Neonatal Resuscitation

‘m the mother of a 13-yearold son who has a grade 3, unilateral cleft lip palate. I breastfed our first two children and had planned to breastfeed Matthew. Unfortunately, I had no support from his cleft palate team. A t the time, there were few lactation consultants who had experience helping mothers breastfeed cleft palate babies. As a result of my situation two things occurred: I expressed my breast milk for five months and gave it to Matthew. Secondly, because of the lack of support and help available, I became a lactation consultant. Through my 10-plus years as a board-certified lactation consultant, I have worked with and helped a number of babies with cleft palates and their mothers. My goal is for them to have the best possible outcome in their particular situation. I find that a mother’s breast shape can be a determining factor. Soft, compressible breasts are the easiest to work with, and creative positioning can help. Often, the mother may need to pump and offer expressed milk for a month or two while the baby grows and learns to breastfeed more effectively. Mothers need to learn to hand express into the baby’s mouth. As the baby grows, she or he learns to milk from the mother’s breasts and the mother conditions her let-down reflex so the milk is let down into the baby’s mouth quickly. When mothers aren’t able to breastfeed their baby due to a cleft palate or other problem, all medical staff should offer a consistent message: give expressed breast milk when the baby isn’t able to nurse directly from the breast. As we already know, some breast milk is better than none at all. Sick and cleft-palate babies need it more than ever. Matthew had very few ear infections and other illnesses. His lip repair healed very well, because breast milk protects against infection and doesn’t allow crusting

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Neonatal Resuscitation

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was captivated by the article on neonatal resuscitation by Ellen Kopel Zottoli (February, 1998). Allowing patients to be present during resuscitation efforts makes all the sense in the world. I cannot count the number of times my role has become that of courier between the resuscitation room and the birthing room to convey to information to a barely delivered mother, her significant other, and her labor support people (friends, relmukt~ atives, and grandparents). What prompted me to take on this role was witnessing the obvious anguish of a mother, father, or grandparent whose newborn has been whisked away to hopefully be “saved” by a medical team of experts. Each moment that passes with no word is excruciating. I often literally run from the family to where the baby’s been taken and back to minimize the suffering. I applaud this extension of family-centered care and hope that others may consider this protocol an option at their hospital.

Allowingpataeni3 be present da&grwca’hataon efforh alt the sense in the world

Cynthia F. Loring, RNC, MS Colby-Sawyer College, School of Nursing New London, NH

Cleft Palates

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ongratulations on your continued publication success! I’m very impressed with the information provided and with its presentation within Lifelines. The journal stimulates its readers in many ways. I would like to respond to “Breastfeeding & Cleft Palates,” (August, 1997). As a lactation consultant for the past seven years and an RN since 1981, my practice has been very family-oriented and holistic. I have specialized in and worked with many types of birth anomalies, including cleft palates. I have provided support and education for these families on breastfeeding. Perhaps this kind of support and education wasn’t available to this particular mom, which caused her to conclude that “bottle feeding is probably most appropriate.” We may never know what she went

June 1998

through or was feeling because the right kind of information may not have been provided. Nurses need to keep in mind that every situation and family is unique and different. Additionally, not all infants born with a cleft palate have the same kind of defect. Families need education and support about breastfeeding from the medical and nursing staff, lactation consultants, and breastfeeding support groups. Most importantly, this support and encouragement needs to be provided within the family and extended family structure itself. Without education and support, breastfeeding or providing breast milk by any artificial means may be unsuccessful.

Debra A. Giugni, RN,ZBCLC Graduate Student; State University of N e w York N e w Paltz, NY

AWHONN Lifelines

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