The most daunting part of raising a newborn as a first-time mom is probably breastfeeding. Diapering, bathing and all the other tasks can be performed by another caretaker but not breastfeeding. And given how pro-breastfeeding almost everyone is these days, there is a lot of pressure to try very hard at it.
I did my research, and attended classes. It seemed that the key was getting a good latch – the baby will feed well and your nipples won’t be sore and cracked. One should expect to get mastitis at least once. You may have supply issues, but keep working at it. If you’re engorged, use cold cabbage leaves to relieve the pain.
When my baby first arrived in my arms, she latched on perfectly and suckled for an hour. Lucky me, I thought. It turned out that there were still challenges to be met. This is the first of a series of stories about my breastfeeding challenges.
Sleepy baby, breastfeeding jaundice?
After the first 24 hours, the baby will start to get sleepier. This is normal, and you can keep the baby awake during feeding by undressing her so that she gets cold, or constantly touching her to keep her awake. Neither of these, or the other techniques suggested (I didn’t use the ice cube method), worked on my baby. I wasn’t too worried though – she was too sleepy to feed in the afternoon, but she did wake up sufficiently to feed for about 15 min the rest of the day. Surely that was sufficient? Besides, her stomach is the size of a cherry, or a walnut, and I’m just producing colostrum.
This was when I got introduced to a new concept untouched by most resources: breastfeeding jaundice. Did you know that more breastfed babies get jaundice than formula-fed babies? I didn’t.
There are two types of breastfeeding-related jaundice: breastmilk jaundice, which is caused by components of breastmilk, and breastfeeding jaundice, which is due to insufficient feeding since the milk doesn’t come in until 3-5 days after birth. The yellow of jaundice is caused by a substance called bilirubin, and to excrete it, the baby needs to either pee or poo it out. The breastfed baby is consuming way less than her formula-fed cousin, who is getting 2oz every 3 hours from day 1, so there are fewer opportunities to get the bilirubin out.
My baby’s bilirubin levels were relatively high on day 2, but she didn’t require treatment. We had to follow up with a check 2 days later to make sure that her levels stayed low, but they thought it would be fine. The nurses didn’t warn me about breastfeeding jaundice.
At the day 4 check up, her levels were borderline for phototherapy – we should probably admit her. We discussed her feeding with the pediatrician, and she thought that my baby was not consuming enough, and thus not peeing enough. One issue with jaundice is that it causes babies to become sleepy. Double whammy for the sleepy newborn.
The pediatrician gave us one more day to try feeding the baby properly, especially during the sleepy afternoon feeds. Since I didn’t have an issue with milk supply, she suggested expressing the breastmilk and feeding the baby after we try feeding her in the afternoons. Bottle, syringe, spoon, whatever: just get the milk into the baby. She also thought the 10-15 min feeding we were able to achieve was insufficient for our baby.
I knew that jaundice is not a major issue, easy to treat, but to admit my daughter into phototherapy felt like it would be admitting that I was an insufficient parent. That day, I pumped and fed my baby 1 oz of milk during that small window of 2 min that she was awake for in the afternoon (we completely skipped trying to breastfeed first), and religiously woke her up every 2 hours for feeding, even at night. I was thankful that we bought a lot of stuff early on just in case, so we didn’t need to shop on the way home – a steam sterilizer, a manual Medela pump (much cheaper, and it was really for just in case), Dr Brown feeding bottles, all in boxes waiting to be opened for when I go back to work, but now torn open for our medical emergency. That afternoon, I finally saw a real wet pee diaper, instead of the little orange splotch of concentrated pee she used to pass out.
We went in for another check the next day, and her bilirubin levels had inched up a little more. We had to admit her for phototherapy. There wasn’t time to feed her since her levels were so high, so I had to use the pump at the hospital – it was an electric pump, which I was excited to try, a Medela Lactina, and despite being hospital grade, it actually didn’t work as well as the manual Medela pump at home. But because I was breastfeeding, I was allowed to visit her to breastfeed during the breaks between therapy sessions.
It’s been almost 4 weeks now, and our baby is still visibly yellow. She has prolonged jaundice, and I think that even with enough feeding during the early days, she probably would have needed phototherapy anyway. But back then, I was upset that I didn’t have the knowledge to prevent breastfeeding jaundice, even though it was something I could have easily done.
Pumping and learning about my milk supply
I did learn about my milk supply in the process, which has been helpful for making me a more confident breastfeeding mom. I was pumping 1-1.5 oz per boob in 10-15 min on day 5/6, which would have been sufficient milk for our baby at that point – plus she’s more efficient at extracting the milk than the pump. Even though she had the correct number of dirty and wet diapers, it was still more reassuring to see the milk in a bottle than to guess how much our baby was drinking per session. I felt like a champion milk cow.