The oral surgeon I presently work with uses an pointy iris scissor. He clips conservatively, puts the baby to breast and clips more if the latch is not adequately improved. The pediatrician I used to work with used a small blunt tipped scissor and she also re-evaluated by checking the latch and clipped more if needed. If baby won't latch they will usually suck on a finger with pad side up and the tongue extension can still be evaluated. Most latches improve right away but some don't so you don't want to reclip more if the tongue can come out but the baby just doesn't know how to use the breast yet. They check the direct latch first, if that doesn't work they do a digital assessment and only then consider clipping more. Both use their free hand to lift the tongue. I've seen viscous xylocaine used and I've seen it done without and I prefer without because the worst part is restraining the baby and lifting the tongue and there is twice as much of that with the xylocaine. Since evaluating the latch is an important part of the procedure I also worry that the baby's tongue function may be affected by drifting xylocaine. In the hospital we use a general consent form and just write in the procedure name. We use the Hazelbaker tool to evaluate the tongue but the decision to clip is also based on mother's nipple's condition and her comfort level with as good a latch as she can get with LC assist. We also evaluate how difficult it is for mom to get a latch on her own. I also feel a mother should be able to breastfeed with less than the "PERFECT" latch in a contrived position. In other words if she can only latch and tolerate it (maybe she has a high pain threshold) with the baby looking down at the breast and mom holding the breast into the mouth then that isn't good enough. Who can keep up that level of intense intervention going for long? Breastfeeding also fails when the effort to do it is made too extreme. I think if she can't hope to get good enough at breastfeeding to do it on the park bench or at the mall but can only do it at home with pillow props and in bed that isn't good enough and if a tight frenulum is the cause then clip it. Carla (in Maryland) *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html