When visiting maternity hospitals in Thailand I was impressed with
the abandoned nurseries full of abandoned crib-trolleys.  I was told
that even with Baby Friendly they had a problem with jaundice, so
they got rid of the cribs and put the babies in the mother's beds.
Almost no jaundice.

These mothers are in hospital for about three days.  They lie in bed
all day on their sides with the baby on the breast.  Occasionally
the baby falls off, sound asleep, but otherwise it feeds around the
clock.  If you asked a mother how many feeds the baby was having she
would think you odd.  It would be more useful to ask how much time
the baby has been *off* the breast.  And this used to be a culture
that discarded colostrum.  Change can be achieved!

While I support the concept that some degree of elevated bilirubin
may be natural, even desirable, I think we need to study jaundice
under optimal breastfeeding conditions before we accept the jaundice
rates we see in the west. "Frequent feeding" has a cultural
perspective.

Ros Escott IBCLC
Tasmania, Australia
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