Why is my baby jaundiced?

Physiological Jaundice
Most healthy newborn babies become jaundiced (yellow) around about day three or day four, we call it physiological jaundice. It usually appears on the face and trunk of your baby's body. The reason for this, is because your baby is now breathing air and no longer requires the excess red blood cells that (carries oxygenated blood) he needed while he was in your womb.  The baby's liver begins to break down those excess blood cells and the jaundice manifests itself through the skin in the form of a yellow pigment.  The jaundice begins to fade gradually over a period of 10 days and does not cause any harm.  

The advice we give is to let your baby feed at the breast for as long as he wants, that way the sufficient quantities of breastmilk will help your baby eliminate the jaundice from his body.  

Breast milk Jaundice
Some babies can develop breastmilk jaundice which is not harmful, in fact, breast milk jaundice can develop later than 10 days after birth and continue for as long as two to three months.  The cause of breast milk jaundice is not known and there is no reason why breast feeding should be discontinued. If the jaundice persists beyond two weeks, your midwife may do a blood test to check your baby's bilirubin levels and seek the advice from a paediatrician.

When should you be concerned?
With the exception of breast milk jaundice, in the case of physiological jaundice, the jaundice will gradually fade and disappear around 10 days.  Your baby will remain alert when awake and breast feed on demand.  A healthy newborn baby will gain weight and have at least six wet nappies in 24 hours, although it will be difficult to tell if your baby has a wet nappy if he has opened his/her bowels.  Your baby's stools will change colour from the thick black meconium (produced for the first three days) becoming lighter, and usually by the third or fourth day are a yellow/brown colour.


If the jaundice (yellow colouration) becomes deeper and covers more of the baby's skin or white (sclera) of the eyes become yellow and your baby's behaviour changes from being very alert as he was in the first few days, to becoming sleepy and not very interested in feeding, it is important that you seek advice from your midwife.  Your midwife can perform a blood test on your baby that records the serum bilirubin (yellow pigment) in the blood and its a way to check if your baby requires treatment.


If your baby becomes jaundiced within 24 hours of birth, you must inform your midwife immediately.
Always seek the advice from your midwife or well child provider if you have any concerns about your baby.


http://www.lalecheleague.org.nz/resources/15/231

I hope Le Leche wont mind that I took this picture from their website, just thought it was awesome :-)

I am a new Nana

Thank you to Graham and Sophie for making me a very proud Nana and to gorgeous baby Luke :-) I am so filled with love for you all and to my daughter Lynda, for keeping me updated.  We cant wait to see you all.xxxxx

Ouch - Sore nipples

Having a baby can often be very tiring and when you are tired it is even more important to ensure that your baby is correctly positioned and latched at the breast to prevent sore nipples.  Breastfeeding is the best thing you can do for your baby and for first time mums and also mums who are breastfeeding for the first time, it can be pretty tough going for the first week to ten days when breastfeeding is becoming established.

Firslty, your comfort is important.  If you are comfortable and relaxed then it will be easier for you.  Pillows or cushions to support your back when feeding, some mums use a pillow under their baby when he/she is laying across the abdomen. Or, you can use a pillow when feeding in the 'rugby ball' position.  It is entirely upto you what position you chose, the main thing is your comfort.  When you are going to feed, have your water/juice close to hand so you can drink while baby is feeding and it is good for you to drink at least one glass an hour (when awake) as breastfeeding can make you quite thirsty.


Correct positioning

• Tummy to tummy.  In other words your baby's tummy towards your tummy.
• Baby's mouth at the same level as your breast, so baby is not trying to reach up to the breast or turn his neck trying to get there.
• Your baby's body is curled around your body like a banana.
• If your breasts are large, you can use a rolled up flannel under your breast to raise it up slightly.

 Correct latching

• Nose to hose.  Your baby's nose aimed towards your nipple.  This encourages him/her to open their mouth wide, very similar to a baby bird in the nest, who is waiting with a wide open beak for mummy bird to put the food in its mouth.
• When you see your baby's mouth open wide, then you can latch your baby onto the dark area of the breast (areola) and not the nipple.  

We do not recommend that you detach your baby, however, if there is sorness and pain when your baby feeds, he may not be on properly, in which case, use a clean little finger (short nails) inbetween his gums and break that suction.  Never ever pull a baby off the nipple - OUCH! Their jaws are very powerful and pulling your baby off can cause more pain and damage.  Do not be afraid to break that suction and detach him if you are hurting.

Mums ask about nipple balms.  Some of them can be soothing initially but the best thing to do is ensure that baby is latched correctly. You can expose your nipples to the air to airdry and sooth and you can also use some of your colostrum on the affected area to help heal.  

You are just awesome and we are here to help and support you as you go through your journey.

Seek the advice from your midwife/lactation consultant or breastfeeding support group.   This link has some great articles and advice.  We are very lucky at Whangarei hospital because we have a lactation consultant and educators, along with a drop-in breastfeeding support centre. 

http://www.lalecheleague.org.nz/resources/15/231 

A labour drink

Curtesy of Nicole who very kindly sent me this energising labour drink.  Thank you Nicole :-)

 1/4 cup honey
1 teaspoon salt
1/3 cup lemon juice
1 crushed calcium tablet

1 Litre of water

Anecdotically, calcium is said to help with the pain of labour, although I have not actually researched this.    

Blast from the past

I came across this early 1960's parenting book called "Modern Mothercraft" and thought I would share it with you.

"Time at the breast


     The time required for the average baby will be between ten to twenty minutes.  Both breasts should be offered at each feeding.  Ten minutes on both breasts, or ten minutes on the first and five minutes on the second, may be required, but babies do not take the same amount of breast milk at every feed, nor will the same amount be available in the breasts at each nursing, because there is more milk present in the early morning than later in the day.


     It is important to make sure that baby sucks well at the breast and that he does not dawdle, play or go to sleep.  The actual sucking time should not exceed 30 minutes."  


Well, at least they mention that it is important to make sure that baby sucks well at the breast.  Thank heavens that we no longer give this advice and the evidence suggests that, letting your baby feed when he/she wants for as long as they want will stimulate the release of the hormone prolactin which builds up the milk supply.  

Your baby will comfort suck and play at your breast, the eye contact and hormonal feedback mechanism between you and your baby is phenomenal.  It is the same hormones that are released when you fall in love, you and your baby are falling in love, we call it bonding.  Your baby is helping you fall in love with him that you cannot put him down because he is dependent on you for survival.  I tell mums that babes require three things, food, warmth and love.  Breast feeding and mummy and daddy give baby all three.


     Royal New Zealand Society for the Health of Women and Children (incorporated) Plunket Society.  (1964).  Modern Mothercraft.  Coulls Somerville:Dunedin.

Chit Chat

Had a wonderful home/water birth last week.  We used my new birthing pool for the first time and I have to say it was excellent.  I have two birthing pools, one where you have to put the frame together, then feed the outer liner through it and then the inner liner.  It was a great pool but fiddly to put together and there was no padding on the floor of the pool, which meant that knees got sore, or I put heaps of pillows inbetween the two liners.  

My  new one has an inflatable floor so knees are cushioned well and its walls are sturdy enough for someone to sit on.  Yes, I am very pleased with my new pool.

Patterns, schedules and breastfeeding your new baby.

Congratulations for choosing to breastfeed your baby, it is the best thing you can do.  As a midwife I am oftened asked when babies sleep through the night or, parents tell me that they were up all night feeding their baby.

Baby Behaviour
I think it would be great for our daughters to know how wonderful breastfeeding is and, that night feeds are really important. Babies do not read the book that say adults sleep at night, also, if I took that sandwich out of your hand and said you cant eat it until later or, tell you that you cannot have that snack you are looking forward to having. I am sure you would not be very happy with me, in fact, you would probably tell me, in no uncertain terms what I could do with myself.  

Babies do cry, it sounds obvious but they cry for many reasons, hunger is one, but also because they want our warmth and comfort, they are having a growth spurt, they are wet, dirty, bored or, they cry simply because they can and want to be held.  Speaking from experience both as mother and a midwife, I find it very interesting (and funny too) that we, as humans, expect our offspring to go into a different room, cot, away from us to sleep etc., when, in the animal world their young are continually clinging to their mothers for protection and, where there is free access to the breast.


Free Access Feeding
So, why do we think babies should be any different and conform to patterns and schedules?  Babies are like any other mammal, they seek out the warmth and protection from their mother and suckle at the breast. All mammals in the Kingdom allow what I call 'Free Access' feeding, in other words, letting your baby feed from the breast, whenever he/she wants for as long as they want. I do not call it 'demand' feeding, because it sounds like your baby is being demanding, when in actual fact, they are displaying normal behaviour and doing what any other mammal would do. 

By giving your baby 'Free access' to the breast, it stimulates the release of a hormone called prolactin to help build up your milk supply and, baby gets a nutritious drink at the same time. Prolactin, is mainly released at night, released during the day to a certain extent but mainly at night, that is why night feeds are important.  

Growth Spurts
Your baby will have a growth spurts, usually every one to two weeks and will want to go to your breast quite frequently for 24-48hrs because he/she has put on weight and needs to increase your milk supply, and he/she can only increase your supply by sucking frequently at your breasts. 

Do not expect any set patterns for a while because it takes at least 7-10 days to get breastfeeding established.  Some advice to get you through the early weeks are to ensure that you get adequate rest, is for you and your partner to sleep while your baby sleeps.  Do not feel that you have to entertain visitors, dust and housework can wait, in fact, organise a good friend/relative to come in to do some housework for an hour or so a day.  

KNOW THAT YOU CAN DO IT.....have the confidence to know that you will produce more than enough milk for your baby, if you allow 'Free Access' feeding to your breasts.  You are just awesome and we totally support you in mind and spirit. 

Some organisations (apart from your midwife) that are just wonderful with help, support and advice are your local Lactation Consultants and the La Leche league. 

http://www.lalecheleague.org.nz/
http://www.midwife.org.nz/index.cfm/1,78,0,0,html/For-Women