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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