Transcript:
Welcome, welcome, welcome to the Milk Minute Podcast. Welcome, welcome, welcome, everyone. You sound like John Oliver. Oliver. I was, I was actually feeling a little, I’ve got like Hunger Games on my mind, Hunger Games, and I was feeling like a Effy, you know?
Oh, welcome. I don’t know why I just re-watched it the other day for, it’s a great series. It’s, it’s, I’ve been thinking about rereading the Twilight Series. Ooh, I, you know what? That. Series gets funnier the more you read it. Oh yeah. Did you ever read Midnight Sun? No. So it’s the first book rewritten from Edwards perspective, and it is the funniest thing I’ve ever read.
Really? It’s, I can’t believe she actually wrote it and published it. It’s so bad. Funny. Really? Like, you’re just like, what? What Stephanie Myers like, what did you write? She’s like, I got more money than God. I could write whatever I want it. So especially if you like, have read the TWI books enough to be like to kind of remember like what characters are thinking during scenes.
Mm-hmm. You’re like, oh, during that scene Edward was literally like counting spiderwebs, like, what is happening? Bella’s like, you’re the love of my life. And he’s like two and he’s like 7,000 plates of cross.
When I was reading it, I was like, is this a joke? Well now that’s on my list. You should, that’s so funny. Yeah. Clearly I just need to check out in my life a little bit. Yeah. Okay. Well, in your opinion, how prevalent do you think jaundice is and do you think we overtreat it? Oh God, I am. I don’t know how prevalent it is personally in my practice.
No. Well, or well, I, I’m just gonna tell you how often I see it. Okay. I see low level, like breast milk jaundice, probably like once every 15 babies. Treatable jaundice. I’ve literally, for babies, I’ve caught like once now really in the hospital bursts that I do, I think it is way overtreated. I see a lot of babies with bilirubin levels that are not at clinical thresholds going off to treatment.
Yep. Well, I’m gonna make a prediction. Okay? I’m going to predict that 20 years from now we are not treating as much as we are now. Yeah. Let me just say that because a lot of this is like normal mm-hmm. Stuff that your baby has to go through after it’s born. Yeah. But you know, we have to pay attention because I will explain later something, something rare but bad can happen to your baby, but, but rare.
Yeah. No, and, and, but preventable. I’ve definitely read some compelling theories about like the physiology of jaundice and like why. It’s normal and why it happens. So I hope we can get into that a little bit. Oh, yes, yes. Yeah. And this is gonna be a little bit more like a lecture today. I’m, I’m so excited though, because I feel like I have a lot of knowledge about jaundice, but it’s not very well organized.
Well, I hope I can make it easy for parents to understand as well as if we have any nursing students or new nurses on an OB floor, or even residents that wanna be listening. Mm-hmm. So they can understand that like the answer is to not stop breastfeeding. Yes. Because depending on where you’re getting your information, it could be out of date and it could be incorrect.
So I’m gonna clear a lot of that up today. We’re gonna talk about how common it really is. Is it actually that big of a deal, why breastfeeding gets such a bad rap with it, and why pediatricians seem to push formula when your baby’s bilirubin is high. Yeah. And then how we can prepare for that and how we can leave the hospital still breastfeeding sounds.
Stellar. I’m so, so excited for this. Yeah. Before we hop into that though, I do wanna remind everybody that we have a new podcast. It’s called Beyond the Boob. It’s all about Heather’s pregnancy needs her midwife, and I love it. I feel like gushy warm feelings about it. I feel warm also. But not for the same reason.
Just as, as you peed your pants, I am an incubator. Yeah, we would love to see you over at Beyond the Boob, either on Apple subscription or on our Patreon, patreon.com/milk minute podcast. Speaking of, we have some new patrons to thank. Yes, a huge, big, big thank you to Shelby, Elizabeth Colanero, who’s a friend of mine, Kelsey Grathwhol, Sarah Grace, and Lila Besser.
Thanks guys. We love ya. Let’s take a quick minute to thank one of our sponsors, and when we come back we’re gonna answer a question about breastfeeding safe acne remedies. That’s interesting. Here we go.
Imagine a world where you seek lactation care and it’s easy. And someone greets you at the door and they’re nice to you and they give you a hot cup of tea and let you sit on the couch and talk about all the issues, not just the breastfeeding issues. What a cozy fantasy is there anywhere that’s real? Oh, it’s real girl.
It’s real, and I’ve been building it for quite a long time. My business is called Breastfeeding for Busy Moms, and me and every member of my team are trained in our three major tenants, which is accessibility. Kindness and personalization. If you wanna book a consult with Heather or anyone else on her team, you should head over to breastfeeding for busy moms.com.
We do accept some limited insurance and we’d be happy to walk you through it if you wanna give us a call. And that number’s on Google. So go sit on the cozy couch with Heather at breastfeeding for busy Moms. Love you guys.
Hey everybody. Welcome back. Before we hop into the deep dive into jaundice, let’s chat about a question from a listener. Today’s question comes from Noel. She asks, does anyone have any good breastfeeding safe acne remedies? My face is awful. My baby’s six months, and I can’t blame it on her. My acne is bad before the pregnancy.
Any advice? Welcome. Yeah, we have a whole episode on skincare that we will link in the show notes if you wanna do a really deep dive. But the good news and the short answer is most things for acne you can use while breastfeeding. So you can do benzo peroxide that, or, or salicylic acid. Mm-hmm. That whole over-the-counter combo.
Use it, use it sparingly. You know, it will get into you. Into your skin, obviously, into your bloodstream, but not in high amounts. Not in high amounts. And if you have any questions about specific medications, you know, cuz there’s just too many for us to like run down the list right now, you can call the infant risk helpline.
You can use their app you can go on the Mommy Meds app. There’s, there’s just like a ton of free resources as well. And I would definitely recommend some vitamin C. So it’s anti-inflammatory and it definitely will help with any skin discoloration. And it’s water soluble, so it’s gonna just, you’ll pee it out so it won’t get in your breast milk that much.
Sounds good. Okay. Well, Heather, can you drop some knowledge about jaundice? Yeah, where, where are we starting? Okay. Well, if a lot of you are out there pregnant listening to this and you haven’t considered prepping for a potential jaundice situation postpartum, I wanna let you know that you can do that.
Because jaundice is one of the most common initial roadblocks in exclusive breastfeeding and barely anyone talks about it. So I actually build it into all of my prenatal. Oh, okay. Nice. And I’m not really saying this to scare you guys at all, but there are some situations where we can prepare and you know that I love to have a plan.
So, first of all, what the hell is it? What is jaundice? So, I’m gonna try to explain this in layman’s terms so you all can understand it and really grasp it. And I use a lot of metaphors. Okay. Yeah. I’m, I’m into it, man. I, I really I think this can be explained simply. Yeah. Well, hmm. We’ll see. You tell me.
So jaundice is a condition that occurs in your baby or your alcoholic Uncle Jim. Sure. When bilirubin builds up in the body, So jaundices is actually the outcome and bilirubin is the culprit. So, mm-hmm. Bilirubin itself is a waste product. It’s garbage. It’s trash. We don’t need it. And this occurs in the body when we break down red blood cells and the average lifespan of a red blood cells about 120 days.
So us sitting right here, we have, we’re making some, we’re killing some, they’re dying. When they die, we have to get rid of them. And the waste. Right. So and, and we turn them into bilirubin and we poop them out. Ideally. Yeah. So, so matter is not created or destroyed. So we just break it down into something else and we have to get rid of it.
And there’s a lot going on during labor and delivery that can cause broken down red blood cells in your baby’s body. And as those cells break down, bilirubin is released as the byproduct that needs to be eliminated. But the baby has to do that now, we used to do that through the umbilical cord, through our liver when the baby was inside, right?
So now the baby has to suddenly do this themselves, sniff that cord and say, good luck. Right. So if we don’t eliminate this bilirubin garbage, it gets stored in your baby’s skin, which gives it that lovely yellow hue. Mm. And like in their sclera and all. Oh, everywhere. It’s fun. Everywhere. And you can check their gums.
Mm-hmm. Everything like that. And 60%. Of newborns have some form of jaundice. Hmm. And most of the time it’s considered just part of getting started in life. And this is otherwise known as physiologic jaundice. Yes. So that’s what you were talking about. Mm-hmm. When you’re talking about the majority of your patients, which is like meh, it happens.
Yeah. It’s low level. It occurs after the first 24 hours and baby’s not really symptomatic. You’re just like, cool, we’ll just keep an eye on it. Right. But of those 60%, about 10 to 19% develop more severe jaundice. That requires some intervention. That’s a wide range. That’s like saying like, you know this or double this, this, or double that.
That’s, that’s a big range actually. Yes. So that’s known as pathologic jaundice. Mm-hmm. And how do we eliminate it? So tell me now we’ve, we’ve got all this going on. Yeah. All right. So when your baby is born, they have a whole plumbing system inside their body that needs to be kickstarted. Oh yeah. Some, some things need to go, some things need to start.
It’s like transition from. Intrauterine life to like being earth side is a little weird. Yeah. You go from being a closed system to an open system. Oh, I love, I love that. It’s like breast pumps. Yeah. Yeah. So I kind of think about it as like a bunch of empty tubes that need to be primed and the faucet needs to be turned on.
Mm-hmm. And so their whole system’s brand new and sometimes it takes a minute to kickstart this. Kind of like turning on the water in an old house for the first time. Right, right. We chatted about Rusty Pipe syndrome last time. Right. You have pipes too. We’re just gonna roll with the metaphors forever.
Forever. So yeah, when you turn that water on it, the metaphorical water in the house, you get sputtering weird noises shooting outta the faucet. It’s not always pretty. And this can get tricky if you’re trying to eliminate a bunch of garbage through a brand new sputtering system. Okay. Okay. Okay, got it.
So now we need to talk about the liver. Okay. So the liver as it relates to the plumbing situation, okay. Is the garbage can of the body. Got it. Okay. So the liver helps us transform compounds into things we can either use like Tylenol for pain relief, which is why you’re not supposed to take a bunch of Tylenol if you drank the night before.
Mm-hmm. Because it’s all compounded in your liver. Or conjugated I should say. Or we send it down the poop shoot to get rid of like bilirubin. So the liver kind of makes that call. It’s like you to the left, you to the right, and your body will send the bilirubin to the liver to be conjugated, meaning converted into a form that can be excreted.
And after it’s conjugated, it gets put into baby’s poo and deposited in their diaper and out of their system forever. However, if there is no poo to be had, like your baby isn’t really eating, there’s no bulk to deposit the conjugate bilirubin you, or it’s the normal first couple days postpartum and they just take like one big poop and that’s it.
Yeah. But if the bilirubin’s hanging out there with nothing Sure, no. Like log to hang onto mm-hmm. It can be sent back upstream, which is the weird part. That kind of freaks out every pediatrician everywhere. Right. So it can then be unconjugated. And put back into the bloodstream. Okay. Okay. So why is this a big deal though?
Okay. This is, this is a big deal because the issue lies in the fact that when the baby is yellow and chocolate block full of bilirubin garbage, it can affect their brain. So it essentially depresses their entire central nervous system and makes them very lethargic. And obviously this is an issue if you’re trying to get baby to breastfeed and they’re simply laying there like a limp noodle with their mouth open.
Yeah. So if they don’t eat, they don’t create poop. And the plumbing just keeps sputtering. And the bilirubin just keeps floating around with no exit. Right. And this is the loop. It gets stuck in. Often when we do have, you know, jaundice, babies who are starting to be symptomatic, we’re like, feed them more.
And parents are like, but how they won’t eat. They’re lying there with their arms to their sides. Like, total submission, or, or you know, when, when patients tell me like, oh, my baby’s so amazing. They’ve been sleeping so long. I’m like yeah, tell me more. Yeah, tell me more about that. Mm-hmm. Well, and the issue is the more the brain is exposed to this bilirubin and the longer it’s exposed, the greater the chances of a rare.
But preventable condition. Mm-hmm. Called Carus. Oh, TTAs. I love that word. That is cantankerous. Like those are the same word, but they’re not. Although I love both of those words. Me too. It just feels good in your mouth, you know? Yeah, I do know. I do know connector presents. With intellectual disability, cerebral palsy features, and hearing loss among other terrible, terrible things.
Yeah. So because it’s preventable, obviously we’re gonna be like screening. Mm-hmm. And we’re gonna be treating maybe more aggressively than. Than is strictly necessary. And, and I think we see that kind of across the board, at least in this country, where unfortunately a lot of our healthcare decisions are really fear-based.
You know, and we see this with groupie strep, we see this with the mammograms, right? With, I mean with so many things across the board where the screenings were doing and the preventative treatments we’re doing, maybe. Aren’t actually making our numbers any better than places that don’t do them the same way.
It, it’s really tricky, right? Mm-hmm. And we have to have just these like giant data sets to know too. Like, oh, are we overtreating, are, are numbers any different from numbers in this comparable country? Yeah. And I, people are starting to look at that. Yeah. Because there are risks to it, but no one talks about it because Sure.
When they dangle ous and they’re like, you’re a baby. Could be brain damage, it could be cantankerous. It’s like, okay, whatever you want. Yeah. Yeah. And, and it can be really scary and it, it is a possibility. It’s not like it never happens. However, I, I think there’s also ways to treat that can be supportive of breastfeeding.
Indeed. Yeah, indeed. And I’m like, you’re telling me all of these cave people and indigenous people that never had any of this treatment, all their babies, just hadis? No. And I really am curious, I don’t know, like what, do we have any data on, like what the level ofor incidents was before? UV treatment for jaundice.
Yeah. That data is out there. But I didn’t put that okay in this because I wanted to just keep it. Yeah. I’m just curious. But we can have a follow up. That would be fun. Yeah. Yeah. Okay, so now that you have a rudimentary understanding of what Billy Ruben and Jaundices is, let’s talk about why it affects some babies and not others.
Ooh, this is fun. Okay, so number one is you’ve got a problem with the garbage can. Okay, so, so the liver. The liver, okay, got it. I’m, I’m, I am having a little bit of trouble following every part cuz it’s a complex metaphor, but I’m here for it. I’m a high functioning person. Let’s do it. Okay. So we have a liver issue.
Okay. The garbage can is not functioning as it should to eliminate the garbage. Got it? So this is all pathological jaundice. This isn’t normal. We’re now in abnormal jaundice. So the first problem we can have with the garbage can liver is that it’s premature. So babies born before 37 weeks have livers that just aren’t ready to handle everything the body is throwing at it, and they’re just not at full capacity.
Sure. So we definitely screen these kids at 24 hours and we are not surprised if they are jaundice because they are probably closer to that 19%. Yeah. You know, that’s probably the wider range there. The 10 to 19%, they’re probably closer to the. Man, statistics are weird, aren’t they? I just don’t wanna be a statistician, but sometimes I wish I had that knowledge.
You know, I wish my brain worked that way, but it certainly does not. So the other problem is we just have a medically unwell baby. Okay? So the, the liver’s being taxed in a lot of other ways, right? So maybe we have like one other comorbidity, hepatitis or something, or we have drug use going on that affected the, the liver question.
You might not know the answer. Do we see a higher comorbidity between babies who are born to G D M moms gestational diabetes with jaundice? No. Okay, cool. Although GDMs often have preemies Yes. Like before 37 weeks. Mm-hmm. Or they have other things going on, but that is not listed on. Okay. The, the higher risk things.
Cool. Thanks. So the other thing with the liver is we have too much garbage itself, so too much bilirubin that the liver is like overwhelmed. So this is probably what, you know, my trash can, looks like the day before trash day, you know, where it’s like, oh my God. Couldn’t, don’t, don’t have another bag in.
Please, can someone just take this out? So this. Can occur for a few different reasons. So number one would be significant bruising from delivery. Mm-hmm. So if your baby has a super bruised face, right. Maybe they got forceps or vacuum assisted delivery. Mm-hmm. Yeah. And a bruise is very literally broken down red blood cells.
Yes. And your body has to clean it up, so baby’s body wants to clean up that little bruise and get everything back to normal. And so it’s literally pounding the liver with all of this garbage. And the liver’s like, help me, I’m drowning. So that’s why we will screen significantly bruised babies at 24 hours.
Yeah. So then we have extensive hemolysis, which is breaking down of red blood cells. And this is most usually from a blood type incompatibility. Mm-hmm. So this is where I lose people. Okay. So we’re gonna try to keep this, I understand why, cuz this is a complicated issue and I feel like I have yet to meet.
Like pediatric staff that explain this well to parents. Oh God. Well I hope this goes well. Let me know. So, so like, let’s listen to this and then maybe just memorize it to tell your patients. Okay. So a blood type and compatibility occurs when mom has an O positive. Or any negative blood type and baby is anything else.
So this is when there’s some mixing of blood between mom and baby at delivery, and then mom’s antibodies to the baby’s blood. Goes to war with the baby’s blood type. So a lot more of the baby’s blood is broken down and has to be cleaned up by its liver. So here’s an example. Like me, I’m O positive.
Mm-hmm. My husband is B positive. Mm. So there’s a chance that this baby inside of me right now takes after my husband and is B positive. So O to B, that’s what we would call it. So I’m O baby could be B. That is actually one of the worst. Ones don’t. Why? Don’t know why. No, we don’t know why. Don’t know why.
Cool. But when it mixes at delivery, my body is like, whoa, B, I don’t know about B. That sounds foreign to me. I should kill it. Okay. And those antibodies, yeah, your body goes all in. It’s like we, yes. Yeah. We’re going to kill that now. Yeah. And so my antibodies end up in baby’s blood. And it just wreaks havoc.
Yeah. And it kills any of the weak red blood cells that are, you know, on their last leg anyway. And it just kind of expedites the hemolysis process. Mm-hmm. And the same thing applies if mom is any negative blood type. Oh, negative, yes. A negative B, negative, AB negative, et cetera. And your baby is positive.
So you will know that your negative blood type, if you received a RhoGAM shot at 28 weeks. Mm-hmm. And if you are negative, they will 100% do the baby’s blood rh factor. Yeah. To see if baby is negative or positive. Mm-hmm. If they’re negative, you don’t have to worry about it. Mm-hmm. Negative and a negative equals no problem.
Yeah. Negative in a positive. Could be angry antibodies. Right. Absolutely. And you know, for your practical use of this as a parent, like you don’t have to remember all of those details, but if in the postpartum a doctor mentions a b o incompatibility, you could be like, oh, right, my blood is mad at baby’s blood and it’s hurting baby.
Got it. And it, you know, on a, on a microscopic level, it’s violent, but really it’s not your fault. No, it’s not your fault. It’s nothing you did wrong. It’s just like, that’s the basic concept. It’s like your blood hates your baby’s blood, and that’s just what we have to deal with now. And it will, we can resolve it.
Right. We can fix it. It’s not a permanent issue. Yeah. And you should have. Some labs from like the first prenatal visit mm-hmm. Where it tells you your blood type. So most people, by the way, if you’re, if you don’t know it, don’t feel bad. Most people that come to me at 36 weeks have no idea what their blood type is.
Oh yeah. No. I didn’t know till I got pregnant the first time. Then I was like, oh, oh, positive. Lovely. Oh, you too. Yeah. So go get on your lab report sheet and look up, either it’ll be either type and screen or an ABO type. Mm-hmm. And it’ll tell you what. Your type is. So, yeah, I actually, this has reminded me.
I meant to order Elden cards for a homeschool lesson for my son. So Elden cards are a way to type blood at home. Oh yeah. It’s not quite as accurate as a lab, but they’re literally like 99% accurate. And honestly, I feel like labs make more than 1% of mistakes sometimes, so I’m, it’s pretty close. That’s awesome.
Yeah, and they’re really fun. You take. Four drops of blood and you mix it with these little things. And then, anyway, it’s really fun and it’s like a good lesson. But also I use them at home births a lot, right? Huh? For RH negative moms who maybe were on the fence about Rogan, they don’t know if they want their second dose.
I’m like, let’s do this right here. We can confirm anything by lab if we want to, but like this can kind of give us a starting point for your decision tree. Mm-hmm. Mm-hmm. Okay. Bring one to mine. Yeah, I will. I usually bring them just, and, and like I, you know, I work with a lot of people that insurance who don’t wanna send off for labs too.
It’s totally fine. So I’m like, well, let’s at least do this. You’re so cool. Thanks a great idea. They’re fun. They’re fun. Okay, so last re, well, last reason that I have listed, there’s about a million other reasons, but they’re all smaller. Rarer smaller. Okay. So a G six PD deficiency. What is that? So I know what that is.
It’s genetic. Okay. So this is much more common in black and African American folks, and it’s rare, but basically it’s an enzyme deficiency in your red blood cells that causes them to die early. Interesting. So instead of having like 120 day cycle, they might have much. Shorter cycle sounds stressful for your bo Yeah.
But usually it’s exacerbated by something else. Right. You know, so it’s, it usually doesn’t like stand alone, but it’s a good thing to know. Okay. So if you have it and your bait should know baby, can you do like a blood testing for that? Probably, yeah. Okay, cool. Yeah, I don’t probably, I don’t know. I mean that at that point it’s like, refer out.
Yeah. Oh yeah. No, that’s why I’m like, I haven’t heard about this one. This, this one is going to the hematologist. Yeah. So all of that, just to regroup, bruising extensive hemolysis due to either the blood type and compatibility or a G six PD deficiency. Mm-hmm. Causes too much garbage. Your trash can is super full.
Every time we talk about humanized blood, I just think about all the times I’ve gotten messages back from the labs. Where they’re like, the sample animalized. And I’m like, well fuck you. Yeah, well really, cuz I ran it down there and I was sweating. Okay. So the, the second reason for pathologic jaundice is we have a lack of poop.
Got it. So this is baby isn’t eating or baby is suckling, but milk hasn’t come in yet. So they’re not transferring. And this is otherwise known as starvation, jaundice? Mm-hmm. Or breastfeeding, jaundice. I do not like that. Those are apparently sys. Hold on. That me. I know, God. So this happens typically in the first three days of life.
Big shocker. You know, where your milk isn’t really in yet. Yeah. This is usually breastfeeding people because if you’re formula feeding, you’re just formula feeding. Right. And you can feed more on demand. It’s not Yeah. Right. And that you can see it. Mm-hmm. So you, you’re, you know, the volume that’s going in there.
So. This, I kind of think about the sputtering plumbing system with not enough water or milk right to go through and make the poop to complete the process. And so people get very confused, and this is where breastfeeding gets a bad rap and they think formula is going to fix everything. And it really doesn’t.
Really doesn’t. I’ll explain that in a minute. Let’s leave that there and we’re gonna come back to that. Third reason for pathologic jaundice is we didn’t identify it because they had a darker skin color at baseline. Yeah. And honestly, it’s like, So when your healthcare provider uses the, like forehead screen mm-hmm.
Those are gonna be less. Accurate for darker skin. Mm-hmm. And same with like the tools that I use postpartum. Two, I use an urometer, which is like the less advanced technology of that, but actually really good for screening in low resource settings. It’s gonna be less accurate when we have darker skin.
So often we’re gonna have to do labs for that. Yeah. And so for me, it, you know, the risk. Mm-hmm. You know, it’s like, well, your risk of having jaundice is increased if you’re black or Asian. And it’s like, no, the risk of. People missing jaundice. And then you end up in a situation. Yeah. Where you’re stuck in that loop where you can’t get rid of it is greater because we done missed it.
Yeah. Sorry. And, and that just ties into too, like the whole risk profile for maternal infant health in communities. Where we have health disparities because of things like racism, right? Mm-hmm. Like jaundices is complicated. We talked about some other reasons why it could happen, like, and you know, those people in those communities are going to then like maybe not be screened properly or you know, it’s just like it’s.
It’s really difficult. Yeah, it is. All right. The next one is breast milk jaundice. Mm-hmm. This is different, so, okay. This is where I think we lose a lot of people too. So we are breastfeeding and there’s enough milk and everything is normal, but your baby turns a little yellow a week after coming home, and so breast milk, jaundice does not harm your baby.
As long as your baby is acting normally and feeding and wedding adequate diapers and the bilirubin levels aren’t dangerously high, it just is what it is. Mm-hmm. And so this is one of those things where it’s like a delayed onset, it’s gonna run its course in the absence of other issues, and we just really don’t need to worry about it that much.
Yeah, and, and I see this most often when I see it. It’s usually like at the end of the first week. And then it can stick around for like three weeks. Mm-hmm. And that’s kind of what freaks parents out mostly is they’re like, why are they still yellow? Yeah. Like, well, Do because they are And your baby’s fine.
Yeah. Here’s the, here’s the risks to look out for. Like, you know, here’s the signs that things are bad, and if that doesn’t happen, it’s fine. Yeah. And I don’t know. Yeah. That’s the answer. I, I don’t know. It is specific to breast milk, but Yeah. It’s really, so this is where people think it’s like, oh, they’re, they must be starving.
Yeah. Because they’re breastfeeding and the breast milk is either not enough. And I’m like, no, that’s different. I see that. Yeah. That’s starvation, jaundice. I see. Mm-hmm. I see. Mm-hmm. So we also need to do a quick nod to delayed cord clamping. Sure. Because this is where a lot of providers are nervous to delay the cord clamping and let baby receive all of their blood volume from the placenta.
Right. Because they are afraid of polycythemia. Mm-hmm. Where they have more red blood cells that can. Have more broke breakage. Mm-hmm. Hemolysis and more bilirubin and more bilirubin. However, delayed cord clamping has not increased Pathological jaundice. Yeah. Yep. And that’s something I reiterate to people a lot.
Like yes, it, it can increase the instance of jaundice, but if the normal kind of jaundice yes. Yes. The American College of Obstetrics and Gynecology does have a position statement on that. Sure they do. And so does the American College of Nurse Midwifery. Yeah. So they both agree with all the evidence that they’ve reviewed.
Mm-hmm. The delayed cord clamping, the benefits greatly outweigh the risks of physiologic normal genres. Right. So yes, your baby will be poly scythe themic. Technically, yes and no. It doesn’t matter. Yes. It’s also hard when like we realize the norm that we’ve set is immediate cord clamping, but. Delayed cord clamping is the physiologic norm.
So then the norm should maybe like adjust. Yeah, exactly. That’s a, yeah, that like those are always very frustrating to me when we have those conversations and I’m like, yes, I see that you’re saying it’s polysomic, but like what if that is the norm in your brain? Yeah. Then that’s normal and like, Do you get it?
I get it. Totally get it. You’re like, what if nature already figured this out? Yeah. Serious question. All right, let’s take a quick break to thank a couple sponsors and when we get back we’re gonna talk about how jaundice is treated and how you can prepare for it.
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Welcome back everybody. I don’t know about you, but I’m excited to get down to the practical stuff here. We’re always excited to get practical. I’m just always excited about these episodes. I love you on Wellbutrin. It’s the best. All right, where are we? All right, so how do we prepare if we are at risk of having a baby with jaundice?
Mm-hmm. Number one, if every single one of your kids was jaundice, Or you know, there’s a chance of a blood type and compatibility because you did what I asked and figured out your blood type and your partner’s blood type. Yep. Shout out to Ivan who doesn’t know his blood type. Thanks, dude. If you know there’s a chance you may have a baby less than 37 weeks, I.
If you have a darker skin color and want to make sure you have your bases covered. Mm-hmm. Express colostrum prenatally, please. Yes, if you can, we have an episode about how to do that and why and all of that. And I hope we covered John in that. Probably we did. I don’t know. It’s listed in the show notes.
Yeah. But it’s also a how to, so, we’ll, we’re gonna leave the how to for that episode, but Colostrum has a stimulant in it that’s actually meant to help. Pass that black sticky meconium turd out of your baby’s poop sheet. And dude, that stuff is sticky. I don’t, so I don’t know if you’ve experienced this.
I’ve had some babies who they poop a bunch of meconium and they don’t poop for like three days. Uhhuh. And the parents are like, what’s wrong? What’s, what’s wrong? And I’m like, it’s a meconium plug. And they’re like, what do you mean? I’m like, all right, you will do all these massage and the thing, and then suddenly they poop.
And this like tiny little bit of meconium comes out and then it’s like transitional poop, breast milk poop, four days of poop. It’s like soft serve ice cream. Every time you wipe their butt hole, like a balloon of poop keeps coming out. It’s lovely. Awesome. Yeah. So if baby needs some food in order to help make some poop to excrete the bilirubin, the pediatrician may come in and say, We really need to get some volume in the baby and we’d like to supplement some formula to help baby eliminate this jaundice.
That’s literally exactly what they will say. Yeah, it is. And you can smile and pull out your frozen tubes of colostrum that you expressed prenatally and say, no problem. I have some volume right here. And then you can use the milk you’ve already expressed instead of switching to formula right away. Yes.
And you can feed it. In the way that you want to, even if you’re using formula, you can still syringe feed, you can spoon-feed, you can cup, feed, whatever you want to do. Yes. We’re taking it feed by feed at that point, and so, Other than that, we can express colostrum in the first 24 hours. So if you are looking at your baby and you’re like, yeah, this baby’s like really sleepy, I’m o positive, there’s, we got the baby’s blood type back.
Mm-hmm. They’re B right. You know, like they haven’t done the screening yet at 24 hours, but, It’s looking like this child is turning a little yellow. It starts in their face, so their face will start yellow and then the yellow starts to move down the body. Right. And that’s part of our assessment, especially working out of hospital.
You know, when I don’t have as advanced tools, I’m like, okay. What is our yellow on the forehead, on the chest, on the belly, on the legs, and you know, we’ll see different levels and I mean, that’s what they used to do. Yeah. In the sixties and seventies. It’s actually still a pretty good screening vertical.
It really is. I mean, listen, if it’s just the face, I’m like, you’re good. Yeah. If it’s the face and chest, I’m like, you’re probably still good. Are you eating perfect? Mm-hmm. If it’s all the way down past the belly button to the hips, I’m like, Hmm. And if your baby is a complete orange carrot and their toes are jaundice, We’re, we’re not.
We need to do something. We’re not good. We gotta do something for sure. So early and frequent feedings or milk expression. Is really important. If it looks like your baby is getting super sleepy and not latching Yes. In the first 24 hours. So please hand express some colostrum at that time onto a spoon or into a medicine cup and just drip it in their mouth.
Mm-hmm. Literally. Yeah. Now I recently had a hospital kind of. Tell off a patient for spoon-feeding cuz they said it increased the risk of aspiration doesn’t, I think they just don’t know how to spoon feed. And it doesn’t matter if they aspirate breast milk anyway, it’ll just get absorbed. Right. But the, the way that we do this, there’s some really good videos on global health media.org, but you really have baby like sitting up and they like lap at the little pool of milk.
Like a kitchen. Yeah. You just like put it on their bottom lip. I prefer a cup. Yeah. Personally I like a cup too. It’s less messy. But whatever. And actually a syringe cuz you’re not even feeding that much. Yeah. And with a syringe too, I just squirt a little in their mouth, let them swallow, squirt a little more, make sure they’re swallowing it.
And I had to give my daughter some medication in a syringe last night. You know when the first squirt, it’s a little stuck and then you do it too hard. I almost made her vomit right in my face. Cause I hit the back of her throat. You’re like, oops, sorry, I forgot to wash the syringe last time I used it. Oh God.
You get the sticker for the day. Woo. I promise. And I, I do just wanna remind you that like one drop of colostrum swiped around in the inside of your baby’s mouth is still helpful. Yes. Because you can activate the top of the tube. Like the whole GI tube. Mm-hmm. When you activate the top, it can activate the bottom and help them pass the meconium.
Yeah. So even if it’s just one drop, don’t be sad. Use it. Don’t waste it. Right. And digestion starts by thinking about food. Okay. We start all of our like digestive juices and stuff. When we think about food, when we smell it, when we see it, and when we taste it, we’re actually. Digesting sugars in our mouth.
Yeah. So that is actually a really important part of digestion. Yeah. So don’t knock it till you swipe it. Yeah. All right. So how do we treat it and keep up with breastfeeding if baby has been diagnosed with John? This is the question. Okay. So now you’re at 24 hours postpartum, baby has. Not passed the screening tool.
They’ve done the beep, beep beep with the transcutaneous bilirubin checker on the head. Mm-hmm. And then they’re like, student, do it again. Do it again. Do it again, again. And they’ve been identified as having pathologic jaundice, and the pediatricians are probably gonna recommend treatment with phototherapy.
Which is a special wave of blue light. Yes. It’s not actually UV light. Interesting. So many people think that’s the case. We call it UV light, usually it, but it ain’t interesting. And the purpose of this light is actually to help conjugate the bilirubin for the liver. Right. Which is why we tell people to bring their babies out in the sunshine.
Yes. When they’re doist Yes. Or an indirect light in the window. Mm-hmm. So essentially what’s happening there is the skin, and then the blood absorbs the light and helps to process the bilirubin like the liver does, to help get it to the next phase of the plumbing, the poop shoot. Mm-hmm. And this treatment was first discovered in 1958.
Hmm. But the practice was not established until the early eighties. Okay. However, most of us born in the eighties, like me can tell you that the majority of the time they were still telling parents to undress their baby and let them sleep by the window in indirect sunlight. Sure. I mean, I still tell people to make sure they get.
Their baby is exposed to indirect sunlight every day and themselves. Cuz it just makes you happier. Exactly. So previously, and even when I first started in my career mm-hmm. The treatment was actually in a special bed with lights on the bottom and on the top, like a tanning bed. Oh. And my gosh, they got little goggles on babies.
It was huge. Yeah. And the baby was meant to lay naked other than wearing a diaper and goggles all alone on this bed for as many hours as possible. Mm-hmm. And parents are instructed only to remove the baby from the bed when it’s time to feed. And this resulted in super freaking stressful situations with really pissed off babies and crying parents.
Yep. And additionally, it led to less frequent breastfeeding attempts since a sleepy baby has been separated from their food source. So we’re missing those cues or babies not giving the cues cuz they’re completely separated, they can’t smell it, they can’t see it, they can’t feel it. And then also mom is exhausted and much more likely to pass out for hours at a time instead of feeding.
Mm-hmm. So if baby well isn’t crying, the more barriers between you and feeding your baby, like the less often you’re gonna do it. It’s just Absolutely. Yeah. And then feeding on a strict schedule. So to mitigate that, they’d set their alarm at every two to three hours. Right. Their baby. And in that case, they’re like, oh, only every two to three, because baby needs the phototherapy between Exactly.
Yeah. And we have really good research that shows that scheduled feedings in the beginning lead to. Engorgement with the breast, which makes it harder for a baby to latch. Mm-hmm. And it turns into a whole shit show. Low, then low supply, low supply and low weight gain, which then exacerbates this whole bilirubin nightmare.
Right? And so recently in the past couple years, we’ve started trying to transition to Billy blankets, which I love, so I love them so much. Better. Ask for one, if your baby needs. Treatment. Yeah. So the baby will lay on this blanket, just a diaper. And the goggles, we gotta protect the balls. And the balls.
Yeah. So you can hold the baby while they’re receiving the treatment. However, they still do like to have an overhead light mm-hmm. Over the baby. So they prefer it to be in the bassinet in a lot of places. But I have been known to put sunglasses on parents. Mm-hmm. And just like move the light over them and be like, close your eyes.
Yeah. You know, like if you can do this for an hour, that’s like one more hour closer to getting the hell outta here. If you can treat while babies feeding. Like, well, so maybe, but also mm-hmm. Part of what, let me get into it. Okay. So please do not skip any feedings that baby requests. So if you’re holding baby and they’re making hand of mouth movements or trying to bite the blanket or stirring at all, take them off the light.
And remove the goggles. Mm-hmm. So you can do eye care. Can we do Billy blanket without goggles? While technically no. Okay. Has it been done? Yes. I’m sure it has. I mean, I’ve seen it done, but I don’t, yeah. Yeah. But their, their little eyeballs are so sensitive that I probably wouldn’t mm-hmm. However, you know, nurses and pediatricians are going to give you shit about it if every single time you go in there, the baby is feeding and not on the light.
Yeah, for sure. And so as long as you know that if the baby decides to eat 14 times that day, there’s a chance you might be discharged a day later. Yeah. And we might have to prolong it. So what? Yeah. So what, you know, like that sucks, but at least your supply is intact. Right? Cuz the light and food are equally important in this treatment.
Right. Yes. Yes. And that’s my whole point here. So if baby can’t or won’t latch during the feeding time, please pump and give any colossal that you can get out. Yes. The, and the reality is like it’s not, there is absolutely nothing about formula versus breast milk that makes one or the other better. For treatment.
We just have to make sure baby eats something. Yeah. And so if you don’t have something for the baby to eat, if the pump’s not working Yeah. Or whatever, you can use some formula, but please pump. Yes. If you’re using formula. Yeah. If your goal is to breastfeed and you’re feeding anything, butt breast milk.
Make sure you’re pumping at the same time. Yeah. So as soon as they’re done eating, you put them right back on the blanket with the goggles. And just again, we’re gonna say it again. The light is important, but so is the food. So pediatricians will scare the living hell out of parents and threaten brain damage and their baby if they don’t leave them on the light long enough.
And then people are afraid to take them out of the light. Folks, the kid needs both. And your boobs need the kid. And like I really. I feel like we’re ragging a lot on peds teams in this episode, but honestly for good reason, cuz Heather and I have sat there while peds is rounding on dozens and dozens of patients and just watch them scare these mothers so badly.
Yeah. For no reason. Like they don’t want to feed their babies. Right. They, they, because they will let the baby scream, just scream and they’ll just keep putting a, a binky back in, standing there crying over. I know that was me. Yep. I was there for five days with my 36 weaker mm-hmm. Who was jaundice as hell in the big bed.
Mm-hmm. With the completely separated from me with my giant engorged boobs doing formula not pumping. It’s tough. And I’m like, right, what was the thing? How is that better? It’s not. Yeah. And I just like, I, I don’t know. Recently I’ve had conversations with people who are just like, wow, the hospitals near you must be really terrible.
I’m like, yeah, I guess they are, because we see this all the time. All the time. And it’s, it’s awful. And even if there, there’s an emergency with your baby, you shouldn’t be spoken to like that. Yeah. No one should be telling you that you are gonna cause your baby brain damage for feeding them. We’re already in the hospital.
Okay. Mm-hmm. We’re already here. We’re already doing the treatment. If my baby gets a rare carns diagnosis, it’s because there’s something more wrong than bruising or a blood type and compatibility. Most of the time it’s a perfect storm of things, or there’s some genetic situation going on where we have like biliary Tricia or pyloric stenosis or something is kinked in the plumbing and it’s not going through.
Right. You know? So it’s like, don’t be pointing at me. I’m the one who’s at the hospital, so if you think there’s connector is, it’s probably not my boobs or the fact that I wanted to hold my baby. Yeah, it’s probably something you need to look into and thank God. Right. We know that now and that’s why we’re here and that’s why we’re here.
You’re welcome. It’s, it’s very frustrating and I, it’s just honestly, like the reason I do this work is cuz I think people deserve to be spoken to with compassion. Yeah. And there’s no re, people are scary. That’s enough already. Honestly, it’s like, that sounds ridiculous to be like, I’m a midwife because I think we should be nice to people, but really though, but really, like I, I think y’all deserve basic decency.
Yeah. I mean, you’re at the most vulnerable time of your lives. Yes. You’re already looking at a perfectly healthy baby. Scared to death. Yeah. And so the wondering if anything you’re doing is right and literally. People will come into your room and only tell you what you’re doing wrong. Mm-hmm. And they never tell you what you’re doing.
Right. So part of what I do is I go in and I start making a list out loud. Mm-hmm. Of what they’re doing. Right. Oh my gosh. Look how you’re holding your hand naturally. Yeah. In the perfect position. I like. That’s so cool. You know, just to like, It’s helpful to know what you’re doing. Right? So if you take your baby off the Billy blanket to feed them, I’m gonna start by saying, that’s awesome that you turned off the light to feed your baby, that you took the goggles off.
Mm-hmm. That you’re prioritizing feeding. Cuz as you know, that’s half the battle. Yeah. With coming over jaundice, you know, just make sure you wrap, baby right back up. Yeah. As soon as you’re done and turn the lights back on. Handled. You don’t need to be a dick. Yep, that’s it. I’m sorry this has turned into a bit of a psa, but I mean, it affected me personally and it could potentially affect me again in the home birth situation.
Absolutely. And I’ll let you know, but we’re gonna be prepared. I’m gonna definitely, you know, get my colostrum prenatally if I can. Yep. We’re gonna bring your elder card, we’re gonna see what blood type this child has by dripping some cord blood. Yeah, it’s gonna be great, Anne, if we have to transfer to the hospital for treatment, we’re gonna be prepared.
To advocate for ourselves. Actually, there’s a lot of research out there that shows that being able to order a Billy blanket to your house mm-hmm. Is much more preferable than a readit to the hospital. A lot of places are starting to do that. I, I’ve really tempted to like order one for rentals, but it’s, it’s, the tough thing is like, midwifery here isn’t fully integrated into the hospital system.
You know, like if. If my work was integrated where I could just call up the PD and be like, oh yeah, can you order this for my patient? Here’s their, here’s their labs. You know, you keep an eye on it from afar, can you approve home care? Like, that would be perfect, you know? That would be great. That would be great.
You know, like to be in a home that actually has windows that aren’t UV blocking. Oh my god. Okay. I know, I know. I. Like every room I’ve been in where they’re, the parents are like, oh, I didn’t put the baby under the blanket because I just set them in the window and I’m like, bad news. The like four inch glass window.
Yeah. Bad news. These windows at the hospital are UV blocked and they’re like, oh shit. Yeah, like you’re gonna need to put ’em on the blanket. Yeah. Sorry. Sigh. But I mean, I think we’re going in the right direction. Starting to have treatments that are breastfeeding friendly. We’re definitely having lots more education around it, so I hope we keep doing that.
All right. I hope that was helpful for you. Please let me know if you have any questions. You can email us@milkmanpodcastgmail.com. We’re gonna take a quick break and when we come back, we’re gonna give an award to one of our valuable listeners who we love so much. You never know. It might be you could be.
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Enjoy.
Welcome back, everybody. Are you ready to get an award? I’m ready to give one. Me too. This one comes from a patron of ours, Katie Siegfried, and she nominates her twin sister Mary. So cute for making it over a year of breastfeeding. She says, our boys were born two weeks apart. My first and her second. I knew breastfeeding would not come natural or easy after having difficulties with my first baby.
I breastfed my first for more than a year and had a big enough oversupply to donate to a friend mom and feed her baby breast milk for nearly a year. Also. My goal this time was to make it a year with my second and help my twin reach her goal. There were ups and downs, but with the help of you awesome ladies.
The podcast each other. We made it. Yay Katie. That’s awesome. Yeah. And they celebrated in Mexico last week. Hell yeah. That’s their baseball. All right, well, what award are we gonna give to Mary? Mary and Katie, we’re gonna give you the terrific 20 award and please send us a photo of both of you and your babies that we can put on Instagram for our stories.
We’re super proud of both of you guys. Thanks so much for nominating your sister, Katie. That was awesome. I love when y’all nominate each other. We’re just here to hype each other up. I would also like to read a recent Apple review, cuz those just make me feel good and I hope they make you feel good too.
They definitely make me feel good. This one is from Michelle BB 87. It is titled Informative and hilarious. I’ve been listening to this podcast for years. Maureen and Heather are informative, unbiased, and hilarious. I feel like we’re pals. Me too, bro. I even like their ads. I can’t say that for any other podcast.
Highly recommended for baby feeding info and just for a good time. Hell yeah. That’s all. Thanks for liking our ads. Yeah, I mean, what the, that’s what we’re hoping for. Every time, time we record them, we’re like, sorry, sorry. We’re like, I hope. That was not boring. Awesome. All right. Well thank you all for listening to another episode of the Milk Minute podcast.
If you guys love us and you wanna hear more, you can subscribe to our new podcast Beyond the Boob. Full Access is available on Apple podcast subscriptions and on our Patreon patreon.com/milk minute podcast. Bye-bye bye.
