Birth, Baby!

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Welcome, this is Birth, Baby.

Your hosts are Ciarra Morgan and Samantha Kelly.

Ciarra is a Birth Dula, Hypnobirthing Educator, and Pediatric Sleep Consultant.

Samantha is a Birth Dula, Childbirth Educator, and Lactation Counselor.

Join us as we guide you through your options for your pregnancy, birth, and postpartum maturing.

Hi, today we're chatting with Dr.

Elissa Gonzalez about all things jaundice.

Dr.

Elissa Gonzalez is a Board Certified and Integrative Certified Pediatrician and Lactation Consultant.

So she's an IVCLC, for those of you that have heard that buzzword.

Practicing at Blue Monarch Pediatrics in Lakeway, Texas, that's near Austin.

She specializes in behavior, social-emotional development, ADHD, and newborn care.

And she understands that each child is a one-of-a-kind individual, and their health is influenced by various factors, like physical, emotional, and social elements.

Her approach is all-encompassing, focusing on nurturing every aspect of a child's well-being, and she looks beyond the symptoms to find the root causes and collaborates with families to create a customized care plan that promotes balance and harmony.

And that is what I love most about her.

So thank you so much for being here, Dr.

Elissa Gonzalez.

And do you want to just kind of get started and tell us a little bit about you and how you became a pediatrician?

Yes, and thank you.

I'm so honored to be here.

Thank you for inviting me.

You already gave such a great introduction about me.

I am also a mom of three, and I'm here locally in Lake Way.

And kind of what got me into, you know, pediatrics and being a pediatrician.

Early on, I was very interested in puzzles, and I'm so that too, I just like try and figure out puzzles.

So I knew I wanted something problem solving.

My interest kind of expanded into, as I got older, science and helping animals and people.

I had this like animal club, this animal rescue club, helping injured animals, and we did like nails.

And I think the biggest animal we had was a bird.

Oh, we did rabbits, baby rabbits.

But it started off with animals.

So I knew I wanted to go into medicine.

And so I applied to a medical academy for high school, Hightower, it's over in Missouri city.

And one night I was shadowing in the ER, and there was this little boy, a four year old, he didn't have his parents with him.

And he had a huge injury on his forehead and the neurosurgeon came up and was like, sir, you know, we're gonna need to suture the laceration.

Do you have any questions?

And I just remember seeing his eyes and they were just like full of tears.

And I just grabbed his hand and I said, look, this nice man, he wants to fix your boo boo and it's okay to be scared.

You're gonna be fast asleep when it happens.

You won't feel anything at all.

And he just looked at me and smiled and it was then, I was like, I knew I wanted to work with children.

And I thought I wanted to be an ER doc.

But then I was, you know, realized that I really wanted continuity of care with the families.

And so I felt like I could make the biggest impression on families and help kids if it was more of a continuity of care.

So it was a long story, a long story short.

No, but that story, I'm a doula and an empath.

And I can't really get over the fact that this four-year-old was in the hospital room by himself when a doctor was talking to him.

And it's like breaking my mom heart.

Yes, it was so sad.

I was like, I'm here for you if you need anything.

He's like, okay.

It was so precious.

That's so sweet.

It's so scary when our kids get hurt and it makes such a huge difference to have a provider there who's able to bridge that a little bit.

So we're glad to have you on the scene.

So can you help explain to our listeners what jaundice is?

Yes, great question.

So jaundice is a condition where the skin, so any of the skin, the whites of the eyes, you can even see it under the tongue.

It turns a little bit of a yellow, sometimes a lot of yellow, tinge.

And what happens is there's a pigment called bilirubin.

And so it is the product of the breakdown.

So your red blood cells, it normally breaks down.

It could break down for various reasons.

We'll talk about it in a little bit too.

But if the blood cell breaks down, it'll break down into like a little bit of a substance bilirubin.

And that's what causes the jaundice, because it's yellow.

And the way our body gets rid of it, there's two ways our body gets rid of it, is through poop.

So yellow, that's what we're always like, is there yellow CD poop?

And then also the sun.

So if the sun, if you're exposed to sun, it translates the bilirubin into a water soluble unit to get rid of it.

So essentially sun and pooping it out is the way we can get rid of it.

I knew what it, like I knew that sun worked, but I didn't know why, so that's kind of cool.

Yeah, and it, the light, cause it has like a blue green light tinge the sun.

When it hits the yellow, it makes the water soluble.

It's really interesting.

So you said like there are things that can cause it.

So do you want to go over that real quick?

Like what are the known causes of jaundice?

And a lot of parents want to know, can I do anything to reduce the risk of my baby getting jaundice?

Yeah, so there are certain things that can increase your risk and then minimal things to kind of prevent, but we'll talk about those too.

So premature birth is a big one.

So babies that are born before 36 weeks, they have underdeveloped livers.

Our livers are what conjugates the bilirubin and helps get it out of our stool.

And so if you can't conjugate it for various reasons, prematurity being one of them, then you can't get it out and it builds up.

So some things to prevent premature birth, making sure as a llama, you're not so stressed out or taking those times to be out in nature or a good hour of just meditating or time for yourself, making sure all your chronic conditions are managed well.

If you do have a history of preterm labor in the past, your physician may put you on a medication to prevent preterm and then infections like UTIs can cause premature delivery.

So making sure that you're not increasing your risk of the, I mean, some of it's out of your control.

And then breastfeeding.

So breastfed infants are at a slightly higher risk.

If they don't get enough fluids, they're not getting enough calorie initially, their gut goes a little bit slower and it doesn't eliminate that bilirubin.

So some things you can help with that.

Antenatal expression is great.

So it helps to establish milk supply early.

And I teach all my mom, during our prenatal visit, they walk out with at least like one to five mls of colostrum in hand before they're giving birth.

And so it just really helps to establish it early and then setting it up so that they can get rid of the jaundice.

Another thing is that it makes them high risk is the blood type incompatibility, something you can't control what blood type you are.

But if you have a blood type that's incompatible with baby, then it can just kind of attack the blood cells.

And when the blood cells break down, you increase Bilirubin, some things to prevent.

So if you're RH negative, your doctor may give you a RhoGAM shot.

And RhoGAM can help protect the attack, call it the attack on red blood cells.

Bruising and birth trauma is another reason that you could be higher risk for high bilirubin.

And that one, again, not something that can really be controlled.

But if you have a traumatic birth, maybe you guys can talk about preventing birth trauma at some point.

But if you're able to do that, then you can decrease the amount of bruising, which also breaks down red blood cells and causing elevated bilirubin.

Another one is genetic.

So if you are East Asian or Mediterranean descent, again, nothing you can control.

Those sometimes have higher risk of bilirubin due to genetic effects and factors.

And then sibling history.

Oh, go ahead.

Oh, sorry, go ahead.

No, you go ahead.

Finish your last one.

Sibling history.

Sibling history.

So if you do have a history of multiple babies needing hyper bilirubin, your next baby does have a higher chance.

However, I just had a mom, her first two needed phototherapy.

We were able to establish antenatal expression and get baby latching and doing well.

And she did get pretty high, but she did awesome.

And we didn't have to do phototherapy, which was great.

Right, I have a couple of things.

You got my brain pinging all over the place.

And I'm just throwing stuff at you that I didn't even tell you that I was gonna ask you.

So buckle up.

One of them is, did you just say that breastfeeding is actually a risk factor for jaundice?

So like formula fed babies don't get this as much?

That's crazy.

Right, so with formula, you are already providing that volume of calories and food and fluid.

And so the gut starts moving faster and you start eliminating bilirubin faster.

So one of the treatments of high bilirubin is, okay, feed fluids, fluids, fluids.

Fluids, fluids.

And so with babies who are breastfed, that might not be able to establish good fluid intake.

So their latch is poor.

Sometimes with C-section babies, they're not able to produce the milk right away and not get enough fluid, then they're not getting rid of the bilirubin that they do have.

So it can be a slightly higher risk.

But I always tell families that should never deter you from breastfeeding because we can do things like antenatal expression.

We can do things like having that colostrum with you, getting a good latch.

There's lactation in either the hospital or home visits to get that intake, keeping the baby awake, wiping them with a cold wipe, keep them awake so that they do feed.

Because a lot of times they're just exhausted, they're tired.

And it's hard work to breastfeed for the baby after going through such an experience.

Whereas, you know, the bottle that's just flowing through their mouth and they're fluid.

And so they're able to take that a lot faster.

So there's just a slightly interest risk.

Yeah, I'm glad that you said that, that it's like, that's not a reason not to breastfeed.

And it's great that you're, I know that this isn't what we're here to talk about, but a pediatrician that is talking to moms before they have their babies, talking about being able to hand express so that you can, you know, supplement your baby with your own colostrum versus having to supplement with formula.

If that's something that you want to do, some people are okay with it.

But if you don't want to, being able to get their colostrum harvested at a time is really cool.

Maybe we should even do a little mini episode on that sometime, Sam, about kind of prenatal expression.

And there was one other thing you've said about Billy Reuben that, oh, I'm not gonna remember now.

That's okay, we can move on.

Sam, did you have anything?

I don't think anything extra, but I do have another question.

So I know like if babies have really high Billy Reuben, then sometimes they need to go on the phototherapy lights, right?

And so a lot of times they have to go to the NICU or if they're in the hospital, or sometimes they'll bring the lights to the room.

So my son actually had jaundice when he was born and they didn't find it until like day two or three when we were getting ready to go home.

And they're like, oh, well, we're gonna have to keep him to put them on lights, but we don't have a bed for you.

So you're gonna go home and you're gonna leave your baby here.

And I was like, absolutely not.

That's like, there's no world where that's happening.

And so thankfully my dad was there and he had had experience like 20 something years ago with his, with my brother who had really severe jaundice and he came home on lights.

And so my dad said, hey, you know, this was an option 25 years ago.

Is this still a thing now?

Like, is there an option for lights?

And it was really, really difficult.

Nobody had any idea what I was talking about.

There was like very little options, but we finally found an option for him to come home on lights and he spent like 12 hours on lights before our pediatrician was like, he's fine.

He doesn't need this.

But I know, you know, what are the other options if a parent doesn't want to, you know, fight that fight?

Let's make that a little more accessible for people.

Yeah.

And you know, I get it.

I'm a mama of three.

You just want to go home.

You don't want to stay any longer in the hospital and not leave your baby.

Of course, that's, you know, more extreme case.

Yeah, I do want to stress the dangers of hyper bilirubinemia because it can lead to connectorosis.

What is, you know, connectorosis?

It's when the bilirubin builds up in the brain, you can get neurologic damage, CP.

I mean, when I worked in Peru, I saw a little boy who had CP.

It rarely ever happens here because we have things in place.

So it can be super frustrating in the hospital to stay longer than you planned.

And I will say that there are new guidelines.

So recently, I had a mom come home with much earlier and a higher ability than I've ever seen in the past because they're adopt the hospital.

It takes time, but the hospitals are finally adopting some of these new recommendations.

The AP came out with a guideline in 2022, stressed, yes, the importance of testing, but then also more conservative recommendations about the treatment specifically with phototherapy.

So it's great that some of the hospitals around here, and I'm hopeful that when they are saying it now, that you need to stay longer a night to monitor levels, it's because it's necessary versus not.

But however, with that said, I've had families leave early, we will make an arrangement.

They'll tell the hospital, hey, I really wanna go.

I have a pediatrician in place.

She will see me even on the weekend.

So make sure you have a pediatrician that will test and monitor for Billy whenever you're interviewing for a pediatrician because I will have families leave the hospital, some even before the 24 hour mark.

Because they're like, I just wanna get home and I'll speak with the pediatrician in the hospital.

Hey, I'll take over their care.

I will see them in the morning.

We will do a Billy Rubin test and go from there.

So if you do wanna leave early, having a pediatrician or a health provider to test the Billy to monitor that if it is a little elevated is really important for your baby's health and then finding someone who you would be able to do that.

And you brought a great point up about doing the treatment in the home.

So currently, and there's two unique things about our clinic is we do a transcutaneous, I have like a Jagger machine, the same one that the NICU has.

So I don't poke for blood unless we're about to start treatment just to make sure that the machine was accurate.

And it's been like point one off.

Every time I've tested, but I'll do the machine.

It's a little light that taps onto the skin, baby's fast asleep, non-traumatic.

And then if it is high, then I will talk with a family.

There's a company, billyblanketbaby.com, I'm trying to remember it.

And they charge $95 a day.

So I'll send them a script and it'll go directly to the house and I can monitor the baby on lights in their home with no problem.

It's hard for other pediatricians outpatient because you can't bring your baby on lights to the clinic to get a test.

And so the majority of the times they are sent to the NICU.

But if you can find a pediatrician that is willing to do the BiliBlanket in the home, that's fantastic, sparing going to the NICU and being in the hospital any longer.

So unfortunately, the reason that we even considered doing this podcast, what made us want to do it was, and I'm not going to say where, but there is a hospital in Austin that we have repeatedly had patients or our clients be told the baby needs to stay another night because we need to check their Billy Reuben levels in the morning.

And sometimes it's not even that they want to be on lights overnight.

It's like we're going to check them in the morning and see if they need to start it.

And it just seems very money hungry to us.

Like it just seems very strange to be telling people that we just need to see.

So I don't know if you can, and if you can't, I understand because it's a medical question.

Is there like a number where it's like, okay, this is a dangerous level that parents can have in their mind so that if they ask like, I'm making up numbers here because I'm so not medical.

My baby's number is three and 11 is like the scary number, but now that they're telling you it's three, like I feel more comfortable going home and doing it at home.

Whereas the number 50 would be like, we've got to stay.

Yes, so bilitool.org, I believe it's adult org, BiliTool.

Look at it.

You put in your baby's hour of life.

You put in the number that they drew and it'll tell you.

And that's the tools we used as, you know, we use as pediatricians and it'll say, it needs to be rechecked within this many hours.

It needs to be, you know, maybe it's safe level.

It doesn't need to be rechecked, but it'll tell you where you are in terms of, you know, danger zone, high risk, moderate risk.

Does it need to be repeated or not?

And it's, you know, you can even ask, and this is a great point of being like an advocate for your child.

You can say, you know, where, how high is that?

Can I see a chart or something that shows that, you know, is he trending up, trending down?

And then also saying, hey, if he needs to be checked next morning, can we set up an appointment with my pediatrician?

And they do it.

Or some hospitals will write an ER slip of Billy, like a lab order, and they just go through the ER.

They don't actually do an ER visit, but they just do go through the lab and get a Billy test.

And then they'll follow up like, okay, that's what it is.

So you're not having to stay in the hospital any day longer for that.

There's the problem is, and it's not really money hungry for hospitals.

The problem is there's just not a lot of support and set up for kids who have John is in Billy Irvin.

You just kind of send them home and hope that they do go to their pediatricians the next day.

And a lot of pediatricians can't see next day, same day in this area, because it's just, they're already overbooked in 30, 40 patients a day and trying to get them in, it may not be feasible.

And so they are really concerned and they want pediatricians and hospital advocates for the babies.

And so making sure that the babies are safe versus, you know, the comfort of-

And I don't mean to make it sound like the doctors are bad by any means.

I'm not saying that.

It's just, we have had a couple where it's been really sketchy, where we're like, I mean, the baby's not even on lights, but you want to check the baby the next morning to like be sure, why can't we just come back?

Some of them have just seemed incongruent, but that does remind me of my other question that I was gonna ask you earlier, which is, you know, you're saying that breastfeeding, for example, if you're doing it and it takes a little while for your milk to come in, even though the baby might be fine, the jaundice levels are gonna be higher.

And same with just all of the things that you said, seems like this would have been a problem forever.

So is it that this is a newer problem or is it this has been a problem forever and we now have Billy Blanket, so we're having less incidence of CP, like you're saying.

And now that we can handle it more, we're not having as many fetal deaths, things like that.

Is that what it is?

Right, so we're able to monitor levels.

Because back in the day, we used to just do it by eyesight.

And like the new guideline says, eyesight's inaccurate.

It can be super high and cause neurologic damage without being highlighted yellow.

It used to be A, if they're highlighted yellow, yes.

But it's hard to know exactly their level until you actually test.

The new guidelines say test within 24 hours and then go by that, whether it needs to be repeated or if they need phototherapy.

Because it can rise really quickly and really fast.

And then if you're not in a setting where you can bring it down quickly, then it can be harmful.

And the hospital too, they see the worst of the worst.

Like they see all of...

I know when I was in the NICU, we were pulling blood and giving blood to newborn baby with high level, high levels of bilirubin so that they don't have neurologic damage.

And so a lot of these visitors too, they're practicing from that standpoint.

I've seen the worst of the worst.

What's one more day?

What's one more night?

And then make sure they're totally, totally safe to go home.

But now with these new guidelines, I'm hopeful that they won't have to keep these babies because they're not having to repeat the tests that even some of these higher levels that previously were.

So it sounds like some of the important things for parents to know is to be chatting with your pediatricians before you even have your baby about is it possible for you to test?

And if it is possible for you to test and maybe does need lights, are you able to kind of help facilitate the home lights?

Yeah.

And be an advocate.

Some levels are really low and they can go home asking how low is this and can it be done in the hospital?

Can it be done in the lab?

Not the hospital.

Can it be done in the lab?

Can it be done at my clinic?

Once you become a mom, you become your advocate for your child and the only way that you can get that support and the services your child needs.

Yeah.

It's a learned skill that we all have to kind of figure out as we're tumbling rapidly downhill, holding a baby.

Yeah, right.

You're like, whatever.

I get that point after you have a baby, you're like, whatever you say.

That's exactly right.

But having that plan first is so important.

So you talk with your pediatrician before you have your baby.

So you have a plan in place if the belly is too high.

And we talk about it too, if glucose too is too high.

I'm like, you bring that colostrum, frozen colostrum, so you can help with your belly.

You can help with your glucose.

You can help early on.

So having that bond in that relationship with your pediatrician before even having the baby is going to be important.

Advocate as well.

Because families will text me while in the hospital like, hey, this is what's happening.

I was like, yeah, let's do this, or let's do that, or see if they can do this.

And there's no harm in asking.

Which is so huge, so huge.

I really think that was a big part of why I was able to bring my son home on lights because I had a family doctor who gave me his personal cell phone number and said, please text me when you have your baby and we'll just go from there.

And so when they were like, oh, we're going to keep your baby and you have to go home, I texted him and he was like, no, we can do this.

It was amazing.

And he came in to clinic on a Saturday morning for me, which a lot of people don't have that.

So figuring that out is also a really, really big piece.

Maybe coloring outside of the lines when you're choosing your pediatrician, looking for pediatricians who are able to support that can be helpful, sounds like.

Right.

So what is the process of dealing with jaundice at home?

What does that look like?

Yeah, so typically, so a family will come home either from the hospital or say it's at home, Birth, I'll go around one or two days, I'll visit them, I'll bring my little Jager machine and I'll at least test the Billy Rubin on the first visit just to see the level is and if it is high.

So it depends on the level, of course, whether we just need indirect sunlight from the sun and increased fluid or do we need to order Billy blanket and I'll send in a script, that's companybillyblanketbaby.com and they'll send out a Billy blanket, I'll put a little sticker on because that's just how you test.

You'll put a little, kind of like a little bandaid because if you just, if you do the lights and you test where you're doing the lights, it really doesn't indicate the level deeper in.

So anyway, you put a sticker, it's a process and then I will test the Billy ribbon every single day until it goes down.

Sometimes I have had to do it every six hours till it goes down until they're in more of a safe zone.

Never have I ever had to fortunately send them to the NICU or do anything more extreme than treatment with a Billy blanket or lights and fluid.

I can see how this would be really intimidating for new parents, especially if it's their first baby.

Some people would just like, put me in the hospital, that's fine.

I feel more safe there and that's totally fine.

But you're right, people that have had home births or birth center births who didn't even start in the hospital, it's more intimidating to have to go into the hospital setting for this.

So people wonder about cost.

And I know you said $95 a day for the Billy blankets to rent.

And then I'm sure that they have to pay you some amount to be coming to the home or whoever doctor that they're going to be seeing.

How many days is an average or do you typically see someone needing to have these?

Is this like a two to three day thing or could this be weeks?

In terms of treatment?

Yeah, I mean, it varies, but no longer than two to three days that I've had to do it.

Extreme cases, those are the ones seen in the hospital where they're having to do blankets and triple lights and things like it.

There's high elevations, their elevations are super high.

These are the ones in the hospital, but no longer than two or three days because it's most likely breastfeeding jaundice or they're just not getting fluid or maybe tired.

The biggest cause, if it's anything else, like if there's something wrong with the liver or if there's other things going on that's more severe levels and those are in the hospital.

But if it's something that can be treated at home, it's the normal jaundice, two or three max.

Okay, it is like this crazy cycle of, well, you have to feed your baby more or they're gonna have higher jaundice, but when they have jaundice, they're really tired so they don't wanna feed as much.

So you gotta wake them up because they're really tired and you gotta feed them more, but it's really hard to keep them awake because they're tired.

It's like constant going in this cycle.

And you're tired.

We're tired.

When I remember with my son, sometimes I go to a postpartum follow-up visit for a birth doula client and they're saying like my baby just is sleeping all the time and it's hard to wake them up for, and they don't have jaundice or anything, but still it's just difficult.

Babies like to sleep only when you're not sleeping.

So they'll say this and they're like, look, he just falls asleep on the boob.

I'm like, you might need to put him all the way down to his diaper.

And I was like, roll a cold little water bottle on his belly, you know?

And I know it seems mean, but like you gotta get the baby to wake up.

So I remember doing that with my son.

It was like, I rubbed the bottom of his feet to try to get him to feed more.

And you're like, you gotta make him mad, which seems like feels bad, but it's better than having a baby that isn't getting enough fluid.

Right, and you don't have to do that for long.

So it may be a day that you have to kind of wake them up, get them a little angry, so they're drinking more.

Because once they're drinking more, they're getting more energy, they're getting more sugar, then they'll do it on their own.

It's just, I mean, you can't run a marathon on empty.

And so once they get some sugar, then they're like, okay, we can do this.

And then they're fine.

But yeah, I say, you know, wipes, cold wipes on them, wake them up, or changing diapers.

They're like, they hate being changed.

They're like, well, great, do that just to wake them up and we can feed them and just do it for a day.

But just, yeah, not long, not long.

Yeah, which is, I mean, that's more doable, right?

Like when you think of it, it is small chunks, little pieces of time that you need to do it for the long-term benefit.

So is there anything else that we need to know about jaundice and babies?

This has been super helpful.

Yeah, one of the, you know, questions that I get a lot of is delayed cord clamping and jaundice.

I'm so glad you said that.

If we got off of here and I hadn't asked you that, I'd be so mad.

Yes, it's a very common question.

And so delayed cord clamping is when baby is born and it's clamped after 60 seconds or when it stops pulsing the cord.

And the American College of Obstetrician and Gynecology, so ACOG, they published a study that shows that peak bilirubins were higher in infants in the delayed umbilical cord clamping group.

But there was no statistically significant difference in the need for phototherapy, which is very important.

So they didn't need any other therapies.

They didn't need any other interventions.

Their, you know, Billy was just a little bit more elevated.

And so I get some pushback, you know, so we do during prenatal visits, I'll say, okay, we want to do it, you know, we want to.

It's great to do.

You can decide what you want to do, but I give them that, you know, the benefits of delayed cord clamping after 60 seconds, you know, one minute to five minutes is what the studies show.

It helps with, you know, anemia, right?

So iron storage, your breast milk does not, you know, it's very low in iron.

The babies get the iron from when they're inside in utero and then also through the cord until they can eat at six months.

And so if they don't do delayed cord clamping, we end up, you know, having to supplement with more iron and that's rough on the gut.

And it's just, so I talk with them all about risks and benefits of delayed cord clamping.

And they'll talk with some of their OB guides and they'll say, well, it's going to increase the risk of bilirubin.

We don't do it past 30 seconds.

And so I've had to send a recent, I'm like, send this.

It's from their journal, it's from their journal.

It's not going to increase any more treatments or anything like that.

Yes, it is going to increase your level, possibly of bilirubin, but not significantly enough that you would require any other treatments.

And then you can save your baby from doing all this iron supplementation and anemia in the future.

And so there is this kind of misconception about delayed cord clamping, but I think a lot of hospitals now are, at least this year, they've done one, two, three, I had one hospital do it till it stopped pulsing.

And I was like, yes, this is great.

And sometimes the providers, like from the birth aspect, sometimes the providers are just open to doing whatever the person wants.

Pretty standard in Austin, at least across the board, pretty standard for one minute of delayed cord clamping.

But we talked to our clients about delayed versus optimal.

Delayed is one minute, optimal is until the cord stops pulsating.

And you can't always get that in a hospital set.

I mean, you could, but you're gonna sit there and argue, and then that increases your risk of hemorrhage and blah, blah, blah.

So, but when we talk to people about this with the delayed cord clamping, that's always their worry is, but my doctor said it could cause jaundice.

And my reply is, well, but babies who had more of their own cord blood have more vigor and intensity to want to eat because I have more energy.

So they're going to be able to eat and then they're going to be able to poop.

And that's what we want them to do to get rid of it.

So that's really exciting to hear you say that it's not significant enough to increase the need of phototherapy.

And I think that that's a really important take away from this is, and I had a dad once we were, I was out of birth, he got super mad.

They called me afterward, very, very, very smart man, like super intelligent.

And he calls me and he's like, they want to keep the baby because they say that his bilirubin levels are high, but that's not fair that they are comparing them to babies that didn't have delayed cord clamping.

That's what the numbers are based off of is these babies that didn't have that.

And they need to have new numbers for babies that get full of their own blood.

And I was like, preach, go sing it on the mountain.

I don't know what to tell you.

Spool everybody there, I agree with you.

That's a good advocate for his child.

He's calling me and I look like the jerk.

He's like, my doula said, don't say that.

We did not say that.

God, I love it.

So if people want to learn more from you or want to have your support dealing with jaundice at home, how can they get ahold of you?

Yes, so if they go online, the bluemonarchpediatrics.com, you can set up a meet and greet.

You can chat with me or my partner, Dr.

W, Dr.

Whitaker.

He is also seeing patients with this model.

We talk about the model and how we support you both in home and pediatric, all through pediatric care.

And then you can sign up once you...

So for moms who are pregnant, you can get in for a prenatal visit before two weeks.

I always say two weeks before.

Find your pediatrician or get in with a prenatal visit.

They can schedule that right off the bat.

And then once your baby is born, you just send it.

I love seeing text messages of the babies.

So we have a text messaging app and they'll send a baby picture.

So-and-so is born this many pounds and then we'll go from there to support them.

But yes, online is the best way to start, fill out a contact sheet or email us or just schedule directly a meet and greet right now.

You can hop on and just schedule a time to talk with us.

And just because I know that people are going to ask us as of this recording, which is early January, are you all currently accepting new patients?

Yes, we are.

So yeah, we just-Dr.

Whitaker just started.

So he is and I still am as well.

You guys, I chatted with Dr.

Whitaker, I don't know, a couple of months ago, we did a meet and greet on Zoom.

I loved him so much.

This model of care is so cool.

Maybe we can do another like little mini episode sometime about what that model of care is and what it's like, because you're not the only one with it.

So it would be helpful for people to kind of understand that.

But it is more of like, I call it like concierge service.

But I just love it.

And the way that you guys treat the whole family and the whole child rather than treating just symptoms, I really appreciate.

So thank you so much for taking time to come on and chat with our listeners about this.

Thank you.

Thank you for the invite.

I'm honored to come and chat with you guys.

Thank you so much.

Thank.

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