6. Facing surgical repair
Most parents face cleft repair with a mixture of trepidation and joy. It’s a difficult time both emotionally and physically.
If your child’s cleft team/hospital is breastfeeding friendly, then you will probably be able to breastfeed or feed your baby up until a couple of hours before surgery . You may find a pacifier, or something similar for the baby to suck on, useful for the wait prior to entering the operating theatre. Surgery protocols vary, but many hospitals do allow babies to breastfeed and bottle feed immediately, or soon after surgery.
Some babies find comfort in nursing immediately after surgery – others not. Some babies are voraciously hungry and do nothing but feed and sleep, others are reluctant to feed and this can be quite distressing for parents if they are unaware that this might happen. Palate repair seems to cause more difficulty in post-operative feeding, than a lip repair. In palate repair, the palatal muscles are repositioned and sutured. This may cause pain for the baby on swallowing (I remember my own daughter would take a mouthful of milk, but not want to swallow it).
Cold, semi-solid food appear to be useful in the early post-operative period. Formula feeding parents often opt for yoghurt and custard type foods. If you are breastfeeding or expressing, it is also possible to thicken milk by mixing it with other foods – pureed fruit and breast milk, for instance1.
Your baby will have a drip shunt in hand or foot during surgery, and this is generally left for the whole hospital stay. If your baby should refuse food, then there is always the possibility that your child be drip fed if necessary. Most babies have some reluctance to feed after cleft surgery and your baby will probably lose some weight. Your baby will be under medical observation in hospital and your paediatrician or the nurses can control that your baby is taking in enough fluids to maintain hydration. Your baby will soon bounce back and regain any weight lost.
If your baby is feeding less frequently, or less effectively, than usual, or you are pumping less frequently than usual, beware of the signs of engorgement and mastitis (hard or hot areas of the breast, overfull, uncomfortable sensation in breast, tightness, fever or flu-like symptoms). If you are unable to pump or nurse, then going to the bathroom and expressing some milk directly into the hand basin to temporarily relieve the pressure, is one way of avoiding engorgement. If you feel any hot, hard areas in your breast then hot compresses before the feed/pumping session, as well as massaging the breast while pumping/feeding can help relieve the engorged area2.
Less frequent, less efficient feeds and/or pumping sessions while in hospital, along with anxiety and stress may lead to a temporary reduction in your supply. Once your baby begins to recover from surgery, he or she may have a rather sudden increase in appetite, just when your supply is low. If you have a stored supply of frozen breast milk, this could be useful while you work on increasing your supply.
Frequent breastfeeds and/or frequent pumping sessions will increase supply again. Getting plenty of rest (a baby moon, where you spend a few days at home in bed or on the couch with your baby, dedicated to cuddling, resting, breastfeeding and/or pumping is one way of increasing supply). All of the suggestions for maximising milk supply (link) are applicable here.
If your baby is reluctant to latch on again, due to pain, or because of the changes in their mouth anatomy, then you may need plenty of patience and perhaps professional support. If your baby has had palate repair and your baby is learning to breastfeed for the first time, then this will be a particularly delicate moment for you. I will write an article specifically about this in the future. The Australian Breastfeeding Association’s booklet3(link) has quite a detailed account of a baby learning to breastfeed for the first time at 7 months.
Further reading ‘One cleft is not like another’
1. Herzog-Isler C., ‘Breastfeeding a baby with cleft lip and/or palate’, (CD) Atti della XI Giornata dell’Allattamento, LLL, Trevi, 15 Maggio 2010.
2. Wiessenger, D., West, D., Pitman, T., La Leche League Int., The Womanly Art of Breastfeeding, 8th ed., Ballantine Books, 2010