Nina quoted me and then said:
>
> "I can't help wondering what happens to all the mothers and their  
> infants who
> are tongue-tied while IBCLCs nurture their relationships with the  
> medical
> establishment.  Surely, if a practice can be supported with good  
> research
> evidence, is carried out skilfully and prudently it matters little  
> what the
> ignorant ENT down the road thinks.  The first principle of  
> biomedical ethics
> is 'Do not harm'.  In some cases, failing to act is doing harm.    
> In most
> cases, if a tongue tie is not sorted out, the outcome is artificial  
> feeding
> ... We know that is harmful.
>
> Of course I am not suggesting deliberately setting fire to good
> relationships with our local MDs - but when they are wrong, they  
> are wrong
> and mothers have a right to know.  There are ways to let them know  
> this
> without saying, 'your doctor is an idiot'.  I personally like,  
> 'doctors are
> really busy people.  They don't always have time to read all the new
> information that comes across their desks.  Let's have a look at  
> what the
> definitive textbook on medications and mother's milk has to say  
> about this.'"

If you think it's okay for an IBCLC to do a frenulotomy, do you think  
it's ok for an IBCLC to do other surgery if we know it is needed and  
an MD has refused to do it and it's a practice supported with good  
research evidence?

I never meant to imply that I would say "Your doctor is an idiot."  I  
usually say something similar to what you said, or tell them that  
physicians don't get training about lactation in medical school or  
usually have the reference materials that lactation consultants  
have.  Then I give the mother information on the topic (such as  
prescriptiion meds or in this case frenulotomy) which quotes a source  
an MD would consider legitimate to show her doctor. Of course some  
moms aren't comfortable doing this but some are, some doctors won't  
read it and some will. But you can't force people to change, you can  
only offer information.

Lucy Towbin, MSW, LCSW, IBCLC

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