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.
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.
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.
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.
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.