Overcoming jaundice, nipple confusion and other interruptions in early breastfeeding relationships

If you live in the Western world, you’ve no doubt heard the catch phrases “Babies were born to be breastfed” and “Breast is Best.” Many women start out with the best of intentions for breastfeeding their new bundles of joy, but sometimes circumstances beyond their control can cause interruptions in early breastfeeding relationships. Talk of jaundice, biliruben levels and supplementing with formula are not things many parents are prepared to be confronted with just days after their child’s birth. So what should you do if you find yourself suddenly dealing with the unexpected?

After experiencing a labor and birth with my daughter that was unlike anything I had anticipated, breastfeeding seemed to be the one thing that was going in our favor. Ava came into the world as they say, born to breastfeed. Although I had a little trouble with her latch initially, with some help from a nurse we soon seemed to be well on our way. She would eagerly latch on and spend 30 to 45 minutes on each breast, nursing contentedly. Then a pediatrician (not her’s, but one in her pediatrician’s practice) told us that she was jaundice and not only did he recommend that she go under the bilirubin lights (in the form of a bili-blanket, thankfully in my hospital room), he also wanted me to supplement with formula to help flush the jaundice out of her system. Formula? But, but, but, I’m exclusively breastfeeding. We even had a note on her bassinet in the hospital saying, “I’m a breastfed baby. No artificial nipples or bottles please.” I had every intention of breastfeeding her exclusively and now it seemed that even that wouldn’t happen. Not knowing what else to do, I acquiesced and allowed my husband Jody and/or a nurse to feed her formula from a bottle, while I continued to nurse her ’round the clock. I absolutely did not want to give her a bottle myself because I wanted to avoid confusing her. I wanted Ava to know I was the one with the breasts and that those breasts were the only way she was getting nourishment from me. (Kellymom states: “If your baby is less than 3-4 weeks old, it is best to avoid the use of a bottle for a couple of reasons: regular use of a bottle instead of breastfeeding can interfere with mom’s efforts to establish a good milk supply; bottle use also increases baby’s risk of nipple confusion or flow preference.”) Little did I know that I could have given the formula to her myself actually from my breast and avoided a bottle all together had anyone at the hospital told me about something called a Supplemental Nursing System (SNS) or lactation aid. “A lactation aid consists of a container for the supplement — usually a feeding bottle with an enlarged nipple hole — and a long, thin tube leading from this container.” The tube is taped onto the woman’s breast, allowing the baby to nurse at the breast and receive expressed breast milk, formula, glucose water, etc. at the same time. So why wasn’t an SNS mentioned to me – a mother who wanted to breastfeed exclusively and obviously wanted to avoid nipple confusion that could come from introducing a bottle so early? Are other hospitals recommending SNS to breastfeeding moms?

Thankfully, Ava did not suffer from nipple confusion and took to the breast well every time (and, if you are familiar with my previous posts you know she ended up breastfeeding for a long time), but that’s not the case for everyone. Many babies who are offered a bottle before they are ready to differentiate between mom’s breast and a rubber nipple have trouble with their latch or will refuse to latch onto the breast at all.

Nell who blogs at Casual Friday Everyday gave birth to her third son Dash just two weeks ago. When her pediatrician (note: not her usual pediatrician) determined that Dash had jaundice – which was not unexpected since her other two sons had it as well – she was told he needed to go to the NICU. That news, however, came out of left field and was completely unexpected. Neither of her other kids received any special treatment for jaundice.

I almost couldn’t process what was being said. Like it wasn’t really sinking in. We walked down to the NICU with our tiny little baby – a place with a few other babies with jaundice also. They removed his clothing and began hooking him up to everything.

We set up a time that I’d be back to nurse him and my husband and I left; left our newborn baby all alone, under lights, with strangers. I cry just writing about this.

I walked back up to our floor empty handed and broken-hearted. My heart felt like it had been shattered. Like part of me was missing – well, because it was. Every single part of me wanted to run back into the NICU, grab him and run out of the hospital.

Dash also received formula from a bottle to help treat the jaundice, and Nell believes, the combination of him being taken to the NICU and use of the bottle contributed to the nipple confusion they are now trying to overcome.

This has been a particularly difficult thing for Nell because she struggled with breastfeeding issues like tongue-tie and thrush with her first two children and was determined that this time, with Dash, the breastfeeding relationship would be different.

This baby was going to be different. I was determined not to introduce a bottle to him. To avoid the nipple confusion. To nurse well into his first year, if not longer. And then unexpectedly he was put into the NICU and supplemented with a bottle. Had I been offered the option of an SNS I would have taken it in a heart beat.

Again, why wasn’t a SNS (lactation aid) offered to this breastfeeding mom? And was it really necessary for them to take a jaundice baby to the NICU?

Since leaving the hospital, Nell and Dash have also developed thrush, but she is determined to make breastfeeding work this time around and is reaching out for help.

I’m not ready to give up even though this has turned into the most difficult experience of all three.

I have reached out to the local LLL gals in my area for help. I’ve explained my problems via email and asked for a phone call. I’m going to attend the meetings for one on one help. And I’m going to try some Thrush remedies that don’t require a doctor to prescribe them.

I think Nell did one of the most important things a woman who find herself in these situations can do – reach out for help. Call another breastfeeding mom, call La Leche League, call a lactation consultant (International Board Certified Lactation Consultant). Call or email someone who can point you in the right direction of the resources and support you need to help you succeed.

Carina of Greetings from the Jet Set had a difficult time getting a good breastfeeding relationship started with her son after a fill-in pediatrician, concerned that her two-day-old son was jaundiced, recommended she supplement her nursing with an ounce of formula after each feeding. The supplementation took place via bottle, her son suffered from nipple confusion and her supply dropped a great deal. After her son’s two week appointment, she sought out a lactation consultant and was able to figure out a good latch and taught how to use a SNS. “After a few weeks of that, my supply righted itself and we went on our way.” She told me on Twitter, “I tell everyone that while they are short term WORK, they yield long term results. 1-2 wks of SNS yielded 2.5 years.” That is to say that she used the SNS for one to two weeks and, as a result of the reestablished breastfeeding relationship, she was able to nurse her son for 2 1/2 years.

Carina, a self-described lactivist, also responded to a woman’s question on Yahoo on this very topic. The woman wrote, “Doctor told me that my breast milk is increasing his jaundice level, so I was told to give him formula milk and breast milk alternatively.” She asked, “how long will I be asked to give him formula milk? When will he be switched completely to breast milk?”

Carina replied, “your doctor gave you outdated advice. It is NO LONGER advised for you to stop breastfeeding and give formula.” She then quoted several articles that support her claim. The first is from Dr. Jack Newman.

Breastmilk jaundice peaks at 10-21 days, but may last for two or three months. Breastmilk jaundice is normal. Rarely, if ever, does breastfeeding need to be discontinued even for a short time. Only very occasionally is any treatment, such as phototherapy, necessary. There is not one bit of evidence that this jaundice causes any problem at all for the baby. Breastfeeding should not be discontinued “in order to make a diagnosis”. If the baby is truly doing well on breast only, there is no reason, none, to stop breastfeeding or supplement with a lactation aid, for that matter. The notion that there is something wrong with the baby being jaundiced comes from the assumption that the formula feeding baby is the standard by which we should determine how the breastfed baby should be. This manner of thinking, almost universal amongst health professionals, truly turns logic upside down. Thus, the formula feeding baby is rarely jaundiced after the first week of life, and when he is, there is usually something wrong. Therefore, the baby with so called breastmilk jaundice is a concern and “something must be done”. However, in our experience, most exclusively breastfed babies who are perfectly healthy and gaining weight well are still jaundiced at five to six weeks of life and even later. The question, in fact, should be whether or not it is normal not to be jaundiced and is this absence of jaundice something we should worry about? Do not stop breastfeeding for “breastmilk” jaundice.

According to Breastfeeding Basics:

In most cases, jaundice is a normal, possibly even beneficial process that can be managed without interrupting breastfeeding. The treatment for physiologic jaundice is more breastfeeding rather than less, and sick babies with pathologic jaundice need breastmilk even more than healthy babies. Even in rare cases where the jaundice is caused by the breastfeeding, there is no reason to wean and every reason to continue giving your baby the best possible nourishment – mother’s milk. In most cases, jaundice is a normal, possibly even beneficial process that can be managed without interrupting breastfeeding. The treatment for physiologic jaundice is more breastfeeding rather than less, and sick babies with pathologic jaundice need breastmilk even more than healthy babies. Even in rare cases where the jaundice is caused by the breastfeeding, there is no reason to wean and every reason to continue giving your baby the best possible nourishment – mother’s milk.

According to a La Leche League article:

In an article in the November 1990 issue of BREASTFEEDING ABSTRACTS, Kathi Kemper, MD, MPH, suggests that prolonged hospitalization, phototherapy, and the interruption of breastfeeding may be unnecessary and even harmful for the mother and for the infant with normal neonatal jaundice. She writes, “In the case of healthy term infants who are jaundiced, the treatment could be worse than the disease.”

So what is going on here? Why are hospitals treating jaundice this way if it’s a “normal, possibly even beneficial process?” Is the real problem that pediatricians attitudes about breastfeeding are deteriorating?

I think educating one’s self is always a good thing. Of course, it’s impossible to prepare for every possible scenario, but if a woman knows in advance that breastfeeding jaundice is a normal occurrence and isn’t always a cause for concern, then perhaps she can make better informed choices with regard to her child’s care. If she and her doctor decide that supplementation is necessary, then knowing about a SNS/lactation aid and asking for the help of a lactation consultant could be invaluable. And then, if a woman finds herself in a situation where, for whatever reason, she has trouble with breastfeeding, knowing where to look for help at the first sign of trouble is key. It’s also helpful for family and friends to know what to do (and not to do) to support a breastfeeding mother.

Lastly, there’s an eye-opening article that ties into this topic nicely on Today’s Parent called “Nursing Confidential: Breastfeeding can be one of the biggest challenges of new motherhood. Now 7,000 Today’s Parent readers tell us why.”

What was your early breastfeeding relationship like? Did you have to overcome any obstacles? How did you do it?

Cross-posted on BlogHer

32 thoughts on “Overcoming jaundice, nipple confusion and other interruptions in early breastfeeding relationships”

  1. In our NICU, we don’t really believe in nipple confusion. While it sometimes seems that a baby going from breast to bottle in the early days might get confused by the change, what is really happening is that they are getting frustrated. They are used to instant gratification from a bottle, and when we switch them to breast, it’s not as quick/instant of a flow, especially if the milk has not come in yet, and it frustrates them to have to work harder for it. However, we have micropreemies who never breastfeed in their early weeks/months of life who go home breastfeeding. We always reassure our moms that just because their babies get bottles first, there is no reason to think that they won’t be able to breastfeed, and most often, that’s true. Therefore, I am not a big believer in nipple confusion…it’s not the nipple, rather it’s the entire feeding experience that is different, and the baby just has to get used to it.

    As for jaundice, when a baby is jaundiced, one of the best ways to flush the excess bilirubin out of the baby’s system is to place it under the lights and hope for lots of bowel movements. Breast milk is a natural laxative, so if a mom has a good supply and her milk has come in, the breast milk will do a much better job of flushing out the jaundice. However, if the mom is not yet producing much milk, and the baby is not having bowel movements, I can see someone recommending formula…we just don’t that often. The problem with jaundice is that if you let bilirubin levels get too high without managing them, the baby can get severe, irreversible brain damage from a condition known as kernicterus. Kernicterus has been on a mini-rise in America, which is why hospitals are so militant about checking bilirubin levels and making sure we manage newborn jaundice properly.

    I know this is not the popular pro-BF, pro-AP stance on things, and while I am very much in favor of both of those things, I do wanted to give you the reasons why I, as a NICU nurse, manage the care of newborns the way I do. Hope this is informative and not too annoying!

  2. I myself, was disgusted with both my boys how formula was pushed upon us. Our firstborn was severely tongue tied, unfortunatey no one caught this until he was 11 mos old and long since quit nursing. However, we knew with our 2nd that TT was an option so we had him checked TWICE!! 🙂 No TT and yet STILL they pushed formula on us in the hospital..not bc of jaundice but bc I wasnt “nursing long enough to give him enough milk”. (Um hello its colostrum at first..ain’t much IN there!)
    We did supplement after each feeding, thankfully with the help of the SNS, and he did avoid nipple confusion. Very happily around 5 weeks i realized…Hey he hasnt had a bottle in a week!! 🙂 BFing, like many things, TAKES PRACTICE. If hospitals, docs, etc spent as much time helping women nurse as they did trying to drug em up and get em out…more women could bf.

    I proudly bf my son til he was 11 mos. (I intended to go longer but a medical scare resulting in me being on meds and out of commission for a week dried up my milk sooner than expected–thankfully I am fine now!).

    And guess what.the ENTIRE time he nursed—He only nursed 5 minutes each side!! I called him my little frat boy kegger! 🙂 So they’re bull about him not nursing long enough–that was just how he was!!

    Lesson learned—TRUST YOUR OWN BODY! They’re YOUR breasts, YOUR baby, and YOUR decision! Don’t let ANYONE force you into anything!! 🙂

    Ok soapbox done now!

    Side note: if you like handmade, please help us save it!

  3. Mu little babe was jaundiced- it peaked about day 5 of her life. This actually initiated my first time nursing in public- I went out to the parking lot of our apartment complex and nursed my babe in the sun for a few minutes- less than 10 because I didn’t want her to be sunburned. That way she could get the benefits of the light. Within a few days, the jaundice was gone.

  4. I didn’t have issues with jaundice, but my sister did. She took her baby out in the Colorado sun, and he was fine in a few days. She didn’t give him formula – I’m not sure what her Doctor was telling her. Maybe she had one smart enough to take a “wait and see and try this first” approach. Love that 🙂

    I wonder. Doctors are scientific people who are interested in stats and figures and outcomes and all that. Sometimes they don’t think about the totality of the mothering experience. They like neat little things they can control like bottles and ounces and such. Breasts don’t have lines on the outside. 🙂

    I would hate to think that some of this advice from Doctors comes from their wanting to protect their paychecks. Breastfed babies just don’t get in their offices much.

  5. Thank you for this post, it reminds me of how lucky I was. Our daughter developed jaundice on our second day in the hospital and had to be put under bilirubin lights for 30 hours straight. (My mother helped me look on the bright side by calling it Cancun.) I felt like such a failure. I couldn’t understand why my milk hadn’t come in. Why couldn’t I nourish my daughter?

    Then, a shining light. Our hospital (we’re in Canada) supplied a lactation specialist who informed us of our options, basically SNS. We started our daughter on SNS immediately, and she ate, and ate, and ate. And I pumped and pumped and pumped. And we worked together to help my milk come in.

    After 5 days in the hospital, we were sent home with bottle of formula, SNS tubes and lots of numbers to contact for help. And after six hours at home my milk came in. (Whoa nelly did it come in!) And now at 1 year+ we both still truly enjoy breastfeeding.

  6. In reply to Mary’s comment I’d like to say a couple of things.

    1. Whether or not someone wants to call it nipple confusion or because the baby is frustrated with how slow the milk comes from the breast the fact is unless the baby is supplemented from a bottle nipple the Mom and baby likely won’t suffer from the problem. I noticed a huge difference in how he ate and latched onto the breast from before the bottles were introduced and after. I think it’s pretty sad that nurses wouldn’t offer a SNS to all breastfeeding mothers as an option and for those mothers to be told why using one would be beneficial to the breastfeeding relationship.

    2. Jaundice can be a health risk I do know this. I also know that taking my child away from me and putting him into the NICU was totally unnecessary. How do I know this? Because even our PED admitted that had she sent us home the day before she would have simply sent us with a lighted blanket to use with him. But because we were going to be there another several hours she thought she might as well send him down. She took our baby away from us, put us and the baby through hell and created a whole new set of breastfeeding problems I didn’t need just because she thought “oh, well they’ll be here so I might as well”. We ended up switching to another PED, saw him a couple days later, told him our story and his response was that he wouldn’t have done that and if his Jaundice didn’t get better with sun and feeding often he’d send us with a blanket. Which we ended up needing a few days later because there wasn’t much sun out that week. He was on the blanket at home with Mommy and Daddy for two days and got the clean bill of health.

    I’ll tell you, the one thing I know without a shadow of a doubt is that if we ever get pregnant again we won’t be going to the hospital for the birth and we’ll make sure our PED has the same “plan of attack” for the Jaundice as we do. There were too many unnecessary interventions in the hospital and not enough support for the breastfeeding part of motherhood.

  7. I think there may be a few key points about jaundice getting confused in this discussion.

    I have had 3 kids born with severe jaundice–and nursed all 3.

    1. Not every baby’s jaundice responds to sitting in the sunshine. Babies who hit high bilirubin ranges in the first 48 hours after birth need stronger treatment from phototherapy. For them, the sunshine tip is laughable.

    The small but real risk? Irreversible brain damage.

    2. Breastmilk does not cause IMMEDIATE jaundice and should not be subsituted with formula. True breastmilk jaundice does not set in until 2-3 weeks after birth. Otherwise, high bilirubin levels immediately after birth point to a different cause (ABO incompatibility, bruising during birth etc.)

    3. Poop and pee eliminate the bilirubin from the baby’s system. The reason many doctors ask new moms to supplement is not because there is anything wrong with the breastmilk, but because higher levels of fluid will eliminate the bilirubin faster than, say, a new mom’s colostrum output. Also, feeding from a bottle keeps the baby under the lights longer than an extended nursing session.

    I have done both in-home and in-hospital phototherapy with mine. The home bili-blanket is much easier to nurse with than the limited time you can remove a baby from the hospital bili-lights.

  8. My pediatrician came up with the idea to use the SNS feeder when my son had lost too much of his birth weight before discharge.

    I was a first time mom and I had my heart set on breast feeding, but what no one mentioned to me was that following a c-section my milk would come in slower than someone who had not had a c-section. When a nurse came into my room at 2 in the morning and announced my newborn had lost too much weight in the last 2 days, and that he should be given a bottle of formula immediately, I broke down. Maybe the nurse was more tactful, but it was 2 in the morning and I was post-partum, tired etc and it seemed like the end of the world and I thought she was evil. I refused the formula and waited for my pediatrician to make his rounds the next day. By the time the pediatrician got to my room the following morning, I had worked myself up in to quite a state. He suggested the SNS feeder after watching me cry through his explanation of losing too much weight etc. The lactation specialist showed me how to use one. It was messy, difficult and I hated it. It would take my Mom or husband and myself to use it and get my son to latch on properly. I also started using a pump after nursing to encourage the milk to come in faster. We used the SNS feeder for 24 hours. My son and I had a fabulous nursing relationship until he was 22 months.
    I will always be greatful to my pediatrican and small hospital for giving me the tools to develop that relationship. So yes there are places out there that offer the SNS feeder.

  9. Mary – I appreciate you sharing your experiences as a NICU nurse. I do find it informative and definitely “not annoying” to have information from the medical profession.
    I agree that jaundice can be a serious thing for *some* babies and I think it should be monitored, but I don’t think carting an otherwise healthy baby off to the NICU (as was done in Nell’s baby’s case) was necessary. Why couldn’t he have gone under the lights in her room with her?
    I also think formula has it’s place and it’s benefits, but it seems like some doctors are using it as a one size fits all “cure” for jaundice. If formula supplementation is necessary, that’s one thing, but why can’t an SNS (and instruction on how to use it from an IBCLC) be offered to every breastfeeding mom? I think that should be standard protocol. The government wants to raise the breastfeeding rate in our country, but if the places where most babies are being born aren’t on board with supporting breastfeeding moms, how is that ever going to happen? As the saying goes, it takes a village.
    Also, I think whether you blame it on the nipple or the bottle, it’s a po-tA-to, po-tah-to thing. The end result is the same. Babies are unsure how to nurse from the breast, and while in some cases (like in preemies) this is going to happen because a baby too small can’t latch on yet, it could be avoided in cases like Nell’s and Carina’s and mine.

  10. I guess I was lucky. When my oldest was born he would not latch to save my life. Nothing I did worked, we had a lot of things going against us. I quickly developed double mastitis and he became jaundice. I was never pressured to give him formula at the time. What did happen was a lactation consultant told me to give up. She was horrid on the phone when I called in crying and told her what was going on. This made me angry and even more determined to make it work. I pumped my milk and fed my son that way for at least 2-3 months. After that he eventually learned to latch with a shield and then without one.

    My youngest started much the same way. This time I was ready to do whatever it took to work. I pumped in the hospital to ward off mastitis and within 6 weeks he was nursing like a pro and still is at 20 months.

  11. Thanks for this post. My first child was premature, and supplemented with a bottle of formula before I even had a chance to breastfeed. We struggled through months of nipple confusion. Although I went on to nurse her for almost 3 years, the tough start took its toll. I agree that more alternatives ought to be offered, instead of automatically sticking an artificial nipple in a (very young) baby’s mouth.

    In the NICU, I had nurses tell me that there was no such thing as nipple confusion. That frustrated me, and made things that much harder. At a time that I was struggling the last thing I needed to hear was that the problem wasn’t ‘real’.

  12. I haven’t had experience with jaundice, but with my second I had experience with an unnecessary initial separation in the hospital. I had to go into the OR after the (vaginal) birth. Before I went in, I was feeding my baby and the delivery nurse wanted to take him from me because she had to weigh him! She threatened to tell the midwife I wasn’t letting her do HER job. Good thing I had an epidural because otherwise I cannot vouch for what I would have done in that hormonal state.

    I pushed back, told her to go ahead and “tattle,” and won that battle.

    Then, after my minor surgery, I wanted to go to him or have him brought to me while I recovered. Recovery had no problem with this but the Nursery did not want to bring him to me until I was settled into maternity.

    First they lied and said he was under the lights (he wasn’t) and then said they didn’t have the staff to send someone 100 feet to recovery.

    Because he was so big, they were worried about his blood sugar and were pressuring me to allow them to formula feed and YET they wouldn’t bring my perfectly healthy baby to me and told my husband that he’d be arrested if he tried to bring the baby to me to eat.

    A kind OR recovery nurse took pity on me and allowed me to fake movement in my legs so I could get up to maternity, get my baby, and feed him!

    Of course as soon as I fed him, his blood sugar was FINE.

    My point is that I knew about the issue ahead of time because my friend also had recently birthed a big baby and was able to research in advance. This way when they started pressuring me, I felt secure in asking the right questions and sticking to what I felt was best.

    That’s why your posts are so wonderful. Some mama will read this and be able to reach an educated, informed decision because she was armed with this knowledge.

    My lengthy comment was somewhat off topic, sorry–but great article as always.

  13. I was surprised I had a bit of a rough start with breastfeeding my son. Even though he was born at a free-standing birthcenter with a midwife attending and therefore no epidural or other drugs to make him sleepy, he did not latch on right after birth, nor for the five hours we were at the birth center before going home. Over the next day he tore up my nipples trying to latch but he couldn’t get it and I was getting worried. I called a wonderful IBCLC and she came over and helped us. It was the best money I ever spent. We have a wonderful BFing relationship still, at 22+ months.

    It’s interesting you wrote about this as I am in the process of writing “my breastfeeding journey” for my blog in the near future. I just wanted to write about everything I experienced for these past 22+ months. It definitely is an amazingly wonderful experience filled with all the emotions you can imagine!

  14. We introduced the bottle to my son at 3 weeks. He took to it fine, and we needed him to drink from a bottle because I would be going back to work PT.

    With my daughter, I was so exhausted I had a hard time pumping enough to put in a bottle, so we didn’t even try it with her until she was closer to 6 weeks. It was too late and she never did take well to the bottle. It made it very difficult for me to work.

  15. I had a difficult time breast feeding my son as well. He was a planned c-section due to being breech and low levels of amniotic fluids. I believe that having the c-section was a reason for my low milk supply in the beginning, and why I didn’t have enough to feed him in the early days. I was not told about the SNS system, and would have loved to try it. I was adamant about exclusively BF in the hospital (I was there 4 days due to the c-section), but was told that my baby was “hungry” and that’s why he cried, and that due to his jaundice (which was not as bad as I was led to believe) I needed to give him a bottle. As a first time mom, I was scared and just overwhelmed by all the conflicting advice and number of nurses trying to show me the “right” way to do things. I ended up saying I would feed him some formula, but I wanted to feed it to him myself and I wanted to wait until after I had talked to the hospital’s lactation expert. Instead, the nurse took my son away and fed him a bottle and I was in tears because I had said very strongly that I wanted to wait and I wanted to feed it to him myself if he needed to be supplemented. The lactation expert was also very angry because I had wanted to wait for her opinion, but the nurse had overridden my desires and fed him anyway.

    I think what I learned is that you must be EXTREMELY clear and forceful about your wishes, especially with the nurses, and to not let them push you into something you don’t want. Talk to the right people and be informed before giving in. And have someone with you (husband, mom, etc) to help you with it because you’re so tired and overwhelmed from the birth that you may not be thinking clearly.

    I ended up supplementing my son for the first 5 weeks of his life a few times each day as I pumped and pumped and pumped to increase my milk supply. It was hard as could be, but eventually he was down to 1 supplemental bottle and then none and we got to exclusive breastfeeding up until he started solids. I now use a little formula to mix into his cereals.

    Breastfeeding is hard, hard, hard. But I felt it was best and I stuck with it and have been told by many people that I should be proud of myself, as many other women would have given up and given into the bottle. And I am proud of myself for it.

  16. Thanks, Amy, it was great to be a part of an article that I hope will inform and help other mothers.

    As a follow-up, when I had my second baby he, too, developed a case of jaundice. He wasn’t as bad as my first (who had been a little early) and I didn’t even want to take him to get his blood drawn for the tests. I took him once and then refused to take him again, telling my husband that if HE wanted to take the baby because HE thought the test was important, then HE could do it.

    When my husband called our Ped office to talk about the jaundice, the nurse AGAIN suggested we supplement with formula. As soon as my husband, who was still on the line with the nurse, told me what she suggested I started to YELL SWEAR WORDS at the top of my voice.



    They are STILL using formula as the first resort? I was beyond furious, and my husband had to talk me down from screaming at the nurse on the phone. I was able to discuss the situation nicely on the phone one I calmed down. She justified it as “Well some parents just find that to be the easiest way.” Easiest way? EASIEST WAY? That easy way put us under three weeks of Hell. That easy way robs the baby of the benefits of a virgin gut, and may catalyze their system to be forever sensitive to cow proteins and more serious allergies. By all means…”easy.”

    *breath in and out*

    As marvelous as some health care practitioners can be, there are also a subset that continue to undermine breastfeeding in every possible way. Just read Kristina’s story, that’s UNACCEPTABLE and borderline malpractice.

    Let me say this in a nice way: it makes me angry.

    To finish the story, I took my son outside, I nursed him around the clock, and within a couple days his bili levels were normal. I’ve come to a school of thought that believes that if most breastfed babies get jaundice, there must be a physiological component that we don’t yet understand and we may be preventing normal biological behaviors through abnormal interventions.

  17. I’m so glad to read all this great information before I’m ready to have children. I know that this will all be so helpful when I am ready and will save me so much trouble.

  18. This is such a wonderful post!! Owen had jaundice but I was just told (luckily) to breastfeed as much as possible by my midwife & dr.

    I had problems with both kids at the beginning. when my milk came in i became extremely engorged and my nipples basically disappeared making it impossible for them to latch on. i was able to use nipple shields (i think that is what they are called) both times and they worked great.

    self education is so important in breatfeeding and not relying on what dr’s tell you and that is sad!! i really wish they would keep up on new information!

    i had a friend who was told to give her baby formula when she had the flu because she would pass it to her baby. so sad!!

  19. Personally, I think jaundice is being made WAY too much of these days. I had my oldest 15 years ago, and as recently as that, everyone I asked about her jaundice said to just put her in the sunlight, which I did, which cleared her up in no time. While extremely bad jaundice can cause brain damage, how many of you (who don’t work in NICU, where you see the worst cases every day) have ever met a mom or baby who was brain-damaged by jaundice? The thing is, for most babies, it’s not that big of a deal, but everyone is making it out to be one.

    But what about those babies who have severe jaundice? There are symptoms of that! You would know if your child’s jaundice is so severe as to require medical attention. There is absolutely NO REASON to separate a baby from its mother with no other indication than slightly yellow skin.

    And regarding the formula supplementation, again, there is NO REASON to supplement with formula. As one of the PPs mentioned, the theory is that formula is liquid, and liquid is good to make a baby pee and poo. The problem is when that liquid is largely composed of cow’s milk. Cow’s milk is constipating. And as a PP mentioned, breast milk has natural laxative properties, while also being composed of 85-90% water. How can one improve on nature’s design? And while breast milk can take a few days to come in, the average case of jaundice is not going to kill a baby within one or two days, so there’s no need to give formula, because it’s not like there won’t be any breast milk for another month. (and incidentally, the more baby nurses, the faster milk will come in. So by supplementing, you are actually encouraging the delay of the milk.) But even so, colostrum also has laxative properties, and should serve well until the milk comes in.

    This topic makes me angry, because the incidence of “jaundice panic” seems to have multiplied incredibly just in the last 5 years. Literally MILLIONS of women are being turned away from breastfeeding based on scare tactics, outdated information, and pressure from the medical establishment.

  20. I think we have to look at what passes for normal birth before we can call any jaundice normal. (Birth trauma, early cord clamping…) I also think heading towards more physiological births will reduce a lot of breastfeeding initiation problems. I’m a big fan of LLL leaders and IBCLCs, but if you’re looking for structural solutions, don’t start there… or at least don’t stop there!

    Now the SNS isn’t for everyone – it can be frustrating for a mom to deal with on top of everything else that’s overwhelming her – new baby, pumping, formula choices and preparation. I don’t even think it necessarily has to be the first line of defense for supplementation. It really depends on why the mom and baby are having trouble and what feeding method is going to work best for mom and baby. Bottlefeeding *can* be done in a way that helps protect and promote breastfeeding – problem is most parents don’t know how to do that, and most HCPs don’t know paced bottlefeeding or how to teach it to new parents. It would be great, though, if SNS were presented as an option more widely, and someone knowledgeable could help families decide what method they’ll use to supplement breastfeeding if needed.

  21. Two of my three were jaundiced, there was never any stress about measuring levels or lit blankets or formula, I was told to expose them to sunlight and to nurse as much as possible. Both girls were watched by the docs to see that it didn’t worsen, and it didn’t. This was the norm at BC Women’s Hospital as of the last few years, unless it’s recently changed.

  22. i could’ve written your post!!! my daughter was also jaundiced and according to the pediatrician, it was breastmilk jaundice. she was put on formula for 24 hours and that’s when our breastfeeding problems began. i started to get low supply, she had nipple confusion. so we ended up mixed feeding for a month. we went back to exclusive breastfeeding when she was 7 weeks and we’re still at it at 14 months 🙂

  23. New reader here, had to comment about this fabulous post. My first, a boy, and I started off BFing well…until I went in for surgery when he was 8 weeks old. I had delayed it as long as I could, for fear of nipple confusion. Happened anyways :/ I worked hard to get back back to breast, and am darn proud of doing it to! He nursed until he decided he’d had enough when I was pregnant with his sister a year and a half later 🙂 I’ve now got another 9 months of nursing his little sister and am still going strong. Best part is, both my kids have a healthy disdain for artificial nipples!
    Can’t wait to keep reading!

  24. It BREAKS my heart to hear of women not adequately supported and encouraged to breastfeed.

    Early breastfeeding is HARD – esp if it is a first baby. A mother needs TONS of support and help to make it through those difficult moments and to help solve the problems with breastfeeding as a priority.

    If I hadn’t been so beyond determined to BF, I would have given up. Thankfully, I pushed through and breastfed both babies until 16mths.

    Susan’s first baby Julia was jaundiced and she was told to supplement. Fortunately she was able to finally get past the nipple confusion and get Julia to nurse. Susan also had to take meds to increase her milk supply at first too. Julia successfully nursed until she was two and a half and Susan was in her third trimester with her second baby.

    GREAT post!

  25. Tim had jaundice quite bad – he almost had to go under the lights but thanks to the lactation aid his numbers came down, my milk came in and we were sweet. The hospital I was at is pro-bfing so they try and do all they can to help mothers achieve it.

    I agree – I can’t understand why it’s not offered more frequently. It’s a pain to use and I needed the nurse’s help each feed but it was only for a short time. Once my milk came in I had enough for Africa and so we retired the SNS.

    I don’t recall anything being said about it in ante-natal classes either which is a shame.

  26. Imagine my dismay when I was encouraged to switch from breast-milk to formula by the APN we regularly saw at the pediatrician’s office who was also the lactation consultant! I was very determined to breast feed and continued to do so even after big complications the first week of my daughter’s life. I continued after returning for work and did so until my daughter was about 5 months old. At that time, the APN decided she was not gaining enough weight (she’d gone from the 65th percentile at birth to the 30th) and encouraged me to switch to formula. I was so completely overcome with emotion at the mere suggestion that my baby was constantly hungry and not getting enough to eat that, of course, I made the switch. Although work life is more simple minus pumping and I certainly have more freedom to come and go, I still wish I could have breast-fed her for a year. And now I know better than to take everything a pediatrician (or our APN) says as gospel. I’m much more skeptical about everything they say now, honestly.

    All that to say, great post! We could never, ever educate each other enough about breast-feeding, the challenges it brings, and the importance of continuing.

  27. I have to say that this post had me torn. On the one hand I believe that hospitals and pediatricians should do everything possible to support a breastfeeding mother, including supply an SNS and offer options to continue breastfeeding in a case of jaundice. On the other hand, I was frustrated by yet another instance of turning the breast vs bottle controversy into “breastmilk” vs “formula.” I understand that in the case of most mothers who were referenced or who posted that formula was suggested to assist with the jaundice. It would be nice though to point out that if for some reason your baby does not breastfeed, this does not mean that he/she cannot get all the benefits.

    My daughter was born 6 weeks early and at 3.5lbs was physically incapable of breastfeeding or bottlefeeding. She was primarily tube-fed for 2 weeks while the nurses, her dad and I worked with her to learn to drink from either bottle or breast. But here’s the important part- she was tube-fed and bottle-fed my breastmilk and took exclusively my breastmilk for the first 5 months of her life until we began introducing solids as well. From the day she was born, I was pumping like a maniac to stimulate my milk supply and provide her with all the milk she could take. I was dead-set on breastfeeding from day 1 of my pregnancy but for our tiny little baby, it was not in the cards. So I pumped around the clock and I don’t feel that she suffered because the milk didn’t go into her mouth straight from my nipple. In order for her to come home with us she needed to be able to feed from either breast, bottle or a combination and bottle-feeding is much easier for smaller babies to master. We continued to work on breastfeeding but because of the bottle it was very difficult. Going on a feeding strike until she decided to nurse was not an option as she was already so tiny and gaining weight was much more important.

    Mothers need to feel like they are not failures if they cannot breastfeed. They also should know that pumping is a completely valid and worthy option in that situation. The baby gets all the benefits of exclusive breastmilk and it is not hard to keep up a good supply if you pump as often as you would breastfeed. It is an extra step and definitely wasn’t my first choice but I was glad that my doctors suggested that option so I didn’t assume that not breastfeeding meant going straight to formula. I hope to breastfeed any babies I have in the future but I’m also glad to know that if I can’t, they can still get the benefits of exclusive breastmilk.

  28. Sometimes, all those things STILL don’t work out. My son was jaundiced. I tried breastfeeding and it wasn’t going well. We did the SNS, I saw no less than three lactation consultants. I read every BF book I could get my hands on…scoured the internet…talked to other BF moms. But my milk never came in. Nobody can tell me why…but I’ve had two kids, and never made any milk. I was devastated when I couldn’t BF, as I always believed all the women who say that any woman can do it, as long as she perseveres through. But that’s not always the case.

  29. Amy,

    Thanks for this post. It was so timely for our family. We just had our 4th and he was jaundiced. I was really reassured both by my doctor and by your post. The doctor just encouraged me to nurse, nurse, nurse and get a lot of fluids. He gave the baby tests for the Bilirubin levels, but we did not even need the lights or anything. We never had to return to the hospital and just treated it at home. My milk is in now and all is well!


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