The Milk Trail – Part 1 : Total Breastfeeding & Jaundice

This is a very long post. You have been warned.

The milk trail is a long and hard one to embark on. Perhaps it can even be called The Milk Trial – it is very trying indeed!!! Hahaha…

Well, when we first came back from the hospital, we weren’t laughing indeed. Again, let me tell you how we embarked on The Milk Trail chronologically, starting from when Isaac was born…

As you can see in the picture I have posted before, we got Isaac to latch on almost immediately after he was born. He was doing a pretty good job of it, though I wasn’t yet very sure of the positioning etc. So, being the current generation of parents as it is, we insisted on TBF: Total Breast Feeding. Funny how it has become the rage nowadays, isn’t it? This breastfeeding thing. Think it wasn’t so ‘big’ during our time, when we were babies. Well, I, for one, was definitely not breastfed.

Anywayz, we’re totally sold on the idea of breastfeeding – the benefits of the milk to the baby, and the benefits of breastfeeding to the mum. It was, and still is, my ambition to be an Efficient, Painless & Skinny Cow --- I hope to Efficiently produce lots of milk, and breastfeed in a Painless way, to eventually lose a lot of weight and hence be a Skinny Cow (cow’s the noun, the rest are all adjectives, silly) kekeke…

But the back of our minds though, we had in mind the contents of an email that a good friend of mine had sent us a few weeks before I delivered – it was regarding TBF and jaundice. It seems that subsequently, we would go on a similar path as my friend Matthew – but thanks to him, our path was much shorter and less rocky. I’d obtained permission from him to reproduce his letter in this blog of mine, for the benefit of the first-time-mothers-to-be reading this blog. Gonna let you read his email before telling you our version of what happened to us. He’s much more concise than I am, I think ;p

Hi Ladies,

Just like to share our experience with you soon to be mothers.I believe you should have read about the benefits of exclusive breast feeding for at least 6 months. The information you read usually comes from books and websites.

Our experience is that during the 2 days stay in the hospital when breast milk is not available yet (only Colostrum is produced) we decided to follow the Total Breast Feeding (TBF) mind set and did not allow the nurses to feed Isabel with any formula milk (even though they strongly encouraged it).

Only on the 2nd night, as Isabel was crying after BF, we decided to give her supplementary formula feeds.Upon returning home, we continued to practice TBF and thought that since she was latching on very well, we did not need to express the milk and Isabel was getting enough.However on the 3rd day when we went for the routine check-up, Isabel was diagnosed with Jaundice (her reading was 11.7 upon discharge and 19.7 on 3rd day after discharge).

While 80% of Asian babies get some degree of Jaundice, Isabel's Jaundice level could have been lower if we had monitored closely her liquid input and more importantly ensured that she was fed properly during the stay in the hospital. Isabel had to be sun for 2 days to reduce the level (this cost money). Jaundice can cause brain damage if the level gets too high.Even though a baby can survive with feeding for a few days, adequate liquid is necessary to flush out the Bilirubin which causes Jaundice.

Do note that it is extremely important for the baby to feed on the breast for 20min each side BEFORE giving formula milk in the hospital. This is to stimulate the production of milk. The nurses are actually quite concerned that many mothers adhere so strictly to the TBF rule (before the actual milk flows) but they choose not to say much as they are afraid to offend the new mothers who think they know so much.

Also it is wise to express the milk using a dual pump so that you know how much you are producing and how much baby is taking. Even if not much is produce initially, the more you pump the more you produce.

So while we are all for TBF, do note that
1. It may be good for your baby to get supplementary feeds during the stay in hospital to ensure adequate hydration.
2. Pump out the milk at home so can ensure sufficient liquids for the period of time when Jaundice is prevalent in babies.

Matthew


We thought that was pretty good advice. And logical to boot – you know, it’s not the kind of illogical and non-scientific advice you get from certain relatives *roll*eyes* So we told ourselves to bear in mind the good advice from Matthew, when our turn comes.

When our time did come, we were totally pro-TBF too. We religiously got Isaac to latch on whenever he cried for a feed – even though we knew there was nothing but the 20ml of colostrum that my breasts were supposed to produce a day. (No, I dunno if it is 20ml per breast, or altogether ;p) We were not concerned that he would be ‘starved’ as all the books and material we had read on breastfeeding all said that the baby has fat reserves inside him that he had built up whilst in the mummy’s stomach, and those fat reserves would be what he is ‘living off’ before mummy’s milk comes in. But (for the uninitiated) baby still has to latch on – to stimulate mummy’s breasts into producing milk. Moreover, Isaac was quite on schedule, he would only cry for a feed every 3 hours or so – so this boosted our confidence in thinking that he wasn’t starving. Coz theoretically, if he’s starving, he’d want to feed more often, right? Thus, for the first two days after Isaac was born, we got him to latch on every 3 hours, upon him demanding for it, even at night, we got the nurses to wheel him in whenever he wanted a feed. We did however, remember Matthew’s advice. Hence we had already bought a soft-cup beforehand, and instructed the nurses to supplement Isaac with water to keep him hydrated. In fact, the funny thing was, when we instructed this, the nurses commented that it was not really necessary.

On the third day, the day we were to be discharged from hospital, Isaac started to get very demanding. He wanted to feed at almost every hour, and every time he latched on, it was for a substantial 30 minutes or more, at a time. This got to be very tiring for me, as I was suffering from sore nipples (I thought I hadn’t mastered the positioning and latching – but upon hindsight, it was more due to the fact that I did not disengage him correctly) and so every time he latched on it was very painful. Furthermore, it was a sign that he wasn’t getting enough, if he was crying more often. We casually remarked to the nurses that pushed him in that Isaac’s timing in between feeds seemed to be shortening – and they replied by saying that that was probably because he had “used up his reserves”. This brought our concern up another notch.

Then the nurses brought us another piece of news – Isaac has jaundice. We spoke to the paediatrician, who informed us that Isaac’s jaundice was a ‘borderline case’ measuring 11.3 He said that if it was below 10, he would immediately say “baby go home.” But if it was above 12, he would say “hospitalise the baby”. But at 11.3, he is saying “It’s up to you.” We asked if it would help lower the jaundice level if Isaac stayed in hospital to be under the uv-ray machine, but he said “No, it’d go up anyway, before coming down. So, not much difference, so maybe you should bring him home.” Well, our thoughts exactly – so we all discharged that day, brought Isaac home. We asked the paed we can help lower his jaundice level by feeding him more water – he replied by saying that we could do that by giving the baby more fluids, whether it is through feeding him more often or by giving water.

So we went home, and tried feeding him as often as we could – on the breast of course. We also gave him water – which he lapped up very quickly. When we got home in the afternoon, we were still adamant on TBF. We did not want to supplement with formula milk at all. However, throughout the day, Isaac wanted to feed at almost every hour, so it was like every half hour interval, he’d be back at my breasts. I still had sore nipples, which were increasing getting worse with every feed, especially since they didn’t have much rest in between feeds. It got so bad, that the right nipple started to bleed.
Also, we didn’t know how much milk/colostrum Isaac was getting from me. And me, being a first time mother, frankly had no idea how it felt like to “have milk”. My mum and the confinement lady kept asking me if I had milk. But I could only reply “I dunno, maybe… dun think so…” but I really wasn’t sure. All I knew is that we were latching the baby on at every opportunity, and if I didn’t have milk, all that latching and suckling from the baby was supposed to aid in bringing the milk on. This was what the books said. So as far as we were concerned – we were “doing the right thing”. Plus we were supplementing with water, so we thought we were giving Isaac enough fluids.

But by night time, we were getting desperate. Isaac had spent most of the day crying and crying when he wasn’t on the breast sucking the life out of me. We were all getting increasingly stressed. Coz it really seemed like he wasn’t getting enough – and we were afraid if this went on, his jaundice would get worse. My mum and the confinement lady were telling me to pump, to see how much milk/colostrum I had, to see how much Isaac was getting.

Finally at about 11plus at night, we finally caved in, and I started to pump to see how much there was. There was hardly a drop. I was so upset. Suddenly it dawned on me that I was starving Isaac the entire day. No wonder the poor boy was crying his lungs out. Quickly, we got Papa to save the day – got him to go to Holland V’s 24 hour Cold Storage to get formula milk for Isaac. By the time he left, it was already 12 midnight.

So that night, the third day after Isaac was born, and the following day, the fourth day till fifth day morning, Isaac was on formula milk, plus latching on as well. On the fifth day morning, was the follow-up check-up to check on the jaundice. His jaundice had gone up to 12.3 ! The paediatrician said this wasn’t a sharp increase (so that’s good), but it was an increase nonetheless (which is no good). Again, she recommended that we continue to flush Isaac with fluids so as to get the jaundice level down. We asked if we needed to sun Isaac, as that’s what we often hear about babies with jaundice – need sunning, right? We were surprised with her reply. She said that the fluids were more important than the sunning. We could do the sunning if we wanted, but it wasn’t crucial at all. I felt rather guilty as I felt that Isaac’s jaundice probably got worse coz we held off giving him formula earlier. I sorely wished that we’d relented and given him formula earlier.

By the fifth day, my milk was in, and plentiful. We put Isaac back on TBF, and come the eighth day morning when we went for the follow-up check-up to check on the jaundice level – Isaac’s jaundice was down to 10.7! We were very thankful that his jaundice level had come down.

This was an important lesson we learnt indeed. Like Matthew and his family, we too were pro-TBF and still are. Just that we have learnt that in the first few days after the baby is born, it is important to supplement the colostrum with formula and water – before the milk comes in. Hubbs and I were discussing about it, and we decided that, on hindsight, even in the first two days after baby is born, we should have got the nurses to give Isaac formula from like midnight to breakfast time, while we get him to latch on the rest of the day. This way, Isaac gets to learn how to latch on, and stimulate my breasts; and at night, I get a full night’s sleep – since there is no milk anyway. I think this is what we would do with our next and subsequent kids.

Matthew’s suggestions are also very valid indeed. Thus, we sincerely urge those first-time-mothers-to-be out there, to learn from our mistakes. One less starving, jaundiced baby out there = one more happy, less stressed parent :)

Take heed!

p.s. Any experienced mothers or medical professionals out there wanna share your thoughts? do leave a comment! :)