HICCUPS IN THE WOMB – What they might be telling you about your baby (In utero) recently revised with links near bottom of article
Definition of hiccup/hiccough from New Oxford American Dictionary:
Noun; An involuntary spasm of the diaphragm and respiratory organs, with a sudden closure of the glottis and a characteristic sound like that of a cough.
(hiccups) an attack of hiccups occurring repeatedly for some time
Obviously in the womb, hiccups of the developing baby are felt by the mother, and not heard. They are characterized by rhythmic, repetitive movements that typically begin to be felt around 20 weeks gestation, but some women begin to feel them as early as 15 weeks gestational age.
Hiccups in the womb have fascinated me since I began experiencing them in pregnancy myself, many years ago. I wanted to gain insight to be able to help breastfeeding parents in particular, first as their lactation supporter and later in my professional career as a skilled lactation care provider and educator (IBCLC and CLE). I was also seeing other tendencies that were consistently correlating for these babies with in-utero hiccups. Families were commenting additionally about their baby’s hands always up and covering their face making it difficult or impossible to see their face in ultrasound images. Interestingly these babies often sucked their fingers, thumbs and hands. Once born, these tendencies continued and were considered by the parents as babies that demonstrated a high need to suck, whether with frequent pacifier use, more frequent suckling at breast or frequent bottle feeds. I was also noticing much difficulty with feeding in general, breast or bottle, but many babies did seem better able to manage bottles than breastfeeding. This incidentally, goes against typical mammalian behavior.
In 2008, I began documenting how these particular babies had something else in common. Oral restrictions and almost always tension throughout their body, right from birth. These were the babies that would roll over just days old. In fact my baby rolled over at just 10 days old, from back to tummy, off of the bed during a diaper change, tearing off her umbilical cord. Thankfully I was able to catch her, keeping her from falling onto the floor. This was clearly before changing tables/belts.
At the time when I first wrote about hiccups in the womb and began presenting on this at tongue tie and airway conferences like ICAP (International Consortium of Ankylorrenula Professionals), I had only ever had one encounter with someone else aware of womb hiccups. They also agreed they might be related to tongue tie somehow. That insightful and well-known dentist was Dr. Martin Kaplan, DMD. I first met Dr. Kaplan at a conference in Palm Springs. He, along with physicist Peter Vitruk had presented on tongue tie release (frenectomy) and more specifically the comparison of different lasers available at that time for use in this procedure. They proclaimed the vast differences in outcomes in patient successes. I remember being blown away by what I learned in that presentation and couldn’t wait to share with both my colleagues and patients in my private practice. For me, it was life changing. A few months later, the first CO2 LightScalpel laser arrived in Phoenix forever changing our landscape. About a month later, colleagues and I attended CO2 laser training by Dr. Kaplan at Tufts University in Boston, MA. At another event we chatted about hiccups in the womb. Again, I was blown away since I had never heard anyone comment on them whatsoever. I happily shared my anecdotal information that I’d been gathering from families over the years and how I felt it would be a very important aspect for tongue tied babies one day and of course, Dr. Kaplan agreed.
Tongue tie is extremely controversial and complicated, even though everyone agrees releasing tongue restriction is far less invasive than circumcision, which is routinely done on infant boys. The release procedure can be an emotional ride for even the most seasoned parents. There is never any guarantee that releasing a tie or multiple restrictions within the mouth that may also be present, will improve breastfeeding and/or other issues a baby or child is struggling with, including hiccups. Hiccups and gassiness are named common symptoms relating to tongue in current best practice symptoms lists used when evaluating tied babies. Parents are left hopeful but may wrestle with their decision to release, or may forgo a procedure and hope issues resolve on their own and hope that new symptoms don’t begin at some point in the future.
Current best practices, and more and more practitioners, also agree that this process must include muscle tension relaxation, commonly referred to as “bodywork”, be performed during the release process, much in the way any surgical procedure requires physical therapy in children and adults, for best outcomes. However, healthcare providers often disagree on when this bodywork needs to happen, some seeing best outcomes before release procedures and others seeing the need for bodywork post release for optimal outcomes. Sometimes the practitioners preference will be both prior release and continuing afterwards. This bodywork can be anywhere from days to several weeks and sometimes months after release procedures. In many situations a frenectomy may be postponed long after what frenectomy studies have demonstrated for years, that sooner after birth consistently yields better outcomes. When delayed, an often lengthy process for families ensues just to achieve the results they desire and realize their feeding goals. Oftentimes there are very similar outcomes in the end either way.
Another common symptom experienced by tongue tie babies is their struggle with tummy distress, commonly referred to as colic. Most knowledgeable healthcare providers agree that this symptom on the list of symptoms is quite common. Dr. Scott Siegel, MD, DDS in NY produced a paper in 2016 on his study of how oral restrictions often present in the way of “Aerophagia Induced Reflux, and not at all true reflux in the way we are used to seeing and treating it. More simply, the ingestion of air in infants both breast and bottle fed.
I’ve personally been involved in the study of breastfed babies where oral restrictions were released and then the baby was nursed immediately afterwards with noted improvement by the mother as well as vast differences measured mechanically with medical equipment. Catherine Watson Genna, author of several books including supporting sucking skills, and well known in the breastfeeding and tongue tie world for many years, has been studying infant breastfeeding with ultrasound imaging and presents on the vast improvements in infant feeding when nothing else was changed other than simple frenectomy. It would be hard to argue against released oral restriction and great improvement in tongue mobility and functionality, in both breast and bottle feeding, as the tongue’s ability to undulate and to reach the palate and make a complete seal while swallowing, becomes visually apparent, and thus reducing or eliminating the swallowing of air as it had happened before the frenectomy was performed.
My professional, patient and mothering experience perspectives on tongue tie release by top U.S. providers, is definitely unique and far from typical of lactation professionals. I’ve been able to feel and see the differences in procedures and bodywork for myself, my own children as teenagers and the babies I have worked with over the years. The outcomes for newborn babies are by far the best outcomes I see consistently.
What if we, both parents and healthcare professionals and practitioners, had insight into infant feeding struggles before babies are born? Perhaps we do. What if we treated hiccups as the most probable “root cause” of feeding struggle in the early days, thus avoiding the compounding of tongue tie symptoms and helping mother/baby dyads experience the normal course of breastfeeding and optimal development of babies?
Food for thought. If a baby is born with webbing between the fingers where apoptosis failed to occur in utero, would we ever treat the situation as wait to see how the baby adapts around restriction? Or would this scenario more likely play out with surgical intervention and division of the fingers allowing the baby to develop optimally?
Hiccups in the womb may be a valid symptom to add to our current best practices recognized tongue tie symptoms list, as that involuntary spasm of the diaphragm of the baby in utero just might be true indication of dysphagia as they swallow the amnionic fluid. What if these hiccups were connected to oral restriction and restraints?
Inspiration for “Hiccups” René Moore, mother, IBCLC and supporter of lactation for over 30 years, has been asking the families she’s supported, literally thousands of parents, one simple question; “Did (or does) their baby have hiccups in the womb?” Interestingly, nearly unanimously they have replied with a resounding, “YES! All the time.” Keeping in mind the mothers seen were only those struggling with breastfeeding their babies, it might be far from coincidental.
I ask you to join in this continuing study of in-utero dysphagia and subsequent hiccups to guide us towards early breastfeeding support and treatment for babies and their families and to share your own personal experiences from professional practice or parenting experience.
Hiccups in the womb – a valid symptom to add to our current best practices recognized tongue tie symptoms list.
Links for further information and research – Practitioners and families may find this helpful:
Catherine Watson Genna’s Fourth Edition Supporting Sucking Skills in Breastfeeding Infants Book
https://www.mdpi.com/2694-2526/50/2/11
https://fn.bmj.com/content/99/3/F189
https://www.theijcp.org/index.php/ijcp/article/view/246
Harvard on Hiccups
https://www.health.harvard.edu/blog/whats-up-with-hiccups-2017090512150
Example Tongue Tie Symptoms list:
American Breastfeeding Foundation is dedicated to providing access to education and lactation care to ALL vulnerable breastfeeding families. If you are struggling with breastfeeding or have questions, American Breast Feeding Foundation can help support breastfeeding goals.
René Moore is a registered IBCLC in private practice in Scottsdale, Arizona. Her interest and passion for breastfeeding began in 1996 upon becoming a mother. In 2000 she became a La Leche League Leader and lead Arizona for over a decade. Realizing the need for skilled lactation care in addition to volunteer support, she became an International Board Certified Lactation Consultant to be able to help more mothers, babies and families. She’s been performing in-home lactation consultation visits more than two decades and regularly attends procedures when requested by parents and welcomed by providers.
American Breast Feeding Foundation Copyright © 2020 – All Rights Reserved / May be used with permission: rene.moore@americanbreastfeedingfoundation.com