My breastfeeding journal - TUG-OF-WAR with BREAST MILK JAUNDICE

After discharged from the hospital on day 3, the paed scheduled for the next SB (serum bilirubin) check on day 5 to confirm if my girl had jaundice. According to the paed, the bilirubin level goes like this (the graph below). So the highest risk will be day 7-8 whereby if the level will get to the peak and if not monitored properly, it might damage the brain. So she was not very fortunate at that time, and was confirmed SB level at 238 umol/L (>200 umol/L) and to be admitted to NICU (Neo-natal Intensive Care Unit) for photo-therapy to lower the level.

Back home on day 3

And that was the start of my nightmare, our nightmare to be precise -- the tug-of-war with jaundice. Every 2-3 days we need to bring her back for SB check and on day 10 (SB level 290 umol/L) she was admitted to NICU again! Twice in two weeks!! I got myself 'checked-in' twice as well to facilitate exclusive 2 hourly breastfeeding to my girl. I know she needed me the most at that time, and another reason was I really could not cope with the pressure and not-so-helpful advises at home, too much of fuss and comments on me doing BF - less ginger, no wine and no Chinese herbs in my confinement diet. I needed a break and hideaway from everyone else, except to have private time with my girl, only the two of us, and also the dad after work.

P.s. To the older generation mothers if you read this, you must understand that if you have concern that the BF mommy (your daughter or daughter-in-law) need to take good care of herself during confinement, she has concern too for her baby, and of course her biggest priority after giving birth is her baby. So if she's decided on something and is determined to do it, please just support her and don't throw more questions and doubts onto her. The human body is quite capable of amazing things, so if you have that endurance to do it, you will be surprised how far you can go beyond the limit. We know you care as a mother but at this moment we just need your moral support, because we are mommies now too.

Well, I think I did a wise decision to 'check-in' to the hospital because otherwise I would not have learned that much about BF and how to take care of my girl. I missed the classes conducted by the hospital before deliver and now I picked up the knowledge through real life practices. I bathed my girl in the NICU as well. Couldn't be more happier. Those few days I talked to a few mommies and most of the nurses in NICU. Some mommies had engorge issue and not able to BF, some mommies had latching issue, some mommies faced pressure from the elders... That's why BF journey ain't easy.

So I spent a few days during my confinement at the hospital, staying in the room opposite to NICU. To my surprise I could actually recognized her crying from another few other babies even when I fell asleep. Perhaps her cries are so loud, and always the loudest... until the nurses also told me, "Madam Tan, you girl's cry is really loud..." 中气十足！"Yea I know... even before you send her to my room for direct latch. (smile)"

The rest of the time in hospital was spent on sleeping and pumping milk for top up storage. The nurse would feed her with expressed breast milk when she cried after direct latch for less than 2 hours, either she did not have enough or feeling dehydrated under the light.

Day 5 when she was diagnosed to have jaundice

Admitted to NICU for photo-therapy

Every 2 hourly feeding on breast milk (top up after direct latch) to avoid dehydration under the UV light

Resting at the hospital freed me from naggings like "Feeding-formula-at-night-to-get-more-rest", "Feeding-formula-then-no-need-to-worry-about-jaundice-and-you-can-eat-ginger", "You-should-not-do-this, you-should-not-do-that", etc. I cried many times in the first 2 weeks wondering why is confinement so difficult when I opted for breastfeeding.

To clear the doubts of the elders, we brought them together when meeting up the paed on a few appointments, and let the paed answer their questions. Slowly my roller-coaster days are over, they finally gave in and accepted the fact that I would never give up on BF, even though my girl was diagnosed and confirmed to have breast milk jaundice - caused by factors in the breast milk that block certain proteins in the liver that break down bilirubin. That was confirmed after 3 weeks of close monitoring and after 5-6 times my girl being poked on her legs to draw blood for SB check and after thorough blood check being done to confirm her internal organs are working fine. I then took charge on how I wanted to feed and take care of my girl until today. And then mom and mom-in-law switched their focus to ways that could help me boost milk production. (^.^)

The paed once told me during the first week after SB check - "You need to be strong and firm if you really want to breastfeed, because only 10% of mothers succeeded to BF until 6 months (the target). Especially when your baby has prolonged jaundice, as a mother you will face double or triple the pressure during her full moon, be prepared for that, many comments you will get from the relatives and friends."

So how did I get over it? Close one eye, close one ear, and also shut my mouth when people talk 'nonsense'. As long as the paed says my girl is healthy and continue to BF, I will continue. We really felt reassured when the paed said to me, "Your girl is healthy and you did a good job mama! Look at her, she's put on weight and growing well. Only that she looks a bit yellow still but no worries."

Happy after discharged for the second photo-therapy

Princess Abigail's full moon, beautiful isn't she?

My girl took about 8 weeks to fully recover with full breastfeeding, no formula milk at all. I know that many mommies are facing this issue and are panic, so since I've gone through with some experience, I would like to share with you how to deal with breast milk jaundice.

1. As my paed advised -- DO NOT STOP BF. Breastfeeding is the best way to let your baby pee and poo more to clear the jaundice. BF every 2-3 hourly, and for the first 2 months, wake your baby up by 3 hours if she/he is still sleeping to feed. Do not let them continue to sleep as low blood sugar level will cause them into deep sleep and even harder to wake up later for feeding.
2. Mommies cut down your ginger intake to the minimum. I did this for the sake of my girl, even during confinement. Least ginger, stop taking alcohol/wine, and even the Chinese herbs （So-Hup 苏合丸）If you've decided to go with BF, go with your instinct to do whatever you want. I talked to the nurses and lactation expert during her photo-therapy session, they've gone through the days too, and the 'So-Hup can be taken after your baby recovered for your own goodness.
3. DO NOT SIMPLY FEED OTHER FOOD/LIQUID TO YOUR BABY! Some people may come with suggestions like feeding lots of water, fruit juices, glucose, honey and blah blah... As a mommy you should do some research online first and always ask the paed. Baby's stomach and digestive system is NOT READY for other stuff until after 6 months (a conservative buffer) to drink juices. You may increase frequency of BF as baby will pee a lot, just to keep her/him hydrated especially after the photo-therapy.
4. Cuddle your baby. You may find her/him very tired most of the time, and keep sleeping, then wake up crying nonstop. They might not be hungry, but just wanted to be cuddled and loved. They can smell their mommies around, hug them, and talk to them till they fall asleep. 
5. Be patient and be firm. Breast milk jaundice will not recover in a few days. Don't give yourself too much pressure, as babies will feel the stress too. I learned it from real experience. When I was really sad, she also cried a lot and looked very unhappy. That is the mother-baby bonding. I believe most BF mommies came across this -- the let-down reflex. You can still feel the sudden pain in your (.)(.) when baby is hungry. If you have been very frustrated and moody for days, it's okay, now you know that you need to stop doing so. Say sorry to your baby and mommy loves you. You need to be emotionally healthy so that you can produce good quality BM for your baby. 
6. Sooth and calm your baby. Mine is very hard to fall asleep sometimes, and will yell and yell. I took a few weeks to calm her and establish the sort of routine thingy for her. Sometimes they are confused if you keep changing sequences of doing things, and having jaundice themselves already made them not feeling very well and kind of tired. So if you are not organized in the routine, you will make your baby feel frustrated. Try to stick to more organized routines. One example, I always feed my girl after bathe her, so in just 1 week's time, she knows that after bathing she will get a bottle of milk. I tried to adjust as much as possible to fix the time range for feeding, so sometimes if I missed the time of bathing her due to some reasons, I will delay the bathing time to half an hour before the next feeding. After that she coped quite well with her daily makan time, and would know that once I take off her mittens and booties, it's time for a bath but not to yell for milk.
7. Always trust your paed or choose the paed that you trust. If you have doubt on your paed, change to another one. My husband and I always think that you should follow advises from your doctor; else change to another one whom you feel comfortable with and that your intuition tells that you can trust him/her. Just the same like how you picked your OB/GYN, I am sure that you chose the one whom you feel really comfortable with.
8. Stay happy and cheerful with your baby. Even if you need to always rush her rush there for paed appointment or frequent SB check (like my case), talk nicely to baby and tell her/him not to scare during blood test or so. Although it's really painful to see her/him crying when the legs got poke for blood sample, smile and cuddle her/him whenever you can at that duration.



So, look at her chubby face, do you still doubt that breast milk is not as nutritious as formula milk? In fact I don't have to worry about unknown hormones in formula milk or the cow milk issues. To be honest I'm really proud of myself for being a breastfeed mommy. Of course, thanks too, to TBAN for the moral support and sharing from all breastfeeding mommies.

HAPPY MOO-MOOing!