2 weeks ago about now we were not long home after a less than 12-hour stay at the local Birth Centre. Time has flown by, although strangely it doesn’t seem to me to have gone as fast as Andrew’s first 2 weeks did. For Tom, though, it has gone faster, and this afternoon is his first afternoon back at work – handily his first day back is a Tuesday and he only works a half day, so we are being broken in gently to his return to work. Andrew is napping, so I won’t notice Tom’s absence fully until tomorrow, when I’ll have to ‘go solo’ with 2 little ones all day – eek!
So what’s happened already in 2 weeks since Joel’s birth? Well we had a trip back into hospital when he was 3 days old, because he was quite highly jaundiced. As we’d had to do this with Andrew too at 6 days old, though his problem was dehydration not jaundice, we kind of knew what to expect and were not quite so shocked. One of the hardest parts for me going back in was being away from Andrew for 2 days and one night (except a couple of visits to the ward), but I knew it was the best place for Joel to be and I couldn’t be there for both my boys at the same time. I also felt better this time knowing that his jaundice was nothing to do with my milk supply (which the dehydration had been) – it would have happened regardless of how he’d been fed.
We didn’t know it at the time, but apparently they take jaundice very seriously in Cambridgeshire these days, as there have been a couple of cases that were missed early and the babies developed serious complications from it. Jaundice is caused by a build-up of a substance called bilirubin in the body which is deposited in tissues such as the skin, gums and whites of the eyes and gives them a yellowish colour. In a newborn it is as a result of many red blood cells being broken down in one go – the baby needed these extra cells in the womb as there was less oxygen available than in the real world, and after birth the extra ones are broken down and excreted from the body. If a baby’s liver can’t do this fast enough (because it’s still not mature enough), the bilirubin level can get very high, and if it gets too high this can lead to it being deposited in the brain tissue and causing complications like deafness and cerebral palsy.
Joel’s bilirubin level wasn’t allowed to get that high, as he was treated with phototherapy and food. Phototherapy is basically like a sun bed that he lay on with blue lights underneath him and blue lights over the top of him. The light helps to break down the bilirubin so it can be excreted. He lay there with no clothes on, except he had to wear a cute little eye patch to stop the lights damaging his eyes – he hated it though and kept pulling it off whenever he woke up! Initially he was allowed to feed on demand from me and therefore spend some time away from the lights, but then his bilirubin level increased again and the doctors decided that he needed to be constantly on the lights, so they fitted a naso-gastric tube and fed him vast amounts of formula through it. Having milk is also effective in treating jaundice, because it makes baby poo it out and that’s how the bilirubin is excreted; breast milk is more effective than formula at this, but at 3 days old, even if I was normal and didn’t have insufficient glandular breast tissue to exclusively breastfeed a baby, my milk wouldn’t have already ‘come in’ and be there in vast quantities. (You know you’re a parent when you don’t bat an eyelid at writing the word ‘poo’ in a blog post!)
The good thing is that Joel responded well to the lights and milk treatment and after 12 hours on the lights he was allowed to breastfeed on demand again and was well enough to get out of hospital after just one overnight stay. I think it helped our case when I explained to the doctors that I was willing to supplement with formula given my previous breastfeeding experience. Plus they saw me using the SNS (supplemental nursing system) that I’d taken in with us in case we needed it, and could see that Joel was feeding well with it.
The hardest thing since coming out of hospital the second time has been how sleepy Joel is. This is a common side effect of jaundice, and I’ve been told that jaundiced babies sometimes take a few weeks to really wake up. But even before we went back into hospital, Joel seemed like a much more chilled out baby than Andrew was, so it could partly just be his personality too. You might be wondering why sleepy means hard?! Surely that’s a good thing, right?! Well not if you want to establish a good breast milk supply and in particular if you have supply issues anyway like I do. I’m having to wake him up for feeds, especially overnight when it’s the best time to stimulate my supply when the hormone prolactin is highest. I’m often feeding him in just his nappy so he’s nice and cool so less likely to drift off to sleep, and he’s next to my skin to help stimulate milk production. I also find myself tickling his feet and changing his nappy during feeds to try and wake him up. This is such a culture shock for me having fed Andrew as a baby who was always so active, awake and keen to tell me when he was hungry.
But he’s already showing a few signs of being less sleepy and I feel like I have much more knowledge and support with breastfeeding this time, so I’m working hard doing everything I can to get things off to a good start. I’m expressing after feeds (though not getting loads out, as I’ve never managed to get loads out with a breast pump – by hand I get more), taking a herbal supplement that is supposed to boost milk supply, eating lots of oats (porridge, flapjacks etc.), drinking fennel tea, resting when I can and, of course, using the SNS to top Joel up with formula so that he gets as much from me as possible. All this effort seemed worth it this morning when he was weighed and his weight had gone up to beyond his birth weight! Hooray! This means a lot to me because Andrew took ages to put weight on in the early weeks and weight was a constant worry for us.
Talking of Andrew, I can’t leave him out of this post. He has been a star in welcoming his little brother to our family. He’s been dishing out lots of kisses of his own accord to Joel (and us) and has carried on as normal being his happy little self, except he doesn’t seem so little any more! As I’ve spent much of the last 2 weeks holding Joel, whenever I have held Andrew for a moment, he feels and looks absolutely massive to me. Of course so far Andrew has had at least Tom around and often another person or more as we’ve had lots of help from family visiting, so the real test of how he copes with having to share my attention will come in the next week. But I’m optimistic from the signs so far.
It’s been nice to sit and write something (the skill of one-handed typing whilst feeding is like riding a bike – never forgotten), though I feel that my head is still quite all over the place and this post is more muddled in thought than usual. I thought it would be good to share our experience of jaundice, as it’s something I’d heard of but didn’t realise was so common and often required such hardcore treatment – about 60% of babies get it, and I can’t help but wonder how many mums of jaundiced babies end up giving up breastfeeding because their supply never really gets going before the formula is introduced and baby is so sleepy that they don’t feed enough. I did also write Joel’s birth story 2 days afterwards so I didn’t forget anything, but it’s still in rather note form and needs some editing to make it publishable; I’ll post it when I get round to it. Anyway, I’d better get back to some more resting on the sofa whilst Andrew is napping and Joel is feeding 🙂