Breastfeeding Together: Nourishing Moms and Babies with Practical Tips 

When Rosa Tsifiregna, M.D. began volunteering with Operation Smile as a pediatrician in Madagascar, she quickly recognized that care goes beyond the operating room. While supporting surgical programs for children with cleft conditions, she noticed a recurring barrier to care: Some infants were not ready for surgery — not because of their cleft alone, but because they were malnourished. 

It was a challenge rooted in something fundamental: feeding. 

That insight shaped Rosa’s path. She saw that helping families navigate feeding challenges — particularly breastfeeding — was essential to setting children up for success, not only in surgery, but in life. From that moment forward, she became an advocate for a more comprehensive model of care, one that centers the health and support of both mother and child. 

“I joined Operation Smile as a volunteer after being called on by a colleague. I discovered a life-changing mission and impactful action,” Tsifiregna shares. “As a pediatrician, I have worked in both pre- and post-operative care during surgical programs, and I have served as a leader for Operation Smile Madagascar’s nutrition program.” 

In 2023, Tsifiregna traveled to Operation Smile’s inaugural Comprehensive Care Conference in Virginia Beach, where she deepened her knowledge of nutrition, breastfeeding and infant feeding techniques specific to cleft conditions. She returned home equipped not only with technical training, but with new tools to support caregivers and train health care professionals across communities. 

Today, Tsifiregna is critical to Operation Smile’s global nutrition efforts. As a certified nutrition educator, she leads trainings around the world — bringing a wealth of knowledge, cultural understanding and compassion to every setting. Her work uplifts families, strengthens local health care systems, and helps ensure that children have every opportunity to grow strong and thrive. 

“Breastfeeding is more than nourishment; it’s foundational for bonding, immunity and development, especially for children with cleft lip and palate,” Tsifiregna explains. “For these infants, feeding can be more difficult. So supporting the families navigating the challenges of cleft conditions is essential.” 

Breastfeeding: A Lifeline in Comprehensive Care 

Infants born with cleft conditions can face unique challenges in feeding, but with the right support, those challenges can be overcome. Research shows that these babies are up to nine times more likely to die in their first year of life if feeding difficulties go unaddressed. That’s why Operation Smile has made nutrition a key part of its comprehensive cleft care model. 

Across the globe, we partner with caregivers, community leaders and health care providers to strengthen breastfeeding education, provide early feeding interventions and provide locally led nutrition programs that help babies grow healthy and strong. 

“Many health workers receive little to no specialized training in breastfeeding support for a baby with a cleft condition,” Tsifiregna says. “This gap can lead to missed opportunities for breastfeeding, poor feeding outcomes and unnecessary reliance on formula or invasive procedures. By equipping providers with the right knowledge, we equip them to guide parents with empathy and accuracy. Education is power.” 

Her approach is not only practical; it’s personal. Rosa meets caregivers where they are, offering support rooted in dignity, respect and the belief that every family deserves to be equipped with the tools they need to care for their child. 

“During one nutrition bootcamp, I met a newborn, born with a cleft palate. She was underweight and struggling to feed. [The mother] was convinced she couldn’t breastfeed her baby. 

“But through gentle support, proper positioning techniques and manual expressing of breastmilk, we helped her feed her baby with her own breastmilk. Her joy was immeasurable. That moment reminded me that training saves more than health; it restores dignity.” 

Tips for Breastfeeding Support 

Tsifiregna’s work reminds us that breastfeeding — while natural — often requires support, guidance and community. Here are her top tips for caregivers navigating their own breastfeeding journey: 

• Initiate breastfeeding within the first hour after birth if possible. Early skin-to-skin contact stimulates milk production and helps regulate the baby’s temperature and heartbeat.  

• Feed on demand, not on a rigid schedule. Look for hunger cues such as rooting, sucking motions or hand-to-mouth behavior. Crying is a late sign of hunger.  

• Find the right position. Comfort is key, for both baby and mother. Try different positions (cradle, football hold, side-lying, etc.) to see what works best.  

• Involve the family. Fathers, grandmothers and siblings can provide emotional and practical support. When the whole family is involved, mothers feel less isolated.  

• Take care of yourself. Drink plenty of water, eat nourishing foods and rest as much as possible. A healthy mom makes healthy milk!  

• Don’t struggle in silence. Sore nipples, milk supply worries or latching difficulties may happen. With support, most challenges can be overcome. Midwives and pediatricians are there to support you, especially in the early days.  

• Every drop counts. Even small amounts of breastmilk offer essential nutrients and antibodies that protect your baby.  

Breastfeeding is just one part of the comprehensive care families need to thrive. Learn more Operation Smile’s nutrition programs and how you can help ensure every child has a healthy start.