Can I really breastfeed my baby with a cleft lip and palate?
I spend a lot of time cleft parent message boards listening out for breastfeeding stories and something I often hear is “Can I really breastfeed my baby with a cleft lip and palate?” and the answers are often along the lines of, “I couldn’t breastfeed, I pumped”. So many cleft parents are bitterly disappointed about their feeding experience with their cleft affected child, despite having gone through hoops in order to feed that child, that I have begun to wonder about what contributes to this – whether we have developed an all-or-nothing attitude to breastfeeding, and whether the way we talk about breastfeeding may not undermine the feeding experiences of many? With these questions in mind I decided to go on search to find the definition of breastfeeding and whether language, and overly rigid views of what is breastfeeding, may contribute to the formation of a commonly held belief that “babies with a cleft lip and palate cannot breastfeed”.
What is breastfeeding?
The World Health Organisation (WHO) defines breastfeeding as;
- Exclusive breastfeeding – the infant receives breast milk (including milk expressed or from a wet nurse, may include ORS, drops, syrups (vitamins, minerals, medicines)
- Breastfeeding – the infant receives breast milk (including milk expressed or from a wet nurse) and solid or semi-solid foods, may include anything else: any food or liquid including non-human milk and formula (this definition may include exclusive, predominant and partial breastfeeding)
WHO definitions for infant feeding (WHO, 2008) (1)
Therefore, according to the WHO definitions;
- Feeding a baby expressed breast milk IS breastfeeding.
- Feeding a baby donated breast milk IS breastfeeding.
- Feeding a baby breast milk along with supplemental formula IS breastfeeding
Variations in breastfeeding
Let’s think about it this way – breastfeeding a cleft affected baby requires more work, both for the baby and the breastfeeding parent. The less extensive the cleft, the less that work will be noticed and the closer to ‘ordinary’ breastfeeding that experience will be. The more extensive the cleft the more work breastfeeding will be both for the baby and the breastfeeding parent and the further from ‘ordinary’ breastfeeding that experience will be.
What if we were talking about another congenital malformation or a neurological difficulty that affects the form or function of their lower limbs? Walking, initially, for this baby will require extra effort and won’t be as effective as a child without difficulties. Would you tell this child or his mother that he is not walking? Is that child is not really walking because they are using an aid? Is that child not really walking because they spend part or most of their his day in a stroller or wheelchair? If the parents thought that, would you be surprised and concerned?
- The parent who uses a supplementary nursing system is breastfeeding
- The parent who feeds expressed breast milk with a syringe, cup, spoon, finger feeder or bottle is breastfeeding
- The parent who uses a pump to express breast milk is breastfeeding
- The parent who supports their child and expresses milk into the baby’s mouth while the baby suckles, is breastfeeding.
Not only is this breastfeeding, this is breastfeeding the hard way. Some children walk the hard way. Some adults walk the hard way. Some older citizens walk the hard way. Some babies and their parents breastfeed the hard way.
Credit where credit is due
Those of us who have breastfed a non cleft-affected baby know that ordinarily, breastfeeding is a full time job in the early weeks and months – even when that baby leaves one or more hands free to use the computer, the phone, to eat a meal or engage with our older child. Breastfeeding a baby who has a cleft is that much harder. Breastfeeding a baby with an oral cleft will require more effort, and it may not provide many of those positive benefits of breastfeeding such as pleasure. Feeding a baby who requires extra care with positioning, maintaining the nipple in the mouth, and breast massage, expression or compression while feeding, is not easy. It may feel like work. Sitting at a breast pump eight or more times a day along with cleaning equipment and labelling, storing and reheating milk is quite an undertaking, all the more bewildering because we have little information and support on how to do it.
To say to a cleft parent, or to ourselves (if we are the cleft parent) that that baby is not breastfeeding because the baby requires assistance – then it just might make all that hard work seem futile.
How do cleft parents breastfeed their baby?
- Sometimes at the breast
- Sometimes with pumped milk
- Sometimes with an at-the-breast supplementer (with breast milk or formula)
- Sometimes with bottles, cups and spoons
- Sometimes by fortifying HM
- Sometimes with donated milk
- Sometimes with supplemented formula
- Sometimes with ease
- Sometimes with difficulty
Is this breastfeeding? Yes! Please don’t think of it as a lesser achievement. Future posts will continue to look at how to get your cleft affected baby to nurse more effectively, and whether it might not be possible to get rid of the pump entirely.
I haven’t answered all of the questions that I posed at the beginning of the post – I have only just begun this quest to explore why cleft parents are so often bitterly disappointed with their breastfeeding or feeding experience. If you have a unique breastfeeding story, or was told that you couldn’t breastfeed and would like to tell it here, follow this link, I look forward to hearing from you,
1. Questioning current definitions for breastfeeding research, Weiss-Neel, J., Boersma, S., and Kujawa-Myles, S. International Breastfeeding Journal 2012 (http://www.internationalbreastfeedingjournal.com/content/7/1/9 accessed 9.11.2013)