Tuesday, 18 December 2012

Triumphant Tuesday: Breastfeeding a Jaundiced Baby

Jaundice happens because babies are born with more red blood cells than they need. When the liver breaks down these excess cells it produces a yellow pigment called bilirubin. Because the newborn's immature liver can't dispose of bilirubin quickly, the excess yellow pigment is deposited in the eyeballs and skin of the newborn. Jaundice tends to be more common in breastfed babies and to last a bit longer. In most cases, it's harmless, but jaundice phobia on the part of medical staff often creates obstacles to successful breastfeeding. The mother in this week’s Triumphant Tuesday pole vaulted over these obstacles with not one, but *two* jaundiced babies.


When I was pregnant with my oldest son, who is now 8, I had planned on breastfeeding.  I took a class offered by the hospital I was delivering at; and when I went into labor, at 38 weeks, I made sure they marked my records that he was to be breastfeed.  

Boobie-Trapped Birth

My son was born after a relatively eventful 8 hour labor in which I had a poorly administered epidural.  During his labor I was also confined to bed and was pumped full of IV fluids (what are we up to now, 2 or 3 boobie traps?)  He was born a healthy 6 lbs. 14 oz; and was immediately whisked away and put under the warmer lights for vitals, eye drops, etc.  His initial billirubin levels came back elevated and I was told to breastfeed him as much as possible.  


Undergoing light therapy 

Commercialized Lactation Consultant

The IBCLC on staff stopped by once to see how breastfeeding was doing; but really she was more there to peddle her wears (pumps, pads, boppy pillows).  As my son's jaundice worsened the nurse told me to pump and finger feed him. I was handed a plastic teaspoon and was directed to hand pump colostrum into that.  I think you can image how well that worked out; it didn't.  No advice was offered, the IBCLC did not return. I felt like I was against a wall and already a failure.  I was alone, isolated and completely lost. 

Separation

In the middle of the night the nurse wheeled in a hospital grade breastpump (yes, it was on wheels and the size of a small car).  She spent about 5 minutes speeding over the basics and left me to "pump on my own in private".  The colostrum I expressed was minimal, and my baby was away from me in the nursery (because no one from the staff could bother with me; the Superbowl was well underway and our local team was in it for the first time in a long time.)  They eventually returned my son and had me feed him via syringe.  

Formula Supplementation

The next morning the pediatrician on staff told me we "needed to supplement" in order to combat his jaundice. This made me feel crushed, but as a new mother I assumed the staff pediatrician knew best. My son responded poorly to the milk based formula and was then put on soy formula.  We were released that afternoon, with instructions on follow up blood work for the jaundice and enough samples of formula to last a good month.  

Rude Relatives

At home I was determined to get him fully on the breast, however this was not easy. To make matters worse, I had a number of family members who were non-supportive of my breastfeeding - but they did it passively.  Questions about when I planned on weaning, off handed remarks about "when teeth come in", I was given a recipe for homemade formula - you get the idea. Despite these annoyances and after a month of battling with no outside breastfeeding support, I accomplished my goal and he was exclusively breastfeed.

Baby #2

Fast forward seven years and I am expecting my next little one.  This time I was determined to overcome all obstacles and set a goal of exclusively breastfeeding for the first 6 months, with the ideal goal being to continue until at least a year.  My husband was very supportive of the goal and attending breastfeeding classes with me and together we read up on the topic and became as informed as possible about breastfeeding.  This time I experienced an all natural, yet precipitous labor and my son was born in the triage unit of the hospital.  We had plenty of skin to skin time and he nursed within the first half an hour.  He weighed in at 7 lbs. 14 oz.  This time breastfeeding got off to a wonderful start, but I was again plagued by a jaundiced baby.

Hospitalisation

The day after we got home from the hospital the visiting nurse stopped by, observed our breastfeeding and took the baby's billirubin levels.  About 4 hours later; less than 24 hours after being home, we received a call from the pediatrician's office - the baby's bllirubin levels had shot way up and he needed to be admitted to the Children's hospital for care and observation.  It was heart crushing and scary.  

Bitter Nurse


In the hospital he was put under the blue lights and when I nursed him I had to keep him wrapped in a light therapy blanket. It was here that the staff nurse argued with me about my "nursing schedule". When I told them I was feeding on demand about every two hours or so one nurse responded very flippantly "that's not nursing, that's snacking".  The same nurse wanted to give him a pacifier. When I expressed concern over nipple confusion, she flippantly answered "there is no such thing."  Yeah, she was a real gem.  

Baby Deteriorating

Despite feeding around the clock, I was told that my son’s levels were not decreasing and I needed to pump so they could monitor how much he was taking in.  I obliged, and the doctor's were happy with my output and how much he was drinking. However by morning he was showing signs of dehydration and had stopped urinating.  His weight had dropped to 6 lbs. 13 oz, more than 20% less than his birth weight.  He was given an oral electrolyte and I was encouraged to keep nursing and pumping.  

As we neared nearly 24 hours of no urine he was put onto IV fluids; and then finally he started going to the bathroom and his jaundice improved.  Aside from being overwhelmingly scared, while he was being treated I feared him being offered formula as a way to "cure" the jaundice.  Thankfully that never happened this time.  

Today we celebrate 19 months of nursing.  Not only did I meet my goal of exclusively breastfeeding for the first 6 months; but I far surpassed my year goal.  

Initially, breastfeeding was important to me as it was "the right thing to do".  I wanted to be the best parent possible and in my eyes that meant breastfeeding. I wanted to offer the best possible start and get the bonding experience I've heard breastfeeding offered with my baby.  However breastfeeding has become so much more than that to me now.   I am training to be a breastfeeding consultant through an organization called Breastfeeding USA, which is an evidence based breastfeeding peer support group.  I have become really became passionate about breastfeeding and wanted to help other women obtain the same success I have.




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