Judy said: "I admit I have neither a magic wand nor a crystal ball in my bag. I think  
most IBCLCs just work really, really hard to assess everything, try lots of  
things, strategize, reassess and discuss my assessments and what might   
helpful to move a family forward toward an "enjoyable", as Dr. Kotlow says  
breastfeeding relationship."

So true, I know that many LC's agonize over seeing so many tongue ties all of a sudden and 
not knowing whether to refer or not. As with everything every mother baby pair is unique.
One mother will be patient and will hang in there, the next one will not tolerate the discomfort
and pain. I think our challenge is to prove that we are not just snipping everything in sight, but
that our clinical reasoning is sound when we recommend release.

If Lea's baby had tongue tie release when he was unable to latch onto the breast, would that have harmed
him. The bottle of formula may have sensitized him for dairy. If she had no "patience and flexibility" she may have given up before week 2 like many mothers I know have done. 

"There are more questions than answers"   

To throw the cat amongst the pigeons now I recently read an interesting article stating that more than half of German doctors prescribe placebos. The German Medical Association responded to this by saying "placebos have a stonger impact and are more complex than we realised. They are hugely important in medicine today."

I have at times wondered whether tongue tie release does not have a placebo effect to some degree. The mother
is at breaking point, she gets substantiation for her pain, she now understands why the breastfeeding is not comfortable, the treatment relieves the pain to some extent, perhaps not fully, but there is hope it will all be well and then it is.  Mothers have amazing powers of endurance.

Just wondering whether we should feel so guilty if at times we are in doubt. 


Also see this article that was in one of the main weekend papers today! Oh dear.

http://www.stuff.co.nz/sunday-star-times/opinion/4838541/The-agony-and-the-ecstasy

Loraine Hamm
Speech Language Therapist/IBCLC
New Zealand
 



  

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