Cleft Lip or Cleft Palate
A baby with a cleft lip can usually feed at the breast without much difficulty. If the cleft interferes with his suck, you can cover it with your finger or by pushing a fold of breast tissue into it to create a seal.
Cleft lips are usually repaired within the first few weeks of life. Some doctors advise against breastfeeding until the lip is healed, but this isn't usually necessary. Many mothers put their babies to breast immediately following surgery. The babies are comforted by nursing, and the mother's milk supply is maintained. If you choose not to nurse right away, you should pump your breasts frequently to maintain your milk production.
Cleft palates can present more of a challenge. Babies with cleft palates are often unable to keep the breast in their mouths and might have difficulty compressing the milk sinuses beneath the areola. In addition, they tend to get milk into their ears and sinuses through the hole in their palates. Under the guidance of a medical professional, breastfeeding can be successful with this particular challenge.
The Australian hold works well with babies who have cleft palates. Before you begin, stimulate your letdown reflex, so your milk is readily available. Place your baby in a sitting position (see Chapter 5), straddling your leg, and press your breast into the baby's mouth.
You can also slide your baby from one breast to the other without changing his position. For example, the cradle hold on one breast becomes the football hold on the other.
Other common solutions include:
Use the fingers of the hand supporting your breast to hold your baby's head in place. Your palm supports your breast.
Keep your baby's head slightly higher than your nipple to prevent milk from flowing into the cleft.
Change the angle at which your baby takes the breast, especially by aiming the nipple away from the opening in his palate.
Use a dental appliance to cover the hole in the palate.
More serious cases might require the use of a special feeding device like a soft cup. Your lactation consultant can help make breastfeeding work for you and your cleft-palate baby.