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Date: Tue, 09 Apr 1996 22:57:58 -0700
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To: Lactation Information and Discussion <[log in to unmask]>
Subject: Frenulums: Who, How & Sedation?
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Dear Jay (Janet?),

You wrote:

> Subject: Re: Frenotomy
> I have a client who is having a heck of a time finding someone to do a
> frenotomy  and  "Is sedation necessary"

Have you considered contacting some Family Practice docs.  I know I'm a
little biased, but I find that overall they have a more holistic approach
than most peds.  I worked with a great group for 6 years and the "oldest
doc" (about 45'ish?) was the one who pointed out to me that frenotomies
used to be so common that the circumcision instruments till have a little
cutting notch on the other end which was used for frenulum clipping.

"Can someone give me a detailed description of frenotomy?"

He showed me how to do my first one and I've done one more since then.  We
didn't sedate either one.  (It can't possibly hurt 1/1000th as much as
circ.! and most are not sedating them although most of "my" docs do penile
block nowadays.)  With the first child I just had mom hold baby's body
/arms (she was a nurse--not worried about being too upset by this
procedure) and my nurse hold the head steady.  When the baby opened wide to
cry I used sterile surgical scissor and gloves to snip the thick, white
extra-frenula tissue.  The tongue moved with the cry but the frenulum
actually seemed surprisingly "still."  So it wasn't as difficult as I had
imagined.  I did 2 or 3 tiny snips (1mm each?) til I saw a drop of blood
(or less?) and knew I was done.  I don't recall the baby crying any harder
when I hit blood.  We immediately handed baby to Mom to nurse and she was
ecstatic as there was IMMEDIATE relief for her.  This was her 3rd nursed
baby and she had come to us saying "something isn't right; it hurts and I'm
sore."  She just kept repeating her happy surprise at the change.  Before
she left, I checked the sleeping baby's mouth--no blood or evidence of the
"surgery."

My 2nd one was not as easy as we were in the hosp--decided to try using the
"circ.board"--papoosing device--which the kid absolutely hated.  Did same
procedure but don't recall any blood (plenty of sweat on me though--don't
like tied down, screaming, trying to thrash babies--goes against my
instincts!!) but knew I had cut thru plenty of non-vascularized tissue
(again just a few mm).  This Mom had not noticed any soreness as we had
been unabe to get him to latch much prior.  He still didn't latch
immediately but did well within a couple of weeks.  His Mom's a BF peer
counselor now.


Meg Wright, PA-C
Physician Assistant