Hoda,

I work as an LC in a WIC clinic so I face some of the same things. One thing I would recommend is that you take the time to accompany the mother and baby to the ENT appointment. You won't have to do this forever, but the first few times are your opportunity to explain to the doctor what is wrong. I have observed that many parents don't do a good job conveying the problem. Doctors are looking for obvious complete anterior ties and don't understand what they are seeing. They don't observe a feeding so they don't understand the problem. 



I accompanied a Spanish-speaking family once, we had sat on the TT for 3 months before they decided that enough was enough and they wanted to proceed. Baby had to be supplemented by bottle to grow well. When the assistant interviewed them and asked how feeding was going, the mother replied, "Bien, bien" (as in, the baby gets enough with what we do and is growing well because of this) and the assistant wondered why they were there. I had to interject, "No bien!" and explain the bigger picture. No wonder they get kicked back to me sometimes! And then the provider wonders what the heck we are doing.  



Another strategy I have employed is to make a video clip of the baby-- showing the anatomical markers (mother and/or baby) and then a feeding, with explanations-- emailed to them. The ENT had initially told the parents that the TT was not a problem, but after viewing my video, did the procedure. 



Nipple confusion: babies who are struggling against anatomic restrictions experiment with compensations as they try to make feeding work. Thus their suck can be confused and disorganized. If they are able to make the bottle work more easily and then come back to the breast, they may indeed appear confused because what worked on the bottle may not be effective for the breast.  The compression you feel is the result of the suck problem, not confusion.



We now have two chiropractors in our area who also do CST type techniques on babies. In California, chiropractic care for babies is covered by Medi-Cal. The reimbursement is not great but my providers have been willing to see the babies any way, for which I am grateful. So in those ambiguous "hard sell" situations, I definitely refer for body care first. (Note: I do not send all babies because these providers are already overwhelmed)



Medi-Cal breast pumps: Contact Kathleen Huggins about this-- she is a Lactnet subscriber also.



Please note that Medi-Cal only reimburses MDs for frenotomies, they do not cover nurse practitioners, dentists, etc.



>> 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.<<



Santa Barbara County PHD/WIC's breastfeeding program has learned a lot- consider contacting our Breastfeeding Coordinator, Meg Beard (also a Lactnet member) as she may be able to give you some ideas for your specific challenges.



~Lisa Marasco





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