MWs, what do you do with your ABO jaundiced babes?

[allnaturalmama]

I am about 3 weeks out from HBing babe #4. All my babes have been Coombs positive, and jaundiced within hours, sometimes minutes, of birth.

My 1st 2 were hospital births, and went into the NICU for phototherapy. My third was a dr-assisted homebirth, and the doc ordered home delivery of a bili-light blanket, which we used at home for the first 5 days.

This time, I'm having a MW-attended HB, but my MW does not have a lot of experience with ABO incompatibility. She also doesn't have privileges to order the lights from the home health care service.

Appreciate your experience and advice.

[Jane]

It's one of the criteria that our state organization "suggests" transferring, so I don't have experience, either.

That said, you'll need monitoring of the baby's levels. Who is going to do that? Can you just contact the home biliblanket people yourself and get it set up? Perhaps a ped's order for them - here they handle the blood draws and everything.

Any chance the baby will be Type O?

[allnaturalmama]

DH is A+. We don't know if he's heterozygous or homozygous (DH's birth father's medical history is unknown, and DH has never been typed for fear of needles). So far we've had 3 babes, and they're all A+. Either we're in for another A+, or we're due for our 25% chance of an O, LOL.

Never thought of contacting the home health care company directly. I've always assumed they needed a script for the lights. Can't hurt to give them a call tomorrow. I'm guessing I do need a script, but you just never know...

[mwherbs]

I have seen out patient lights ordered- when living in Washington along with drawing serial labs--
where I live sunlight and we use observation-- how much of the body is yellow? is the baby awake enough to eat , and eliminating frequently? the trouble with going to a hospital for lights is that the baby usually ends up not breast fed enough- and frequent nursing and elimination are key---in one of the journals there was a study on what worked to reduce the use of transfusion and lights-- "These changes, which occurred without prophylactic use of phototherapy or pharmacotherapy, are considered to reflect a renewed emphasis on provision of warmth, early institution of breast milk feeds, and improved care in the labor room."
and
here is an abstract on effectiveness of sunlight--
Photodermatol Photoimmunol Photomed. 2001 Dec;17(6):272-7.

Can sunlight replace phototherapy units in the treatment of neonatal jaundice? An in vitro study.
Salih FM.
Department of Clinical and Biomedical Physics, College of Medicine, Sultan Qaboos
University, Sultanate of Oman. [e-mail]

.....................skipping most of the abstract......
CONCLUSION: Data revealed that sunlight is almost
6.5 times more effective than a phototherapy unit when operating at the ward geometry after taking isomerization efficiency and area of exposure into consideration. Moreover, sunlight is still more effective during the winter
season, when its intensity is lower. Thus, sunlight may be considered an
alternative phototherapy source for the treatment of neonatal jaundice,
particularly in areas where conventional phototherapy units are unavailable.

[sevenkids]

I don't usually blood type a baby unless Mom is Rh-, and so far I've only seen one baby that needed to go to the hospital because he was looking like a lemon at 24 hours old, and more importantly, and was rather lethargic.

I always suggest sunbaths for every baby starting 24 hours old, 30 minutes around 10 am, and 30 minutes around 4 pm, sitting in a sunny window with a naked baby. And nursing every time baby appears interested, no longer than 4 hours between nursing until the milk is in. Jaundice appears to be more severe in infants who are not exposed to natural light in the first few days (babies in hospital nurseries and babies kept in a darkened room). Other factors which may increase the severity of jaundice are cold-stress and hypoglycemia, which a nursing mama holding her baby is going to avoid.
I've never seen ABO incompatibility be so severe that the baby needs more than phototherapy, though I understand it rarely can be. ABO jaundice is typically self-correcting once the milk comes in to help eliminate bilirubin.

So, if the baby is yellow below the nipple line at 24 hours, and is lethargic and not nursing well, then a call or visit to the pedatrician.

[Charmie981]

I'd suggest talking to your ped. about if he is willing to treat the jaundice outside of the hospital. He can order the home health billi blanket.

[lorijds]

In our hospital (and at the birth center where I previously worked), we never took care of this aspect of the birth. The baby is the pediatrician/family practice doc's responsibility. Even in the hospital, it is not the CNM or OB who orders the baby's care, it is the baby's physician.

So, your baby's physician will need to be contacted. He/she can order the home therapy lights, labs, etc. I seriously doubt the home care agency will do anything without a physician's order.

ETA: Obviously, you can do what you choose; I didn't intend to imply that all of this is somehow high risk and must be managed by a physician. But if you, as an experienced mother who has had previous infants with jaundice issues, feel that more than sunbaths and frequent nursing are needed, then you should contact the baby's physician to get these things ordered.

[allnaturalmama]

This has all been very helpful, thank you so much.

I'm taking meticulous notes and mulling it all over.

As far as sunbaths, what about climate/time of year?

I live in the northern US. Our days are short and cloudy, and not a whole lot of sunlight streams in any window at any time of day. Also, it's very cold here, so even though we're inside, the air around the window would be very cold for a naked baby. : Of course, I'd be holding babe, so he'd have my body heat, but would still be exposed to drafty air. Any thoughts or advice?

My MW consulted with another 30+yr veteran MW locally. She stated that she's never used bili lights, and never had to transfer a babe to the hospital for jaundice. Her standard treatment is activated charcoal: 1 capsule in 1/8 cup purified water: 2 drops every 2 hours with exposure to light 5 min every hour. I'm thinking about trying this, and appreciate your thoughts.

[mwherbs]

activated charcoal is pretty hard to get down a newborn and to get it in with fluids is messing with breast milk supply/demand
delayed cord cutting
baby massage , keep baby warm and nursing alot
sunlight figure out how to heat an area around a south facing window --30 minutes isn't long through out a day 5-10 minutes at a time even with over cast sunlight- still a broad spectrum is coming though.
I guess I would say that we do newborn exams and 1st day exam and check on baby on day 3 and at one week and 2 weeks and 6 weeks and any time inbetween if we get a call and although we recommend parents take the baby to be seen by their family practice or ped- very few do until after 6 weeks unless there is some serious problem-- and usually that means an ER visit instead of just a doc visit. --
you could talk to your family doc ahead of time and see if he would order some bili lights for home care if you wanted--
If you use photo therapy I would recommend mom take some B vitamins so that it will boost the Bs in her breast milk- certain Bs are lost via exposure to the lights---
since this is baby #4 for you who is going to be helping out? some babies are those efficient nursers that get what they need in 5 minutes and then there are those that seem to be constantly at the breast- and if so in order to stay on top of baby's needs you might need some significant reliable help-- someone who won't make you crazy but will get-er done...laundry,food, shopping,kid monitoring, wait on you hand and foot as well... mom's job-- nursing
I would also say go to LLL meetings and learn as much about nursing cues as possible-
in pregnancy for you eat plenty of vitamin K foods how about atleast 2 servings of greens/day to start with-- it will help prevent blood mixing and in turn sentization ...

[allnaturalmama]

Thanks, mwherbs!

I'm thinking that just 2 drops of the charcoal solution every 2 hours should be manageable for not interfering too much with the nursing.

I am planning to do nothing the first few days other than be skin-to-skin with baby and nurse, nurse, nurse, with visits to the window, of course. Between DH and my mom, as well as local IRL friends, I think I'll be covered as far as help with the other kiddos and household stuff. I've got about 3 weeks of meals in the freezer, so that'll help, too.

Unfortunately, my house has no south-facing windows. All are east, north, and west, with the westward ones all set back 6 feet under a porch roof. However, there are certain spots where the sun comes in better than others at various times of day, and we'll just go to those. I'll ask around and see if any of my friends have a space heater they can loan me.

I've been going to LLL meetings on and off for about 7 years now. My MW is a LLL leader, as well as one of my close IRL friends. I'm also plugged in to the best LCs in the area, so I'm hopeful nursing will get off well. I've overcome HUGE obstacles, each different, with each of my first 3 babes, so I'm ready for whatever may come with this one.

Will work on making sure I'm getting the B vitamins. Definitely already eat lots of dark leafy greens, so I'm good there.

Thanks for all the help. I'm sooooo very grateful!

[Synchro246]

Aqua colored lights should work too, if sunlight isn't available.

[allnaturalmama]

Originally Posted by Synchro246

Aqua colored lights should work too, if sunlight isn't available.

I'm not familiar with those. Where would I buy them? Are there particular brand names I should be aware of?

Thanks!

[Synchro246]

Well, I just went searching for the info that I read while preg with my last baby. My first baby had ABO issues. My second did not.
Anyway, I couldn't find what I had read before & I can't remember where I read it!
Let me continue searching.

[lorijds]

MWherbs--

I have a question. How does delayed cord cutting help with jaundice? I always assumed it contributed to jaundice--after all, the infant gets more of his/her own blood, which results in more red blood cells to start breaking down and recycling, etc. Don't get me wrong, I'm a strong advocate of delayed cord cutting, I think it helps with so many other things; and I also think a little jaundice is as natural as a little head molding--it just is part of being born. But I've always just figured delayed cord cutting contributed to jaundice. Do you feel this isn't true? Do you mind explaining it to me? I'd appreciate it!

Thanks for letting me pick your brain--

Lori

[Synchro246]

I totally cannot find the article. Sorry. The only specific I can remember from the article now was that the ideal light wavelegnth is between blue & green. The article referred to this as aqua.
GTG. If I remember where it was I'll direct you

[mwherbs]

most likely because it allows for enough healthy blood to carry out normal processes- including blood gas exchange (asphxia increases jaundice)- ABO similar to but not the same as Rh sentization is more than physiologic jaundice it is hemolisis the immune system attacking RBCs - on top of the normal hemoglobin change over - there are some that theorize that clamping early before deliberate shunting causes distruction of RBC by the heart still forcefully pumping toward the cut end- but it could be simpler than that just contracted volume increases distruction of RBCs

[lorijds]

I'll buy that; thanks for the explanation, MWherbs!

Lori

[daintyfrump]

I've been told that the light that comes through our modern windows is too filtered to be useful.

Thoughts?

[mwherbs]

low E-windows don't block UV light some heavy window films will block UV--

[3daughters]

My third was coombs positive and we had no jaundice issues. Plan for the worst, but hope for the best!