I fully understand Laurie's frustration.  When I worked in the
hospital, the attitude of docs ran the gamut from willing to clip
any that the LC thought would be a problem to being adamant that it
should never be done and never caused any problems!  Then there were
the ones that would agree to having it done, but insist that it
needed to be done by an ENT who usually insisted it be done as OP
surgery under anesthesia!!   When I would note one, I tended to
first check on who the doc was.  If it was one who was amenable to
clipping, then I would tell the mom that snipping it might help,
reassure her that it is a minor procedure-less invasive than a circ
and tell her I would let the doc know so he/she could determine
whether or not to clip.  The other confusion came when the one who
was most likely to clip is an OB while the baby at that point is
"under the jurisdiction" of the Ped.  When neither OB or Ped were
open to clipping, or when I wasn't sure of the doc's view, I would
mention to the mom that I did note a variation in the baby's tongue
(reassuring her it wasn't a birth defect, just a variation) and that
such a variation can lead to some breastfeeding challenges.  I would
point out that while it would be a simple procedure to clip the web
of tissue, there is a great deal of disagreement as to whether or
not it should be done.  Not only would I put my observation (being
careful not to "diagnose" it by name) in the chart, but I would also
ask the mom to point it out to her doc and ask if it should be
clipped.  If the doc would not clip it, I would definitely follow-up
with the mom after discharge,  If it was causing a problem, I would
then mention other options including going to the doc who does clip
them, not only for his patients, but for anyone needing one-often
without charge since the insurance could get sticky if they don't
have him on their "list".  Over the years I was there, I did see
some movement toward more docs being open to clipping.  Those FP
docs who did a residency with us usually went away very knowledgable
and having had the opportunity to observe and do them.  Even some
docs who started out totally opposed did come around and either
learn to do them themselves, or readily refer to someone who would.
A few ENTs did come to the point of doing them without anesthesia
and in the newborn nursery.

In my opinion, IBCLCs should have the authority to assess and
diagnose this condition, but we have to recognize that some docs are
very territorial so we have to "play the game" of describing without
naming and adjusting what we say to a mom based on the doc's
attitude.  I do feel we have the obligation to point out what we see
to a mom and let her know that it can sometimes give a challenge and
when it does, clipping is often a valid solution.

Winnie

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