Maxillary Labial Frenum and Tongue Tie

When I think of a ‘whirlwind vacation’, I imagine jetting off to Paris for a romantic weekend.

Jetting off ANYWHERE is not relaxing or romantic at all.

I flew with Ruby to Albany, New York yesterday… and here’s why:

Ruby and I have had nursing troubles for ages, and there didn’t seem to be any real solution beyond just muscling through. She had been ‘checked’ for tongue tie at birth and I was told she was fine. She was ‘checked’ again by a lactation consultant and again by my pediatrician who all pronounced her ‘normal’. Several weeks ago, I read an article on “maxillary labial frenum” tie on Facebook, and it got my wheels turning. I checked Ruby’s upper lip. It looked like this:

Ruby's Maxillary Labial Frenum

I was sure the moment I saw it that it was tied. My little wheels kept right on squeaking. I tweeted about it. I had a bunch of responses, but one person in particular (and I can’t remember who) sent me to, where I started reading article after article. I knew it, this was our problem, and Ruby need to be ‘fixed’.

I began talking with Brock about getting Ruby’s lip tie separated, and brought it up with our pediatrician. I knew many people flew to Albany, NY to see Dr. Kotlow because of his experience and his methods of laser separation WITHOUT the use of anesthesia, and we were prepared to do so as well. My pediatrician talked me into getting a consult with a plastic surgeon before I considered flying. When they called to schedule my appointment, the earliest they could get us in for a consult was June 22nd. I called Dr. Kotlow’s office and asked how soon they could get us in – to see if it would be worth our time going that route. I was asked, “Would you like to come in tomorrow?”

That sort of cemented it for me. I looked into flights to Albany, and there was a non-stop option. Brock’s dad, Ted, help me plan out the flights, the tickets were bought… and it all happened to work out. We were going. The very next day.

That night, I slept well but woke at 6am and couldn’t go back to sleep. I got up and showered, got dressed and myself all ready. I re-packed the diaper bag and picked out an outfit for Ruby. I cleaned. I ate. I changed the car seats so Brock would have a seat for Ronan while I was gone. I sat. I tweeted. I got really, really bored. It was 9am and NO ONE else was awake. I finally woke Brock up so I would have some company.

Ruby eventually woke a little after 9:30, and I bathed her and dressed her. She was in a great mood and I was excited for our day. We loaded into the car – me, Ruby, and my trusty Ergo – and it was off to the airport. After parking and checking in, we were really on our way.

Mommy and Ruby - Ready to GO!

Security took us mere seconds to get through. In the Charlotte airport, I wasn’t asked to take Ruby out of the Ergo, but instead was given a quick pat-down. We arrived at our gate and patiently waited. Ruby was handing out smiles left and right! I stood near the counter so I could be sure to hear if they called my name, and I could see on the monitor how many passengers had checked in, how many seats were left. We were flying stand-by, and all we needed was ONE seat to get on the plane! I watched as person after person walked down the jet-way, and I felt myself getting more and more nervous. My hands started shaking, and I was a little sweaty. There were at least 4 other people still ‘sitting’, so I assumed they were also stand-by. By my counting, there was only going to be one extra seat. After the last person boarded, I nervously walked up to the counter and said who I was, and that we were waiting for a seat on the plane. I had mentally prepared my sob story, and how I was taking my poor, sweet baby for surgery… but the gate agent picked up a boarding pass that was sitting next to him, scanned it, smiled at me and said, “Enjoy your flight!”

We were on the plane!

Nursing... on a plane!

While on the plane, I began chatting with the lady sitting beside me. I told her I was planning on nursing Ruby while on the flight, and she was very pleased! She told me that she had breastfed all three of her children, the youngest of which is now 47. We had a lovely conversation about breastfeeding and how it would be wonderful to see more women doing so, more normality and less derision. Ruby smiled and smiled at her. I think it made her day. She became Ruby’s honorary airplane grandma, and held her so I could have a bathroom break.

Ruby and her new friend.

After landing in Albany, I hopped in a cab that was waiting curb-side at the terminal. I told the driver the address, and we were on our way. Nerves had really started to to kick in, and I was starting to feel scared about putting my tiny, sweet baby through surgery. We arrived at the dentist’s office, and it looked like a repurposed house. I wish I had taken a picture of it. But as soon as we walked in, it became apparent that this place was in the business of kids. There were sweet, lovely, colorful signs every where… there was even a carousel in the waiting room! Dr. Kotlow has been a pediatric dentist for so many years, his patients are referred to as “Kotlow’s Kids.”

Kotlow's Kids - 20 minutes early!

I filled out mountains of paperwork, and Dr. Kotlow came in and introduced himself. He asked to examine Ruby, and laid her down between us with her bottom in my lap, and her head on his knees. The man is incredibly professional, and incredibly proficient. He pulled Ruby’s lip up harder than I ever have, and it immediately became apparent how tied her lip really was. He then forced his fingers and thumbs in her mouth and pulled her tongue up as far as he could, and showed me how tight her lingual frenulum was. I had no idea how significantly tongue tied she was, but he described it as a “very severe tie”. Ruby wasn’t bothered in the least by all of this, and he handed her back to me so I could watch a video about the procedure. While the video was very informative, and showed exactly how the procedure is done (using clips of actual procedures) my heart was racing. I wasn’t sure I wanted to go through with it.

Dr. Kotlow came back, asked me if I had any questions, and said, “Ok! Let’s get this done!”

He held his hands out to Ruby, and I hesitantly placed her in his arms. With very confident, assured hands, he carried her away.

I was suddenly very alone with her paci and my tears.

Seeing this picture still makes me cry.

I strained and strained my ears to hear her screams of torture. I convinced myself that it was awful, and my poor baby was going to be scarred for life. I prepared myself to sit in suspense for the duration of this exhaustive procedure. Moments later, and I am not exaggerating, but mere MINUTES later, I heard her whimpers coming back down the hall. My shock was washed away with relief at seeing my baby with tears down both cheeks, but quite obviously fine. He said the procedure went smoothly, and commented that she was a VERY good yeller. He showed me her incisions, and it didn’t seem to bother Ruby at all. I suspected that she was crying simply because she had been restrained and not at all because she was in pain. He said he would leave the room and allow me to nurse to see if I noticed a difference.

Boy, did I notice a difference.

It was as though I was nursing a different baby. It was as though our problems had melted away. It was as though she was nursing the way she was meant to all along. I cried, and I cried – happy tears. I felt justified, vindicated… but most of all, just thankful. My fears of picking up and flying across several states for a problem that may have been all in my head just melted away.

Dr. Kotlow returned and could tell from my face that things had improved. I thanked him profusely and we went over our “discharge” instructions. He showed me how to stretch her incisions so that they wouldn’t heal back together. We discussed what normal healing would look like. He pointed out potential problems to look for and gave me his cell phone number. He told me I could call or email him any time with any questions or concerns. He then apologized that we came such a very long way for such a very short visit, and I assured him that it was incredibly, unbelievably worth it.

Happy it's all over.

We cabbed our way back to the airport and over-exhausted Ruby fell asleep as I was waiting in line to check-in. I walked to security, and put my things on the conveyor belt, assuming that I would be allowed through with Ruby in the Ergo as I was in Charlotte.


They insisted I take her out of the Ergo and put in on the conveyor to go through the x-ray. I questioned it, told them I hadn’t been required to take her out at our previous airport, and was informed that it was “regulations” and that the rules were the same everywhere. Let me just say this – airport security, and all your pompous crap is just power tripping. Anyways.

I had lunch at a cute little salad bar, and watched as leagues and leagues of people went to McDonalds next door instead of opting for soup, salad or sandwhich. I laughed and moved on to our gate. We waited almost two hours for our flight home, and I was given a seat before we even started boarding. The flight wasn’t even close to full, and my last anxiety faded away. We had survived the trip, we simply had to survive the flight and we’d be home free.

Ruby was fussy on the flight, and unable to fall asleep. She comfort nursed more on that single airplane ride than she ever had before, and I think both of us found it relaxing. I can already tell that she finds nursing to be less frustrating than ever before. Near Charlotte, when we started making our descent for landing, I strapped Ruby in the Ergo and she became very upset. She was screaming and didn’t want to be strapped in, but I felt that it was necessary to have some extra security when taking off and landing. I whipped out mah boobage and nursed her in the Ergo and it calmed her instantly. BECAUSE she was in the Ergo, it was nearly impossible to tell that I was breastfeeding her. However, when the flight attendant walked by, she stared intently at what we were doing, and when she figured it out, she gave me the most heinous stink-eye I’ve ever seen. I laughed it off, and said to my seat-mate, “Did you see that look? I’m entirely impressed,” to which she responded, “You’d think she’d just be glad the baby isn’t crying.”

Landed, traversed the airport, and a short car ride later we were HOME. Brock immediately noticed how mobile her tongue was – it’s incredible to watch her experiment with her new-found mobility. I nursed her again and put her to sleep around 9:30pm, and she slept until 7 this morning. She’s my hero.

Here is a before and after comparison of Ruby’s lip.

Maxillary Labial Frenum - Before and After

Since photo-blogging our journey yesterday, I have had several people ask me questions about the lip-tie, the procedure, and what to do. Here’s how I feel about it – it was so easy, so fast, and quite obviously doesn’t bother Ruby a bit. (I have done the stretching exercises several times since we’ve been home, and she smiles immediately afterwards.) My only question is – Why not? If there is a chance it could improve your nursing relationship, or improve your child’s chance of not having speaking/eating/etc problems in the future… what really is there to lose? I read an entire thread of people on Facebook yesterday who opted not to have tongue or lip tie clipped as an infant and ALL of them had it done at a much later time, suggesting it be done earlier because it’s easier and heals faster.

Check out the link (again, it’s and see what Dr. Kotlow has to say about it. I am SO thankful I decided to go through with this, and could not be happier with the result. If you have a question or a concern, consult a pediatric dentist or ENT – and find someone that can do it without general anesthesia, because it isn’t necessary. And good luck. 😀