What is Jaundice?
Jaundice describes when a baby has a high level of bilirubin in the blood. Bilirubin is a yellow pigment which is byproduct of the breakdown of red blood cells that would usually be cleared from the body by the liver(1). The trouble is that the newborn liver is not mature enough to break down such large quantities of bilirubin just yet(2), so much of it remains in the blood stream until it is processed. More than half of full-term babies have bilirubin levels which cause them to be yellow, or jaundiced, which is a normal, physiological occurrence(3). Jaundice will usually resolve within the first week to several weeks of life and normal levels peak between the 3rd and 5th day before starting to fall. Bilirubin may also benefit our babies’ bodies as they mature since they have very few antioxidants in their systems and bilirubin is an antioxidant! It is important to consider the bilirubin levels in relation to the baby’s gestational age as well as their age at the time of the test(3). While most cases of jaundice are normal, and resolve with frequent breastfeeding, there are instances of pathological jaundice which present as rapidly rising levels or high levels of bilirubin within the first day or two(2).
Three factors contribute to normal, physiologic newborn jaundice. The increased bilirubin production, increased re-absorption, and limited ability of the liver to process the large amounts of bilirubin(2). What is commonly referred to as “breast milk jaundice” does not really exist. This could be more accurately called “lack of breast milk jaundice” or “starvation jaundice” which may result from inadequate intake due either to supply being slow to expand or a poor latch(3). Although jaundice is usually physiologic, sometimes there is a pathological cause behind jaundice, especially if it occurs within the first day or two of life. One is ABO blood incompatibility and occurs when a mother is O type and her baby is either A, B, or AB blood type this may result in higher levels, but resolves like physiologic jaundice with frequent feeding and time in most cases. Additionally, any condition which may interfere with processing of bilirubin by the liver or that increases re-absorption of bilirubin by the bowel, or any condition which causes there to be additional blood cells for breakdown, such as bruising during birth(2) may result in higher levels of bilirubin. Some ethnic groups have higher physiologic bilirubin levels as well, such as Chinese, Japanese, Korean, Native American, and South American babies. Induction by synthetic oxytocin, called Pitocin, also increases instances of newborn jaundice(4).
My oldest son, Aiden, was pretty orange. he is 10 days old in the picture above. He was never lethargic or ill, just going through a normal process. Two of our three kids had ABO incompatibility. He had a good "tan" for several weeks and people regularly commented on what a nice complexion he had! "Yea, Bilirubin can do that!"
For normal jaundice the baby’s skin will appear yellow usually on the face, including the whites of the eyes and may descend down to the chest, belly, and in severe cases even down to the legs and feet(1). Generally these babies wake to feed regularly and poop normally (at least the number of poopy diapers a day as days old the baby is). If the jaundice is pathological in nature the baby will be extremely sleepy, difficult to wake, will not wake regularly for feeding1 and may not be having normal amounts and types of poopy diapers.
The goal of treatment is to prevent a condition called kernicterus which is a dangerous neurological disease that may be linked to high levels of bilirubin, although not all babies with high bilirubin will get kernicterus and not all babies with kernicterus had high bilirubin(3). More often than not, frequent breastfeeding will eventually, and physiologically, clear the bilirubin1 without interrupting breastfeeding or potentially disrupting it by introducing an unnecessary supplement. Additionally, colostrum has a laxative effect on the baby which helps with passing excess bilirubin and reducing the occurrence of jaundice(5) so breastfeeding frequently in the first days is extremely important. The doctor will base treatment options for the baby on the bilirubin level, the baby’s chronological age, gestational age, and how well the baby is feeding (ideally)(3).
If the baby’s levels are troublesome the treatments include a few options. Many physicians choose a watchful waiting approach to monitoring the baby with levels below 20mg/dL, and some will simply monitor a baby in the 20-25mg/dL range if the levels are not rising rapidly and if they appear to be reaching peak(2). At home it is important to breastfeed at least every 2 hours, and to identify and address any breastfeeding difficulties(3,2) which may be interfering with the baby getting enough breast milk. By increasing and improving breastfeeding, the baby will be prompted to poop more which will help get the bilirubin moving out of the system more quickly(2). It may also benefit the baby to be in the sunlight as UV light helps to break down bilirubin. The baby can be laid or held in front of sunny windows with the body uncovered as much as possible or, if the weather is warm enough, taking the baby out in minimal clothing.
If the baby’s levels become too high or are rising very rapidly, this is suggestive of a pathological jaundice that may require medical treatment for the jaundice and its cause. It may become necessary to use photo-therapy, special blue lights which emit UV rays similar to sunlight, to help treat the baby’s jaundice while continuing to breastfeed frequently. In some cases this photo-therapy can even be done at home(1), so you and your baby will not need to be admitted to the hospital during treatment. Sometimes the baby will need to be hospitalized for this treatment and others, but breastfeeding should continue throughout treatments. Rarely a baby may be so severely jaundiced that they require an exchange transfusion but this is unusual and unlikely(1).
Generally normal physiologic jaundice resolves in a few weeks, it is a normal process with no after effects. In extremely rare cases bilirubin levels may cause complications such as cerebral palsy, deafness, or kernicterus as discussed above. Not only are these complications extremely rare, it is also very unlikely that levels capable of causing these complications would go unnoticed and untreated.
Jaundice is usually a normal process for more than half of newborn babies which peaks between the 3rd and 5th days of life and may take a few weeks to completely resolve. Frequently breastfeeding problems can contribute to rising bilirubin levels so every effort should be made to address the breastfeeding relationship in order to bring levels down. The more the baby breastfeeds effectively, the faster levels drop. The levels at which complications occur are not fully understood, so monitoring the baby’s health while breastfeeding frequently is usually recommended. A baby with extreme or pathologic jaundice will be extremely drowsy, difficult to wake, and will not feed or poop well. The American Academy of Pediatrics does not recommend or advise supplementation with formula in most cases of jaundice and encourages continued frequent breastfeeding.
Resources and Further Reading
2. The Breastfeeding Answer Book, La Leche League International
3. Dr. Jen’s Guide to Breastfeeding, Dr. Jennifer Thomas
What is Group Beta Strep (Group B Strep, GBS)?
GBS is a bacteria that is naturally present in our body, usually in the colon and genital tract. It is carried by about 40% of adults and while not strictly considered an STD, infection due to OVER colonization increases with sexual activity. It is estimated that up to 26% of pregnant women are colonized with GBS.
What does GBS have to do with your birth?If a mother has a high colonization of GBS it is possible for the uterus and amniotic fluid to become infected. If this happens, the membranes may rupture prematurely, preterm labor may set in, and in some cases a cesarean may become necessary. Ultimately the primary concern for a GBS carrier is the possibility that her baby may become infected with GBS. About 1-2% of newborns born to untreated mothers who were positive for GBS will develop GBS disease. GBS disease is a serious respiratory illness, which for a small percentage of babies, mostly preterm babies, can result in death. In some cases GBS can contribute to infections of incisions and lacerations as well as intrauterine infections in after the baby is born. If you are a GBS positive mother in the hospital you will be “required” to receive IV antibiotics every four hours during labor to prevent transmission of GBS to your baby. You will also be advised to come to the hospital as soon as your membranes rupture or your labor starts in order to start this protocol.
If we look at the numbers for GBS disease in newborns we can put this in better perspective. About 1 or 2 in 1000 babies will develop GBS disease. Of those 1 or 2 babies only a quarter will become so ill that they will die. So 1 in 4000 babies, or about 80 babies per year in the United States, die of GBS disease. This is an extraordinarily low number. By comparison, between 4 in 10,000 and 4 and 100 women have a life-threatening allergy to penicillin, which is used during labor to eliminate GBS. Furthermore the broad use of antibiotics contributes to the development of antibiotic resistant infections, including GBS. Use of antibiotics at birth may also put babies at risk for infection by other organisms later on and disturb the development of the baby’s gut flora which it first develops by passing through the mother’s flora during birth. Exposure to antibiotics during labor and birth may compromise the baby’s immune system not only in the short term, but also for many weeks, months, and possibly years to come.
GBS Testing: When, Why, and How?GBS testing is usually done between 35 and 37 weeks. In mainstream medicine this is done for all women across the board. Some out of hospital providers, however, will only screen those who are at higher risk such as those women with recurrent or an active UTI and those who have previously tested positive for GBS.
Currently the most common way to test for GBS is to take a swab of the vagina and rectum and culture it in some kind of medium including a selective antibiotic which encourages the growth of the GBS organism and restricts the growth of other organisms. A swab can be taken at a prenatal appointment with your provider, but it is then sent to a lab to be cultured. In some practices providers will allow women to take this swab themselves in private during their appointment.
Conventional & Alternative Treatments for GBSThe CDC currently recommends not only that all pregnant women be screened but that all who test positive should be treated with IV antibiotics in labor every four hours.
Though not evaluated scientifically there are several alternative treatments.
Understanding and Reducing Risks
The babies at the highest risk for infection are:
As briefly discussed above, broad spectrum antibiotics are not without risks themselves, both short and long term, for the health of the mother and the baby. Simply put, the long term risks associated with early exposure to antibiotics are not known.
It is best to reduce the potential for vertical transmission by limiting, or avoiding all together, any procedures which bring bacteria from the lower vagina up to the uterus not only in labor, but also in pregnancy. This includes vaginal exams prenatally and in labor, sweeping of the membranes, artificial rupture of the membranes and internal monitoring during labor. Especially avoid vaginal exams once membranes have ruptured. Using upright positions may also prevent GBS infections from going into the upper vagina, cervix, and uterus.
Learn morePlease check out more information about Group Beta Strep and ask your provider to share more information, not just by word but also studies and research. The below resources are excellent for researching Group Beta Strep. Several were used to put this post together and there are many more!
**Please do NOT use chat rooms or lists, comment threads, message boards, etc for doing this type of research. You need to see credible sources, not opinions and personal experiences**
***Gentle Birth, Gentle Mothering, Sarah Buckley, MD*** This is a must read for all new families for so many reasons!
These are available for you from our Greenwood, Indiana lending library if you choose to work with us during your pregnancy.
Myles Textbook for Midwives, 15th Edition. Diane Fraser, Margaret Cooper
Understanding Diagnostic Tests in Pregnancy, 6th Edition. Anne Frye
Pregnancy, Childbirth, and the Newborn. Simkin, et al.
The Thinking Woman's Guide to a Better Birth. Henci Goer
Obstetric Myths Versus Research Realities, Henci Goer
Optimal Care in Childbirth, Henci Goer
Explore these websites for quick information right now:
In the weeks leading to birth one thing you want to pay attention to is your iron. It is needed for red blood cell production and to prevent anemia. Not only are iron demands increased in pregnancy, but it is also protective against the effects of postpartum blood loss. When we foster a solid iron base in the pregnancy, you in turn set yourself up for fewer complications after baby is born. Your care provider will probably check your iron levels around the 28 week mark. It is completely normal for you to be a little anemic at this time due to something called "hemodilution," which is literally the dilution of your blood. This is caused by the doubling of your blood volume at this point and a drop in your hemoglobin signals that the expansion is underway. Ask your care provider to check your iron again a little closer to birth so that if it’s still low you have time to bring that up some. Most providers look to keep your iron above 10.
Some things you can do to ensure healthy iron levels:
So, lets talk about Hydration and what that means for a woman with child
Near the end of your pregnancy every single cell of your amniotic fluid is replaced every three hours.....let that little fact sink in....EVERY cell, EVERY 3 hours....amazing right? By the time you are full term this adds up to about a 6 gallon a day exchange in amniotic fluid. Add to that the doubled blood volume, the increased strain on the muscles, physical activity and the weather and you start to get a clearer picture as to why hydration is so very key for the pregnant woman.
Symptoms of dehydration can range from annoying all the way down to serious. Keep an eye out for things like
Pregnant women are prone to urinary tract infections. By keeping the urine diluted with a high volume of water, you minimize the risk of contracting one. Not only that but many women suffer from edema when pregnant. Swelling that is more than normal is usually associated with elevated blood pressure. Drinking water helps flush out the sodium, thereby minimizing the swelling.
So, how much water should you be drinking? Well, women need at least2.3 liters of water daily during pregnancy and 3.1 liters daily for lactation. But this can vary due to your weight, weather and physical activity. Worry not! The internet is great. you can find some greathydration calculators that will help you determine how to set your hydration goal!!
Starting to feel like your eyeballs are floating? Finding it hard to drink that much? In the land of Cokes and Sweet tea drinking that much water can be a little daunting. Try eating foods that are high in water... Melon (all are great), Iceberg lettuce, Oranges, Apples, Cucumbers ......you get the idea. Also considerinfusing your water with yummy fruits and herbs!! Are you a soda addict? Try switching to carbonated water and flavor it with fresh fruit or flavorful herbs to get that bubbly fizz without the chemicals and sugar, which your body don't need anyway. Make hydration a priority. It's good for you, its good for you baby and it will help you avoid complications during your childbearing journey!
Pomegranate & Blueberry Bliss
What you will need:
Small box of plump blueberries
1 to 2 cups fresh pomegranate seeds
Make it into a fruit infused iced tea by adding AuthenTea Blueberry Black Tea.
In a 2- to 2 1/2-quart pitcher, combine water, Pomegranate seed and blueberries. Cover and chill at least 2 hours or up to 8 hours. Add ice cubes just before serving. Add blueberries to skewers as an added touch for each glass.