Tongue- Tie Tale

True Story:
this was this week
Mother's nipples hurt during latch of newborn and ended up pointy like a lipstick.
Nurses told mother that the baby looked tongue-tied. They recommended checking with the IBCLC.  ((Yay, for the nurses!))

IBCLC confirmed the tongue-tie. Referred her to me. ((Right-on!))
PEDIATRICIAN even confirmed it was tongue-tie!! He referred to ENT!
ENT AGREED!!

ENT scheduled baby to have frenotomy relaeased in out-patient center. :(
Mom's nipples still hurt.
Out-patient surgery center notified parents that they don't take newborns. Either they can re-schedule at 6 months or go to the operating room.

Waiting won't help breastfeeding TODAY.
Anesthesia is not necessary.

Mom came to me. Determined to breastfeed.
She explained all this to me. Showed me the baby's tongue and her lipstick shaped nipple after latching.

A very simple snip in the office released the frenulum.
The baby went to breast.
No pain.
No lipstick shape to the nipple.
Everyone Lived Happily Ever After.
The end.

Milk Sharing (My Statement)

Addendum1/22/12 : I have been sent updated links and comments in response to this post.  My post is outdated. Until I can update, read through the comments. As I have found out there ARE guidelines from LLL. Not too many people are aware that leaders can discuss the pros and cons of milk-sharing when it is brought up. Per the guidelines it is very appropriate for a leader to refer to a health care professional for a discussion of medical pros/cons of informal milk sharing. That is where I would come in. I want to evaluate why the mother can not meet the needs of her baby (low supply or medication exposure or other reason), can it be corrected and if not discuss the options of what to supplement with (donated milk, home-made formula, commercial formula, cow's milk, goat's milk, or vegan mylks with and how to supplement it (bottle vs supplemental system, etc..). Human Milk 4 Human Babies is a commerce free site on facebook to offer your extra milk or seek potential donors. Look for the global network and your regional group.

From my attendance at the recent conferences it is apparent that even some of the breastfeeding doctors can be adamantly opposed to milk sharing. La Leche League does not support informal milk sharing either.

It would be very reasonable to support milk sharing amongst friends who have known blood tests and are obviously healthy.

If the mother is feeding milk to their own baby, and recipient knows both the donor mother and the baby, it sounds responsible for a breastfeeding group to support informal milk sharing. Then go on to clarify if you must that if you don't know the mother and the baby that carries risks of the unknown.

There is VERY little that makes milk bad. I'd be afraid of the risks of formula and increased illness.

 If you don't know the donor you can get to know them.

The only reason I once heard for La Leche League not supporting the use of donor milk was desiring credibility to new-comers and the public.

There is much more awareness now on the benefits of milk-sharing, it is time to update policy and make a huge positive impact.

I could also accept if a new policy stated that both mothers and both babies be monitored for good health through out the donation period. The donor mother's prenatal labs with HIV should suffice (HIV is a topic for another post). A donor baby who is healthy and growing, labs are not necessary. We just want to see that the baby won't be compromised if mother shares milk. The recipient mother should have an evaluation on why she can't produce enough milk and optimize her own production.

Doctors get blamed for making decisions based on pharmaceutical and financial interest. I have wondered if the hold out for breastfeeding groups to accept donor milk has something to do with collaboration and survival of milk banks.  I don't know if this is fact, so don't quote me. It's just a thought.

Pasteurized milk serve a special community: the preemie babies and research. It is not easy to get pasteurized milk out to the communities healthy babies.

I will take this one step furthur. I have been a Raw food advocate. The same principle applies to breastmilk. While pasteurized breastmilk is much better than formula. Minimally processed breastmilk has the  LIVE enzymes. I also support the use of minimizing the handling of fresh milk.

If anyone has milk to share at this time, I can probably find a home for it.

Finally,

I do not support buying milk from Craig's List and Social Media.

Miami Physician's Breastfeeding Summit

 Like a geek, I sat in the front row of this physician's meeting on breastfeeding in Miami. I wanted to make sure I heard EVERYTHING. I didn't even know about this conference til about a week ago. 

I get patients from Miami and when I heard about the meeting, I felt like I should now what is going on there. 

Who's at the table:

Grisel Garcia MD from Miami

Joan Meek MD from Orlando

Julie Kelogg MD from Jacksonville

Liz Westwater from Baby Friendly

Lourdes Forester MD from Miami

Alberto Dominguez-Bali MD from Miami

So Miami has 14 hospitals and 12 are working towards Baby Friendly! Part of becoming Baby Friendly is that your physicians must have 3 hours of formal training in breastfeeding. Attending this meeting was physicians and other staff trying to meet this requirement. How do you get a physician at a meeting on a Saturday morning, on breastfeeding.  FREE CME, FREE breakfast and lunch, and a mug.... the good view of the harbor was a bonus. It got me there!

This was not a lecture to the choir!

Joint Commission a group that hospital quality control has a campaign directed towards mothers to "Speak Up".

That's how the meeting started-- by showing the brochure. What does it mean when your mother speaks up and asks for skin-to-skin. ((It never entered my mind that a physician might not know what skin-to-skin was.)) This was a good non-threatening starting place to reach the participants. Dr. Bali showed a video of attachment after birth and the phases in detail. He emphasized touch, touch, touch... and he was quite passionate about it. He said, if the mother couldn't do skin-to-skin immediately, partner or grandma should. 

He said we forgot something very basic-- WE ARE MAMMALS! No other species survives without breastfeeding. 

We talked about removing warmers from the delivery room

Talked about how damaging suctioning is because it cause aversions, stresses baby, changes the flora.

We talked about how WE interfere with breastfeeding. We ((doctors)) and our policies interfere. 

But the good news is how a little education and a little encouragement form the physician GOES a long way.

The speakers told the other doctors to tell their patients:

"As your doctor, "I want you to know I support your breastfeeding."

A point was made that if you tell mothers this, you should remove the formula display from your waiting room which undermines a mother's confidence in herself and you.

In the hospital, anticpate the baby will be up all night.  The hospitals are implementing a no procedure, restful period from 1-3 o'clock in the afternoon. We talked about how society prepares mother that everything will go back to normal. We need to support mother better.

It was noted that in one area no one came to the breastfeeding support group, but they changed the name and  many came to massage class (and they spoke about breastfeeding).

When the hospital got an estimate to purchase formula, the formula company inflated the estimate.  There was several reasons that actual usage didn't meet the estimated purchase cost. For example- staff passed out extra formula because it was free. As time went on and they used less formula, they purchased less.

We talked about delaying procedures, growth curve, reflux, hepatitis, glucose, jaundice, starting solids. 

The participants got to ask Questions at the end. I thought this three hours was excellent for Physician Breastfeeding 101.

The AAP is coming out with a new breastfeeding statement this year emphasizing the physicians role in management.

At the end Liz from Baby Friendly encouraged the doctors and said that surveys use to come back with negative about the doctors being the barrier, but in more recent years, the surveys come back as the doctors being the one who moved it forward!

I see mothers from Miami for tongue-tie (frenotomy was not discussed) and alternative vaccine schedules (discussed briefly, if any of the speakers supported an alternative schedule I didn't here it). Also, most of my Miami consults have had out-of-hospital births. This meeting should have a positive impact on what is going on in the hospital! A good start has lasting effects!!

What's New Here at Permission to Mother

Over the New Year's Weekend in my blog reader, I noticed a lot of blog authors reposting their favorite blog post of the year. It made me realize how long it has been since I have added anything here. My kids don't like me taking their photos and they like more privacy. I get that. Although I do plan to update about their homeschooling and other activities very relevant, I am not using this so much to update family and friends. I will use it for birth, breastfeeding, and homeschooling mostly.

I've been actively following a facebook group for the La Leche League of the Treasure Coast. We have over 200 enthusiastic mothers standing up for their breastfeeding and asking tons of questions to make good choices. I love seeing so many involved mothers in one place!

I've been to two breastfeeding conferences this fall. I am planning to attend a morning conference in Miami geared towards baby-friendly and physicians this weekend.

I've been going to some local LLL meetings and events. I have an events tab up above on my blog. I like meeting you and seeing your babies out of the office, so hope to see you there!

In my office we have moved from paper charts to EMR (electronic medical records). This continues to be a big transition.

I frequently get e-mail like this:

I received your name from a local IBCLC after being horrified by my current ped's advice. After taking a look at your website, I really hope you can make room for my baby and I in your practice. Here is our situation...


We exclusively breastfeed, cloth diaper, and babywear, and I consider myself very knowledgeable in all 3 areas. Breastfeeding is extremely important to us and I plan on doing baby led weaning.

Now at 6 months, she hasn't gained anything since 4 months. We question vaccines. We'd like to have an opinion from someone else on vaccines, weight gain, etc...

PLEASE be our new doctor!!! 

I carefully keep tabs of the amount of active patients in my practice. I leave space each week to offer appointments to those moms who share the same beliefs as I. I hope to fill ALL those spaces with moms and babies who need well visits or consults.

Another question I get asked:

We don't go to the doctors much, but it would be nice to establish with a doctor just in case something comes up. Can my family come to you without getting caught up with vaccine schedules and other demands.



I am very flexible. I know there are many families who take good care of themselves. I know that they don't get sick much and have remedies they use before calling a doctor. That is the goal! You take care of yourself. I only make recommendations and/or support you your choices. As long as we have good communication and what kind of situations you may need medical care, I find this flexibility works. 




So despite the blog being quiet, I've have not been.   One more thing... I don't know why I have problems with fonts and laying out photos. It doesn't make it fun to blog. When the fonts and spacing  are no longer easy to deal with. I can easily kill a lot of time figuring out what is wrong with the spacing, but I am going to hit publish now...Sigh.