Hello everyone,
I'm a new IBCLC, and for the past 5 months, I have been working in a
community clinic on a pilot project to offer lactation services in
California. I have quickly taken note to the differences in providing BF
care for clinic versus private practice patients. Here are the challenges
I'm facing...
1. For one, I'm having a lot of trouble finding an ENT doctor who accepts
MediCal who will do frenotomies for posterior tongue ties or lip ties. They
all state that they do them, but when I refer the patients, they don't do
the procedure (with one baby, who wasn't gaining weight, feeds for a very
long time, and has already chewed into the mother's nipples) the parents
were told the baby didn't need it). Similar things have happened to other
patients, and I truly only refer the ones who have significant problems
that are not corrected with adjustments in positioning, and whatever else
we can teach them in the clinic.
2. Does nipple confusion sometimes mimic a posterior tongue tie when you
feel the peristaltic motion of the tongue? In both cases, I feel the same
thing; the posterior portion of the tongue compresses the finger up against
the palate, and the motion is often disorganized. Many of the babies who I
felt had tongue ties did better with my "pseudo suck training" (for those
whose parents understood and were committed enough to do it). What I teach
them is more a gentle stroke to relax the tongue rather than true training.
This has seemed to work with some who I knew will not get the frenotomy. Am
I on the right track with this? Do you use similar techniques to help with
babies who are symptomatic like this?
3. MediCal and our county's subsidized insurance programs cover 1 type of
pump that we know of- the Evenflo single electric pump. Based on pt.
feedback, they break easily and don't do very well pumping. Does anyone
know of alternative pumps that insurances for the underserved are willing
to cover?
4. Now I just need to vent on my frustrations. While I feel so blessed to
be able to encourage more exclusive breastfeeding in an area that has very
little support, it's also very saddening how even something so natural as
exclusive breastfeeding ends up being a luxury due to the lack of resources
for the poor.
5. Anyone know where a pediatric NP can be trained in performing
frenotomies??!!!
I'm trying to make the best of my limited resources, but I wanted to see
what suggestions or wisdom you may have to offer so that I may be more
effective.
Thank you!
Peace and blessings to all,
>
> Hoda Shawky, RN, MSN, CPNP, IBCLC
> *Owner, Baby's First Nurse*
> (424) 26-BABY-7 OR 262-2297
> www.BabysFirstNurse.com
> [log in to unmask]
>
>
>
>
> "Whenever kindness touches something it beautifies it, and whenever it is
> removed, it disfigures it." (Prophet Muhammed, narrated by his beloved
> wife Aisha)
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