sorry to all who didn't understand the Canadian values of a Micro bili of
338. Thanks Dr. Newman and a few others who explained it to all.And thanks
to all others who privately emailed me your support. You are a great bunch.

 Jaundice came down quite nicely after 24 hours of ultraviolet lights,
pumping and giving ebm with a bit of extra formula if an ounce of ebm was
not available. Now I have one more question. Baby went home the next day.

When I did my research again on Hyperbilirubinemia in the healthy newborn
looking for some short , concise info to give to the GP, the AAP guidelines
are pretty specific about what to do for the breastfeeding infants, such as
more frequent feeds, (8 to 10 times in 24 hrs.)etc. and that water and
gluecose water really don't help etc. I quote
"Depending on the mother's preference and the physician's judgment however
a variety of options are available... see table 3" ....table 3 states:
1.Observe
2.Continue breastfeeding, administer phototherapy
3. Supplement BF with formula without photo therapy
4.Interrupt breastfeeding, substitute formula
5.formula, adminster photo therapy        "

My usual approach is to initiate pumping when I see very little milk
transfer at breast if mother is already feeding frequently enough and if
latch looks good and only after there is no wt gain for a few days or if
there is wt loss with increased jaundice levels even if they are not at
photo therapy levels. I feel that by giving a bit extra EBM and pumping I
may be preventing higher levels of Jaundice by increasing calories for baby
and supply of milk for mother thus, hopefully preventing readmission or the
need for formula.

Am I jumping the gun by pumping on day 4 or 5 or in this case day 6, if the
above indicators present?
More often than not doctors will suggest formula before suggesting pumping.
Neither pumping or giving espressed breastmilk is mentioned in the AAP
guidelines. I see very little discussion about giving mother's own
expressed milk, in any literature directed at physicians.

The family doctor actually really shocked me today by calling to apologize
for her inappropriate behaviour and her verbally abusive approach on the
phone to me. I accepted that and stated that I felt still somewhat
responsible for such a strong reaction so I asked her for some specifics
that may have triggered her reaction. I think what it boiled down to was
that I was having patients pump. That was totally unnatural to her way of
thinking. She felt that she was a very breastfeeding supportive Doctor. (I
didn't question her patients' frequent use of formula until milk comes in
etc. nor did I question her patients continued BF rates and duration, I bit
my tongue)I also didn't Throw any articles at her about the patients here
in Canada being in a bottle feeding culture.

 Maybe I am using the pump a bit to much? but I never suggest it if there
is even the smallest wt. gain, no jaundice, voiding and stooling is
appropriate for age and a bit of milk transfer is noted since I know that
the clinic is an artificial setting not like home at all, and that all
feedings can differ. I will just see them for wt checks more frequently. I
am afraid to show her these physician directed breastfeeding guidelines.

Does anyone have any other suggestions or do you feel that the AAP
guidelines are appropriate? Am I caving in to a fast paced, quick fix,
bottle feeding culture by artificially trying to get milk supply up quickly
so doctors have no need to push formula?

Sorry I got lengthy again.

Attie