Hi!
I hear your frustration. I was frustrated for three years trying to get our pediatricians to understand that this may not be a speech problem, but it is a BREASTFEEDING problem. Their rationale was soley that our Ped ENT's would not consider clipping. So, three years ago I started on the trail to get a plan in place for these moms. (By the way we deliver 5-6,000 births per year and have a 85% initiation rate.) I wrote a proposal that I gave to our Peds section reporting the literature that states 1. it is a problem with breastfeeding and 2.  the outcomes are good. There were a few who "got it" and a plan was put in place. The plan was to refer these babies to our pediatric ENT's for clipping. They talked to these docs and set up the plan. What ensued was worse than not having a plan. Every mom we referred the ENT would not clip. So since they were willing to refer, we set out to find an MD who would clip. Every time we had a referral we would find a MD who agreed to clip. Sometimes it would take a month before they could get a referral and sometimes they would not clip. So, if we had a mom who was persistent and a MD who would clip, we would get a clipping. I was very frustrated because many times we were setting moms up for failure.

After three years of this, I rewrote my "A Case for Frenotomy" with all the new literature. We got two female Hospitalists(our nursery pediatricians) who said that they would be willing to be trained. Now we have a pilot going where we are clipping in the nursery any baby with a short frenulum who has trouble latching and/ or whose mom has sore nipples. We are collecting outcome data on each clipping. We still have pedi's who are skeptical and those who are worried about people doing this procedure that are not "certified" and that there currently is not a "procedure" written, but it is a beginning. We even had a private MD whose baby had a very short frenulum. The mother has horrible sore nipples with two feedings! I called him and noone thought he would agree to the baby having it done, but he did and was very pleased with the results!

So my message is to hang in there and keep providing them with the literature that states that it is a problem and that the outcomes are good. Most of them have to admit that circucision is not needed, but it is done and is much more risky than a Frenotomy.
Carol L'Esperance, Albuquerque, NM

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