Except from The Birth Center Client Manual

What is Jaundice?

A common condition in newborns, jaundice refers to the yellow color of the skin and whites of the eyes caused by excess bilirubin in the blood. Bilirubin is produced by the normal breakdown of red blood cells when they complete their life cycle and die off.

Normally, bilirubin passes through the liver and is excreted as bile through the intestines. Jaundice occurs when bilirubin builds up faster than a newborn’s liver can break it down and pass it from the body.

There are several variables present in the first week of a newborn’s life, which make high levels of bilirubin and hence, jaundice.

  • Babies in utero have a much higher number of red blood cells to give them an adequate oxygen supply. After birth, the newborn gets oxygen quite easily through breathing, and does not need extra red blood cells. The excess number of red blood cells break down, producing bilirubin after birth.
  • Newborns make more bilirubin than adults do since they have more turnover of red blood cells.
  • The bilirubin becomes conjugated (or able to be excreted) by the liver, but the newborn’s liver is still fairly immature and is slower at conjugating bilirubin than an adult’s is. A newborn baby’s still-developing liver may not yet be able to remove adequate bilirubin from the blood.
  • Too large an amount of bilirubin is reabsorbed from the intestines before the baby gets rid of it in the stool. The baby’s intestines are storing meconium (the thick, black, tar like substance that lines your baby’s intestines during pregnancy). The longer the meconium sits in the intestine, the more time there is for the bilirubin it contains to become reabsorbed in the bloodstream, thus adding to the newborn’s load. This creates a backlog of bilirubin which then stores itself in the fatty tissue underneath the skin while it waits to be broken down in the liver. This storage causes the skin to turn yellow or to become jaundiced. As the baby’s liver catches up on its work, the jaundice slowly disappears.

If jaundice becomes severe, however, it is known as hyperbilirubinemia, which in its worst form can cause brain damage due to build-up of unconjugated bilirubin in the brain tissue, but this condition is rare; when proper assessment and follow up are done, it does not occur.

How to Assess Jaundice

Assessing the degree of jaundice yourself helps the CNM decide if a blood test needs to be done on the newborn to determine the bilirubin level in the blood. To make the assessment, follow these steps:

  • Undress the baby to his diaper in a comfortably warm room.
  • Hold the baby near a window with a strong indirect or direct light. It is best that it not be in a room painted yellow.
  • Press the baby’s forehead firmly with your finger. As you release, look at the color underneath. Is it white or a shade of yellow?
  • Continue down the baby’s face, upper torso, lower torso, arms, and legs, making the same assessment.
  • If the baby does have a yellow hue, assess where the yellow stops and starts changing back to white underneath. Jaundice is noticeable first in the head and gradually extends downward.

How to Control Jaundice

While a certain amount of jaundice in a newborn is normal, there are several ways you can help prevent the development of significant jaundice or hyperbilirubinemia.  One way is to nurse the baby frequently in the first few days of life. The nursing helps the baby’s intestines to contract and rapidly excrete the meconium. The faster the meconium is excreted, the less chance there is for the bilirubin in it to get reabsorbed and added to the liver’s workload.


A second way is to sunbathe the baby. Sunlight has been shown to break down the bilirubin most effectively; in fact, one hour of sunlight equals 6 hours under the special bilirubin lights at the hospital. To sunbathe the baby, put him in a bassinet or on a blanket near a window with sun or indirect light (even on a cloudy day). Make sure the room is warm and take off the baby’s clothes except the diaper. Sunbathe the baby like this for 20-30 minutes twice a day. The baby won’t get sunburned through a window.

If Jaundice Gets Severe

Proper follow-up is needed if bilirubin levels get too high. The level of bilirubin normally peaks within 72-96 hours after birth. If the jaundice has reached a certain level, a blood test may be ordered by your pediatrician to assess the bilirubin level. The physician will determine if any follow-up is needed, such as further testing or treatment with special lights either at home or in the hospital. If the baby needs to be hospitalized, he is monitored more closely for bilirubin levels and placed under the bilirubin lights for a day or two. These fluorescent lights are of a particular frequency that mimics the sun’s effects and cannot be purchased for use at home.