Why do jaundiced babies have to be given bottles? Sorry long post :(

[Fredfred]

This is a difficult subject to write about for me as I have many feelings of guilt and anger still associated with it, but I really want some answers so I hope that you can help me. Sorry this is going to be long.

I am one of 6 children and we were all ebf until at least 6 months and some of us until the age of 2 years. Therefore it seemed only natural to me that when I had my own children I would ebf. So much so that when I was pregnant with DD1 I didn't buy any bottles or formula in preparation as I just assumed I would ebf.

Well, DD1 was born over 2 years ago following an extremely traumatic labour from which I suffered PTSD. Among other things I had a pph and had 2 blood transfusions (4 units). As a result my milk was extremely slow to come in. DD1 latched on fine and bf was going well, or so I thought. Within hours she developed extremely severe jaundice (probably as a result of the ventouse that was used to get her out on 7 separate attempts- NICE guidelines are 3 attempts I think, but that is another story). Anyway, she was put in an incubator and I was told that as she had jaundice she would have to have top up feeds. I was told that she could have donated breast milk as I didn't want her to have formula (we have lots of allergies in my family). I told the midwife that I had read and been told that giving a baby a bottle if bf was not established could lead to confusion and difficulty with bf. She said 'there is absolutely no evidence of this'. I was too exhausted and drained to argue, so they gave her a top up bottle after every feed. I was told to express every 2 hours which was completely soul destroying as absolutely nothing came out, not once in the week that I was in hospital did I manage to get a single drop from expressing and all I got from the midwives were looks of disbelief when they saw nothing was coming out. :( I did know that DD1 was getting milk though as I could see it round her mouth when she was feeding, but because nothing came out when I was expressing the midwives wouldn't believe me and continued to give her top up bottles.

Well done if you have read this far!

Well, to cut a long story short when we finally got home bf was a nightmare. DD1's appetite had been artificially increased by all the top ups. As well as this I wasn't producing enough milk because of the blood transfusions. She would scream in hunger and I was left sore and bleeding from letting her suck even when there was nothing there. Plus when I tried to feed her she would arch her back and pull away- she didn't want me, she wanted a bottle. This carried on for a week and I saw breastfeeding counsellors and went to a support group before I just couldn't take it anymore and gave her a bottle for one feed. Well, it was amazing, she stopped crying and fell asleep for the first time. From then on, trying to bf was so hard as each time she just wanted a bottle, so I used to trick her by getting her to suck a dummy and then pull it out and put her to the breast quickly which was the only way I could get her to feed. My milk supply dwindled and I had to feed more bottles. I mixed fed for four months like this. By four months I was only BFing at night and by five months my supply just stopped. I had continued to express to try to keep my supply going, but it just didn't work. To add insult to injury, the formula feeds caused her to reflux and she continued to have reflux until she was 11 months old (including with solids- yuk).

Now that I have had DD2 (born 5 months ago) who had no problems and is ebf, I keep thinking of what could've been with DD1 :( It seems to me that so many of our problems were because she was given a bottle so early on. My mother used to be a nurse and told me that jaundiced babies that were going to be bf used to be given sugared water and this could be given from a cup. I mentioned this to the midwives at the time, who said they had never heard of such a thing. I am racked with sadness and guilt over the fact that I couldn't ebf DD1, especially as she has bad eczema. So my question is why do they have to give jaundiced babies bottles? I just don't understand :( I know they have to have extra fluids, but why from bottles?

Sorry for the long post, but I have found it very hard to get past this. :(

I'm really sorry you're feeling so bad about the situation. I can't address all your questions, but can only share what happened with me and dd2. She was early, and quite jaundiced, so had to have the lights treatment. I wasn't allowed to feed her fully on demand simply because that would mean she ended up out of the lights for too long - I could take her out to feed for about 20 mins every two hours. She had tube top-ups (with EBM, I was able to express by bringing the pump to the bedside, were you offered this option?) rather than feeds from a bottle.

So I can't really answer your questions but I am surprised they insisted on a bottle for the donated milk rather than tube feeds - not much fun for the baby but avoided any danger of getting stuck on bottle rather than breast feeding.

I think you had absolutely rubbish rubbish support and you should not feel guilty for having been given a rough start.

Did they offer cup-feeding as an alternative?

My DN had jaundice as a newborn. SIL was breastfeeding and not sure what to do - was told to give formula bottles until the jaundice flushed out. Did so initially (until they let her get the hell home) but we both researched like crazy and read somewhere that the laxative effect of breastmilk and regular frequent breastfeeding would probably do the job of flushing out at least as well, and she also cup fed expressed milk. She was able to express at home, relaxed and without scrutiny. DN took a while to 'wake up' after the delivery (ventouse, 4 weeks early) and until then was worrying for SIL as he was so sleepy was difficult initially to initiate feeds. But wake up he did, and the jaundice went.

She had ace support from BFC at the hospital who, when DN went in at 1 week with a little jaundice and having lost more than 10 percent of birthweight, was great at reassuring her and acting as an advocate for breastfeeding rather than leaping into top ups.

I am really really sorry that you were let down. You'djust given birth and were vulnerable and of course you would take the advice of HPCs. I do think confidence comes with baby No. 2 and beyond. It did with me. I was all over the place after I had dd, whereas with ds1 and ds2 I knew the score more, and was better able to be my own advocate.

I think you need to take comfort from the fact that you did bloody well with mixed feeding and did your absolute best for your dd. And also remember that each baby is different.

My ds was jaundiced too but it sounds like he was less severely so than your DD. We were in hospital for 4 days after the birth and he was in a lightbox by my bed, I was told to take him out to feed him at least every 3 hours.

My milk didn't come in til after we left hospital - he did have some urates in his wee and it took a while for him to start pooing, but I wasn't told to top up at all. But it does sound like his case was less serious than yours.

Thanks for replying jumpjockey. No I was made to go the the expressing room to try to express. On the last day one kind midwife brought an expressing machine to my cubicle as I was feeling so low and she thought I could do with some privacy. I wasn't allowed to take DD1 out of the incubator for more than 20 mins every two hours to feed either and when I did she had to have a UV light thing against her skin the whole time. :(

Sorry you had such an awful time. Just wanted to say that I EBF my DD1 and she still has bad eczema, so don't feel guilty, probably wouldn't have made any difference!

Thanks for the replies.

Pooka, no cup feeding wasn't given as an alternative or I would've jumped at it. Thanks for your kind words.

Oh yes - ds1 has bad eczema. DD and DS2 don't = all 3 fed the same. Also ds2 puked constantly for about the first year. I remember sobbing at 10am when he'd just puked over his 4th change of clothes (neatly circumnavigating the ubiquitous bib).

They couldn't be more different, my 3, even with the same feeding method.

Maybe DD1 would've had Eczema and reflux anyway then. [sigh]

Thank you.

I have some experience of this too, although it doesn't sound as if my DS1 was as jaundiced as your DD.

DS1 was born by forceps after a failed ventouse and shoulder dystocia, very traumatic birth and he was very battered and bruised. He was very sleepy and although he did latch on after birth for a few sucks, every time I tried to feed him he just fell asleep, it wore him out. I did try cup feeding for the first two days, along with frequently putting him to the breast and expressing although very little came off until day 5. The cup feeding was not a success, it took an hour to get about 10ml down him, hardly anything. Tried little syringes too to drop it in gently but that didn't work either. After 3 days he was becoming more jaundiced (although not enough to have to go under the lights, we just had to move by a window) and still too sleepy to feed. The paediatrician decided that I needed to offer him the breast, then feed him what I had expressed previously (via syringe), then offer formula top-up to get fluids through him. By the time I'd fed him, them expressed it was almost time to start again!

By day 6 he 'woke up', his jaundice was improving, and he was breast-feeding for longer and hardly needing any formula. I stopped that the next day as he was feeding so well. I had been so worried about nipple-teat confusion but it wasn't an issue in this case, but I know from others that it can be. I was lucky that he then bf exclusively but he would take a bottle (of expressed milk or formula) happily if I needed to leave him occasionally. Perhaps that was just a personality thing and he didn't care where he milk came from as long as as he was fed?!!

I think that you shouldn't beat yourself up too much about it, DS1 also has a bit of eczema despite being ebf for 9 months (except those first few days), I'm sure genetics play a bigger part in that tbh.

Does anyone else with a jaundiced baby know if they were born in a "Baby Friendly" status hospital? I wonder if that has some impact on whether they prescribe formula/bottles for jaundice.

Thanks littlemisslozza, it's good to hear other experiences similar to mine. Reading what you say about the cup feeding, maybe the reason they insisted that I bottle fed DD1 because they knew she wouldn't get enough fluid if I cup fed her. I do know that her jaundice levels were 'dangerously high' whatever that meant because they said so, so maybe they needed to be sure that she was getting in enough fluid. She slept continuously the whole time we were in hospital.

I do try not to beat myself up over it, but this has weighed heavily on my mind for 2 years now and now that I have been able to ebf DD2 I feel guilty that I couldn't do the same for DD1, like I have let her down or something :( So stupid I know, but I can't help how I feel.

What is a 'baby friendly' hospital?

My BF DD had eczema and reflux, my FF DS had eczema, but not as badly, and didn't have reflux. In fact DD's reflux was worst when she was EBF, and when I started MF was not as bad!

It sounds like you had a really bad combination of circumstances to start off with. I would think the biggest problem for you was actually your lack of supply due to the transfusion, rather than the bottle. DD took bottles of BM from the start without it causing a problem. With DS I had been very ill in the run up to having him and I'm sure that impacted on my supply so I ended up topping him up and like you ended up in a vicious circle that ended up in me FF him.

I think the difference for me was that I knew before I had him how ill I had been, and that there was a chance it would make it harder. I had decided in advance that although I'd give it a try I wasn't going to jeopardise my own recovery by pushing it to make it work so I was ok about turning to FF. I think you need to be kinder to yourself about it. It sounds like you did everything you possibly could. And don't assume that the reflux and eczema have anything to do with it. Chances are she would have been affected anyway.

I work in a baby friendly hospital and we'd give forumula in these circumstances but it would be cup feeds not bottles. However even before we were baby friendly we only used cups, thats for at least the last 6 years that I've worked there and probably a long time before. So its not like its new research.

Even if a hospital isn't baby friendly status then they should still follow best practice, etc and I'm shocked that midwives would give breastfed babies a bottle rather than a cupfeed.

Please don't feel guilty though - its not your fault. You did question it and was told something that was not right. Its not your fault the milk didn't come in well at first - thats quite normal after a bad bleed. It sounds like you were also given poor support/advice to get your milk supply to increase - again not your fault.

I'd be very tempted to write to the hospital. Hopefully their practice will have changed by now but if it hasn't then letting htem know how badly their outdated practice affected you may make them think about what they're doing.

Thanks mouseanon , I am sure that the transfusions played a big part, but I can't help feeling that if she had never known a bottle then she wouldn't have been so difficult to BF. I literally had to trick her into latching on by using a dummy, she would not voluntarily latch on no matter what I did, even if she was starving hungry. I'm sure that the fact there was an easy supply of milk in the bottle, but that she had to suck and suck for ages due to my lack of milk supply definitely contributed to this though. :(

vivaLeBeaver Thank you. You are the first (qualified I am assuming from your post) person who has said that it was not right to give a bottle. Their practise has not changed. DD2 (5 months) was monitored closely from birth because of DD1's severe jaundice and I was determined not to let history repeat itself this time, so I asked if she would have to be given top ups in a bottle if she needed them and was told yes. I then said specifically 'can she not be given top ups from a cup' and the midwife said 'we used to do that a long time ago, but we don't now, so yes it would have to be from a bottle' at which point I burst into tears!

I had DS seven years ago in a baby friendly hospital. He was jaundiced (difficult labour, ventous delivery) and struggled to bf, under lights. he ended up having lots of formula top ups by cupfeeding. so although the cups avoided nipple confusion, the level of formula given did scupper my supply (I tried to express as much as possible but it was gruelling, as so little time between feeding/expressing till next feed due! ) which caused problems as I was encouraged to exclusively bf on discharge from hospital, rather than try and phase out the formula gradually.

One thing that really shocks me about your account is them making you go to a separate room for expressing!

We were readmitted to hospital on day 4 as DS had jaundice but also had low blood sugar and wasn't waking up to feed. He didn't need to go under the lights but we did have to give formula top ups - and this was automatically done by bottle. I was in a right hormonal weepy mess and not really in a fit state to question it. We were in a private room with a decent pump so I was able to express as well, which was good. My hospital doesn't yet have baby friendly status.

Luckily in my case we were able to get back to EBF within a few days as my milk came in, and the infant feeding coordinator showed me how to finger feed using a tube so we actually only used bottles for a couple of days. After a couple of weeks I stopped the top ups and we were away. I know how lucky I was that we were able to get to EBF and how easily it might not have been the case.

Thanks totalchaos maybe it would have been difficult even if I had cup fed her. Yes, the separate expressing room was horrid. I found it one of the worst bits. I actually found it humiliating as well as boring having to sit in a room staring at a wall for 45 mins with a machine attached to me out of which nothing was coming. The whole thing was absolutely awful. I actually didn't realise until your post that it might be unusual to have an expressing room.

I am so glad I posted on here. I have been thinking about it for a while, but wasn't brave enough as it is such a difficult topic for me. It is so nice to read all your comments. I wish that I had discovered mumsnet 2 years ago and posted at the time this was all happening. Thank you all. x

I had DS nearly 5 yrs ago. Was a straightforward delivery, but he developed jaundice and was getting sleepier and sleepier, we were admitted to hospital when he was 5 days old (had also lost more than 10% of his birthweight). The MW who came to see us at home mentioned topping up with a bottle, but we went into hospital instead.

Once in hospital (which as far as I know has Baby Friendly status) formula and bottles were not mentioned. DS was under lights, I was instructed to take him out every 3 hrs to feed, then to express after every feed. Staff gave him 'top-ups' of my EBM by cup. After 24 hrs he came out of the incubator and we went home after another 2 nights.

So sounds like the jaundice was not as severe as in your case, also I was in good health and had plenty of milk - DS was just too sleepy to suckle properly.

Fredfred sorry to hear you had such a hard time. But please don't feel guilty. Specially with a first baby and after a traumatic birth and exhaustion you just do what you are told... there not much brain and energy to anything else.

I'm not sure if "my" hospital was a baby friendly... but perhaps it was. My DS was born at 35weeks and we stayed over a week in hospital. Although he was healthy and didn't have any breathing problems he was very jaundice, and around day 3 he had to be under the lights for 4 days. I had to wake him up every 3 hours, take him out of the incubator/lights, BF him and I had to give him a formula top up on a cup feed (20ml). But I always thought it was because of his low weight and no one ever mentioned it was because he was jaundice.

I don't think the hospital I was in has baby friendly status, I just googled it! Strange as it is a well known hospital with a big neonatal unit and a milk bank- I would've thought it would have.

Formula doesn't cause reflux, nor does it cause exzema. Nor does formula artificially increase a babies appetite. The arching and pulling off the breast that you describe are classic reflux symptoms and not due to the baby preferring bottles to your breast. It s very very common to be unable to express anything like the volume of milk that a baby can achieve. Lastly, mix feeding between breast and bottle is perfectly possible, it can affect the mothers milk supply but in reality the bottles given over these relatively few days in hospital do not themselves negatively affect long term breastfeeding. The most likely alternative to giving a bottle would be to pass a ngt into your baby and this would've been pretty unpleasant for both of you. I know all about the disappointment of bing unable to breast feed successfully and the difficulties of having a baby in the scbu but "blaming" the medical team who were helping your baby to get better seems to me to be a bit unfair. I bet you are a fantastic mum in so many ways it seems a shame to be using energy being wracked with guilt about something outwith your control and which in the grand scheme of things actually doesn't matter that much. Breastfeeding is not the pinnacle of successful motherhood xx