FCC: C:\Netscape\MAIL\Sent Message-ID: <[log in to unmask]> Date: Tue, 09 Apr 1996 22:57:58 -0700 From: [log in to unmask] X-Mailer: Mozilla 2.01KIT (Win16; U) MIME-Version: 1.0 To: Lactation Information and Discussion <[log in to unmask]> Subject: Frenulums: Who, How & Sedation? References: <[log in to unmask]> Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit X-Mozilla-Status: 0801 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