Wednesday, October 27


I should edit: apparently, his bili level yesterday was actually 15.4. Today's level was 16. The doctor wanted me to start supplementing with formula after every feeding for twenty-four hours, which made no sense to me, especially considering how well he's gaining weight (eight ounces in three days!). When I questioned her about it and suggested again that we could use the bili-blanket at home, she changed her mind and agreed with me.

(Eric's not impressed with our doctor, he says.)

Anyway, the blanket should be on its way here shortly. Hopefully, this will be just what he needs. We were told at the hospital that there could be a slight rebound in bili levels after coming off the lights, so maybe this will be a good counterbalance to our sunless days.

      Posted on October 27, 04:28 PM | TrackBack

Well Tina, neither of mine had jaundice officially. My oldest looked a little yellow when we took her in for her 1 week follow-up, but the doctor said it was so milk he didn't bother to take a blood sample.

Posted by: Kelly on October 30, 2004 08:35 AM

Welcome to the great, big, brillant world Gabriel. On the medical profession front: being a medical professional myself, I will shoot it to you straight. By and large, the doctor wants what is best for her patient. However, sometimes doctors follow a "protocol" and dont always take the time to personalize it for each situation. Ex: "Breast fed bili baby = supplement with formula" the end, not taking into consideration that baby is growing and flourishing quite well without the formula. Lots of babies would not be doing as well under those circumstances and thus the protocol was born. Another thing about doctors that I have witnessed as both a nurse working with them and as a patient being cared for by them. They do not always listen. I explained to my pulmologist 3 times that I had to eat 5 or 6 small meals a day, otherwise I would only take in 700 calories a day because my pouch could only hold a small amt at each sitting. Such a small amt for three meals equalled about 700 calories for the day. I pratically had to scream it in his ear to make him understand that I was saying 700 cal a DAY not a MEAL.
Absolutely be comfortable with the medical doctor that you are entrusting the health of your children to. But even if you find one that puts you completely at ease, make sure you are being heard correctly and feel like the doc is recommending the best option. It is always ok to question a doctor. You (or your insurance) pays for her. She is working for you. Lots of docs forget that and get a God complex and just dare you to question their recommendations. Take that dare. Ive learned the hard way.

Posted by: Ami on October 28, 2004 10:19 PM

I agree; I'm not impressed w/ the doctor, either.

And by the way, I don't think I know of a baby that has NOT had jaundice. Including my own little guy who had to keep having blood milked out of his poor foot to have it checked. Hang in thereRichmond Family!

Can't wait to see more pictures of that cute little addition.

Posted by: Tina on October 28, 2004 06:43 PM

I think I would be inclined to agree with your husband and not be overly impressed with your doctor. Have you two thought about finding another dr. It saved my daughter, if I had stayed with my first dr. she would have been dead in no time. The second dr. caught right on it and took care of the problem and sent us to a specialist for what he thought was in her best interest. I know that jaundice is not life threatening each and every time but you are trying to get it taken care of and you know best. Please consider getting a second dr's opinion on what to do. I'm with you, I didn't breast feed at all but I don't think that if he is nursing well and gaining that you need to suppliment at all. Maybe some ultraviolet sunlamps might help.

Posted by: stacey on October 28, 2004 12:06 PM

Heh, probably the thing to be remembered about this comment thread is just that people care about you and your family :)

They care to the point where they're unable to suppress their opinions - that's a lot of caring! Hope you all are doing really well.

Selfishly, I also hope there will be more pictures of Sam and Gabe soon! The camera flash is almost like sunlight, right? (I kid.)

Posted by: jay on October 28, 2004 09:42 AM

I think a dropping of the subject is in order here. We're lucky just to be reading about their lives.

Posted by: Matt on October 28, 2004 09:19 AM

At the risk of being edited by Carrie, I will just let out a deep sigh. ARRGGHH!!

As well, praying for you Gabe! Can't wait to meet you.

My name is Eric and I approved this message.

Posted by: alysia on October 28, 2004 08:57 AM

(Just posting that I thought TMR - while obviously having a different opionion on this topic than the majority, it seems - was being very respectful of Carrie and Eric. I didn't see anything as an attack.. questioning out of concern, if anything. But that's just me. I don't even know this person, but I didn't take anything he or she said as offensive. I'm sure this person wants the best for Gabe as much as the rest of us).

I would agree with Dena that probably because of the area you're in, the suggestion of formula might be thrown in because there doesn't seem to be a whole lot of understanding/support for breastfeeding. Here in Ohio, I haven't found much of anyone in support of it. Heck- how Carrie managed it while in northern OH, I'll have no idea. (If my inlaws ask me one more time if I'm still breastfeeding Matthew, I'm going to scream!!)

But I just thought I would mention that supplementing with formula- IF that was indeed something the doctors decided was best for Gabe (which doesn't seem to be the case here, and I think that's great)- it is not the end of the world. That would not mean your nursing relationship is ruined. Introducing a latex nipple even at two weeks does not *necessarily* equal a serious problem, either. I nursed Lauren til she was 9 months, and Matthew is nearly 14 months and is still nursing- however, they were both introduced to bottles at a very early age (2 weeks) so that David could give them breastmilk in a bottle.

Again, this doesn't seem to be anything worth worrying about at this point- I doubt the doctors will all come to the conclusion that formula (even supplementation) is going to be necessary. :) I know how important breastfeeding is to you, Carrie & Eric. But as a mom who has found the necessity for use of bottles at a very early age (for both breastmilk & for eventually formula when needed), I can assure you that it doesn't necessarily mean permanent damage. :)

I sure hope Gabe gets better real soon and that everything works out the way you (as parents) want for them to- for him and for your comfort level. :)

Posted by: Steph on October 28, 2004 08:35 AM

I am amazed that the doctor did not give the blanket to begin with. I live in the same city as Carrie and know several people that were given the blanket right off the bat. I do not know which pedit. Gabe is seeing, there are so few too choose from. I would suggest, if your insurance plan allows, travel to the bigger city just north of you. Find a pedit. there that you feel comfortable with. I do have a pedit. in our city that allows me to try other types of treatment. She actually incourages chiro for many problems. I understand with this suituation they need to step in and do something more. I agree with Carrie that the blanket is the best bet since Gabe is not having other "issues" as far as weight and diapers go.

Best of luck to the little guy. Everything will work out and he will be fine.

Hope you are feeling better as well.

Posted by: Dena on October 28, 2004 08:14 AM

Sounds as if Gabe is doing splendidly, and the bili blanket (and Mr. Sun, if he ever decides to come out!) ought to do the trick. Very impressive that he's growing and gaining weight as well.

I think that the docs around here are probably not as familiar with natural/AP and aren't used to someone questioning them. Just a regional thing.

Good for you guys.

Glad Gabe is doing well!

Posted by: Kate on October 28, 2004 08:02 AM

They told me to supplement w/formula too when my son also had jaundice. (We used the bili blanket at home.) I just nodded and said, uh huh. I never fed him any formula, just nursed like crazy. From what I've read, mama's milk is the best thing for jaundice. Hang in there. This is very frustrating for you, I'm sure.

Posted by: Kathy on October 28, 2004 04:32 AM

From what I can see, the only 'treatment' that Carrie has questioned is the formula supplementation. Introducing a bottle and latex nipple this early in the game could do permanent damage to Carrie and Gabriel's nursing relationship. The ped ended up agreeing with her, as well. :)

I am sorry that you have experienced the heartache of watching a child die due to the unwillingness of the parents to act on medical advice. But, this is not so extreme a case, and time isn't really a crucial factor.

I don't want to continue a debate here on Carrie's site, so I will close with these two thoughts:

*I feel that you are projecting your frustration at other parents onto Carrie. Gabe is in no danger.

*Questioning her parenting decisions on *her* board is really inappropriate. I'm sorry that is harsh, but it's my opinion.


Posted by: RobynGirl on October 27, 2004 11:02 PM

Hey, don't get me wrong.

I've got diabetes. I *love* modern medicine. Really. I've got sleep apnea, too. Couldn't get by without my BiPAP.

The thing about diabetes - it teaches you to be a really, REALLY informed consumer of medical resources. The ADA ( actively encourages diabetics to question physicians when they deviate from the standard of care, which they just love to remind us about at every turn.

(A quick aside: If you want to read the most depressing magazine in the KNOWN UNIVERSE, pick up a copy of "Diabetes Forecast", the monthly pub from the ADA. I get to enjoy articles like "One Step Ahead of Foot Ulcers" and "Kidney Disease: What You Should Know". I read this joy-filled pub becasue it keeps me up-to-date on the standard of care. How else would I know if my health care team was functioning properly?)

Anyhoo, I had my brother (a surgeon) and the doctor at my workplace fill me in a little on the standard of care for infant jaundice. And, as another poster pointed out, supplemental formula is usually only suggested when the baby is not producing wet and dirty diapers, and is not gaining weight rapidly. The excess pee and poop carries biliruben out of the bloodstream.

We had Gabe at home, but sought out prenatal care. We met with a backup OB, in case we had to transport. We're seeing his physician regularly, to make sure this condition is under control. And we did just spend a few days in the hospital - because he needed it. We wanted home phototherapy, but our doctors were not comfortable with that (since his level was >20).

I had a point in here somewhere...

Oh, yeah. It is all about making informed decisions: and we're trying to stay *very* informed here.

I *do* appreciate the concern from everyone, and the support too.

(My name is Eric, and I approved this message.)

Posted by: Eric on October 27, 2004 10:56 PM

I never, ever questioned whether Carrie and Eric are being good parents. They are better than most I know, and am in awe of them and what they do and how they raise their family.

However, I am also a nurse, and I've seen many - too many - people walk away from medically suggested treatment because of their beliefs. I've seen, and watched, many babies - and children - die because their parents have been unwilling to accept something technology or scientifically based.

Medicine is not perfect. I know that. And, I know it is not always the answer.

But, answer your question...I am not a parent. But, I am a foster parent to two children who lost their parents; I was/am guardian until / unless things change; a situation that is beyond complicated and not to be dug into in this situation. These two children are in my care now. They are not born of my body. Yet, their lives, well being, happiness, satisfaction and abilities to funcion are of utmost importance to me. I have quit my full time job - thereby cutting our income in half, while adding two new members to our household - in order to be here with, and for, them.

I would, and will, give my life and soul for them.

At the same time, I will never, ever use a principle to prevent them from receiving what they need.

I only meant to suggest that shutting off an option out of personal beliefs is not always the best answer.

I would not ever question a parents' decision or choice for their child. Only their motivation. And even at that, it's not meant to question or degrate - just to offer ideas, an alternative perspective, and hope.

I didn't mean to offend Carrie, Eric or any of Carrie's readers. I admire natural parenting and all that goes with it. I only get concerned when ideals interrupt options. That is all.

Again, I apologize, yet I stand by what I said.

Posted by: tmr on October 27, 2004 10:31 PM

just jumping in late here to say congratulations and let you know I'm thinking of you and Gabe every step of the way. I hope all will be resolved soon. Hang in there!

Posted by: liz on October 27, 2004 10:11 PM

I think you are doing the right thing to question your ped. Also, I wouldn't worry too much if his bilirubin is under 20. Breast fed babies tend to have slightly higher levels. Here is a link to Dr. Sears website. (which has saved me calling the poor man in the middle of the night many times!)

To the poster down below, tmr...

I understand what you are saying, I really do. I wonder, though, if you have children? I only ask because that blissful moment that your baby is placed in your arms, your perspective changes on so many things.

No, you are right, the medical community *as a whole* is not out to get us. I do believe that the vast majority of doctors and professional medical caregivers have the very best interest of their patients at heart.

*However*, I will also say that they are not emotionally involved with your child, not the way a mother is. Mothers make their decisions based on an intuition that is unrivaled and unerring. There are times I actually *do* know better than my ped. I know my children intimately in a way that nobody, not even my husband, knows them.

If I feel that another course of action needs to be explored, I am going to advocate for my child. I am their voice, and come hell or high water, that voice will be heard. Questioning a doctor is not is vital. We need to be involved in every decision being made for our children's health. That is tantamount to being a good parent.

Carrie and Eric are being good parents. :)

Robyn, mommy to Natalie (19mos) and Meghan (7mos)

"It is not a slight thing when they, who are so fresh from God, love us."

-Charles Dickens

Posted by: RobynGirl on October 27, 2004 10:11 PM

There are times for medical intervention (I know someone who thinks she'd be okay birthing a premature infant at home because she took a day-long class in ressusitation -- I think premature babies should probably be born in birthing centers or hospitals). Then there are situations when parents have plenty of time to seek a second opinion.

Gabe's bilirubin level isn't in the dangerous range (which is anything over 20). Breastfeeding jaundice probably isn't an issue here, either -- that generally starts 4 days or so after birth, not the next day.

The most common cause of jaundice is that the baby's liver hasn't fully developed. Babies have huge amounts of red blood cells, so if their livers aren't quite up to speed at breaking them down, they end up with a lot of extra bilirubin -- a red blood cell by-product. The bilirubin builds up under the skin causing the jaundice. This is common. It happens in about 50% of newborns.

The bili blanket should work fine. It usually takes a week or two for jaundice to go away. Gabe should be nice and pink this time next week.

It's not like he's being raised by wolves. No matter what your opinion of home birthing, nursing, AP, etc., going all chicken little on a newborn's mother is not helpful or kind.

Carrie -- you know you're doing everything you should. The number of people monitoring this situation puts more focus on this very normal event than anyone really needs to have. Finding a doctor you feel comfortable with is the best way to go. Trust is so important. If you don't trust a doctor, you won't feel right listening to him/her, even when they're right (and in this case, your doctor probably wasn't).

Take care. Godspeed.

Posted by: Rebecca on October 27, 2004 08:54 PM


Just wanted to say I fully support your opinion that formula is unwarranted here. It's clear that you guys are on top of the situation and are working with your doctor to get Gabe healthy.

Research has firmly established that jaundiced babies need to have good calorie input in order to stool frequently, thereby eliminating the excess bilirubin. Formula supplementation would perhaps be warranted if Gabe were not obviously getting plenty of calorie input from you, but in this case you're right, it doesn't seem to be indicated and of course supplementing with formula brings a host of other risks and effects (like vastly increased risk of sensitization to dairy proteins and the permanent alteration of Gabe's gut flora).

Ignore "mom23poms" well-intentioned but obviously uninformed opinions. You guys are doing great. :)

Posted by: jennifer and the beans on October 27, 2004 08:31 PM

Do whatever you have to do.

However, the medical community is not out to get you or hurt you. Sometimes, some things are better than others, even if those things are medical intervention and/or formula.

Formula is not the end of the world.

What will you do if your doctor still refuses the idea of a bili blanket? Seek out another and wait another day or two to get into see another doctor? A single day can make a difference between life and death. You know that.

I do not want to degrate your parenting. I know that you have Gabe's best interest at heart.

At the same time, modern medicine, formula, hospitals and doctors are not all about altering your life and plans.

Children died in the past because there was no way to determine how their life affected them. There were not alternatives. There are alternatives now.

Modern medicine has ways, and alternatives, to help the "non standard" situation. Children who used to die of intolerance to their mother's milk can, and do, now live to be normal, healthy people. Living is the key word. And no, I am not saying Gabe has an intolerance - - -it was only an example. Children used to die in the birth canal, since there was no technology, or knowledge, to prevent it - - and mother's died as well. It's progress.

It's knowledge. Alternatives. Help. Experiences.

Modern medicine is not the enemy; use it to help keep your child healthy.

I guess this isn't going to be popular, so I will say good-bye now. I won't post anymore respones.

I have enjoyed reading your journal(s), but my opinions are not going to go over well, so I will be done now.

I wish you all a lot of luck, health and happiness.

Posted by: tmr on October 27, 2004 07:47 PM


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