Many parents will be worried before their appointment for a frenulotomy, this is completely normal and understandable and I would like to reassure you that I will not do anything to your baby that you are not comfortable with. I am a mother also, and know what a vulnerable time early parenthood can be, so I aim to give you plenty of unhurried time to decide whether a frenulotomy is right for your baby.
I am passionate about true informed choice, and as such, I will explain the assessment process, discuss with you the findings from the assessment and before the procedure happens I will talk you through the risks and benefits of the frenulotomy. I also have a consent form and medical questionnaire for you to complete, (a copy of which goes into your red book) and I also write to your baby's GP so a copy of the procedure can be entered on your baby's electronic records.
Does my baby need to be hungry or starved before the frenulotomy?
In my experience, babies who are 'starved' before a procedure are so hungry by the time the frenulotomy happens, they are too upset and stressed - which in turn makes for upset and stressed parents.
Please feed your baby as normal, I have never seen a baby NOT feed after the procedure, and quite often with milk in their bellies they barely notice the procedure and are a lot happier after !
What equipment do I need?
You do not need to have any special equipment or space for the frenulotomy. All we need is a light muslin or blanket for the baby to be wrapped in, ideally one that belongs to you so that your baby has the comforting smell of home.
Your red book is helpful to have to hand and if your appointment is in a clinic, please bring it with you.
I use sterile gloves, scissors and swabs, all of which I provide.
What about Bleeding?
Because the frenulotomy involves a cut to the frenulum, a small amount of bleeding is to be expected. However... like any mother, I do not wish to see any blood and so I do my absolute best to hide that from you!
Once the cut happens, the swab is placed under the baby's tongue (and it is usually at this point that the baby will shout at me their disapproval!) I will hold the swab under the baby's tongue until we have lined the baby up close tot he breast or bottle teat. I remove the swab, and the baby latches on, and I then hide the swab out of your sight.
There is a risk of bleeding of 1:1000 babies, where they may bleed a little bit more. This is the same risk, regardless of whether it is a posterior/central/anterior tie, thick or thin, tight or stretchy. I carry other swabs that are soaked in a haemolytic clotting agent (Kaltostat) which I would use if I thought your baby was bleeding a little more than usual.
Once the baby has fed post procedure, the bleeding will have stopped.
In very rare occasions, some babies may bleed a little a few hours or a couple of days later. This has largely been due to bottle teats/dummies knocking the wound site, or an older baby putting their fingers in their mouths and accidentally knocking the wound. If this happens (and I Stress it is incredibly rare) please feed the baby as a priority as this will stop the bleeding.
What about infection?
The risk of infection with the frenulotomy procedure is 1:10,000. All scissors, swabs and gloves are sterile, and breastmilk also contains all the antibodies and immunities needed to help baby fight off any infection. For formula fed babies, please make up all formula milk safely, and ensure that all bottles and tests are sterilised prior to use.
Do I need to do any post wound exercises?
No, there is no evidence that post release wound massage helps in any way. Stretching and rubbing any wound site, increases the risk of infection, bleeding and can cause scar tissue which is can be more tight than the original frenulum.
The only post release 'exercise' I recommend is to talk, sing, and engage with your baby- as this encourages normal facial movements which are all connected to the tongue.
What if I change my mind?
It is absolutely ok for you to change your mind about the procedure, right up until the snip has happened. Before I snip the frenulum, I will ask you again if you are happy for me to go ahead, and if not... then the scissors are put away.
What Follow Up do I need?
I offer follow up appointments either at the clinic setting or as a home visit. The Eton clinic (see main tongue tie/lactation consultant page for address) is a FREE drop in, and runs weekly to provide ongoing support. How much follow up you need depends on your individual circumstances, however I do recommend that you come to the clinic or have a post procedure follow up home visit to make sure that any feeding plan that we have discussed is still right for you and your baby.
Please note that any txt or phone call support following the procedure is not charged for, however if there are further issues that need face to face support, this will be offered as a clinic or home visit.