You'll find hundreds of files on cleft lip, cleft palate here on widesmiles.org.

This one is about: Successfully Breast Feeding Andre


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SUCCESSFULLY BREAST FEEDING ANDRE
by Judy DeSwart

Andre Marc was born on Sunday, 17 March, 1991 at 12:10 pm. I had had an uneventful pregnancy and had gained 37 pounds. It was a long 9 months (I don't enjoy being pregnant!) and Andre was 9 days late! He was born with the umbilical cord twice around his neck. More than half the placenta separated some time during the last four contractions - the four I used to push him into the world.

The obstetrician, who had been most supportive and consenting, was wonderful and said, "Your baby has a small birth defect. He has a cleft lip." and handed our beautiful 9 lb, 10 oz. baby boy to me - a third son.

He was quiet and alert and interested in nursing straight away. He nursed on and off, sometimes achieving good suction, other times not. But we were very closely cuddled together all the time until they moved us from the birthing room up to the post-natal ward. Our delivery nurse, herself a young mom of a 2-month-old boy, left us together as a family for much longer than the standard one hour and was very impressed at how Andre was nursing. I remember my first concern after seeing Andre's cleft lip was whether he had more birth defects. On noticing his gum line, which is also cleft, I wondered about his front upper teeth.

Andre has a unilateral left side cleft lip and alveolus. There also may be a submucosal bone cleft. The palate beyond this seems normal.

Prior to delivery I had done a lot of letter writing and organization with the staff and the pediatrician (not our regular pediatrician) to ensure that our newborn baby and I would have a minimal amount of separation, and that no supplemental feedings be given. I requested 24-hour rooming in. We arrived at the compromise in connection with the initial observation period. Instead of the customary 4 - 6 hour observation period in the nursery, our newborn would be in the nursery for observation for only 2 hours. So Andre Marc was brought to me after 2 1/2 hours. I had to stand my ground because an initial response was, "No, he has to be in the nursery." But a quick referral to my letter resolved the problem. I was so pleased I had written because he had no glucose feeding and was spared many heel pricks for hypoglycemia.

He nursed often and for varying lengths of time, drifting peacefully off to sleep. (Note: Andre had a cleft of the lip only. His palate was intact, greatly increasing the probability that he could successfully breast feed.)

All my careful planning fell beautifully into place. Andre Marc never left my bed but for a brief period during a 7-8 pm visiting hour when all babies had to return to the nursery for security reasons. He was cranky so I was allowed to follow him and to nurse him in the privacy of a back room filled with incubators.

Once calm I could leave him to get a cup of tea and he joined his pals on display for all the visitors to see. I was as proud of him as ever. I saw right past his little lip. I've heard a very sad story about a girl who was not "displayed" alongside the other babies because of her cleft. How terribly sad for that poor mom. It was essential that they treated and admired my baby boy like all the others.

The nurses at Abington Memorial Hospital were superb - nothing but encouragement, care and concern for our well being. They admired my baby and I was asked more than once if I was "the lady with the special rooming in".

For the first 27 hours Andre and I did not nurse very well. He was calm and very patient with me. He had a lot of meconium stools that first evening. When he was weighed on the morning of day 1, he weighed 9 lbs, 2 oz. He'd lost 8 oz! Finally we got it right.

He seemed to know to tuck his head in real close and to curve his little back to enable himself to do this. He did not pull back like my other sons did when I held them too close to the breast. When he sucked his thumb it was as if he placed his fingers across the cleft. The best positioning on the left breast was very close in, pointing down into the breast (head pointing down toward my pelvis). My index finger held the areola away from his nose. My middle finger supported the breast under his mouth, lifting the breast and pushing it up and into his mouth, thus filling the cleft. His tummy was against mine, the nipple pointing toward his intact right side.

On the right breast things seemed to work out easier initially. The "football hold" on this side worked well. He now prefers the left breast much more and sometimes only nurses on the right when held in the "football hold".

I suffered a fair amount of breast and nipple soreness in those early days as we tried to find the most efficient nursing positions. Andre did not wait for a letdown reflex. He just sucked hard right away. Amazingly, my letdown reflex speeded up immensely.

As I said earlier, Andre was 9 lbs, 10 oz at birth and 9 lbs, 2 oz on day 1. On day 2 he was 9 lbs, 4 oz. I was delighted and terribly relieved. We went home on day 2 and on day 4 he weighed 9 lbs 8 oz at our regular pediatrician's office. By his 6-week check-up he clocked in at a healthy 12 lbs, 2 oz and had grown from 22" to 23 1/2" in length. He is still entirely breasted (at age 3 months) and feeds approximately 2 hours during the day. He is a fast nurser and only lingers at the breast during his fussy hours of the evening. Usually rocking puts him to sleep more quickly than long continuous suckling, which he does not seem to want to do.

He does swallow a little air but he burps easily. During the night time feedings (he still sleeps next to me in my bed) he nurses from both breasts while I stay lying on my left side. This position seems to offer the best positioning for nursing him. The only differences I see between nursing Andre and his brothers is I need both my hands on the job. He can't just "dangle on the end", to quote a friend of mine. Also, we can't nurse in the dark. We need a light on to see what we are doing. Finally, I need to crouch down really low to get nice and close to him, which can get tiring on my back. A cushion under Andre definitely helps.

In coming to terms with Andre's little birth defect, I can still say it certainly would have been a lot easier if he had not been born with a cleft. But I have always seen past it and do not even notice it. It's Andre.

Looking at him in a mirror for the first time made me really "see" his cleft lip. Yes, I did cry in those early days, and I remember telling my husband I was so ashamed that I had to cry about his little cleft (ashamed of crying, not of him.)

I think my constant telephone calling those early days and repeating over and over again that my baby has a cleft made it really sink in. They were difficult words to repeat and comprehend and connect to our beautiful newborn. I also went back to last year's diary to check what I was doing around the time Andre's cleft was forming.

I am apprehensive about upcoming surgery. I cannot visualize how he will look post-operatively. He will be allowed to nurse immediately when we get him back and will be allowed home the same day, all being well.

In conclusion my heartfelt thanks to all the tremendously helpful people I have spoken to over the phone throughout the country. The support and information have been incredible. I hope somehow I can contribute to another mother and her newborn. I also have La Leche League to thank, who have given me the guidance and know-how to nurse all my children. It is the experience I had with my other sons that gave me the perseverance to nurse our big, bouncing Andre.


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