Susan, I totally and completely agree with you. I just think that what is tricky is that there is such a lack of studies that have been done on breastfeeding interventions. So while we wait for the research to be done, how do we handle ourselves and that is very very tricky. And that is why a list serve like this is so important. So that we can compare notes, in the absence of the studies, which hopefully will be following. And every time I recommend a clipping of a posterior tongue tie, I have ringing in my ears, the expression "first do no harm." I think that it is always possible that an intervention may cause an unintended outcome and I always think of the reports I have heard on Lactnet where a baby stopped nursing after a release. We carry around a huge responsibility because we are making recommendations that have enormous consequences and we need to be aware of that. I really am not disagreeing with you at all. I do want to make evidence based recommendations, but in the absence of careful studies, how do we make those recommendations????

Suppose the only doctor in your area who does tongue clippings is not very good at it? How does that change your recommendation to do the procedure. Even if there are good studies you might make a different recommendation vs. somebody who has access to a really skilled surgeon. Suppose the rock star of tongue clipping practices is your town??? Suppose you have seen a baby who refused to nurse following a release, or a hemmorhage or an infection. How does that impact your thinking v. somebody who has not had a bad outcome. In the absence of studies, how you process your personal experiences must inform your advice. And Lactnet serves as a wonderful sounding board for those impressions that we are forming. 

Again, I totally and completely agree with you about studies....it's just that they might be a long time coming!!!!

Kathy Lilleskov

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