What do tongue-tie and infant formula milk promotion have in common?

There are some striking parallels between the promotion of tongue-tie surgery and artificial infant formula milk. When I read Gabrielle Palmer’s books, The Politics of Breastfeeding and Why the Politics of Breastfeeding Matter these are the six that struck me.  

1. In the last century, it’s a sad fact that the more contact mothers have had with health workers the less they have breastfed. 

I hope they will continue to support breastfeeding mothers. But where are the data? Breastfeeding rates have not improved with the use of infant formula milk top-ups nor in line with higher rates of tongue-tie surgeries. A causal link between tie surgery and breastfeeding has not been established. Some lactation consultants believe their profession is losing its skills to help mothers breastfeed as a direct result of the increase in tongue-tie referrals.

2. It is often easier and more lucrative to work out a stopgap way of alleviating a problem than it is to discover why it occurred in the first place. 

The stopgap Palmer was referring to was artificial infant formula milk. Mothers are desperate for action, they want a quick fix for their sore nipples or their baby’s colicky symptoms, and (as one expert said) in the current environment, where everyone is worrying about ties, health professionals feel the need to respond pragmatically. In other words, they feel compelled to act. A scissors frenotomy is apparently a low risk procedure with limited short-term implications; no-one really knows if it will help—why not cut it and see?

3. Our reliance these days on technological solutions and how women in industrialised countries crave instructions as a direct measure of their lack of confidence. 

We Google everything, don’t we, for ‘how to do this or that’, ‘10 tips to become a brain surgeon’. Back in the 1950s, doctors persuaded mothers that artificial feeding with formula milk was ‘scientific’. The gobbledygook they talked it up with was impressive. Now we have ‘tie savvy’ lingo with every second word from the medical dictionary. Obfuscatory language is typical of pseudoscience. 

In Palmer’s books, I read, ‘Advertising makes us feel we need something that previously we didn’t need.’ ‘Effective distribution of promotion by a universal means of communication creates a market’.

4. How very often mistakes become sanctified because they are in print. 

As an editor, I’m aware of how things get picked up and repeated as truth. Google ‘tongue-tie’ and articles often start with the assertion that tongue-tie, which still has no accepted definition, is a congenital abnormality. Anatomical variations are sometimes simply that and normal differences are pathologised. 

Along with the drive to market artificial infant formula, breastfeeding failure became accepted as a common flaw in women’s bodies, and now tongue-tie is becoming accepted as a common problem in infants’ mouths. 

Where are mothers able to find consistent and impartial information? Palmer tells us that informed choice is the mantra of western society and is seen as a right, but are parents fully informed? I don’t think so.

5. The medical profession strives to be neutral, yet manages to ignore the integration of commercial interests with medical issues. 

Palmer describes how a thirst for profit systematically undermines a mother’s confidence in her ability to breastfeed and challenges our complacency.

I am not saying that the majority of health workers are not acting in good faith nor that it is wrong to make a living from treating patients. Nevertheless, there are grey areas, like the fact that treating more patients can cover the costs of expensive new equipment. 

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Here’s an interesting dilemma. In New Zealand, the largest private health care provider will refund a lactation consultant’s fee to its members when a tie surgery is performed, but not if the lactation consultant addresses a breastfeeding issue by using soft skills, offering guidance on how to improve positioning and attachment instead of recommending a surgical procedure—such breastfeeding advice is not recognised under the insurance policy terms. One can imagine, in some instances, that such a restriction could lead mothers to put pressure on a lactation consultant with regard to how to fix the problem, particularly when they are already being urged to go along the surgical route by the vast majority of social media tie support groups.

There has been a proliferation of opportunities for ‘education’ on ties: conferences, symposia, and ‘master’ classes, webinars at which advocates of these surgeries sell their promotion and encourage professionals to further their beliefs. 

Homeopathic remedies now exist specifically to help with the emotional and physical trauma involved in tongue-tie surgery, some of them come with an endorsement from lactation consultants. Laser dentists have teamed up with enthusiastic IBCLC referrers. One GP wryly suggested the idea of a new formula milk designed for babies with ties. And there is now a ‘magical Minbie teat’ being marketed at mothers with tongue-tied babies. 

Tell me again how there is no bandwagon.

6. The confusion between philanthropy and vested interest and how many are so caught up in the whirlwind of career progress and profit seeking that they seem unable to review the damage they do. 

And tongue-tie surgery can cause damage. To show how much they care for vulnerable new mothers, ‘generous’ donations are being publicly presented by providers of laser surgery, a percentage per procedure carried out, to perinatal mental health charities that support mothers with postnatal depression. The opportunities don’t stop there. For a small sum you can join a Facebook program, a mothers’ circle, for support on your tie ‘journey’. To some extent, presumably, this shows an awareness of the misery they foster. Promotion of tongue-tie surgery can be found all over social media, even using photos of cute babies together with assertions of how relaxed they are. I guess most infants do not not expect this invasive surgery before it is inflicted upon them! 

There does exist a genuine desire to see mothers and babies master breastfeeding. One paediatric dentist commented, ‘It is not so much kickbacks but the club of “feel good” when they [health professionals] believe they are saving mothers and babies from a life of hell.’

A growing number of health professionals now admits they dare not rock the boat over these speculative tongue-tie surgeries. On social media, if you are bold enough to question tie enthusiasts (practitioners or mothers), more often than not you get shouted down. Health professionals are told they are ‘not keeping up’ and are subjected to attack: a common tactic used by those selling snake oil. 

Science doesn’t care whether you believe it or not. The truth will always be true and any theory needs to stand up to scrutiny. 

In her book The Politics of Breastfeeding, Palmer notes that in spite of the lack of evidence that the ingredients in artificial infant formula milk are essential or even safe, no company has ever put a label on the tin that reads, ‘This product is as yet unproven to be completely safe, thank you for letting us use your baby as a guinea pig.’ She rightly judges experimentation on babies to be unethical.

Tongue-tie is a new chapter in the politics of breastfeeding. Time will reveal the results of these experiments.

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