Dear Lactnet friends,
     My heart is breaking.  Can any of you offer advice on this problem?
I have posted before about the lactation support program started at my
hospital in August of 97, a ten year dream of mine come true!!  Four of
us pp nurses worked together with full support from two supervisory
levels, we found an $8000 grant for furniture, books, equipment, for
starting and the hospital is paying us from the OB budget.  The four of
us have some pretty strong personalities and I have been humbled several
times and learned others often have some pretty good ideas!  We went
through forming, storming, conforming, and norming stages (wonderful info
on groups from my sister the college student), and it seems we are
storming again.  The problem is that I have been the only LC identifying
babies with short frenulae, the others don't want to "alienate the
doctors".  It doesn't help that a few years ago when I was a staff nurse
I had a mild disagreement/ argument with one of the pediatricians who
said a baby had breastmilk jaundice, he stopped short of removing the
baby from the breast (whew!) but I couldn't let it go when he was blaming
the breastmilk for causing the jaundice on the second day of life.  One
of my team LCs has reminded me a couple of times that the Dr. still
hasn't forgotten that episode.  After attending Dr. Brian Palmer's
presentation in Scottsdale last June I learned more about the case for
clipping borderline short frenulae, not just the obvious cases.  I bought
two videos of him speaking, and his article in the JUne JHL has been
sitting on our office desk for months... still unread by my colleagues!
And one of them informed me today that even if she does view/read the
info she won't change her mind.
Also I arranged for a Peds Grand Rounds on the topic the end of Oct that
was well attended and went very well,  a sweet FP doc prepared and spoke
for it, an older doc had taught her how to clip frenulae as a resident,
just in case she would ever need to do it.  Also our medical director, a
Peds, is very open to the idea and wants to learn the procedure, I showed
the tape from Dr. Jane for part of the grand rounds.  So that brings us
to today, when one of my fellow LCs again reminded me not to alienate any
of the Dr.s and I mustn't use the word clip to any of our Moms, that
involves diagnosing and only the MD can do that.  My answer is what about
making an assessment?  I always try to be polite and mannerly to all
fellow workers no matter their title, many of our docs are unfamiliar
with tongue tie.  During the first year of our program I have identified
9 babies who were possible candidates for frenotomy, 2 were done who were
lucky enough to be on the FP service, 2 were helped with nipple shields,
one   held the baby as closely as possible, and 4 Moms on the Peds
service opted to bottle feed when the doc told them "they don't clip that
anymore."  Identifying 9 babies out of about 1000 is a very close
percentage to many other studies on incidence.  But I feel a little
crazy...why am I the only LC identifying this???
     Anybody have advice/wise words for this predicament??  Please email
to Lactnet and also privately...my Juno email has been sending me only
half of my email lately.
Any counsel will be greatly appreciated.  One other thing, my basic
philosophy about being a nurse/LC is being a patient advocate (not
pleasing all the Dr.s)
     Thanks to all.
     Susan Potts, RN IBCLC