I’m tired of you, pretty baby, being tied up on a string.
Oh get up, little baby, off that light machine.
Please change your color, baby: Go back to white from yellow gold.
‘Cause till you pale up, baby, you’re awfully hard to hold.
Little David Ebenezer is six days old today. Tomorrow will make a week. And for three of those days, so far, our son has been tied to a light bulb. He has jaundice, an affliction he shares with apparently half of all newborns. Jaundice is officially defined simply as unnaturally sallow skin, which today makes me envious of all Asian, Pacific Islander, Indian and African babies, who by the dictionary can’t get jaundice.
Jaundice is caused by two things working in conjunction against each other: first, infants, like their mothers, at first have a superabundant supply of blood in their system, which is designed to facilitate the exchange of oxygen and other important things in the womb. The red blood cells are constantly breaking down and being replenished over time. The two primary waste products of red blood cells are iron and a chemical called biliruben. The iron is kept, and the biliruben must be processed by the liver and flushed out of the system,
Secondly, before birth, babies don’t use their liver. Why should they? The placenta keeps the mixture in a baby’s blood exactly the same as its mother’s. Mommy has a liver of her own and it doesn’t need any help, thank you. But when the baby is born, the liver switches on, ready to process about as much old blood per day as the bones are producing new blood. Except that there is more old blood already in the system than new blood being produced, so the liver starts out a little behind. Extra waste products are always stored in the skin. Since biliruben is yellow, the skin starts to turn yellow.
In most babies, this is all very fine. In a few days the liver catches up, the baby’s normal color returns, and we go on. Bur what happens if the liver doesn’t catch up? Well, that’s a problem. The biliruben starts to build up in the blood, and somewhere around a concentration of 25ml/dl, it begins to affect the brain. Too high a concentration for too long a time can cause brain damage. And since nobody wants brain damage, as soon as we start seeing high levels of biliruben, all sorts of panic buttons begin to be getting hit.
There are two possible reasons why the liver might not catch up. The first is the scariest and, frankly, the least likely, which is that the liver is immature or improperly formed. Improperly formed ultimately will mean dialysis and blood transfusions. If the biliruben gets past 25 ml, people start talking about blood transfusion. But as long as it stays below, there is a less drastic solution. There is another organ which can help to break down biliruben into something less toxic: the skin.
I am coming to think that the skin can process anything given the right stimulation on the outside of it. Got weak bones? What you need is vitamin D, which the skin produces in response to sunlight. Got a backed up liver, skin full of biliruben? What you need is vitamin K, which the skin produces in response to (you guessed it) sunlight. Lots of sunlight. Your baby needs a trip to the Bahamas. However, in lieu of the Bahamas, your baby can be hospitalized, where they will place him in a tray under a blinding white light for hours at a time, his eyes covered by a special blindfold to protect them. For this you will be charged only slightly less than you would pay for a trip to the Bahamas.
In lieu of a hospital visit, however, a medical supply store can ship to you an object which looks remarkably like an overhead projector without the overhead attachment. Instead, it will have an attachment that looks remarkably like the arm of a giant squid: a long tube full of fiber optic cable, with a fin at one end to distribute the conducted light over a wider surface area. The fin is fitted into a transparent sleeve, which is then strapped to your baby, who must wear this contraption day and night until his biliruben returns to an acceptable level, such as zero.
There. Two days out of the womb, and already your baby has his umbilical cord back again. Isn’t that grand? He is now awkward to hold and to feed, difficult to change, and can only be removed from the room in which you first strapped him via surgery.
This is the situation that we now find ourselves in, and it is all the more frustrating because of the second, and more likely, cause of jaundice: poor food supply. Here’s how this works: the liver can process the old blood just fine, but only if it has somewhere to dump the waste. Waste products from the liver are dumped into the large intestine, where they are ultimately – well you know what babies make.
But what happens if they don’t make any? This is exactly what happened to David. In 31 hours, we had about four incidents of waste product number 1, but no incidents whatsoever of waste product number 2. The culprit? He was eating frequently enough, but wasn’t getting sufficient calories in each feeding. Somewhere in there, we had a blood test and discovered his biliruben was at 18. And oh the sirens started screaming! A glowworm suit was ordered, and we were given an ultimatum: Bowel movement in 6 hours, or supplement his food supply.
You see, there is really only one way to increase the waste product of a baby: increase the food supply. But there are two ways (again) to increase the food supply: increase what comes from mommy, or get a bottle of something from Wal-mart. One of these two options is easier, and the other is mountains cheaper and healthier for the baby, and much as we love Wal-mart, they aren’t the entity producing the cheaper product. (Formula also apparently produces smellier poopies.)
Ultimately, we resigned ourselves to supplementing for a while as we try to increase the supply of real milk, and we have seen good results. First his biliruben went up to 18.9, but yesterday it was down to 17.8. He now has a present for us most every feeding. But now we are running up onto the other precipice of the problem: Easier doesn’t only mean fewer encounters with the pump.
Easier also means that a bottle is less work for baby than suckling at the breast, and eventually the baby starts rejecting mom and waiting for a bottle. Then what do you do? You can hold off on feeding him until he’s hungry enough to accept what you offer, but the whole start of the problem was that he wasn’t eating enough in the first place. Easier also means that the bottle has a different shape to it than the breast, and a baby who’s gotten used to the bottle is likely to get confused and suckle wrong, which hurts and encourages mommy to convert all one way or another. Since milk supply was the problem in the first place which option does she feel unwillfully pulled toward? It’s not the cheap one. And back of all of this are feelings of inadequacy combined with lack of sleep and frustration.
In a few minutes, we will be making another visit to a lactation specialist, hopefully one more interested in helping us find ways of sticking with lactation rather than switching to formula. And until our baby’s skin looses its yellowish tint, we covet your prayers, for until it does he will be hard to cuddle and to hold, for he has a thick and rubber tail.