Breastfeeding and Expressing Breastmilk

Breastfeeding a baby with a cleft palate (the lip can be either cleft or intact) is not easy. This topic is somewhat controversial and no set rules can be applied. You will be encouraged by some to give it a go (and may even be told that it is possible), others will tell you it is a waste of time and energy. The only advice we can really give is to follow your instincts and get as much advice and support as you can handle.

EXPRESSING BREASTMILK

• The Early Days
  In the days following birth, your breasts will produce Colostrum (a thick yellowish fluid) which is packed full of nutrients and antibodies. It may be too early to start with an electric breastpump, your nipples will be quite tender, and Colostrum is more effectively expressed by hand. This is probably the first time you have done this and it will take a while to learn the technique. Be prepared to let a nurse/midwife or lactation consultant demonstrate the best method. Initially you will only be able to express a few mls. at a time – this is quite normal and the volume will increase with time. Every drop you express is precious so make sure your baby gets it. The idea is to express whenever your baby is hungry – you are mimicking the normal feeding pattern. In reality this will mean expressing as often as you can. At this stage your baby will probably be fed using either a teaspoon or a small cup. If your baby is hungry consider giving him/her some formula to keep their strength up. It is important to stimulate your breasts to bring in the milk (an important trigger is supplied by putting your baby onto the breast to attempt to breastfeed, hand expressing will also help). You and your baby may enjoy spending time together either attempting to breastfeed or letting your baby lick/play with your nipples. This can be very frustrating as right from birth a baby wants to be able to breastfeed and can smell the milk but can’t understand why they can’t get to it - try directly hand expressing into their mouth.
• Finally the Milk Arrives
  Within a few days you will notice an increase in the amount expressed and a change in colour from the yellow Colostrum to a milkier colour. As the volume of milk expressed increases, using a teaspoon or small cup no longer becomes practical. You should by now have been seen by the Hospital Lactation Consultant (if you haven’t, ask to speak to one), your Plastic Surgeon and referred to a Speech-Language Therapist who will advise you on bottles to feed your baby with. At this stage you might like to consider either purchasing or hiring a breastpump.
• Breastpumps
  If you are serious about expressing milk, it is worth investing in an electric breastpump rather than a manual one. An electric pump will not only shorten the amount of time you will spend expressing, it will also help to keep your supply going as they are supposed to mimic the way a baby feeds. There are two different types of electric pump available in New Zealand:
• A mini-electric such as those produced by Medela and Pur/Tommee Tippee. These can be purchased from Chemists or baby care shops. These pumps will only express off one side at a time but are ideal as a back up to a larger pump or for being out and about (they can be run off either mains electricity or AA batteries). A double mini-electric (by Medela) is now available in NZ. Despite their relative expense, they are not designed for long-term expressing so it is not a good idea to rely solely on one of these.
• A larger pump which allows you to express from both breasts at once, such as the Medela Lactina which can be hired from a Chemist who stocks Fisher & Paykel Healthcare products. Call F&P Healthcare customer service on 0800 800 631 for your nearest stockist. Your local hospital or Parent Centre may also have similar pumps available for rent. It is well worth shopping around and negotiating if you can, stating that you are feeding a child with a cleft and expect to be using the pump for many months. Prices vary widely.  You will also need to purchase the tubing and plastic cups– check with your local support group to see if anyone has a set they no longer need.
  The disadvantage of these pumps is that they are large compared to the mini-electric pump and do require a power source. The big advantage is that you can express both sides at once – this both cuts down the amount of time you spend expressing and helps to stimulate your supply. A word of caution – these large pumps rely upon mains electricity, so in case of power cuts you will need either a mini-electric pump with batteries, or hand pump which you are confident using.
• Keeping the Milk Going
  In the early days when you are engorged with milk, getting enough to feed your baby may seem relatively easy. However, as things settle down your body will come to terms with the fact that it does not have a nice, sweet smelling baby to extract milk. Instead you are using a noisy, cold electric pump and you will probably find your milk supply dropping off.

There are many herbal remedies you can try (speak to a herbalist personally before trying anything, some ideas are: Blessed Thistle, Lactogogue tea, Fenugreek, Brewers Yeast, and Fennel). There is also a drug available on prescription in New Zealand called Maxolon that may increase your supply (it can also make you more tired though). The most natural and effective method is to apply the same principles that are used in breastfeeding to increase supply:

• Increase the number of times you express each day. As a general rule try to keep in line with the number of feeds a baby of that age would take – in the first few weeks this is a minimum of  6-7 times in 24 hours. Practically this works out to expressing every three hours during the day, plus (if you are up to it) once during the night. Nighttime expressing during the first two weeks is ideal due to high prolactin levels at this time. To increase supply you may need to express every 2 hours for a couple of days. This will seem very hard work and requires a lot of self-discipline but does pay off.
• Plenty of rest, nutritious food and lots of liquid (try to always have a glass of water on hand when you are expressing).
• Look after yourself – you are doing a very important job and it is hard work. Be prepared to ask for help when you need it – your partner, family, friends, Plunket, etc.

• Storage Guidelines
  Breastmilk storage guidelines seem to vary widely between publications, as a conservative guideline you may find the following useful. Breastmilk should retain its nutritional and immunological properties for a few hours at room temperature, up to 8 days in the back of the fridge (not on the door), and for up to 4 months in the freezer. Always label with an expressing date, time and expiry date. Frozen breastmilk should be thawed either overnight in the fridge or by placing the container in some lukewarm water. A microwave should not be used as it causes damage to milk components.