Today I read a post on my CAPPA Yahoo group from a gal who just had a baby a little over 3 weeks ago who has come down with “breastmilk jaundice”. Now, I have absolutely no personal experience with this common occurance myself, but I’m sure that some of you (my millions of readers, that is) may have. Ahem.
She was being told that she had to put her baby on formula until the bilirubin levels were acceptable. Her three week old baby’s last bili count was at 9.7, and the pediatrician was not happy, and told the mother that the proteins in breastmilk are “sticky” and cling to the bilirubin, not allowing it to leave the baby’s body. Like I said, I don’t have personal experience with this, so I don’t exactly know what that means. But…on with the show.
One of the other doulas in the group was able to provide some great information for this mom, and I wanted to share it with you. Needless to say, I’ll be doing some reading over the next few days for myself to learn what I can about this issue. The more I learn, the more I realize how little I really know! To quote her post:
“Hopefully, this information will put you at ease. Please share with your pediatrician. If he gives you a hard time about not being PROactive, ask to see the studies he is basing his opinion on. That usually settles the debate quickly as they don’t have any information to back them up.
It is true in this case. It is not uncommon for jaundice to recede slowly in the breastfed infant.
‘Hyperbilirubinemia that peaks between 6 and 14 days has been termed late-onset or breastmilk jaundice and can develop in up to one third of healthy breastfed infants (AAP 1994). Total serum bilirubin levels mayrange from 12 to 20 mg/dL and are considered nonpathologic. It can persist for up to 3 months.’ (Gartner, 2001; Neifert, 1998).
‘The underlying cause of breastmilk jaundice is not clearly understood and may be multifactorial. It has been suggested that substances in breastmilk such as B-glucuruonidases and nonesterified fatty acids might inhibit normal bilirubin metabolism.’ (Brodersen & Herman, 1963; Gartner & Herschel, 2001; Melton & Akinbi, 1999; Poland, 1981).
‘Maruo et al. (2000) suggest that a defect or mutation in the blilirubin UDGPGT gene may cause an infant with such a mutation to be susceptible to jaundice that components in the mother’s milk may trigger.’
‘Breastmilk jaundice is seen in healthy, thriving neonates who have good weight gain; it may persist for many weeks. Breastmilk jaundice is a normal physiologic phenomenon, not a disorder.Two thirds of all breastfed babies have an elevation in bilirubin, and half of those have visible jaundice during the second to forth weeks of life. As bilirubin is a potent antioxidant, modest elevations ofbilirubin may possibly be beneficial, though this requires additional research. Although neonatal jaundice without other signs is almost never indicative of a bacterial infection, in 7.5 percent of afebrile, asymptomatic jaundiced newborns (predominantly formula-fed) younger than 8 weeks presenting in the emergency department, a urinary tract infection was diagnosed.’ (Garcia & Nager, 2002).
‘Research indicates that breastmilk jaundice, although it may persist for many weeks, is a benign condition. Hence, (ILCA) believes that interrupting breastfeeding solely for the diagnosis of breastmilk jaundice in an otherwise healthy and thriving infant is rarely justified. ILCA believes that such a potentially hazardous intervention must becarefully undertaken after fully informing the mother of the value of continued lactation, the importance of continuing to express her milk, and the potential risks of introducing breastmilk substitutes.’
–International Lactation Consultant Association Position Paper“
Whew. If that doesn’t make your brain feel like exploding, I don’t know what will!
This is a perfect example of what “informed consent” really means. This mom wasn’t happy with her pediatrician telling her that her only option was to basically give up breastfeeding when her baby isn’t even a month old. She felt that somehow, somewhere, something just didn’t feel right for her, and she sought help and information.
Which is what you should ALWAYS do. Every time your doctor tells you something – ask questions. Not to be a know-it-all or to prove a point. Remember, this is YOUR child you are discussing, not the doctor’s child. As well-intentioned and knowledgable as doctors are (and have to be), they are not the end-all be-all for everything. And they don’t always have the right answer for you.
So…while you should never outright shun your doctor’s advice, neither should you swallow everything they say as Gospel-truth.
Educate yourself. Everything you need to know is at your fingertips! What else could Google possibly be for?
Here are a few links to get you started.