I have a few comments about tongue tie, payment for lactation consults, and
residency training all wrapped up into 1 consult today. I saw a mom who
really wants to breastfeed, so she came to the consult with a check already
made out for the fee (this rarely happens), and stating that her OB
prescribed nystatin cream for her nipples because she told the OB she had
thrush (but was never seen in the office), and today she came to see me with
persistent nipple pain and symptoms of mastitis.  Well, the OB didn't refer
to lactation appropriately, so the mother was treated without being seen, and
misdiagnosed.  I don't think thrush ever existed.  But, upon assessment of
this baby (33 days old), the baby had a short, anteriorly located frenulum.
When I assisted with an exaggerated asymmetrical latch-on, the nursing went
better than ever according to mom.  Oh, by the way, baby had a history of
poor weight gain in the first 2 weeks of life, but the pediatrician didn't
refer her to an LC. Mom was more than willing to seek frenotomy to resolve
the situation.  So, in conclusion, this mom didn't hesitate to pay for the
consult, she was very happy to have gained remedies for her breastfeeding
difficulties, and her physicians weren't appropriately educated to refer to
an LC.  If she'd sought a consult earlier, the shallow latch would not have
led to plugged ducts, and consequently to mastitis.  I wish the physicians
would recognize our profession more readily and refer sooner, rather than
prescribing meds. over the phone for thrush and mastitis. And, I believe our
profession will gain respect and recognization when we collaborate, such as
massage therapists, chiropractors, doulas, etc. and provide our services for
payment.  I have great respect for the volunteers in my community (La Leche
Leaders), don't get me wrong, and strive to collaborate with them.  But,
these other entities do not offer services for free, and I think it does harm
our reputation as a profession.  (Please don't slam me about my
opinions...I've worked 6 days in a row and I'm not in the mood.  I'll go back
into hiding again....)
Carol Chamblin, RN, MS, IBCLC
Geneva, Il

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