I am reading with interest your accounts of issues relating to tied
frenulum.  I work in a university-affiliated government hospital   We
have some 9000 births a year, 700 a month, and I am the only LC and am
employed part time.
I first raised the issue in a lecture to the  ped. residents  by showing
the slide of tied frenulum and asking if this could cause problems in
breastfeeding.  Only one student guessed that it might.  Since I  began
working last January, we have had 12 cases of tied frenulum.  Nearly all
have been discovered by me, as thus far this has not been considered
important enough to even report on initial examination, unless one of
the medical students from that lecture is on duty. In most cases there
is some family history of tied frenulum, usually on the maternal side or
in an older offspring.  After about the third case, in which the parents
insisted on frenotomy,with positive results and  one of the heads of the
dept. began to ask me questions and  requested documentation in order to
justify adding frenotomy to the protocol.  The studies I gave him from
JHL were "too anecdotal"  and besides JHL is not "high impact "  enough
for him.  So I suggested that we do a study in our hosp.  He is
considering it together with the ped dental staff.  Does anyone have a
protocol for such a study?  I was thinking on the lines of doing
ultrasound before and after the procedure to show tongue mobility. Then
there is always the problem of how to decide when to clip or not.....on
what basis?  Measure  what?

If anyone is interested in participating in a multi-centered study,
please e-mail me.  If anyone  has a hosp protocol for this  procedure, I
would be very interested to show it to the head of Neonatology, who is
the  doc who was  responsible for my being hired in the first place
because after years of heading a dept in the States, couldn't imagine a
maternity hospital without an LC. He will fully back any study I want to
do.
I am working so hard to bring this hosp around to being mother-baby
friendly, that I hardly have time to think of research, but after
reading all your posts, I guess it is time to get started.

Esther Grunis, BA, IBCLC
Lis Maternity Hospital
Tel Aviv, Israel
mailto:[log in to unmask]

PS  some  articles on epidural and affect on infants:
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9458931&form=6&db=m&Dopt=b

http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=1451936&form=6&db=m&Dopt=b