I very much appreciate where Barbara is coming from. We all want to make a
good impression and to build bridges wherever and whenever we can.

I have, however, a different perspective that I'd like to share, especially
since the subject matter is close to my heart. I started out by using
Barbara's approach with my clients and their primary care providers when I
became a Lactation Consultant. I quickly found out that it was ineffective.
The problem was, we were beating around the bush. My experience is that
physicians don't have a clue what all that circuitous explanation means. They
know next to nothing about the fine points of infant sucking and they
certainly don't know the central role the tongue plays in deglutition. So how
could they possibly cull from a long-winded explanation of findings that what
really needs to happen is a frenotomy? Many of them don't even know what a
frenotomy is.

If we don't teach them, who will?

This soft, touchy-feely, let's not upset the applecart approach may be
politically correct but how does it solve the real problem? Isn't our goal to
garner quality outcomes and isn't it a standard of our practice to advocate
for the mother and baby?

There is a larger principle at work here. It's called Who Has The Power.
Ideally, we want to have power with. When you choose, however, political
correctness in lieu of clearly stating what the problem is and how it can be
corrected, you actually choose power under. Power under the doctor. Guess
what? That's a recipe for disaster. When one group of people constantly expect
and get others to give up their power to them, they stop working hard to be
the best and give the best. This is a no-no in the US economic system. It is
why we don't allow monopolies. Monopolies are about power. So why would we
want to give up our power thereby facilitating and buttressing a medical
monopoly?

If we had fewer power struggles in medicine and more of a team approach,
imagine what we could accomplish! To achieve this, WE have to stop being
afraid to assert ourselves and to clearly communicate that we know what we are
doing. And THEY have to admit that they don't know everything and that its OK
for a non-doctor to help them help their clients. For breastfeeding to truly
become the societal norm, WE is ultimately going to have to include all of us:
docs, LCs, PTs, OTs, nurses, peer counselors, etc.

The fact is, right now, LCs know more about breastfeeding than physicians do.
Physicians are working hard to bone up but it will take them awhile. The other
fact is that physicians know next to nothing about tongue-tie except what
their text book or professor told them, which is it never causes a problem.
LCs are one of the few health professionals who know that tongue-tie (by a
functional definition) causes breastfeeding problems. There are only two
treatments for it: frenotomy and frenectomy. Frenectomy is overkill: that
leaves frenotomy. Frenotomy is a proven successful treatment for tongue-tie. I
think we are on pretty "safe ground" suggesting it. If someone gets offended
because it is suggested by a LC, oh well. Perhaps they should get over
themselves. After all, what is the doc gonna recommend? On a good day,
frenotomy. On a bad day, they will pass the buck to an ENT, suggest a
frenectomy, or a frenotomy under anesthesia, or, worst of all, NOTHING.

So what is the magic in them handling it? Improved provider relations? Maybe
it appears that way, but its more like ego massaging. Think about what we and
mothers have to lose in the long run. If you continue to give up your power
instead of asserting yourself, (and that can be done diplomatically and
tactfully), as an autonomous therapist then lactation services will be co-
opted and possibly medicalized to the point that the mother and baby will once
again get lost. This is an old story.

Sound like I'm demonizing yet once again? No, its not me. The system has done
it to itself and if we don't do something about it, we become part of the
problem.

I encourage all of you to recognize and respect your substantial skills;
recognize that LCs deliver care unlike any other health profession to date,
which is partly why they have been so successful; recognize that because of
your persistence and efforts that great strides have been made regarding
breastfeeding, and not just in the US but all over the world. And it isn't
because we shrink from controversy. We embrace it, we bathe in it, we eat it
for breakfast, lunch and dinner.

Dealing with politics in our arena is not always comfortable or convenient but
we must. We are getting recognized for our efforts more each year because we
do. Now is not the time to cave. Sublimating ourselves to the system will not
do anyone any good. Power With is where its really at and where it should be
really at. So, suggest that frenotomy and if the doc gets enraged, go to lunch
with him or her and have a nice chat.

Moreover, the mothers and babies are counting on YOU!

Alison K. Hazelbaker, MA, IBCLC
The only good rationale for a health policy is biology.
(By the way, the above approach works with insurance companies, too.)