​ So, what is a healing birth? Every woman's perspective of ideal birthing is different so obviously every woman’s idea of what is healing will be different. She may know, very clearly, why she felt so traumatized and powerless during her last birth and have a clear idea about what must change for her the next time.. She may not even consciously say “this is the kind of birth that will heal my hurt.” In fact, she may not be entirely aware of her trauma until she is laboring again and the familiar sensations trigger difficult memories and emotions from past experiences. 

​I want to relate a story (with permission) of a mother who experienced a traumatic birth following an induction at 35 weeks for pre-eclampsia.  As this was her first baby and being that she was pre-term, the process was long and hard, ultimately ending in a cesarean birth. She remembers feeling totally unprepared, railroaded, powerless, and terrified.
Fast forward to her second pregnancy during which she, again, developed severe pre-eclampsia but much much earlier. At 25 weeks she was put on bedrest, first at home and then in the hospital on medications. She was bed bound for a week before her care team decided that her life and her baby’s life were at risk if she stayed pregnant any longer.  Her baby was delivered via cesarean birth at 29 weeks and 2 days weighing just 2lbs 10oz.
          The next day she told me how beautiful this birth was. She talked about how she felt so present, so in control, so safe, and so supported. She talked about how the sensations were so very different this time and that she felt she had done all she could to ensure her baby was brought as gently as possible into the world. She called her birth healing ...... and it was.
So what made the difference? Well, for her the difference was knowledge. While on bedrest she invested herself in knowing her options and communicating with her providers about her wishes. She was engaged in the decision-making from the minute she was put on bedrest to the minute her tiny baby was born. 

​It seems we are repeatedly sent messages that we must “heal” from *cesarean* birth by birthing vaginally. naturally, maybe even unassisted!! Here is a woman who did none of those things but walked away feeling empowered and healed. Was the healing in the birth or in the knowledge? Was the healing in the being heard by her care providers?

Another example, of a "healing birth" can be found in Whitney, After experiencing a very difficult pregnancy that included bed-rest and a pre-eclampsia diagnosis. She was induced early and had a very negative experience. She did not feel well-informed by her providers about her condition or options. So when she found out she was going to have another sweet baby, she began to arm herself with knowledge. She chose a CPM provider and home-birth this time. She was active in her own care. She worked through her fears and anxieties about her previous pregnancy through the course of her care. She was educated. Whitney birthed powerfully in water. She felt healed and empowered .


Two women with similar circumstances and yet two very different experiences, both walking away feeling healed.. The common thread here is not the healing births they experienced, but how they got to those births.. For both women the difference was their engagement in their care the second time around. They knew more, they felt more in control of their care, they felt like respected, active participants.

We can never guarantee an outcome or a healing birth, no matter how many books we read or how many assertions we make about our care, but we can be better prepared even if things go askew. We can shoot for the moon…our preferred birth, and if we are well informed, well supported active participants in our care, we can still land happily among the stars even if we miss our target due to circumstances beyond our control. The ticket here was to be an informed decision maker. Asking questions, doing research, setting goals and understanding that flexibility is important in birth. Sometimes when we accept and adhere to protocols and regulations without learning the why behind them, the research that may support or dismantle them, without asking questions of our providers and exploring alternatives we are not fully informed. When we are not fully informed, we may end up feeling dis-empowered, lost, afraid, or confused. We also need to be willing to say no, sometimes we need to be willing to change care providers and take a leap and change up the scenery when we are not feeling safe and trusting.

In the end, no mater your choice of birth method…be it a midwife-attended homebirth or a scheduled cesarean, the biggest thing dictating how you will feel at the end is whether you were well informed, prepared, supported, and educated. Did you prepare yourself for alternate scenarios? Do you trust your provider? Do you have good support for your pregnancy and birth? Or do you stand the chance of being blindsided by an unexpected bend in the road with a provider you are unsure of and without good emotional support to see you through whatever challenges you may face? Being plugged into your care can be critical. It can’t guarantee a healing birth and it can’t guarantee you won’t have a traumatizing one but it sure stacks the odds in your favor! As a doula it is my job to stand by and support a woman’s choices, help her find resources to educate herself if she so desires from the moment she hires me until she no longer needs my support in the postpartum. It is not my role to ensure her birth is healing or to ensure a certain outcome. No one can do those things, but I can help a woman find her way through her own circumstances to the birth that is right for her IF she takes the initiative to be in charge of her care.

So what IS a healing birth? It’s ANY birth that you feel positive and empowered by. It’s ANY birth that you felt you did your best to ensure you and your baby had the best possible outcome. It may still be disappointing if you wanted a natural vaginal birth and in the end the best decision was to get an epidural or circumstances lead to a cesarean. But if you are informed and engaged in your care, the likelihood that you will feel traumatized by a change in plans is much lower. Take the time to consider WHY you carry trauma from a previous birth or experience then consider what you could have done (if anything) to change the course. Please don’t misunderstand me here, I’m not suggesting women who are traumatized by their births are to blame, there are many factors that lead to trauma. I’m suggesting that in order to heal from it she has to understand where things went askew and what things she can do differently to try and avoid that happening again, even though the source of the trauma was not her doing in the first place. It’s like defensive driving. You can’t prevent other drivers from driving recklessly, but you can learn to look out for them and avoid them when possible. .

Now. SEEKING a healing birth is a different ball game all together. We have a post pending on this topic.
​
Recommended reading if you are seeking out good information for a positive and empowering birth:
Gentle Birth, Gentle Mothering by Dr. Sarah Buckley
The Thinking Woman’s Guide to a Better Birth by Henci Goer
Ina May’s Guide to Childbirth by Ina May Gaskin
Silent Knife: Cesarean Prevention and Vaginal Birth After Cesarean by Nancy Wainer Cohen and Lois J. Estner
​(an OLD but still VERY applicable book)
Gentle Birth Choices by Barbara Harper, R.N.

For internet research:
Evidence Based Birth
Plus-Size Pregnancy
The Well-Rounded Mama
VBAC Facts
​These sites have EXCELLENT research for women of all sizes regarding prenatal screening and much much more.

You are tired, so tired and sore. Your feet are swollen, your back aches and you're pretty sure that if you take one more step, your sweet baby may very well just fall out in front of you. If one more person offers you (well meaning) advice, suggests a day to have this baby or *tries* to be funny and you may very well end up shooting steam out of your ears. You have been pregnant for 37 long weeks, Thats long enough, right? (no). That's what you've heard. You're done. It's time to get this sweet little parasite (said with love) out into the world. Eviction notice served! So what can you do to get this party started? Turning to google..... or more likely pinterest, you search "natural induction:" inundated with lists, blogs and graphics about sex, herbs, oils, exercises and recipes. You start to feel like maybe you have some control over this! 
​
Off to the store, list in hand. It's time to get this baby out of your womb and into your arms! You get home, take a looooooong walk and meet your fella at the door with your motor running! "Come on, babe! Lets make some magic!"

Stuffing your face with larabars and jalapenos, applying your oils and trying to massage both your ankles and the webbing between your thumb and pointer at the same time prove to be exhausting. So you hop on your yoga ball for some hip circles before you take a shower and hit the sack with sure knowledge that you will be awoken at 2am in labor........

Here is the thing. It won't matter what you do. You can use Castor oil, you can hit the birth prep, but if your body is NOT READY to go into labor then none of this will work. It will simply wear you out, irritate your bowels and give you heartburn as a cherry on top. 

​Now, what do we mean by "ready?" 

• Ready means your baby is developmentally ready to greet the world, strong enough to tolerate labor and birth, mature enough to transition to life outside the womb, and able to thrive in your arms without intervention and challenge.
•  Ready means your body's hormonal cocktail is balanced in such a way that your cervix is ready to open, your uterus is ready to contract, and you will have the most efficient labor possible in your circumstances.

Natural or medical, induction is far less likely to be successful if your body is not ready. That is why it is so important to talk to your care provider about your Bishop Score when the subject of induction is brought up. The higher your score, the less likely the induction will be to end in a disappointing trip back home or an unplanned Cesarean Section

As I often say to clients, if you wear yourself out chasing this baby, you will be less likely to have the energy needed to do the work required to bring them to your arms. I know this feeling. This done, a million weeks pregnant, over it feeling and I am more than happy to listen to you vent, but before you reach for the laxative let me remind you of patience. Patience in your final weeks of pregnancy is very challenging. You've waited 9 months (longer, if conception has been a challenging journey). A few more weeks so that your baby, your body and your mind are ready and perfectly primed for an efficient labor will be well worth it. Hang in there, for your own well-being and that of your sweet baby.

Now don't get me wrong, there is some science behind these "natural induction methods" and IF your body is READY then they may work..... but then your body was ready...so it was about to happen anyway. 

Placenta encapsulation is not a black and white issue. I encourage you to research the topic at length before deciding to have your placenta encapsulated. Start here with some basic concepts, I will be adding further resources to this post in the coming weeks for you to consider. 

What is Placenta Encapsulation?
Placenta encapsulation is the process of dehydrating the placenta to be ground up, put in capsules, and taken by a new mother in the postpartum period.

What are the Potential Benefits of Placenta Encapsulation?
The placenta is thought to be rich in iron, protein, and vitamin B6 as well as an important hormone called Corticotropin-Releasing Hormone (CRH). CRH is a stress reducing hormone that exists in high levels during the third trimester, but after birth the levels are lower than normal. This may be part of the hormonal imbalance behind the baby blues experienced by 80% of women in the first few weeks postpartum. Thus, placenta encapsulation may reduce, and even prevent, the baby blues in the first two to three weeks postpartum. Some also believe that placenta encapsulation may protect against postpartum depression for some mothers, though no solid research has been done to demonstrate these effects. Placenta medicine may reduce bleeding, aid in healing following birth, and result in faster uterine involution. Taking encapsulated placenta may also help to replenish iron stores following the birth and could increase energy and feelings of wellness in the postpartum period. At the very least, women who take placenta capsules report that their postpartum healing was much quicker and their energy levels higher following the birth than it was for previous births.

What Placenta Encapsulation IS NOT
Placenta encapsulation has never been proven through research to provide the above benefits. Some research exists which has been strictly anecdotal and subjective.  We cannot guarantee either the effectiveness of encapsulation for each woman, her specific results, or any particular outcomes. Despite using excellent sanitation precautions, we also cannot guarantee that the placenta itself does not harbor potentially harmful pathogens which cannot be eliminated at any heat or by any means. 
Placenta encapsulation is NOT a cure all. It is our philosophy at Family Way Birth & Baby, LLC that women need support and encouragement in the postpartum period in order to feel their best as new mothers. Encapsulation may offer some additional biochemical support, but it likely is not a cure for underlying psychological disorders which may be unmasked during the first days and weeks, sometimes months, after a baby is born.

Is there any reason a placenta cannot be encapsulated?
Yes. If you have had a fever during your labor (not associated with epidural use, which causes an elevation in maternal temperature) it is possible you have an infection. In this case we are unable to encapsulate the placenta as it may make you ill. If you have a known case of chorioamnionitis, if the placenta looks diseased in any way or has an unusual, foul smell, we cannot encapsulate it.  If your placenta arrives and I have concerns about encapsulating it, I will refund your deposit and return the placenta to you so that it may be disposed of in a way that you see fit. 

What if I Haven’t Contacted You Before the Birth?
No big deal, just make sure you've refrigerated the placenta, call me, and I will do my best to come to you as soon as possible. Understand that because I am not “on call” for your placenta previously, I may not be able to get to you as quickly.

Regarding Freshness…
The process of encapsulating a fresh placenta should be started within 72 hours after the birth, so you should contact me as soon as you are able to following your birth to make arrangements to begin the encapsulation. If you are not able to get the fresh placenta to me within 72 hours, be sure to freeze it right away so that it does not spoil. If you do this, be sure to use double-zip freezer bags, the gallon size, and remove all the excess air. It should be frozen within about an hour of its birth if possible, but at least kept in the fridge until it is frozen, no later than 72 hours after birth 

Music, this is something that I have had a number of clients ask me about. Do I know of a good birth playlist? What are some songs I would suggest for birth? 
Lets be honest. We (you and I) are some pretty cool people but the music that moves us may not be on the same groove. With that in mind I wanted to think about what *I* would put on a birth playlist.  Something more than Erykah badu(doula) and Salt-n-Pepas "Push it". Don't get me wrong, I am more than sure you would see some Badula on my list but what else? Would I make it clever?  Hurts so good, Under Pressure, Comfortably Numb, and the ever prevalent Ring of fire?,  
All great songs but I can hardly expect the right song to be playing at the right moment. I think your playlist just needs to be something that makes you feel. Something that makes you want to close your eyes and move. or that helps you relax, step into yourself and sink into the sensation. Something that takes you back,  Maybe something that means a great deal to you.
You can listen to it throughout your pregnancy or maybe just at night when you are naturally entering a relaxed state. Training yourself. So that when you go into labor you can hit play and be taken to that peaceful place. Or maybe it will inspire you to start your sway (get your doula hula on!).
Its less about theme and more about preference. You dont have to set your music to your birth. Your life already has a soundtrack, just keep playing it. 
So, here it is. There is nothing all that birthy about it except that most of these songs have a base line that makes me feel heavy and connected. Thats it. Thats all that makes them birthy. The words don't really lend themselves to birth. I just dig them. Done. 
You can do like I did and hop on Soundcloud and make a playlist, plug your ipod in and hit shuffle or maybe just pick a station on pandora and start your groove. What are some songs that move you? Have you got anything smooth, mellow and deep to add to my list? Let me know, I would love to add it! 

Four and a half years ago I attended a birth that affirmed, to me, why mothers who CHOOSE epidurals should still consider hiring a doula. Mama was 42 weeks and consented to an induction for being "overdue." She was hoping to still go pain medication free. I supported her and her husband as she worked hard for several hours before reaching a breaking point emotionally and asking for an epidural. When her epidural was placed, it only worked on one side of her body. She felt the full force of the contractions on the other side. So we rolled her to help distribute the medication on the other side.. While this helped shift coverage of the epidural medication to the other side as well, it still left an area on her abdomen that was feeling the force of the contractions. It was about the size of my hand. I sat pressing on this spot through contractions for several hours before mom was complete. Once her epidural was placed we also needed to do some positional tricks to help make room in her pelvis for a baby descending with his head just a little crooked. When it came time to push we thought for sure this would go quickly, we could see the baby descending. Unfortunately the mother pushed for a grueling 4.5 hours due to that crooked head. She and her family needed all the love and support that the midwives and I had to give. We worked hard to overcome the epidural in order to move her to alternative positions for pushing to help this baby descend. He was born vaginally but mom needed a lot of support for that birth.

To begin with, your doula will help you to make an informed decision about receiving an epidural by encouraging you to ask questions and to help you review the pros and cons. She can also help you with comfort measures until you are further along in your labor before receiving your epidural which will help to decrease the number of additional interventions such as pitocin augmentation, episiotomy, forceps delivery, and cesarean. Once you are in an established labor pattern it is less likely you will have trouble with baby's presentation as your labor continues. and baby's position is a major factor in stalled labors. It is important to have an open mind about the tools and tricks you will use to navigate your birthing journey, you may find that you do not need that epidural after all. Your doula will support you, no matter what you choose.

Having an epidural placed is no cakewalk either! Often it can be arranged that your doula can stay with you and your partner while the anesthesiologist places your epidural. She can support you through the one or two contractions you will have during placement, as well as helping you to cope with the general discomfort of having it placed. Afterwards she can help to get you and your family comfortable.

Because your doula is amazing, she will ensure that you remain the focus of your birthing journey after your epidural is placed. There are many tubes and monitors involved when an epidural is in place, so that a mother's assigned care providers can monitor her labor from down the hall. Your doula continues to focus on you and not the equipment you are surrounded by, She encourages the rest of your support team to stay supportive and engaged in the process.

Your doula will help you change position regularly to encourage baby to descend. She may use pillows or a specialized birth ball to get you comfortable and keep your labor progressing. When it comes time to push your doula can work with your partner and other support people to get into more effective positions for pushing your baby out. She may spot you at the squat bar, or help you with a rebozo to maximize your efforts. Pushing a baby out when you have an epidural often can take a little longer, and your doula will be there to encourage you and your supporters during this time..

Overall your doula is still caring for your emotional well-being. If an emergency arises she will provide comfort and information as the medical staff goes into swift action. She remains in YOUR service at all times and works to meet your needs and the needs of your family. "Drs & Midwives are focused on 'healthy baby, healthy mom.' Doulas are focused on 'healthy mind, healthy bond." (Randy Patterson, Owner & Operator of Pro Doula). This means your doula is going to continue to actively serve you regardless of what type of birth you choose or what happens during your labor and birth.

Epidurals can be an amazing tool for some mothers, there is definitely a time and a place and I have seen an epidural save a woman from a c-section by allowing her to rest and relax, and allowing baby to navigate the pelvis. I have seen an epidural bring down a climbing blood pressure to protect a mother and baby and allow a non-emergent birth. I have also seen epidurals fail to provide relief. I have seen them paralyze a woman's pelvic floor and lead to vacuum assisted deliveries and cesarean sections I have seen epidurals cause baby and mom to suddenly go into distress and get rushed into c/s. I have seen them provide spotty relief. I have seen them leave women alone in a room and ignored by her family since now she is not in pain. I have also served women who planned an epidural but were unable to get one due to a rapid labor or a long wait for the anesthesiologist. All these reasons are why you need a doula there, even if you PLAN on getting an epidural.

Problem: During those first few precious days of nursing a new mother often has many visitors. Often these visitors want to hold the baby, comfort their cries with rocking motions, give mom a "break" by holding him/her, etc. These things are all nice... but they can also cause a disruption of that initial bond. That crying baby needs to nurse most of the time, not to be rocked, soothed, or pacified. If the visitor is staying in your home for an extended period of time they might be doing more harm than good.

Solution: Make a postpartum plan, just like a birth plan, that outlines your wishes, limits, and expectations. Share this with everyone before the baby is born and after. Please understand that the postpartum period is about YOU, BABY, and YOUR FAMILY, not your visitors. They should not expect you to host and cater to their needs. There is nothing wrong with asking visitors to bring food for the family, fold a load of laundry, and help out with household things so that you are better able to care for and bond with your baby. There is also nothing wrong with printing up a sign asking guests to wash their hands immediately upon arrival to your home and to limit visits to 30 minutes or less. I know Michelle at Mother Nurtured Midwifery has a sign families can post on their door following the birth of the baby. This allows the family to use her as a scape goat Isn't that sweet?

If this visitor is staying in your home, you may need to have a frank discussion with them about the importance of bringing baby to the breast often. This may lead into unwanted advice about how you are 'spoiling' the baby or that they must be 'starving and you should use formula since they nurse so much' and it is important to remember that babies have tiny tiny stomachs that need to be refilled with the good stuff frequently. It is biologically normal for your baby to wake at night to refill and to nurse very frequently during the day. There is nothing wrong with this, with your baby, or with you.

One of the biggest culprits behind milk supply issues is the fact that baby is not permitted unlimited access to the breast and one reason that baby does not get this access is because mom has many visitors to entertain, share baby with, and she may not be comfortable nursing in front of them, even in her own home. So limit visitors and if baby wants to suck, don't give baby a pacifier so grandma or aunty or neighbor can hold the baby a little longer. Give that baby a breast and ask your visitor to bring you a glass of water and a snack.

Please make sure all your visitors know how committed you are to breastfeeding, ask THEM to leave the room if you or they are uncomfortable with nursing at that time. This is your time to bond with baby, you need lots of rest, water, and skin to skin time. Your guests can admire baby while baby is in your arms, and even at your breast! Baby is at his or her best in your arms in those first days anyway. That's where baby was meant to be. Accept help around the home, with older children, and with meals, not with baby. Baby is your task these first weeks, developing a bond, establishing milk supply, and recovering from the birth are your only responsibilities Newborns are boring anyway (or so they say) there will be lots of time as baby gets older for giggles, smiles, playing, and the like. For now, you need a hot meal, a jug of water, and quiet time with your baby.

**I originally posted this article on The Good Letdown a few years ago in collaboration with a good friend of mine, Deanna.**

Back in September, I ran across this wonderful Meme by The Adventures Of Captain Dad about Birth Announcement Etiquette. I thought, "YES!! Seriously! This should be common sense." So I shared it and moved on with my life, then I started to really take notice of how often I see this. But it's not as simple as an accidental "congratulations" before mom and dad are ready to share. It's the Dick Vitale type constant updates that are being splashed all over Facebook.
Whose Birth is this?
     That seems like it might be a simple cut and dry question, after all there is only one person giving birth. So, who gets to know about the birth? All the details, the pictures, the story? Again this seems obvious, the person giving birth decides. It's their story, and they can share it with whoever they deem worthy. So if this is the case, why is it that every time you log into social media there seems to be a play by play of someone's cervix scrolling across your feed from someone other than the owner of the cervix involved? Someone's best friend, mother, grandmother, sister, uncle is super excited about the arrival of their new loved one and wants to share that with everyone.

It starts with something simple like "I'm going to be an Aunt today!!" That's it. Mom does not get to make any announcement. Auntie just took that birth and made it hers. She didn't mean to. She would never intentionally do that, but the fact is that she did. The family that is giving birth is now receiving texts, FaceBook messages and phone calls full of people giving well wishes, congratulations, and wanting updates. That might not seem like a big deal to some, but please keep in mind that this woman is dealing with a TON of emotion right now. Labor is intense, and she is working hard to bring her baby into this world. But somehow she is expected to give updates. She is busy, you say? No problem! A friend or family member is giving the world a play by play. 

"Dr. will proceed to induce if needed starting IV and we are progressing"   ***We?***

"She's dilated to 3. 80% effaced. The nurse says her blood pressure is high. Watching that and relaxing until time to push." 

"Dilated 6 cm, 100% effaced. Epidural in and we are waiting!"

"Dr. is here and WE ARE PUSHING!!!!"          ****** Wait, who is pushing?******

"7# 6 oz and breastfeeding with gusto!"

And a recap!! "Her water broke at 9:30 at home. We got to the hospital at 10. She went from 3 cm to 10 in 2.5 hours. Started pushing at 12:40 and had him after 3 pushes at 12:47." 

Now each of these updates is receiving comments from the gallery. Lots of love, prayers and congratulations all going to the wrong person. Mom and Dad don't get to make any special announcement about the arrival of their sweet babe. What would be the point? Someone already did it. Everyone in your family already knows all about the most intimate, emotional moment of your life.  Even family members without social media will know everything. The only thing they want to know from mom and dad now, "When can we visit?" Then there is the c-section mom coming out of recovery only to discover that the whole world has already seen pictures of her baby and heard the details of her birth....all before she has even held her sweet baby.

Are we really at the point that mothers have to sit friends and family down to let them know what is and isn't OK to share with everyone? Not even just birth; surgery, losses, pregnancy, promotions. Who gets to share what? Who is receiving the attention? Can we keep our egos in check and not be insulted when someone we love asks us not to share something on Facebook or Twitter?  Is it really that hard? You love them. You want the best for them. You want prayers for them. What do they want? What do they need? Let's put the focus on them and offer our love and support, and let them decide what they need and who they share it with. 

Here is the thing. I know that these loved ones mean no harm. They are super excited/joyful and want to share it with everyone. They may even have permission to post these things, but the birthing woman is too busy to babysit your sharing. So, where do you draw the line? What detail is too personal? How much do you open someone else up to the world? How much do you open yourself up to it? Maybe simply taking notes for mom would be more helpful. I think it's great to have all these details, and mom will likely want them when she goes to write her story. But let her live it before she writes it. Don't get me wrong, I love to read birth stories. I think they are powerful, and it is always an honor when a woman wants to share her story with me, but it should be her choice to share. 

It should come from her.

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).

Causes  
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[2] 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!"

Symptoms
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.

Treatment
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).

Outlook
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.

Summary
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
1.    www.nlm.nih.gov/medlineplus/ency/article/001559.htm
2.    The Breastfeeding Answer Book, La Leche League International
3.    Dr. Jen’s Guide to Breastfeeding, Dr. Jennifer Thomas
4.    http://www.llli.org/docs/lad/ChildbirthandBreastfeeding.pdf
5.    http://www.llli.org/faq/colostrum.html

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:

• Eating iron rich foods - Some examples would be beef, eggs, nuts, dark leafy greens (spinach, collards, kale), beets, beans (garbanzo, kidney, black, lentils), artichokes, black-strap molasses, raisins,  and dates.
• Eat iron with food rich in Vitamin C.
• Eat B vitamin rich foods or use a supplement.  Some anemias are caused by B Vitamin Deficiency.
• Eat vitamin E containing foods ( nuts, seeds, eggs, dairy, whole grains, high quality oils, avocados, soy, sea vegetables). to help prevent the destruction of red blood cells.
• Avoid Calcium ingestion with iron (milk antacid, prenatal supplements.) as it blocks iron absorption.
• A GOOD Iron supplement - This is something I have touched on before. There are certain types of Iron supplements that are going to be hard on your body. They will aggravate that morning sickness and may even give you some constipation. So look at the back of that bottle!

1. Ferrous sulfate-Bad (yuck! Put that bottle down and move on)
2. Ferrous fumarate- Okay
3. Ferrous gluconate- good  (More absorbent and easier on your gut)

• A good option would be Floradix. The absorption rate of Floradix (liquid iron gluconate) is 25% compared solid iron tablets that have an absorption rate of 2 to 10%. Check this stuff out. Its good for you and it tastes pretty good too!

• Liquid Chlorophyll - Also called green blood or plant blood, is similar to the hemoglobin in human blood and carries oxygen to the cells. The difference is hemoglobin surrounds an iron atom and chlorophyll surrounds a magnesium atom. Its first use was to treat anemia. Now it is known to combat bacterial invaders and even stabilize blood sugar. The Magnesium acts as iron that attracts oxygen, helping to oxygenate your cells. It is high in iron, magnesium, and copper. Made from alfalfa, liquid chlorophyll is also high in vitamin K, which will assist in clotting and can help prevent hemorrhage after your baby is born. Some studies suggest that increasing maternal vitamin K intake may help support the baby's vitamin K levels after birth. World Organic Liquid Chlorophyll recommends taking 1 tbs daily. A down-side of this that it can cause the skin to become extra-sensitive to the sun and it could interact with medications.
  
• Nettles- An excellent nutritive tonic that has long been used in pregnancy.  Nettles is high in iron and many, many other nutrients.  Nettles boosts energy, improves the function of the kidneys and liver and is beneficial for the blood pressure, skin and urinary tract and may reduce swelling.  You will find this any many pregnancy teas.  I LOVE Euphoric Herbals! She has some wonderful blends, not just for pregnancy but for woman in all stages of their mothering journey.

I would encourage eating all those yummy iron rich foods but talk to your care provider before you start a supplement. They will be able to help you decide what option works best for you!