Another picturesque history lesson for today:


This inclusion of the grooved tongue director in the circumcision set was routine in my hospital experience and no doubt dates back to the days when general family practice doctors delivered many babies and both mother and baby were their patients. For girls, we just opened the hospital-sterilized circumcision set solely for the purpose of accessing the grooved tongue director and the scalpel.


This was back when FP residents had just a one year residency after medical school before they went into practice with another family doc or into solo practice. (Family docs also had the highest rates of heart attacks because they kept office hours all day and yet got up to deliver babies.) Whenever moms went into spontaneous labor, they came to L&D (what a riot! We all believed the full moon was a sure part of this deluge we often experienced.) L&D nurses called and notified docs on admission, then nurses used routine orders for twilight sleep etc. When it got close enough to delivery that the L&D nurse finally called him, heaven help her if mom precipitated before he got there or he had to wait very long!) I saw this when I entered nursing school near the tail end of the baby boom in 1948, (3600+ births a year in the smallest of the 3 general hospitals in our town!) and it continued as long as I worked in hospital OB till 1976. I have no doubt that tongue tie release was in part of the FP docs' training.


However, at some point along the way, things began to change at least in our southwestern Ohio general hospital, perhaps related to the dawn of perinatal care???? which was introduced gradually to our hospital in the very late 1960's- early 1970's??? by a few docs trained as OB's. There appeared what seemed to me like a "Grand Canyon" opening up between the care of the mother and the care of the baby, plus an earlier and earlier discharge from the hospital after a birth, meaning hospital folks saw fewer and fewer of these mother/baby dyads on day 3,4 & 5 and beyond, and this happened during the same era when more and more mothers were just beginning to have 'managed labor' with more and more IV fluids, fewer and fewer general anesthetics and more locals, pudendals, caudals and spinals. No nurse anesthetists were awakened unless for generals. Epidurals came much, much later in our place


I vaguely remember fewer and fewer family practice doctors delivering babies (insurance rates???) and more pediatricians whose preparation apparently lacked training on TT other than to pooh pooh the idea that TT caused any problems at all, (because the baby could still take a bottle). Obstetricians were still doing the circumcisions when the word got around that peds were saying "Why are you doing surgery on MY patient???" and gradually, that changed the nursery picture too. 


Frankly, it amazes me that grooved tongue directors are still packed in the circumcision sets!! In today's world, does the hospital OB department still have it's own autoclave and wash and rewrap and sterilize much of its own equipment??? Do I hear laughing in the backround? (BTW, we also had our own formula kitchen where formula was made and sterilized 6 days a week!! That ended in 1954 when we moved to a new building which had no formula kitchen, and we received "inservice training" from at least 3 formula companies;-)


K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC  Dayton OH

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