Welcome to the first of an eight-part blog post series: Understanding Tongue Tie from Birth Onwards. Today, I’ll be guiding you through the modern birthing process, with the goal of fostering a deeper understanding of how induced labor affects infants. We will also spend some time reviewing labor’s impacts on tongue-tied babies, thus empowering you to make more informed choices early on, as well as better treatment decisions overall.
The rise (and fall) of induced labor
There are good reasons to medically induce a labor, especially when the pregnancy poses increased risk to the mother or her baby. Post-term pregnancies, for example, may benefit from induction as there can be increased risk for still birth. Evidence also suggests moms with pre-eclampsia benefit from induction past 37 weeks.
While the prevalence of induction had been steadily rising over the past two decades, in recent years the trend has seen a slight reversal. This is largely due to the overall decline in elective induction, which is where the mother requests to be induced even when it isn’t medically necessary. This trend is a net positive for newborns, as we discuss in greater detail below.
Natural vs. induced labor
When not medically necessary, it is recommended to avoid induced labor, and to let the birth happen naturally. There are many reasons why, but to get right to the point, I want to remind mothers of something that is often overlooked. The natural birth process is a sphincteral process, entailing both contraction and relaxation. Induction disrupts that balance strongly in favor of contraction, which can have detrimental effects on the baby.
A sphincter is a circular muscle which opens and closes in a wave-like process as to pass objects into, through, or outside of the body. Swallowing, digesting, passing food, and elimination are all common examples of sphincteral processes. Mechanically speaking, childbirth functions along the same principles–marked by alternating periods of relaxation and contraction in order to deliver the baby out of the mother’s uterus, through the birthing canal, and into the world.
Essentially, labor entails “two steps forward, one step back”, which is both natural and beneficial for the baby. In induction, that step back is virtually never taken. Let’s take a closer look at why that is significant.
In natural labor, the baby’s body makes “headway” upon contraction, and then retreats slightly. This forward/backward motion of the baby allows for constant repositioning; the head can turn as needed to help the shoulders clear the mother’s pelvic bone.
In addition, this important, natural process functions to “turn-on” the baby’s autonomic nervous system in a way that is not well simulated after a C-section birth, and is often disrupted and dysfunctional in an induced birth. For example, the uterus contracts much more forcefully and more often during induction, drastically increasing the periods of strain on the baby’s body, while disallowing sufficient periods for recovery or natural turns.
To cope with this continuous strain, the baby’s connective tissues–their muscles and tendons, or “fasciae”–undergo a process known as “armoring”. Imagine a football player tensing their body to brace for an impact; the baby does the same while being pushed against the dilating cervix and then out of the vagina, but on an ongoing basis until delivery is complete.
Delivery room stressors
It’s also important to remember that hospitals are businesses, and thus have incentive to “help” the baby get out more quickly one it reaches a certain point in the process. The means of assistance include forceps, vacuums and even manual force. Yes, the baby will come out sooner, but they usually suffer consequences from the intervention. These may manifest immediately (often in the form of shoulder dystocia and/or broken clavicles) or down the line (as is the case with fascia trauma, where symptoms are initially subtle, but lead to significant issues throughout development).
It is extremely rare for medical doctors coming out of residency to have ever witnessed a truly natural birth (where mothers are generally more relaxed, and the baby has time to make the needed turns in order to come out in their own time). They may have seen moms who have labored nearly to completion in their absence, only to step in to “catch” the baby. However, the vast majority of what MDs participate in–and therefor understand as “normal”–is inducing the birth, then getting the baby out quickly once it begins to crown (or simply performing a C-section).
In other words, doctors are trained that moms who stall in labor need to be induced, and to surgically remove the baby if labor fails to “progress” by the book. Tragically, this well-intended philosophy of precautionary intervention is often a self-fulfilling prophecy. Sphincteral processes like birth are highly responsive to stress; the anxiety moms feel in abdicating agency over the tempo and method of the birth can (and usually does) result in labor stalls. It’s not uncommon for moms to enter the hospital at 8cm dilated, then regressing to 2cm in the face of these stressors.
I don’t fault doctors for doing what they know and are trained to do. However, I think it is critical to keep things in perspective: the modern hospital setting is not natural, and it does have consequences.
Natural birth is strenuous enough for mother and baby alike. But after an induced and/or C-section delivery, the baby’s body has almost always already endured hours of armoring against unrelenting contractions, and enters the world in a state of extreme tension. What’s more, a majority of infants are then separated for a time from the mother for cleaning and inspection. Left untreated, this accumulation of tension wreaks absolute havoc on their entire system, and often directly impacts their ability to breastfeed.
Effects of a traumatic birth
As mentioned above, induction denies babies the opportunity to shift positions in the womb prior to and during delivery. As the baby is continuously impacted against the mother’s uterine wall, cervix, and pelvic bone, its connective tissues begin to armor. Prolonged armoring in utero can “train” these fasciae to assume an unnatural default tension and shape. (For an incredible visualization of how the fasciae work, watch Strolling Under the Skin).
The most commonly seen and known results of this armoring are conditions such as Torticollis, or “wry neck” and occipital compression. Both can cause significant tension in the head and neck, and negatively impact breathing and breastfeeding. Infants can also present with a highly constricted craniofacial complex. Left untreated, these issues can negatively impact neurological development and feeding as well as alter the growth of the face, jaws, and airway.
Tongue tie and its impact on breastfeeding
After delivery, the baby’s first natural reflex is to crawl on their mother’s tummy up to the breast, then latch on via the rooting reflex. This often happens even with the umbilical cord still attached! (Watch: Baby’s First Crawl.) This is very natural, and allows babies to open wide for a great first latch and feed. What’s more, mom holding her infant skin-to-skin against her chest allows its tiny body to regulate after the trauma of birth.
Unfortunately, this beautiful process rarely takes place within the modern hospital setting. Research shows that medicines and inductions blunt the baby’s ability to have this experience, which is fundamental to healthy nursing. Often, hospital procedure dictates that even babies who are physically capable are not allowed to make their first crawl and latch.
Tongue-tied babies must face all this, and more. Even when they are allowed to successfully crawl to the breast, the latch may not be comfortable or effective. This abnormal latch may even be painful for the mother, baby, or both. Tension in the body, especially in the head and neck, then limit the baby’s ability to open wide.
In addition, the tensions, torsions, and effects of the birth can directly affect cranial nerve function. This, in turn, affects the baby’s innervation and use of muscles associated with breathing and feeding. Restricted fasciae impede normal functionality of the muscles needed to latch and feed, so even if there is no pain, it can be difficult for babies to transfer milk from their mother’s breast.
Insufficient transfers can then disrupt mom’s milk supply, preventing its release and stunting its ability to replenish. Sadly, most Moms aren’t given this information, and so frequently think something is wrong with them when their milk supply doesn’t match their baby’s needs.
Intervention begets intervention
Once Pitocin or another induction drug has been administered, the delivery is placed on a clock. After a certain window of time has elapsed, usually 24 hours, without a successful birth, clinicians will typically recommend a C-section. While C-sections have been shown to reduce infant mortality in their intended use-cases, the procedure does not come without its drawbacks.
Vaginal delivery equips a newborn’s microbiome with the initial culture it needs to thrive. Without this exposure (as is the case in C-section), children face increased risk for developing autoimmune and allergic diseases, and may experience respiratory complications as well. C-section babies are more likely to face complications breastfeeding, as well as increased rates of obesity and ADD. The process of delivering a baby through the birthing canal also offers a wealth of physical stimuli which are integral in helping the baby’s autonomic systems to “turn on” as mentioned before (and which are not easily approximated by artificial means).
What’s more, sadly hospitals are financially incentivized, as a business entity, to hurry deliveries along, placing significant psychological and physiological strain onto the mother. In stark contrast to midwife-led home births, hospitalized mothers have less to say on who comes and goes into the delivery room or how things will progress. This can make an already troubled delivery even worse, leading clinicians to elect for interventionist methods like induction, forceps delivery, and C-section.
A more holistic approach is needed
Throughout history as far back as antiquity, childbirth has been viewed as something rather miraculous and perhaps even beyond the full scope of human reckoning. As such, midwives have traditionally concerned themselves primarily with facilitating the natural birthing process, letting the mother’s body take the lead.
Today, virtually every aspect of pregnancy up to delivery is subject to clinician oversight and control, for better and worse. Across the myriad medical disciplines, research and development have surged to produce the most sophisticated body of knowledge we’ve ever possessed on human physiology. On the whole, however, the practice of medicine has not moved towards a holistic paradigm in managing this incredible complexity.
Instead, the focus of well-meaning clinicians has tended towards solving highly granular issues at the expense of the bigger picture. The most common modalities are thus prescriptive and largely interventionist in nature. Such methods are typically quite successful within their intended use-cases, but may inadvertently trigger other problems to crop up elsewhere in the patient.
Unfortunately, this is tragically evident in our handling of childbirth. This observation is not meant to denigrate the advances of modern medicine, which have ushered in an era of plummeting mortality rates among both mother and child alike world-wide. Sadly however in the US we have one of the highest maternal mortality rates of any developed country. The US is 3 times higher in this alarming statistic than in neighboring Canada and 6 times higher than some European countries. This illustrates the need for humility enough to admit that our understanding of pregnancy and birth is inadequate in the medical area, and to serve as the basis for developing a more nuanced, holistic approach.
How to get the support you need
Pregnancy and the birth that follows are not “one-and-done” processes. What’s more, no single clinician holds every answer to the question “how do I give my baby the best start in life?” For this reason, I am a staunch advocate for assembling a team of knowledgeable providers who can help you address the nuanced requirements of your newborn’s emergence into the world, especially if they suffer from tongue tie.
In the coming weeks, I will be sharing a blog post detailing the role each of the following personnel plays in treating infant tongue tie:
- Internationally Board Certified Lactation Consultant (IBCLC) – Pre-frenectomy
- Internationally Board Certified Lactation Consultant (IBCLC) – Post-frenectomy
- Bodyworkers such as Osteopaths, Chiropractors
- Functionalist Medicine Pediatricians
Finally, I will conclude the series with a post on Tummy Time, “container babies”, and the Back to Sleep initiative. Taken together, this body of information should go a long way towards guiding your pregnancy and birth in a healthier direction for you and your baby.