I would appreciate any information anyone can share regarding assisting
mothers to breastfeed babies with cleft lip/palate.  I have permission to
post from parents.  

Background as I know it: 
Locally the mothers who wish to breastmilk feed now appear to get help to
express their milk for their babies at the hospital.  Babies are fitted with
plates (obturator?) within 24-48hours and they also have a strap (piece of
fabric) stretched across the lip if the cleft extends to the lip. There has
been some resistance to assisting women and their babies to breastfeed in
the past so when asked to come into to the hospital to see this mother I was
excited and also worried due to my lack of extensive experience - mainly
seen women more than a couple of months after birth which is slightly
different to being able to give information early. 

I saw this family whilst they were in hospital last week when baby was 4
days old. 
Parents very keen to breastfeed and had seen another LC prior to birth who
had given them lots of information (she is currently on holiday).  I was
asked by staff at medical consultant's request to come and give intensive
breastfeeding session.  

The baby did well without the plate - in fact could I be wrong that he spat
it out :-)? Baby used great jaw action on the right breast (cleft on left)
with the aid of a nipple shield and breast compressions and a SNS that
mother used in place of squeezy bottle.  On the left breast we had to juggle
positioning a little more but again he was eventually calm and content with
some jaw action but not felt as strongly by mother. Baby had 20mls from SNS
and 20mls+ from breast - then topped up with squeezy bottle (preferred
feeding method at hospital).   On subsequent visit the baby was not as happy
at the breast - was this because the plate was insitu?    Or just
coincidence? Will the baby get used to the plate?  

Since my first visit the parents have spoken to the dentist and surgeon who
state that they would like the plate to stay in 24 hours (removed for
cleaning only).  It appears that one of the reasons they don't want the
plate out for feeding is the concern that the baby will prefer the plate out
and then not want it in at all. One of the nursing staff statements was that
our State has a great surgical record with some of the best results because
of the use of the plate and strapping.  

I would love to hear what other places in the world are doing? How are you
assisting the babies with clefts to breastfeed?  Do you use plates
(obturators)?  If so when are the plates fitted?  Do you remove plates for
feeding with breast? Do you remove for alternative feeding methods?  What
alternative feeding methods do you use?  Do you attempt at all feed times to
beastfeed or mix it up - some breastfeeds and some squeezy bottle (or other
alternative feeding methods).  What levels of success do you have?  In fact
please share whatever information you have :-)

It seems the research is not out there or that I can't find it so if you
have any good references to suggest would love those too please.

If you can help with information please post to the list or if you prefer
contact me privately.  

Shaughn Leach RM, IBCLC, DipT
Perth, Western Australia
Where yesterday we had our hottest December day ever 44.2C!

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