>An LC or nurse should have a list of people in the area who will do
>frenulotomies to whom pts. can be referred. (Dream on - as if there were
>huge numbers of them in most places....!) That's what we do with other
>resources, right?
>
>Cathy Bargar RN IBCLC Ithaca NY

Here's the way I "found" my MD who clips frenula for my clients.

The baby obviously needed to have the frenotomy done in order to continue
breastfeeding. The ped disagreed but did agree to have a consult with an
ENT physician.  The mom went to the ENT and he said that he didn't see it
as enough of a problem to put the baby through "general anesthesia" for the
procedure.

I sent him the material from the JHL on the subject.  He read it (!) and
called the mom with an agreement to do the "simple" frenotomy, which he had
never done before.  (He had thought she was asking for a frenulectomy.)

Her nipple-pain relief was immediate and she wept as she thanked him.  "He
has never fed this well!" I sent a follow-up report to him telling about
the improvement in feeding and growth of the baby--and thanking him for
assisting this mom and baby.

That was 5 years ago and this doctor has clipped numerous babies' frenula
since then.  Sometimes he tells the mom that her baby's frenulum doesn't
look overly tight, but that other babies have improved in their ability to
suckle well after the procedure. He advises her to be ready to feed the
baby and that there will be little or no bleeding.

I've seen him do the procedure several times, because the mom is often
scared and asks me to go with her. He has a pleasant, calm demeanor.

In these 5 years, every baby whose frenulum was clipped has gone on to feed
well (and thrive) without trauma to mom's nipples. Depending on the age of
the baby, sometimes the resolution isn't instant, and there needs to be
some suck training--the older the baby, the more set is the suck pattern.

I am now encountering a few peds who will clip the frenulum and I have one
OB who will do it as a second opinion consult.  I would like to see more
OBs trained to do it so that the procedure could be done early.

Sadly, many peds still refuse to approve the procedure and the mothers wean
the babies to abm (or pump for a while) either because of the pain or
because of poor weight gain. These parents don't have the courage to get a
second opinion and will agree to the procedure only if their ped agrees.

But, to end on a happier note, I am thrilled to have this ENT on my team.

Pat Gima, IBCLC
Milwaukee, Wisconsin

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