New NICE guidelines on jaundice - formula?

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I'm training as a BFC with the NCT and today at a drop-in, came across a mother who had a baby who'd had what sounded like mild jaundice. (I wasn't seeing the mother in any official capacity, but sat in.) The MWs at the unit she gave birth in reacted rather extremely - they said there were new NICE guidelines in treating jaundice in newborns, and after a bilirubin test they gave a day-old baby formula because obviously, the mother was still producing colostrum and they said the baby needed 'food' to clear the jaundice.

She, meanwhile, was told to express, and ended up developing mastitis. She was confused and upset about this advice, but felt she had to follow what they were suggesting because she had a day-old baby and no experience of breastfeeding.

I've tried to track down these new NICE guidelines - I www.nice.org.uk/nicemedia/live/12986/48578/48578.pdf think these are they - and I can't see anything that says that a baby with mild to moderate jaundice should be given formula rather than allowed to breastfeed normally and wait for the colostrum to change to mature milk. This MW unit has UNICEF accreditation, by way way, and I don't understand why they were intervening in a case like this, that the mother said wasn't serious. (The baby wasn't hospitalised, so I presume it can't have been severe jaundice.) She feels that it got in the way of establishing breastfeeding, and is sure that the expressing she was told to do caused her mastitis.

Any thoughts on this? I was rather alarmed to see mild jaundice treated like this - DS had mild jaundice, as many babies do, and I was just told to breastfeed regularly and frequently, and to keep him close to the window!

(and sorry if my comment 'they gave a day-old baby formula' comes across as judgy or anti-formula. Not intended to! It's just that this woman wanted very much to breastfeed exclusively and knew that colostrum was great for her baby, and didn't see why he was being given formula instead.)

hmmm...very strange.

Isn't it? I mean, clearly I'm not medically qualified (and I'm not even qualified yet as a BFC so I'm in the dark here!) but it seems very dodgy. The mother said that one of the MWs there (a renogade??) sniffed at the treatment and said that if the baby hadn't been given a bilirubin test because they suspected jaundice (this recommendation has only just come in, with these new guidelines) then this wouldn't even have happened.

I agree with you. I too was just told to breastfeed as much as possible. Also, I was looking forward to getting out of hospital ASAP and go to a more relaxed environment where they don't contantly bother you with questions such as "has he done poo/wee yet?" and "no? ok let's do a glucose test. Oh it's marginal". If the test is not good they tell you to bottlefeed. And I could hear women giving the same negative reply about the nappies, but because they were bottlefeeding I think, they were never asked for baby glucose test to be done.

My last baby was screaming because he ABSOLUTELY HATED colostrum and I was full of it. He wasn't even making serious attempts to drink it. He would drink a bit then smell, lick me and and expression of "..bliah". I was feeling so sorry for him but after starving he had to drink it. I was determined not to give him any "supplement" because proper milk comes only if the baby continues to drink, so he HAD TO make an effort. Eventually after a few days the right side produced milk and then he was happy and content. But the left took more than 10 days to produce proper milk from the left side and my baby was still refusing to drink from that side, apart from tiny bits. I could tell from the colour of my left breast pad which was yellow that it was colostrum.

I think that some babies really dislike colostrum and keep crying and you get the false impressions that a) they have wind b) they are clingy c) the mother doesn't have enough milk! Personally I tried to express milk after 30 days and I couldn't do it, but I knew I was producing milk. It was a hand pump though, but still it was not a good indicator of me producing milk. At 3 weeks he still had mild jaundice and the midwife said herself without even being asked that I should NOT use bottles because mild jaundice is very common in breastfed babies and it's alright.

All my babies btw have put on weight very fast which has surprised people a lot since they all ask "don't you use supplements? WHAT??" Why does everyone think that breastmilk is not enough?? It contains more fat so it makes sence that babies gain weight quicker.

I am also sceptical about the poor woman having developed mastitis. Could it be because she had to bottlefeed so she had to skip breastfeeding sessions? I know that with a first baby if you skip a few meals the pressure from the milk supply that builds up is IMMENSE and UNBEARABLE. I once skipped 2 meals because I had fever and didn't want my baby to get ill (although breast milk would actually pass antibodies!) and within 6 hours I was in agony, almost crying. So for the next feed, I put my baby down and said "now, you've got to empty this to help mum get better!". It felt a lot better :)

I presume she was told to pump because she wanted to bf and therefore had to keep reminding her breasts to make milk. I'm not sure if it's why she got mastitis - my thought was that if she was using a hard cup or one that was placed badly, she could have got a blocked duct quite fast. But I don't know.

According to the NICE guidelines, babies are more likely to get and stay jaundiced if they are breastfed, and the chances of getting 'significant hyperbiliribinaemia' are increased if breastfed. Though if breastfeeding is the biological norm, presumably we've all survived this so far!

I have experience of this because I had to do it with DS1 a few years ago. To be honest, it did the job and by 6 days old he was exclusively breastfed so it didn't interfere with that.

He had a traumtic forceps birth, became jaundiced and very sleepy, wouldn't latch on for more than a couple of minutes at a time and had no energy to feed so it became a vicious circle.... I used a double electric pump, and for every feed I would firstly try to get him to bf, then feed him what I had expressed previously, then top up with formula. By day 5 he suddenly 'woke up' and started to breastfeed brilliantly. I wouldn't knock it - it is obviously worth a try in some cases.

By the way, I atsrted off feeding him milk from a cup but he only took a few mls at a time and it took so long, he still wasn't getting enough fluid, and I was getting no sleep due to endlessly trying to get him to feed or pumping!

My DS was jaundiced at birth and ended up under a phototherapy lamp for 24 hours. The hospital were very unsupportive regarding breastfeeding; I remember having an argument with a nurse from SCBU who threatened to take my baby away unless I agreed to give him formula.

I very much suspect that the desire to give formula was more about being able to measure and quantify intake rather than a preference for formula over breastmilk, but it left me very distressed at a time when I felt very vulnerable.

The experience with the SCBU nurse was a large factor in be becoming far more assertive about my birth choices and preferences second times around.

Ok, it seems I don't have enough ecperience with expressing milk. But I remember being kicked there by my son and I was honestly in tears. My husband asked me why I was crying and I answered "because ..he hit me ". Now I find it so funny! Ok back to subject, having being hit there didn't develop mastitis for me, so I must be very lucky. I remeber applying mild pressure so it woudn't stop the baby from breathing and the midwife stopped me saying that it could cause mastitis.

And again I agree with you, not just the last one but other midwives had told me that breastfed babies develop more jaundice. Is it because the fat content of breastmilk is higher (to help them develop their brain, store fat etc.) so the water content is lower than cow's milk? I have been told that if you get the baby to pee more he can significantly improve. So more feeds, more wet nappies. I have even been adviced by elerly people to give water in such a case. I tried it with my first baby at 3 weeks and worked. Of course I am not trying to tell you that everyone should give their young babies water, I am just mentioning that I have been told.

I also believe that the art of breast feeding had been lost and we are trying to redescover it. In my mum's generation so many women were bottlefeeding. I was bottle fed because there was no other way. So when a woman starts to breastfeed she doesn't have many people with breastfeeding experience (apart from having read their m/w books) to advice her against what the books say. Even people who had pressumably breastfed their children admitted to having mixed bottles as well to reduce.. jaundice. And then I was thinking "oh but you had said otherwise, right!". For example the leaflets they give you say that if you hurt (and I am not talking about the contractions that close the uterus) there must be something wrong with your technique so you should remove the baby and try again. But guess what?? I was suffering for the first 2-4 weeks! Sore nipples! I was reassured by my MIL that this is normal. And then I asked other women and they told me the same. It takes time for the pregnancy hormones and their effects to subside.

littlemisslozza
My first baby although born without any special aid only woke up after 3 days! You can't believe what I could here from my own environment about him being too sleepy, I was "obviously" not producing enough milk, I was again ..obviously "ill" so I was "passing the illness to him" etc. He was crying, sleeping, waking up after 5 minutes to drink more milk. The same story as yours. But your milk came even though you added bottles! I am sure it can work, but in my case I was so scared of interfering with bottles and having my milk supply diminish! I know everyone is different but I just didn't know whether I was one of those women who if they do mixed feeding and their milk supply stops or not.

llareggub
Are you sure that it wasn't mostly their desire to tick the boxes? I have heard of women decades ago who had children in the special care unit and jaundiced that they would take them to the baby a couple of times a day to breastfeed. Nowadays it seems that the quality of care has decreased and many of us are left scared feeling we have no choice over what is beneficial for our children :(

when ds (3,5 years ago) developed jaundice a day after birth, still in hospital, the consultant told me to put him on my breast every 2 hours until the milk comes in. also to check for tiredness (a bit daunting when you don*t know how much sleep is normal when newborn sleep a lot) and to strip him down to his nappies and put him in the window sill during mid-day. jaundice was gone after a week.
I think I read that jaundice is caused by red blood cells that have died and need to be swept out of the system via the kidneys. for that baby needs to wee and only colostrum might be too little liquid to achieve that.

ninani
Sorry to hear you had problems too, it's such a worry going through that.
I too was worried about what might happen when formula was introduced, and whether my baby might then get 'nipple-teat confusion'. I turns out that he didn't really care where his food came from thankfully as once he had 'woken up' he exclusively breast fed .

You mention that you were worried about your supply diminishing and I know that the baby is the best thing to establish it, but the key difference was that I was expressing as well. If I hadn't been expressing it's unlikely I'd have been successful in breastfeeding.
My first few days in hospital went like this....
every 2-3 hours I would wake him up (he didn't wake for feeds very often), strip him off, try to get him to latch on. Occasionally succeed but not manage more than about 2 minutes. Feed him what ever I had expressed previously. Feed him formula until he had had enough. Change his nappy etc, cuddle, put him in his cot. Use the electric double breast pump to get whatever I could. Put in fridge til next feed. Try to get some sleep before it had to be done all over again (often not very long at all). That electric breast pump stimulated my supply so much I was leaking copiously for weeks afterwards, but it did the job!

It was wonderful when DS2 fed with no problems, so easy in comparison but then he didn't go through a traumatic birth.

I thought most babies had jaundice after birth to some degree? Well at least it's really common. Midwife barely mentioned it to me, simply put it in his notes to check for in a few days. I think the presumption was that I was going to feed him anyway!