Full Circle Midwifery

Yesterday, I received an email from a mother whose baby was strictly breastfed but had what is commonly called “breastmilk jaundice”. The doctor told her to give only formula for 48 hours, which she did and the baby is now refusing to take the breast. From our information sheet on jaundice at our website:

So-Called Breastmilk Jaundice

There is a condition commonly called breastmilk jaundice. No one knows what the cause of breastmilk jaundice is. In order to make this diagnosis, the baby should be at least a week old, though interestingly, many of the babies with breastmilk jaundice also have had exaggerated physiologic jaundice. The baby should be gaining well, with breastfeeding alone and be generally well. In such a setting, the baby has what some call breastmilk jaundice, though, rarely, infections of the urine or an under functioning of the baby’s thyroid gland, as well as a few other even rarer illnesses may cause the same picture.

Breastmilk jaundice peaks at 10-21 days, but may last for two or three months. Breastmilk jaundice is NORMAL if the baby is well, breastfeeding well and gaining weight well. Rarely, if ever, does breastfeeding need to be discontinued even for a short time. Only very occasionally is any treatment, such as phototherapy, necessary. There is not one bit of evidence that this jaundice causes any problem at all for the baby. In fact, bilirubin (the pigment that causes the yellow colour of the skin, is now known to be an antioxidant. Breastfeeding should not be discontinued “in order to make a diagnosis”. If the baby is truly doing well on breast only, there is no reason, NONE, to stop breastfeeding or supplement even if the supplementation is given with a lactation aid, for that matter.

The notion that there is something wrong with the baby being jaundiced comes from the using the formula feeding baby as the model of “normal” and imposing this model on the breastfed baby and mother. This manner of thinking, almost universal amongst health professionals, truly turns logic upside down. Thus, the formula feeding baby is rarely jaundiced after the first week of life, and when he is, there is usually something wrong. Therefore, the baby with so called breastmilk jaundice is a concern and “something must be done”. However, in our experience, most exclusively breastfed babies who are perfectly healthy and gaining weight well are still jaundiced at five to six weeks of life and even later. The question, in fact, should be whether or not it is normal not to be jaundiced and is this absence of jaundice something we should worry about? Do not stop breastfeeding for so-called “breastmilk” jaundice.