I can offer some suggestions about bfing a baby with a cleft -the breast
reduction adds another challenge. You have to consider how detailed is the
cleft or how much of a functional palate is left. Medela has an excellent
resouce brochure about breastfeeding a baby with a cleft. Another
consideration is whether there are other problems that may impact
breastfeeding. Then to compound the problem, the parents, grandparents,
friends etc are is shock and mourning over the loss of their "normal"
appearing baby.  I hope you are providing moral support, education and
encourgement. Putting the baby to the breast and seeing what he can do is the
first step. Position the baby in an upright position, sitting on mom's lap
facing the breast. A breastfeeding pillow pulled around the baby's back
helps. Mom needs to use her thumb on the top of the breast to help seal off
the cleft while supporting the breast underneath with the other fingers. This
takes practice.  Dad can help by providing breast compression and watching
for the baby's cues to suck and swallow, pause and breath. If the baby needs
to use an alternative feeding device, many families have found the Haberman
works well if the baby is not at the breast, an SNS if at the breast. Tape
the SNS when it will not interfer with the cleft. You may provide the family
with information about a palatal obturator (discussed in the Medela booklet).
I have usually heard MD's tell families "we don't use those" and I tell the
family that isn't a medical reason for not trying it. There is some
information on the internet but some of it is not very good, suggesting
feeders from 20 years ago, and discouraging breastfeeding. I tell parents
that they alone measure their success. If they want to breastfeed, try it and
then if it doesn't work, move to plan B using altenative devices as needed.
If that doesn't work, pumping and using an Haberman feeder will provide the
important nutrients and immunities for the baby. And if they are pumping,
encourge them to continue to put the baby to the breast each day for a trial,
and to allow the bay to snuggle, feel and smell Mom. While at the breast the
mom doesn't see the cleft as much and it helps her to see her baby without
the cleft (a mom in the Medela booklet discusses how important this was to
her).

Barb Whitehead, BS, IBCLC
Eastern NC (presenting on this topic at a conference in Nov. with Dr Denk)

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