Kate's Story: Talking Ties and Tips with an IBCLC and Mama of Three

A Mum of three, Kate Visser is now in her 4th trimester and on maternity leave from her role as an International Board Certified Lactation Consultant (IBCLC). Kate has been such a great source of inspiration and knowledge for us at OMM Label through her instagram page @milkybusinesslactation. She strives to help mothers achieve their feeding goals - but now it’s her turn to be back in the feeding chair once again.

We decided to sit down for a little chat with Kate to find out more about her and her own personal breastfeeding stories, as well as her work as an IBCLC.

Q: Hi Kate! Thanks for agreeing to chat with us! Can you tell us a bit about you and who makes up your family? We'd love to hear about how you became an IBCLC and what you love most about it!

Hello! Thank you so much for having me!

I am Kate, and I wear so many different hats these days - it can be a bit messy! In my professional world I am an International Board Certified Lactation Consultant (IBCLC) and work in my private practice, Milky Business, to support mamas in all aspects of their feeding journey. I am also a shift working registered midwife and nurse. In my personal life, I am a wife and mama to three young kids. Life is big and busy!

I was a student midwife at the time of learning what an IBCLC was, and it set me on a path to complete all the requirements to certify. I became an IBCLC when my first child was one, after around five years of working towards this goal. I love that I can support all women with their own individual goals. I am passionate about accessible care and autonomy. I want women to be the lead drivers in their care and it is my privilege to work with them as a cheerleader and to guide them in making their feeding goals happen, whatever that may be!

Q: This is your 3rd breastfeeding rodeo yourself, but it sounds like it still hasn’t all been smooth sailing from the get-go - even as an expert! Can you tell us more about your different breastfeeding stories? We all hear and know that each breastfeeding journey is unique, but do you find this has been true yourself, and with all the Mamas you’ve worked with?

It definitely hasn’t been smooth sailing. My first journey was quite tough and a difficult introduction to motherhood. My daughter had a tongue tie that I needed to navigate. I was studying to be an IBCLC and I knew something wasn’t right but wasn’t confident with oral assessment at the time. My nipples were badly damaged so even after a tongue tie release, I had to work through healing, transition of nipple shields, vasospasms and later, biting. I’m really proud to say she only weaned a few months ago, not long after her third birthday. Then my second was a beautifully redemptive and easy journey. No issues and she continues to feed sporadically at almost two. It was only in the last few weeks of my last pregnancy that I had a lightbulb moment and thought “What if this is challenging like it was the first time?”. I already had a challenging postpartum season planned with surgery and I wondered how I would cope if breastfeeding difficulties were added to my plate as well. 

Low and behold it’s been probably more challenging than my first, however I’ve been in a very different head space and, ultimately, have many more tools and much more knowledge to support myself with. I birthed my third born, my son Tommy, at home in late November. At a day old, when I had a blister on my right nipple and he finally cried, I saw a very tightly restricted tongue. I try not to be my own health professional but I knew that a tongue tie revision was absolutely needed. I contacted an amazing colleague and arranged for an appointment and revision at 5 days old. In the space of those days my nipples progressively became more damaged. I tried nipple shields with minimal success, and ultimately ended up expressing because Tommy was unable to drink effectively at my breast. He lost over 10% of his birth weight and the day of the revision was lethargic despite me expressing and giving top ups. 

The revision was a huge turning point for us. He gained a significant amount of weight immediately as he could now feed effectively. Tongue tie revisions aren’t often immediate miracle cures, and this is something I share with clients. It was an immediate cure for his milk intake though. My nipples, on the other hand, have had a longer journey. I wanted to work on directly breastfeeding and immediately ditched the nipple shield. I developed a crack on one side that was excruciating, causing me to donate a lot of money to the swear jar. When latching came with swearing and tears I opted to stop and express. The first 4-6 weeks of breastfeeding is often the hardest. Breastfeeding is a dance between you and your baby, it takes time to learn the steps together. I am no different. Babies also grow a lot in the newborn period. This is why we see that most latching issues resolve over time, as babies become bigger and more efficient feeders. The space of time between birth and this milestone though can be so challenging to navigate and that is why support and sound advice is crucial. While I expressed on one side to maintain my milk supply, I worked on healing it and practiced paced bottle feeding with Tommy. I continued to directly feed him on the other side to keep our breastfeeding relationship going. I also encourage skin to skin and baby wearing to keep chest time positive. 

He is a month old at present and we aren’t in the clear, but we are doing much better. To any mama in this hard season, break it down. Do one day at a time, or one feed at a time, and reach out to an IBCLC for support. Each journey truly is unique. Every mother is different and every baby is different. The two of you have never danced together before in this way! That’s both amazing and challenging.  

Q: Tongue (or lip or cheek!) tie releases are something not every first time Mum would have heard about, can you tell us more about your experience? Who are the professionals that can detect it, what are some signs a baby may have ties and what is usually involved in an assessment and release?

There is much more awareness about tongue ties than there used to be. I was not aware that I had a tongue tie myself until I was a student midwife. It made so much sense, because I grew up with my own mum telling me stories about the nipple pain and damage she experienced breastfeeding me over two years. 

I have had very positive experiences with tongue tie releases. I have been supported by an IBCLC before and after the release, which is something I advocate for clients as well. The release itself is important, but the support equally so. Tongue ties are where the frenulum (tissue under the tongue) is abnormally tight and restricts the normal movement of a tongue. 99% of people will have a frenulum, so the presence of this tissue doesn’t indicate a tongue tie, it’s assessing the function of a tongue, with multiple movements, as well as how it appears, that will determine if there is a tongue tie and how it is impacting feeding. If someone says “Oh she can stick her tongue out, she doesn’t have a tongue tie” or someone simply looks in a baby's mouth without taking the time to feel with a gloved finger, find someone else. Oral assessment is a complex skill. I encourage families to ask “Are you confident in oral assessment for tongue ties?” because not all health professionals under one domain may be competent at this skill. Women may see an IBCLC, dentist, GP, speech pathologist, midwife, paediatrician or paediatric surgeon. I would encourage women to ask around in their local area, as supports will differ. 

The two most common symptoms that are seen when a tongue tie is present are nipple pain and damage for mum, and low weight gain for baby. A big reason why mamas wean earlier than anticipated is because of pain and damage. Navigating tongue tie support can be incredibly challenging and mothers are expected to push on through the pain. Early support and intervention is paramount. This may be a revision or it may be more basic breastfeeding support. Low weight gain in babies comes from their inability to transfer or drink milk well from the breast. Their tongue isn’t moving in the way it needs to go to access the right amount of milk to see them thrive. If this happens over the longer term, a mama's milk supply will drop and the problem will worsen even more. Likewise, pain and damage occurs because babies cannot utilise their tongue to achieve and sustain an effective latch at the breast. They often end up ‘nipple feeding’ rather than ‘breast feeding’. Our nipples are not designed to be compressed! It’s like squashing a hose, affecting the milk flow and damaging equipment. 

Assessing tongue function is complex, but what we want to see is a baby who can move their tongue in multiple different ways. The tongue needs to extend past the lower gum line, cup the breast by lifting the sides, and move effectively in a wave like motion. It needs to sustain this position! So just because a baby can do these movements once or twice, doesn’t mean they can do them well enough to sustain a whole breastfeed. Someone assessing for a tongue tie should take a full medical and breastfeeding history, breast assessment, inspect a baby's mouth visually and then insert a gloved finger to assess movements. If a revision is recommended, the process is usually explained to the parents so that consent can be gained. There is the option of both laser or scissors for release of the frenulum. Many mamas ask what is better and the research isn’t conclusive. What we do know is that the best tool is the one the professional feels the most confident using and has the most experience with. In both procedures babies are positioned or swaddled as to keep arms out of the way and their head gently held in position. The tongue is lifted with a surgical tool, frenulum identified and tissue cut/lasered to the base of the tongue creating a diamond shaped wound. Gentle pressure may be placed with gauze to limit bleeding. It depends on the care provider and practice but quite frequently, where laser is used, parents are in a different room for safety reasons. When scissors are used, parents and babies can remain together. Immediately after the procedure you should be supported to breastfeed your baby. Regaining normal tongue function is a longer process. A baby with a tongue tie has never had the ability to move their tongue freely and effectively before. I often say it must feel like the equivalent of us going to the dentist and having an anaesthetic - we have a loose, lax tongue and can barely sip from a glass. It’s frustrating but improves with time and support.  

Q: In your work, you'd often be helping women who are really struggling to establish or maintain breastfeeding. What do you find to be some of the most common challenges Mamas face when it comes to feeding?

I think the two most common difficulties faced are misinformation and a lack of support. These are often intertwined but I would be hard pressed to see a client who hasn’t experienced one of these. We are constantly learning more and more about breastfeeding. We live in the day and age of research which is fascinating. Not all health professionals are up to date with best practices and recommendations for breastfeeding. This significantly affects the advice given to mothers. I’m still hearing that women have been recommended to scrub up their nipples while pregnant to toughen them up or that there is no benefit to breastfeeding past 6/12/18 months or that babies need to feed every 3 hours etc - all of which is incorrect advice. On top of this, generationally, our mothers and grandmothers received some of the most atrocious breastfeeding advice, drastically damaging breastfeeding rates and success. This means that our own family members are likely to give advice that is not only outdated but damaging based on their own experience. It’s important that women are informed and empowered with information about normal newborn behaviour, feeding patterns, supply and demand etc. It truly makes the world of difference! 

The other common issue is a lack of support. Again, this can be from a variety of sources. We know that the role of partners is highly influential, and poor support from them can result in early weaning from breastfeeding. This may look like anything from words of encouragement, learning about breastfeeding or taking care of other tasks so that mama can focus on breastfeeding. We are also naturally quite affected by our peers, so it’s important that women surround themselves physically or virtually with other women breastfeeding. It creates a sense of solidarity and support which is invaluable as mothers experience anything from common challenges to major issues. Mostly though, women need timely access to professional breastfeeding support, someone like myself as an IBCLC. It's not uncommon for mothers to exhaust all care options before seeing an IBCLC though. They may see their midwife, GP, child health nurse, hospital, chiropractor etc before seeking out support from an IBCLC. Unfortunately for some women, professional breastfeeding support isn’t available and this can mean they don’t receive the care and advice they need. Early support from an IBCLC, even in the absence of issues, along with good partner and social support can go a long way at helping a mama to continue to breastfeed. 

Q: We love the wealth of knowledge and evidence-based information you share on your page! For some of our readers who might not be as in the know about how to get prepared for breastfeeding, what are your top tips to set them up for success?   

Preparation is key! I am a huge advocate of mothers thinking about breastfeeding during pregnancy and proactively doing something with that thought. 

• The Australian Breastfeeding Association is an incredible resource with a 24/7 breastfeeding counseling hotline, online information and resources, support groups and classes. 
• Consider antenatal expressing and discuss it with your care provider. I talk about it as though it’s an insurance policy. The most important part about it is learning how to hand express, but any colostrum you do collect can be stored away and accessed if you need it. It’s a practice I have personally used with three babies (and used the colostrum every time), and recommend as a professional.
• Do some breastfeeding education for yourself and your partner. The time to learn is when you are pregnant, not in a pickle and tired with a newborn. I created the first online breastfeeding course by an IBCLC in Australia that supports families in learning about normal newborn behaviour, milk supply, latching, pumps, positions, nipple pain and a lesson just for partners.  

Q: We adore the space you have created over at the @milkybusinesslactation and so appreciated that you took over our stories to answer questions from our community of Mamas! You’d have seen our mission is to empower all mothers to feed with confidence. Tell us what helps you to feed with confidence and what is your best advice for a Mama who might be struggling to find hers?

Thank you for having me! I love the thought that someone is always watching and will be influenced by me breastfeeding. So many women have never seen another woman breastfeed! You could be that woman that normalises it for another, or someone else in the community. Personally, I want to shape the views of my own children. My daughters breastfeed their dolls because they see that that is how babies are fed. It is their normal. Remembering the power of breastfeeding on our cultural norms gives me confidence. 

If this isn’t you just yet, start small. Breastfeed somewhere other than home where you feel safe. If you go out to a cafe, start with a table in the corner facing the wall, maybe wear something like an OMM Label shirt that helps you to feed discretely and feel more comfortable, and better yet, take a friend or partner for support. In the end, I’m all for faking it until you make it with confidence! 

Thanks so much for joining us, Kate! It’s been wonderful.

Interview by Lauren.