back online

thanks to a wonderful client of mine (and her incredible husband!) I am back online. It feels good, though I'm sure my housecleaning will now be on the decline.

I have many things to blog about, including a birth story (waiting for the ok to share), but cannot take the time to sit for very long right now.

Instead I leave you with a video of the most recent song that gets me moving!

still around

Thanks to my BlackBerry I'm able to check emails while my computer is down. I haven't been visiting too many blogs simply because it's more complicated on my phone.

I have a client who is bartering with me for a solid computer. In the meantime, my online time is limited. You'd think that this would naturally result in a much cleaner house, but we recently acquired cable TV. The ability to record and watch later my favorite programs is a dream. I have to admit there are some new shows that I've taken to...I won't even begin to list them here because they are so embarassing!

The two holiday moms have not birthed yet. Everything is rather quiet around here, aside from my trip to Sephora last night!

Hope everyone is warm, healthy and feeling loved!

computer woes

Interesting that I took the time to upload all of my photos "in case". My computer is now dead.

About a year ago, a certain baby loved to open my CD drive. She liked to push the little button and watch the drawer open. Once when the drawer was open the laptop was dropped. The CD drive door - and the connections to the hard drive - broke.

I contacted a friend/relative about the issue and he said that it would cost as much as the computer was worth to repair it. He said that it may continue to boot off and on (and we learned a little trick to help the computer to bypass the CD drive), but eventually it would die.

And it has.

So updating might be slow...I'm using my girlfriend's old Sony Vaio - and while I'm grateful for something, I know a new computer is on the horizon. I'd love to get a MAC this time and not deal with all the spyware and viruses. Anyone have leads on an inexpensive iBook? My birthday is in a week - anyone interested in my Amazon Wish List? (Hey, I'm not shy about putting it out there!)



It's been a sweet, slow time in the land of birth. Two first time moms, due around Christmas and New Year's, await their babies. Our appointment days continue to be full and I'm grateful, so grateful, for such amazing families to journey with.

Life is good. I'm just a bit quiet. Hibernating with the family. Will update more later.

going through pictures...

I have been organizing and filing photos online so in the event I ever lose my computer data, they are uploaded elsewhere.

Here are two complete births that I photographed for clients - a few of these photos ended up in my montage:





We're hoping that the second set will get published in Midwifery Today. It seems that there are so many photos on the inside back cover that feature reclining women in bed. It's nice to get more in there that show women upright, receiving their babies into their own hands. If you've got pictures that you'd like to share, please offer them to Midwifery Today!

thanksgiving 2007

some pics from our Thanksgiving dinner...I wish all the food was photographed, but we didn't have time (taking pictures when we wanted to eat? please!)...

excuse the salmon color of my walls. I'm hoping to get around to painting them soon.

changing of the seasons

Fall is quite possibly my favorite season. So is Spring. Really, the transitions from one extreme (Winter and Summer) to something different is appealing to me. Having moved every two to three years growing up, transition and change is welcome and positive.

This Fall brings many changes in my life - some good, some painful. I keep working on my personal life, my integrity, my needs. In the end, we all have just this one life. We have to live it in a way that reduces suffering and pain for ourselves We work towards what we want, what we need, what brings us peace and fulfillment. Some people refer to this attitude as selfish - I happen to call it self-aware. Self-aware or even self-centeredness is not a negative in my book - you are not taking from others in a way that robs them of their own identity and needs, but you are looking at yourself honestly and asking for what you need. To me, selfish and self-centered are polar opposites. Aren't we, as humans with egos, all self-centered?

Moving forward, I see hope and pain. Both of these are easy to feel in life. For too long, nearly all of my adult life, I've felt somewhat hopeless and stuck. I've dealt with a mental illness that crippled me and my relationships. I've been dishonest with myself about who I am. I have let myself down repeatedly when I don't ask for what I need.

We are all stronger than this. Digging deep inside, we must find that place that looks towards what we need to fulfill this time on earth. We don't get a second chance - and in the end, I want to look back and feel that I have been honest, have worked for good, lessened my judgment of others and felt true to my heart. I want this of those I love, too.

So emotional, this post. No ranting today about the state of obstetrics in our country...just a need to put it out there that midwives, like all care providers, deal with the same issues everyone else does. We all carry our own baggage, our own life experiences that affect us in deep ways.

Moving forward, just like the seasons, I am grateful for change and look to the benefits and growth that it always provides.

Looking for a midwife in the Denver area...

I'm helping someone search for a midwife for her upcoming birth, due 1/1/2008. She lives in the Denver area, but has been told by the midwives she contacted so far that they are completely booked. Knowing it's late notice, I still have great hope that this woman can have the peaceful homebirth she desires.

If anyone can pass on names I'd appreciate it.

last baby of November!

Thanksgiving day brings gratitude to a first-time mom patiently waiting for her baby two weeks past the 'due date'.

Was called last night at 10.30pm, drove to their house (about an hour and 20 mins north of us), got lost, arrived at 12.20am - quick and furious labor saw their 7lb 5oz baby boy born into his father's hands in the water at 3.32am.

This beautiful baby boy was 'diagnosed' with a two vessel cord in pregnancy - and while his growth was right on for dates, they received anxiety and pressure from their physician to induce early (very rarely do two-vessel cords cause issues, but it's always something to keep in mind in regards baby's growth). Eventually they decided that the birth they wanted for their baby wasn't going to happen in the hospital. At 35 weeks, prior to leaving for Kauai on vacation for a week, they hired me as their midwife. The remainder of her pregnancy was uneventful with a strong baby, continued growth, fabulous reactivity and constant movement.

Now they can actually put that sweet boy in his Thanksgiving outfit! The cord definitely had two vessels, but her placenta was gorgeous and healthy.

Came home around 7am, grabbed a few hours rest and now am getting ready for the guests to arrive.

Happy Thanksgiving!

thanksgiving eve baby

Had a birth early this morning, third baby (first boy!), 11lbs 8oz, born posterior. Short and sweet aside from some extra blood loss that resolved rather smoothly.

We have one more November mom, was due at the beginning of the month, that is expecting her first baby.

Doing a group prenatal up in Portland on Saturday.

Lots of preparations today for Thanksgiving dinner tomorrow! We have a vegetarian dinner - Our Menu:

Cocktail
Pilgrim Punch

Hors d'oeuvre
Goat Cheese Crustini with cranberry compote

First Course
Individual pot pies in acorn squash

Main Buffet Course
Stuffed Portobello mushrooms
Salad w/ dried cranberries, walnuts, apples, goat cheese
Vegetable tian
Parmesan roasted asparagus
Vegetable dressing
Mashed potatoes and gravy
Candied sweet potatoes
Rolls
Cranberry sauce

Dessert
Individual pumpkin mousse parfait
Apple crisp

I'm grateful for the path that I'm on, for the families I'm involved with, the beautiful births I am witness to, my health, my own family and my dear friends who have seen me through so much. I am also eternally grateful for my incredible apprentice/assistant who believes in birth so wholly that it always humbles me.

CPD = care provider disproportion

I have seen so many birth stories just like this. I've known a few women that wanted to send birth announcements to their previous providers (that 'diagnosed' CPD), but they knew that the providers wouldn't remember them at all. How upsetting that we remember the providers that cause us trauma, grief and intense pain from birth...but we are invisible to them even days later.

loss and birth

A close friend (a homebirthing doc) called me last night when I was on the road. She was in tears, telling me that her dog (who had been ill over the past few days) was dying and if I wanted to say goodbye, I should come now.

I drove straight over (fortunately I was close to the house) and entered their home. She had this dog for 13 years, since she completed her residency. Over the years I've known my friend, this dog (loudly) greeted me and our friends at gatherings in their home, she accompanied us to the lake picnics year after year, and hung out in her office for patients and staff to love on.

A couple times we watched her dog while her family went out of town. She was an amazing, sweet, beautiful dog.

Seeing the family around this dog was hard. The children were crying, my friend was crying. The dog was laboring with every breath. They cut hair from her as she lay in her bed. My friend told me that the vet had given them the medication to put the dog to sleep. She then asked if I would administer it. Just being asked to do this was intense. I agreed.

The family gathered on the couch, the dad lovingly held the dog in his arms. We unwrapped a bandage on her leg, revealing an IV start. In a slow, smooth motion I pushed the pink fluid into the IV port. Seconds later her labored breathing stopped. She left this world surrounded by those who loved and knew her.

They buried her last night out in their garden. The kids put some treats in the grave along with her bowls (of food and water). The stone with the children's footprints and the dog's handprints, made years ago, was placed atop the grave.

It reassured my friend to hear that a baby was on the verge of being born as I left.

~*~*~*~*~

Remember the client with no due date? The one we thought was due October 20th? She had her baby this morning, her fourth baby, third home VBAC with me. Beautiful girl, 9lbs, born in to her mother's hands in the water. Called at 4.30am, baby born at 7.39am. Her last baby was born in my apartment!

My apprentice estimated gestational age around 41 weeks. What's funny is that every pregnancy with her has been like this: nursing, no regular cycles, no idea of conception date, etc. She has an amazing sense of humor about her due date - and even when she's way over our guess date, she's still good natured about it all.

Ani Difranco's homebirth

Ani Difranco talking about her homebirth at a show last year...(language may not be appropriate for all)



I love, love, love her. I felt like a freak repeatedly calling her merchandising staff when she was pregnant asking, "is she having her baby at home? please tell her to consider a homebirth!". They were nice enough, but after the third time, I'm sure they had a "hang up on this woman right away" note on the phone. I also bombarded her MySpace with messages. Yes, more than feeling like a freak, I am one.

Artificial Rupture of Membranes

From the Cochrane Reviews comes this review of research that finds AROM (artificial rupture of membranes) does not hasten labor or ensure baby's well-being.

The researchers reviewed 14 randomized controlled trials involving almost 5,000 women and found little evidence for any benefits. Amniotomy did not shorten the length of labor, decrease the need for the labor-stimulating drug oxytocin, decrease pain, reduce the number of instrument-aided births or lead to serious maternal injury or death.

Anecdotally, there have been situations where I know rupture of membranes - both spontaneous (on their own) or artificial - has made a birth happen more quickly. I think it's safe to say we all know of times where late AROM has picked up a slow labor at the end of dilation. Whether or not it's supporting the natural process of labor (it's not), there are times where I've seen it work.

However, we also know that this information is not a surprise to many providers. I think the biggest disadvantage is when it's used to induce prior to 4-5cm (having seen AROM at 1-2cm for induction it seems to shows the least amount of effectiveness) or when labor is moving forward, but not to the appreciation of provider and/or mother. This review only pulled instances where labor had begun spontaneously and AROM was not used for induction.

In my opinion,this is where looking at evidence-based research is key: as providers, we carry alot of anecdotal experience. The important thing for me is that we don't allow those experiences become the truth for us. Giving full informed choice (including research like this) is important for each woman - including that our own experience includes an amount of women that a study this size would consider insignificant.

Thoughts?

waterbirth in the media

ABC's Private Practice, a spin-off from Grey's Anatomy (which I love, but not as much as ER), is featuring a waterbirth...looks like at home? The clip of the waterbirth was fast, though it looked like it could be in the hospital...but there are candles involved (hospitals can't allow candles because of the presence of oxygen).

Either way, Addison (the main OB/Gyn) is a quick-to-cut doc (her birth scenes in Grey's were almost laughable)...I wonder what this experience will be like. They're likely to have some 'emergency' like meconium (remember The L Word's attempted home waterbirth turned cesarean because of meconium while Tina was pushing?) or something else. It has to be dramatic.

Normal birth can be so boring for TV. Ha!

(Thanks to my apprentice/assistant for this heads up)

Mothers Naturally

A new website put together by MANA (Midwives Alliance of North America) for consumer awareness about midwifery and birth options Mothers Naturally

in the morning I'm surprised...

that I'm still in bed and not at a birth!

One first-time mom due last week, one third time mom due last week and a fourth-time mom (her third VBAC with me) due who knows when. (She was nursing and like her other two babies, her due date was unclear. We guessed October 20th, but now it's clear we were wrong...)

I need to stop looking at YouTube birth videos. It's so hard to see how babies are handled. I can deal with what women choose for their births, but the babies...isn't there a more gentle way to introduce them to the world than suction the heck out of their noses and throats, scrub them off with harsh surgical towels and clamp their cord right away?

again, with the cords around the neck

Doc: "Got the cord around the neck....Ohhh....good thing we did this, got the cord around the neck twice....normally would have resulted in an emergency c-section..."

ridiculous

birth in IKEA

Combining two loves of mine....natural birth and IKEA...

Cosmetic Vulvar Surgeries

This is off the topic of birth, but timely for women to be aware of. In the last five to ten years, there has been an increase in surgical procedures to alter a woman's sexual organs.

It starts with the commonly-known breast enlargement, lift, etc. I think I'm pretty numb to that already, as it's been around forever. Surely I must have been horrified when I first heard about it? I could have been too young to care or to even think that looking like my Barbie was something that should have raised my eyebrows.

It seems that there are a host of surgeries offered to women who don't like the look of their vulvas. Of course, this distaste for their own girlie bits comes from pornographic images. As a late second/third wave feminist, I'm not down on porn. To each her/his own. I am down on the increasing pressure for women to alter their bodies to look like certain genres of porn stars. Who is introducing these changes to women's anatomy? And WHY? To top it off, male porn stars have not changed their own genitalia at all in the last 100 years (well, aside from shaving and always looking to be 'bigger', a male myth that it's 'better' for women).

One blogger posts about the surgery to restore a woman's hymen (a hymenoplasty). From a Russian website extolling the virtues of "recovering [their] virginity". Why on earth would a woman want this surgery? My 'favorite' reason from the Russian site was this:

4. Enhancing the feelings of sexual gratification

Some women undergo surgery to please their husbands and partners. They want to “lose their virginity” all over again to celebrate their twentieth wedding anniversary in a very special way. Others have their hymens stitched back together to receive and give more pleasure when making love.

Perhaps you're thinking that this is an isolated look at this subject. Do a Google search for 'hymenoplasty' and you'll be treated to even more. The sad fact is there are women around the world, due to religious and cultural beliefs, could be at risk for alienation, abuse and sometimes even death if an intact hymen was not found.

Now on to more cosmetic and outrageous procedures...achem, "vulva enhancements":

• Clitoral de-hooding (yes, that's right, the removal of the clitoral hood)
• Labia majora and labia minora reduction (including labial liposuction for those with 'fat labias')
• Episiotomy scar revision - with or without tightening
• Or for those with 'skinny' labia, the labia majora can be increased with fat injections
• Thick pubic pads (the mons above the vulva) can be reduced

Last but not least, there has been a huge trend in the last five years for anal bleaching. Yep, you read right: anal bleaching.

Let me be clear personally: After the third degree episiotomy involved with my daughter's birth, I had to undergo perineal reconstruction surgery at 15 months postpartum. Even after a year postpartum, I was unable to have sex without incredible amounts of pain and was experiencing fecal incontinence. The surgery helped me regain my sphincter control, as well as remove a quarter-sized piece of hard scar tissue right at the vaginal introitus. I am grateful for that option that allowed me to have sex without intense pain and to not poo my pants in Target.

But still...these procedures? When they're done for cosmetic purposes, we have to examine why we believe that it's more attractive.

revisions

Because there were many readers that were unable to get the JoFP article on Breastfeeding Myths visible (to those using anything but Mozilla FireFox browsers, the entry was a white block), I fixed the formatting. Hopefully the article can be seen by all browsers now.

The First Cry - Le Premier Cri

Linked from Rixa's blog, this is a French film being released tomorrow (in French theatres, of course). I hope that one day soon we can purchase this on DVD!

Here is the website for the film...Enjoy! Pass the word!

more homebirth exposure...

I heard that the current issue of Vogue (with Jennifer Connelly on the cover) features an article about a woman named Daphne Beale who had a homebirth with her second baby. Evidently, it's a positive article where Daphne discusses safety of homebirth and the upcoming release of Ricki Lake's The Business of Being Born.

If anyone has this article, would you want to scan it in so it can be posted? Otherwise, I'll head to the store later and get a truck to help load up the current issue (second only to Bride magazine, Vogue is huge with advertisements).

An eloquent response to the unattended piece on To The Contrary...

From Rixa's blog...please read it if you haven't already. (Do you have her site bookmarked? You should!)

Breastmilk is NOT a complete source of nutrition...????

My apprentice forwarded this article from the current issue of the JoFP - the Journal of Family Practice:

October 2007 Journal of Family Practice
Newborn Care: 12 beliefs that shape practice (But should they?)
Common beliefs that require a second look

#1. Breast milk is a complete nutritional source for a healthy term newborn

The Evidence: Breast milk is not a complete nutritional source for heatlhy term newborns. In fact, breast milk provides the ideal source of nutrition, and it is almost a complete and perfect source of nutrition--with one important exception. The AAP recommends that all breast-fed newborns receive 200 IU/day of Vitamin D until they are getting at least 500 mL/day of vitamin D formula or milk.

The purpose of the supplementation is to prevent vitamin D defiency and subsequent rickets. The AAP makes no mention in its recommendation of infant pigmentation or the expected amount of exposure to sunshine. The AAP recommends that vitamin D supplementation begin by the time they infant is 2 months old.

#2. Supplementing with formula because the mother's milk hasn't come in yet is a reasonable, routine practice.

The Evidence: Formula supplements are not necessary as routine practice.

Formula supplements are counterproductive, taking away the primary stimulus for breast milk production---nursing at the breast. Infant dissatisfaction with the initial volume of breast milk produced actually works to the infant's advantage, driving the child to the breast more often, and thus increasing the likelihood of successful breastfeeding. In certain circumstances, formula supplement can be reasonable, such as when an infant is hypoglycemic or when the baby is receiving phototherapy and experience excessive weight loss and becomes severely dehydrated. However, formula supplementation is not reasonable or necessary as routine practice.

#3. Mothers on magnesium therapy should not breastfeed their infants.

The Evidence: Mothers on magnesium therapy may continue to breastfeed their babies.

The misguided recommendation that mothers who are being treated with magnesium therapy should not breastfeed is based on an unreasonable fear that magnesium therapy can cause hypermagnesemia in breastfed newborns due to excessive magnesium levels in the breast milk. Supplemental magnesium, usually given intravenously to mothers with severe preeclampsia, does not cross over into breast milk in any significant amount, even when the mother continues to need intravenous magnesium after the birth of her baby.

#4. Mothers who are positive for hepatitis B surface antigen or who are carriers for hepatitis C should not breastfeed.

The Evidence: Mothers who are hepatitis B surface antigen positive or carriers for hepatitis C can safely breastfeed their newborns.

The idea that mothers who are infected with hepatitis B or C should not breastfeed their babies at first seems obvious to many who care for newborns, as the diseases are transmitted through blood exposure, and nipple cracks with associated blood loss are common in mothers when they begin to breastfeed. The hepatitis B immunization protocol for infants born to hepatits B surface antigen positive mothers takes care of the first infectious concern. In addition, no case of hepatitis C transmission from breast milk has ever been reported. The Centers for Disease Control and Prevention confirms that the transmission rate of hepatitis C from infection mothers is the same whether the babies are breast or bottle fed.

#5. Mothers who are febrile should not breastfeed.

The Evidence: In most cases, febrile mothers may safely breastfeed their infants.

The advice for mothers not to breastfeed while febrile seems intuitively true because of concern that the infection might pass over into the breast milk to the baby. This rarely happens. There are only 4 contraindications to breastfeeding during maternal fever.

a. Active, untreated maternal tuberculosis
b. Mother who are human T-cell lymphotropic virus type I or II positive
c. Mothers who are HIV-positive
d. Mothers with a herpes simplex lesion on the breast.

#6. Mothers who smoke or drink alcohol should not breastfeed.

The Evidence: While this recommendation seems self-evident, the research proving harmful effects to the infant is lacking.

In fact, in its most recent statement on "The Transfer of Drugs and Other Chemicals Into Human Milk," the AAP removed nicotine from a table of drugs for which adverse effects have been reported on infants during breastfeeding. While it would be ideal if no breastfeeding mother smoked or drank alcohol, the fact of the matter is that some do. In light of this, it's wise to encourage the mother to smoke outside the home, and to change her clothes before holding her baby. In so doing, she will avoid exposing her baby to most of the effects of secondhand smoke. In addition, while mothers who breastfeed their infants should, of course avoid alcohol abuse, a single, occasional small alcoholic drink is acceptable.

#7. Pacifiers are bad for newborns.

The Evidence: It is not clear whether pacifiers are "bad" for newborns.

The belief that newborns should not have pacifiers came into being for a well-intended reason; breastfeeding advocates were concerned that newborns would spend too much time sucking on the pacifier and too little time sucking at the breast undermining the mother's ability to breastfeed successfully. Consensus on the matter though is lacking. The UNICEF World Health Organization Baby-Friendly Initiative, for instance, recommends that pacifiers not be used. The AAP, however, advises that pacifiers can be used once breastfeeding is well established. The research is also mixed. On the one hand, new evidence indicates that pacifier use may decrease the incidence of sudden infant death syndrome. On the other hand, pacifier use for longer than 48 months has been linked to orthodontic problems and dental caries. Thus, while prolonged pacifier use may be harmful to dental hygiene, newer evidence allows that pacifiers may be acceptable in the first few years during breastfeeding.

#8. Newborn emesis is an indication for a formula change.

The Evidence: No literature supports the belief that is is appropriate to change an infant's formula in response to emesis in the first 2 weeks of life.

The overwhelming majority of vomiting episodes in newborns have no accompanying medical problems. A 2002 study by Miyazawa et al that looked at more than 900 infants showed more than 47% of Japanese infants

#9. Umbilical cord care can prevent umbilical cord infections.

The Evidence: There is no definitive evidence regarding the best method for preventing umbilical cord infections among babies living in developed countries.

In fact ,there is no evidence that any topical preparation, be it dye, an antiseptic, or an antibiotic is any better at preventing umbilical cord infection than keeping the area clean and dry. Umbilical cord infections such as omphalitis or tetanus neonatorum are more common in developing countries than high-income countries. In developed countries, cord care with topical antimicrobial agents is frequently unnecessary.

Infants who were delivered at home and those who room in with their mothers have no need of a topical antimicrobial therapy. If an infant is kept in a hospital nursery or intensive care unit, topical antimicrobial therapy to the cord may have some benefit in keeping down cord colonization with pathological bacteria such as methicillin-resistant Staphylococcus aureus. Umbilical cord infections sometimes occur even when the cord area is kept clean and dry, so healthcare providers must be attentive to signs of possible infection.

#10. It's easy to spot when a newborn is jaundiced.

The Evidence: Jaundice is actually difficult to detect in darkly pigmented babies and in babies sent home within 24 hours of birth, because bilirubin levels reach maximum levels between the third and fourth days of life.

Years ago, when infants stayed longer in the nursery, doctors had the chance to see them when their bilirubin level was highest and when the babies were most jaundiced. The current emphasis on early discharge does not allow this practice. The AAP recommends clinical assessment of a newborn's state of jaundice and that a bilirubin level be obtained whenever a physician is in doubt about the degree of clinical jaundice. The AAP also recommends that physicians consider obtaining a routine screening bilirubin in all newborns at the time of hospital discharge even if by clinical assessment, the child is not jaundiced. The AAP made these recommendations because of an increasing concern that the incidence of kernicterus in American is rising.

#11. All infants who require phototherapy need IV fluids to prevent dehydration and enhance excretion of bilirubin.

The Evidence: Unless the baby is clinically dehydrated, IV fluid therapy for infants under phototherapy is not needed.

Though IV fluid therapy is commonly used to increase the excretion of bilirubin and combat dehydration, the research tells us that IV fluids do not bring down bilirubin levels and that even with mild dehydration, the best fluid therapy is breast milk or formula because it inhibits the enterohepatic circulation of bilirubin. Intravenous fluid therapy should be reserved for jaundiced newborns with moderat to severe dehydration or those with milk dehydration who are not able to take fluid by mouth.

#12. Breast-milk jaundice is best treated by stopping breastfeeding for 24-48 hours.

The Evidence: Breastfeeding should not be discontinued as a way to treat breast-milk jaundice.

In fact, breastfeeding should not be discontinued for jaundice due to any cause, as demonstrated in the opening scenario, unless you believe a baby is at risk of requiring an exchange transfusion. The need for phototherapy alone is not sufficient reason to discontinue breastfeeding. Breast-milk jaundice is a common problem facing parents and physicians, but it is not a disease and does not represent an abnormality in and of itself. Rather this normal physiologic condition gains its importance only in that it must be distinguished from pathological causes of newborn jaundice.

Breastmilk jaundice is believed to affect 1% to 33% of breastfed infants. One treatment measure--to stop breastfeeding--began, in part, as a cost-effective way to diagnose breast-milk jaundice. Rechecking the bilirubin 24 to 48 hours after breastfeeding is discontinued would reveal a significant drop in the bilirubin level, confirming the diagnosis of breast-milk jaundice and obviating the need for testing for more serious medical illness. The consequence of this misguided treatment approach, discontinuing breastfeeding, is that some mothers are more likely to stop breastfeeding altogether.