A soft palate cleft is more severe than a submucosal cleft, which is a 
cleft that is under the mucous membrane of the palate. Soft palate 
clefts make it impossible for the baby to make negative pressure in the 
mouth, which is what draws milk out of the breast. A very few babies 
figure out alternate ways to get milk, but most babies with clefts 
require alternate feeding.

The best thing you can do for this mom is to teach her how to maintain 
her milk supply by expressing milk (usually pumping at least a few 
ounces a day more than the baby can take is wise, so that there is a 
cushion against future supply problems, the target I give is around 32 
oz/day by 2-4 weeks postpartum), help her feed her baby in a way that 
helps the baby develop correct tongue movements for speech and 
swallowing, and perhaps get some breast nurturing going on to help with 
facial development and bonding. Suction based supplementer systems don't 
work for infants with clefts, so forget the SNS, etc. Mom can give the 
baby some milk at the breast with a syringe and tube, if she actively 
pushes the milk from the syringe, carefully paced with the baby's 
sucking motions.  Most feedings are going to need to be by Haberman 
feeder, Brecht feeder, pigeon cleft nipple, or some other specialty system.

You can also show mom upright feeding positions to keep milk out of the 
baby's nasal passages, and help her pace feedings appropriately to avoid 
aspiration and stress. The baby will likely have a team of doctors who 
will repair the cleft some time between a week of age (Magee and Denk in 
Virginia are one such early repair team) and a year or more (standard 
care). Mom will need a lot of emotional support. You can provide that, 
at the very least.

Catherine Watson Genna, IBCLC NYC

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