Breastmilk rotation in NICU

[shayflo919]

I have a baby who was born 3-8-13 at 31wks6days old. He's been in the NICU for the last week and we've met a lot of awesome nurse but the last few days have had a nurse I haven't been on the same page with and I'm looking for some advice. I've been coming to kangaroo care during the noon and 3 pm feedings, I pump before each feeding. This particular nurse won't use the freshly pumped milk because she strongly believes in "first in first out". We've gone back and forth a few time about fresh versus older milk but just don't agree.
I totally get the concept of using the older stuff first and not wasting anything but I'm making way more than he's eating right now so either the old or the fresh needs to be frozen. I guess I always thought my milk changes daily to be exactly what the baby needs, so wouldn't it be best that he gets the freshest milk? She's also talking about freezing some of the older milk to give to him next week but surely fresh would be better than frozen and thawed right?
I'm so frustrated and feel so helpless. This particular nurse also won't let me hold him for two feedings in a row (all the other nurses thought it was great) and make comments about him "not tolerating" the kangaroo care because he spit up a bit when she put him back.
I wonder what advice other mom's might have for me, I'm feeling pretty crappy about my role in his care and am not sure what to do.
I also realize nurses have his best interest in mind and I want to be careful not to overstep any boundaries, especially since I rely on them to care for him. I just don't even feel like we're on the same team.

[LLQ1011]

She is out of line. Just tell her what milk baby gets. If she still fights you talk to the director. For some people they just want to control the situation and latch on to weird things. Your baby you are in control.

[maryeliz]

You definitely need to talk to someone higher up.  Do you see your baby's doctors regularly?  If so, I would speak to them, if not I would speak to the charge nurse and tell her that you need to speak with your baby's doctor (or even better her whole team) and you need consistent standards of care for your baby.

When I encountered similar push back from certain nurses, I asked that the standards of care for the things we disagreed about be written into my daughter's chart (how much could we hold, how often could we breastfeed, what and how would she be fed if she wouldn't take the whole feed by breast).  I don't think anything you want is overstepping.  I think some nurses get so focused on the babies that they forget that they are also there to support families, and that means stepping back to let parents be involved in care and to facilitate bonding between babies and families.

At our NICU, they always stressed that it was best to have fresh milk.

[Ratchet]

I know they want to make sure baby gets all the colostrum, but after that, fresh is great.  Frozen breastmilk keeps for MONTHS, what's her hurry?  Don't worry about stepping on her toes here- I agree with maryeliz's plan

[Springshowers]

Could you just take home older milk? I agree fresh is definitely best.

[MeepyCat]

You know, if you're not getting on with a specific nurse for a specific reason, it is okay to talk to the team lead or the neonatalogist and ask for that nurse to be removed from your baby's care team. I have a bunch of thoughts about the situation, but that's probably the most useful. You and this nurse are a bad match and she's being a control freak at you (don't say that). The rest of the staff has been very supportive of your kangarooing, etc., and she's not, which makes her just a bad fit for your family. We spent 32 days in the NICU. You would not be overstepping if you asked for a staffing change. I agree with you, really, that fresh milk is best if you have it. THere's no reason why a tube of breastmilk can't go right from the pump to the feeder, no pausing in between. They can use the stuff in the fridge when you aren't there, when you are, you want the shortest route possible for getting the breastmilk into the baby. When a baby changes angles - say, from kangarooing to lying down, especially after a feed - the baby is very likely to spit up. This isn't a sign that the baby isn't "tolerating" anything. It's a sign that the baby's esophageal sphincter is immature. Which is hardly shocking in a premature infant. It wouldn't be shocking in a full-term infant. It may be a sign that they need to reconsider the size of feeds, or angle the mattress in the isolette, or that he needs to stay kangarooed until he's burped. If you can hack it, it wouldn't be crazy to just kangaroo him for the entire three hours from noon to three, feeds included, and a little extra over. It's transitions that are challenging, so the longer between them, the better. However, when my DD was in the NICU, I was recovering from a c-section, and that much sitting and holding the baby at ten days post-partum would have hurt. I hope that your LO has an uneventful course and comes home soon.

[eabbmom]

I had a problem with a nurse when my son was in ICU. I just kindly explained to the charge nurse why we weren't a match. We didn't see her again. I find most staff to be understanding and patient and want to respect your needs, you just need to voice them. I hope your whole family gets to be home soon.

[maos211]

I had to have that talk a couple of times with nurses in the NICU. In fact at one point I told the nurse to chunk the frozen milk if t was the source of her confusion! She couldn't believe it but it made the point. I talked to he charge and she made me make a friendly sign to post on my baby's bed hat read: thank you for caring for me today. If mommy is here during my care time, she will feed me, take my temperature, change my diaper, etc. we kangaroo care. Please make sure you always give me fresh milk! Thank you. And you know what it worked. In fact, a couple of he nurses said it was a good reminder. Also I had to place a nurse on my NOT my nurse list. She plainly told me she let preemies cry it out because babies cry and she had to chart. She said if I wanted someone to look after my baby the whole time I should hire a nanny! By the time I worked up the nerve to go talk to her supervisor, another nurse who overheard the conversation had already told on her. The nurse came up to me crying, she apologized, we hugged but I told her her parenting style was different than mine and that I did not believe in crying it out, she understood and we remained civil but she was never my baby's nurse again. If you haven't picked primary nurses I'd advise you to do so. It is a different game when they get to know your baby

[Melany]

Originally Posted by shayflo919 

I have a baby who was born 3-8-13 at 31wks6days old. He's been in the NICU for the last week and we've met a lot of awesome nurse but the last few days have had a nurse I haven't been on the same page with and I'm looking for some advice. I've been coming to kangaroo care during the noon and 3 pm feedings, I pump before each feeding. This particular nurse won't use the freshly pumped milk because she strongly believes in "first in first out". We've gone back and forth a few time about fresh versus older milk but just don't agree.
I totally get the concept of using the older stuff first and not wasting anything but I'm making way more than he's eating right now so either the old or the fresh needs to be frozen. I guess I always thought my milk changes daily to be exactly what the baby needs, so wouldn't it be best that he gets the freshest milk? She's also talking about freezing some of the older milk to give to him next week but surely fresh would be better than frozen and thawed right?
I'm so frustrated and feel so helpless. This particular nurse also won't let me hold him for two feedings in a row (all the other nurses thought it was great) and make comments about him "not tolerating" the kangaroo care because he spit up a bit when she put him back.
I wonder what advice other mom's might have for me, I'm feeling pretty crappy about my role in his care and am not sure what to do.
I also realize nurses have his best interest in mind and I want to be careful not to overstep any boundaries, especially since I rely on them to care for him. I just don't even feel like we're on the same team.

Can you talk to the charge nurse? Perhaps you can ask that she assign someone who is more inline with your desire to breastfeed. You are still baby's mother even though baby is in the NICU and having say as to which breastmilk is given to baby and how it is given is totally withing reason.