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Subject:
From:
Linda Pohl <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 3 Dec 1998 15:32:37 -0700
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I have been unable to access the archives for the last 24 hours.  Keep
getting the message the it "cannot open the site" so I am asking you for
help.

Situation:

Baby boy born 11/21/98.  C-section for breech at 38 weeks but mom went into
labor on her own.  Nipples sore in the hospital before discharge.  Saw
hospital LC who talked with mom but was unable to observe feeding because
she is terribly overworked and understaffed.  Baby discharged 11/24 or 25.
Milk came in on 11/26.  Nipples were so sore mom stopped breastfeeding on
11/26, obtained hospital grade double pump on 11/27 and began pumping.  Mom
pumps 15 - 25 cc milk.  Baby takes about 40cc EBM and formula by finger
feeding.  I saw Mom & baby 12/1.  Mom's nipples were still raw on tips in
spite of baby being off breast for 6 days.  Baby has never been seen to
stick his tongue out of his mouth.  With positioning and encouragement, baby
can extend tongue just beyond gums but after 6 - 10 sucks, he seems to
fatigue and the tongue goes back behind gums and mom's nipples are sore
again.  He cannot stay on long enough to both get milk flowing and swallow
enough to grow well before mom has to take him off.  Baby has a thin
frenulum that does not come clear to the tip of the tongue but it is VERY
close and very short.  I called Pediatrician's office to as them to see baby
to evaluate situation.  An appointment was made for the next day.

About an hour before the scheduled appointment, the doctor called and
informed me that He does not clip frenulums.  It is not supported in the
literature.  Well I told him it was in the peer reviewed lactation
literature, just not in the pediatric literature.  I also told him of other
doctors in the community who did clip tongues when needed and that I would
be happy to give him some of their names if he would like to consult his
peers about this.  He replied that only the older doctors do that and he
does not.  I explained again what I saw (he already had a written consult
report Faxed the prior day.)  Then I asked him what we were going to tell
this mom about her sore nipples and breastfeeding since the baby was unable
to cup his tongue under and extract milk.  He didn't answer, he just mumbled
something about willing to be educated and if I would send peer reviewed
literature he would look at it.

About an hour after the appointment with the parents, the doctor called me
back and asked me if I intended to do follow up with the parents.  I told
him that I followed up as long as the parents needed help.  He said the
parents were now "too tired and too stressed" to breastfeed.  Furthermore,
"The baby would be better off on formula with less stress in the house than
working this hard to breastfeed.  I know breastmilk is better, but we can
deal with the allergies later.  This baby needs his parents to not be so
stressed."  At this point he told me that when I saw the parents again I was
to inform them bottle feeding formula is just fine for their baby and they
should just enjoy being parents.

Fortunately all of the curse words that ran through my mind did not find
their way out of my mouth!  I told him that my professional ethics and the
AAP policy from December of 1997 would not allow me to do such a thing.  My
job was to support the parents decisions and to give them ACCURATE
information so that they could make informed decisions.  Unless the parents
told me they were ready to wean, it was not my job to tell them they should.
If they had a baby so allergic that the baby needed donor milk eventually, I
did not want to be responsible for feeding this baby $2.50 per ounce donor
milk!  Oh, and he did not clip the tongue.

Anyway, I am doing the research now and want to SNOW this guy with peer
reviewed literature.  I have the JHL on tongue tie from 1990.  What else
that is peer reviewed do you know about?  I offered to show him the Evelyn
Jain, MD, video but since that was not peer reviewed literature, he was not
interested.  Is Allison's assessment tool in a peer reviewed journal?  What
else is there that I can send him?  I did try to access the archives but am
unable to do so at this time.

I am hoping we can turn him into a "Breast milk is best but, formula is just
as good" type into one of those "breastfeeding fanatics."  Well, at least I
can hope he will refer to us in the future.

Thanks in advance for your help and thanks NOW for listening to the rant
that went along with it.

Linda Pohl, IBCLC
Phoenix AZ

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