Interview with The Tongue Tie Expert: Lisa Paladino

Welcome to the Milk Minute Podcast! Today we’re thrilled to be joined by Lisa Paladino of the Tongue Tie Experts. For those of you who saw the recent pieces in the New York Times about “the big business of cutting babies’ tongues” and have seen Heather’s responding letter to the editor, you know we have lots to discuss with one of the nation’s foremost experts on lip and tongue ties and breastfeeding. Before we dig into the recurring controversy, let’s get to know Lisa and why she does what she does.

Stay 'til the end and we will read you Heather’s spicy letter to the editor of the New York Times!

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Listener question: My 8-month-old handles her own bottle, but she doesn’t always do it in a paced feeding way. Is that OK?

Mentioned in this episode
Home - ICAP International Consortium of Ankylofrenula Professionals

Connect with Lisa:

Website: www.TongueTieExperts.net
Instagram @TongueTieExperts | Facebook
Free Download: Preparing for Frenotomy Day

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Transcript

Maureen: Hey everybody, welcome back to the Milk Minute podcast. We have an interview today that I am kind of excited about. 

Heather: Oh, yeah, it's actually a really timely interview because a lot of you saw the recent piece in the New York Times about the big business of cutting babies tongues 

Maureen: And by saw, I mean a lot of you sent it to us. Yeah, sent it to us. We're like, have you seen this? 

Heather: Yes, we have. Oh, we saw it. And then I actually responded and I wrote a letter to the editor, which was actually published. That was so exciting. Yeah, so I guess I've made it. I'm in the New York Times. Now I can put that little thing on my website that says, as seen in the New York Times.

Maureen: But not really. We should. Definitely do that. Okay. Definitely. I, I should put, as seen in Rolling Stone, you should put New York Times and then we'll be. 

Heather: Absolutely. I mean, yeah. So, you know, we have a lot to discuss about tongue ties and we thought we would bring in one of the nation's foremost experts on lip and tongue ties and breastfeeding. So today we are bringing you Lisa Palladino and she is absolutely fantastic and I can't wait to introduce you. She is a women's healthcare professional midwife with over 30 years of experience and holds a bachelor's degree in nursing, a master's degree in midwifery, and she's been in IBCLC since 2011.

She co-founded the breastfeeding initiative at Staten Island University Hospital and worked in collaboration with the New York City Department of Health for eight years in efforts to achieve the baby friendly designation. So, you know, she's going to tell you a lot more about herself as we get into this interview.

But basically, she's a badass and we are absolutely thrilled to have her. Yeah, 

Maureen: like, Like one of the OG lactation warriors really out there because she was on the ground working in the 80s, which was a rough time for 

Heather: lactation. It was hard for us back then. Those poor babies. Hard for 

Maureen: this formula fed 80s baby over here.

Yeah. Yeah, but anyway before we get into that, I'm going to thank a couple patrons here. Thank you to Michelle from Colorado, Rachel T. and Maya from Toronto, Canada. Oh, Canada. Love it. Sorry. We're so cautious that we have Canadian 

Heather: patrons. I love it. Be cooler, be cooler, Heather. All right. Okay, our question today is from Tiffany from Patreon.

And Tiffany says, My question is that I have a very independent 8 month old girl that handles her own bottle very well. I'm an exclusive pumper and she's been feeding her own bottle for almost 2 months now. She doesn't always do it in a paced feeding way. Is that okay? I try to correct her or feed her myself but she gets upset and wants to do it herself.

I have no vision of ever getting her back to the breast, but I think there are other benefits to pace feeding other than keeping it similar to chest feeding. Thanks! 

Maureen: I love this question cause it's actually something I kind of forget to talk about when I'm like releasing parents pace feeding into the world at 12 weeks, never to see them again, is that after six months, your baby might not give a crap about pace feeding.

Especially when they're holding their own bottle and they're drinking from a cup or a straw. You know, I would say it's more important to slow down feeds if it's like a before bedtime feed, so we don't have spit up and gas and all of that, but otherwise, eh, 

Heather: whatever it be. Yeah, it's only a problem if it's a problem.

And, yeah, I mean, the thing is, there's a lot of mechanisms that are being set up. early on, like anything that's a loop in the body. Many things are loops in the body, like the stretch receptors in the stomach respond to the brain and set the fullness centers. A lot of that happened with the pace feeding that you did early on.

We can't control your eight month old it. Whose centers are set already, no more than we can control my cake eating abilities postpartum as a breastfeeding, starving parent, you know, like if you put a chocolate cake in front of me, I could easily eat all of it right now. That's just the way it is. No one can slow me down.

Maureen: And, and that's fine, you know, so really like we're, we're going to encourage you to not make problems where they don't exist. If you had never heard about the term pace feeding, you would probably just be super chill about it. So, you're doing great, your baby's doing great, and everybody out there who's been having like internal freak outs about this with their 10 month old, also you're fine.

Heather: Yeah, you're fine. Fine, fine, always fine. Alright, well let's get into this interview without further ado.

Maureen: Heather, I had a rumor that your business is changing. 

Heather: It is. We are actually expanding exponentially. 

Maureen: Well, tell me about it, because I think I am ready to jump ship from my current primary care provider. 

Heather: Okay, so we still offer lactation. That is always going to be one of our main aspects of the business.

But now you can establish primary care here. We do sick visits. We do problem visits, GYN. Basically, if you're a woman and you have something going on that you need help with, we can help you. And that even includes some hormone replacement therapy. We're even going to be doing the bioidentical hormones.

We're going to do IV therapy. So if you have a hangover or if you have a migraine, we can do all of that in house, which is super exciting. And probably the most exciting part is that we're taking all of the insurances, including Medicaid. 

Maureen: Have you welcomed new staff members to help you guys with this change?

Heather: Oh yes, we have. So we have Sarah Woods who is a family nurse practitioner and she is also certified in bioidentical hormone replacement therapy. So she is a wonderful asset to the team. We are also looking at hiring a pelvic floor PT and we are kind of in the process of that a little bit right now, possibly maybe.

And there's of course me, I'm going to be doing lactation and. Some GYN stuff. Ah, returning to 

Maureen: your full scope. 

Heather: Yes. I'm super excited about that. And then we still have Meredith who's going to be helping with lactation. So the three of us right now are going to be doing all of it. But as soon as we start getting full, we have people lined up actually who are trying to get a job here.

I just need a minute. So. 

Maureen: If I wanted to transfer over for GYN care or primary care, how would I 

Heather: do that? You would just call 304 212 5663 and that will be in our show notes and you can schedule an appointment on the phone or you can do it directly online at, it's still breastfeedingforbusymoms. com and there's an online intake form that you can fill out.

Well, 

Maureen: I'm really excited to see what new adventures await you at Busy Moms Healthcare. Everybody head on down to 10, 000 Coombs Farm Road in Morgantown, West Virginia to check 

Heather: it out. Alright, everyone. Busy Moms Healthcare, where women always come first.

Alright, Lisa, welcome to our show. Before we get started, I just want to let everyone know How much Lisa and Maureen and I have in common. We are all three from New York. We are all midwives and Lisa and I are both IBCLCs. We both have three children and we both had home birth with our third children after some disappointment about our hospital birth prior to that.

And then our subsequent breastfeeding journeys. So these parallels immediately make me feel a kindred spirit with you. And I'm so excited to have you here and also thank you for being an advanced practice nurse, IBCLC, who kind of like trailblazed in a lot of ways, because I'm sure, I mean, it's not awesome now it's better.

So thank you for all of the work and advocacy that you did. I'm sure. You know, starting 30 years ago. 

Lisa Paladino: Well, thank you. Thank you for that. And, you know, when we first made contact, I had no idea of all those coincidences. So, I think that's amazing. And it's really there aren't enough IBCLC midwives, right?

Like, I think it should go together. I think it should be required to have advanced lactation knowledge to be a midwife. And unfortunately, many of us who are midwives thought we knew about breastfeeding. And didn't really, I didn't realize that I didn't understand. I didn't know what I didn't know. Right.

Until I started deep diving into breastfeeding and trying to help the people beyond the general, you know, latch looks good and right now. How many times a day to breastfeed and, you know, those kinds of things. So yeah, it's exciting to be here. I love what you do as well. And yeah, I've been doing this for a long time.

Heather: Yeah. Well, tell us about that. If you don't mind do you just want to share a little bit about how you got into midwifery and lactation work and, you know, because right now, as we sit here, there's not a lot of midwives. Who are also IBCLCs. So how did you end up on that journey when you were first starting out?

Lisa Paladino: So I started as an RN and I worked in the hospital. I always knew I wanted to work with babies, but I was told, you know, you have to get medical experience first. So I was on the medical floors and I learned how to be a real nurse and do all the sick care and, and all that stuff. And finally I was allowed to work postpartum and in the postpartum nursery.

I still didn't know what I didn't know. I worked with an amazing nurse. who had breastfed her babies. And believe it or not, back then that was rare, right? Because this was like late 80s. A lot of people weren't breastfeeding. So to meet someone who breastfed and could help me learn how to help the patients who wanted to breastfeed, who were rare, It was quite an experience and I knew I wanted more than more of that.

I knew like it was, that was the part of it that I love. Like I went then to work in labor and delivery and a lot of labor and delivery nurses are all about the excitement, the, you know, the triage, the what's going to happen, the exciting crash section and saving lives and all that. And I honestly just wanted to be at the bedside helping people breastfeed.

Like that's, you know, holding hands during birth. So once I met midwives and realized it was. a career choice, I knew that's where I wanted to go. So I started slowly but going back to school. And coincidentally, right before I graduated with my midwifery degree, I was involved in a research project at the hospital about skin to skin.

And that drew me into breastfeeding. And I started to be known around town or around the hospital as the breastfeeding. because just because I was doing this thing. So I'm like, well, I better learn about this thing. So I started learning and studying and doing practical stuff for my IBCLC at that time.

So I know this is a long, long, long answer, but that's, that's what happened. And because of my work on the skin to skin project at the time, New York city was having, A breastfeeding initiative. And I'm in Staten Island, which for those who don't know, Staten Island is a part of New York city, but we're known as the forgotten borough.

And we don't get a lot of the services that the rest of the city gets because we don't have a city hospital. So the city hospitals were getting all this money to have breastfeeding initiatives. But we weren't getting anything. So I petitioned myself and my friend who was like my partner in crime. We petitioned the mayor and we wrote to the Congress.

We did all this stuff, right? We forgot to tell our bosses though. I got called into the office one day saying, Lisa, what have you been doing? Who have you been calling? But we got a grant. And I was able to write my own job description as breastfeeding initiative coordinator. And so for eight years I worked part time as that was part of it and the other part of my job was as midwife delivering babies and doing all that stuff.

So that's where that came from. Long story. 

Maureen: I love that. That's a great origin story. 

Lisa Paladino: Yeah, it kind of just happens. Like, I feel like it was just what I was meant to be, you know, what I was meant to do.

Heather: You know, it's funny to me too, because a lot of the folks that we've talked to, like Marie Biancuzzo and, you know, some of the other trailblazers that were really hard hitting the lactation scene in the eighties, they were like, They did create their own job descriptions because it just didn't exist.

So like seriously filling the shoes of you all. And that really means a lot to me. And I just want our listeners to really understand the impact of that and how none of us would exist truly. And you would still be, you know, probably feeding formula at, or if you were breastfeeding, just, you know, the people that got lucky with the baby that would latch with the boobs that sprayed milk, they would be the ones that were breastfeeding.

So gosh. All right. Well, when, during your career working with women and babies, did you begin to understand the influence of oral tethers on infant success and breastfeeding? Was it before or was it after you got your IBCLC? 

Lisa Paladino: It was after. So I kind of knew I was hearing whispers about it. I knew it was a thing, but as a midwife, I always felt that, of course, we're non interventional, right?

We want to do the least possible that we have to do, right? So when I heard that there was people that thought that babies needed surgery, quote unquote, to feed, I was like, they're crazy. You know, I was one of the naysayers, so I, I totally, what, what's the word I want to use? I have empathy for the people who don't understand it's a problem yet, right?

I don't have empathy for people that don't continue to learn, right? And that's what I hit my head against the wall constantly about. So I didn't know. And there was one week and I tell this story often. So if anybody's ever listened to my podcast, they've heard this story. During one week, I had three babies that everything that I did not help them.

No matter what I did, I could not get these babies to feed. And I looked what I thought was looking under the tongue and saying, maybe there's a tongue tie. The lips are usually more obvious and easier to see. Yeah, there's a lip tie. So are they doing like, I was like asking all these questions in my head.

Are they doing surgery for the lips too? Like what should we be doing? And I just felt so bad and I started doing a deep dive into learning. I'm like, let me, I started Googling, started researching, reading everything I could, going back to my midwifery books, going back to my nursing textbooks, going back to my lactation textbooks, looking for the information on tongue tie and it was not there.

So then I started going and researching and one, one baby came to me. After, and said, the mother said to me, I went to this ENT and he fixed the baby's tongue tie and things are better now. And I looked and I saw and they were better and this baby was latching and transferring milk and he hadn't been before.

So that was it. I was like, all right, I have to take a deep dive and learn all about this. I found one of the professional organizations at the time, which it has evolved but the, and I went to a conference and I walked into this conference and I found people from all over the world who were asking the same questions that I was.

And it felt like I found my people. Like it was, it was amazing. I still am friends with people I met at the table during that conference. I think it was 2013. So yeah, so that, that's how I found out about Tantai. And then I am very fortunate to have a professional relationship, not a kickback relationship, relationship with Dr.

Scott Siegel, who is one of the premier You know, people in this field, and I'm sure we'll talk more about that situation before we get off this conversation, but he inspired me because I said, I don't know how to do that. I know how, I know what to look for. I know how to assess, but I don't feel confident.

And he said to me, Lisa, if you're not helping them and there's no other IBCLC on Staten Island. Who else is going to help them? So he empowered me and then he had a, I just learned and learned. I went to every talk I could go to. I learned as much as I could. I read as much as I could. I did online stuff.

And he was having a, like a forum like a kind of like a conference, but like a mini conference and you have to do something and you're like, how did I just do that? He told me about it and I was like, I want to speak. Can I speak? And I had never spoken public before. He's like, of course you can speak.

And then there I was speaking at this conference for the first time following Kathy Watts and Jenna, no less, right after her. Yeah. So, and that was like, then I became known as the person who knows about Tongue Time. 

Maureen: Right. You made your own name. 

Lisa Paladino: Yeah. Yeah. And it's just evolved since then. 

Maureen: Yeah. Well, you know, when we talk about tongue ties I think usually the conversation centers on baby's birth, you know, baby's birth weight and how much weight they've lost and their milk transfer and how baby is doing.

But I do want to also talk about the other side of the equation and how oral tethers can create pain for the parent. You know, is, if that's the only symptom, like, is that enough to warrant a revision? You know, I think people really don't feel comfortable with you know, assessing revision just based on parental systems.

Lisa Paladino: So I love this question, and I feel like you're reading my mind this week. We really all are on the same wavelength, because the podcast that just dropped today on my channel. show is all about, I actually went on a rant about nipple pain and dismissing nipple pain. Oh, I love it. 

Maureen: I love it. We'll have to go listen today.

Lisa Paladino: Because a couple things there. First of all, it started because I was reading comments from an article that was critical of Tongue Tie Release. And in these comments, people were saying, Well, a mother is selfish. They're getting this, they're doing this thing for their baby, just for them. And that just, I just, my head exploded.

Because, first of all, a mother's experience breastfeeding matters. Doesn't it? I mean, this is, this is a dyad situation. This is like a dance. If you were dancing with someone that was stepping on your toes constantly, would you want to keep stepping on their toes? Dancing with them, right? No. The other thing, well, I have a little bit, I don't know how raunchy you like to get, but Go for it.

Okay, so I've been using this example for a really long time. If a man had to do something eight times a day that hurt his penis, would he continue to do it? So if you believe that breastfeeding is important, and that without even thinking about what a mother's desire or what a parent's desire is, if you're thinking that it's something that is going to do very good things for that baby for the rest of their life, which I honestly agree with, then wouldn't the mother's experience matter?

Because she's got to continue to do this. The other thing is And this is a major point that everyone forgets. Typically, If a mom is not comfortable with the nursing, that means the baby's not efficient. So the baby is, unless the mom has that, as you said, those fountain breasts that are going to let milk out no matter what happens, chances are that the baby is struggling to feed, and that's why she's in pain.

So, sometimes all we can judge is maternal pain, but because it's 

Maureen: obvious, pain is a vital sign, you know, 

Lisa Paladino: exactly. And I write breastfeeding is a vital sign, right? So pain is a vital sign. We can talk about breastfeeding is a vital sign. That's a whole nother. I love that. 

Maureen: We will do a follow up show on that. If breastfeeding doesn't work, something's up, right? Something's up. 

Heather: Yeah. Oh gosh. 

Lisa Paladino: On either side of the equation, right? I mean, that, that's if, if they desire breastfeeding, right? I'm, I'm not like everybody has to breastfeed, but if a person decides they want to breastfeed and it's not working and they're trying and it's not working.

Then the root cause of that needs to be investigated. Yes. 

Heather: Yeah. The root cause is it could be oral ties or it could be a systemic problem because the systems that we have in place to help people aren't working. And I mean, we've kind of danced around this topic a little bit, but why don't we just go ahead and bring up the recent New York times article about tongue ties?

Yeah, the 

Maureen: day that came out, I don't, I don't pay for the New York Times anymore. I don't want to, but the day it came out, about 15 people texted it to me as a gift article. 

Heather: Yeah, same. I was like, what is going on? Yeah. So obviously the article stirred up a lot of talk in the lactation and pediatric care world and, and dental world really.

So I want to take a second to talk about this but quote unquote, big industry of midwives and lactation professionals and pediatric dentists who are seemingly conspiring to slice and dice these baby tongues, causing pain and suffering for financial gain. I know, I think I know what your take is on this, but I want to, I want to hear from you because this, we had to.

I'm not getting the help they needed, which is what I knew was going to happen. So how did this affect you? What do you have to say 

Maureen: about it? 

Lisa Paladino: Just to address what you just said, Heather. The, the parents, the scariest part about this article was a couple things. Parents weren't going to get help that they needed.

And if you were brave enough to read the comments of the article, parents who had good results were questioning themselves. So all we need is more parent guilt, right? I mean, there's not enough of it, but okay. So I appreciate the opportunity for me to give my opinion on this article. First of all, I think that if we look at any healthcare segment, we will find an industry that's making money referring back and forth to each other.

I mean, how about, 

Maureen: healthcare wouldn't exist in this country if it didn't make 

Lisa Paladino: money. Right. I mean, the people who are providing a service deserve to make money. Absolutely. End of story. Are there kickbacks? I don't know anyone who gets kickbacks. I admit. Not in the lactation world. I got a plant when I opened my first office from a dentist.

I'm guilty. I got a plant. What a kickback. Right? It was Christmas time, it was a Christmas plant, it was pretty, whatever. We refer back and forth to each other, and I don't only refer to one dentist. I have a list of providers that I give to my patients. That I know do a good job, that I know, that I have experience.

I've, I don't recommend anyone whose office I haven't been in, whose work I haven't seen, whose bedside manner I'm not aware of, whose, You know, I just, I don't like randomly go down the phone book and pick names. Nobody does that, right? So I have people asking to be recommended by me all the time, and not just dentists.

I have pediatricians and, you know, OTs and PTs and SLPs. Everybody, of course, wants me to recommend them, but I only recommend the people that I have had experience with, that I trust, that I've seen good results from, and that I know that parents trust. Because that's important, right? So, I don't know anyone getting kickbacks.

Me neither. And then I'm curious. Does anybody say this about the pediatrician who's sending to an ENT for tonsils and adenoids? 

Maureen: Right, which might happen way more often. That's such a common referral. 

Lisa Paladino: Or the primary care. Doctor or nurse who's referring to the doctor who does colonoscopies, right? I mean, like, yes, those are different procedures, but there are, it's, it's a system.

That's what we do, right? So why shouldn't we? And this speaks to the entire vision and the entire model of care that I promote, which is a team, it takes a team to take care of a breastfeeding dyad, especially if there's an oral restriction involved. So I am referring, as I've mentioned, to physical workers, body workers, for lack of a better word, manual therapists, we're trying to figure out a better way to say that because whatever, but they're either PTs, OTs, chiropractors, CST providers.

Speech language pathologist, depending on what's going on. The dentist and the lactation professional. All refer back and forth to each other and work together because in the ideal world, we have a functional assessment. Not just what it looks like, but a functional assessment. And the only person that can do a functional assessment is the IBCLC who can examine under the tongue and then see what the function is.

Rule out other things. And then send to I'd like to send to whatever is in the best interest in the financial capability and logistically and geographically solvent for that parent, whether it be a PT, an OT, you know, some sort of somebody who can make sure that the baby is functioning well otherwise.

Right. 

Maureen: Yeah, I mean, the article made it. Really sound like that. We were just like, Oh, look, there's a frenulum that are getting clipped when the reality is, you know, we do these in depth assessments and then, yeah, we look at this patient and, you know, for, for us now, Heather and I work in a very rural state and I work extremely rurally.

So I'm like, okay, would it be better to recommend that you drive three hours to get a revision or should we maybe see the chiropractor first who's 20 minutes down the street? Or should we do OT? That's an hour and a half away, like, you know, those are such complex, right? There's such complex decisions that you make with a family before we even get to the point where I'm writing a referral.

Heather: Right. And also, can I just add that the article mentioned that we're just raking in cash because it's not something that insurance covers and it's like, okay, I have no control over what insurance will or will not cover. Right. Trust me, I wish I did, and it's not really lactation's fault that, you know, these small private practices aren't in network with some of these bigger insurance companies, and same with pediatric dentists who are performing the laser, so I think you know, if you think about like Botox, you know, nobody is being like, okay, Botox is such a, a, a cash industry.

They're like, Botox is a cash industry and you should definitely do it. You know, this is, this is like completely different. And I wish that more insurance companies would cover it and hopefully they will someday with enough advocacy, but not with these New York times articles coming out. And 

Maureen: you know what, though, 

Lisa Paladino: a lot of the A lot of patients who go even to a dentist who doesn't take insurance do get reimbursed by their insurance companies if the dentist knows the right codes to use.

The other thing is I don't know if people realize what a lactation visit entails. I mean, I spend at least an hour and a half with my clients and there's work before and then there's follow up after. This is not an easy profession. This is intense and it's emotional and, and you're dealing with the, the family's experiences.

If you're good at what you do, right. It's not just like, Oh, come on in. Let me weigh the baby and look under his mouth and go. Oh, the latch looks good. See how, you know, write a check. Right. And, and it's 

Maureen: not like I can check my messages coming through my chart, like every three days. No, cause I've already missed the problem and they've already moved on to something else.

You know, it's like, okay, now I'm checking messages every like four hours to make sure no one has a. Feeding crisis right now, exactly. 

Lisa Paladino: And, and to add to the critique of the article, I have spoken to multiple people cause they were based in New York, obviously. And I have at least three other friends that I spoke to who were interviewed and didn't fit their narrative.

So they weren't included. Oh, see, I had really 

Maureen: wondered, I was like, is this just, Is it just shitty reporting, or is it purposefully 

Lisa Paladino: obtuse? It was purposefully not nice. And also, there were procedures witnessed in the office. They had conversations at Dr. Siegel's office. with parents before, watch the procedure, and after, who had good results.

They 

Heather: just didn't include him. 

Lisa Paladino: Dr. Siegel showed them. You have the inside scoop. I do. Well, I actually, I interviewed Dr. Siegel. It was weird because he was like driving home and I was on Instagram, so it was a weird conversation. But like, it was like we both had to, I had to give him a voice. Yeah. Because I felt so bad for him because he's the sweetest man you've ever met in your life.

Like he wouldn't hurt a fly. So he said that he showed them all of the sonogram equipment and the specialized computer system they have for the research they're doing. Yeah. 

Maureen: Was there any mention of 

Heather: that? No. Well, and also this pissed me off, too, where they're like, for a three second procedure, they're charging upwards of 700.

Okay, all right, the procedure itself might take three minutes, but the consultation and informed consent that went on it. With an exam beforehand was, I don't know, an hour and a half, then afterwards, you're going to come back for a follow up. That's probably included. This person is a doctor who's doing it.

How much do you think a doctor charges per hour? Probably 250 to 300 an hour. I think that sounds about right, you know, 

Lisa Paladino: like, yeah, and I've heard other dentists say, This man could be making more money doing other procedures. 

Maureen: Exactly. 

Lisa Paladino: What do you think he'd make for a root canal? Like, I'm 

Maureen: sure if he just put veneers on people for the rest of his life, he would 

Lisa Paladino: make better money.

Anyway, and not to mention, I mean, not to go down more of the rabbit hole, but he has two Very two practices in very expensive places to have practices. And he takes very good care of his staff. He's got very well trained staff. He sent them for educate. Oh, there's the collaboration and collusion. He sent them to become IBCLCs, the girls that work in his office.

So like he's. It's not like he's just sitting there like counting his money while everybody else works. He's taking care of everybody, you know. He does stuff for the community. He does so much pro bono work. Like, if I call him up and say, I have this family that really needs this done and they can't afford it.

He'll just do it, you know, 

Maureen: it's, it's disappointing to see this like specifically from the New York Times, which I feel like usually is pretty good reporting. But if, if we forget which newspaper it is, I'm like not shocked at all, Heather and I have, you know, been involved in several news articles and every time we're like, Oh God, that's really what they published at the end.

Heather: That's what you got out of what we said. Right. 

Maureen: Oh my God. Yeah. So 

Lisa Paladino: getting back to my early work at the hospital, I had this happen to me once. I had a friend who worked, who was a part time reporter for the New York Post, which I don't even know if they're still in business, but they were, they were big.

And she was also a Lecce leader. So she pretended to me that she was very excited about my baby friendly work. And we were just implementing. The steps to baby friendly. We never actually got there, but we had just started keeping track of formula So she did an interview with me all about this and I mentioned that the nurses We're training the nurses to not run for formula and we were gonna lock the formula in a cabinet So the nurses nobody could just grab it and give it away.

The nurses would have to unlock the cabinet Well, what she did to me was, that's all it was about. Formula is going to be locked up in Staten Island hospital from now on. And it's my fault. And, you know, parents aren't going to get formula and all this stuff. And I got calls from all over the country.

People wanted to interview me. Wow. And I was like, no, I just put a score. I was like, this is not what I said. It was all about baby friendly. 

Heather: I'm not here for that clickbait. And I'm sorry that happened to you. And you know, it's happened to us enough times that I'm almost like, I'm not sure interviews are worth it anymore, because they can barely get my credentials correct.

I 

Lisa Paladino: know. I B I C L B up. 

Maureen: The only interview I ever did that I read it and I was like, this is good, was in Rolling Stone. Yeah. Wow. That was it. And I was like a very small piece of that article. That's cool though. I was like, well the two lines they put in were correct. That's 

Lisa Paladino: cool. Yeah. Yeah. I mean, it's like a narrative to fill and they're looking for somebody to say something so that they can do their narrative, you know, and this was literally, she was the La Leche League leader.

It's wild. It didn't make any sense to me. She's getting kickbacks.

Heather: From who? The formula companies. 

Lisa Paladino: Craziness. Anyway, so that, that was, yeah. So that, I think that's why this past article like hit a nerve for me. Cause I was like, wait, that was done to me. Don't do this to my friends, you know? 

Maureen: Okay. So let's take a very quick break to thank one of our sponsors. And when we come back, we're going to talk a little bit more specifically about tongue tie revisions.

Heather: Let's take a quick break to thank our sponsor, Aeroflow. Aeroflow 

Maureen: is your one stop shop to get the most popular breast pumps and accessories through your 

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Thanks Aeroflow. Thank you so much. Go ahead and check out the link to Aeroflow in our show notes and order your pump through them.

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Heather: Amazing. I'm so glad a company has finally realized that a D cup is not a large. 

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Well, what else do we get? Well, if you guys follow the link in our show notes, you can use the code MILKMINUTE at checkout for free shipping on all 

Heather: domestic orders. Thank you so much, Dairy Fairy. 

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Heather: Okay, welcome back everybody. We have some follow up phrenectomy questions. Phrenectomy. That's The revision in case you all didn't know and these you don't have to go into long answers We're kind of looking for like a lightning round of questions because we have so much we want to cover But let's start with why does this procedure seem to go in and out of favor in the medical community?

Do you 

Lisa Paladino: think well the reason it's in favor right now is because more people are breastfeeding and more and many people aren't having functional assessments. They're just going to someone who can look and see a frenum. So in a way that silly article that we spoke about, there are some points to it.

Everyone should not be randomly having tongue tie releases without being sure that that's actually the problem. And I like the word release better than revision. Revision to me is redoing it. Which, you know, I don't like to have to redo anything. So I think that's it. We obviously people have been releasing tongue ties forever.

I mean, there's mentioned in the Bible, there's mentioned in old medical textbooks, and there's pictures of tools that were used to look under the tongue and release it. And there's, there's. You know, stories of midwives who kept one of their nails, I know, right? Like, think about, like, they weren't wearing gloves or anything and whatever, skeevy, but, so, I think now that people are breastfeeding more, it's being recognized more, but it's also being done.

Too much. And, and I'm, you know, I'm here to say that as someone who runs a platform called tongue tie experts, part of what I do is education so that it's not done unnecessarily, because that's what gives our, our fields a bad name, right? When we're doing things that aren't necessary. So we want to be really, really, really sure and try everything else first before we do the procedure.

That being said. For some people, it, you need to do it so the baby can feed, the baby can't even open their mouth, they can't lift their tongue, they can't latch on at all, we have to do it and then figure out what else to do, right? So it's, it's a complicated issue. 

Heather: It is, and I think that is further complicated by the fact that there's a lot of providers that are involved in a newborn's care.

At first, and I've had a lot of parents say, I've had my baby's mouth looked at by three different providers, and none of them said anything about a tie. They all looked for a tongue tie. They said it doesn't look like an M, and the tongue can come out over the bottom lip, so it's not a tongue tie. And then you look in there, and you're like, ugh.

So, can you explain what else we're looking for on an exam? 

Lisa Paladino: Yeah, so on an exam, I'm looking for a, on a breastfeeding exam, I'm looking for a tongue that is not lifting or on my finger, keeping the tongue up with the mouth open. So it's not so much out, out is important, but it's more about up with the, with the mouth open.

Because if a baby can't lift their tongue up while their mouth stays open, they slip on and off. And that causes friction wounds, literally if a baby can even. Get the milk out. So that's basically what I'm looking for on a physical exam, but I'm looking more for symptoms and explanations of what's been going on.

So, especially if you can't do a weighted feeding or you don't know if the baby, you know, you don't know about weight gain. You want to assess, is this baby feeding all day long, like never satisfied? And the mom has nursed before and she knows what it's like. And all of a sudden she's got this kid who's nursing all day long and she can't even put him down.

And he's not even making fantastic diapers, right? So you're like, you know, and only a midwife lactation consultant would describe diapers as fantastic, but you know what I mean. Yes, we do know what you mean. So. Are they getting enough? P possibly, but maybe not. And It's just an all-day experience with no break and mom has pain and there's some reflux for the when they get some milk in and you know I'm just like there's a myriad of symptoms that can happen.

Sometimes it's a baby that cannot even latch at all There is no latch the baby just roots at the breast cannot go on and it's not only breastfeeding There are some babies that can't even get milk from a bottle, right? So those you know, what's going on? There's something's going on. Is it a tongue tie?

Maybe it is Maybe it's torticollis. Maybe the baby can't turn their head in a certain way. You know, those babies that can nurse on the right breast but not the left or vice versa might be a positional thing or a torticollis, right? So there's that. On physical exam, I'm looking for tightness around the face.

I'm looking for blanching. I mean, sometimes you can actually see when you look at a baby that they're Their lips almost look turned in and they're pale around the face. And I don't mean like cyanotic pale, I mean like a blanching. You can see the tightness of the tissue. What else is red flags right at the start?

Babies who, who have an open mouth posture, which is really, really scary to think that, you know, we're all supposed to be breathing through our noses, not our mouths. So if a baby already at birth has an open mouth posture, then something is going on. It could be tongue tie. It may not be. It might be a combination of things.

It could be a high palate. It could be something going on with the nasal area. It could be a defect, a cleft somewhere like this, all things to investigate. So when somebody is doing a tongue tie exam, they should be aware of all the other things to rule out to make sure that there's nothing that they're missing.

Cause I mean, palates missed by pediatricians. You know, because we don't really, not everyone, let's put it that way, is doing a good internal in the mouth exam. Right, 

Maureen: right. Well, what if on the flip side, we have a very obvious tongue tie or lip tie, but baby is gaining well, mom's fine, not having any pain, you know, would you still recommend a tongue tie release?

Are there still benefits you would talk to parents about? 

Lisa Paladino: So, in general, no, we never do a procedure, or I never recommend a procedure to prevent future problems. However, I have had many families come to me and say, Everything's fine, but the doctor says my baby has a tongue tie. And I'll say, and then I go down the list.

symptom checker and everything actually isn't fine, you know, so you want to make sure that, you know, don't just assume just cause, not that I don't trust parents, but just because the parents think it's fine. If they've never nursed before total flip side to that, that mom who has nursed before, and this is different, this is someone who's never nursed before.

No one in her family has ever nursed. She doesn't know what it's supposed to be. And this is what's happening for her. And, oh yes, my nipples were bleeding for the first two weeks and the baby was jaundice and slow to gain weight. And all these things happen. Oh, he was never able to keep a pacifier in his mouth or like all.

Maureen: Yeah. Like fine. Doesn't mean normal. Right, 

Lisa Paladino: right. If everything actually is. Doing well that I, I don't suggest release. What I suggest is I do what we learned in nursing school, anticipatory guidance, right? This is what could happen at this stage. If this happens, this, and, and I will, even if I see a baby that I'm feel has a tongue tie.

And for some reason, we're not going to have the procedure. or they came to me for something else and they don't even want to hear about tongue tie, I will want to mention it because I never want to be that person that didn't mention it, right? So I will say, here's what I see. It's not causing a problem right now, but this is my, what might happen.

And some of the things that might happen is, you know, do you see this too, in your practice around? Maybe three to five months weight gain drops. Yes. Right. Absolutely. All the time. Things become more difficult. The babies all of a sudden nursing all the time or refusing to nurse because they're not getting as much milk.

And so the three to five month mark, I say, you know, watch what's going on there. Keep an eye on weight gain because even though it's not only about weight gain. I see around here, there seems to be a drop off in Peds visits at a certain point. So there's weeks where they're not weighed and then all of a sudden they're weighed and they haven't gained anything or they're not gaining anything.

Well, it's always 

Maureen: that gap between the two month and the six month visit. Right, right. And, and, you know, they'll bring him in because baby's not doing great, weight's terrible, Peds like, ah, just add some formula, it's fine, and that's the end of the visit. Right, right, 

Lisa Paladino: right. Yeah. Or add solids. 

Heather: Can I ask a follow up question though?

Yeah. So, for example, I have this exact situation right now with a patient, and it's her second baby, and the baby's in the 25th percentile, holding steady. Her other baby, her older baby, was much bigger. You know, bigger baby, No tongue tie, no problems, this baby is compensating really well, even though he has an obvious tongue tie.

And she was asking me about starting solids, because he's technically gaining, he's objectively fine, he's pretty content and happy, she's not having any pain. But when I do the lateralization check, this kid cannot lateralize his tongue. Which is like the biggest safety thing for starting solids. So she was asking me about that and I said, listen, I'll be honest with you.

I, this kid's lateralization is, is not the best. So, you know, if you're afraid of choking and that's something that you won't have time to handle, or you don't feel like you'll be able to do the stretches on a six month old as easily as you can now, then I would recommend at least a consult with another specialty.

So that's kind of my go to. Is that what you do or do you have a different, thing that you 

Lisa Paladino: like to do. That sounds, that sounds like an appropriate handling of that. And so that's one of the things I say is, you know, if a baby is exclusively breastfed and you try to introduce a bottle and there's problems with the bottle, that could be a sign.

Cause it could go either way. Like my own grandson could not take a bottle. He wouldn't even suck on my finger. Like my own grandson, one day I'm going to write his story because 

Maureen: It was 

Lisa Paladino: like, Lisa, let's see how we can challenge you. Like the universe, whatever sent me the, the biggest challenge was my own grandson that I've ever taken care of.

And he's still, he's two, he's still, he's still, I mean, he's perfect, but he's still challenged like health wise and not health wise, if you saw him, he's not unhealthy, but the things that I look for, he's been challenging for him, right, sleep and all that stuff, you know, so he couldn't even suck on my finger, he could not take a pacifier and I like pacifiers as an emergency, you know, I think every baby should be able to use a pacifier because they can't the same way a baby who can't breastfeed.

There's something's up if they can't suck. So he was blessed because my daughter had a magnificent milk supply, especially in the very beginning. So he didn't have to work a lot. If she didn't have that milk supply or she had decided that she wasn't even going to work, start breastfeeding, he would have wound up on a feeding tube because he could not take any milk.

So it goes both ways. And I like to tell that story because, you know, people think this is all about breastfeeding and the bad press is all about breastfeeding and this is not all about breastfeeding. So we talk about bottle refusal, signs at different stages, difficulty with solids, you know, the kids that gag and choke no matter what you do or will not.

You know, tongue thrusting won't, won't accept the solids. And then speech development, right? So, not every baby who has a tongue tie will have a problem with speech. So, I don't think if we see a frenum there, we should cut it just in case at all. But, if a kid is having a problem with speech, or are speech delayed, we should definitely be assessing for tongue ties.

Absolutely. 

Maureen: And truly, like, with, you know, some more extreme cases, we have dental issues. That and we have issues that can be lifelong, you know, I have a couple adult friends who had, you know, tongue tie releases and now have gone through months and months of physical therapy to try to when, when they realized, you know, when they heard about this and they were like, Oh, other people don't have mouth pain every single day.

Right. Guess I should get that 

Lisa Paladino: checked out. Yeah. Yeah. So yeah, absolutely. It's definitely a lifetime issue and the end result, and here's where I say breastfeeding is a vital sign, the end result is airway, right? And I'm fortunate, excited to be involved in a project called the Airway Revolution Foundation.

It's a nonprofit and there's actually, I'm going to be on TV. I don't know. It's a documentary. Ooh. It's a documentary and it's going to be really cool. But the point of it is, you know, I know that some, some of the day it was all about older people at first, but I'm friends with the dentist who started this.

He's my dentist actually, but he's more than that. He's, I'm friends with his whole family. And when I said, you know, you better have lactation consultants. I wasn't saying me, but you know, I'm like, you better have lactation consultants involved in this project. And he was like, well, tell me why. And I said, well, if a baby can't breastfeed and if their tongue is tied or any other problems, including, you know, problems of the neck, like torticollis, or any musculoskeletal difficulties that make it hard for them to breastfeed.

Their palate is not going to come down. They're going to have a high palate. And they, all know that the tongue is supposed to be up on the palate for older people. Well, guess what? If that's not happening as a baby, it's not going to happen when they get older. 

Maureen: Right. It doesn't just magically happen. Like this isn't a problem that appears when you're 80.

Oh no. This is a lifelong slow progression of problem on top of problem on top of problem. 

Lisa Paladino: Yeah. So that high palate It is the palate is the basis of the lower, you know, the nasal cavity. So if your palate is high, your nasal cavity is necessarily small. And if you think about in a three dimensional image, your whole airway is narrower if your palate is high.

So if a baby is not breastfeeding, something's up somewhere and we have to investigate. The other thing is that, you know, the tongue is called nature's palate expander. And if we. don't have the tongue up there regularly, it increases, we know this for fact, there's research that shows that it, it increases sleep apnea at old, even in children.

So children who had difficulty breastfeeding and were bottle fed have increased snoring and sleep apnea when they're eight and 10 years old. So, again, I don't mean to scare everyone, and I always say, when I say this, I love Maya Angelou's quote, When you know better, you do better. That's a, you know, shortening of it.

Because I don't talk about this because I did everything right. I didn't do anything right. 

Maureen: And, you know, I always like to qualify, like, breastfeeding is not the only way. To set your kid up for success in these ways, you know, if that's not working, that's fine. We can talk about using bottles that are better for baby's mouth or just simply closing their mouth when they sleep or just, you know, different like exercises and tummy time.

It's just, it's so multifaceted, which is fantastic because it means there's more accessible solutions for more people. 

Lisa Paladino: Exactly. We have to do the best with what we have and what we were able 

Maureen: to do. 

Heather: Plus, you know what was really scary is the palate expander that I had to wear for like four years. And the Bionator.

Do you have a picture of that? Do you have a picture? Girl, I will find one. I, I had a, a Bionator appliance that was like a hollow ball of plastic that I put in my mouth that had swords that came down from the roof of my mouth that would stab my tongue when I would, Swallow wrong. And in retrospect, I'm like, Oh, so I had a tongue tie that was undiagnosed and y'all just tortured me as if it was my fault.

Maureen: And not 

Lisa Paladino: only that you couldn't, you couldn't keep put your tongue up on your palate. No, it was awful. And that's where 

Maureen: it's supposed to be. Yeah. That's a lot. So the 

Lisa Paladino: same way you guys have funny, the same way that. You know, on the issues that we were talking about earlier about the kick, the feedback and the, and the pushback from other professionals, orthodontists among themselves are having pushback on an older person level, because basically that we're telling them.

In the airway revolution projects that everything they did was wrong. I mean, like I had six teeth taken out and my mouth made smaller and yes, I had a tongue tie, my own, whatever. I could talk for hours on this. We don't want to take all 

Heather: of your time. I selfishly would love to keep talking to you for hours, but I have, I have a couple more important questions.

So next would be what baby would be a good candidate to wait on a release and just do some. body work or whatever phrase we're trying to use now for that and some suck training. 

Lisa Paladino: I think every baby should, unless there's an immediate need. So oftentimes, I'm not a proponent of let's check for this in the hospital and release it.

Because I don't think there's been a chance yet. I don't think that baby's had an opportunity to learn to nurse. Mom's milk comes in. I mean, you know, and, and this is one of the things we started talking about mom's experience, but we also have to say physically what's going on for, for the parent. Right.

And I use the word mom. I'm sorry. I try really hard to, to incorporate the right terms. I am trying, but. If there has been a difficult birth, if the milk is not in yet, or if the milk is in and her nipples are bleeding. I mean, you know, there's old things going on. Yeah, I've been there too. If she lost a lot of blood.

If she had a, was in labor for an induction for three days and then had a C section, I mean, like, let's let her recover. Let's see where her mental status is. Let's see where her emotional status is before we say, Guess what? Your baby needs surgery. Like, blow my mind. Are you kidding? Like, what do you mean my baby needs surgery?

Right? You 

Maureen: know, we see these babies. They've, they've been in a very flexed, upside down position for months. They're all going to come out kind of tight in front, and most of the time when we observe them over the first few days postpartum, we see their chins come forward, their necks release upward, their tongues come forward.

And it improves to a degree, you know, and I feel like we need to give babies that chance to have some physiologically normal stretching before we 

Lisa Paladino: decide what to cut. Absolutely. And let them stretch. Like 

Maureen: I'm not a fan of 

Lisa Paladino: swaddling and containers like let them be, let them open up and 

Maureen: see what happened on your chest.

Lisa Paladino: So there's, there's that. And I mean, what I will say is There have been one or two baby. I would say maybe one or two a year that I say no, let's just do this We may have to redo it. We may have to do a lot of therapy after but this baby is just so tight You know, you know those babies that we used to say Oh, she has to grow into her mother's nipple.

Like, you know, like you would say the baby's mouth is too small and the mom's got big nipples and that's why the baby can't nurse. No, the baby can't open their mouth. So sometimes there's a little bit of, you know, and sometimes it's the lip that's more restrictive than the tongue. That I'll say to the parents, here's an option.

We can do this now. Can't promise you. I never promise any, anything, but I can't even promise that this is going to be it for you. As she stretches and opens, you may need another procedure because she's still all curled up. I use, you know, it's not a technical term, but. And parents understand that. And sometimes that is all the difference.

You know, sometimes it just needs a little bit more opening up to allow that parent to get that baby latched, to get the baby to help bring the milk in. Right? So, so it's very individual, you know, it's, it's, case by case basis, but I, I think as I'm growing older and wiser, I, I am more cautious with my recommendations for immediate procedure.

That's a long winded question. I don't remember where we started, but 

Heather: I love it. Well, so versions of releases scissors or laser? Cause I get this one from parents all the time. And I think I know what you're going to say, but let's hear it. 

Maureen: Okay. 

Lisa Paladino: So it depends on the provider. So if you're going to a provider who is very, very, very used to using a scissor and they don't know how to use a laser or they have a laser, but they've never used it.

But in general, and I like particularly the CO2 laser. I've seen different, for lack of a better word, scars from different types of lasers, but even that it's more about the person operating the tool than the tool itself. Because there's a dentist that I know that the first time I went and saw his release, I was like, yeah, I don't like, maybe you're not reusing the right settings.

I didn't like something about, you know, not to get into detail, but it was a little bit more

So, again, here we go with multidisciplinary learning, right? Who would have thought, years ago, that I would walk into a dentist's office and tell them how to use their tools, right? But that's how we learn because he doesn't know what the baby needs to do with their tongue. He doesn't know what I'm looking for as a result for, for movement.

So it's a functional exam. Functional care is really important. 

Heather: That's awesome. And you know, because we see a lot of the downstream babies who have had these releases, and so I, I could tell you right now if a baby walked in from this one particular provider who uses scissors in West Virginia, I know who did it.

I'm like, I know that brand of release and I'm sorry, and we're going to probably have to redo that. 

Maureen: So, I mean, the 

Lisa Paladino: benefits of the laser is it's a more complete release. They can go deeper without causing collateral damage and let almost no bleeding. Like every once in a while, there's a drop of blood, but there's almost no bleeding.

There's almost no irritation around the actual wound because the laser seals everything up as it goes. If it's, if the person is well trained, you know, and a scissor is a little haphazard or, and you can't go deep. You can't go deeper because you don't want to get too close to blood vessels and, and nerves and all the important stuff.

You 

Maureen: know, What it comes down to where I am, too, is just what, what actually exists here, because there are more providers near me that will do a revision with scissors, and there's just less that actually have access to the technology to use a laser, you know? Not that they all do it equally, I certainly wouldn't refer to everybody, but yeah, it's, it's really, you know, and especially in this country where we do have so many areas that lack in resources, it definitely does have to just come down to provider competency rather than their specific 

Lisa Paladino: tools that they're using.

Right. Absolutely. And also, do you know, as midwives, you could be doing 

Maureen: it. Oh, yeah, yeah, there's a great midwife in the southern part of our state who will travel and do them, which is fantastic because it's really the only way pretty much anybody in the southern half of the state gets them done. 

Lisa Paladino: Yeah, yeah.

I mean, I've been asked, of course, the laser company wants to sell me a laser, you know, because I, it's in my scope. I could do it. 

Maureen: Sure. But 

Lisa Paladino: I just feel like because of things like the controversies that come out, I don't want to be the one assessing for it, diagnosing it, and doing it. I want another set of eyes.

It is really 

Maureen: nice to have two different people assessing before we do a surgery. A small surgery, but a surgery. Right. 

Heather: Right, yeah. For sure. I like having that support, and I think some midwives, you know, Or nurse practitioners, advanced practice nurses kind of get some flack about, you know, wanting to do everything ourselves.

And I couldn't disagree more. Midwives and other APRNs that I know love that we have physicians available to us. We don't actually want to 

Maureen: do everything ourselves. No. We just have to sometimes. Right. But how 

Lisa Paladino: great is it that if the need is there, you can fill it, right? It is. Yeah, that's why advanced practice RNs are becoming so popular because there's not enough medical professionals to do the thing, right?

It's 

Maureen: a, it was actually part of my initial training and I haven't done one since. And I've really thought maybe I should, maybe I should get trained to get into it because there's just nobody near me that does it. So, I guess I'll have to eventually. Yeah, I 

Lisa Paladino: mean, and then you get, like around here, the people who use scissors mostly are ENTs, not dentists, and they don't quote unquote believe in lip tie.

Yep. Which I didn't, you know, it's a weird religion and, you know, so. It is, it's interesting. 

Maureen: Yeah, so there, 

Lisa Paladino: there's that part of it, or I'll see, you know, on social, I, I run a very big local social group, media group about tongue, about breastfeeding, and I get things all the time, like. I had the baby's tongue tie clipped and it didn't do anything, you know?

So, and then people start saying, well, who'd you go to? And of course it's, you know, Dr. So and so that we know, you 

Heather: know, well, As we wrap this up, I just want to give a quick nod to ICAP, the International Consortium of Oral Ankylophenyla Professionals, and your involvement there. So can you tell us what your involvement is and why you're a member, because we have a lot of lactation professionals that listen to this podcast, or people that are interested in becoming lactation professionals.

So What's going on with ICAP? 

Lisa Paladino: Oh, ICAP is amazing. So it's an interdisciplinary organization surrounded by, surrounded by, why can't I talk all of a sudden, but time's up now. The rounds that are on the topic of tongue tie or tethered oral tissues or ankyloglossia, which is the fancy word for tongue tie.

And what I love about ICAP is that when you walk into the conference, You're all equal. There's not like doctor is more important than doula. Everybody's on the team. Doctors, midwives, SLPs, body workers, everybody's on the team. Everybody gets, you know, you can speak. I'm speaking at ICAP in Cleveland. I'm really excited about it.

It's a place to network with people from all over the world who are experiencing similar things as you. Like the same way we're enjoying talking to each other because we've had similar experiences. Now you have people from all over the world who are different levels and different experiences And different years of experience.

So coming together and talking and relating and just being in the same room is just amazing. And now ICAP has study groups almost every Sunday if you're a member. You can dial into their zoom call and different topics are, are handled. So it's, that's great too. We have a Facebook group where there's a lot of interaction and it's just fun.

It's the most fun conference I've ever been to. I mean, I've been to a lot of like the midwife conferences, the lactation, but they were all like, everybody's learning in silos. Everybody's a little stuffy. This is. Fantastic. Plus they're doing research. There's a whole research committee. Awesome. You coming to Cleveland?

Maureen: Yeah, 

Heather: I'll come. 

Maureen: Absolutely. Yeah. 

Lisa Paladino: It's, it's in May in Cleveland. What are you, LeBron 

Heather: James? So I was like, come to Cleveland. I don't 

Maureen: even know. I 

Heather: will put that in the show notes. So if anybody is more interested in learning about ICAP or joining, you can find that in our show notes. But Lisa, as we wrap things up, I just can't thank you enough for this interview.

And it has been such a pleasure to meet you virtually, and I hope I can come see you in person in Cleveland. And do you have any final words of wisdom before we let you go to impart on our incredible listeners? 

Lisa Paladino: Well, first of all, thank you for having me because I've had so much fun. I've had a ball. This was great.

We could talk, I think, probably about six more hours and not run out of things to talk about. But I, I always like to give this message. I think it, it applies to the professionals that listen, but mostly to parents. Always follow your instincts. If you feel like something is not right, believe those instincts.

More than you believe Google, more than you believe your doctor, more than you even believe me. I tell this to my patients, if I'm saying something that doesn't feel right to you, please don't do it. You know, you have to follow your own instincts. And I think that we have lost that ability or we've lost the nurturing.

Of mother instincts in our society. And I think that that's the message that I want everybody to think about. Like take a moment and say, how does this feel for me? Does it feel right for my baby? Cause really only, you know, what the right thing is for you and for your own baby. Oh, 

Heather: that's so true and good.

And I think a lot of times it's just been conditioned out of us. And postpartum is a beautiful time to relearn it. And it's nice that people have you to guide the way. And I'm going to start using that if you don't mind in my consults. All right. Well, Lisa, thanks again. And let's take another minute to thank a sponsor before we get into our favorite segment, our award in the alcove.

If you're pumping milk away from your baby at all, at work, or wherever you go, you deserve a Bougie product to make that easier for you. You deserve a 

Maureen: series chiller, and frankly, I could not live without one 

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It is the only thing I 

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Heather: manufacturing. Series Chill also has other products that you might want to check out too. My personal favorite is the Milk Stash.

They have a great nipple shield that 

Maureen: actually changes colors, and it's not clear like all the other ones. And you know how we feel about that. If you want to have your very own series chiller, please go to the link in our show notes and use code MilkMinute15 at 

Heather: checkout. That's MilkMinute15 for 15 percent off your series chill products.

Enjoy.

Maureen: You know, it's always so great to talk to someone that just sounds like all of my aunts. 

Heather: I know. I absolutely love talking to New Yorkers because I don't know what it is. I just feel like I could talk to them forever. 

Maureen: Forever. I mean, it was just our, our, you know, it was how we were raised. It's how I'm pretty sad of New York kids.

And I don't sound like that anymore, but I did. Yeah. 

Heather: We all just interrupt each other. Like with the only way we stopped talking is if we interrupt each other. I love it. 

Maureen: It doesn't bother me. It bothers my husband who was not raised in New York. And he's like, it's one of your big flaws. I'm like, you don't even know the half of it.

Heather: You don't know how much I was trying not to interrupt you. I love that Lisa is such a gift to this community. And I kind of want to be a fangirl now, and I'm going to go to Cleveland and hold up a sign in the front row. Yeah. So I, I don't think there's any more to say about it. Cause we said so much and.

We're going to have all of that extra stuff for you in the show notes if you want to learn more, but let's go ahead and give an award in the alcove. 

Maureen: All right. This week's award goes to Ashley. Ashley says she has breastfed her baby for 16 months who was non latching for the first six weeks of their life.

Oh my goodness. And now they are going strong and it's going great for the both of them. Yes, 

Heather: Ashley good to hear from you, buddy. And Ashley is going to get the Negotiating Ninja Award because you negotiated that no right into a yes with latching, and we couldn't be more proud of your tenacity. 

Maureen: Yes, we are super proud of you.

Congratulations on all of your hard work and having that come out in a super successful breastfeeding relationship. All right, and then to wrap up, I'm gonna read a quick little Apple 

Lisa Paladino: review. It's a cute one. This 

Maureen: is from Andymb2 and it's titled, I'm a physician mom and I love this podcast, which like, warms our little hearts.

This podcast is phenomenal. The co-hosts are smart and funny. I love their banter. It feels like Heather and Maureen are my good friends. This podcast is evidence based and I learn so much. They clearly do their homework and stay up to date. This podcast has increased my confidence in breastfeeding and I feel so grateful.

Thank you. 

Heather: I love that one. 

Maureen: Yay! 

Lisa Paladino: Yeah. 

Maureen: We love them. Please leave us reviews. If you haven't, we read all of them. We love all of them. Even if they're not good reviews, I still love reading them. They're all good. I'm nosy and I just need to know what you think. 

Heather: Yeah, me too. Please just fill in that, that void of confidence that we have.

And, you know, keep in mind right after this, I have to go to a tax meeting with my accountant. So that review is going to keep me going for the rest of the day, no matter what I have going on. Ha 

Maureen: ha ha. And everybody, if you want to find out more about our guest today you can go to her website at www.

tonguetiexperts. net or lisapaladino.net and we're going to link all of her stuff in the show notes so you can find out more, maybe she can help you out, maybe you can help yourself out with better education on tongue ties. And 

Heather: don't forget, Staten Island is one of the boroughs. Staten 

Maureen: Island is in New York City.

The end. 

Heather: Goodbye. Bye. See ya.