How can I best counsel this mom when the two local ped surgeons can't visualize a lingual frenulum, so don't do anything?  Baby's labial frenum was successfully clipped, though.  We are in Los Angeles area.  Any help or insight greatly appreciated.

Permission to post:

Hx: Baby 7 weeks old, born by emergency cesarean; cord wrapped around neck twice. Mom had a great, easygoing labor, dilated to 5 cm prior to arriving at hospital, where labor slowed, she was monitored, fetal heart rate scare, made to lie down, etc.
Saw hospital LC's and "everything looked great." 

As soon as mom and babe home on day 5, baby "screamed at breast," and either latched briefly and fell asleep, or was frustrated, arched back, refused.

Hospital Breastfeeding Center LC's gave her an SNS. Mom has been pumping, and is not happy with the SNS's cumbersomeness, and her nipples are somewhat sore.
She calls me at 6 weeks not wanting to quit, but not wanting to continue with this kind of stress for baby at breast.

Baby's tongue lifts to midline plane with mouth wide open; no visible lingual frenulum; possibly a slight speed bump, a webbed look under the tongue. Tongue is completely horizontal, only tipping up at the anterior tip. Baby's sucking is choppy; mother reports that it feels like biting, clamping.

I repositioned mom and baby in a biological nurturing, laid-back position, which she found very comfortable and had never tried before. She reports baby does best at night, lying-down to nurse.

Tight labial frenum clipped yesterday per my referral to ped surgeon, Dr. #1, to whom I over the past year have supplied numerous TT articles, and even copies of Supporting Sucking Skills, ch's 8 & 9.

Mom reports baby did well with the labial frenotomy:

"He acted like nothing ever happened immediately after surgery. I already noticed that he can open his mouth wider. Dr.#2 (another, ped plastic surgeon and DDS) examined him prior to the procedure and couldn't find anything under his tongue," 

(I don't know whether he used a grooved obturator) 

"but did confirm that his tongue does not function normally, but that he has a strong suck. Dr.#2 said to give it some time to allow him to further develop his skills of using his tongue". 

(what is that supposed to mean??)

"Dr.#1 (the ped I refer to) examined his tongue again in great detail when he was under" 

(they used general--ugh)

"and they could not diagnose a tongue tie, yet the symptoms definitely indicate such. Dr. 2 said that his upper lip was very tight. He immediately nursed after the surgery. The latch is much better, but we still need to work on the breastfeeding. I breastfeed him for a few hours on and off today and he wasn't able to empty my breasts, but i don't get as sore anymore."

Mom is very motivated, has an appointment with a CST, and has started with the post surgery exercises. She says with test weights baby is only getting 1/2 to 1 oz per feed at breast today. 

I am encouraging her to use special needs feeder first, breast, then pump; warned that it may take at least 2-4 weeks, probably more as he is older to transition back to breast completely. 

My question is whether it is worth it to go 2 hours away to Poway or San Diego for another opinion? Anyone here have experience with the Surgeons on lowmilksupply.org? Otherwise what would be the best way to help her on my follow up visit with her?

Thank you so much!

Sincerely,
Nadja Catano, M.A., IBCLC, RLC 
mom of 8, LLLL 

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