Overcoming jaundice, nipple confusion and other interruptions in early breastfeeding relationships

BlogHer Original Post

If you live in the Western world, you've no doubt heard the catch phrases "Babies were born to be breastfed" and "Breast is Best." Many women start out with the best of intentions for breastfeeding their new bundles of joy, but sometimes circumstances beyond their control can cause interruptions in early breastfeeding relationships. Talk of jaundice, biliruben levels and supplementing with formula are not things many parents are prepared to be confronted with just days after their child's birth. So what should you do if you find yourself suddenly dealing with the unexpected?

After experiencing a labor and birth with my daughter that was unlike anything I had anticipated, breastfeeding seemed to be the one thing that was going in our favor. Ava came into the world as they say, born to breastfeed. Although I had a little trouble with her latch initially, with some help from a nurse we soon seemed to be well on our way. She would eagerly latch on and spend 30 to 45 minutes on each breast, nursing contentedly. Then a pediatrician (not her's, but one in her pediatrician's practice) told us that she was jaundice and not only did he recommend that she go under the bilirubin lights (in the form of a bili-blanket, thankfully in my hospital room), he also wanted me to supplement with formula to help flush the jaundice out of her system. Formula? But, but, but, I'm exclusively breastfeeding. We even had a note on her bassinet in the hospital saying, "I'm a breastfed baby. No artificial nipples or bottles please." I had every intention of breastfeeding her exclusively and now it seemed that even that wouldn't happen. Not knowing what else to do, I acquiesced and allowed my husband Jody and/or a nurse to feed her formula from a bottle, while I continued to nurse her 'round the clock. I absolutely did not want to give her a bottle myself because I wanted to avoid confusing her. I wanted Ava to know I was the one with the breasts and that those breasts were the only way she was getting nourishment from me. (Kellymom states: "If your baby is less than 3-4 weeks old, it is best to avoid the use of a bottle for a couple of reasons: regular use of a bottle instead of breastfeeding can interfere with mom's efforts to establish a good milk supply; bottle use also increases baby's risk of nipple confusion or flow preference.") Little did I know that I could have given the formula to her myself actually from my breast and avoided a bottle all together had anyone at the hospital told me about something called a Supplemental Nursing System (SNS) or lactation aid. "A lactation aid consists of a container for the supplement -- usually a feeding bottle with an enlarged nipple hole -- and a long, thin tube leading from this container." The tube is taped onto the woman's breast, allowing the baby to nurse at the breast and receive expressed breast milk, formula, glucose water, etc. at the same time. So why wasn't an SNS mentioned to me - a mother who wanted to breastfeed exclusively and obviously wanted to avoid nipple confusion that could come from introducing a bottle so early? Are other hospitals recommending SNS to breastfeeding moms?

Thankfully, Ava did not suffer from nipple confusion and took to the breast well every time (and, if you are familiar with my previous posts you know she ended up breastfeeding for a long time), but that's not the case for everyone. Many babies who are offered a bottle before they are ready to differentiate between mom's breast and a rubber nipple have trouble with their latch or will refuse to latch onto the breast at all.

Nell who blogs at Casual Friday Everyday gave birth to her third son Dash just two weeks ago. When her pediatrician (note: not her usual pediatrician) determined that Dash had jaundice - which was not unexpected since her other two sons had it as well - she was told he needed to go to the NICU. That news, however, came out of left field and was completely unexpected. Neither of her other kids received any special treatment for jaundice.

I almost couldn’t process what was being said. Like it wasn’t really sinking in. We walked down to the NICU with our tiny little baby…a place with a few other babies with jaundice also. They removed his clothing and began hooking him up to everything.

We set up a time that I’d be back to nurse him and my husband and I left…left our newborn baby all alone, under lights, with strangers…I cry just writing about this.

I walked back up to our floor empty handed and broken hearted. My heart felt like it had been shattered. Like part of me was missing…well, because it was. Every single part of me wanted to run back into the NICU, grab him and run out of the hospital.

Dash also received formula from a bottle to help treat the jaundice, and Nell believes, the combination of him being taken to the NICU and use of the bottle contributed to the nipple confusion they are now trying to overcome.

This has been a particularly difficult thing for Nell because she struggled with breastfeeding issues like tongue-tie and thrush with her first two children and was determined that this time, with Dashel, the breastfeeding relationship would be different.

This baby was going to be different. I was determined not to introduce a bottle to him. To avoid the nipple confusion. To nurse well into his first year, if not longer. And then unexpectedly he was put into the NICU and supplemented with a bottle. Had I been offered the option of an SNS I would have taken it in a heart beat.

Again, why wasn't a SNS (lactation aid) offered to this breastfeeding mom? And was it really necessary for them to take a jaundice baby to the NICU?

Since leaving the hospital, Nell and Dashel have also developed thrush, but she is determined to make breastfeeding work this time around and is reaching out for help.

I’m not ready to give up even though this has turned into the most difficult experience of all three.

I have reached out to the local LLL gals in my area for help. I’ve explained my problems via email and asked for a phone call. I’m going to attend the meetings for one on one help. And I’m going to try some Thrush remedies that don’t require a doctor to prescribe them.

I think Nell did one of the most important things a woman who find herself in these situations can do - reach out for help. Call another breastfeeding mom, call La Leche League, call a lactation consultant (International Board Certified Lactation Consultant). Call or email someone who can point you in the right direction of the resources and support you need to help you succeed.

Carina of Greetings from the Jet Set had a difficult time getting a good breastfeeding relationship started with her son after a fill-in pediatrician, concerned that her two-day-old son was jaundiced, recommended she supplement her nursing with an ounce of formula after each feeding. The supplementation took place via bottle, her son suffered from nipple confusion and her supply dropped a great deal. After her son's two week appointment, she sought out a lactation consultant and was able to figure out a good latch and taught how to use a SNS. "After a few weeks of that, my supply righted itself and we went on our way." She told me on Twitter, "I tell everyone that while they are short term WORK, they yield long term results. 1-2 wks of SNS yielded 2.5 years." That is to say that she used the SNS for one to two weeks and, as a result of the reestablished breastfeeding relationship, she was able to nurse her son for 2 1/2 years.

Carina, a self-described lactivist, also responded to a woman's question on Yahoo on this very topic. The woman wrote, "Doctor told me that my breast milk is increasing his jaundice level, so I was told to give him formula milk and breast milk alternatively." She asked, "how long will I be asked to give him formula milk? When will he be switched completely to breast milk?"

Carina replied, "your doctor gave you outdated advice. It is NO LONGER advised for you to stop breastfeeding and give formula." She then quoted several articles that support her claim. The first is from Dr. Jack Newman.

Breastmilk jaundice peaks at 10-21 days, but may last for two or three months. Breastmilk jaundice is normal. Rarely, if ever, does breastfeeding need to be discontinued even for a short time. Only very occasionally is any treatment, such as phototherapy, necessary. There is not one bit of evidence that this jaundice causes any problem at all for the baby. Breastfeeding should not be discontinued "in order to make a diagnosis". If the baby is truly doing well on breast only, there is no reason, none, to stop breastfeeding or supplement with a lactation aid, for that matter. The notion that there is something wrong with the baby being jaundiced comes from the assumption that the formula feeding baby is the standard by which we should determine how the breastfed baby should be. This manner of thinking, almost universal amongst health professionals, truly turns logic upside down. Thus, the formula feeding baby is rarely jaundiced after the first week of life, and when he is, there is usually something wrong. Therefore, the baby with so called breastmilk jaundice is a concern and "something must be done". However, in our experience, most exclusively breastfed babies who are perfectly healthy and gaining weight well are still jaundiced at five to six weeks of life and even later. The question, in fact, should be whether or not it is normal not to be jaundiced and is this absence of jaundice something we should worry about? Do not stop breastfeeding for “breastmilk” jaundice.

According to Breastfeeding Basics:

In most cases, jaundice is a normal, possibly even beneficial process that can be managed without interrupting breastfeeding. The treatment for physiologic jaundice is more breastfeeding rather than less, and sick babies with pathologic jaundice need breastmilk even more than healthy babies. Even in rare cases where the jaundice is caused by the breastfeeding, there is no reason to wean and every reason to continue giving your baby the best possible nourishment – mother’s milk. In most cases, jaundice is a normal, possibly even beneficial process that can be managed without interrupting breastfeeding. The treatment for physiologic jaundice is more breastfeeding rather than less, and sick babies with pathologic jaundice need breastmilk even more than healthy babies. Even in rare cases where the jaundice is caused by the breastfeeding, there is no reason to wean and every reason to continue giving your baby the best possible nourishment – mother’s milk.

According to a La Leche League article:

In an article in the November 1990 issue of BREASTFEEDING ABSTRACTS, Kathi Kemper, MD, MPH, suggests that prolonged hospitalization, phototherapy, and the interruption of breastfeeding may be unnecessary and even harmful for the mother and for the infant with normal neonatal jaundice. She writes, "In the case of healthy term infants who are jaundiced, the treatment could be worse than the disease."

So what is going on here? Why are hospitals treating jaundice this way if it's a "normal, possibly even beneficial process?" Is the real problem that pediatricians attitudes about breastfeeding are deteriorating?

I think educating one's self is always a good thing. Of course, it's impossible to prepare for every possible scenario, but if a woman knows in advance that breastfeeding jaundice is a normal occurrence and isn't always a cause for concern, then perhaps she can make better informed choices with regard to her child's care. If she and her doctor decide that supplementation is necessary, then knowing about a SNS/lactation aid and asking for the help of a lactation consultant could be invaluable. And then, if a woman finds herself in a situation where, for whatever reason, she has trouble with breastfeeding, knowing where to look for help at the first sign of trouble is key. It's also helpful for family and friends to know what to do (and not to do) to support a breastfeeding mother.

Lastly, there's an eye-opening article that ties into this topic nicely on Today's Parent called "Nursing Confidential: Breastfeeding can be one of the biggest challenges of new motherhood. Now 7,000 Today's Parent readers tell us why."

What was your early breastfeeding relationship like? Did you have to overcome any obstacles? How did you do it?

Contributing editor Amy Gates blogs about green living, attachment parenting, activism and photography at Crunchy Domestic Goddess.

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