I have been an IBCLC who has practiced in areas where no provider is
available to do the surgery. It is VERY frustrating and can lead one to
believe "I could do it"...

PLEASE think again!  This can lead to all sorts of dangers and personal
financial risks to yourself and your family - and the bigger picture is:
IBCLCs are NOT to do this within their scope of practice.  (I am of course
NOT speaking about those IBCLCs who have other licenses.)

In fact, I cannot DIAGNOSE the need for one - and in Puerto Rico I was able,
with the help of a patient, to learn who WOULD.  After that, this ENT and I
"collaborated" (I never met him personally, but referred all my patients to
him).  Only ONE patient did not get treated, so I feel I did pretty well.

On another vein - one of the things I have learned, again, living in an area
where I cannot easily (unless the patient has Kaiser) get seen to be
evaluated for a need for a frenotomy...notice what I said - I don't diagnose
- I refer to a physician to diagnose and treat this - what I HAVE learned as
an IBCLC, is that IF the mother's breasts are very flexible, malleable,
easily stretched...she and her baby can learn to nurse with effectiveness
and little or no pain.  

This still does not, in my opinion, change my responsibility in referring a
mom to a physician who will diagnose and if necessary, treat.  I have seen
and met far too many adults whose whole lives were affected by their
inability to speak and pronounce well.  If I can help prevent this for the
child, even if they CAN breastfeed effectively, I DO refer.  Is this within
my scope of practice as an IBCLC?  I don't know, but I believe as a health
care professional it is.  

One of the first moms I met here in California WAS able, with my help, to
breastfeed her baby well.  However, DAD had a tight frenulum - and made the
trip and paid (despite family financial limitations) for the treatment - he
didn't want his daughter to have the problems he had suffered all his life.

Jeanette Panchula, BSW, RN, PHN, IBCLC
in BLISTERING California, USA  (116 F or 46.5 C)

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