Jaundice is a relatively common condition in newborn babies today in America. Hospitals and doctors routinely check for jaundice at least once if not numerous times during a postpartum hospital stay, and at follow-up visits after release. While catching jaundice is certainly an important goal, I sometimes wonder if as much focus, money and time went into supporting the first 24-48 hours of breastfeeding if we wouldn’t find we prevented many if not most cases of jaundice.
If this seems like an odd query, it’s important to understand the effect of early breastfeeding on the incidence of jaundice.
Early, Frequent Breastfeeding Prevents Exaggerated Newborn Jaundice
While the general recommendation for breastfeeding is that mothers should nurse newborns 8-12 times in 24 hours, some lactation professionals believe this recommendation should really be 10 or more times in 24 hours. This is because of several studies that indicate that higher frequency of breastfeeding leads to reduced levels of bilirubin. The Breastfeeding Answer Book, 3rd Edition (pg 28) describes an important study in 1990 (Yamauchi and Yamanouchi) that studied 140 healthy, full-term babies and showed that
0% of babies who breastfed 9-11 times in the first 24 hours showed exaggerated jaundice on Day 6.
That’s 0% folks – none – no babies in this study nursed 9-11 times in the first day developed exaggerated jaundice! These numbers increase up to 28% for babies who breastfed 0-2 times, a staggering difference. What is possibly even more shocking is that just the jump from 9-11 feedings down to 7-8 feedings (within or darn close to the common recommendation) raised the percentage from 0% up to 12%.
Imagine the jaundice that could be prevented by making it clear to mothers that they could likely prevent this condition (common enough now that many mothers have heard of it and are worried about it) simply by being diligent about starting breastfeeding and nursing at least 9-11 times starting right away in that first 24 hours. Instead, many mothers are told that it’s normal for babies to be tired after birth and that it’s not that important to nurse often until their milk “comes in.” This could not be farther from the truth, both for the prevention of jaundice as well as the establishment of breastfeeding.
Why Does Early Breastfeeding Affect Jaundice?
The obvious question then is, why? Early breastfeeding has such a profound effect on jaundice for several reasons, but does not really include the reason many would guess. Although formula is sometimes used to “flush” the system with a jaundiced baby, and this does sometimes make sense for a baby 5 or 6 days after birth, the effect of frequent nursing in the first days has little to do with volume. The milk in the first days of a baby’s life is a special low-volume, but high “value per drop” type of milk available only for a few days after birth, called colostrum (see my related article, What is Colostrum?).
This colostrum affects the baby’s body in special ways that do help prevent jaundice (see my related article, Colostrum and Jaundice, coming soon), but not through volume or “flushing” the system. There is a relationship to volume though in that low frequency of early breastfeeding may lead to reduced supply or a delay when the milk transitions to the higher-volume mature milk on day 3-5 that can affect jaundice levels on days 5-6, when exaggerated jaundice is most common. For a baby who has not been breastfeeding enough in the first days, the temporary addition of formula can sometimes kickstart the process of eliminating bilirubin that the breastmilk was meant to be stimulating (ideally, while the mother receives support for the challenges that led to the insufficient breastfeeding in the first place!).
For mothers worried about jaundice, it is worth understanding that one of the most effective ways to combat this condition is to turn the attention immediately after birth to establishing breastfeeding, and having appropriate peer or professional support lined up to help if there are challenges.
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