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.

Newborns and sleep, two words that don't always go together.  Newborns wake up at all times of the day and night to eat, complain about soiled diapers and sometimes it seems, just to exercise their lungs.  Everyone has opinions and ideas about how to get your newborn to sleep through the night.  

There are books about getting your baby to sleep through the night, you can take classes or hire someone to come into your home and "train" your baby to sleep through the night.  I have some opinions on the idea of getting your baby to sleep through the night.   

There is the thought that once baby reaches a certain weight (12-13 lbs is considered the standard), baby should sleep through the night.  Not all babies know this. Sleep is more of a neurological and development issue than a weight issue.  Not every baby has made the developmental advances at 13 lbs they need to sleep through the night.  

There is also the idea that once baby reaches a certain age they should sleep through the night.  Depending on what source you are referencing, this can be 3 months old, 4 months old, 6 months old etc.  Again, not all babies know this.  Just as babies grow at different rates, babies make the developmental advances to sleep through the night at different ages, so a "one size fits all" approach should not be applied to when  baby should sleep through the night. 

If you want to try sleep training, there are some milestones and markers that I feel need to be present before beginning. 

• Your baby should be gaining weight without any issues.
• Your baby is at least 4 months old
• Your baby has transitioned to or has their own sleep space
• Your baby has shown the ability to self-soothe
• You and baby have a bedtime routine in place
• You and your family are ready to navigate sleep training

One way to "sleep train" your baby is to let them cry it out.  This involves putting baby to bed and then ignoring thier crying for however long they take to exhaust themselves and fall asleep.  It could be 10 minutes, or hours.  I am not a fan of this method for many reasons, especially how stressful it is on baby and parents.  

Other sleep training methods include shortening the amount of time you rock baby before laying them down, setting your chair farther and farther away from the crib each bedtime, or having intervals before coming back in to soothe baby.  If you do decide to use one of these methods, make sure you understand it and are comfortable with it.  Remember, it is training so it may take some time before baby figures out the goal is to sleep through the night on a consistent basis. 

Some families solve the sleep dilemma by co-sleeping, whether that means baby shares the bedroom with parents, or baby shares the bed with parents.  I feel bed sharing is an acceptable option, and yes I know many organizations such as the American Academy of Pediatrics disagree, although they do recommend that baby sleeps in the same room as the parents for at least the first 6 months of life.  I do have criteria (using Unicef guidelines)  that I feel make bed sharing a reasonable option.  Those criteria are:

• a non-smoking household
• no illicit drug use
• no alcohol use
• not using prescription drugs that have drowsiness as a side effect
• the mattress used should be firm
• baby should not be near pillows, or have their face covered with blankets

There is no "perfect" way to get baby to sleep through the night, and there is no "one size fits all" solution.  What works best for you and your family is the best solution, even if it is different than what other families choose to do.  What is important is that you and baby get good sleep, and that you are comfortable with whatever decisions you make regarding how to get baby to sleep longer, and eventually through the night.

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