Results
At the hospital, all of the 20 newborns with complete CL-CP were successfully breastfed with no problems (e.g., choking). Their weight gain was found to be in a normal range. They were discharged with their mothers by the first week of hospitalization. At 1st week and 1st month after the discharge, all of the 20 newborns were exclusively breastfed with normal weight gain. When they were few months old, 18 newborns were still exclusively breastfed. Two other newborns received the formula since their mothers needed to go back to work. At 3-4 months, most of the newborns (n = 16) received the formula via bottle feeding for the same reason. At this point, all of the 20 newborns underwent surgery to fix their upper lip. At 6 months after the cleft palate was fixed (at 4.5 months), only 2 newborns were still breastfed in combination with the formula. These 2 newborns were healthy with normal body weight and development. During hospitalization, all of the 20 newborns’ parents intended to exclusively breastfeed their newborns for at least 6 months. The relationship between the parents and the newborn was found to be positive due to breastfeeding. The parents seemed to accept their newborn’s problems well. They asked questions about treatments of CL-PL. All of the mothers stated that breastfeeding changed their perceptions toward their children from negative to positive. They stated that they did not think their newborns were different from other newborns without CL-CP. They also reported that they felt confident that their newborns would look fine from surgical procedures. They were not ashamed of having a newborn with CL-CP and felt confident to care of their child. Furthermore, all of the mothers shared with the research team that they felt very proud as a mother who did what they were supposed to do (breastfeeding) for their newborn.
At 6 months follow-up
From our assessment, we believe that introducing bottle feeding after artificial palate surgery caused nipple confusion among our studied newborns. Also, noticing that their babies could be bottle-fed had motivated some mothers to think about going back to work and had caused some of them to stop breastfeeding. Feeding the newborn by a dropper postoperatively also prompted some mothers to stop breast feeding in order that they could return to work since they experienced financial hardship from having only their husband as the bread winner. The two mothers who exclusively breastfed their newborns until at least 6 moths shared that a major factor in their success was their joining in a group whose members were new mothers and whose goal was to support exclusive breastfeeding. Both mothers stated that the members of the group were friendly and good role models. In addition, probably the best facilitator was spousal support. Both mothers reported that their spouses were very supportive of breastfeeding. Their spouses encouraged them to stay home to breastfeed the baby since these families did not encounter financial problems.
Conclusion
Exclusive breastfeeding can be done successfully in newborn with complete CL-CP when an experienced nurse educates and coaches the mother to breastfeed in the early postpartum period. To assess the newborn’s milk consumption, newborn weight gain, urinations, and bowel movements need to be noted. The newborn benefits tremendously from successful breastfeeding. A positive parent-newborn relationship is generated. The newborn can grow and develop normally. Breastfeeding can help the mother to feel strongly attached to her newborn and to change her perception toward the newborn from negative to positive, leading to adherence to follow ups with treatment instructions. This aspect is crucial since at least 15 years is needed to appropriately care and treatment of a child with complete CL-CP. Without appropriate attachment and love from the parents, a newborn with complete CL-CP could end up with less than optimal physical and psychological outcomes throughout their life.
Acknowledgements
This article was supported by the Center of Cleft lip-Palate and Craniofacial Deformities, Khon Kaen University, in Association with Tawanchai Project (The Tawanchai Center). The authors thank all the associates at The Tawanchai Center and, Miss Karen Welker for assistance with the English-language presentation of the manuscript.