Very well said Judy:
 
" a whole cascade of issues, or even a downward vortex overwhelms the whole family: 
pain, nipple wounds, crying, unhappy baby, protracted or ineffective/brief 
feeds or feeding attempts, poor weight gain, lack of normal sleep patterns, low 
milk supply, etc, the whole family gets sucked into this vortex. I don't 
think babies who can latch fairly and seem to "look good" and seem to be 
moving milk appropriately in the first week have to get all frenulums released 
just because one is visible, but certainly they need very close follow-up 
for any of the vortex issues popping up."

I am in the interesting position to see the Patients we see in the Hospital as Outpatients, as we Have a Lactation Clinic Outpatient staffed  with Dr Murphy and a LVN he has trained to help him with the after care/Lactation issues.  Dr Murphy performs the frenotomies.  So often on the day I know a patient I referred is going to have the procedure I will sneak down to be present and assist with the latch/nursing after. Yes, it is not always an instant cure, meaning the Mothers pain does not always go from 10 to 0. However in the cases I have seen the pain always goes down, most often from 7-10 to a 1-2/10 scale. Sometimes, suck training and if the parents can afford it Cranial Sacral therapy are needed to  deal with the co exisiting issues, i.e. cranial nerve entrapment, or other muscular tensions in the cranium or mouth from VAVD or c/sec or just a rough vaginal birth. 
 
I saw a mother today, her second, she quit after 3 weeks with her first, nipples damaged, pain, and infant fussy and having to continuously feed at the Breast. She saw a IBCLC and they did not note or address the TTie. This baby also TTied and she is having the same issues. Deeper latch, positioning, etc did nothing to help. So yes, I made appt for her at her request with Dr Murphy and I told her about possible other co exisiting issues and taught both parents about FFeeding and suck training, so they know this may need to be done post release to completely resolve the problem. But when you do not see the patients for long term f/u it is easy to have magical thinking ,  thinking everything will work itself out.  Most of the time they switch to formula, as this Mom told me, " when we switched to formula, everything was solved and got better". Lisa Mooney CNM MSN IBCLC
  		 	   		  
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