Hi All,
I need your collective advice on a a very interesting case I had this week.  I saw this mom on Tuesday.  She is 25, and this was her 4th baby.  The oldest is 4 years old.  She sucessfully BF first 3 with no milk supply issues or weight gain problems.  On # 4, who was 2 1/2 weeks old, she barely has any milk and baby was doing nothing at breast, taking a few sucks and coming off.  By the way, they had casually mentioned to her the baby had a tied tongue, may have to be clipped later, but not related to BF.
I saw on Tues, baby could not even sustain latch, tongue not protruding past gum line, sent her to have tongue clipped and got her pumping to increase supply.  In meantime bottle feeding to get baby back to BW.  She wanted to get supply established, and her mother was visiting, decided to pump till Sunday when I could see her again.  Supply came up nicely, but even after it was clipped on Tuesday, till Sunday she noticed no improvements at the breast.
I saw her Sunday morning, and baby was almost thrusting nipple out of mouth.  I thought that just not used to proper tongue movement after 2 weeks of being restricted, but then did manage to get a latch of a few sucks and heard whishing sound.  To make a long story short, I discovered a cleft in the back of the soft palate-  I had no flashlight, noticed it by the light of the window- you could only see it if you really pressed the tongue down.  This was obviously undiagnosed in hopital.
First of All, just out of curiosity, this is the second undiagnosed cleft I have found this year.  Is that ridiculous, are the docs not checking properly, would something like this happen in a US hospital?

Second, there was no milk transfer- and I am kind of confused if it is still tongue issues or the cleft.  I spoke to the ENT who said that of course the cleft will have NO affect on the BF.  Also to note is that the baby sounded very stuffy-  I thought it was due to milk going up there.  The ENT said had nothing to do with it- just a cold.  (This was based on my description over the phone, not having seen the baby.)

I feel ethically I need to let my client know what is involved in terms of getting this baby successfully BF.  Keep in mind she has 3 others above this baby and below the age of 4.
Baby ate fine from an Avent bottle, did not need a Haberman.

What experiences have you had with a cleft of the soft palate?  Does it destroy the vacuum and make milk removal very difficult?  It is to far back for breast tissue to reach.

Or can we just deal with the tongue issue and that is what is causing the problems?

I don't want to start her on a long road which will be very hard for them financially, emotionally, and stress wise- if the chances of succeeding are towards the slim side.

Don't misunderstand, What I really want to do is present the parents with all the info and let them make an informed decision, and I don't have enough experience with the cleft to be able to tell them.
Help!
Please also e-mail privately as I am not positive I will get to Lactnet.
Thanks,
Jessica Billowitz, IBCLC
Israel

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