By far the most common cause of initial soreness and ineffective
breastfeeding is problems with positioning and technique and no expectant
parents should be in any doubt about this.

It is still definitely worth mentioning that the causes of technical
problems include anatomical variations in the baby, with tongue tie being
the most common one (and certainly the one most amenable to simple, safe
treatment) so that if simple position changes don't accomplish major
improvement in a short time, someone who is knowledgeable about
breastfeeding should examine the baby.
Particularly since we are in our infancy of our understanding of this factor
(I SO agree, Cathy!) you are doing parents a favor if you inform them that
tongue tie exists and that there are people out there who believe in
treating it.  If you get yourself a file folder to put a few of the latest
articles on tongue tie into, you can offer them copies to take to their
practitioner when they phone you back a few weeks later, wondering whether
it was in your class they heard it and if you know where they can get help.

After my gushingly ecstatic post a day ago about how wonderful our
collaboration with ENT is, I arrived back at work after vacation to find the
mother of a baby with a posterior tongue tie at the BF group today.  It
seems the ENT on call today was the one non-believer in that department and
he had managed to determine in the course of a phone call from the peds
resident who examined the baby, that there was no point in even looking at
this case.  Luckily there is a different doc on call every day and so we'll
try again tomorrow.  I'm not planning to give up on this one either.

Like Nina B, I thought the long nail of the midwife was for breaking water.
I know this is off topic, but I once watched a video of a Danish home birth,
shown at an informal gathering of some home birth midwives here.  The
midwife had a very visible hunting-type knife in a sheath on her belt, and
knifesmiths are a revered craftsmens' group here in Norway, where handmade
knives are worn as ornaments, like really macho jewelry.  One of my
colleagues joked that she had it for cutting the cord but I thought maybe it
was Just In Case she needed to do a crash CS, which sent us all into fits of
uncontrollable giggles.  This was before I read Chris Bohjalian's fabulous
novel 'Midwives' and if you haven't read that, I'm can tell you that the
midwife in it had more than a long fingernail.

If I could stand the way it feels to have fingernails maybe I'd grow one to
do frenotomies with, though.

Rachel Myr
Back on the job in Kristiansand, where the yearly summer epidemic of shield
misuse is in full bloom

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