3. Latching and positioning

3. Latching and positioning

A baby with a cleft lip may feed better with the cleft positioned toward the breast. This may mean using a rugby hold on one breast and cradle hold on the other. In the ‘laid back position’ you can encourage the baby to position more weight on the cleft side of the body. Some mothers recount that holding the baby’s cleft closed with their fingers also helps. The ‘laid back’ position1,2,  or baby led latching 3 may also help the baby latch on more effectively and, as the baby’s is practically face down on the breast may help create a seal. This position also leaves the hands free to help position the breast tissue in the cleft, do breast compressions if necessary. (I haven’t seen the laid back position used with a cleft baby – would love to hear feedback on this).

If the baby is having difficulty breastfeeding, some of the techniques described below may be useful.

Cleft of the soft palate

This mother demonstrates how she positioned her baby for breastfeeding (add other comments)

If the baby is latching well, it would be possible to monitor carefully the baby’s weight gain, use breast compressions1,4,5   during feeds to help baby transfer more milk, express milk after feeds to stimulate the milk supply and supplement the baby with this expressed milk, if necessary. The baby can be supplemented at the breast using a plunger type supplementer crafted from a syringe and fine tube (many IBCLCs and midwives know how to craft these), or a purchases Lact-Aid or SNS system.

Cleft of the hard palate or complete cleft lip and palate

As above, if the baby is latching well, the baby can be helped to get more milk by using careful positioning, breast compressions,  and an at-the-breast-supplementer (either hand crafted plunger type supplementer) or a purchased system such as SNS or Lact-Aid (where there is no suction formed by the baby’s sucking, the SNS or Lact-Aid will need to be modified. Lact-Aid provides instructions for this (basically, inverting the system to make use of gravity) and the SNS can be modified by making a small hole in the bottle to improve flow (equalizing the inner/outer pressure more rapidly).

Further reading ‘Expressing milk’

1. Wiessenger, D., West, D., Pitman, T., La Leche League Int., The Womanly Art of Breastfeeding, 8th ed., Ballantine Books, 2010

2.Colson, S., An Introduction to Biological Nurturing, Hale Publications, 2010

3. Watson Genna, C. (ed.), Supporting Sucking Skills in Breastfeeding Infants, 2 ed. Jones and Bartlett Learning, 2013

4.  Newman, J., Pitman, T., The Ultimate Breastfeeding Book of Answers, Three Rivers Press, USA, 2006

5. Newman, J., Kernerman, E., ‘Four-day-old after tongue tie release with breast compression’, DVD, Breastfeeding Inc. http://www.breastfeedinginc.ca/content.php?pagename=vid-4dayold (accessed 19.07.2013