Home Birth and Severe Jaundice anyone dealt with this?

[cagirlintexas]

My first had the type of Jaundice that started before they are 24 hours old. I think it was called ABO incompatibility. Anyway pregnant with number 2 and due in 4 weeks and trying to come up with a plan. I don't want to be going back and forth between home and peditrician everyday like number 1. Exspecially not in the first 48 hours. Was I making a mistake planning a homebirth.

[NewSolarMomma]

My son also had ABO incompatibility and extreme jaundice, spent 3.5 weeks in NICU. I was glad to be at a hospital where they caught it quickly, as I never would have known what it was. I don't see any reason you couldn't HB, if you take your baby in to be checked right away I doubt it will matter where he is born. I haven't HB, my last hospital experience was VERY pleasant, I was happily surprised.
I don't think every baby gets ABO incompatibility, even if a previous one did. 1 out of 15 babies have a different type than their mom, but only one out of every few thousand has problems with it. Hopefully it won't happen this time. I also have Big and little E antibodies, but DH does not. we were told it wouldn't be a problem when he was tested, but baby still ended up with ABO problems!

Best Wishes!

[elus0814]

I had a homebirth two months ago, the baby had jaundice because of being a few weeks early.

Here's what happened:
-There was nothing in the first 24 hours or so.
-The midwife came about 36 hours after the birth and drew a bili. level which came back high but not enough for concern.
-we took the baby to the ped. the following day (at 2.5 days old) where they did another bili level which was even higher.
-we began home photo therapy by sitting outdoors with the baby in just a diaper (in a light but shaded area to prevent sunburns, this was summer in florida so this might not be possible in the winter or in the north), this was a friday of a holiday weekend
-the baby seemed to be getting more yellow and we were talking with both the midwife and ped every few hours trying to decide what to do, we continued the time outside
-by sunday night we were getting concerned because the baby's eyes were starting to look yellow (btw, we had looking into having bili levels checked over the weekend and/or renting a biliblanket but since we live in a semi-rural area these weren't options)
-we made the difficult decision to take her to the er to have the bili level checked on sunday night (because of the possibility of brain damage from high levels)
-they checked her levels and they came back elevated, right on the edge of needing to be admitted; one doc was a jerk and had the nurse who drew the blood do it with an iv line because he was so sure the baby would be admitted (the iv was far and away the worst part of the whole thing) but one was cool and wanted to talk about the homebirth, the doc told us I would need to immediately stop breastfeeding, DH and I nodded so they would let us leave without a fuss even though we both knew I wouldn't (they claimed it was because of breastfeeding, riiiiiight)
-after calling our ped again we decided to take her home and continue our time outdoors until tuesday when our ped would be in her office again (a military base so everything was shut down for the holiday until then)
-we spent tons of time in the sun the next day
-we took the baby back to the ped on tuesday for another level check but by that time we were sure it was going down because the baby looked much less yellow
-the level went down, it was checked again two days later to confirm it was continuing to go down and that was it

At the peak the level was about 17. That number was high because of the number of 'risk factors'; abo incompatibility, borderline premature, weight under 6lbs.

[mclisa]

Do you currently have a pediatrician that for your other child? If so, maybe schedule a meeting to talk about it.

Otherwise, I would plan on seeing a ped around 36-48 hours for a bili. I think I would be aggressive and ask for a bili blanket at that time so as to not get so incredibly high that you need to be readmitted. Just be ready to explain what happened with the older child and see what they think.

[raelize]

if you have a cool ped, i would look into getting a biliblanket before you hb, just in case you birth on friday night, or saturday early morning and can't get in soon enough. or just to be safe.
dd1 had jaundice, and we needed a biliblanket. i wouldn't have known what it was if the ped didnt' catch it. i HATED the biliblanket, but dd was born after a snowstorm in december, so, we couldn't really do sunlight outside.
dd2 did not have even a trace of jaundice - i was tandem nursing and i think this is why she did so well - my milk came in superfast.
if the ped won't okay it, see if your midwife can order you one.

if the insurance won't cover it without the baby being born, they aren't that expensive to rent. i think here we ended up paying for most of it cause of our deductible at the time - around 200 dollars for a week. not money i wanted/had to spend, but i wasn't going into the hospital after a homebirth.

both dd1 and 2 were born at home.

[Vaske]

Both of our children have had ABO-incompatibility jaundice to some degree. This is what we have learned:

1. GETTING BREASTFEEDING GOING WELL IS ESSENTIAL. Sorry for shouting in all caps, but it's for good reason: the most significant difference between ABO-incompatible babies who get severely jaundiced, and the ones that don't, is simply how well they are eating. Nearly all ABO-incompatible babies who develop severe jaundice are breastfed and nursing is not going well for them.

We had heaping handfuls of breastfeeding difficulties with our first child, leading to re-hospitalization. Worse, the hospital just pushed formula, kept me and baby separated almost all the time, and took DAYS to get us any breastfeeding help at all. Our second child, born at home, took to nursing with no trouble at all. He too had jaundice, but no more than a normal baby would, and we just nursed through it.

2. Phototherapy (including a biliblanket) is basically useless if the baby is not eating enough to absorb and flush out the bilirubin. Otherwise, it just recirculates and the level keeps rising. So, make sure first attention goes to fixing the feeding, rather than initiating phototherapy. Hospitals generally do this by initiating formula feeding. If you don't want formula, stand your ground and demand that some competent breastfeeding help be provided immediately. I found the hospital lactation consultants to be not very helpful, but our midwife knew of a very excellent one.

3. The levels of bilirubin that doctors start treatments at are set very conservatively low, mostly to prevent lawsuits. The graphs and guidelines typically used can be found here. Kernicterus, which they try to scare you with, is extremely rare; I once found a paper where the researchers admitted that it was so rare that they could only guess at its incidence rate. Roughly one in a million.

As we did with our second child, I would go ahead and have the homebirth, and only take the child in for a bilirubin check if they started to develop a level of jaundice that alarmed you and your midwife. If the baby is nursing well, and not looking sick at all, you'll be far better off at home.

[MsBlack]

Vaske said: "3. The levels of bilirubin that doctors start treatments at are set very conservatively low, mostly to prevent lawsuits. The graphs and guidelines typically used can be found here. Kernicterus, which they try to scare you with, is extremely rare; I once found a paper where the researchers admitted that it was so rare that they could only guess at its incidence rate. Roughly one in a million."

I think you are right that the 'bili level'standard for initiating treatment' is low due to liability concern. I also think that doctors and parents find the yellow color of jaundice to be a scary sight in a newborn--just very hard to beleive, looking at that color, that baby could possibly be ok! But the incidence of harm even with bili level much higher than 17, is indeed very low.

Well said on all counts I've learned not to go by baby's color nearly so much as baby's behavior--not 'what color' but 'how vigorous and happy'. Lethargy is a bad sign, and refusing to eat. As V pointed out, getting BF started well is best--and any early BF troubles need timely, skilled assistance...gotta keep the fluids flowing to help exit the bilirubin from the system. Kernicterus is from bili-overload--too great a buildup of bili in the body; we can help baby prevent that buildup with frequent nursing/eating, some sunshine, etc.

A remedy I've heard of that makes sense--though I've never tried it--is using activated charcoal to help baby exit the bilirubin faster. Activated charcoal is a known detoxifying agent, assisting our bodies in removing poisons.

So you take a normal capsule of activated charcoal, and you stir it into 2-3 Tablespoons of water. Use a container with a lid. Then, using a sterile dropper (like tincture bottles have), give baby 2-3 drops every 2-4 hrs until it's gone, keeping it covered between servings, and stirring it again before using (the charcoal doesn't dissolve). More drops of *plain* water can be given too, if baby wants it--but only 2-3 drops of charcoal water at one time. Longer intervals ok during usual sleep times, unless baby is already lethargic/hard to wake/not eating.

Vaske also said: "As we did with our second child, I would go ahead and have the homebirth, and only take the child in for a bilirubin check if they started to develop a level of jaundice that alarmed you and your midwife. If the baby is nursing well, and not looking sick at all, you'll be far better off at home. "

Agreed. Whatever the baby's color, watch baby's behavior...a baby can be pretty yellow looking for awhile, and still be happy, growing fast. A baby might only slowly shed the last bits of the bili over a week or more--but if that baby is waking spontaneously to eat, having alert periods every day, making wet diapers, then the concern about the actual bili count is far less. Babies can handle the matter just fine, most of the time--and sometimes there are ways we need to help them some, with sunshine or bili blnkts, charcoal water or formula. I don't like to see people rush in for a bili stick if baby is doing well apart from color. It can cause needless worry and more stress for all. And a stressed baby is not going to exit those toxins as efficiently as happy one.

But if your baby is truly lethargic or otherwise doing-poorly-then getting the bili test can be a useful piece of info to work with. Look at the Big Picture and decide if your baby is ill or just yellow , get BF or other help if you need it, know the bili number is just one piece to consider, NOT the whole shooting match by any means.

Good stuff V, thanks

[Lady Lilya]

Originally Posted by cagirlintexas

My first had the type of Jaundice that started before they are 24 hours old. I think it was called ABO incompatibility. Anyway pregnant with number 2 and due in 4 weeks and trying to come up with a plan. I don't want to be going back and forth between home and peditrician everyday like number 1. Exspecially not in the first 48 hours. Was I making a mistake planning a homebirth.

Let's take the situation with your first child and compare what the differences would be between a hospital birth and a homebirth.

Born in the hospital: They usually keep you there for 24 hours before releasing. If the bili levels were high at that point, they would have kept your baby, right? If they were not super high, they would send you home, and you'd be going back and forth to the pedi every day.

Born at home: Either you get worried, or the midwife gets worried, that the baby looks yellow. Either you go to the ER or a pedi or the midwife can do a test to check levels. If it is dangerously high, into the hospital the baby goes. If not, you are going back and forth to the pedi.

I am not seeing much difference between these 2 options. Except that maybe with the homebirth version you get more skin-to-skin cuddle time without interference in the first day or so, and therefore more milk to flush out the bili faster.

But I definitely don't see how homebirthing would make this situation WORSE. In both cases, if the jaundice is bad enough the baby would be hospitalized, and if it was more borderline there would be the annoying trips back and forth to the pedi.

[madcap150]

Also, keep in mind that this baby may well have type O blood as you do. Your oldest must have inherited dad's blood type, but this one may inherit yours. In that case, there will be no concern about ABO incompatibility at all.

[mwherbs]

Start eating more vitamin k foods now or taking alfalfa tablets in order to reduce any blood to blood mixing many also recommend increased vit c. Delayed cord clamping and cutting, consider not clamping or cutting until after the placenta is delivered. Then even if there is some red blood cell destruction the baby will have plenty to compensate.
I also think feeding early and often , fats are what that bili will bind to and exit the body via the bowels .. So doing infant massage to help stimulate a bm is also helpful . Line up at home bili lights and someone to draw the labs at home. So you want baby in your arms naked ,nursing at home, running around just has to be counterproductive if you don' t need it then fine but get it all in place as much as possible ahead of time, rx for the lights and an order for someone to do the lab draw find out what your insurance requires ... Also consider giving your baby vit K oral or the shot .

[jengacnm]

If she isn't going to do this already, ask your midwife to get cord blood samples 1) to get the baby's blood type and 2) to test bili levels at birth. This precludes waiting until the cord completely stops pulsing, but I can get enough blood by waiting until the cord is ALMOST done pulsing.

If the baby needs more draws, your midwife or a visiing nurse can do them.

I second what a PP said about making arrangements to get a bili blanket ahead of time, and about meeting with the baby's ped ahead of time.

And I ALSO second what a PP said about the scenarios of home and hospital-they wouldn't have been much different.

HTH-

[laurata]

I haven't had this experience as a mother, but the book Breastfeeding Answers Made Simple had a great chapter about jaundice and the cut offs between normal/ not normal, studies on treatment, and how various breastfeeding factors are associated with incidence and severity.  It also addresses the role of formula, and when and how to use it if it is needed.  Since its an expensive book, and fairly new, you might want to see if a local LLL Leader or IBCLC has a copy that you can read through, or maybe a local library has it.

[mommato5]

I'm kinda late with this, but when you have blood incompatibilities, they CAN be severe enough to cause problems inutero. Severe jaundice can lead to brain damage and can kill a baby. This isn't just your run of the mill jaundice. These types are more severe and the treatment needs to be more aggressive. I've been there. In the hospital, they can start testing baby after birth as the levels can begin rising immediately. Isoimmunized mothers are high risk and need to have regular testing during the pregnancy to watch the baby for signs of anemia as some babies do need intrauterine blood transfusions.

[MamaCc]

My 2nd baby had ABO incompatibility.  IT IS NOT THE SAME AS COMMON JAUNDICE.      My daughter's bili level was 5 in her cord blood. It doubled in 8 hours. Had we waited the 24-36, she would have been at a crazy high level. She was sent to a hospital with a level 3 NICU so she could have a transfusion if she needed it. She needed one a week after she was released. 

. And if your next babies have it depends a lot on if your husband is AA or BB, instead of OA of AB or something. My husband's parents are both AA and gave him AA. So his blood will win out over my O every time. (i think) So our future kids will probably have ABO incompatibility as well. As far as severity each time, I don't know. Borh our kids have A blood. When I was preggo with #1, my body started creating antibodies to type A blood. Then during my 2nd pregnancy, my body was attacking her.

I would love to have a home birth or at a birth center. I'm not even preggo right now. But I'm researching it a bit. The only way I would do it is if they could immediately test the cord blood. Also.. if you wait for the cord to stop pulsing, MORE of the blood with antibodies gets to the baby. So those blood cells..the ones getting attacked..will die off and create even more bilirubin. It totally sucks. But that's how it works.

While there is no reason for YOU to need to be in the hospital to birth a baby with ABO incompatibility, it is important that your baby be around capable physicians who will act quickly, not to save their own butts, but to keep your baby safe. Because if the bili levels get too high (over 20) you are flirting with brain damage, cerebral palsy, etc. I have a friend whose doctor went the normal 24-36 hours then waited too long to transfuse. The baby has cerebral palsy. It was heartbreakingly preventable.

Btw, the NICU staff only gave her my breastmilk. I got to feed her when I was there. She was mostly under the lights or in a warmer. But they never wanted to give her formula, even when she had too much sludge in her liver. Breastmilk is harder to process by the liver ..ie breastmilk jaundice. Just b/c the liver is not that mature at birth.

[mwherbs]

All of the blood is baby's the antibody exposure will destroy/ continue to destroy blood cells , what you are hoping for is after leaving mom,s body that the antibodies will not compromise the baby's circulatory system to tHe point of needing a transfusion, having extra blood even though it is exposed provides a bigger pool before the baby is compromised.