Saturday 21 January 2012

My Greatest Gift

The euphoria of achieving gentle birth for Baby Ally was short-lived.  On the third and last day of our hospital stay, the covering pediatrician (our pediatrician was out of town) advised that Baby Ally could not be discharged due to her high jaundice level of 12.5 mg/dl. I was not totally alarmed as I knew for a fact that almost all babies are born with jaundice – due to the newborn’s liver not mature enough to break down excess red blood cells and thus produces yellow pigment called bilirubin. 

The point of contention is how high is high and 12.5 mg/dl is not even close to 20-25 mg/dl which most doctors consider high.  Probably too close for comfort but not close enough for me to sacrifice all that we’ve gone through, i.e. drug-free birth so Ally and I are both alert to initiate early latch and bonding.  Leaving her behind in the hospital would forego whatever little we have established so far.   I asked, “what about breastfeeding?”  Doctor replied, “not to worry since you can express breast milk at home and the nurse can bottle-feed Ally.”  “What about nipple confusion?”  No answer.  I thought so.

My husband and I came up with two options.  First, I can also check myself in the hospital and continue to breastfeed Ally (which meant a bloated hospital bill) or we can rent the phototherapy machine and treat her at home (a less bloated bill).  The doctor agreed with the latter on the condition that we have to check her bilirubin level the very next day.  We were so relieved we could bring Ally home that we didn’t realize agreeing to this was apparently a lost case.

Of course her bilirubin went up to 15.5 mg/dl the following day.  The doctor did not give us a fair chance.  I mean what could an overnight phototherapy treatment do to bring down the level which is expected to peak on the first week?  We appealed for an extension. Still, it went up to 17.2 mg/dl the next day.  Again, we argued that the increase had gone down from 3 to 1.7 mg/dl.  The doctor saw the logic in this and relented saying if it reaches 19 mg/dl he had to put his foot down.  After religiously putting Ally on phototherapy in between feedings and cuddles, it finally went down to 15.5 mg/dl.

Baby Ally getting her 'spa treatment' at home

So you’d think the story ends here.  Unfortunately, this leave-no-loose-ends doctor wanted us to come back a week after just to make sure.  Personally, I saw no point in this.  Aside from the fact that I can visibly see Ally’s yellowish skin color clearing up, my heart went out to her – crying in pain from constant needle pokes (6 times by now, twice from BCG and hepatitis jabs, four times from bilirubin level checks).   I know it takes time. The important thing is it has gone down.

Nonetheless, after a week her bilirubin level remained at 15.5 mg/dl (still ok in my opinion considering she stopped phototherapy and it was raining constantly so ‘under morning sun’ was not an alternative).  This time the doctor surmised it could be breastfeeding jaundice.  I knew right then and there he would advise me to introduce formula feeding.  I have heard of this prescription before and as long as her bilirubin level is nowhere near the ‘intervene now’ level, I didn’t see the need to do so.  Call me a naturalist but can we give the body a chance?!  Sometimes we give less credit to how much our body is capable of.

Dr. Sears, a leading US pediatrician actually caution healthcare providers and parents of an overreaction to jaundice in breastfeeding babies, where the cure can create more problems than the disease.  And in most cases, it is unnecessary to treat jaundice when bilirubin level is less than 20 mg.  I was informed and I knew what I wanted – exclusive breastfeeding for the first 6 months with no water, formula or glucose.  The benefits far outweigh the ‘cure’.  The doctor did not pressed on but wanted us to come back AGAIN after a week to make sure. 

On this same visit, he also diagnosed a heart murmur.  He has a way of explaining things that makes a mom nervous.  The hole previously attached to mom for ‘air’ probably did not close… but it’s been more than a week already… or there could be hole/s somewhere in the four chambers of the heart etc… He then proceeded to arrange an appointment with a pediatric cardiologist to schedule an ECG and heart ultrasound.  By the time he was done, I was having a splitting headache.  I suddenly missed our doctor and wished he would come back from his trip soon.  In the meantime, I could not wait to go home and consult Dr. Google.

When the nurse called to confirm the appointment, guess what I had to deal with again.  I was asked to bring bottled breast milk so they can feed Ally if she cries while on ECG.  Again, I said our latch was not well established yet and I wanted to avoid bottle-feeding.  She replied they could make Ally sleep instead.  What?!  General Anesthesia?  How can an otherwise harmless procedure suddenly turn evasive?!  How about I come back a week after when our latch is more or less stable, in the event Ally does cry (which I was pretty sure she wouldn’t).  That is a good idea, she agreed.  Whew!

A possible delay in the check-up was not a cause of concern since Ally displayed none of the symptoms of congenital heart defect.  Her breathing was normal, never appeared breathless or bluish/purplish, no difficulty nursing and really thrived (she weighed almost 4 kilos at 2 weeks old!). Anyway, to make this long story short, a negligible-size hole was found but eventually closed several weeks after.  Her jaundice also disappeared. 

Baby Ally on ECG 

Medical protocols that are not sympathetic to breastfeeding, especially when it is truly unnecessary, make it more challenging for moms who already find breastfeeding difficult enough.  Looking back, it has tested my commitment and has stressed me out, on a vulnerable time when I should be recuperating post-partum.  Instead, I found myself negotiating with doctors and nurses just so our newborn could avail wholly and uninterrupted the most important gift – exclusive breastfeeding.

Our healthy baby.  Hooray for breastfeeding!


  1. E's bilirubin was up to 18.7 on day 6. and the doctor didn't tell us to go to the hospital for phototherapy. instead, she asked us to come back the next day and when we did the test again, the bilis went down to 18.4 so she told me to continue feeding. on the 2-week check up, she told me that E looked better and didn't have to be put on bililights. Also, E gained almost 2lbs in 2 weeks! so i think that helped me cause.

  2. Good for baby E! My real doc did the same for Ava but he was away! And this new doctor was so uptight!

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  4. My golly Mec!!!! Over kill!!! I am sorry you had to go thru this. I am so happy that you held on to your breastfeeding goals and did not get lost in all this mumbo jumbo! In a way you are lucky to be able to rent the billi lights here in Davao you can not bring one home, or at least I do not know of anyone who was able to bring one home. Most moms are even told that if baby is not in the nursery and something happens "they" should not be blamed- or something to that effect! Talk about support for breastfeeding!!!! Thank you so much for sharing this!

  5. Hi Mec and Baby Ally! Congratulations for hanging on to what you knew to be proper! You are both troopers! :) Very inspiring and informative blog, Mec. We love you both!

  6. Thanks Alex! Overkill ! We had to go back hospital everyday to have her bilirubin level checked! Poor Ally getting poked so many times! You know even after it went down, when he said its breastfeeding jaundice, he even had her poked directly on her tiny vein (arm instead of sole) to rule out liver problem when her level in the first place is nowhere near danger... At least all ends well still... See you soon! =)

  7. Hi Auntie Lyn! Thank you so much! We love you too!

  8. Good for you. Baby M also had high bili levels at 1 month. This was noted before he got operated for a separate problem. I was so hesitant to give in. But eventually did. For a week he was given formula. During the ff-up, bilis went down and as soon as doc gave the go signal, I gave him my milk. I've always wondered if his pedia (who was away then) would have asked me to stop breastfeeding.

  9. @ambquezada - thanks for sharing. I think doctors have different comfort levels, which sometimes doesn't match with the mothers'. Best scenario is if both can work together. Hope Baby M is doing great!

  10. One important aspect to consider is how much room they have to work with. If the bedroom is on the smaller size they will want to take exact measurements to ensure the bed will fit in the room properly. twin triple bunk bed


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