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 are transitioning from fetal red blood cells which have a slightly different form of hemoglobin to normal red blood cells. That process begins right after birth. Their liver is just beginning to function so that makes them more susceptible to jaundice.

How common is jaundice in a newborn?
It is pretty common, 60% to 84% of all 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.

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 start to take on a yellowish tinge.  Jaundice usually peaks between 2-5 days after birth, and  lasts 1-2 weeks.

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. (Supplementing with formula does not clear out bilirubin any better than breastmilk so formula supplementation is not beneficial.) 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 20 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 sunlight in your home.  

When should I be concerned about jaundice?
In between postpartum visits, these are things that would indicate baby may need some help:

• Baby has yellow skin within the first 24 hours after birth
• Baby becomes jaundiced around 3 weeks old
• Baby has yellow skin below the knees
• Baby is lethargic
• Baby is not having wet or soiled diapers.  Baby should have wet diapers equal to how many days old they are, and should have some soiled diapers as well.
• Baby has lost more than 10% of birth weight.

Can jaundice be a problem?
Yes, in rare cases, jaundice can be a problem. There is breast milk jaundice, and pathological jaundice, often caused by blood type issues. These types of jaundice are typically recognized by when they appear, or how long they last. Both types are easy to treat if they are recognized and treated early.

Summing up
Jaundice is pretty common in newborns. It is also pretty easy to address with frequent nursing, and some sunlight exposure or other light therapy. There are some recent studies that indicate jaundice may actually have some benefits as an antioxidant in the first few days after birth, as well as protecting baby from Group B Strep infection. As your midwife, I will help you monitor and address any jaundice your newborn may develop, and advise you when it might be necessary to seek medical help.

Other sources not linked in post:
Thureen, Patti. Deacon, Jane. O’Neill, Patricia. Hernandez, Jacinto. (1999) Assessment and Care of the Well Newborn. W.B. Saunders Company.

Approaching your estimated due date, or going past it can be super stressful. It can be challenging not knowing when you will meet your baby. Concerned friends, family, and even total strangers commenting, asking questions, sharing birth stories and more can add to the stress. 

The number one suggestion I have to reduce stress and let families enjoy the last days of pregnancy is do not share the estimated due date. Just don't tell anyone, if you feel you need to share, then shift it two weeks farther out, or say something like baby will be here sometime in May or June. Due dates are wrong 95% of the time so why would someone count on it!

If no one knows your actual due date, you will save yourself the headache of having to deal with questions about what's wrong, when you're going to be induced and hearing "horror" stories 2nd and 3rd hand. You won't have people come to your home to ask if baby has been born (yes that really happens!). You won't have to deal with inquiries becoming more frequent as your due date draws near, and then passes. You will keep your stress levels low which will benefit both you and your baby.

This is the perfect time to savor those last few days just as you are before baby comes. You have the opporutnity to create some lasting memories with friends and family. Be present in the moment with family, friends and yourself.  Babies bring change whether this is the first baby or the tenth baby.

Some suggestions are: 

• Planning some fun things to do in the local area as the due date approaches.
• Having a stack of good books to read as you wait.
• Having a list of movies to watch.
• Starting a new hobby or project.
• Going for walks, doing yoga or some other forms of exercise to reduce stress.
• Get a manicure and/or pedicure.
• Check into a day spa, or plan an at home spa day to pamper yourself.
• Try out some new recipes, and make extra to freeze for postpartum meals.
• Have a meal at a restaurant you've been wanting to try.
• Have a board game night with friends or family.

Due dates may come and go, but no one stays pregnant forever. The last few days or weeks of pregnancy can really become a mind over matter sort of thing. I hope the suggestions I shared are helpful and let you savor the final bit of pregnancy.

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Recently, a client decided during labor to transfer to hospital care for birth.  Shortly after we got there, the OB asked me why I "let" my client continue to labor. That got me thinking about what I see as the biggest difference between midwifery care and obstretric care.

There was nothing happening with the labor I was at that would indicate an immediate trip to the hospital was needed.  As I've written before, hospital transfers can happen for benign reasons like a client wanting pain medication, or because the client is tired and wants the tools hospitals offer to get contractions stronger to get finished. The client is in charge and if they want to go to the hospital, it's my job to facilitate and support them in that.

In the past the American College of Obstetrics and Gynecology has had wording to include "allow a trial of labor after cesarean"  as well as "allowed to push" in their provider guidelines. I was asked why I "let" someone continue to labor at home. The connotations those words have is the difference between midwifery and obstetrical care. 

To allow or let means someone is in charge, or has control over what another person is doing. My clients are adults who have taken the time to educate themselves on the risks and benefits of home birth, and they have also educated themselves on the risks and benefits of hospital births and interventions that are offered at hospitals.  

My clients are the ones making decisions regarding their care. My role is to facilitate and offer education so they understand what is happening and understand fully the risks and benefits of the options so they can decide what is best for the individual situation and for them. I don't "let" or "allow" my clients to do anything!!  My clients are fully capable of making decisions without my permission and I wouldn't want it any other way.