Re disagreement with the pediatrician's recommended treatment: I think your action was knee-jerk. I've been there, done that. It is very hard not to. If you are in the usual USA hospital setting, I think your best course of action is to NOT alienate any doctors if possible. This will help more moms in the long run. Line up your facts first, like baby's risk factors, bili levels and weights, then read up about treatment options (AAP algorithm is a good one), then call the ped with an alternate plan. Nicely ask if he would consider another route. You could say something like this: Ms Jones is really gung ho about breastfeeding and has shared with me she doesn't really want to give the formula and pump for 3 days. I've observed 2 feeds today and baby is feeding quite well. Since the baby is full term and his levels aren't jumping up too fast, I would be happy to see them every day and check the baby's weight and observe for increasing jaundice. (by the way, I love the transcutaneous bilichek machine and highly recommend it, it sure saves alot of guesswork and heelsticks to monitor bili levels - get one!)
Be aware that many doctors feel the breastmilk itself is giving the baby the jaundice and know that formula does make the bili levels go down faster. Usually not-enough breastmilk is the reason for high bili levels at 3 days old and you can make a case that if baby is feeding well he will improve, or if he is supplemented with ebm he will do well. This argument doesn't work if the doctor is fearful of the breastmilk itself. As a compromise you can ask if she can continue to bf and supplement with formula after each or some feeds. Hopefully baby won't want much formula. Offer to do followup. Another alternate is begin home phototherapy and continue bf. Very very often, if you present a thoughtful and polite alternate, the doctor will agree.
Re soap: try liquid castille soap, I've seen it in little packets you can stock in the unit and I believe it is a mild soap with a pleasant, not strong, scent.
Laurie Wheeler, IBCLC, MN, RN
Mississippi, s.e. USA
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