Question About Jaundice

[kristenyostdc]

My cousin and his wife just had their first baby 2 days ago. It was a hospital birth via c-section. She didn't want to have a section but apparently the baby was under a lot of stress and the heart rate kept going way down. Anyway, yesterday I went to go see their new boy and the nurses had just taken him to the nursery to put him under the bilirubin lights. He is pretty jaundiced and they are worried because it had only been 24 hours since his birth and his bilirubin was pretty high. So we got to see him through the nursery window. At first she was refusing to supplement him with formula but I think that she was scared into giving him some. She told them to absolutely not give it to him through a bottle and to use a syringe. She is really trying hard to nurse and I'm pretty sure that won't change. Has anyone experienced this before? Her milk is not in yet, but hopefully it will start coming in today since this will be day 3 after his birth. I wanted to give her some advice but didn't really know what to give her. My kids all had jaundice and my daughter actually almost had to be readmitted to the hospital after we had gone home because of it but ended up being ok. I'm wondering if I should bring her my Mothers Milk tea and see if that helps her milk come in faster so that little guy can get the good stuff instead of yucky formula. Sorry this is so long, any advice would be much appreciated!!!

[mikayla's mama]

My 4 month old was re-admitted at 72 hours old with a level of 17.something. My first also had jaundice, but not as bad.

Now, when I had my 4 month old it was a very easy delivery so my milk seemed to come in almost immediately. The Ped had me breastfeeding her on demand and also pumping breastmilk and supplementing with bottles of BM.

What I would do is pump, pump, pump and see how much if any milk she has coming in, hopefully that will help stimulate her milk to come in faster. They will have a pump and sterile attachments there at the hospital if she doesn't have her own, she will just have to specifically ask for them. They told me to just give her formula but after talking to the Ped he said that BM is always preferable to formula.

I worry if they are giving the baby formula then the baby is not going to want to suckle as much from mommy, possibly sabotaging the nursing relationship before it gets started. Jaundice babies are usually lazy/sleepy eaters to begin with.

Regardless of whether or not she has to keep using formula just tell her to pump constantly that way she can build her supply up for once the baby is released. I don't know if the nurses are giving her a hard time or whatever, but maybe it would be preferable to set the baby up in her PP room. The nurses probably just figure that it's easier to feed the baby formula and put him under the lights and be done with it. We had the baby's bili-light machine set up in our room and that way it was more comfortable for me to nurse whenever I wanted.

Good Luck to her.

[sedalbj]

pump and nurse and pump and nurse. the hindmilk is the most important part of the BM for jaundiced babies (the fatty part), as it comes in either pump off the foremilk first so there is lots of good hindmilk (jaundiced babes are sleep and every little second they are away and eating counts!) or pump into a bottle, let it sit for a little while, and skim off the fatty top and feed w/ syringe or bottle or cup or spoon. dd was 18+ at about 5 days old, and we didn't do anything special except stay outside a little more in the sun, and pump and feed the hindmilk first, then the foremilk if she was still awake.

[liseux]

I've been there too with early jaundice, which depending on the cause, can be more dangerous than typical jaundice that comes at day 4 or 5. I've had 2 rh sensitized babies and the first one actually had worse jaundice & had to have 1 bottle of formula. My second had no jaundice even though he was coombs positive & I attribute that to him getting more colostrum.

Here's my 2 cents. He should be off the lights every 2-3 hours for feeding. I asked for my baby to be brought off lights before he even cried, when he started sucking his fingers, so he would nurse calmly. If she can offer the breast every single time she has him & then keep him nursing until he goes back on, he will get colostrum, which for moving jaundice out is even better than the milk--its more of a laxative and gets the meconium out quickly & helps process the bili.

Formula is given b/c they want baby to start peeing & pooping & they don't think moms will nurse as often as needed, so formula is quicker. But... formula stays in the gut longer, harder to digest & won't move the bili out like colostrum. If she can nurse every 2-3 hours, day & night, keep him with her, skin to skin, nursing for at least an hour, put him back on lights, repeat. Soon her milk will be in & the dr's should leave her alone then. Formula is not a huge deal & she shouldn't feel bad, its hard enough being pp with a section, but if she can keep him on the breast as much as possible right now, her milk will come in & he will get lots of colostrum. She may not get much sleep & she may have sore nipples, but it will help get through this tough part. Good luck to her!

[AmieV]

I don't know a ton about this but I do know that jaundice in the first 24 hours is MUCH more of a concern than the kind that sets in later.

Does she have anyone she trusts to bring in donor milk to give instead of formula? I wouldn't freak out about the formula though, like a PP said, in this case it might be warranted. But she does need to make sure she's doing all the normal things to get nursing started, PLENTY of time for baby at the breast, maybe she could be pumping in between feedings to get milk going, etc. The tea couldn't hurt and you're sweet for bringing it to her!

[pamamidwife]

yes, jaundice in the first 24 hours is a serious issue. this is vastly different than NORMAL jaundice from days 3 to 5.

[kristenyostdc]

Yes, jaundice this early is pretty serious. I think that's why the docs put him under the lights right away. I'm going to call her later today to see how everything is going. I know she isn't going to let this get in the way of breastfeeding. I'm glad she thought to have him fed the formula with a syringe so he doesn't get confused. Hopefully her milk has come in and he is getting the good stuff now! Thanks for everyones suggestions and comments!

[XanaduMama]

Make sure she takes her iron supp to offset any anemia from blood loss during the c/s. I've learned recently that low iron can be one reason it takes longer for c/s mamas' milk to come in (and can cause supply issues). I had a vag birth but hemorrhaged badly afterward and it took 5 days for my milk to show up. Fortunately I had plenty of milk once it did arrive. Hugs to her.

[lesley&grace]

I am not sure what the practices are at your hospital, but where I had my babies they were under the phototherapy in the room with me. And I nursed on demand and told the staff that formula was not to be mentioned to me at all (and it was not). The staff were very encouraging of my bf since it's one of the best ways to treat jaundice.
Yes it's a concern that early, my son's was not high but it was up within 24 hours.

It sounds like your cousin's wife is going to have to get aggressive about her baby's care and start demanding that she be able to bf and demanding that EBM not formula be given if they feel the need to supplement. Good luck!

[InPhoenix]

I think that if she needs to supplement, it's not the end of the world.

My DS was born 4/18 and put under the bili lights on 4/20 because of pretty severe jaundice. I breastfed as much as possible and also supplemented with formula. My pediatrician is a strong breastfeeding advocate except when it comes to jaundice: because it's important that the baby not be dehydrated, then she recommends supplementing with formula only until the jaundice has cleared up. She said that in her experience, the only babies who did not do well under the bili lights were those who were not properly hydrated either through breastmilk or with formula supplementation.

It took me about a week afterward to build my milk supply so that I could do away with the formula, but I was able to do it. (I then went back to formula supplementation because I was hospitalized with a staph infection in my c section incision and couldn't see my baby for two days, but that's another story...)

You need to do what's best for the baby: if she can produce enough breastmilk to properly hydrate the baby then that's the best option; otherwise, I'd definitely supplement until the jaundice is cleared up. Jaundice can result in brain damage- you don't want to mess around with it.

[Marlet]

DD had it bad enough that we were genuinly worried about it. I spent the following day nursing on our porch with her naked. Worked like a charm.

Hope her babe gets better soon!

[pamamidwife]

I think the issue of jaundice causing dehydration in breastfed babies is bunk. I think that the real issue is that some babies get severely jaundiced because of feeding issues.

Colostrum, present even before the milk comes in, is a laxative. This laxative effect produces more bowel movements, therefore it helps get rid of more red blood cells and bilirubin.

Adding formula to normal breastfed jaundice only compounds the issue of what is really happening: an intake problem. Aside from those babies that are truly SICK and jaundiced (another issue altogether and occurs within the first 24 hours after birth), formula is only going to relieve the symptom of jaundice, but make the nursing problem and issues that much worse.

The fact that doctors repeatedly order formula for jaundice in breastfed babies means that they are looking over the fact that the baby is not nursing well - and the addition of artificial milk can further compound the release of bowel movements and worsen the jaundice. Not to mention make the baby go longer between feedings and not nurse as often.

We overtreat babies with jaundice without looking at why it naturally occurs and what the root of the problem is in babies with severe jaundice. Just the other day I saw a midwife supply/herb online shop that sold jaundice tea to give to the baby. This is horrible! Jaundice that starts at day three is NORMAL BREASTFED jaundice. Why are we treating it like it's something dangerous? If your baby is lethargic and not nursing that's one thing - and likely to be the reason why your baby is more jaundiced. But for a baby that is nursing well, why even worry about it??

I just don't agree that a doc that is truly "breastfeeding friendly" would offer a baby with jaundice formula. Physiologically, it may clear the jaundice but it totally dismisses the issue for the severe jaundice in the first place. This, to me, is not breastfeeding friendly. The numbers of when to treat keep getting lower and lower - and soon we'll just be treating any baby with slight yellow tinges.

No disrespect here, I just think that we get our panties in a wad over jaundice when it's a normal response to the transition from intrauterine to extrauterine life.

[Marlet]

Good point! I usually forget since it was only an issue in the beginning but DD didn't latch. We were basically overdosed on medicine used for surgeries and as a result neither of us wanted to nurse. It wasn't until we got home two days later that she even liked the idea of eating. Once she did though everything cleared up!