To add a personal anecdote, my son was the first known born-at-home baby in
my town for decades, so once everyone figured out where we were, the hordes
descended.  He was my first child, so I was not confident about
breastfeeding, and did not have at-the-breast as my default.  His father
and a family friend took him to the OB floor for all the routine neonatal
testing at close to 72 hours of age, and his bilirubin was 25.9.  He had
been asynclitic, needed a five hour second stage, and had a significant
hematoma on head (though it did not cross suture lines, so we did not seek
treatment or further evaluation).

I remember him latching on to some extent before the midwife went home the
night he was born, but that's it.  She had told me that when he did, it
would feel like a baby elephant, and he did not latch like that until we
were in the ER.  So I basically starved my son for close to three days.

That 25.9 was freak out territory for the hospital as soon as the test came
back, and had he not woken up and learned to nurse in the ER, they would
have sent him to the nearest large town for an exchange transfusion.  Given
the food sensitivity spiral we entered at week two, I wonder what horror
that could have been.  Anyway, we spent 48 hours in the hospital, the bili
dropped rapidly to 13 and held steady there, so we were discharged.

All those memories dredged up just to say that scary high bili numbers
don't necessarily indicate anything to be super worried about.  A
combination of less-than-scary risk factors (boy, long 2nd stage, hematoma,
poor feeding) can work together, and they might all or mostly be solvable
problems.  To make sure it didn't happen again when my second was born, I
allowed a student doula to be there, and told her that she was welcome to
practice all the standard doula stuff on me, but the one thing she MUST do
was ensure that I FEED THE BABY no matter what.

Lynn Carter OFS IBCLC
Missouri USA

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