Bonny, I would focus, in this case, on good pumping to establish and
maintain a supply! The fact is, that from what you say...this baby cannot
do a good job at the breast anyway, and no matter whether babe goes to
breast or not...this mom is going to have to be an avid pumper for a long
time.

Then I think...the thing to do is to educate the mom. She will, no doubt
get conflicting info. from a variety of sources and it is her decision how
to feed the baby. Carol is right that a breast nipple is probably safer
than a bottle nipple...however, the plastics guy will have his own ideas on
this.

I have worked with a few cleft babies and, have seen these kinds of
devices. To be honest, I haven't seen any of these kids develop really good
sucks. The issue of whether to feed at breast then takes on a whole new
twist...not only "Is it safe?" (which I believe it is) but also "can this
baby gain weight doing it?" (questionable.)

This brings us back to the original goal...lots of good pumping to get and
keep a supply! Mom is no doubt overwhelmed. In cases such as these...I try
to approach one problem at a time. First get the milk established
then....help mom develop goals and then teach her how to achieve them. I
have found it is not productive to go "up against" the surgeons in cases
like this as, the parents are likely to follow their advice anyway. All you
can do is educate...and get her started with a good pump and offer lots of
encouragement about how much her baby needs her milk now, more than ever!

Good Luck,

Susan Keith-Hergert RN, MS, CPN, IBCLC
Mercy Health Partners
Cincinnati, Ohio

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