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We had our 22Wk ultrasound today and they are 99% sure that baby has a cleft lip. They say it is thin, on the left side and they are pretty sure it doesn't involve the palate. The consultant who did the scan says I will not be able to have a homebirth and as a doula and childbirth educator I'm a bit confused as to why. They say there may be breathing problems but as I understand it that is only a problem if the palate is cleft. They worry about feeding issues but I don't see why that requires me to deliver at the hospital, we could always go in if baby was indeed unable to breastfeed or take a bottle, or dropper.
Does anyone have any experience with cleft lip and homebirth? We are under the care of a NHS midwife who we will see on Monday and I will question her further but could use all the info I could get. I had my son at home and unless there is an absolute medical risk factor that precludes me from delivering at home I would like to homebirth this baby as well. They will scan again on Nov 8th to confirm this diagnosis. Thanks for your help.
I just wanted to post an update. Afer a lot of research I discussed it with my midwife who said that she had no problem doing a homebirth if the cleft was isolated to the lip, but that I had to clear it with the consultant at the hospital. We went back for a follow-up scan this past week and they once again confirmed the cleft lip but said the palate was not involved. I told the consultant that I had discussed homebirth with my midwife and that research showed that there was no increased risk at delivery for a baby with a cleft isolated to the lip and that I wanted to proceed with the homebirth. She then admitted that she personally was uncomfortable with the idea of homebirth in general but if the midwife and I were happy to proceed she agreed that there wasn't an increased risk for a cleft lip baby at delivery. Turned out her attempt to prevent me from birthing at home had nothing to do with a medical concern about the cleft lip. She was simply using it as an excuse because she felt that all women were safer birthing in the hospital!!!
Let me encourage everyone who is seeking a homebirth and being discouraged to do your research about the condition that is being held up as the reason you should birth in the hospital. Make sure it realy is a valid medical reason and not just a matter of a care provider who is uncomfortable with the idea of homebirth.
I would be thrilled if my experience could help other women out. I had a hard time finding any info on homebirthing with a cleft lip baby on the internet. I was lucky to have several midwives back in the US that I could run our situation by and get their advice as well as doing a lot of research into the causes of cleft lip and cleft palate and what the potential complications at birth could be. I would like to share what I learned to be included with my other two emails.
Cleft lip alone is not associated with any increased risk at delivery unless it has been caused by a syndrome that has affected the formation of other organs. When a cleft lip is detected by ultrasound, a thorough anomaly scan should be done to check that internal organ, spine and brain formation are normal. If this ultrasound shows normal development then there is no increased risk at delivery over a non-cleft lip baby.
The main concern related to a cleft lip baby in the first 24hrs is potential feeding difficulties. If a mother is planning to breastfeed she should research in advance the techniques for feeding a cleft lip baby and also have a breast pump and special bottle designed for cleft lip/palate babies on hand should the newborn be unable to nurse. This will help prevent an un-needed transfer to hospital for supplemental feeding.
If the baby has a cleft palate, with or without a cleft lip, then there can be potential breathing problems at birth. Some babies with a cleft palate have a condition known as Pierre Robin Sequence/Syndrome. Almost all babies with Pierre Robin have a cleft palate only and no cleft to the lip. Babies born with Pierre Robin have a smaller than usual jaw and the tongue is positioned far back in the mouth. These babies frequently need to be resuscitated at delivery and more severe cases require a tracheotomy in order to breathe.
Many cleft palate babies have been born at home without complication, however there is a significant increase in risk for them at delivery and factors such as attending midwife's skills/supplies for resusitation, distance from hospital and availability of ambulance for medical transfer should be considered in deciding whether or not to pursue a homebirth.
Cleft lip alone, with all else showing normal on the anomaly ultrasound, is not a medical reason to prevent homebirth.
Hope this helps,
Melody
I have cared for a woman who had two babies with cleft lip at home. One of them had cleft palate as well.
My colleague who cared for her during her first pregnancy had a conversation with a Paediatrician and was told that there could be slightly increased risk around resuscitation. Having a little plastic airway at hand was suggested. Neither baby needed any resuscitation.
What really impressed me was that they had a home visit by the consultant from Great Ormond Street for the second baby the day after the birth who examined the extent of the cleft palate.
Both babies had their first operation after 3 months - it doesn't seem to be the case that there is any rush to be seen.
It is very important to have good support with feeding, but this wouldn't be any better in a hospital birth.
I am sure you have checked it our already but in case you haven't there is CLAPA (Cleft Lip and Palate Association) www.clapa.com
Best wishes, Elke (midwife)
About two years ago, as a student midwife, I 'caught' a friend's baby for the first time. It was her second baby. She had two scans, both recorded having examined both sides of the palate and found them fully formed. 'A' was planning a home birth following a traumatic first birth in the hospital, and we all looked forward to the event. On the night, she was very active and on all fours as 'F' was born, which meant that he came out facing me. I saw as he emerged that he had a cleft lip. The midwife and I caught each others' eyes, and handed 'F' to my friend immediately after he was born, as we planned. After a few minutes of ecstasy following her achievement, she looked down to discover that 'F' had a cleft lip (and later we discovered it was a cleft palate as well).
In this instance, we were very fortunate in that her husband worked at a private school where one of the parents was a pediatric plastic surgeon. There was no requirement for immediate consultation, and the next day they began what was a very challenging period of phone calls and consultations and corrective surgeries, although today, 'F' is as happy and healthy as could be, and I think the whole family believes that having the calm, straightforward home birth they planned provided a solid foundation for the strength they needed from there out. It was also a special time when they could be together as a family, enjoy their achievement and cherish 'F' for the wonderful newborn delight that he was without countless other medical persons becoming involved.
'A' did not breastfeed 'F' but she did manage to express and feed him breastmilk exclusively for quite a long time. Although I can't give you medical advice or textbook knowledge, I would say that there are many benefits to proceeding with the home birth you've planned. And you have the additional advantage of being able to consider before the event your backup plans, your feeding support, and all other support networks you may need as you care for this lovely new baby in the way you will feel best.
Shawn
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