I think we are ethically bound to share information with mothers. They can then make the choice they want to make.I make copies of articles on these unusual things (CST or tongue tie issues) and give it to the mom to read and think it over. This way it is not just your "opinion" -- you are backing it up with what is in the literature. I also give her names of professionals who can help her. 

In my physician report, I do not say "this baby is tongue tied and needs a frenotomy", I just explain what I am seeing and the problems, and suggest a referral to an ENT for evaluation and I name the two who do frenotomies here in this area. I find many moms won't get CST or a frenotomy and I am respectful of this. I do phrase things in this way, "It is my professional opinion that __________ will help your baby. I don't know of anything else to suggest to you that will make breastfeeding better because your baby is doing ________ which needs to be corrected. You are the expert on your baby and know what is best for him/her. I can only suggest what I have seen work for other breastfeeding babies -- it is up to each mother to decide what to do."

Kathy Eng, BSW, IBCLC

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