Jaundice and breastfeeding

[Shell_Ell]

My brother's partner just gave birth on Saturday. Labor was induced and pretty rough. Nursing has been going okay. He had issues with his blood sugar so they already gave him formula on day 1. She said that he's been really sleepy. He was circ'ed yesterday so I assume that he was just a little out of it.

Today his bilirubin was up to 20.6, so they admitted him into the hospital. Her and my brother are staying there, but since she can't take him out from under the lights, she's pumping. She is getting about 1/4 ounce of colostrum, which sounded GREAT to me, but she's really down about it. They are giving the baby formula to help him poop out the red blood cells and get his levels down. I'm confused because I know colostrum is a laxative. Why does he need formula??

What I don't understand is that they are giving him a bottle, but they are syringe feeding him the colostrum. Without being there and talking to them, I'm not sure why. I told her that I thought it was strange. She seemed to be really depressed at how fast he downed a bottle, while nursing seemed to take an hour each time. It made me really angry because it seemed like it hurt her confidence, which was totally high on Sunday when we visited.

They will likely be discharged in the morning, and since I dont' have any clients right now I'll probably be going to help out. I'd just like some accurate information about breastfeeding and jaundice so that I can tell her that if the Dr is saying formula, to get a second opinion. I know how important breastfeeding is to her, and it just breaks my heart that this is happening. I was trying to reassure her that it would be okay, but if she's around people that know nothing about what giving formula and bottles will do at 3 days PP, then I just think it will be much harder to stick with it.

Advice please! I just want to support her!

[2 in August]

They could be pushing formula to just get more liquid in him.

Have her ditch the bottles as soon as she gets home. I didn't with my dd and we never got rid of them. try to help her find a good lc to help him latch right and make sure his suck is good.

My ds had a portable bili-light here at home. We had to take him to the hosp every day for blood work. She'll need extra support because it's extra hard when you first get home to deal with baby plus the extra worry.

[pamamidwife]

well, he has to process ALOT of drugs out of his system - from the birth, from the circ...that little baby has alot of work to do.

Frankly, I'm not a fan of bililights unless there is something WRONG with the baby. I also think this could be a case of normal physiologic breastfed jaundice combined with a slower system to break down the red blood cells because of the drugs that are in his system (the liver wants to break down the red blood cells, but the foreign substances in his body compete for that).

I think we WAY OVERTREAT jaundice in babies. The formula suggestion is just WRONG. Here's the deal: he needs to poo more. Colostrum has a natural laxative. Breastmilk is processed easily and quickly - this baby needs less stress on his system.

Sometimes bililights make babies lethargic and unwilling to nurse.

[Shell_Ell]

Thanks for the information. Now what can I do to help her?

My heart just breaks. This poor baby has been through so much already.

[blsilva]

My youngest had jaundice pretty bad- it got as high as 19.2. I never gave him a bottle, never had him in the hospital. Tell her to nurse him more. As often as she can get him to nurse. The breastmilk will help him more than formula will. And beware of dr's who treat it too aggressively. Part of the problem with us was a ped who wanted to do a bloodtest every day, which added stress to me, the baby, and the family in general. Stress can make jaundice worse, and keep you from making as much breastmilk as you need. I would tell your friend to relax, nurse, and sleep. Those three things are what the baby needs most.

[Benji'sMom]

http://kellymom.com/newman/07jaundice.html

Not-enough-breastmilk Jaundice
Higher than usual levels of bilirubin or longer than usual jaundice may occur because the baby is not getting enough milk. This may be due to the fact that the mother's milk takes longer than average to "come in" (but if the baby feeds well in the first few days this should not be a problem), or because hospital routines limit breastfeeding or because, most likely, the baby is poorly latched on and thus not getting the milk which is available (handout #4 Is My Baby Getting Enough Milk?). When the baby is getting little milk, bowel movements tend to be scanty and infrequent so that the bilirubin that was in the baby's gut gets reabsorbed into the blood instead of leaving the body with the bowel movements. Obviously, the best way to avoid "not-enough-breastmilk jaundice" is to get breastfeeding started properly (handout #1 Breastfeeding—Starting Out Right). Definitely, however, the first approach to not-enough-breastmilk jaundice is not to take the baby off the breast or to give bottles (see Handout B: Protocol to Increase Breastmilk Intake by the Baby). If the baby is nursing well, more frequent feedings may be enough to bring the bilirubin down more quickly, though, in fact, nothing needs be done. If the baby is nursing poorly, helping the baby latch on better may allow him to nurse more effectively and thus receive more milk. Compressing the breast to get more milk into the baby may help (handout #15 Breast Compression). If latching and breast compression alone do not work, a lactation aid would be appropriate to supplement feedings (handout #5 Using a Lactation Aid). See also the handout: Protocol to Increase Breastmilk Intake by the Baby. See also the website www.thebirthden.com/Newman.html for videos to help use the Protocol by showing how to latch a baby on, how to know the baby is getting milk, how to use compression, as well as other information on breastfeeding.

[Shell_Ell]

I read that earlier today. What I don't get is she said he pooped like 10 times on Monday. Her milk isn't quite in yet, so that could be an issue.

[newbad]

If she is currently still in the hospital with him, have her ask if they have the Wallaby Lights (they are the same ones that they send you home with and are a strip of the lights that you can swaddle baby around). That way she can breastfeed and hold the infant, while he is still under lights. If the hospital doesn't have any, possibly look into getting them from the home health people. Since they will probably being sending him home on lights anyhow, maybe they can get them early and sent to the hosptial. Other wise, make sure she is pumping every 2 hours for 20 minutes to get her milk to come in as soon as possible. As soon as she has milk have her insist that the infant get only breastmilk. I would also have them insist on finger feeding infant the formula using an SNS tube or atleast be using a Haberman bottle ( a special bottle from Medela that teaches them to suck harder and not have the instant gratification of a bottle). The bilirubin levels should be at their peak now and should naturally start to fall soon.

How was her latch prior to this? And what % of weight loss?

[birthgreeter]

QUOTE: They are giving the baby formula to help him poop out the red blood cells and get his levels down. I'm confused because I know colostrum is a laxative. Why does he need formula??

What I don't understand is that they are giving him a bottle, but they are syringe feeding him the colostrum. Without being there and talking to them, I'm not sure why. I told her that I thought it was strange. She seemed to be really depressed at how fast he downed a bottle,>>>>>

Prior to becomeing a CPM, I was a nurse in hosptial (not always doing what they wanted, I was pushing midwifery views very often. )

But the staff is prob. thinking to give the colst. the way they are so he does not think he is getting breast milk from a bottle. weird, but it is one thing they use to do where I worked. The formula should have been given the same way also, and not from a bottle. I agree with nursing often, and not to worry so much. get baby into the sunshine at home. I often see better results from the sun than I do the bili light.

[Shell_Ell]

He's home now and nursing is going great. I'm so glad the whole thing is over! Thanks for the information... it's always good for future reference with clients.