Linda Pohl asks about breastfeeding after cleft palate surgery in a 5 mo
baby whose mother has been expressing.

Firstly, the mother is obviously dedicated to breastfeeding, however I'm
sure Linda has given her a lot of support and that is a marvellous
achievement in itself. Well done.

I don't have personal experience with cleft palate babies, however a friend
of mine and LC (who is not yet on Lactnet) has had quite a bit of
experience.  She has recommended Sarah Coulter Danner's booklet 'Nursing
your baby with a cleft palate/lip'.  Her experience has been that the
surgeons here in Brisbane will not allow anything into the baby's mouth for
7 days after surgery.  They are fed with a big dropper or cup.  However, in
Western Australia there is apparently a plastic surgeon who is a woman who
allows the babies to go straight to the breast after palate surgery.
(Perhaps a WA LC might like to comment on this).  And afterall, a nice soft
breast and nipple in baby's mouth with an undulating tongue action shouldn't
be able to damage the surgery.

18 months ago the international cleft lip/palate conference was held here in
Queensland.  Apparently breastfeeding was conspicuous by its abscence,
except for an LC from Switzerland and my friend - both of whom presented
papers.  The Swiss LC works as part of a team whenever a baby is born with a
cleft.  She puts all babies directly to the breast immediately after birth,
regardless of the type of cleft, and has varying degrees of success.  When
the palate repair is done the baby feeds directly at the breast straight
afterwards.  She has made an excellent video (in English) which would be
marvellous for health professionals and mothers alike.  Feel free to e-mail
me and I will give you her address.

However back to my friend's advice - the baby needs to be familiar with the
breast before the surgery, even if the baby isn't able to feed for
nutritional purposes he should be encouraged to do what he can at the
breast, and this should be stepped up frequency-wise prior to surgery.  My
friend has had quite a few babies who suck well at the breast prior to
surgery, however all of them have needed to be cup fed as well.

The literature she has doesn't necessarily support splinting the arms either
after surgery as it didn't make much difference to whether the baby did any
damage to its repair by finger sucking.

I hope this has been useful and I'm sorry it couldn't have been in the first
person.

Good luck Linda :-)

Denise