Overcoming jaundice, nipple confusion and other interruptions in early breastfeeding relationships

If you live in the Western world, you’ve no doubt heard the catch phrases “Babies were born to be breastfed” and “Breast is Best.” Many women start out with the best of intentions for breastfeeding their new bundles of joy, but sometimes circumstances beyond their control can cause interruptions in early breastfeeding relationships. Talk of jaundice, biliruben levels and supplementing with formula are not things many parents are prepared to be confronted with just days after their child’s birth. So what should you do if you find yourself suddenly dealing with the unexpected?

After experiencing a labor and birth with my daughter that was unlike anything I had anticipated, breastfeeding seemed to be the one thing that was going in our favor. Ava came into the world as they say, born to breastfeed. Although I had a little trouble with her latch initially, with some help from a nurse we soon seemed to be well on our way. She would eagerly latch on and spend 30 to 45 minutes on each breast, nursing contentedly. Then a pediatrician (not her’s, but one in her pediatrician’s practice) told us that she was jaundice and not only did he recommend that she go under the bilirubin lights (in the form of a bili-blanket, thankfully in my hospital room), he also wanted me to supplement with formula to help flush the jaundice out of her system. Formula? But, but, but, I’m exclusively breastfeeding. We even had a note on her bassinet in the hospital saying, “I’m a breastfed baby. No artificial nipples or bottles please.” I had every intention of breastfeeding her exclusively and now it seemed that even that wouldn’t happen. Not knowing what else to do, I acquiesced and allowed my husband Jody and/or a nurse to feed her formula from a bottle, while I continued to nurse her ’round the clock. I absolutely did not want to give her a bottle myself because I wanted to avoid confusing her. I wanted Ava to know I was the one with the breasts and that those breasts were the only way she was getting nourishment from me. (Kellymom states: “If your baby is less than 3-4 weeks old, it is best to avoid the use of a bottle for a couple of reasons: regular use of a bottle instead of breastfeeding can interfere with mom’s efforts to establish a good milk supply; bottle use also increases baby’s risk of nipple confusion or flow preference.”) Little did I know that I could have given the formula to her myself actually from my breast and avoided a bottle all together had anyone at the hospital told me about something called a Supplemental Nursing System (SNS) or lactation aid. “A lactation aid consists of a container for the supplement — usually a feeding bottle with an enlarged nipple hole — and a long, thin tube leading from this container.” The tube is taped onto the woman’s breast, allowing the baby to nurse at the breast and receive expressed breast milk, formula, glucose water, etc. at the same time. So why wasn’t an SNS mentioned to me – a mother who wanted to breastfeed exclusively and obviously wanted to avoid nipple confusion that could come from introducing a bottle so early? Are other hospitals recommending SNS to breastfeeding moms?

Thankfully, Ava did not suffer from nipple confusion and took to the breast well every time (and, if you are familiar with my previous posts you know she ended up breastfeeding for a long time), but that’s not the case for everyone. Many babies who are offered a bottle before they are ready to differentiate between mom’s breast and a rubber nipple have trouble with their latch or will refuse to latch onto the breast at all.

Nell who blogs at Casual Friday Everyday gave birth to her third son Dash just two weeks ago. When her pediatrician (note: not her usual pediatrician) determined that Dash had jaundice – which was not unexpected since her other two sons had it as well – she was told he needed to go to the NICU. That news, however, came out of left field and was completely unexpected. Neither of her other kids received any special treatment for jaundice.

I almost couldn’t process what was being said. Like it wasn’t really sinking in. We walked down to the NICU with our tiny little baby – a place with a few other babies with jaundice also. They removed his clothing and began hooking him up to everything.

We set up a time that I’d be back to nurse him and my husband and I left; left our newborn baby all alone, under lights, with strangers. I cry just writing about this.

I walked back up to our floor empty handed and broken-hearted. My heart felt like it had been shattered. Like part of me was missing – well, because it was. Every single part of me wanted to run back into the NICU, grab him and run out of the hospital.

Dash also received formula from a bottle to help treat the jaundice, and Nell believes, the combination of him being taken to the NICU and use of the bottle contributed to the nipple confusion they are now trying to overcome.

This has been a particularly difficult thing for Nell because she struggled with breastfeeding issues like tongue-tie and thrush with her first two children and was determined that this time, with Dash, the breastfeeding relationship would be different.

This baby was going to be different. I was determined not to introduce a bottle to him. To avoid the nipple confusion. To nurse well into his first year, if not longer. And then unexpectedly he was put into the NICU and supplemented with a bottle. Had I been offered the option of an SNS I would have taken it in a heart beat.

Again, why wasn’t a SNS (lactation aid) offered to this breastfeeding mom? And was it really necessary for them to take a jaundice baby to the NICU?

Since leaving the hospital, Nell and Dash have also developed thrush, but she is determined to make breastfeeding work this time around and is reaching out for help.

I’m not ready to give up even though this has turned into the most difficult experience of all three.

I have reached out to the local LLL gals in my area for help. I’ve explained my problems via email and asked for a phone call. I’m going to attend the meetings for one on one help. And I’m going to try some Thrush remedies that don’t require a doctor to prescribe them.

I think Nell did one of the most important things a woman who find herself in these situations can do – reach out for help. Call another breastfeeding mom, call La Leche League, call a lactation consultant (International Board Certified Lactation Consultant). Call or email someone who can point you in the right direction of the resources and support you need to help you succeed.

Carina of Greetings from the Jet Set had a difficult time getting a good breastfeeding relationship started with her son after a fill-in pediatrician, concerned that her two-day-old son was jaundiced, recommended she supplement her nursing with an ounce of formula after each feeding. The supplementation took place via bottle, her son suffered from nipple confusion and her supply dropped a great deal. After her son’s two week appointment, she sought out a lactation consultant and was able to figure out a good latch and taught how to use a SNS. “After a few weeks of that, my supply righted itself and we went on our way.” She told me on Twitter, “I tell everyone that while they are short term WORK, they yield long term results. 1-2 wks of SNS yielded 2.5 years.” That is to say that she used the SNS for one to two weeks and, as a result of the reestablished breastfeeding relationship, she was able to nurse her son for 2 1/2 years.

Carina, a self-described lactivist, also responded to a woman’s question on Yahoo on this very topic. The woman wrote, “Doctor told me that my breast milk is increasing his jaundice level, so I was told to give him formula milk and breast milk alternatively.” She asked, “how long will I be asked to give him formula milk? When will he be switched completely to breast milk?”

Carina replied, “your doctor gave you outdated advice. It is NO LONGER advised for you to stop breastfeeding and give formula.” She then quoted several articles that support her claim. The first is from Dr. Jack Newman.

Breastmilk jaundice peaks at 10-21 days, but may last for two or three months. Breastmilk jaundice is normal. Rarely, if ever, does breastfeeding need to be discontinued even for a short time. Only very occasionally is any treatment, such as phototherapy, necessary. There is not one bit of evidence that this jaundice causes any problem at all for the baby. Breastfeeding should not be discontinued “in order to make a diagnosis”. If the baby is truly doing well on breast only, there is no reason, none, to stop breastfeeding or supplement with a lactation aid, for that matter. The notion that there is something wrong with the baby being jaundiced comes from the assumption that the formula feeding baby is the standard by which we should determine how the breastfed baby should be. This manner of thinking, almost universal amongst health professionals, truly turns logic upside down. Thus, the formula feeding baby is rarely jaundiced after the first week of life, and when he is, there is usually something wrong. Therefore, the baby with so called breastmilk jaundice is a concern and “something must be done”. However, in our experience, most exclusively breastfed babies who are perfectly healthy and gaining weight well are still jaundiced at five to six weeks of life and even later. The question, in fact, should be whether or not it is normal not to be jaundiced and is this absence of jaundice something we should worry about? Do not stop breastfeeding for “breastmilk” jaundice.

According to Breastfeeding Basics:

In most cases, jaundice is a normal, possibly even beneficial process that can be managed without interrupting breastfeeding. The treatment for physiologic jaundice is more breastfeeding rather than less, and sick babies with pathologic jaundice need breastmilk even more than healthy babies. Even in rare cases where the jaundice is caused by the breastfeeding, there is no reason to wean and every reason to continue giving your baby the best possible nourishment – mother’s milk. In most cases, jaundice is a normal, possibly even beneficial process that can be managed without interrupting breastfeeding. The treatment for physiologic jaundice is more breastfeeding rather than less, and sick babies with pathologic jaundice need breastmilk even more than healthy babies. Even in rare cases where the jaundice is caused by the breastfeeding, there is no reason to wean and every reason to continue giving your baby the best possible nourishment – mother’s milk.

According to a La Leche League article:

In an article in the November 1990 issue of BREASTFEEDING ABSTRACTS, Kathi Kemper, MD, MPH, suggests that prolonged hospitalization, phototherapy, and the interruption of breastfeeding may be unnecessary and even harmful for the mother and for the infant with normal neonatal jaundice. She writes, “In the case of healthy term infants who are jaundiced, the treatment could be worse than the disease.”

So what is going on here? Why are hospitals treating jaundice this way if it’s a “normal, possibly even beneficial process?” Is the real problem that pediatricians attitudes about breastfeeding are deteriorating?

I think educating one’s self is always a good thing. Of course, it’s impossible to prepare for every possible scenario, but if a woman knows in advance that breastfeeding jaundice is a normal occurrence and isn’t always a cause for concern, then perhaps she can make better informed choices with regard to her child’s care. If she and her doctor decide that supplementation is necessary, then knowing about a SNS/lactation aid and asking for the help of a lactation consultant could be invaluable. And then, if a woman finds herself in a situation where, for whatever reason, she has trouble with breastfeeding, knowing where to look for help at the first sign of trouble is key. It’s also helpful for family and friends to know what to do (and not to do) to support a breastfeeding mother.

Lastly, there’s an eye-opening article that ties into this topic nicely on Today’s Parent called “Nursing Confidential: Breastfeeding can be one of the biggest challenges of new motherhood. Now 7,000 Today’s Parent readers tell us why.”

What was your early breastfeeding relationship like? Did you have to overcome any obstacles? How did you do it?

Cross-posted on BlogHer

Peanut butter granola squares – recipe

Peanut butter granola squareThanks to tifi who tweeted this peanut butter granola recipe to me the other day. I made a few modifications to it (like cutting the amount of honey and sugar in half because it seemed like a lot, using whole wheat flour, and adding in flaxseed to it). The results were quite delicious. Here’s my version of the recipe:

Peanut Butter Granola Squares

Preheat oven to 325 degrees.


4 1/2 cups old fashioned oats
1 cup whole wheat flour (or another kind of flour if you prefer)
1/3 cup ground flaxseed
1 tsp baking soda
1/4 tsp salt (optional)

1 cup butter*
1 tsp vanilla
1/2 cup honey
1/2 cup brown sugar
1 cup peanut butter (preferably organic PB with no sugar added)

Combine oats through salt in a large bowl. Stir to combine.

Heat butter through peanut butter in a sauce pan until all are melted.  Add melted mixture to the dry ingredients in the bowl. Stir to make sure oats are completely covered.

Spread the mixture into a 13 x 9 baking pan. Bake at 325 degrees for about 30 minutes. Let cool and cut into squares. Enjoy!

* Farmer’s Daughter asked about cutting back on some of the butter and suggested applesauce as a replacement. I think this would probably work well and cut down on the fat. I plan to try it out the next time I make them. :)

Update 1/30/09: I made this recipe again, but this time used only 1/2 cup of butter and added 3/4 cup of mashed ripe bananas. This worked really well. It cut down the fat and the squares held together a lot better and were a lot less crumbly. And they are delicious!

Fill ‘er up: Reusable water bottles

According to Wikipedia, Americans buy about 28 billion water bottles a year. 28 BILLION WATER BOTTLES! Does that number freak anybody else out just a little? What’s also alarming is that 80 percent of bottles end up in landfills. It all seems like such a waste (literally) when there’s an easy, cost-effective, and eco-friendly alternative available – refillable/reusable water bottles. These days, when living “green” and being “eco-friendly” are all the rage, there is certainly no shortage of refillable water bottles on the market to choose from.

Water bottlesThere are a lot of things to consider when selecting a reusable water bottle. Do you want plastic, aluminum, stainless steel or even glass? If you choose plastic, is it BPA-(Bisphenol A)free? Do you prefer a biter valve or a straw or neither? Is the bottle spill-proof? Does it fit in a cup holder? Is it dishwasher-safe? How much does it cost?

This week I’m going to take a look at a few of the adult water bottles on the market. In a couple weeks, I’ll be tackling water bottles for kids.

Despite that it’s made of plastic, my personal favorite water bottle is the Camelbak BPA-free Better Bottle with a bite valve. My husband, our two kids and I each have one of these bottles (each a different color) and they go with us just about everywhere – out to eat, on walks, anytime we go anywhere in the car, to parties, etc. Seriously, ask my friends, I have it with me everywhere I go. I heart my Camelbak.

Everyone has their thoughts on what makes a water bottle right for them. Melissa at Nature Deva recently wrote about her Quest for the “Perfect” Water Bottle and put together a list of criteria the “perfect” water bottle should meet:

  • BPA-free
  • Double-walled stainless steel
  • Straw top
  • Cover for straw
  • Non-leaking
  • Attractive
  • Fit in my car’s cup holder
  • Hold more than 2 cups of water
  • Reasonably Priced

Melissa was recently able to find a bottle that met everything on her list and has declared the (drum roll please) Intak Steel Hydration Bottle by Thermos to be the “perfect” water bottle.

Tiffany at Nature Moms Blog is also a big fan of Thermos and their the Intak Water Bottle. Tiffany says, “I have always had a favorite water bottle and his name is Mr. Klean Kanteen. But step aside Klean because you may have been replaced. Okay maybe not replaced, but you will now have to share your coveted position in my cupboard. Make room for the sleek and ingenious Intak by Thermos.”

In her post Reusable Bottles: BPA-Free for Everyone, Tiffany reviews bottles by Thermos, Klean Kanteen, SIGG, Camelbak and Nalgene.

Over at Eat Play Love in her post Plastic Water Bottle Alternatives, Denise explains what the different types of plastic are and which to avoid, how to wash your plastic water bottles, and reveals her favorite water bottle – hint, it’s not plastic at all.

Jessica who writes at Shine lists 5 eco-friendly water bottles to reuse, rehydrate, refill. Making the grade are a $22 aluminum Sigg bottle, a $20 Sigg flask, the $10 Camelbak Better Bottle, a $30 Klean Kanteen, and a free (or nearly free depending on where you get it) glass jar with a lid.

Another stainless steel bottle not previously mentioned is the Think Sport water bottle, reviewed over at The Soft Landing.

If you haven’t taken the plunge into using a refillable water bottle yet due to concern about the safety of your tap water, check out the post Green Resolution: Info about Tap Water from the OC Family.

A recent study by the Environmental Working Group found a surprising array of chemical contaminants in every brand of bottled water they tested. Unlike tap water, where consumers are provided with test results every year, the bottled water industry does not disclose the results of any contaminant testing. In addition, there is increasing evidence of adverse health effects tied to Bisphenol A, or BPA, a widely used chemical in the manufacturing of plastic polycarbonate bottles, including water bottles.

There you have it. Lots of different water bottles with lots of different options. So tell me, what’s your favorite or if you’re still buying disposable water bottles, are you considering switching to a reusable?

Related posts:

Cross-posted on BlogHer

Photo credit: Eat Play Love

Great Green Goals for 2009

I was rereading a post I wrote at the start of 2008 – Living Green past and future – where I outlined the things I’d accomplished in 2007 toward living a greener lifestyle and then added more eco-friendly things I hoped to accomplish in 2008. This year I’m going to do the same thing and Great Green Goals for 2009invite you to post about your green goals for the upcoming year too. If you write a post and link back to this one, leave me a comment with the URL and I’ll add you to a list at the bottom of this post.

First, here were my goals for 2008 and my comments on how I did beside them in italics:

Green goals for 2008:

  • Grow a bigger garden – Did it! I grew tomatoes, basil, green beans, carrots, strawberries, zucchini, and yellow squash.
  • Possibly join a CSA to eat more locally and shop at the farmer’s market – Did not join a CSA but I did learn more about them and picked up a friend’s CSA share one week (when she was out of town). And I did some of my shopping at the farmers’ market.
  • Buy some cloth diapers that can stand up to Julian’s nighttime pees and stop using disposables (7th Generation) at night (We cloth diaper during the day.) – Yes and no. We stopped using 7th Generation dipes at night and instead stuff a Fuzzibunz diaper with a prefold and a gDiapers insert (which are biodegradable). Not the perfect solution, but better than where we were at.
  • Learn how to can foods – YES! And here’s proof. I canned three types of jam/jelly, spaghetti sauce and pear sauce in 2008.
  • Learn how to make my own yogurt – YES!
  • Read “Animal, Vegetable, Miracle” – No, and don’t even have it yet.

In 2008, I also:

  • Made my own butter.
  • Started using a clothesline to dry our clothes/diapers (at least some of the time).
  • Started using an eco-friendly dish soap.
  • Bought a dehydrator and dehydrated apples, nectarines, and strawberries.
  • Joined a food co-op.
  • Started using a Moon Cup (like a DivaCup).

As for 2009, my green goals are as follows:

  •  Grow a bigger garden still! Although my yard is small, that is not the problem. The problem is that we have three large trees in our backyard that block out most of the sunlight. I’ve been trying to figure out if there are some places in my front yard that get good sun where I might plant some veggies, but we have a lot of trees there too. The only places in the front yard that I can think of that aren’t shaded are right by the sidewalk. We don’t have a ton of foot traffic on our street, but I’m not sure I want to dig up the yard to plant veggies when we want to sell the house in the next year or two. Hmmm. I think I might have to do some container gardening in addition to the small garden I already have.
  • Join a vegetable seed co-op.
  • Can more than last year.
  • Dehydrate more than last year.
  • Bake my own bread more regularly.
  • Continue to move away from the use of plastic and be mindful of plastic packaging.
  • Learn how to sew using my mom’s old sewing machine.
  • Read The Omnivore’s Dilemma (which I already have) by Michael Pollan
  • Learn more about ownership and care of backyard chickens (as our chicken crusade plods on)
  • And, of course, continue with all of the other things I’m already doing.

Now it’s your turn. This isn’t exactly your typical “Green Challenge,” but it is kind of similar. Write a post telling me your green goals for 2009, leave me your link and I’ll add it to the list below. (If you link back to this one, that’d be great too.) Or just leave me a comment telling me what your goals are. I’d love some more ideas! :)

Other bloggers making green goals for 2009…

20/20’s Extreme Motherhood falls short, disappoints

As I found myself watching and live Tweeting the 20/20 episode on Extreme Motherhood on ABC Friday night, I felt disappointed that once again mainstream media had let me down. It didn’t come as a complete surprise, but I really had hoped for better from them.

The show, for those of you who were occupying your time with better things (wise choice), consisted of segments on Orgasmic Birth, fake babies – women who buy Reborn dolls and treat them very much like real babies (um, yes, it was more than a little freaky), long-term (extended) breastfeeding – including a mention of 2 1/2 yr old twins still nursing (uh, what’s extreme about that?) as well as a few older children, serial surrogates, and home birth. The majority of the time seemed to be spent on the fake babies and the serial surrogates, with lesser amounts devoted to the rest. The least amount of time (and what I felt should have received the most) went to home birth.

The home birth segment had very brief interviews with Ricki Lake and Abbie Epstein (producers of Business of Being Born) and Laura Shanley (author of Unassisted Childbirth). There were no interviews with any midwives. There was no talk of the training midwives go through or the preparation that women who choose unassisted birth generally undertake. It all seemed very much focused on fear rather than offering up real information. The AMA says blah, blah, blah – nothing we haven’t heard before.

One of my main issues with the show was that it was not objective journalism at all. The correspondents spewed a lot of shock value comments instead of asking intelligent, thought-provoking questions. Maybe I’m naive to expect better from them.

twitter fail whale for 20/20Overall, I have to say I’m sorry I wasted my time watching it. I felt it was very exploitative. 20/20 gets a big ol’ Twitter Fail Whale from me. I don’t feel the show gave much, if any, useful information, except maybe some women will seek out Business of Being Born or Orgasmic Birth (which has a lot more to it than the name implies) after watching 20/20.

For those of you who are looking for some real information, you might be interested in reading my thoughts (and others’ thoughts) on orgasmic birth – Giving Birth can be good, ecstatic and even orgasmic or long-term breastfeeding Breastfeeding until age 3, 4 or 5 – more common than you think? – including a list of moms who have breastfed older children. I’ve also written about planning for a home birth and my home birth story.