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Hi again Pam
Thanks for your email and for so strenuously
defending the need for TTs. I agree with you
completely. Had I seen a baby with what looked
like a TT which seemed to be compromising
function and thus compromising breastfeeding
itself, then I would not have hesitated to find a
practitioner who could perform a frenotomy.
You describe some excellent cases where there did
seem to be a TT which was causing a difficulty,
and it was divided, and that did mean that
breastfeeding could go forward without further
pain/suffering/low supply etc. And - the crucial
factor IMHO - you followed-up to make sure that all was well.
In my private practice in Zimbabwe I saw over
3000 mothers and babies. I did an oral
assessment on every single baby I saw. I was
able to do consults for newborns in the hospital,
and I saw plenty of ties, and I watched closely
to make sure they weren't giving problems. Amazingly (now...) none did.
But what I see in the UK is that almost every
mother who contacts me has already had her baby's
tongue snipped. I'm not able to see the
before-situation, I can only see the problems
afterwards - and hear history after history where
having the tongue divided did not seem to resolve
the original problem. If a tongue has been
snipped FOUR times and still the mother is
shopping around for further solutions then this
cannot (surely!) have been the causative
problem.... This weekend I saw one and spoke
extensively on the phone to the father of another
baby. This happens again and again and
again. The TT practitioners (often IBCLCs)
charge £120 a pop to do the snip, .. and I can
have an opinion if the tie apparently "needs" to be revised four times!!
I think we agree Pam, that we just want the
mothers we work with to be able to breastfeed
comfortably and successfully, and for the babies
to thrive. I'm not denying that some TTs
definitely need to be divided. I'm absolutely
amazed that I've seen none, but I don't deny that
there are some severe enough out there that
really require dividing. What I am questioning is
how frequently they happen, and and how do we
know whether the frenotomy fixed the problem (ie
was necessary, or medically indicated) if we
don't follow up to make sure that the procedure
resulted in resolution - as you've described??
I tend to agree with Heather on this one. She
describes a case where she took the time to sit
with a mother, apply her skills and the problem
resolved, but someone else came along and the
tongue was diagnosed as tied and snipped after
all. That mother could then well have contacted
me Heather when _that_ didn't work and as she
continues to shop around for even more answers -
the scenario sounds so depressingly similar!
One thing's for sure - this is a topic that's
becoming very controversial. We need more
research, and better evaluation of outcomes for
suspected ties that were or were not
snipped. But meantime I know what I've seen,
and I'm worried. I'm very grateful if Nancy's
paper is giving some of us pause.
Warm regards
Pamela Morrison IBCLC
Rustington, England
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