Breastfeed and jaundice

[mrslka]

Hello ladies!  I am about 6 weeks out from LOs arrival and have anxiety over my desire to breastfeed.  Even though DD is my third child I have had success BFing before.  With DS1 I had mastitis while I was pregnant and was unable to bf because I had open wounds from having 2 spots drained.  With DS2 I thought I was prepared, I had met with the LC and taken classes. Well I wasn't prepared for dealing with high jaundice levels. once we got home i couldn't get him to stay awake to feed, he lost ~20% of his birth weight by day 4 so our pedi insisted on supplementing with formula since my milk still hadn't came in. After that I could get him to stay latched to feed. Since the near LC is an hour away I wasn't able to meet with her again and BFing sadly went out the window. 

Sorry for the long story.  Anyways, I desperately want BFing to work this time. Since both of my boys had jaundice, I want to be prepared to deal with it again but not hurt my chances to BF.  Any tip/advice would be wonderful!

[lauranicole91]

My daughter was severely jaundiced and was at the hospital for 2.5 days from 4-6 days old.

At first they were letting me pick her up to nurse, but her bili levels kept rising. So they told me I had to keep her on the lights, no exceptions. They offered me a pump but I refused. I some how managed to just dangle my boob over the rolling cart and fed her both sides every two hours.

Keeping her awake was definitely a struggle. But we powered through. I'm not sure how much weight she lost, but she didn't hit her birth weight until close to 4 weeks. Her pedi never pushed formula or supplementing.

I set alarms to wake her every 2 hours to nurse both sides until she was back at birth weight. Then I finally started letting her sleep through feeds if she was asleep.

Good luck! I hope you get a chance to have the BF experience you are wishing for!

[ellabee]

No experience with jaundice here, just another vote of support. Sounds like you're doing everything you can to prepare yourself for success. Good luck mama!

[melody330]

DS had jaundice, but not to such an extreme as others. He lost a little more weight than they like, and no one ever asked me to supplement. They taught me tricks to help feed (compressions, keeping baby latched, skin to skin) and I fed him every two hours around the clock until it went away. It was tough, but by 7 days old it was pretty much gone.

He was also very very sleepy so I had to undress him for every feeding. It woke him up enough and we got through it.

[mrslka]

Thanks for the support ladies.
lauranicole91 thank you for sharing your story. It's reassuring hereing someone was able to power through even with the billi lights!

[babycaps]

Feed your baby close to the sunlight and naked at much as possible from day one. It doesn't have to be direct sunlight, but feed by the window!
Feed on schedule EVERY 90min-2hrs for the first week.
If they insist on your supplementing pump after each feeding to use your own milk to supplement.
See about hiring a post partum doula who is an LC to come to your house and help in case you need the help
YOU CAN DO IT!!!!

[robinbird]

My baby wasn't severely jaundiced, but he had it for several weeks. Something like 8-10 weeks I think. We had to use a bili blanket at home for a few days, but other than that they just told me to nurse, nurse, nurse even though they said it was breastmilk jaundice. I fed him every 2 hrs (or less) and every 3 hrs at night for several weeks. He also never had a weight problem. The worst for us was when they had to prick his feet to check his levels. He also had (has) reflux, but that's another story! Try again to meet with a LC. We met with her twice (once when he was about 5 days old and once when he was around 8 weeks old) and she was a ton of help. I understand not wanting to travel an hour, but if she's good, then I think it will be worth it! Good luck!!

[mrslka]

Jan 28, 2015 9:41:03 GMT -5 babycaps said:

Feed your baby close to the sunlight and naked at much as possible from day one. It doesn't have to be direct sunlight, but feed by the window!
Feed on schedule EVERY 90min-2hrs for the first week.
If they insist on your supplementing pump after each feeding to use your own milk to supplement.
See about hiring a post partum doula who is an LC to come to your house and help in case you need the help
YOU CAN DO IT!!!!

Thank you for the advice! I wish I had the option of a doula for labor and/or postpartum, but it's just not an option. I have had a few indepth talks with DH about how he can support me. And I am hoping to be able to meet with the LC that is an hour away at least once before DH goes back to work.

[lavwana]

Look up La leche league and find the group closest to your area. They have groups all over the place, and usually facebook pages as well. The leaders give great breastfeeding advice, and it's nice to have a support group close by. Your baby will have to poop lots to get the bilirubin levels down as I'm sure you know already. I've got a new little one with mild jaundice, and our pediatrician hates bili lights. She recommended nursing as much as possible and putting her by the windows and any other ambient light. My first daughter was not jaundiced at all, and didn't want to nurse as much the first few days as this new one did. She nursed almost constantly the first few days until my milk came in. I think pumping early on to have breastmilk to supplement with just in case would be a good idea for you. Hopefully won't be necessary You may end up with pretty sore nipples though. Mine came in this time around on day 4. Also the more time you spend skin to skin with baby will help with your milk supply and establishing a good nursing relationship early on. I felt selfish doing it since everyone else wanted to hold the baby, but we did lots of skin-skin (kangaroo) time. I'm not sure if the hospital where you're giving birth encourages it, but you should request it for immediately after birth if possible.

[theresat858]

We had to supplement with formula for my first LO because of jaundice, but it didn't ruin our chances of breastfeeding... did you not get the advice to pump when baby wasn't eating well because of the jaundice?
DD1 had a level of 9 at 24 hours, which I guess was on the high side, so she went straight to the lights and also got a bottle of formula. She got another bottle of formula the next day. I started pumping every 2 hours with a hospital grade pump, going 3 hour stretches at night. I nursed her often as well, but we were giving supplemental bottles too because of the jaundice, and it was hard to nurse her bc she was so sleepy. I don't remember the details, but we only needed a few bottles of formula before all of her supplements were pumped milk. Then we gradually worked on getting her back to the breast. It took her until ~2.5 weeks old to wake up and figure out how to transfer milk efficiently. We did weighed feedings to help know that she was getting enough. she took 3 weeks to get back to birthweight even w/ the supplementing.
I then breastfed her until she was 2.

So jaundice isn't automatically a reason you can't BF a baby...you just have to work at it and be willing to pump to establish your milk supply if baby is not nursing efficiently. Plan to rent a hospital grade pump and pump often in addition to doing lots of skin to skin with baby.

[mrslka]

lavwana thank you for the helpful advice! Our closest LLL is 3 hrs away so it's really hard to go to that. I am meeting with the LC at my next Dr appointment, I am going to ask her about start to pump at 37-38 weeks. I know this isn't popular in the US but it is very common in other countries.

theresat858 I know jaundice doesn't mean I can't breastfeed, that's why I am asking for advice! DS2 wouldn't latch on again after having a bottle, that's why I wasn't able to continue.

[nursefrizz]

As PP said, I would definitely ask for skin to skin immediately after birth and try to nurse during that first wakeful period. My hospital emphasizes skin to skin after birth, but when I asked if I should try to nurse DD immediately, they told me no. I wish I would have tried anyway because she was always so tired after that and her latch was so weird it took us a while to get nursing down. I always wonder if I would have tried at the very beginning if it would have made a difference. She did become jaundiced after that. I couldn't get her to latch, so I fed her pumped milk with a dropper after the attempted feedings. I kept trying to nurse and eventually she got the hang of it. I can totally relate to not having an LC available. We have them here, but they seem to be stretched super thin. I didn't really feel like I was getting the help I needed.

[mrslka]

Jan 28, 2015 18:20:23 GMT -5 nursefrizz said:

As PP said, I would definitely ask for skin to skin immediately after birth and try to nurse during that first wakeful period. My hospital emphasizes skin to skin after birth, but when I asked if I should try to nurse DD immediately, they told me no. I wish I would have tried anyway because she was always so tired after that and her latch was so weird it took us a while to get nursing down. I always wonder if I would have tried at the very beginning if it would have made a difference. She did become jaundiced after that. I couldn't get her to latch, so I fed her pumped milk with a dropper after the attempted feedings. I kept trying to nurse and eventually she got the hang of it. I can totally relate to not having an LC available. We have them here, but they seem to be stretched super thin. I didn't really feel like I was getting the help I needed.

Thanks you for your story and support!  We planned to do kangaroo care right away last time but the student nurse wisked DS2 off and won't bring him back until 30 mins later when DH yelled at her.  I was able to feed right away then but I didn't get to see the LC until right before we were discharged.  We have made it very clear this time there will be no students in during delivery and DD will be given directly to me for kangaroo care.

[octavia65]

mrslka - Sorry you've had problems in the past. My son had low blood sugar and slightly elevated bilirubin. I agree with PP about how awful the heel prick test was!! We supplemented in the beginning but only a very small amount after each BFing session. We actually used a syringe instead of a bottle. I also had to used a nipple shield until he was able to latch on his own around 10 weeks. I would recommend using a syringe instead of a bottle and then nipple shield if latching is an issue. The nipple shield was definitely annoying but it was a great tool. I'm not sure BFing would have worked out for us if we hadn't used it! Good luck.

[mrslka]

Jan 29, 2015 10:07:50 GMT -5 octavia65 said:

mrslka - Sorry you've had problems in the past. My son had low blood sugar and slightly elevated bilirubin. I agree with PP about how awful the heel prick test was!! We supplemented in the beginning but only a very small amount after each BFing session. We actually used a syringe instead of a bottle. I also had to used a nipple shield until he was able to latch on his own around 10 weeks. I would recommend using a syringe instead of a bottle and then nipple shield if latching is an issue. The nipple shield was definitely annoying but it was a great tool. I'm not sure BFing would have worked out for us if we hadn't used it! Good luck.

I agree the heal pricks are horrible.  Thanks for the syringe suggestion that is something I am going to add to my list! 

[Deleted]

Yes you can say that baby can only receive supplement thru cup spoon eye dropper syringe or finger feeder. Or if you are able to nurse use a supplemental nursing system at the breast to give extra.

You can try once you are at about 38-39 weeks to collect small amounts if colostrum to use as your own supplement. Basically you'd hand express into a s syringe and it can be store for up to a we or just freeze it. Bring to hospital with you in. A small cooler and expect that if baby's numbers are high that you are able to nurse and use that supplement first before any formula.

You can also begin right after first nursing session to pump or hand express colostrum and after some feeds give an extra teaspoon or so of colostrum to help flush the bilirubin. You can also ask about donor milk if she needs more volume but again use a breastfeeding friendly supplementation method other than a bottle. Push nursing sessions on an every two hour schedule as much as possible.

Part of the big issue with jaundice is the catch 22. Sleepy newborns don't wake to eat as often as they should so they don't eat enough to poop out the bilirubin so it builds up and jaundice gets worse. And as jaundice e gets worse baby gets sleepier and won't wake to nurse and it can easily compound. Also premie and late term premies are more prone to higher jaundice levels faster

[mrslka]

@amyg thank you! I am really hoping to have a little stash of colostrum before birth. I know colostrum is almost like a lacative and helps flush their system. I had to be induced at 39weeks and 38 weeks with my boys and labor/delivery is so fast that the extra bruising also causes high jaundice levels. So I am hoping with the advice from you ladies and previous experience I can start combating it right away so it hopefully doesn't get as bad this time.

[lavwana]

Jan 28, 2015 17:55:12 GMT -5 mrslka said:

lavwana thank you for the helpful advice! Our closest LLL is 3 hrs away so it's really hard to go to that. I am meeting with the LC at my next Dr appointment, I am going to ask her about start to pump at 37-38 weeks. I know this isn't popular in the US but it is very common in other countries.

theresat858 I know jaundice doesn't mean I can't breastfeed, that's why I am asking for advice! DS2 wouldn't latch on again after having a bottle, that's why I wasn't able to continue.

Pumping releases oxytocin which can cause contractions and induce labor, so make sure before you do that that you are prepared for baby to be delivered.  They will also usually only recommend only stimulating one breast at a time as it can cause your contractions to be too strong and stress out baby.

I think the advice to not allow a bottle is a good idea, and to try other feeding methods first. I tried to pump some before this baby came along as an idea to induce labor which didn't work, and I got very minimal colostrum out. During labor I leaked a lot of colostrum though so you might try to catch that as well, if your labor allows you to.

My little one just had her 2 week appt and is still slightly jaundiced, but our pediatrician feels it's breastmilk or breastfeeding jaundice and not worried, she's not very yellow now though, if she was I'm sure we'd have a very different conversation. So this may be something you experience as well.

[saraml13]

DS was jaundiced and we had to spend an extra day in the hospital under the bili lights. That experience was honestly awful. DS hated being in the cart undressed under the lights. He kept pushing off his blindfold, so one of us had to stay awake the whole time to watch him and keep putting it back on. He cried himself hoarse and we were only allowed to take him out to breastfeed (and even then he had to stay on top of a bili blanket).

But as bad as that experience was, we never had to supplement and he regained his birthweight quickly. In some ways I think him having to do the bili lights helped our breast feeding relationship, because he kept waking up in there crying and I nursed him so many times because that was the only way I could take him out and comfort him.

Good luck!

[mrslka]

Jan 29, 2015 17:22:00 GMT -5 saraml13 said:

DS was jaundiced and we had to spend an extra day in the hospital under the bili lights. That experience was honestly awful. DS hated being in the cart undressed under the lights. He kept pushing off his blindfold, so one of us had to stay awake the whole time to watch him and keep putting it back on. He cried himself hoarse and we were only allowed to take him out to breastfeed (and even then he had to stay on top of a bili blanket).

But as bad as that experience was, we never had to supplement and he regained his birthweight quickly. In some ways I think him having to do the bili lights helped our breast feeding relationship, because he kept waking up in there crying and I nursed him so many times because that was the only way I could take him out and comfort him.

Good luck!

It sounds like you had a very hard situation, I am glad you were able to make it though and breastfeed!

We had to stay an extra day also, DS2 was under the billi light for about 12 hours and I was able to breastfeed every 2 hours. That was during the night shift, my nurse was awesome and would bring him to me in my room undress him, put the billi blanket over us. After the feeding was done she would bring him back to the nursery into the billi light. Once the day nurse got there she turned off the billi light because the pedi said 12 hrs then retest, but I think he should have stayed in there longer. We were discharged and when we saw our regular pedi 2 days later his numbers were so high again and he had lost too much weight.
Our regular pedi is in a different town then the hospital but we have already spoke with him about what course of action to take so DD gets the right care from the start. Meaning under billi lights or sent home with a billi blanket of needed. I am really hoping with the advice of syringe feeding and pushing feedings as much as possible we will be able to avoid billi lights this time.

[jennlin]

my daughter was very jaundiced and we had 24 hours inpatient bililights and 48 hours outpatient bililights...i pumped and finger-fed my daughter with a few mL at a time with a syringe in between feedings (i was allowed to pick her up every few hours).

she's still nursing now, at 35 months