I have a situation that I would like some input on. My client delivered on
Friday April 8, 38+ weeks, no complications during pregnancy. Infant had
transient tachypnea and ended up in our Level II or special care nursery for
increased respirations, and rule out sepsis. The mom began pumping to
express milk and stimulate production Friday afternoon. The first time she
pumped I assisted. She used a double electric hospital grade pump and
afterwards I added <2cc glucose water to each flange/bottle to draw out the
colostrum. The total obtained was 9cc and mom was very pleased. She took
the syringe of colostrum to the Nursery and the nursery nurse called me and
BLASTED me out. She was completely inappropriate in her manner, but just the
same, I took her complaint seriously. She said that every time I send
expressed colostrum to the nursery, they throw it away because I am not
suppose to add any water to it. If an infant is on limited feedings then
the milk cannot have any water added. I tried to explain that it is just
drops and when I say < 2cc, I mean it is barely over 1cc if that. (yes to
each side so a total of <4cc) I also rarely use glucose water, usually just
sterile water, however, I happened to grab the glucose bottle and since the
baby had no blood glucose issues, and was not a premie, I felt that it would
be alright. I did tell her NOT to throw it away because the baby would not
always be on limited feeds and mom could give it at a later time, dad could
even take it home if she was that concerned about storing it here. In the
end, the mom said that she thought it was stored here, however I looked for
it yesterday (monday) and it is no where to be found unless they already
gave it. By the way, the other staff do not throw away any milk I send, it
is just this one nurse.
OK... I am dealing with that part of the situation but there is more...
Sunday night this nurse worked again. She helped the mother with
breastfeeding. Mom had begun nursing infant Sunday morning and infant had
been nursing very well. For some reason the neonatologist still wanted
infant followed up so after every nursing mom was following up with 1+
ounces of expressed breast milk (baby was supplemented with formula and EBM
on Saturday) Sunday night mom's breasts were getting full and she was
experiencing mild swelling/engorgement that accompanies this kind of
situation. Her breasts reportedly were not hard but filling and firm before
feedings and pumping, but softened after, with mild swelling.
The nurse came in to assist with a feeding and she felt that the left breast
was "too knotty" so she vigorously and with extreme pressure, compressed and
milked the breast while the baby nursed. Mom stated that the force used was
so strong the nurses hands were white and shaking when she squeezed down.
Mom states she was in so much pain she was speechless, and it brought her to
tears. The nurse was instructing the dad to do this for each feeding and get
all those knots broken and soft. The dad told me that he couldn't do it
because it did not seem right to him to squeeze that hard. Afterwards the
infant was given almost 2 ounces of EBM. When I came in yesterday morning
the mom was anxious about putting baby to the breast, since the last feeding
was so painful. I did not know the story yet. After examining both breasts,
I noticed that the left breast was much harder and more edematous compared
to the right breast. I suggested we start the feeding on that side and
showed mom how to do RPS. The infant latched very well to that side, then I
noticed mom squeezing like crazy her breast and I explained that compression
didn't need to be that vigorous. I demonstrated compression and explained
how vigourous massage can sometimes cause increased swelling on already
sensitive swollen tissue. That is when she broke down and told the story of
her last feeding.
After nursing, we applied ice packs to both breasts and throughout the day
we alternated breasts at each feeding and pumped after 2 of the feedings but
not after every one, mom had plenty of milk stored in the fridge for
supplementing if necessary. We supplemented at the breast when the nursery
nurse said the neo wanted the baby supplemented after each feeding. The baby
is doing well (now with hyperbili)
And sadly due to increased swelling which we are trying very hard to get
control of, mom expresses considerably less from that breast than from the
other even when the baby has not nursed from that side. In spite of
everything, breastfeeding is going beautifully, mom supplements at the
breast with feedings.(I confess, we do this to satisfy the neo and nursery
nurses, and yes it is a shame when the infant is nursing well and it is a
shame that the mom has to continue pumping to obtain this... but we have
come so far, there was a time not too many months or years ago that the mom
would have been told to formula feed until her baby was well enough, no
matter what the medical condition, to get "just" her breastmilk instead and
even then she would have been told to supplement her hungry baby with
formula to be sure they get enough... Education of our staff is a priority,
and to keep everyone listening, I do what I can to sway them, but it is a
slow process.)
In discussing the matter with another nurse, I found out that the nurse
herself was reporting how she massaged the mother's breast and the person
she reported to said "it sounded extreme even as she described it" she just
assumed that she was using dramatic effect when describing, and felt certain
that the nurse would not really have been that forceful.However when the
second nurse talked with the mom, she too became concerned and so here we
are... (meanwhile in front of mom we are calm and discuss ways to help and
we are being very politically correct)
What I would like some input on is what to do about the nurse. I know she
needs to be educated, but shouldn't she be disciplined? I have called my
director who is out of town until tomorrow. I am concerned that this borders
on assault, even though I know that the nurses intention was not to harm. I
hope I have descibed this well enough on paper, because there is not ever a
situation that anyone would have used that type of force, it was much more
than just firm or vigorous. The mother did not have bruises on her breast
yesterday, but wouldn't it be a little soon for that? Today we plan to use
warm packs prior to feedings and ice packs after on the breast that is
swollen. Also keeping up with her ani inflammatory medications.
Thanks for any suggestions/comments and by the way... the OB was called and
made aware and his response was to order a consult with the LC. (me)
Pam Price IBCLC,RLC
Charleston, SC USA
(843) 209-3477 cell
(843) 797-4554 office
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