the pain, right? Like it's pretty clear that's what needs to happen in order for everyone to be able to take a deep breath, really calm down and plan and evaluate, right? Or I should say evaluate and then plan. So I can get most Hang Thai babies, especially if they're if they're under three months, I can get them easily on the breast without pain. Babies have this miraculous ability to breastfeed because they are born with feeding reflexes. So these babies are born with feeding reflexes because we are all mammals. If you've listened to some of my other podcasts, I have quite a few on this, and I have quite a few that are talking about infant reflexes. So mammal babies are born knowing how to feed, it's just an innate behavior, just like breathing. Baby doesn't need you to breathe for them. They shouldn't need you to feed for them either. They should be born knowing how to do this, even a tongue tie baby. So when I work with a tongue tie baby that's a newborn, period, we use these reflexes. Baby has so many feeding reflexes. They have the body ones that help them get positioned, like the spinal gallant and the ATR, and even that step reflex. They have some in their hands, like the babkin and the palmer, that help them use their hands for feeding. And then they have a ton in their mouth and face area with the root and the seek and the gape and the suck and the attachment. All of these lead to a good deep latch. So basically, most of the pain comes down to one really big factor baby has a shallow latch, right? Why does baby have a shallow latch? So if we take that back a step, what we see is baby has a shallow latch because they're not opening their mouth wide. So if you open a human jaw a small amount, you get that jaw in an up-down motion where it just compresses, right? And at the breast, breast compression does not feel that good because baby is just up and down with their jaws. If you open the jaw more than 50%, there are studies that show this. What you get is that lower jaw moves forward in that joint. It's a hinge joint, and it allows the jaw to function in its rocker motion. So now instead of the jaw going up and down, the lower jaw moves forward and rocks while the upper jaw stays fixed. This is a huge difference because now we're pulling the breast instead of chomping on the breast. Why isn't baby opening their mouth? Right? Why are we not getting that naturally? So there's a couple reasons. One can be that baby is so tight around their body with their musculature, their bones, and every their fascia is just so tight that they can't let go and open. Okay, that can be. Usually we can at least make it better, not always perfect, but better. But then there's the other reason that we really get in the way. And when I say we, I mean Western medicine, providers, well-meaning people that are over there kind of helping breastfeed in this very Western idea of, you know, sit up really tall, use a breastfeeding pillow, swaddle that baby to keep those hands out of the way, and you know, use a C shape with that breast and really push that baby on as soon as you see them open. Very artificial way to breastfeed, right? That is not at all how mammals were designed to feed. You watch any mammal out there, from a whale in the ocean to a chimpanzee to a cat in your, you know, garage nursing its kitten, they don't do anything at all, really. Occasionally they might nudge a baby over, especially if they have multiple. They might just kind of nudge one over to make sure it's getting something, but even that's rare. Most of the time, the mammal mom lays there and the baby comes over and feeds. And many mammals, not all of them, right? Because some of them don't have hands, but a lot of them that have paws or hands will do kneading with that feeding too. So they will use their paws or hands like a little baby monkey or a kitten or a wolf or a bear. They will use those paws or hands to really massage and help get out more milk. That's why our babies have those reflexes of that poly and that babkin, right? That's why those are there to help with feeding. So we get in the way by swaddling and artificially positioning and pushing baby on. We really block their reflexes. Well, they can't use their hand reflexes if they're swaddled. They can't use their body positioning reflexes of that ATR or that spinal gallant or that step if they're swaddled. And then when we get up to the mouth where they have four or five more reflexes for feeding, we really take away the ability by shoving them on the breast. So I teach my clients all about infant reflexes in a very short version. It's not like they need to be reflex experts, but how it applies to their baby and how they can assist their baby without taking over, right? And transition to letting this baby do it because they're amazed when they see a one, two day old or a two-week old latch themselves for the first time. Because we have taught them in Western medicine that we have to latch the baby, that it's us who does the work, which is very misleading, incorrect, and sets up the parents to think that their baby can't survive, right? Their baby absolutely can and will, if allowed, to do what it needs to do, right? So, really, that's number one. We stop the pain by going in and working on reflexive feeding, getting that latch open, getting that jaw into a rocker position instead of a chomping position. And we stop the pain. Do you know what we do when we do that? We also increase the transfer. So that helps greatly with babies who aren't gaining as well. And if they're not gaining, the last thing they need is the stress of surgery. So if we need to supplement at the breast or with a bottle or with a tube, however, we do that because the last thing a stressed baby who's not gaining weight needs is more stress of surgery. So we help that baby gain weight first, right? And so this really plays into that timing of release. So when I meet someone beforehand, whether they knew the baby had a tongue tie or didn't, the first things we want to address are any maternal pain. We want to address that transfer. We want to get that baby reflexively feeding and take that pressure off the parent, both in terms of latching pressure and in terms of, I need this tongue tie release today, right? When I do those two things, when we stop the pain and we help baby activate the breast, swallow and transfer milk, it takes the pressure way down. The parents tend to take a deep breath and go, whoa, okay. So now we can think about me. Now we can think about the tongue tie. Now we can plan. And this is where then I come in and explain to the parents that this isn't permanent, right? Like everything we're doing right now is great and it is helpful, but it most likely will not be a permanent fix until we address oral function as well. So when I'm working with clients pre-release, we start oral exercises and rhythmic movements. And I always refer to body work, always, always. So sometimes it's an issue of trying to find a skilled provider that can be challenging with, you know, pediatric training, especially oral and cranium training in the client's area. But we work hard and we try to find someone and we see what we can do, right? Um, in terms of doing all of this though, we should see, I tell the parents, we should see improvements right away. You know, if you first off, if you get that baby reflexively latching and the parent out of pain, that's a huge improvement immediately. And then we start working on all of these things and we should start improving. We should have improvement pre-release. Okay. So when I say timing of release, I think there's this misconception from providers and parents alike that we're just hanging out. We are waiting for some magical day that we have put on the calendar to go in and do release. And we're sitting on our hands. And that is absolutely not it. What we're doing is trying to prepare the baby and the family for release. We're trying to make sure we've had as much increase in oral function as possible. We're trying to make sure that body is nice and relaxed as possible. We are trying to prepare that family with coping strategies and homeopathy and pain management. We're trying to make sure to protect the maternal milk supply, look at maternal and infant wellness. We're trying to calm everybody down, okay? Because it serves no one when the parents go rushing in for a release. They feel like they walked into a tornado, they leave and they feel so shell-shocked. They don't know what happened. And I talk to some of these parents. Sometimes I will get a call, you know, a day or two or three after a release, and these parents are just overwhelmed and scared, and they don't know what they're doing, right? And that doesn't serve anyone well, not them and not the baby. And as providers, we all want to see good results, right? That's what we're hoping for. We are hoping for good results. So this doesn't help. You know, I do want to also touch on a few of the reasons we definitely need to wait, even if I'm working with a family. These are signs that we are not ready for release. So one of them is not gaining weight. Like again, I will say a baby not gaining weight does not need the stress of surgery. It doesn't matter that it's a quick and tiny surgery. It is still surgery. It is still stress on that body, it is still cutting its tissues, it is still a stressful, painful event for that child. And they don't need that. Bottom line, they don't need that when they are stressed and not gaining weight. Another time they don't, you know, that it's really not advisable to do the release is when we have tortocolis or head preference. If you have a baby with tortocolis, that their head is tipping to one side and you know, turning to the other, every piece of their body is going to be tight. That shoulder, that neck, that arm, those legs and feet, that torso, every bit of it, all the way in and down. That high hyoid bone is gonna be off, the condyles are gonna be off, like everything is going to be off because that baby is not in symmetry. That baby is not moving in symmetry, it is not existing in symmetry, it is not feeling comfortable in their body. And so if we go in and release that baby, we are gonna have a very asymmetrical release. You are absolutely not gonna have an even symmetrical release when you release a baby with tortocolis, right? Which is a set of the babies that I'm dealing with right now. I have a set of twins that came to me. They were released at seven weeks. They found me at 12 weeks when it wasn't any better. And even at 12 weeks, they're absolutely both still super tight and very much in tortocolis. One baby turns to the right, one baby turns to the left, and they are very uneven. You can see the tension all the way down their body, and they were released. And these babies should not have been released because you cannot possibly get a good result when their body is tangled and twisted and tight like that. It's just not going to happen. And the last time I say is an absolute red sign for do not proceed, do not do a release, is a baby that is in a very hyper neuros state. So, what I mean by that is one of those babies that gets called colicky, right? That's very fussy, very difficult to calm, spends most of its day in this really hyper stressed state. Again, kind of like the gaining weight baby. The last thing that baby needs is surgery to push it over the edge and not be able to calm. So if we have a baby that already can't calm, right? The parents are already struggling to calm it down and spending much of the day dealing with this frantic, upset baby, the last thing it needs is surgery, right? That is not gonna help calm this baby at all. It is not gonna help the parents feel competent to soothe their child, and it is gonna probably push everybody over the edge and stress everybody out. So those are times when I say that's an absolute sign we are not ready for release, not gaining weight, a body asymmetry like torticalis, and a hyperneurostate, those are absolute signs we are not prepared. We are not ready for release. Those should be red flags. Like I would love to only see release providers in this country that are requiring functional assessments by an IBCLC for babies under two that want those babies assessed first, want these things addressed. But even in lieu of that, even without that level that I would love to see that some providers are doing, but not all, definitely, not most by my by my travels, I would say, even the ones who are not doing that, they need to have a stop sign for these babies. They need to say, if your baby is not gaining weight, if it has Tortocolis, or if or some sort of body asymmetry, or if your baby can't calm and you spend hours a day trying to soothe this baby, we need to not do the release today. We need to wait. And we need to refer you to help. You know, this is where a skilled IBCLC should come in. But these babies do not need surgery. That is not gonna help them. That is going to push them over. And then, yeah, then we see negative results. That's not a negative result, is a number. I'm talking about these families that have negative outcomes where the baby gets pushed over and really is not gaining weight and it's even more stressed and struggling longer than necessary, right? So it's it just perpetuates the problem, right? You release a baby that has a body asymmetry like tortois. It does not unwind that tortois. In fact, sometimes it makes it worse. And usually we end up back where we started, needing another release once we actually unwind that body. So it's really challenging. It's really very challenging to understand this timing of release. And while I hear many providers speak of it, you know, I have traveled this country for the last 18 months and I've met with a lot of release providers, some that are really popular and some that are just kind of doing their thing in their little corner of the country. And I will say that there's a lot of release providers talking the talk. There are a lot of people saying, oh yeah, timing of release is very important. And working with the IBCLC and getting body work, yeah, those are all great things. And then I will say that typically speaking, those same providers are not actually walking the walk. I would say, in my experience, more than 80% of them are not. More than 80% of those providers are accepting people who are calling them saying, I found you on Google, my baby is hurting, my nipples, I'm in pain, I need a release tomorrow. And they'll say, Oh, I have that first appointment tomorrow for tongue tie emergencies, you know, and it's it's doing a real disservice to the family, first and foremost, and really to this tongue tie culture right now, where we really need to educate and support and get the word out there. With this tongue tie culture, we really Really want to start educating people. And we really want to see, we really want to show what we know, right? We want to show that this can really make a difference in a person's life. And you don't do that by rushing into it and doing it half-assed. Like we just don't. That is not how we get good results. And unfortunately, that is how it is in much of the country. Too many parents are still trying to crowdsource their support. They're still trying to ask other parents. They're still trying to go on Google. They're still trying to go to Facebook and Instagram and say, what does it mean when my baby clicks at the breast? Why are my nipples lipstick-shaped? What do I do when my baby is not gaining? Because they're not getting support on the whole in the medical community and they're feeling ignored. And so they're crowdsourcing. And then they're researching for the most popular tongue type provider who is not always the best. And they're running off and getting released because they are desperate for help. They are desperate for help. And unfortunately, that help does not always lead to a good outcome. And so it's really essential to me that we all start getting on the same page. And I think the first step is for the other providers, like a release provider, to understand what timing of release means from the IBCLC side. Again, I am not sitting on my hands. I am not waiting. I am not trying to delay a referral to you. What I am trying to do is make sure that when I send that family off for release, they are 100% prepared. You can ask them questions about aftercare and they'll say, Oh, yeah, Katie taught us that. We know what to do. When you ask them about pain management, they'll say, Yep, we already went over that. We have some homeopathy, we have some coping strategies, we know what we're going to do to soothe baby. And we already have an appointment in a couple of days with Katie. And this is what I'm hoping is happening. And I know it is with a lot of other IBCLCs throughout the country. Not all, but a lot. And, you know, I think that when I send a family off for this, again, I want them fully prepared. I want them coming into you with an unwound baby. I want them coming into you with a baby that is gaining and a mom not in pain and totally ready to progress for this release. And that is the difference. And in reality, yes, it is going to delay some referrals, but they're going to come in so ready and so prepared. And the release providers are not going to need to deal with a million questions of, well, what do we do about this? And what do we do with that? Because I've had weeks to talk to them and visits to prep them and been available for support, right? And so all of that means that they come in better prepared. And that is number one. We want better prepared families going in for releases. So timing of release is essential. I am not seeing it done in most of the providers I have even interviewed or seen throughout the country. And those who are doing it, we talk about it and we highlight it. So if you go through my podcast, you'll hear some that say, Yeah, I need an IBCLC referral to see a baby, right? And that's unique and that is rare. So I think that's that's what we really want. And I hope that it starts happening more. I have a few more recordings soon with other providers who are doing that wonderful work. And I plan to ask them how they transitioned into that, right? Because we know that they don't have that happen, right? So I just I think it's really crucial that we all start talking about this and that it starts getting practiced more and more. And I know it's been talked about for a very long time, but it needs to be talked about more and more until it becomes commonplace. And timing of release is really everything. So if you have questions on this, please reach out to me. I would love to hear comments. I would love to hear how your release provider required an IBCLC or how this made a difference in your care. Or if you have questions and you're like, you're a provider and you're saying, what does this mean for me? How does this work? Please reach out. I would love to hear from you. And I thank you for listening. When you change the way you look at things, the things you look at change you. I hope that you enjoyed the podcast today and learned something new. If you know someone who would benefit from this podcast, please share.