When I began to consider the tight frenulum as a factor in breastfeeding
difficulty I ran into the common, uneducated "belief" that a tight frenulum
does not interfere with breastfeeding and it also causes no long-term
problems for the baby. "We don't do that any more," was the usual response.

The first mother whom I chose to work with in getting her baby's frenulum
clipped happened to be a woman who is blind.  I sent the Ped. the material
from JHL but she stood firm in her objection.  Her solution?  Feed formula
or, if Mom is insistent on breastmilk, pump and give it in a bottle.
(!!!!!!) It didn't stike my fancy to score points with this MD by
accomodating a possible delicate ego. I persisted in my assertion that this
mother's pain and her baby's frequent feedings were due to the inability of
baby to feed properly and that the baby needed a frenotomy.

Finally the Ped sent the mom to an ENT for an evaluation. The mom hired a
taxi on a cold winter's day and made her way downtown to the office
building. The ENT checked it and said that it didn't look like a problem to
him-- information which he relayed to the Ped.

I sent the ENT doc the JHL material and in two days he called the mom and
said that he would do the procedure--the simple frenotomy. (He READ the
material! So some MDs do educate themselves from wherever they can.) He
later said that he was grateful for my sending the material.

Mom was nervous, especially with all of the objections she had experienced,
and wanted me to go with her.  I did, and that was the first time I had
seen it done.  Sooooo simple.  As soon as he was finished, the doc told her
to nurse the baby, and her joy and glowing face were the pay-off for all of
our efforts. She exclaimed, "It doesn't hurt!"

From that time on this ENT is the one who will clip the frenulum of any
baby whose parents want it done.  If the Ped makes a referral we go that
route, if the Ped refuses, the parents make the appointment and go have it
done. The ENT has performed the procedure a few times when he didn't think
that it looked necessary, but ALWAYS the outcome is so positive that he
says that he doesn't even question anymore. And he loves those joyful faces
of the mothers or the grateful letters he gets from them.

I couldn't live with myself if I failed to clearly point out a problem like
this that is so easily resolved. If this frenotomy hadn't been done, this
mother would not have been able to continue to breastfeed.

There was another mother who called me when her baby was 3 months old.  She
had been pumping all along and wanted to know if I could help her baby to
learn to feed at the breast.  We set up a consult.  I walked in to their
home and baby awoke and began to cry.  She was severly tongue tied.  I
explained why she would not be able to feed properly at the breast.  The
parents knew of the problem, but the Ped said that it wouldn't affect her
feeding at the breast.  I asked, "What do you think?"  They had thought all
along that it was likely the problem. So they called the ENT and he clipped
it.  Since the baby was 3 months old and the tissue was tougher, there was
more discomfort than with a newborn, and baby seemed to have some soreness
for about 36 hours, but then she latched on and was a happy breastfed baby.

There was one baby whose frenulum was "probably" a problem, but it wasn't
as clear as the above. We had tried all of the other solutions.  I talked
to the Ped who said that he didn't agree that it could be a problem.  I
sent him the JHL material and called him back to discuss it.  He said that
he didn't know about frenotomys but he would make the referral as it didn't
seem that it could cause much of a problem.  There was instant resolution
and he has since referred babies himself.

The doctors involved are apprised of the actions the parents take and some
of them are probably annoyed with me for pursuing this course, but it is
just not MY way to take a chance on a mother and baby's not being able to
have the breastfeeding experience that they deserve just because the MD
doesn't know something--yet. *This* baby can't wait for the paper to be
written by a Physician and be published in the proper journal. By the way,
I get referrals from most of the doctors whom I challenged on issues like
frenula or yeast or jaundice. I love the "team approach" when working with
pediatricians. I like to assume that their first concern is the health of
their patients.

There are a lot of us in this profession and there are a lot of ways of
doing this work.  We need all of our "styles," and we must be true to
ourselves.  Each of us enhances our profession by approaching things in
*her* way. Personally, I find that I am most respectful of physicians (or
anyone, including myself) when I don't allow them to be less than they can be.

Patricia Gima, IBCLC
Milwaukee, Wisconsin, Upper Midwest, USA






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