Women who continued to supplement with formula because of their experience expressed fear that jaundice would return if they quit supplementation.
“I am still on formula now [7 weeks after experience]. The doctor said he wanted to wait until it is 3 weeks after he is released to wean down. ... I think it caused some damage for me because I am still frightened to really let go of the formula. I may be wrong and maybe it can’t come back at this stage, but I think that something could go wrong and I am still giving formula to make sure that he is getting enough.”
Although mothers whose infants did not receive phototherapy were more likely to be told to continue breastfeeding or to be given no feeding orders than mothers whose infants received phototherapy, there was not a clear pattern between feeding method at 2 weeks postpartum and form of jaundice treatment. Although a few mothers expressed concern about breastfeeding during phototherapy because of having to remove their infant from the light, no mother quit breastfeeding or began supplementing specifically because of treatment. However, many mothers discussed the strong emotional impact that blood work, phototherapy, and the mother-child separation had on them.24
The majority of mothers had prior exposure to neonatal jaundice, approximately one third through personal experience with previous children. Although a few mothers had previous experience with jaundiced infants undergoing phototherapy, only one had been told to stop breastfeeding a previous infant because of jaundice. Even though this mother was not told to stop breastfeeding her current infant, she supplemented with formula because she felt her milk was “no good.”
Maternal internalization of experience
Mothers who received breastfeeding orders to suspend or supplement, or who were given conflicting orders, repeatedly expressed confusion or discontent with these instructions. They commented on the conflict between the medical professional’s advice and their own understanding that breastfeeding was healthier for babies, and on not receiving sufficient explanation to justify changing their feeding method.
“She [doctor] just told me to stop breastfeeding because…. Actually she didn’t tell me why. Which got me confused. I remember I was thinking why did she tell me to stop breastfeeding if breast milk is better for the baby?”
Mothers also shared concerns about nipple confusion affecting their ability to exclusively breastfeed, and feeling that decisions were out of their control.
Lack of understanding about causes of jaundice and feelings of guilt over their role in the etiology were common among all women. More than one third of women expressed guilt that they had caused jaundice either during pregnancy or while breastfeeding.
“I was afraid I did something wrong... that my milk wasn’t coming in right… that I wasn’t feeding her enough or I wasn’t feeding her the right things. Or that my milk was broken ... that I wasn’t making enough or it was wrong somehow. Like it wasn’t meeting her needs.”
Several mothers also expressed belief that their infant may not have gotten jaundice if they had not started breastfeeding.
“I wonder if she would’ve started with the formula, if we would’ve started to supplement with formula from the very beginning, I wonder if it would’ve happened.”
More than half the women discussed breastfeeding as a cause of jaundice. Those women had experienced early neonatal jaundice. More than one third had a previously jaundiced infant and approximately half had previously breastfed. Those who received breastfeeding orders to suspend or supplement, or who were given conflicting orders, were much more likely to discuss breastfeeding as a cause of jaundice than were those who received no breastfeeding orders. Mothers told to continue breastfeeding were least likely to discuss breastfeeding as a cause. No pattern was evident among women by language spoken, parity, bilirubin level, jaundice treatment, or feeding at the interview.
Women’s perceptions of what it is about breastfeeding that causes jaundice related to either quantity or quality.
The causes related to the quantity of breast milk included:
- Insufficient feeding. The infant is not receiving enough breast milk because he or she is not eating enough or the mother is not feeding infant enough.
- Insufficient milk. The mother is not producing enough breast milk.
The causes related to the quality of breast milk included:
- Milk composition. The breast milk caused jaundice, often because it was not good.
- Something in milk. There is something passed through the milk to cause jaundice, such as medicine, hormones, or emotions.
Women who gave explanations for jaundice closer to a biomedical understanding of jaundice, such as insufficient fluid intake, received this information primarily from medical professionals and occasionally from family and friends. Many issues related to feelings of guilt came from their own thoughts, though they were, at times, triggered by something said by a medical professional or family member. Mothers interpreted the information, or lack of information, they received in their attempt to explain why their infant had jaundice.