As I'm finally coming up for air after having been away for several days of
several weeks, I'll chime in here.

Judy and Traci are right: in my book, Breastfeeding the Newborn: Clinical
Strategies for Nurses, I've advised that you have the mom point the cleft
away from the nipple. Judy's hunch that I'm suggesting a way to achieve a
better seal and better negative pressure is correct. (Remembering, of
course, that negative pressure it NOT what gets the milk out. Or at least,
not the *primary* mechanism for transferring milk. It keeps the
nipples/areola in place correctly, as Michael Woolridge showed us ages ago.)

The deal with the sore nipples is trickier, however. But let me first say
that I've often been called for "Mom has sore nipples and baby has a
cleft...." only to find out that baby having a cleft may not have a darned
thing to do with the sore nipples! Don't start looking for exotic stuff:
it's often that the baby didn't open wide and achieve a good latch-on; same
as any other kid! I distinctly remember one mom, whose baby had a fairly
significant cleft, and she experienced immediate relief just by correctly
his latch.

If the baby  has a substantial cleft of the palate, however, mom is likely
to end up with sore nipples. Pointing the nipple away from the cleft isn't
realistic when they are right smack in the middle of the palate. The
problem is that the hole, i.e., the cleft, rubs against the nipples, making
them sore. Obturators, which aren't used much these days in most parts of
the US, cover up the cleft, but they also cause sore nipples, because the
mom's nipples then rub against them.



>Traci wrote:
><<  Anyway, I have a question about positioning
> at the breast for a baby w/ a cleft palate.
>
> In her book, Clinical Strategies for Nurses, Marie Biancuzzo states that the
> nipple should be pointed toward the opposite side of the mouth from the
> cleft. I've also read this in other resources as well. My question is, how
> does a mom keep from getting sore nipples? It seems that this would position
> is awkward. Any clarifications are appreciated.
>  >>
>I guess what she means is that the baby might have a better shot at acheiving
>negative pressure on the side without the cleft, or have something to press
>up against to help milk the breast, and that as with any good latch, if it's
>deep enough the mom should not get sore?
>Judy LeVan Fram, Brooklyn, NY

--
Marie Biancuzzo, Perinatal Clinical Nurse Specialist
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Resources to simplify breastfeeding management are available at
http://www.wmc-worldwide.com

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