Booby Traps Series: Did you get good breastfeeding care when your baby was jaundiced?

This post is the 57th in a series on Booby Traps, made possible by the generous support of Motherlove Herbal Company.

Jaundice (neonatal hyperbilirubinemia*) is the most common reason why babies are readmitted to the hospital in the first two weeks of life.  And since the majority of jaundiced babies are being at least partially breastfed, it seems fair to ask how our healthcare providers do in protecting breastfeeding while caring for jaundice.

For the answer (since there doesn’t seem to be any research on actual practice), I turn to you.  I’m listing the recommendations of the American Academy of Pediatrics (AAP) and the Academy of Breastfeeding Medicine (ABM) as they relate to the care of breastfed and jaundiced babies.

If you’d like to play along, give your providers a grade of “pass or fail,” and let’s see what kind of a score we come up with.

Prevention of jaundice*

AAP:  “In every infant, we recommend that clinicians promote and support successful breastfeeding.  Your provider’s grade (pass/fail): ___

AAP:  “Clinicians should advise mothers to nurse their infants at least 8 to 12 times per day for the first several days.”  Your provider’s grade (pass/fail): ___

AAP:  “The AAP recommends against routine supplementation of nondehydrated breastfed infants with water or dextrose water.”  Your provider’s grade (pass/fail): ___

Identification of at-risk mothers and babies

ABM:  “Both maternal and infant-related health factors [maternal diabetes, Rh sensitization, infant bruising, prematurity/late preterm, ABO disease] may increase the likelihood of an infant developing significant hyperbilirubinemia.  When such risk factors are identified it is prudent to seek lactation consultation in the early hours after delivery to assure optimal breastfeeding management.”  Your provider’s grade (pass/fail): ___

Treatment with phototherapy

AAP: “In breastfed infants who require phototherapy, the AAP recommends that, if possible, breastfeeding should be continued.” Your provider’s grade (pass/fail): ___

ABM:  “Breastfeeding infants who are readmitted from home for phototherapy should be admitted to a hospital unit in which the mother can also reside so that breastfeeding can continue without interruption.” Your provider’s grade (pass/fail): ___

ABM:  “Phototherapy is best done in the hospital and in the mother’s room or a pediatric room where mother and baby can stay together so that breastfeeding can be continued.” Your provider’s grade (pass/fail): ___

ABM:  “Interruption of phototherapy for durations of up to 30 minutes to permit breastfeeding without eye patches does not alter the effectiveness of the treatment.” Your provider’s grade (pass/fail): ___

ABM:  “Such decisions should be individualized taking into account the specific clinical setting and indications for therapy with the goal of keeping mother and baby together, preserving and optimizing breastfeeding while delivering the required therapy to effectively treat the condition.” Your provider’s grade (pass/fail): ___

ABM:  “Encouragement to continue breastfeeding is of the greatest importance since most of the parents of these infants will be fearful that continued breastfeeding may result in more jaundice or other problems. They can be reassured that this is not the case.” Your provider’s grade (pass/fail): ___

If breastfeeding is interrupted for temporary formula supplementation:

ABM:  “In infants less than 5 days of age, interruption of breastfeeding and replacement feeding with formula may not be as effective as the use of phototherapy.” Your provider’s grade (pass/fail): ___

AAP:  “In breastfed infants receiving phototherapy, supplementation with expressed breast milk or formula is appropriate if the infant’s intake seems inadequate, weight loss is excessive, or the infant seems dehydrated.” Your provider’s grade (pass/fail): ___

ABM:  “[When breastfeeding is interrupted] healthcare providers should offer special assistance to these mothers to insure that they understand the importance of continuing breastfeeding and know how to maintain their milk supply if temporary interruption is necessary.” Your provider’s grade (pass/fail): ___

ABM:  “Excessive amounts of formula should be avoided so as to maintain frequent breastfeeding and preserve maternal milk production at a high level.” Your provider’s grade (pass/fail): ___

ABM:  “Supplementation of breastfeeding should be achieved by cup or use of a supplemental nursing device simultaneously with each breastfeeding. Nipples, teats and bottles should be avoided where possible.” Your provider’s grade (pass/fail): ___

ABM:  “With temporary interruption of breastfeeding, it is critical to maintain maternal milk production by teaching the mother to effectively and frequently express milk manually or by pump.” Your provider’s grade (pass/fail): ___

So, how did your providers do in caring for your jaundiced baby while protecting and supporting breastfeeding?

*There are several types of jaundice, and a variety of causes.  This article pertains to jaundice resulting from inadequate intake, sometimes called “starvation jaundice” or “breast-non-feeding jaundice.”

Image credit:  Wikimedia Commons

 




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17 Comments | Last revised on 09/28/2012


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17 Responses to Booby Traps Series: Did you get good breastfeeding care when your baby was jaundiced?

  1. Melissa K says:

    My pediatrician wasn’t at all worried about my 35 week babies jaundice. The hospital actually bullied him into additional tests. He encouraged me to use the hospital’s lactation consultants but otherwise he just stepped back and let my daughter grow on mama’s milk.

  2. Katie says:

    My healthy EBF daughter never even had jaundice, yet the pediatrician tried to pressure me to give her formula as a way to prevent it. Thankfully I knew better.

  3. Kate D says:

    This is a topic near and dear to my heart. Both of my boys (spaced 7 years apart) suffered from jaundice. The older one was given formula as “medicine” and we had a struggle to get him back at the breast full-time once we got home. The younger one was discharged with me when I had him, and then readmitted for light therapy. He was not supplemented, but breastfeeding him a huge struggle in the hospital while still trying to care of myself days after his birth in a non-private room and less than helpful staff. Eventually he became dehydrated and required IV fluids. It was a nightmare… today he’s 19 months and still breastfeeding (never once had formula).

  4. Tiffany says:

    We were so blessed to have given birth in the hospital we did. When our first son was born he was jaundiced. His billi level was 21 and we were not once asked to suppliment formula. They kept him in the hospital an extra week to keep him under the lights and they gave us a room to stay in so we did not have to leave him. He was exclusively breastfed from birth and never supplimented. We had a wonderful CLC who checked up on us daily while in the hospital and I attribute her amazing help to the reason why I am a LC now.

  5. Janine says:

    My son was fairly jaundiced, and I would give my caregivers a PASS on everything applicable (my son never had to be under the lights). He was born at Adventist Medical Center in Portland. I was originally told that he would need the lights, but my doctor/pediatrician decided that breastfeeding him in the sun would be enough. :) We also saw an LC who helped us supplement nursing with a tube and with a bottle for awhile. We got great care!

  6. Bekah says:

    FAIL! My first born was severely jaundiced. I took him to the ER and his bilirubin was over 22. I didn’t know what this meant, and they sent us home and told me to stop worrying. It was a holiday weekend, and by the time we saw our pediatrician, his bili levels were 32.7. My pediatrician did not have privledges at the local hospital and had another take over my sons care. The pediatrician had me stop breastfeeding. I questioned him about it and cited the AAP. He yelled at me and asked who the doctor was. I was scared, and with the help of a LC pumped, while my husband fed our son a bottle of formula which he promptly spit up. It was a horrible time. I worked my tail off to breastfeed. I nursed, pumped, nursed, pumped, took herbs, nursed, pumped, etc. Luckily I had access to a hospital grade pump. However, he was failure to thrive. I never recovered a full supply and ended up using a SNS to get to a year.

    • Bettina Forbes, CLC says:

      You are a warrior babe and kudos to you!

    • Tanya Lieberman, IBCLC says:

      What a scary story!

      Scary most of all for your son, but also that his care was so poor. Sent home and told to stop worrying with a bilirubin of 22? A later level of 32.7?!? Any chance you’d write a letter to risk management at the hospital where you took him to the ER?

      I admire you for working so hard to breastfeed as much and as long as you did after such a rough start! Relactating can be a huge battle. Like Bettina says, you’re a warrior babe!

      Tanya

  7. Unfortunately I was convinced to supplement when I had to be in the hospital with my son who was jaundice, fortunately for both of us as soon as I got home and did the research, thanks to KellyMom.com ! I got of the supplements very fast and continued to exclusively breastfeed for 6 mo and then full term breastfed until my son was 3. :) He is a beautiful and healthy 5 yo now!

  8. Andrea says:

    All three of my babies were mildly jaundice. WIth my third they almost didn’t let us out of the hospital because of some forehead test they do put him in the warning zone. I was exhausted and just wanted to go home to my other two kids and was ready to cry if they made us stay another night. Luckily they did the blood test and let us go and he was jaundice for a few days but I knew it would pass once my milk came in and he was fine. The nurse was awesome and she knew that he was probably fine but hospitals are getting so worried about things that they are testing more even when its not necessary (for example: they ALWAYS test my kids for blood sugar levels because they are big and they refuse to get that I just have big babies but poke at my kids anyway. :-/ )

  9. Jena says:

    We had a very negative experience. We were discharged after birth with only the knowledge that she was jaundice and that we needed to follow up with the pediatrician the following day. We had her out of our hometown so for the hospital stay we used the on call pedi and since our follow up was on a Saturday we saw her as well since we could not expect to see our new pedi in our town with a 1 day notice on a weekend.

    She drew another round of blood work and readmitted us within a few hours. We got to stay in a private room with her but it was torture to only hold her 30 minutes every few hours. After about 12 hours we were spent and so was she. I can’t imagine being forced to sleep by having a mask strapped on. Luckily, or so we thought, the Dr. called at 3am, in the middle of our family meltdown, and told the nurses to remove her until morning. They sent us home the following afternoon with only a few digits dropped from her number (I can’t remember now what they were). The entire time they pushed formula but we only gave her less than 1 oz. and I cried the whole time so we stopped. We felt pressured and almost bullied. I was told constantly that my supply must not be enough.

    We were then told to do a follow up with our permanent pedi and they got us in that Monday. She took one look at her and rushed blood work and sent us immediately to our local hospital. Their treatment was better, we were able to hold her more because not only was she under a light but that had a light blanket under her so if we did need to hold her for longer times we could hold her and keep that blanket on her so the therapy would not be interrupted.

    Our pediatrician told us that with her original levels they should have sent us home with instructions on light therapy by a window, that alone should have corrected it. Then when the 1st Dr. decided to stop the therapy short she actually caused her levels to jump, why the 2nd Dr. was able to instantly see that she was too high the following day. By the time we got to her she had gone from an above average level to almost brain damage level. The 2nd hospital stay was longer to correct her new number. Overall we did 3 days for birth, 2 at the 1st hospital and 3 at the 2nd. For a long time we felt like we missed out on a lot of the “bring home baby” joys. Just as we’d spend a night at home and get settled we were readmitted.

    Our Dr. is VERY pro breastfeeding but was honest with us and said that formula pushes stool faster and that a 2 oz. bottle was all we needed to do this late in the game. We felt it was critical and did the bottle. Our baby DEVOURED it. I cried even more. They did a few tests and measurements and realized that because of days of trauma to our little family my milk was not coming in. They helped me pump, gave me fenugreek and oatmeal while we stayed at the hospital and sent me home with plenty as well. But, that began a month long battle of having to supplement while nursing, pumping and weaning her slowly from formula. Our Dr. was not happy about prescribing formula but she was the first to tell us that we could actually wean her from it as my milk increased. We thought it was a permanent thing! What a relief!

    It was not a fun road to take and we were disappointed that we had to supplement, if we would have known or gotten better advice the first week of her life she and my supply would not have suffered.

    But, we know better now, and she is almost 17 months and still nursing!!

  10. lisa says:

    My daughter (now 7) was born at 35 weeks . She had to be in the NICU . I was devastated because all I had ever been told was that having a premie (esp one in the NICU) meant you could not nurse. I had a friend who was an avid nurser who was told by her Dr that nursing her baby with jaundice was dangerous and she put him on formula. With her having jaundice among everything else I was certain that this would be the same case. When I was put in my room a breast pump was waiting for me as well as a nurse to help . I was literally dumbfounded . I couldn’t believe it ! How was I going to nurse when I couldn’t even hold her, my milk had not come in yet and to top it all off she had jaundice . They were spectacular . She assured me that it could be done it was the best thing that I could do for her and it would not harm her. I pumped and the nurses fed her with a syringe . She spent 8 days in the NICU . I was certain that she wouldnt latch on but she did right away . She was my 3rd child . Had she been born in a different hospital I know that it would have been very different . Our healthcare providers simply dont know enough about nursing . Esp in small town hospitals. My older children were only successful at nursing because I was determined and I had friends that cared enough ,had experience to help. One little problem and everyone says “Oh it cant be done .My problems were far from little but it happened.

  11. Ruth says:

    Our Pedi got a pass! We did inhome phototherapy starting at 5 days old (jaundice didn’t appear until after discharge, noticed by our LC at our follow up visit at 3 days old.) We were encouraged to supplement with expressed milk After nursing (only 1oz) due to her climbing levels and continued weight loss. I was never told to stop breastfeeding, or that I HAD to give formula. Baby was back to birth weight by 3 weeks old and was up 3lbs by 6 weeks, without formula.

  12. liz may says:

    I’m in the UK. Had a wonderful home birth but took the baby to hospital myself because extreme sleepiness of baby and failure to take breastfeeds. I was told by the midwives that the standard treatment for jaundice was formula. I said “but I’m breastfeeding”. So the midwives had to adapt to my wishes. (I had read so much about breastfeeding that I was unwaivering in my commitment). The midwives then had to research what the dosage of breast milk should be given (I expressed loads with their industrial pump). Baby received photo therapy treatment. Baby did not lose an oz of birth weight and actually put on weight during our 3 day hospital stay. The most valuable member of the healthcare team to me was the lowest paid, a healthcare assistant and mother of four, who showed me how to cup feed breast milk and spent hours with me during the night reassuring me that when I was breastfeeding ” I was doing it right”. My thorough reading prior to giving birth gave me the confidence to challenge the “usual/non-breastfeeding friendly” jaundice treatment. The doctor at the 6 week check also recommended formula to clear the jaundice more quickly. It was the first time in my life I realised that doctors don’t know it all. Doctors- fail, midwives – could do better, health assistant – top grade, difficult/educated/confident Mum- gold star!

  13. Casey says:

    The Baby Friendly Hospital I delivered at in Elkhorn Wisconsin was wonderful in all ways!! Our son was premature @ 35 wks and had jaundice. Reading throught the list of questions, Lakeland Hospital “passed” in each and every way!! :) They allowed me to stay in the hospital a couple extra days for rooming in with my newborn to continue breastfeeding while undergoing phototherapy there prior to taking home a billy blanket. Even gave me glasses to have him in the hospital bed with me under lights. So blessed to have them close by and wish more hospitals would go Baby Friendly!!

  14. Hallie says:

    My son’s pediatrician totally passes. I had no idea what he did wasn’t standard care. He sent my home birthed baby back home with a bililight that cost us $100 per day to rent (compared to who knows how much it would have cost to stay in patient at a hospital) and never even mentioned formula, and said we could take our baby out of the light whenever we needed to feed him or change him, as long as we put him back in the light bassinet when he was sleeping. My sons bilirubin level was like 20.5 to start, but after 2 days with the at-home light bed it was like 12 and the pediatrician said we could return it.

  15. Melissa says:

    My baby never had jaundice, but my pedi/hospital pass in the all the prevention categories. Not a baby friendly hospital (not sure why) but they do many of the baby friendly practices anyways.

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