What's Jaundice All About?
Jaundice in the postpartum period is the name for the yellowing of a baby’s skin and eyes in the newborn period from the breakdown of red blood cells the liver is unable to handle due to immaturity. Since yellow is not a normal color for a human, it can make doctors and parents very nervous, especially if it continues and worsens over the first week of life. Jaundice is a physiologic response in the newborn’s body to the adjustment from womb to world, as the liver learns how to work and process the excess red blood cells. It’s normal for it to begin around day 3 postpartum, and can last longer if the milk is delayed in coming in if breastfed, or if a baby hasn’t been eating in the first few days postpartum, like during a NICU stay.
There are times when jaundice is not normal and can indicate a very sick baby, like if it happens before the baby is 24 hours old, or if it spreads to their feet. Jaundice coloring starts in the face, normally the eyes are the first to start changing, and then it travels down the body if it progresses, normally only to the chest before it starts to go away. This does not mean the baby is sick, it means that the newborn’s body is normal and going through a process to get its body to work on its own.
The fetus, or baby before it is born, has a completely different system of circulation than the baby once it is born and breathing on its own. Blood doesn’t circulate through organs and the body in the same way in the womb as it does out of the womb. So your baby is not only coming out of a warm, quiet, dark environment, but they are also going through a huge change in how their body works at the base level.
To test bilirubin levels, the amount of red blood cells in the body that the liver has yet to filter and remove, a blood test is required. It is a heel prick on the baby and blood is collected to see the level and decide if treatment is necessary, if the levels are rising or falling, and to have a scientific picture of what is happening inside the baby’s body. Many doctors will require the baby to be under bililights, to help the body get rid of the build up of bilirubin, even if the baby is healthy and fine. The lights make babies tired, so they have a harder time waking up to eat, which can be a reason for the higher build up of bilirubin since their body isn’t going to have as much energy and food to poop out the excess once the liver processes it.
Yet here is the thing beyond the scary - jaundice is protective! It’s an antioxidant, preventing cell damage of the brain and liver among other organs, it prevents damage to oxygen and fat cells, and it prevents premature babies from eye disease. It is also a way for the body to protect against bacteria! Which is really helpful for premature babies, which have a higher rate of jaundice than full term babies. Another neat thing is that vernix, the incredible white frosting covering most babies, helps lower jaundice levels, as yet another reason to delay their first bath and let them be in their own body for awhile before intervening. Which is really cool!
There are a lot of things we know about why some babies get jaundice more and why others don’t, but there is also a lot we don’t know about why physiological jaundice happens. Male babies are more prone to jaundice than girl babies, just like premature babies are more prone to jaundice than full term babies. Any drugs the mom is given in labor will affect the jaundice of her baby because it makes her liver more overloaded to cleanse the body, same with drugs given to the newborn.
Dr Jack Newman, a doctor in Canada that is an incredible resource for breastfeeding, says that jaundice is a breastfeeding problem. If your baby isn’t nursing well, if they aren’t clearing their bowel because they aren’t eating well, the buildup of bilirubin in their gut will lead to jaundice, sometimes higher levels than would happen if the baby ate well right from birth. If your baby nurses well right from birth, they will clear out the bilirubin quicker than a baby that doesn’t, maybe appearing to not have jaundice at all, or a very mild case. It’s also helpful to know that if your baby isn’t nursing well and has jaundice, it’s best to get breastfeeding help as soon as you can, to help not only with the jaundice, but your breastfeeding relationship.
Jaundice doesn’t need to be scary. In many ways, it’s a normal part of life for a newborn baby, and we overthink it. And in the medical world, they see many more sick babies than midwives do, and their thought process goes to those babies and not normal healthy babies that are 100% fine regardless of their yellow face and chest.
Resources:
Taking Back Birth Podcast - Why Jaundice Freaks Out Doctors and How to Protect Your Baby Anyway
Dr Jack Newman