I keep trying to figure out why the resistance to clipping a frenulum when
circs are done so soon post-partum -- generally with no pain relief.  I heard
a PT at a conf. once caution against casual frenulum snipping because she had
concerns that cutting anything that anchored a muscle had consequences.  Is
this what the docs are worried about?  If so, what is there in the literature
which gives rise to this caution? Details please!

The interesting thing, to me anyway, is that many of the parents of
tongue-tied babies themselves were tongue-tied.  Most have been clipped at
some point.  My nephew (who had trouble breastfeeding) was NOT clipped as an
infant.  By age 5 he had speech problems and was clipped.  This seems to be
commonly reported.  Why is there not similar concern when the proceedure is
done for speech reasons?  How commonly IS this proceedure done for speech
reasons?  I am going to sniff around the speech path. community resources I
have and see if there is literature in their field which might elucidate any
of these issues.

I see a lot of babies with tongue-tie (probably 4 since Christmas).  Often,
if there is any range of motion of tongue (i.e. it stretches to bottom lip
line) creative positioning will assist things.  If the baby can be latched
with the chin cocked so it 'shovels' under the breast and really digs in, the
tongue and jaw closure can be located over lactiferous sinuses and off the
nipple.  This helps both pain and intake.  This position looks 'wrong' cause
the nose is so backed off the breast, but with mom holding the weight of
breast off baby's chin, it can work.  Then I suggest mimicing
sticking-out-the-tongue exercises, and coaxing tongue out with light touch to
the tongue-tip to elicit a thrust.  This helps increase range of motion --
esp. is the frenulum is of the thin and stretchy variety.  Sometimes these
things work well enough that clipping is delayed or prevented.  But who knows
if this is the best way to proceed.  I knew a woman once who was a teacher
who had a tight frenulum.  She complained sometimes that by the end of the
day her tongue was so sore from talking.  It took a lot of effort to make
that tethered muscle work.

So anyway, I'm still looking for a rationale for the current belief system on
cutting or not cutting the frenulum. The sad thing is that the way mother's
pain and her desire to breastfeed are so commonly dismissed in this
situation.
Barbara Wilson-Clay, BSE, IBCLC
priv. pract. Austin, Tx