Whether you choose to breastfeed or bottle feed, if in fact you have that choice...it is a highly personal decision. This cleftAdvocate page has been made possible through the joint efforts of several mothers of babies with clefts. Our sincerest gratitude to all those who participated in compiling this information!
One-on-one interaction on this and other cleft issues is available at the Family-To-Family Connection. Come meet real families with real solutions to the challenges you are facing! If you have a personal lactation story you'd like to share, we'd love to hear from you! Contact Kiku Collins for further information.
Article quotes the Cleft Palate Foundation and cleftAdvocate members
My child has a cleft. Will I be able to breastfeed my baby?
There is a lot of confusing and conflicting information regarding breastfeeding babies with cleft lip and/or palate. Some information says that breastfeeding babies born with a cleft never works, and sometimes you will hear that all you need is time and persistence. This conflicting information often leads to upset and frustration in mothers who desperately want to breastfeed their babies, despite their cleft.
Babies born with a cleft lip only (no palate involvement) are usually able to nurse with little trouble. The difficulty for mom is often in finding a position for breastfeeding that will make it easier for the baby to nurse. There are nursing pillows that may help solve this common dilemma. One is called My Brest Friend. It Velcros around your waist, holding baby in the correct position. There is also a pillow called the Boppy which will help support your baby on your lap. Some women find that using a footstool will help, too.
If your baby has a cleft palate (with or without lip involvement), this is where
breastfeeding information starts to get fuzzy.
Generally speaking, no matter what we may have read, most of us eventually come to the same conclusion...breastfeeding a baby with a cleft palate is very difficult. Have you ever tried to drink out of a straw with a hole in it? It's really tough...you often lose suction, or can't get any suction at all and you end up swallowing a ton of air in the process. Because the palate is what allows for suction, when there is a hole in it, most of the time adequate suction for breastfeeding can't be achieved.
There are, however, many women who have had breastfeeding success after their child's palate repair. Some use special bottles and other feeding alternatives before the repair and try a supplemental feeder after surgery.
The Lactation Institute in Encino, California has had unique breastfeeding success with these babies. The mothers feed their babies with a periodontal syringe at the breast. The babies think they are being breastfed, when in reality the milk comes from the syringe. After palate repair, the babies go back to their regular feeding method at the breast with the syringe. Within a few weeks, the stitches dissolve and the baby's mouth is healed and he/she is able to breastfeed without the syringe.
The syringe-feeding method taught at the Lactation Institute is complicated and time-consuming. But if you are truly committed to breastfeeding your baby, and willing to make the effort, it's extremely rewarding and it works! Many moms and babies, after consulting with the Lactation Institute, have gone on to be happy breastfeeding couples for a long time after palate repair.
Every now and then you hear about a woman who was/is able to breastfeed her baby with a cleft palate before surgery with no problem. Though this is not common, don't be afraid to try it...you and your baby may be the exception to the rule! Contact a lactation consultant who is experienced with this specialty, or who is willing to do her homework.
If breastfeeding my baby is not working, how can I assure he gets mother's colostrum and milk?
I'm feeling a huge sense of loss because my baby and I can't have a normal breastfeeding relationship.
Many mothers-to-be anticipate the wonderful bonding process of breastfeeding. You may have breastfed your other children, or this may be your first baby and you were excited about breastfeeding. You may have known about your baby's cleft through ultrasound, or been completely surprised by it at his birth. Some moms aren't bothered at all by the inability to breastfeed their baby. They are happy to pump breast milk or use formula for the baby, and are able to move beyond the loss quickly.
However, there are mothers who are completely devastated by the loss of the breastfeeding relationship, and perhaps you are one of them. You desperately search the internet and all your paperwork from the cleft team hoping for some breastfeeding cure-all that you must have overlooked. You go to every lactation consultant in your city, only to discover none of them know how to help you.
You are not alone. Many moms before you have grieved the same loss. La Leche League groups can be helpful, even if you aren't breastfeeding in the traditional way. Your La Leche group leader may be able to introduce you to moms who have had similar breastfeeding difficulties, or those who are also pumping. Remember, if you are willing to take the time, and be persistent, the techniques described above used by the Lactation Institute in California have been very successful. They have a proven program for helping mothers breastfeed their babies with clefts. If you are determined to breastfeed your baby, this is the place to call.
I've heard that some women "mimic" breast feeding with a tube. Does this work?
Some mothers have found the supplemental nursing system LactAid to be beneficial when attempting to breastfeed a baby with a cleft palate and/or the inability to suck. The system is comprised of a container of milk connected to a tube which the mother tapes to her breast. The milk travels through the tube by what is described as a "gravity assisted flow". The flow can be adjusted for babies with a complete lack of suction, allowing mother to find the best speed and volume for her baby. The breastfeeding mom can choose whether to pump her own breast milk and use it to fill the container, or to use formula. In addition, mothers will typically have to supplement feedings using a cleft palate bottle system to ensure adequate weight gain.
What types of pumps are out there, and which one should I get?
There are many types of breast pumps on the market today. The strongest and most reliable are the hospital-grade pumps. They are made for long-term pumping, and will generally have a stronger suction and be more comfortable for pumping.
The two most common hospital-grade breast pumps are the Medela Lactina and the Medela Classic.
The Lactina is the pump most commonly rented out. The Classic is not as commonly rented out, but is usually available at the hospital for your use while you are there. You may have to check around to find a rental of this model. They are both great pumps, and are excellent choices for babies who can not breastfeed. The Classic is a little stronger and perhaps has a smoother pumping motion; however the Lactina is easier to transport in most mothers' opinions.
Both of these pumps need a universal pump kit. The pieces in the pump kit convert to a hand pump, so be sure to save them! Often, if you rent a breast pump for several months up front, you will pay less per month. Ask your lactation consultant which model will be best for you and your lifestyle. Remember to tell them that you will be exclusively pumping and that there will not be any physical breastfeeding.
The next category of pump is the double electric consumer model. These usually range from $100 to $250. They are very similar to the hospital-grade pumps, but are generally not as strong. These pumps work very well for some women, but if supply issues or nipple pain are involved, this style may not be for you.
The Medela Pump in Style is a very popular model which also comes in a backpack style called the Traveler,. Another choice is the Ameda Purely Yours. Most of these pumps have a cigarette lighter adapter, so that you may even pump breastmilk in your car! Be sure to get one that "auto cycles". Some double electric pumps require that you roll your finger on and off a hole on the top of the pump flanges. This can be difficult to do properly, and can get tiring for a mom who has to pump frequently. They are not always covered by insurance, though in some cases if you are in a low-income situation, you may be able to obtain one for free or very low cost. Check with your state. Some women who pump full time have had issues with the motor "burning out", but many have great success. This may be a good option if you do not have a Durable Medical Equipment (DME) rider on your insurance plan and hope to pump for a while, as rentals can be as high as $50 per month.
There are also smaller single electric pumps. These pumps are not recommended to moms who are pumping full time, as they can be very harsh on your breast tissue and nipples. It's also quite a strain on such a little machine, so these pumps aren't known for their longevity! If it is battery-driven, you will probably spend enough in batteries to have rented a hospital-grade pump. This is a good pump for women who need them for only a few hours when they are away from home.
Hand pumps are a nice option for outings. There is one very effective hand pump that gets rave reviews over and over called the Avent Isis. It is a single hand pump which has a "petal" insert. It massages the breast tissue and mimics (sort of) the motion and softness of a baby. The problem with using this pump full time (though some have with short-term success) is that not only will your hand and forearm get tired, but it's very hard to cycle your pumping to mimic the rhythm of a baby sucking. Also, since you aren't pumping both breasts at the same time, it will take much longer to pump than if you were using a double pump. However, because of its compact size, this is a great "toss in your bag" pump. It is advisable to purchase a second pump kit, so that you don't find yourself in a perpetual wash cycle. It is also smart to have a large supply of bottles. Most pumps will connect directly to standard baby bottles, therefore making it simple to cap when done, or affix the nipple onto the bottle for the next feeding. The Mother's Milk Mate is a great little contraption for pumping moms. It's a metal rack that sits in your freezer to hold milk bottles. Ten 5 oz. bottles come with it, and roll down as you take a bottle of frozen milk out, ensuring that the oldest milk is used first. You can also pump directly into some breast milk freezer bags, though not everyone is comfortable with that method since it may not feel as steady as a bottle. Medela makes a breast milk freezer bag that attaches directly to the flanges, as do other manufacturers. A very good breast milk freezer bag (that does not attach to the horns) made by Gerber is called Seal 'n Go. It is a Ziploc-style, so once you fill the bag, you zip it shut, and lay it flat in the freezer. This way, you will end up with "milk bricks". Don't forget to label them with the date and time! Once they're frozen solid, you may want to sort them into different, larger Ziploc bags and mark those. This is a good space-saving method if you have a small freezer or a big supply!
Will my insurance company pay for my pump purchase or rental?
As the mother of a child who is possibly physically unable to breastfeed, you should check your insurance plan for a Durable Medical Equipment (DME) rider. This will enable you to be reimbursed up to 100% of the rental cost for the duration of your rental. This cost normally does not include carrying cases, bottles (except for those included with the kit), freezer bags, etc., but does include the pump itself and one accessory kit (horns, bottles, and lids for storage). Medela offers these tips for getting your pump paid for by insurance.
One of the best ways for you to have your pump paid for by insurance is to go through your pediatrician. He or she understands the importance of breast milk, and will be a great advocate for you and your baby. Pediatricians' offices can work the pump rental like a referral, similar to a referral to a physician, but for medical equipment. Often this can take a week or more, but it's well worth it. Some insurance companies will purchase the pump for you, others will rent. It's best to try and have this done while your baby is still in the hospital. Insurance companies will pay for a breast pump while your baby is hospitalized. It's when your baby is at home that they can often be difficult.
Can I pump hands-free, so that I may do other things with my time?
When pumping full time, you'll find that more of your time is taken by this machine than you originally thought! Of course you'd like both hands free, to read a book, type on your computer, surf the net, talk on the phone so how can you achieve that when you're holding two plastic flanges attached to bottles to your breasts?
There are several ways to pump hands-free. There are now special bras made just for the pumping mother who wants that kind of freedom. They hold the flanges snugly in place so that you can attend to other things. Some women have used regular nursing bras and just snapped the "flap" over the flange. The athletic nursing bra seems to work well because of the firm, stretchy material. Some women simply put large bottles onto the flanges and prop their feet up so that they may rest the bottles on their thighs! It actually works very well for computer users! Be careful, though, many a pumping mom has dumped full bottles in her lap because she "forgot" she was pumping...or fell asleep!
Which bras work well when pumping?
Of course, you don't have to wear a nursing bra, especially since your pump doesn't start crying in the middle of the supermarket to be fed! You can usually control your pumping situation to a certain degree (like locking yourself in a bathroom stall or sitting in the car). It can, however, make access to your breasts easier if you wear a nursing bra. One suggestion for leaking is nursing pads. They come in disposable and reusable styles. Some pads look very natural under tighter clothing, others are made more for the heavy leakers, but may look less natural. Experiment to find what works well with your body, style and flow!
How often should I pump?
Some women find that when they first start pumping they have plenty of milk for their baby, so they relax about the schedule and pump when the feel like it. Those early months, because your baby eats much less than you pump, is the best time to build up a large supply of frozen milk. Cutting down on the number of pumps greatly affects your supply, especially in the beginning.
Most women agree that every 2 to 3 hours is a good schedule until your supply is well-established. It seems like a lot, but this is how often babies eat! As your baby grows bigger and eats larger, less frequent meals, your pumping can follow suit. Of course, if you stay on a strict schedule as you did in the beginning, you may be able to build up a nice freezer stash, and keep feeding your baby breast milk only, instead of supplementing with formula.
When you are pumping with a double pump, you need to pump for at least 10 minutes each session. This will ensure that you are sufficiently stimulating your breasts as your baby would. The more you pump, the more milk you will make. Double pumping increases blood prolactin levels which is an added boost to pumping moms and double pumping will encourage more milk to eject during the milk eject reflex.
Why does one breast produce more milk than the other?
Nobody is perfectly symmetrical, and this includes your breasts. One breast usually produces more milk than the other.
What are the general guidelines for storing my breast milk?
According to La Leche League, expressed milk can be stored at room temperature (66-72F, 19-22C) for up to 10 hours, in a refrigerator (32-39F, 0-4C) for up to 8 days, in a freezer compartment inside a refrigerator (variable temperature due to the door opening frequently) for up to 2 weeks, in a freezer compartment with a separate door (variable temperature due to the door opening frequently) for up to 3 to 4 months, or in a separate non-frost-free deep freezer (0F, -19C) for up to 6 months or longer.
Refrigerated or frozen milk can be stored in hard plastic or glass containers with well-fitting tops, or freezer milk bags that are designed for storing human milk. Disposable bottle liners are not recommended for storage. Freeze milk in small amounts, 2 oz is best with a new baby. It will make for easier defrosting, and less waste.
You can add to milk that is already frozen, but be sure to chill the new milk first in the refrigerator. Adding warm milk to frozen milk will make the top layer of frozen milk defrost and can lead to bacterial growth. Fresh breast milk is better for your baby than frozen, so if you know that you will need to feed your baby soon, store it in the refrigerator.
How do I warm my breast milk?
Thaw or heat the bottle under warm, running water. Do not boil the milk and do not heat it beyond normal body temperature. Shake before testing the temperature. Shaking will redistribute the cream into the milk. Also, it's not advisable to use a microwave oven to heat your milk. Microwaves can weaken the infection fighting factors in breast milk.
What about thawing breastmilk?
Milk that has been frozen and thawed can be refrigerated for up to 24 hours. It should not be refrozen. It isn't clear whether milk that is left in the bottle after a feeding can be safely kept until the next feeding or if it should be discarded.
How can I pump when I work?
Many mothers have at least their lunch break to pump, and one or two other short breaks during the day. Providing breast milk is a serious health choice for both mother and baby, and there are significant advantages to continuing breastfeeding once you go back to work. Breastfed babies are less likely to get sick in the first year of life than those who are formula fed. This means that mom doesn't miss as much time from work. Some states have enacted legislation to encourage breastfeeding by state employees.
The frequency with which you need to pump depends on the baby's age and how often you are able to pump in your workplace.
Mothers vary widely in their ability to produce milk. Try to relax as much as you can while expressing at work, think of your baby, and be proud of whatever you produce...it will provide excellent nutrition and immunities, even if you also need to supplement. Since time is in such short supply for a working mother, pumping with a double pump is ideal. By double pumping, mothers keep their prolactin levels up, and they can usually finish in 10-15 minutes.
As for storing your milk at work in a common refrigerator, the US Centers for Disease Control and the US Occupational Safety and Health Administration agree that human milk is not among the body fluids that require special handling or storage in a separate container, according to La Leche League.
How can I approach my boss about pumping during work hours?
You might be surprised at her or his reaction! It's much more common these days for new mothers to be pumping milk at the office. Some businesses actually set up a "lactation room" for their employees! They range from a dingy little (but private) room, to a lounge, complete with sink, water cooler, refrigerator, and sometimes even a hospital grade pump so that you only need your own personal attachments!
Arm yourself with some information if necessary. Your lactation consultant or La Leche League can help. They will also know your rights in your state.
When I'm not home, where can I pump?
You have many options here. You can pump in your car, a bathroom stall, or a park bench...anywhere you would breastfeed your baby. Most pumps have battery packs and/or car adapters available for you to use. Some of the high end chain bookstores (Borders, Barnes and Noble) have really nice bathrooms. You'll become an expert at spotting these places.
You can also wear a nursing shirt. Most maternity stores sell these. It's possible to position the flanges so that only the very ends stick out when you're pumping. Also, First Years makes a nursing cover-up that may interest you. The main obstacle in pumping away from home is finding a place where you're comfortable enough to be able to do it.
Why am I'm feeling pain in my breasts/nipples?
A mother with a sore breast may be told she has a breast infection, mastitis or a plugged duct.
A sore breast can occur when the milk flow is blocked. You may notice a tender spot, redness or a sore lump on your breast, which usually indicates a plugged duct. This condition comes on gradually, and there may be redness or a hard spot in that area of the breast.
Milk flows through a duct system in the breasts. If an area of the ducts becomes blocked, the milk is blocked. The breast may or may not be red in that area. The breast is usually tender and painful. The location of pain and hardness may change in your breast. If the blockage is not treated, the area may become infected.
If your breast soreness is accompanied by a fever and or flu-like symptoms, you may have mastitis, a breast infection. Mastitis can come on suddenly, and your breast may be red hot and swollen. The pain is intense, but localized. Frequent pumping or feeding will reduce inflammation and encourage opening of the blocked area. Mastitis is the first sign that a mom may be doing too much. Rest is a very important part of the treatment for mastitis. Plan to spend a few days in bed, or at least off your feet, eliminating all unnecessary activities. An antibiotic may be needed to treat for mastitis if your fever has not disappeared within 24 hours or if your fever suddenly increases. As always, check with your doctor.
One very good way to help treat this condition is to pump or nurse frequently, emptying the breast as much as possible, massage the sore areas, apply heat to the areas, and rest! Frequent pumping can reduce inflammation and encourage opening the blocked area. Taking warm showers or baths and gently massaging the sore breast seems to help, as do warm compresses. Remember also that the milk expressed during these times is fine for the baby due to the antibacterial properties.
To help prevent this condition from happening again, pump frequently and try to empty the breasts as much as possible. Look at the bra you are wearing: if it's tight or has underwires it may be part of the problem.
Another problem may be the flanges you're using - they come in different sizes, but every pump comes with a "standard" pair, usually with smaller inserts if you need them. Your lactation consultant can help you determine the proper fit.
Lanolin products made for sore nipples are wonderful. Lansinoh is a product that is safe for baby, so you don't have to rinse it off before coming in contact with your baby or the pump. Some women will also moisten the flanges with Lansinoh, or will hand express some breast milk and use that to moisturize.
Can I go on a diet to lose the baby weight while I am pumping?
Many women are anxious to lose the "baby" weight after childbirth. Just remember that your pregnancy weight wasn't gained overnight, so it won't disappear overnight. You actually gained that weight so that you would have plenty of reserves for feeding your baby. Breastfeeding burns about 500 extra calories a day (more or less, depending on your supply), so you are working at losing weight every time you pump!
It is safer for you to wait at least two months postpartum to purposely lose weight, so that your body can recover and establish a good milk supply. Check with your doctor about increasing your activity level and reducing your caloric intake, but remember...you need calories to produce milk! Weight Watchers has a program especially for the breastfeeding mother, but please check with your doctor first!
As far as exercise, it is advised that you wait until the baby is at least six weeks old or more. Start exercising slowly and gradually, and consume liquids to replace those lost through perspiration. Walking briskly, mild aerobic exercises and water exercises are some good ideas. Later on, add swimming and aerobics. Don't wear yourself out though! You have plenty of other stuff to concentrate on as a new mother!
Should I be concerned about food allergies?
Painful, unhealthy allergic reactions are no fun for baby or you, and are potentially very dangerous. Diarrhea, a sore bottom, runny nose and/or eyes, rashes, eczema, or a crying, sleepless baby can result from food allergies.
If allergies present themselves on either side of the family, it is better to avoid the foods you or the baby's father is sensitive to. If you have a dairy intolerance, proteins from cow's milk present in your own milk can cause problems for your baby. Hopefully your baby will not be sensitive to these foods later on, and breast milk is thought to help prevent allergies, since it lessens the baby's chance of becoming sensitized to the allergen.
Dairy, wheat, citrus, corn, nuts (especially peanuts) and shellfish are among the top contenders for food allergies. Try cutting these out of your diet and see if your baby feels better. It may take up to ten days for it to clear out of baby's system, so be patient.
Don't rule out allergies to supplements. If you or baby are taking taking iron, or you are consuming products with preservatives or artificial coloring, they may be the culprit. Speak to the pediatrician about supplements for your baby.
Caffeine may cause a cranky, sleepless baby. Try to decrease your intake of coffee, tea and chocolate, and see if this helps. It's tough getting through life as a new mother with so little sleep, but just remember to nap with baby and have friends clean your house...or just leave it like it is...other mothers will understand!
My supply is low. What can I do?
Supply is an issue for many women, whether they are breastfeeding or expressing milk for their baby. Make sure you get plenty of rest when you can, drink plenty of water, and eat properly and abundantly, although we agree that it is sometimes easy to forget a meal when you have a newborn on your hands!
Double pumping both breasts at the same time simulates the tandem nursing that moms of twins use. Some women find that their body makes more milk when it thinks that it has two infants to feed. There are some prescription medications available to help with supply. Talk to your doctor about the possibility one of these medications may work for you.
There are a few good tricks to encourage your breasts to produce more milk. All Medela pumps come with two small "flange inserts" that fit inside the flanges of your breast pump. Pump for 7 ½ minutes (half of 15 minutes) without the inserts in, then pump for the remaining 7 ½ minutes with the inserts in. The inserts will stimulate different areas of your areola, and will help more milk to eject. Before you put the inserts in the flanges of your pump, there is a great procedure for assisting the milk ejection reflex called Massage, Stroke, Shake ("Getting More Milk When Pumping" article from LLL). There are also some anecdotal supply boosters. Fenugreek is an herb that helps some women with supply issues. Talk with your doctor before taking this or any other herb or medication. There may be links to peanut allergies, so use caution! It usually comes in pill and tea form, and will leave some women with a maple syrup smell (and perhaps some pancake cravings!). A tea often found in health food stores, called Mothers Milk Tea, can help boost on a low-supply day. It contains Fenugreek among other herbs.
Try pumping after you shower, while listening to calm music, or while holding something your baby has worn close to your face (mmm, new baby smell). Make sure you have plenty of protein in your diet. Drink milk to replace the calcium your body is giving to your baby. Many mothers don't know that a bedtime snack is very important to supply. A sandwich and a glass of milk before bed is just what your body needs. And don't forget that water! Carry a bottle of water with you at all times.
Other possible supply boosters, based on information shared between nursing mothers, are oatmeal (or anything containing oats like cookies, granola bars, even oat milk), and fish (especially in soups - this is a popular Asian remedy). Will they work? If there are no contraindications for you or the baby, give it a whirl!
Can I take medications?
Definitely check with your doctor and research any medications you are even thinking of taking, even ones available without a prescription, including herbal remedies. Your doctor needs to know that you are expressing milk and that you want to continue doing so. A few things to consider:
An older baby who is breastfeeding less frequently may consume smaller amounts of breast milk, and consequently would have less exposure to medication through mother's milk.
A medication prescribed for infants is usually a good choice for mom.
A medication that has a history of use by breastfeeding mothers is a better choice than a new or untested drug.
The duration of the therapy can affect its compatibility with breastfeeding.
A medication considered compatible with breastfeeding short term might not be compatible when taken over a long period of time.
Some drugs can affect the milk supply.
I'm sick. Can I still give my baby the milk I'm expressing? Should I stop pumping?
If you stop pumping, your supply will take a nosedive and possibly come to a near halt, depending on the length of your pump hiatus. Mother's milk is usually fine when you are sick. The common cold, most infections, and chronic conditions like diabetes are usually fine, though of course you should ask your doctor. Your baby is exposed to illnesses you have before you even know you are sick, and when your body is making antibodies to fight illness, they are passed directly into your milk!
In rare cases, a doctor may recommend weaning due to a mother's medical condition. Most conditions, however, can be treated while expressing milk. Talk with your doctor to develop a safe course of treatment. Always think of both your needs and the needs of your baby.
May I drink alcohol?
Moderate to heavy alcohol consumption may interfere with the let-down reflex. Since what mother consumes does make up parts of the breast milk, alcohol may affect infant motor development. It may also cause slow weight gain, as well as other side effects. Check with your lactation consultant, La Leche League, OB/GYN, midwife, or pediatrician.
The American Academy of Pediatrics considers alcoholic consumption compatible with breastfeeding, although harmful side effects are noted if alcohol is taken in large amounts.
Will breast milk help keep my child well?
We all know that painful ear infections are an unfortunate condition associated with clefts. Breast milk has been shown to help prevent ear infections. While it is not the cure-all, it certainly can help somewhat, and perhaps the degree of infection will lessen while your baby is consuming mother's milk.
The antibodies present in breast milk, made by your body's immune system, are the very same molecules that help you fight illnesses. At birth, immune systems are immature, with less ability to fight off germs. Through breast milk, your baby receives immunities to illnesses to which you are immune or have been exposed to. If you are exposed to bacteria or viruses, your body will make antibodies against them, which will be in your milk. This includes things like flu shots.
Breast milk also contains a host of other immune molecules that also help protect your baby from germs. It is thought that the immune system of a breastmilk-fed baby develops more rapidly than in a baby who is not fed breast milk. So remember, even if you don't pump long term, know that you have done the best you can for your baby! There are plenty of folks out there who were raised on formula only and lead very healthy lives!
I have been diagnosed with Post Partum Depression. Should I still pump? Should I take medication?
There are some PPD medications thought to be safe while breastfeeding. Talk to your doctor and together, you can be the judges. Don't forget that pumping literally sucks the energy out of you (since calories are energy!), so some women feel a rush of energy once they stop pumping. This is in no way an instruction for you to stop pumping if you're depressed, but something to talk about with your doctor and/or therapist.
My supply is great, but my baby is not gaining weight. How can we increase the baby's calorie intake?
Breast milk fortifiers are sometimes recommended to supplement the breast milk you lovingly provide your growing infant. When mixed with breast milk, these additives increase protein, calories, calcium, and other nutrients. Fortifiers are mainly intended for low-birth-weight infants until they reach a weight of approximately eight pounds, or as directed by a doctor.
Breast milk is considered by many to be the best food for infants because of tolerance and immunological benefits. Our babies born with clefts sometimes have a hard time feeding because of their anatomy; therefore we need to make sure they grow properly and consume enough calories and nutrients to remain healthy and reach developmental milestones.
Most breast milk fortifiers come in a powdered form, designed be mixed directly into the breast milk. Ask your doctor about these products if you suspect they might help with the development of your child. Never self-prescribe any type of additive for your baby...better to be safe than sorry!
I'm making so much milk, there's no room in my freezer for grown up food! What should I do?
While this is not a common complaint of pumping mothers, it does happen. If you happen to be one of the lucky ones who doesn't have to worry about supply, consider purchasing a separate freezer, that is if you have the space and the use for it later on. If that is not an option, perhaps you can look into donating your surplus to a milk bank. There are very strict guidelines to become a donor. You may check some guidelines out at Mother's Milk Bank, but certainly call your local hospital and ask where the nearest milk bank is. They will be able to tell you their specific rules, and determine whether or not you are a good candidate for making this generous donation. Overall, be happy that you have such an abundant supply! With all of the milk in your freezer, you may be able to feed your baby for a month or more on mother's milk after you've stopped pumping!
Lynne, mommy to MaryGrace, born with a cleft lip, said this about breastfeeding a baby with a cleft lip...
"I found the easiest way to help Mary Grace get the seal necessary for suction was to breastfeed her with the cleft side down. For us, this meant cradle hold on the left side and clutch (football) hold on the right side. My extra breast tissue filled in the cleft.
"I also learned to breastfeed with the cleft side up using my finger to plug the hole, but I found this position to be awkward. I also needed to compress my breast (fingers on bottom thumb on top to make a breast sandwich). I would then latch her on at an angle so that the breast filled up the cleft.
"Additionally, I used a My Brest Friend nursing pillow. It would Velcro snuggly around my waist to hold her in the correct position. I found that it worked better than lots of regular pillows especially when traveling. After surgery we had to relearn to breastfeed, like a baby without a cleft. Only her lip was corrected, she still has a cleft of the alveolar ridge but it does not affect breastfeeding."
Kelly, mom to Blake, born with a cleft palate only, said this about breastfeeding her baby...
"Learning to feed him with a periodontal syringe was tricky. I used a Boppy nursing pillow to support Blake on my lap, and a footstool to raise my lap up higher. I'd squish my breast up, thumb on top fingers underneath, and use my other hand to hold the syringe in the corner of Blake's mouth. When he sucked, or made his feeble attempts to suck, I squirted a little milk in his mouth. It wasn't "real" breastfeeding, but he thought it was, and I was glad that we were on the right road.
"Blake had his palate repair at 6 ½ months. Four weeks to the day later, Blake breastfed on his own."
Kiku, first-time mother to Tani (who was born with a bilateral cleft lip and palate), knew in the fifth month of pregnancy that she would face much more than she bargained for...
"I had my heart on breastfeeding. I never pictured anything else, at least for the first few months. When I found out about Tani's cleft, I was very upset for about 3 days, knowing nothing about clefts. I searched around and educated myself, and called a lactation consultant who encouraged my instinct to want to provide breastmilk.
"We spoke of pumps and the methods of pumping. We also spoke of the possibility of breastfeeding, which I decided was not a good option for me, considering the stress that would probably be involved.
"When Tani was born, my LC came to me in the hospital with a Medela Lactina rental pump and taught me how to use it. She also showed me the Medela Classic, which was available for use in the hospital. I tried both and found the Lactina to be more productive and comfortable. I pumped for 9 months (though my original goal was 3), only stopping because of medication contraindications.
"It became such a routine in my life. I belonged to an online support group called Pumpmoms through Yahoo. Mothers from around the world shared pumping, supply, storage, and emotional secrets. I had a freezer chock full of mother's milk, and Tani went on for another month without formula! Tani has had no ear trouble to date, which all of her doctors are surprised and pleased about. They do credit breast milk as being very helpful at preventing these problems (though not the cure-all).
"My husband Jason was wonderful throughout this experience. He would often prepare and wash the equipment, as well as feed Tani. Although it was hard to do, I will never regret it. I even worked my freelance job starting at 6 weeks postpartum while pumping! When I needed to pump outside of the house, my Avent Isis was wonderful. We went to the hospital at least once a week for the first four months to have Tani's Nasoalveolar Molding Device (NAM) adjusted, and sometimes we were out for hours. It was wonderful to be able to disappear for 10 or 20 minutes and come back with another bottle for her".
Cat, mom to Darren AKA "The Devious One", tells of the surprise in the delivery room that made her question her ability to provide her son with breast milk...
"When Darren came along, we had no knowledge of his cleft lip and palate. Throughout my pregnancy, I had my heart set on nursing him. But when it came closer to my due date, my husband and I were talking about whether we should stock up on formula, just in case. Why, you ask? We were about to make a major move to Alaska, and for that reason, we'd thought about keeping some formula on hand just in case.
"Darren made his appearance in February, and little did we know what we were in for. I was depressed after I'd found out about the cleft lip and palate, and confused on the subject of breastfeeding or pumping, although our doctors all recommended it. It wasn't until I saw little Darren in the NICU for the first time that I revisited my desire to give Darren breastmilk. I met Liz Flight, the Lactation Consultant up at Bethesda Naval Hospital, and she reassured me that I could still pump. She gave me the equipment, and ended up convincing me to try it out. All I had to think about was Darren getting the best start in life to encourage me to continue.
"I used the Medela hospital-grade model while he was in NICU, and then at home, bought the Medela Pump in Style. We also supplemented with formula, since I was running back and forth to the hospital all the time. We had so many appointments during the daytime, that it was very difficult to get that valuable pumping time in, though I managed it most of the time.
"All in all, I amazed myself. I really hadn't expected to "hang in there" for four months, but I did, and at one point, practically broke down because I knew it had to come to an end. But, my doctor and my husband both convinced me that I had to look out for myself, as well. I learned that I had to sacrifice something to keep myself healthy. Darren is a healthy little boy, and I'm glad I had the chance to pump to give him that "kick-start" in life."
Karyn is mom to EmmaLeigh. Here's how pumping and a supplemental nursing system gave them that bonding experience mom desired...
"My daughter was born with a wide unilateral cleft lip and cleft palate. I desperately wanted to breastfeed her and to have that bonding experience. I had a wonderfully supportive lactation consultant in the hospital after I gave birth that got a breast pump and helped me to get pumping started so that my baby could enjoy the benefits of breastmilk. She also had an idea that would allow me to simulate nursing at the breast using a supplemental nursing system. She connected a syringe to a long thin and flexible tube. We taped the tube to my breast and I was able to put Emma up to my breast and feed her at the breast while plunging the tube slowly to give Emma a steady supply of milk.
"It was very tough to maintain this set up! I felt like I needed to be an octopus with at least one or two more hands to keep everything in place! (My hubby's hands worked GREAT for the extra help I needed!) After using this contraption for awhile, I began researching the Internet and I discovered the Lact-Aid. This device was exactly what I was looking for! I ordered one and found it was much easier to use than the syringe/tube contraption!
"I was able to nurse Emma the easiest when she was nursing on my left breast. My breast sort of sunk down and the tissue filled up the hole in Emma's lip. With her non-cleft side faced up I was able to make sure the tube from the supplemental nursing system was positioned so that it was between her tongue and the intact portion of her palate. We also used the MJ cleft palate bottle in addition to nursing at the breast to supplement Emma's feedings to ensure adequate weight gain.
"I only used this supplemental nursing system for a short period of time. It just took too much to keep it going with pumping, too. It took Emma a full 45 minutes to take about an ounce of milk from the LactAid at my breast. With her MJ nurser she was able to take at least an ounce and a half of milk in about 10 to 15 minutes. I really am glad that I was able to use the LactAid (and the original syringe/tubing thingie) to simulate breastfeeding because I really wanted to breastfeed Emma and to have that experience and it was the closest thing to it, given our situation. It eventually became too much with pumping, too and Emma began to prefer her MJ bottle as she got bigger and hungrier.
"If I had to do it all over again, I wish I would've fed Emma with her MJ bottle for her nourishment and then used the supplemental nursing system when she wasn't so hungry, instead of trying to use it every single nursing session. I continued pumping for a year.
"And what a year it was! I dragged that pump along with me everywhere I went. I even brought it to the hospital for Emma's first lip surgery...I didn't want to bother anyone at the hospital, but my husband kept saying, I think you should go ask someone so you can pump in private. I didn't bother to do that...I just hid in the ladies public restroom at the hospital, plugged my pump in by the mirror and hid in the corner up against the paper towel dispenser and pumped away. A woman walked in and exclaimed, "Are you pumping your breasts?" Uh yes...what did you think I was doing?!!!
"As it turned out, she was a hospital volunteer and promptly offered me a private area to finish pumping. At the time I was so worried about Emma and her surgery, I wasn't even embarrassed that at least a dozen people saw me pumping away. Thank goodness I will never see those people again! "
Patti is mom to Conall, born with a unilateral cleft lip and bilateral cleft palate. Read how challenging, and rewarding, pumping mother's milk can be.
Thank you for indulging me, I've been dreaming of the day I would post a message saying I was "hanging up the horns" and here it is...
Today I am pumping the last drops of milk and bidding adieu to one of the most incredible and most difficult things I have ever done in my life. My son was born with a cleft lip and palate and I decided he would receive breastmilk exclusively for a year which would see him through two surgeries. I pumped for 11 months and have enough frozen to see him through his 12th month.
I have one bit of advice for those of you just beginning to pump - EXPECT IT TO BE DIFFICULT. I know that doesn't sound fun, but it is the only way to stay sane. If you expect it to be simple and problem-free, you will quit when it gets rough. It is certainly easier at 11 months than two months, but there are different problems
as you do it longer (e.g., supply).
I've pumped every 2 hours for DS when he was small, I've pumped in moving cars & planes, airports, and hospitals. I've shed many tears over painful nipples, low supply, lack of sleep, and emotional exhaustion. I've taken medication to increase supply. I've pumped with three children under the age of five and with DH away on business trips. I've had plugged ducts and thrush. And through it all I've had to deal with countless doctors appointments and medical treatments for my son's cleft palate.
What an accomplishment! I feel so proud of what I've done. Rest assured you will make it to your goals. If I can do it, you sure can!
So, I finally have come to an end I never believed I'd see. I can stop saying "Mommy can't, because she has to pump" or "I have to get home so I can pump". I can return this rental pump (I wish I could run it over with my car) and celebrate. What, you ask, will I do to celebrate? GO TO BED EARLY for the first time in almost a year!
PubMed article reviews the evidence
Lactation and advocacy consultants throughout the world
Find a lactation consultant in your area
Article outlines manual expression technique
Organization recommends breastmilk to avoid Sudden Infant Death Syndrome
An overview of three study groups
On-line support group for mothers who pump
Donate your surplus breastmilk
Nursing pillow available from the Motherwear catalog
From the Motherwear catalog
Supplemental feeding system encourages suckling at the breast
Double electric consumer model breastpump
Backpack-style double electric breastpump
Portable double electric breastpump
Breastmilk storage system
Collect, store and freeze breastmilk
Ziploc-style freezer bag
Hands-free attachment kit
From the Leading Lady catalog
From the Motherwear catalog
From The First years catalog
Relieves the discomfort of sore nipples
Breastmilk supply booster
From Mead Johnson
From Ross/Abbott Laboratories
Breast Milk Fortifiers