Following the string of treatment for elevated bilirubin:
At our facility the frustration begins when a mother who is breastfeeding
and the pediatrician schedules a follow up visit for day 4.  Of course mom's
milk is just coming in or just came in so baby is at it's lowest weight and
just starting to gain. Mom is just getting really comfortable with the
frequent feedings and getting baby to latch easily. They site weight loss/
dehydration as the reason that baby is jaundice and admit baby for hydration
and to have levels drawn.  So, baby is admitted, mom is running from office
to hospital and does not get to nurse as often during the process.  When
baby gets admitted they start an IV for hydration, meanwhile mom does not
have time to nurse because of all that is going on ( and since they are
listening to the Ped they are often too worried or just do not realize that
they should feed the baby while all of this is going on.)  When the infant
is admitted the LC's get a referral.  We go see the couple and mom is now
trying to breastfeed the baby while they await results from the bili
testing.  So even when the bili is under 20 the baby ends up with a 24 hour
stay and the whole nine yards ... of course it slows feeding down because
the fluids reduce the infants desire to feed so mom is pumping to keep
things going... meanwhile she is engorged by now because of not nursing as
often at such a crucial time... therefore she has difficulty pumping out
what the Ped is telling her the infant needs to take in every 2 hours ... so
they supplement with formula because even though the baby has no interest in
nursing you can usually force down a bottle ... then baby is not hungry as
soon because formula yada yada yada ...then mom thinks it is her breastmilk
that caused this to begin with ... Then baby's bili takes longer to come
down because the formula is so constipating ... and so on and so on... then
I pull all of the hair out of my head!!!  Is it any wonder that some mothers
give up?  when during their most difficulty time ( for any mother) that
first week, this  kind of thing happens?  That is what destroys all of the
pregnancy and post partum teaching.
And just FYI... physician "updating" regarding breastfeeding and breastmilk
is a big portion of our job and education plan.  Some of them must have been
formula fed though... they seem to be challenged in this area. (lol)

Pam Price
Community Ed. and Lactation Program Coordinator
Women's and Children's Services
Trident Health System
Phone 843-824-5013
Fax 843-797-4692
e-mail [log in to unmask]

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