Why is  at-the-breast feeding with a cleft lip and palate so elusive?

Why is at-the-breast feeding with a cleft lip and palate so elusive?


Up until recently, whenever I spoke or wrote about breast feeding with a cleft lip and palate, I would warn parents that it was unlikely that their baby would breastfeed exclusively at-the-breast, as breastfeeding literature suggests. I have always been extremely wary of creating false hopes  having spoken to many bitterly disillusioned mothers over the years, but, from my own experience, I know that my own daughter, born with a unilateral cleft lip and palate (UCLP) became quite adept at latching and triggering a let-down reflex by the time she was three months old. There is also a medical study, from the Srinagarind Hospital, Thailand (2010), which maintains that exclusive breast feeding at-the-breast with a cleft lip and palate is possible. Until now, besides my own experience, and having read the Thai study, I didn’t have any personal accounts which supported my belief that exclusive breast feeding with a cleft lip and palate might be possible.

Recently, though, I have been coming across positive accounts of at-the-breast-feeding with a cleft lip and palate (also cleft palate here). The mothers who have recounted their experience confirm the method indicated in the Thai study. Mothers have recounted creating a breast ‘sandwich’ and positioning the baby firmly against the breast. In the Thai study, the babies were positioned in an upright position, the mothers I have heard from have recounted using the cradle hold and rugby hold in order to position the cleft (in unilateral cases) and with the cleft positioned against the breast  ie. left hand cleft; cradle hold at right breast, rugby hold left breast so that the cleft is positioned on the underside of the breast, pressed against the breast tissue.

From parents’ accounts, breast feeding intentions seem to come ‘undone’ when the breastfeeding parent lacks support, receives criticism, is made to feel guilty about time spent feeding, is unsure about how and whether to continue, or enters what I call ‘the dark tunnel of breastpumping’. Dr Jack Newman has written that “pumping to increase milk supply can be very overwhelming for the mother”. I believe, from my own and other parents’ accounts, that providing a full supply of breast milk via pumping is even more overwhelming for a breastfeeding parent who is also learning to latch a baby with an anatomical impediment such as a facial cleft (along with the medical visits and decisions that parents must make).  Mothers have often recounted choosing to concentrate their efforts on the pump over their attempts at latching/breastfeeding sessions as they find it impossible to sustain both. Should we be taking this into account when discussing exclusive breastfeeding with a cleft lip and palate?

Should we be taking a look at breastfeeding with a cleft lip and palate from a different perspective? Could it be that breast milk expression, up until now,  has been an impediment rather than a solution to breastfeeding where there is a facial cleft? Could the lack of ‘successful’ or positive breastfeeding stories and cases with a cleft lip and palate be due to a lack of support and expertise rather than an inherent inability? Should we be increasing expert breastfeeding assistance in the early postpartum period as the Srinagarind Hospital has done?

I look forward to hearing comments at the end of this post. Personal accounts are also gladly accepted here.