The beginnings of motherhood and neonatal jaundice

Recovering from a c section is tough going. Not only have you had major surgery but they leave you to look after a baby as well. Normally with surgery you are told to take it easy, but how easy are you supposed to take it when you have a newborn to care for. Your body aches all over, you can’t laugh because it hurts. You walk around the house like a 90 year old and have to get people to carry the baby around the house for you because you don’t want to risk tripping up or down the stairs with them in your arms.

As well as that you have to try and remember when you last fed, changed, burped the baby as well as when you took your painkillers and if you have changed your underwear that day. Not to forget postnatal bleeding, breast leakage and sleep depravation.

Sounds great right?

Then you see the tiny creature in the Moses basket and you just smile and get on with it.

I made good progress and recovered quite quickly now I look back. Caleb had a few mishaps but was fine in the end. Two days after discharge the midwife came to visit and did all her usual checks. All seemed fine but Caleb looked a little tanned. The midwife said that jaundice was common and nothing to worry about, just to keep an eye if it got worse or didn’t improve over the next few weeks. I was continuing to feed every three hours and I was having to set alarms as Caleb did not cry for food or anything for that matter. I think he would happily have starved to death in his sleep in those early days if I had not kept to that strict routine for the first few weeks. At 5 days after birth we went for his first weight check and amazingly had only lost 100g. Most babies loose weight initially after birth as they are adjusting to their new life on the outside and learning to feed. Anything under 6% is normal and Caleb was well under that. He was however still quite tanned. I hadn’t noticed as much as we had been indoors at home in not great lighting. It wasn’t until we were at the midwife checkup in the well lit room that I could see he was actually quite yellow.

Jaundice is the term used to describe yellowing of the skin, sclera (Whites of the eyes) and mucus membranes (gums etc). Jaundice is common in newborn babies and usually occurs a few days after birth. It is known by its medical term of neonatal jaundice. Babies before they are born have lots of red blood cells which after birth are not needed in such high quantities. These cells also are used up and replaced quite quickly and are recycled by the body. In these cells the red pigment that carries the oxygen around the body (haemoglobin) is broken down with a waste product called bilirubin. This is processed by the liver and excreted by the body in the urine. The liver of a newborn baby may not be fully functioning at first so the bilirubin builds up in the blood stream and has a sort of back log which you see in the yellowing of the skin. Neonatal jaundice is common in newborns and especially those that are preterm or premature. Often there is no treatment needed just close monitoring of the baby but if the levels of bilirubin are high or do not reduce then treatment may be needed. Treatment most commonly is phototherapy where the baby spends some time under a special light in hospital which changes the bilirubin into a form that is easier for the liver to handle. More severe cases may require a blood transfusion but this is very uncommon.

They did a quick jaundice check with a bilirubinometer which is a devise shaped like a pen that is placed on the babies skin to calculate the level of jaundice. This result came back borderline for a slightly premature baby to be admitted to hospital so the midwife called the hospital for a doctors opinion. The hospital felt that as it was a borderline result and that Caleb seemed fine when the midwives check him that we should recheck it in 24 hours to make sure it was dropping and not getting higher. 24 hours past and Caleb had his jaundice retested and it was dropping so no need to go back to the hospital. So we were left to fend for ourselves for a few more days. We settled into a routine and had many many visitors who all wanted to meet the tiny bundle.

At ten days post partum Caleb has not only got back to his birth weight but he has also put on a little extra. At the next health visitor check though Caleb still appeared a bit jaundiced and so they refer him to the hospital to have a delayed jaundice screen done. This appointment is not for two weeks and as well as a blood test I have to get a urine sample from him to take with me.

On the day of the appointment getting a urine sample was much easier than I had thought it would be. As anyone who has ever changed the nappy of a baby boy will know the do like to pee as soon as the nappy is off. So a quick nappy removal and strategically placed pot got a good urine sample on the first attempt. When we got to the hospital Caleb was checked over, weighed and measured. Then they needed to get a blood sample and needed a good amount not just a few drops. After a few tries on the back of the hand with a needle and syringe the doctor placed a cannula to get the sample. It did take a few minutes to get the amount they needed and apart from the initial stick with the needles Caleb didn’t cry too much. I had to wait a few days to get the results back but it showed that his bilirubin levels were fine and his liver was fully functioning.

So that’s one thing out of the way and good to know that his tiny body seems to be working ok.

Bring on the next appointment