I am thrilled to have a pediatrician who wants to formalize a procedure
to ease the ability to obtain needed frenotomies by doing them within
our hospital based lactation clinic.  She will train other pediatricians
who are willing but she herself is available in-house full-time (minus
weekends, vacations, etc.).  She is experienced in the procedure from
previous employment in an HMO.

We must formalize a policy/procedure for this.  I am thinking:
1) register the baby not the mom as the outpatient (not needed if still
inpatient in hospital)
2) obtain surgical consent form for frenotomy from mother
3) use Allison H's assessment tool and complete lactation assessment to
document need
4) supplies needed would just be sterile blunt nosed scissors and gauze.
5) Procedure is done by pediatrician after independent assessment of
need and explanation of risks to mother. In our clinic and with this
doctor the infant is placed on a high counter, on a normal bed pillow
with head pointing to doctor.  There is an overhead light under the
cabinets here.  The baby is restrained by LC by holding arms and
assisting to hold open mouth.  Peds elevates tongue with 2X2 inch gauze
and snips frenulum with scissors.  Mom is just behind ready and waiting
to breastfeed.
6) assess infant for bleeding immediately post procedure and if not
excessive place to breast.  If unable to latch allow infant to finger
suck.
7) monitor for bleeding after procedure every ????WHAT???? minutes for
?????HOW LONG???? minutes
8) if bleeding is excessive place pressure on area with 2x2 gauze and a
gentle, steady squeeze
9) complete lactation consultation with appropriate teaching to deal
with supply/latch/normal management issues.  Needs will vary.

We need to decide on length of time baby must be monitored for
bleeding.  I don't expect problems but my manager feels this needs to be
a formalized length of time for policy purposes.  She also wants to know
how long LC will be tied up monitoring for bleeding to determine costs
of the procedure.  We already have cost figures for other lactation
visits.

I'd appreciate any thoughts on this on this proposed policy, expecially
the monitoring times issues.   Carla

PS, Allison, thank you for your thesis (purchased at Kay and Chris's
workshop).  It was pivotal in bringing this about.