- Babies who are automatically taken to be weighed and assessed before skin to skin. Make sure staff know you want your baby placed skin to skin immediately. As long as there is no medical emergency, baby can be assessed while in skin to skin, weighed, measured and the full assessment done after the first feed.
- Glucose checks on babies who aren’t showing symptoms but are at risk for problems with their blood sugar level such as babies who are larger or smaller than average, preterm, or born to moms with any form of diabetes whether or not they take medication for it.
The checks themselves are a good thing. The policies surrounding them can be problematic because there are disagreements on what number constitutes low blood sugar and when to perform them. Baby should be allowed to feed first and then have at least 30 min to start digesting the colostrum. If baby is uninterested, ask for lactation assist, or possibly use hand expression and an alternative feeding method.
If baby is showing symptoms (irritable, jittery, sweating, low temperature), the glucose did not rise adequately with the feeding, or the levels continue to be unstable and baby needs supplementing, ask for an alternative feeding method - formula does not have to be fed by bottle - then start expressing your colostrum frequently.
- Jaundice – 100% of babies will experience a temporary elevation in bilirubin levels though not all will turn yellow or need treatment. A baby’s liver is brand new to digestion itself and life without an umbilical connection to mom. Also, meconium is saturated with bilirubin and babies who aren’t getting rid of it fast enough can start reabsorbing bilirubin from the gut, too. Many babies get a yellow tinge to their skin which can take some weeks to resolve. This is the bilirubin getting trapped there, where they can’t metabolize it easily. You can’t tell how high bilirubin is by looking at a baby though and most places are testing all babies before they go home. If bilirubin is rising too high or too fast, a baby may need to be re-evaluated sooner than the 2 weeks check-up, or they may need treatment by being exposed to blue light. For lack of a better word, the light re-dissolves the bilirubin so babies can eliminate it in their stool.
How is this a problem to breastfeeding? If pediatricians aren’t aware about the current thinking that bilirubin has a protective aspect and the AAP’s higher treatment thresholds, they use old school thinking bilirubin needs to be “flushed” from the system by giving formula, and limit time at the breast in favor of time under the lights.
Testing is also done at 24 hours. This is right when second night syndrome kicks in, so babies protest the separation with a lot of crying and cueing! They still need contact and cluster feeds! At higher levels, jaundice can also cause a sleepier baby (unless its nighttime) who may start feeding less effectively, starting a cascade of getting dehydrated, which worsens bilirubin. And a super-high bilirubin can cause an irreversible condition called kernicterus.
What to do then? Early, frequent feeds, making sure baby is effectively transferring colostrum, utilizing hand expression and alternative feeds if they are not. If baby needs treatment, asking for a bili blanket instead of overhead lights or blue blocking sunglasses so baby may be fed and comforted while both of you are under the light. Ask to supplement with expressed colostrum or banked human milk if medically indicated.
- Separation – babies who are taken to a nursery for “transition” or any other care or assessment. Babies do best with mom and moms tend to relax more when they are with their baby. Babies who are separated cry more, have their early feeding cues missed or ignored then shut down and don’t feed well, have more trouble maintaining their temperature and thus more problems with glucose. They are more likely to have early pacifiers and supplements. I’m not talking about babies who need stabilization or critical care but normal newborns. Ask for 24-hour rooming in if your facility doesn’t already do it.
- Maternal meds – many really are ok. Have an IBCLC look it up in Medications and Mother’s Milk by Dr. Hale or contact them yourself at www.infantrisk.com 1-806-352-2519 or the app is mommy meds and costs a small annual subscription.