Newborn Jaundice is NORMAL!!

One of the most frustrating things I dealt with in my career as a lactation consultant is newborn jaundice. 

First let me tell you the physiology of newborn jaundice:

Babies are born with a high number of red blood cells.  This number is needed when the baby is in utero, but not after birth.  So…the red blood cells start to break down immedicately after the birth.  Inside the red blood cells is something called bilirubin which is yellow in color.  Usually bilirubin is excrested through the liver, but a baby’s liver does not start to function well until at least the third day after birth – and longer than that with preterm infants.  When the bilirubin is rejected by the liver, it goes back into the baby’s system and ends up under the skin – causing the yellow tinge that we call jauddice.  It starts at the top of the head and goes down, thus we see the whites of the eyes get a little yellow or the tip of the nose.

Why the big concern among physicians about jaundice – well, about 75 years ago, babies would get very jaundice and once in a blue moon, a bilirubin level would go so high that it would cause brain damage.  This has happened once in 100 years where I live.

Now we know that bilirubin is excreted through the bowel in newborns – the more they poop, the sooner the bilirubin leverl will go down.  Breast milk has a natural laxative – so the best idea is to keep breast feeding -right??  No, says many doctors – stop breast feeding and give the baby water or formula – which will not work!!  I have also heard physician tell new moms to put baby in front of the window as unltravilet light breaks down the bilitubin in the skin – unless you livce in a house that has very old windows, this will not work.  New windows have ultraviolet protection – so they block the rays that would help.

Physicians seem to look at the bilirubin number and not the baby.  Poor parents have to take their newborn to the lab for a poke in the heel and pooir baby is put through that pain.  Parents feel their baby is sick and worry, of course.  There have been studies done that report that parents who go throught this process of testing take their babies to the doctor twice as often in the first year because they label them as sick children.  Sad…

OK, my thoughts on this…..look at the baby and not the number.  If the baby is alert, eating, pooping and content – things are ok.  If the baby is lethargic, not pooping or eating and the soles of his feel and the palms of his hands are very yellow – a trip to the doctor is needed.

Do not stop breastfeeding!!  Do not give formla without a very good reason.  Do not pump and measure your milk – as I have written about before, this is not effective or accurate.

Now, one more thing, there is something very rare called breastmilk jaundice.  I am not going to write about it now – maybe later.  But it is rare, RARE and not in the category of normal newborn jaundice.

Let me know if you have questions…….

Informed Consent

People in the medical profession are taught that patients must always give INFORMED consent. All too often, that is not done.
What exactly is informed consent? It is the patient giving their consent for a procedure, surgery, medication, whatever after they have and understand the pros and cons and have all their questions answered.
One prime example of this in the maternal child field is the AFP (alpha-fetal protein) test that is done between week 16-18 of pregnancy. It is a blood test that detects a protein in moms’s blood that can indicate a higher probability of the baby having a neural tube defect or Down’s Syndrome.
Unfortunately, there can be false positives with this test. Lets talk about what happens if the test comes back positive:
1. Mom gets a call from the doctors office
2. Mom is told the AFP is positive and baby may have a birth anomaly.
3. Mom is told that to find out for sure, she needs an amniocentesis.
4. From that moment on, mom will worry for the rest of the pregnancy and after. It will stay in her mind that her baby is not ok.
5. There are risks to an amniocentesis, though small.
6. Mom then has to wait for the result.
7. If the test shows the baby may have an anomaly, parents then have to decide if they want to continue the pregnancy.
8. As I said, even if the test comes back normal, the joy of the pregnancy is taken away, at least a bit.

Mamy people say that the test should be done so the parents can be prepared. As the parent of a mentally and physically disabled child – you can NEVER be prepared.

There are many moms who ask questions or do research and decide against this test. These parents have made the decision to have their baby – no matter what.

My point – informed consent is very important and the responsibility of the medical profession. And patients need to ask questions and get answers they understand.

Allergic to Breast Milk – NOT!!!

Many moms stop breastfeeding because they think or are told that their baby is allergic to their breast milk. Baby may be spitting up, colicky, constipated, whatever.
Well, the truth….baby cannot be allergic to mom’s breast milk, but can be intolerant of something mom is eating.
I am not a believer that moms should avoid certain foods just because she is nursing. Things like chocolate (years ago, my 3 year old son thought if I ate chocolate, I would produce chocolate milk for his baby sister), spicy foods, etc. are fine. I suggest that moms try everything and see what happens. Often if a food upsets mom’s stomach, it will upset baby. Mom can try a food, nurse baby and if baby gets upset tummy, mom knows to avoid that food – but try it every so often as things might change. Another sign of baby intolerance is green baby poop.
My daughter could not tolerate Nacho Cheese Doritos – one of my favorites!
I think the hardest intolerance is baby not tolerating cows milk. If this happens, mom usually needs to stop all dairy intake. This includes milk, ice cream, yogurt, cheese – you get the idea. It takes a couple days of this diet change to see a difference in baby. Again, this intolerance to dairy is often outgrown.

Changed Name of Blog

I have had several readers suggest that I changes the name of my blog. I did not know that “Baby Whisperer” is the name of a book on baby sleep training.
So I changed to “Words from an OB Nurse “

Baby Poop

When I tell expectant parents that they will be obsessed with their baby’s bowel movements, they just laugh. And then, their baby is born and that is just what happens.
I think it will help if I give some explanation first.
Breast milk is pre digested. It passes through the baby’s digestive tract very quickly and easily.
Infant formula, on the other hand, needs to be digested and so it passes slowly.
This means that breast fed babies usually need to be fed more often – at least for the first few months.
Back to baby poop…..
The first few bowel movements the baby has after birth are called meconium, which contains the contents of the baby’s bowel during the pregnancy. It is sticky and oily. After the meconium, the stool changes and, if the baby receive exclusively breast milk, the stool looks like a stain on the diaper with some small pieces that I describe as mustard colored cottage cheese.
The reason for this….as waste passes through the digestive tract, fluid is taken out. Breast milk passes so quickly, very little fluid is taken out. Baby will have several bowel movements a day for the first few weeks. Then things start to slow down. That is when parents start to worry. They think baby is constipated because they do not have a daily BM. the parents then call the doctor and are often told to give Karo syrup in water, or add solids to baby’s diet. WRONG!!!!
Constipation is defined as hard, dry stools that are hard to pass.
If baby has a bowel movement every 5 days, and the stool is soft and passes easily, that is NOT a problem. Breast fed infants usually do not have a bowel movement daily. The longest I have seen a baby go between bowel movements is 21 days. That mom laughed that she had to stay home every 21 days as the baby pooped all day. I am not saying this is normal for all breast fed babies but just to give an example. Every baby has a different pattern. Learn your baby’s pattern and trust your instincts.

A Few Tips to Avoid Sibling Rivalry

Just a couple quick thoughts today. To attempt to avoid sibling rivalry from the start:

1. When big brother or sister visits the hospital to meet the new baby, mom should not be holding baby. Leave baby in bassinet, off in the corner. Allow big brother/sister to hug and kiss mom and wait for him/her to ask about baby. If baby is in moms arms, it is an instant intruder – and someone will say “be careful of the baby”.
2. Babies are pretty durable. Everyone needs to stop saying “be careful”. After hearing this over and over, big brother/sister will give up!!
3. Before baby is born, go to the Dollar Store and buy lots of inexpensive gifts for older child. Wrap them and keep in a box by the door. When a visitor brings a gift for baby, hand them one of the small gifts for older child. Cuts down on gift envy.
4. Buy a few items for the older child that you can play with while breast feeding. Make a breast feeding box. The toys in the box (books, flash cards…) can only be played with while baby is nursing. This gives the older child one on one time with mom while nursing. Instead of mom worrying about what older child is doing during feeding time, it becomes quality play time.

Induction of Labor

There are many reasons to induce labor. Unfortunately, the most common reason is “I am tired of being pregnant”.
First, can labor be induced anytime? The answer is no. The cervix has to be ready. In medical term: the cervix has to be “ripe” – during pregnancy, the cervix is firm like the tip of your nose; when labor is near, the cervix softens, like your ear lobe. In order for induction to work, the cervix must be soft and stretchy.
There are ways to medically soften the cervix – with medication called cervidal or cytotec. These medications are sometimes inserted into the cervix the night before an induction to get the cervix ready.
Sex can also soften the cervix. There is an “ingredient” in semen that softens the cervix and oxytocin is released when a woman orgasms – oxytocin is the hormone that brings on contractions. Nipple stimulation also causes release of oxytocin.
Medical reasons for induction: baby is not growing, mom has PIH, membranes are ruptured.
Many times, physicians suggest induction if pregnancy goes over 40 weeks. The logic…..the placenta is only meant to last for 40 weeks. After that, the placenta may start to deteriorate. If this happens, the baby would be deprived of oxygen and nutrients and would be better off outside than in.
The fetal activity test is one way to check baby’s status. Monitors are put on mom to check baby’s heart rate. Mom is asked to push a button when baby moves – this makes a mark on the monitor paper. Baby’s heart rate should increase after movement – just like ours does when we go up stairs. If the heart rate does not increase, it may mean that the placenta is not able to supply the need. If the fetal activity test is not reassuring, there are additional tests such as a biophysical profile to check further.
The moral of this: induction should not be done just because the 40 week mark has been reached. Testing is non invasive and allow for time for the cervix to ripen naturally. Too often, induction is attempted too soon and does not work, and ends with a cesarean section for failure to progress.
I know the end of pregnancy is exhausting, but baby needs those 40 weeks or so to be ready to make their appearance healthy!!

Let’s Talk About Thrush

 

One of the things that can cause a mom to stop breast feeding is thrush. 

Thrush is caused by yeast. Yeast thrives in a warm, moist, dark environment.  Examples of this environment – baby’s mouth and mom’s nipple. 

Many mom’s get antibiotics while they are in labor. The antibiotics set mom and baby up to get yeast. 

Symptoms of yeast in baby: white patches inside the mouth that look like milk but will not wipe off. 

Symptoms of yeast in mom – very red nipples that feel like they are on fire. 

 All too often, mom takes baby to the doctor and gets Nystatin suspension to treat the thrush. But mom is not treated. Even if mom does not have symptoms, she should be treated to  prevent giving the yeast to each other. 

Treatment may be putting the Nystatin in the baby’s mouth just before nursing.  This will allow for the transfer of the Nystatin to the nipple. This is not the most effective treatment. 

The most effective treatment is Diflucan, oral medication. Both mom and baby have to be put on the medication at the same time.. It is completely safe for baby. 

Mom’s nipples may be very sore. Putting ice on the nipple to dull the pain may help.. Mom may also want to wear a nipple shield for a few days to make nursing more tolerable.

Hope this is helpful. 

 

Role of the Childbirth Coach

Definitions:

Coach: yells the plays, runs up and down the sidelines, knows the rules and the game plan. 

Partner: supports, offers encouragement, is present

Our society puts a lot of pressure on the significant other (S.O.). We expect them to attend expectant parent classes, learn how to help mom relax, know the breathing techniques for every stage of labor and watch their baby come into the world. 

I am a believer that the S.O. should be in the birthing room if that is what the couple wants. But many S.O.s are not meant to be a coach. 

So, who should be the coach? Maybe a female relative or close friend, or maybe the nurse.  Someone who is available to practice relaxation and breathing techniques during the pregnancy and knows mom well enough to be there for her during labor and birth. 

I have been a nurse for 40+ years, worked labor and delivery, taught childbirth classes for 25 years, was a doula/labor support and post partum support. I remember the many times I talked about the role of the coach and saw the look of relief on the S.O. faces. And many told me that giving up the role of coach and being a partner during their child’s birth allowed them to relax and be totally there to support their partner and marvel at their child.

so, if you are pregnant right now, think about who fits these roles for you. 

 

Delivery vs. birth

Delivery – what we do with newspapers, pizzas and milk when I was a child. 

Birth – giving birth is what a mom does. The baby is not delivered to her, she gives birth to her baby. Birth says empowerment..