Each country generally has its own guidelines and regulatory bodies for who
can do what to whom.  I had some very pleasant correspondence about this
with Mervyn Griffiths and Carolyn Westcott last year, thanks to Sheila
Company who provided me with their e-mail addresses when I was searching for
more info on frenotomies.
Mervyn Griffiths is a surgeon.  He works in Southampton, UK, where both
health visitors and midwives learn to do frenotomies under the supervision
of the health visitors and midwives who work at the breastfeeding clinic
there and who have performed thousands of them.  Griffiths wrote to me that
'frenotomy is not an operation, it is a nursing procedure' which I found
very reassuring.
When I launched the idea of our hospital sending me to Southampton to learn
how to do them, the head of peds, also a friend of mine, said I wouldn't be
able to do them legally in Norway because I am not a physician, and only
physicians can cut people.  I reminded him that as a midwife I am authorized
to cut women and suture them and in a much more intrusive way than a
frenotomy and he allowed that I did have a point.  I think I could argue
this successfully, if necessary in future.
At present we have a good system with our own ENT staff and I don't feel the
need to acquire this skill myself right now.  Besides, I showed the last ENT
who did a frenotomy on my referral how to immobilize the baby's head, using
the method Lisa Amir showed me, and now they are probably all going to do it
that way because it is brilliant.  We have a good atmosphere of mutual
respect which I appreciate all the more, having experienced the opposite
previously.

A couple of years ago, there was a German midwife on our staff who said that
in the hospital where she trained, there was one special person who was
designated to do all the frenotomies, a midwife with a special extra
credential, something called an IBCLC.  I don't know whether this is
widespread in Germany or if her hospital was unique.

The point is, the domain of practice for various professions varies from
country to country and in the US, state law regulates a lot of things too.
So what is routine in one place may be unheard of or even prohibited by law
in another.  In the case of frenotomies I think we'd have a job on our hands
trying to get support for US IBCLCs to do them if they do not hold some
other credential in which taking sharp instruments to soft tissue is
involved.  

Who can do ornamental piercing in various countries?  Not quite the same,
but related...
Rachel Myr
Kristiansand, Norway, where I can give IV opiates on my own authority to
women in labor according to standing protocols in my ward, but where my
colleagues would fall over in shock if I ever auscultated a chest, because
only doctors do that!

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