Jane,
The two main issues here are to help mom feed the baby in some way that
does not take forever (and gets most of the milk in the baby's stomach,
and as little as possible in the airway); and to help her pump
frequently enough to increase her milk supply.  These two problems
intersect- the better we can feed the baby, the more time mom has for
pumping.  In the (admittedly few) cleft babies I have seen, the big
issue was helping the baby use the tongue, and making sure no one is
pouring milk down baby's throat, we want to get the baby's own efforts
synchronized with the milk flow to maximize tongue function and
coordination of swallowing and breathing.

This really needs to be seen in person.  Encourage mom to see an IBCLC
who is really savvy about feeding in general, or a speech or
occupational therapist who is bf savvy as well, or an LC and a feeding
therapist who can work as a team.

Sight unseen, I would advise feeding baby some alternative way, giving
some breast time, perhaps with mom manually expressing as the baby
attempts to suckle, and having mom pump at least 10 times a day (they
don;t have to be evenly spaced, she does not have to clean the kit every
time, etc to make it easier for her).  Poor mommy needs help with her
other children and household tasks too.

And perhaps mom would be willing to see Dr. McGee or Denk, who do very
early repair of clefts and have IBCLCs on staff to help baby breastfeed
post-op.  They are in Virginia.

--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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