Complicated, long case

I am working with a mother & baby with some real challenges.  Baby has a
portion of soft palate missing & does not appear to have much of a suck.
Mother started out with large, very flat nipples that just wouldn't stay
out.   Great efforts were taken by midwives, doula & an LC to get baby to
breast with little result.  Mother is now pumping & bottlefeeding with the
Haberman.  Baby is 6 weeks old.

Mother has had the baby to a chiropractor that specializes in children
twice & they believe there is a TMJ problem which may be inhibiting the
suck.  Baby is being treated for this.  The baby was seen by a specialist(I
apologize but I don't know what type of doctor) at 3 days & he was glad
that she was expressing milk for baby & told her that if there were feeding
problems they would fit her for a prosthetic plate.  Palate will be
repaired when baby is 1 year.  Baby is gaining fine now.

Mother is exhausted with the pumping schedule (8 times per day including
the middle of the night) & yet mother & baby had such a negative
association with trying to breastfeed I recommended that they get used to
the idea again without the pressure of latching on.  Mom offering baby
breast in bathtub, doing lots of skin to skin & letting baby play at breast.

Mother came to a LLL meeting & made the comment that she wishes that
someone would tell her it is OK to bottlefeed - that everyone keeps telling
her that she should be able to do this.  However, she is also very proud of
the fact that baby hasn't had one drop of formula.  Mom is a nurse
anesthetist & very knowledgeable as to the benefits of BFing.  But she is
tired & wants the easy experience of BFing on the go - easily.

We are going to try with shield & SNS as LC reported baby could latch & get
some milk with shield early on.  I hope that baby can at least draw fron
breast directly & eventually cut down on the pumping.  LC said plate is a
good idea but not to introduce anyting new to baby now.

I have several questions for lactnuts out there:
1) Is the shield & SNS where to start?  Pros & Cons?
2) When should the prosthetic be introduced?  What are the pros & cons of
that?
3) Any ideas on the mother's comment regarding bottlefeeding.  I have been
doing lots of listening & reflective listening but it sounds as if she
still doesn't feel supported.  My job is not to convince her to breastfeed
but to support her if she needs it. But I am not going to tell her she
should just give formula either.
4)Mother is seeking support from other mothers doing this.  Do we know
other moms who pump bottlefeed &/or have cleft babies at breast? I put her
in touch with another mother who breastfed 2 cleft children but this mom
took away the hassle aspect of these challenges from that conversation vs.
the positive idea that she can eventually get the baby to the breast.
5)Is there something we should be doing specifically to suck train with
Haberman?

I apologize for the length of this - there is even more to say about this
case.  THANK YOU IN ADVANCE.

Kimberly Anthony LLL Leader

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