Lucy said "We should not do frenotomies just because nothing has
specifically said we should not.  I'm sure if word got out about it, the
medical community, MDs, DDSs, CNPs, everyone, would be up in arms.  It's
just like the situation with medications. There are many times we know
better than the woman's MD that she can take a particular medication and
continue to breastfeed, but if we start telling her that her doctor doesn't
know what he/she's talking about that will not go over well when word gets
back to the doc. We have to try to educate the medical community, sometimes
through the moms, sometimes directly."

I can't help wondering what happens to all the mothers and their infants who
are tongue-tied while IBCLCs nurture their relationships with the medical
establishment.  Surely, if a practice can be supported with good research
evidence, is carried out skilfully and prudently it matters little what the
ignorant ENT down the road thinks.  The first principle of biomedical ethics
is 'Do not harm'.  In some cases, failing to act is doing harm.   In most
cases, if a tongue tie is not sorted out, the outcome is artificial feeding
... We know that is harmful.

Of course I am not suggesting deliberately setting fire to good
relationships with our local MDs - but when they are wrong, they are wrong
and mothers have a right to know.  There are ways to let them know this
without saying, 'your doctor is an idiot'.  I personally like, 'doctors are
really busy people.  They don't always have time to read all the new
information that comes across their desks.  Let's have a look at what the
definitive textbook on medications and mother's milk has to say about this.'

I also realize that if MD's won't refer to you then, mothers won't get your
help and then many mothers and their infants suffer a great harm.  However,
I would hate to think that we are more worried about harming our
relationship with the 'establishment' than we are about harming individual
mothers and babies.

Perhaps we could create a list of ways to let mothers know that they have
been given dud info without compromising our professional standing.

Nina Berry BA/Bed(Hons) Dip Arts(Phil)
Breastfeeding Counsellor
PhD Candidate - "Ethical Issues in the marketing of 'Toddler Milks'"

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