I know that there has been great discussion recently on tongue-tie but I did 
not find any recent information on labial frenulum.  I have a client who 
appeared to have a beatiful latch (stated that it was comfortable, no trauma 
or reported tenderness) up to the end of the first week.  I saw her in the 
hospital on the day of discharge, saw her for engorgement on day 5, all 
with "easy fixes"  Seen on day 15 for nipple trauma after baby vomited blood.  
Significant trauma at base of nipple where upper lip meets.  Initially believed it 
to be continued engorgement and shallower latch until I noticed that the baby 
left a significant dent in mom's breast at the upper lip line.  On assessment, I 
noticed a thick labial frenulum.  Mom states her sisters daughter had both 
labial and lingual frenulum, some minor impact on breastfeeding, chose not to 
clip, now at age 4 child having speech and eating issues.  
Mom reluctant to take baby off breast entirely as baby doing well, nursed only 
on non-traumatized nipple.  Tried nipple shield for protection through night 
until eval by pedi and ent next day.  By morning, same damage to that nipple. 
Mom in tears.  Ent states, "yes she does have a labial frenulum but they do 
not clip those, don't know of anyone who will"  Pedi says "yes, but not that 
significant"  I and mom have stressed that it is SIGNIFICANTLY impacting 
breastfeeding! 
Right now, mom is pumping and feeding via bottle and is finally not crying.  
She has an appointement Monday with a plastic surgeon/dental surgeon for a 
2nd opinion.  The baby cannot go to the breast as things stand.  Even drinking 
from a bottle, her lip is tight and turns white.
My question, now, is: What else should I be doing? Where else can mom go? 
We live in Eastern CT, a trip to New York is not out of the question but is a 
long trip.  I have never seen (or noticed) a labial frenulum before but this 
appears to be pretty significant. I found a link from a presentation by Dr. 
Palmer 
http://www.brianpalmerdds.com/pdf/Bfing_Frenum03.pdf
and it looks just like the picture.

I would love any input or advice that I could pass on to the mother.
Thank you,
Andrea
Eastern CT, US

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