What is jaundice?  
Bilirubin is a yellowish substance that is a byproduct when red blood cells are broken down. Red blood cells are always being broken down and replaced by the body. Bilirubin is normally broken down by the liver.  Jaundice occurs when bilirubin builds up faster than the liver can break it down and eliminate it from the body. Newborns have more red blood cells than adults and they begin transitioning from fetal red blood cells which have a unique hemoblogin to regular red blood cells after birth.

How common is jaundice in a newborn?
It is pretty common, 60-84% of  newborns born at term will experience some level of jaundice in the first week of life. It even has a name, physiologic jaundice because it is considered normal.
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How will I know if my baby has jaundice?
The newborn will start to get a yellowish tinge to the skin. It starts at the top of baby’s head and travels down the body through the torso. The whites of baby’s eyes may also start to take on a yellowish tinge.  Jaundice usually peaks between 2-5 days after birth, and  lasts 1-2 weeks.

Can jaundice become a problem?
Yes, in a small amount of cases, jaundice can be a problem.  Jaundice can be a sign of blood type incompatibility, whether due to rH factors, or blood type. If bilirubin levels get high enough, brain damage can occur. Thankfully, jaundice induced brain damage is rare.

What can I do to minimize jaundice?
Bilirubin is eliminated through the digestive system. The single most helpful thing you can do to minimize jaundice is to nurse baby frequently. I prefer that baby is nursed every two hours. Light therapy can also be helpful since sunlight breaks down bilirubin. Place baby where natural sunlight will shine with just a diaper on, or completely naked. Do this for 45-60 minutes 3 times a day. You could also consider having baby under a SAD (seasonal affective disorder) light if there isn’t a lot of direct sunlight in your home. 

New perspectives and understanding of jaundice  
In the past, blood serum levels of bilirubin were used to determine whether treatments were necessary, regardless of the age of the newborn. As the understanding of the normal trajectory of newborn jaundice has expanded, blood serum levels of bilirubin based on how old the newborn is should be used to determine if treatment is needed. Results from recent studies show that jaundice may be beneficial to the newborn, acting as an antioxidant and preventing illness from Group B Strep. As a midwife, I find it reassuring that the research is showing increasing evidence that physiological processes after birth may not be harmful but actually serve a beneficial purpose.

We have a lot of myths about postpartum which are perpetuated by many sources: TV, movies, social media posts, etc. Myths that Mom is going to have the time to get dressed and put on makeup, myths that life instantly goes back to "normal". Myths are interesting, but they are nowhere close to reality. It's time to talk about the reality of the first few days (think 5-7 days) postpartum.

In the first week postpartum, things to expect include:

• bleeding: this will be like a heavy period the first few days and will gradually begin to decrease
• sore bottom: Mom has just pushed out a human being, things are going to be a little tender to downright sore down there
• swelling: the tissues in your nether regions have been through a lot! Swelling is normal, it may take up to 24 hours to peak and should start to go down on day two or three.  
• moving around like a Great-Grandma: it is normal to feel the need too move very slowly as you get around. Mom may have sore muscles all over, like she just did a marathon and then climbed Mt. Everest.
• still looking pregnant: yes, baby is out but your body needs time to go back to your pre pregnancy state. Your uterus is slowly shrinking, organs are shifting back into pre pregnancy positions, and your stomach muscles are recovering from stretching out to support your belly in pregnancy
• tiredness: this is the one thing that the myths get right. Expect to be tired.  You will be waking up every 1 to 3 hours to feed baby around the clock. That will tire anyone out!
• heavy and leaking breasts: as your milk comes in, your breasts may start feeling like they weigh a ton. Leaking like anything between a faucet trickling and a fire hydrant when your baby cries is perfectly normal
• new fashion accessories: breast pads, diapers, belly support wraps or belts, nursing tops, or going topless are all going to be options Mom may want to try out in the first few days postpartum.

I share all this to prepare families. We glamorize pregnancy as a society, having gender reveal parties and pregnancy photo shoots. Pregnancy is beautiful and I don't want to discount that but...I feel postpartum is even more beautiful. Mom has given birth, an act that requires digging deep into strengths she has never tapped into before. Baby has arrived, and the same body that sustained the baby in pregnancy is sustaining the baby after birth, and doing all the things it has to do to shift out of pregnancy mode. That is absolutely amazing to me.   

Let's celebrate just how amazing Mom's body is after birth. Let's start having postpartum photo shoots, just like we do during pregnancy.  Slip into that adult diaper, grab your camera and take some pictures.  It's time to normalize, document and celebrate every aspect of postpartum!
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