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.