Finding out your newborn has jaundice can be an overwhelming experience for any new parent. You’ve just begun your breastfeeding journey, and suddenly there are medical terms, bilirubin levels, and specialized treatments to consider. Jaundice often makes breastfeeding establishment harder, not only because babies with jaundice tend to be sleepy but also because of rigid outdated phototherapy schedules that only allow for breastfeeding once every three hours. These schedules often lead to supplementation and bottle feeding that interrupt normal establishment of lactation. Jaundice is common, and can be easily overcome in the vast majority of cases. It shouldn't mean the end, or even a risk to, your breastfeeding relationship.
What are Jaundice and Bilirubin?
Jaundice occurs when there is a buildup of bilirubin in a baby’s bloodstream, causing a yellowish tint to the skin and eyes. Bilirubin is a byproduct of the natural breakdown of red blood cells. While adults process and excrete this through the liver, newborns often have a backlog because their livers aren't yet efficient enough to keep up with the surge of red blood cell breakdown that happens after birth.
There are different types of jaundice, including physiological jaundice, which affects most infants, and breastfeeding-related types like sub-optimal feeding jaundice (when a baby isn't getting enough fluids) or breast milk jaundice, a prolonged but typically harmless type. When bilirubin reaches a level that is considered in the risk zone for the baby’s age, the baby is given a treatment called phototherapy. This is when a blue spectrum light is shined on the skin and it helps to convert the bilirubin into a form that the body is able to excrete, essentially saving the liver the trouble of converting bilirubin into a water- soluble form.
Why Feeding Matters
Frequent feeding is actually the first line of defense against jaundice. Bilirubin is primarily excreted through stool. By nursing 8 to 12 times a day in the first several days starting in the first hour postpartum, you help keep your baby hydrated and encourage the bowel movements necessary to clear bilirubin from their system.
When bilirubin levels are high enough to require phototherapy, many parents worry they will be separated from their child. But the medical consensus is clear: interruption of breastfeeding is never indicated for jaundice treatment. The treatment can be given in the mother’s hospital room so that no separation occurs that might interrupt breastfeeding. New protocols also state that the efficiency of the treatment is not affected by stopping to breastfeed on demand.
My Story: Breastfeeding Through Phototherapy
When my son was diagnosed with jaundice and required phototherapy, only one day postpartum, I was determined to maintain our breastfeeding bond. By that point I was an IBCLC and breastfeeding was something I was very passionate about. At first the hospital told me that the treatment needed to happen only in the nursery. I sat by my baby’s phototherapy bed on a chair and was very uncomfortable. Then I decided to change the situation. I spoke with the charge nurse and explained that the treatment could happen in my room. She agreed and I was relieved I could be next to my baby and still be comfortable (I use comfortable here loosely, but it was better than a chair in the nursery and it allowed me to keep it up for five days). We were able to do things differently. This might have been due to the fact that I was a staff member at the hospital where I gave birth, but I know that it’s possible for other mothers too in many hospitals.
Within 15 minutes we had the phototherapy lights set up right in my hospital room. This was a game-changer. Because he was right next to me, I could see his early hunger cues immediately, the rooting and stretching, rather than waiting for him to cry and the nurse calling me or only coming in at pre scheduled feeding times. To ensure he got as much time under the lights as possible, I stayed right there with him, patting and shushing him to keep him calm while the lights did their work.
When it was time to nurse, I didn't stop the treatment. I wore sunglasses to protect my eyes, just as his were protected by his eye patches, and breastfed him right under the lights. It wasn't always the most comfortable setup, but it allowed him to stay under the therapy while getting the vital colostrum and milk he needed to flush out the bilirubin. Research shows that interrupting phototherapy for up to 30 minutes to nurse without eye patches does not reduce the treatment's effectiveness, but being able to feed on demand gave me peace of mind and kept my milk supply strong. I won’t say it was easy, it was a hard few days, I barely got any sleep, but I left the hospital with a baby free of jaundice and exclusively breastfeeding.
Tips for Parents
If you find yourself in a similar situation, remember these points from the experts on promoting breastfeeding establishment while dealing with jaundice:
Monitor Output: Keep a close eye on wet and dirty diapers. Stools that remain dark or a lack of wet diapers can be signs of sub-optimal feeding.
Optimize the latch: Make sure to be seen by a lactation consultant who can help you get the best latch and be comfortable.
Protect supply: If you are supplementing the baby with breast milk or formula make sure to pump after every feed to give your body the stimulation it needs to produce more milk. Hand expression after pumping will also help you remove more milk from the breast and increase supply.
Watch for Lethargy: Jaundiced babies can be very sleepy. You may need to use techniques like skin-to-skin contact, finger or spoon feeding the baby expressed colostrum, or activating the suck reflex to keep them awake during feeds.
Advocate for Rooming-In: Ask if phototherapy can be done in your room to facilitate on-demand breastfeeding and bonding.
Jaundice is a hurdle, but it is one you can clear while continuing to breastfeed. By staying close and feeding frequently, you are providing the best possible care for your baby during their recovery.
by Maya Dubinsky IBCLC
