I think if a "search" is done on past lactnets, you would get some of the
information I shared previously, but I'd like to provide some of the
follow-up on my previous experience:

1. The recent idea of not doing frenotomy is based on Speech Therapists'
research that children could learn to speak "just fine" without the surgery

        In Puerto Rico, I imitated how a baby would speak in English and in
Spanish with a tight frenulum, and explained to parents that the studies
done by Speech Therapists who are teaching English and those studies done
by people who speak other languages (spanish, in our case) would have very
different results.  As most of us want our children to be at least
bilingual, the need for a "free" tongue is not just for breastfeeding, but
for life.

2.I also compared the surgery to the circumcision or the ear piercing which
is part of our culture, and explained that the frenotomy was less invasive
or painful than either of these.

3 I referred them to an oral surgeon who gained a great deal of experience
with all my referrals, so that we made a great "team" - even though we
never met.

4.If their pediatricans were part of the group that did not believe in
frenotomies, I would explain this very clearly up front to the parents so
they would be aware there was a difference of opinion, and I let them know
they could get  a second opinion from their pediatrician, another
pediatrician or the oral surgeon...     (These pediatricians refused to
send me patients for over 2 years - but by the last year I was there, they
were referring patients to me, even though they still disagreed about the
frenotomies.)

CAUTION - I have seen babies with tight frenulums who breastfed without
problems (perhaps mom's breasts were "made" to fit their babies better, or
her milk supply was really great), and I have seen tongues which did not
appear all that "tight" - but with moms having the typical line across the
nipple and low milk supply, I have sent them to the oral surgeon, he has
done frenotomies and their problems have been solved.  So in the hospital,
I always tried correct positioning and careful latch on monitoring first to
see if things could be solved without medical interventions.  However, we
started pumping and finger-feeding early if things were not solved by
discharge (48 hours) and a quick referral to the surgeon before mom's
nipples were so terribly damaged that she would be unable to breastfeed for
days...

My first case in Puerto Rico was of a third-time mom whose twins were both
tongue-tied and her nipples were terribly damaged.  When I explained the
problem, she and her husband were very interested in having the surgery
immediately - as their 3 year old had also had a tight frenulum,
breastfeeding him had always been painful (but more tolerable as he was
only one and she could alternate sides), and he had just had a frenotomy
due to problems with speech...  It was they who told me of the oral surgeon
I began using for all the babies...

Good luck - it can be sticky, but I felt that as I was evaluating and using
my expertise at the request of the parents, it was up to me to give them my
professional opinion.  I always explained that I was not 
"diagnosing" - that was up to the doctors - I was recommending a course of
action, and it was up to them to decide whether or not to follow it.  (As
it always is, whether for frenotomies, pumping, "scheduling" or anything
else...)

Jeanette Panchula, BA-SW, RN, IBCLC, LLLL
Vacaville, CA
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