Newsletter #47: BMSG Interview with Dr Jack Newman

by Nabila Hanim, BMSG Staff

Last June, BMSG (Singapore) had the honour of recording a video conferencing session with the esteemed Dr Jack Newman, paediatrician and breastfeeding expert, who is also an International Board Certified Lactation Consultant (IBCLC). During the session, Dr Newman had responded to some pertinent questions about breastfeeding and jaundice. In this article, we summarise the interview for the benefit of our readers and followers.


Many of us would have recognised Dr Newman from our own readings and research on breastfeeding. His resource pages have been very popular and widely referenced. Dr Newman is also known for helping many mothers tackle breastfeeding challenges even in the early newborn days. His video on breast compression, among others, has been shared extensively in the breastfeeding community.

What is Jaundice?

Jaundice is usually detected a few days from the baby’s day of birth. Jaundice is typically diagnosed after a blood test is done on the baby to check bilirubin levels. Bilirubin, a by-product of the breakdown of red blood cells, are in abundance in babies while in the womb. Once baby has been birthed, baby’s body breaks down these excess red blood cells because they are no longer needed. Bilirubin is one of the products of this process.

Bilirubin is also an antioxidant and can help the body to manage Group B Strep, which can cause meningitis in baby. Dr Newman suggested that this is probably a huge clue as to why bilirubin may be present in many babies, particular in East Asian babies.

Bilirubin has a Function

Dr Newman spent a significant amount of time talking about how bilirubin levels may not necessarily be an indicator that something is wrong with the baby. He explained that since bilirubin is not normally produced by the body, there must be a reason why it exists in babies. He also compared the high levels of bilirubin in jaundiced babies to the Gilbert syndrome, a disease by which otherwise normal adults experience higher than usual levels of bilirubin as compared to other adults. It was found that persons with Gilbert syndrome will experience elevated bilirubin levels when they fall ill and are also protected from atherosclerosis. 

A baby receiving phototherapy. This is the usual treatment for jaundiced babies. Dr Newman, however, questions its safety and the high risk of it interrupting the breastfeeding relationship. [Stock Photo]

Is Breastfeeding to Blame?

Dr Newman then shared about how the problem is not breastfeeding but rather dehydration. Dehydration in jaundiced babies increases the risk that bilirubin will cross the blood-brain barrier, which is dangerous for babies.

On the question of whether formula is necessary for babies who are jaundiced, Dr Newman stated that breastfeeding does not have to stop because of jaundice. Introducing formula will affect the breastfeeding relationship since baby will not nurse as much.

In fact, Dr Newman believes the issue of hydration can be solved when breastfeeding is successful. A lot of times, jaundiced newborns are not breastfeeding optimally and therefore not drinking enough to hydrate themselves.

Birth Interventions Also Contribute to Breastfeeding Problems

Parents may also notice that some of their babies may not be interested in breastfeeding or are always falling asleep at the breast. Dr Newman explained that mothers who receive interventions during labour, such as epidurals, IV fluids (which are compulsory with epidurals) or taking other pain-killers while labouring, risk having babies born being sluggish, inactive or sleepy. This makes it difficult for babies to learn to breastfeed right after being born and he urged parents to become empowered to reject such interventions because it can obstruct breastfeeding later on.

Citing his experience of witnessing mothers giving birth in African countries while he was still working there, Dr Newman observed that mothers rarely received interventions during labour. He found that the babies to these mothers remain alert at birth and subsequently had little issues to latch onto their mothers’ breasts. In contrast, mothers in modern settings who birthed at hospitals frequently face the challenging tasks of breastfeeding sleepy babies. 

Birth interventions, such as IV drips and taking painkillers, can affect baby’s alertness levels and interest to breastfeed after birth. [Stock Photo]

While a jaundiced baby has always been thought to become sleepy because of their condition, Dr Newman, on the contrary, attributed this to the lack of hydration or being over-hydrated from the fluids that mums take during labour. Over-hydrated babies may show less interest to breastfeed because their bodies do not need excess fluids. He also added that taking painkillers such as epidurals allows the medicine to pass over to the baby through breastmilk, resulting in sleepy babies. 

He emphasised that parents need to be empowered to reject birth interventions and to know that these interventions “are not without consequences” and implications especially on breastfeeding. He also urged that all mothers should have the choice of not taking epidural and understand that birth interventions can impact breastfeeding drastically. 

Remedying Jaundice

Dr Newman was also asked if there was a need for phototherapy in the treatment for jaundice or exposing jaundiced to sunlight. Dr Newman replied that it is strange that we encourage adults and children to put on sunblock but have no issue with putting a jaundiced baby for long hours, sometimes days, under phototherapy light. He also mentioned that there is evidence that exposure to phototherapy can also alter the cells in babies’ bodies, which are precursors to cancers. There are also studies that show babies can experience DNA damage after undergoing phototherapy. 

While he acknowledged that phototherapy can be helpful when a baby is already hemolysing and to prevent exchange transfusions, it does not tackle the root of the matter which is the lack of hydration or the infrequency of breastfeeding. “Jaundiced babies need to breastfeed and drink well,” Dr Newman said. He mentioned that if breastfeeding was going well in the first place, there would be no need for phototherapy. If the mother and baby are already engaged in breastfeeding, having jaundiced babies undergo phototherapy also “disrupts the routines” of breastfeeding.

A lot of mothers worry about their diet causing a rise in their babies’ jaundice levels. There are no conclusive findings and the priority is to ensure baby is breastfeeding well. [Stock Photo]

Mothers’ Diet & Impact on Jaundice Levels

Some mothers had also voiced their concerns about the impact of food on jaundice levels and if certain food can cause jaundice or allow its levels to worsen. Dr. Newman responded that as long as babies are healthy, thriving and gaining good weight, mothers can continue to breastfeed their babies. Instead, mothers should troubleshoot early breastfeeding issues and ensure that babies are drinking sufficiently. “We have to remember that as long as baby is well there is no need to be concerned,” he said, emphasising the importance of good breastfeeding to help baby cope with jaundice.

Closing Remarks: Bilirubin is Not the Real Problem

As the conversation rounded up, Dr. Newman once again questioned why bilirubin is a problem when it is so abundant and normal in many babies. He believes that there is a link between this and the fact that babies who are healthy and still experiencing jaundice (also known as breastmilk jaundice in otherwise healthy babies with no other medical complications) can still thrive and grow well despite clearly still being jaundiced. At the end of the day, he urged the audience to embrace the fact that jaundice levels will rise when breastfeeding is not going well, and that to fix that first and foremost.

Newsletter #46: Breastfeeding Crucial During COVID-19

By BMSG Editorial Committee

Since it appeared in late 2019, we have been continuously learning about the SARS-CoV-2 virus and COVID-19. We don’t yet know of its full impact on the world. Understandably, parents have particular concerns for their young children including wanting to know if breastfeeding is safe during this pandemic.

Parents would naturally be concerned about breastfeeding their newborns in the midst of COVID-19 [Stock Photo]

Why Breastfeeding Should Continue During COVID-19 

It is imperative to understand that breastfeeding is not just for nutrition and nourishment; it also plays a huge role in the developing immunity of a child.  It has been shown that the level of SARS-CoV-2 virus particles present in the breastmilk of mothers who test positive for COVID-19 is  insignificant, and that COVID-19 does not pass through breastmilk.

When  the human body encounters  a virus, the immune system works to produce antibodies to part or all of it. Generally  these antibodies, specific  to particular viruses and pathogens, are present in breastmilk. There are some preliminary findings which suggest that breastmilk actually provides babies with protection against COVID-19.

When a mother is infected with COVID-19, it is recommended that simple hygiene measures such as hand-washing and mask-wearing should be taken when breastfeeding. Breastmilk is still the best food (in the presence of COVID-19 or not) for babies – including for those who require donated breastmilk.

Breastmilk Contributes to Food Security  

The COVID-19 pandemic has also had  massive economic repercussions. Rates of unemployment have increased exponentially due to disrupted economies. In a highly commodified world, this naturally translates to limited resources, including food.

Formula milk, which has become a very common milk substitute for babies in developed countries, is expensive and is also vulnerable to supply disruptions. In times of crisis, it may become an even more costly commodity and may run off the shelves due to panic buying. The World Health Organization (WHO) is now encouraging mothers to consider relactating  or delay weaning off the breasts, to continue providing immunity to their breastfeeding children.

Empty shelves at supermarkets threw people into a frenzy, including parents who wanted to obtain formula milk for their babies. [Stock Photo]

Improving Management of COVID-19 for Postpartum and Breastfeeding Mothers in Singapore  

WHO guidelines on management of COVID-19 encourage breastfeeding and advise against the separation of mother and child. 

As the only Singaporean charity that supports breastfeeding mothers via various counselling channels, BMSG encourages mothers to continue breastfeeding and for family members to give their strong support. A previous article outlined the worries of our mothers during the initial Circuit Breaker period and we want to offer recommendations for mothers to continue breastfeeding even if they are infected with COVID-19 at the time of their pregnancies or when giving birth.

  • Infected Mothers Should Continue Rooming-In with Newborns After Giving Birth

Most hospitals which are Baby-friendly Hospital Initiative (BFHI) certified have policies where mothers and babies are able to room-in together after birth, unless there is a medically indicated reason for it. It also allows mothers and their newborns to have unrestricted skin-to-skin time after delivery, a recommendation by the WHO that helps to facilitate  breastfeeding. Hearteningly, this guidance has been instituted at the various maternity hospitals in part or in totality since 2013.

While there have been no reports of infected mothers giving birth as of yet in Singapore, there was a mother in Australia who was infected with COVID-19 and was allowed to room in together with her baby until discharge. The baby did not contract COVID-19 and was breastfed by the mother from Day 1. India has also reported that 100 babies born to mothers who had contracted COVID-19 before they went into labour had shown negative results for COVID-19, with the exception of two babies. These babies were also quick to bounce back, showing negative results after subsequent tests were done just a few days later. These mothers and their babies were also allowed to room-in together and the mothers had breastfed their infants.

Unless either a mother or her baby is ill right after birth, it is recommended that mothers and babies are together to establish breastfeeding through efforts such as skin-to-skin and initiating the first latch. [Stock Photo]

If you come down with COVID-19, you can insist on rooming-in with the baby as long as you and all visitors practise good hygiene. The precious hours and days right after the birth are when babies receive the goodness of colostrum which can be considered their very first immunisation. Every single drop is filled with antibodies and immune factors that serve to develop the child’s fighting capacity against the very pathogens that we seek to protect them from.

  • Babies of Mums with COVID-19 May Not be Allowed in Quarantine Facilities  

In relation to the above point, BMSG has contacted the Ministry of Health (MOH), and from our communication there seems to be no clear guidelines as to whether or not  breastfeeding mothers can be housed with their babies should they be infected with COVID-19.  

If you find yourself in this situation, advocate strongly for your baby to be allowed in the facility with you to protect your breastfeeding relationship. Breastmilk is one of the best ways to protect babies from the infection, which is why it is crucial to ensure that the breastfeeding relationship continues.

If it is not possible for you to be with your child (e.g. warded in ICU), you can still continue to pump milk. As always, practise good hygiene while pumping, such as washing hands before pumping and storing milk, sterilising all pump parts before pumping and making sure that milk is stored according to the recommended milk storage guidelines.


Breastfeeding remains the best form of protection for babies against COVID-19. Breastfeeding should begin right from the moment baby is born. [Stock Photo]
  • Lack of Postpartum & Breastfeeding Resources for Mothers at Home 

Many mothers struggle with breastfeeding in the few days after birth, particularly after discharge from hospital. Breastfeeding challenges typically arise around days 2 to 4 when breast engorgement, difficulty in latching, and the overall struggle of caring for a newborn can impede mothers’ efforts to breastfeed.

The Circuit Breaker that started in early April 2020 affected mothers and infants at their most vulnerable period. Mothers who required a Lactation Consultant (LC) to assist with breastfeeding were not able to have one visit them and yet may not have been well enough to visit one at the hospital. Families who were expecting confinement nannies from Malaysia to help care for newborns had to cope on their own. Other postpartum care services such as postnatal massages were similarly nonexistent for isolated new mothers, and more so with no visits from extended family members for support. This posed a huge challenge and strain, physically, emotionally, mentally.

We know that the first two to four weeks are when both mothers and babies learn how to latch well and we often refer to this as the “golden period”. When mothers receive adequate support during this time, they tend to have a better breastfeeding journey. By the time a mother is able to access help, she may have already given up on breastfeeding.

Breastfeeding feeds not just a baby, but the whole nation. If we aim for a healthier generation, we need to be able to support our breastfeeding dyads.

How Should Singapore Move Forward?

It is clear that Singapore needs to create or adapt our own national guidelines to safeguard our vulnerable young children in the event of a future crisis – be it another pandemic, a natural disaster, or others. 

Australia updated its IYCF-E guidelines this year after the catastrophic Australian bushfires in 2019. Dr Karleen Gribble, a breastfeeding advocate, produced detailed recommendations for families with young babies to plan for evacuation. We also looked for inspiration from Safely Fed Canada, an organisation that offers very clear advice to parents on how to facilitate breastfeeding and sustainable infant feeding during times of crises. 

We urge Singapore to create ICYF-E policies that will help policymakers and our nation be more prepared on safe infant feeding during national crises, which include and promote breastfeeding at home and in institutions, and which guide parents and carers in detail on safe formula preparation and feeding. The availability of formula milk for babies is at the mercy of supply chains and carries with it increased risk of infections and contamination, especially in emergencies. Ample preparedness will safeguard the health and security of our children.

We also urge that Singapore create a national breastfeeding committee to encourage, facilitate and protect breastfeeding at a national level, for all times. When breastfeeding becomes part of our national policies, and our culture as a society, we will be providing our babies their primal rights, maintaining food security and improving overall health for our children now and in the future.

Breastfeeding remains a crucial aspect of infant and young children feeding in emergencies (IYCF-E) and should be part of nationwide policies in the event of a pandemic or national emergency. [Stock Photo]