CHAPTER VIII. THE PUERPERAL PERIOD. (Part 2)

rub a little borated vaseline into the nipple, and then place a fresh piece of absorbent cotton over the nipple. This is to protect them and absorb the milk that might ooze out. Be sure that these pads are always clean and dry. If neglected the milk oozes out on the cotton and dries, thus forming a hard rough surface. This scratches the nipples, irritates them and makes them sore. If the nipples are cracked and are very sensitive, apply a little borated vaseline and dust well with boric acid powder and use a breast shield when nursing until 116 healed. If the nipples are small or sunken much trouble may be saved by put- ting the infant to the breast and teaching it how to take hold before they became engorged. Any marked sensitiveness or redness of the skin should be reported to the physician at once. Report to the physician at once any signs of ab- normal occurence. I have found by keeping a small pleget of cot- Fig. 36— Dr. c. s. Ba- ton wet with a one in eight thou- con nipple shiel± sand bichloride solution over the nipples prevents soreness and tissues. It must be kept wet and changed each time baby nurses. Dr. A. N. Curtis Method.— Dr. Arthur N. Curtis, of St. Louis has introduced a method of nursing the baby that has many fold advantages, saving time and trouble for the mother, baby and nurse. With his permission I herewith give this method to the nursing public, feeling sure they will be as grateful as I was, and will realize its advantages. The follow- ing are the directions : The baby is nursed every four hours, using first the bare nipple, the baby is encouraged to take the nipple and the nurse should continue her efforts un- til the little stranger understands how to take hold. The next time baby nurses the nipple shield is used, alternately, nipple and shield. This rule observed, the baby takes the nipple every eight hours. The nipple unaccustomed to performing any funcition, by this method gradually accommodates itself and is not used abruptly or abnormally as the case would be if used every three or four hours. This is one of the causes 117 of soreness. The breast unaccustomed to any func- tion, immediately becomes full and distended and if suckeled every two or three hours as is the case after the third day when baby is nursed every two or two and a half hours. By using this method there is seldom any soreness or tenderness of the nipples ; cracks and fisures are rare ; the secretion is stimulated and renders nursing easier in the beginning as the suction will cause what fluid there is in the breast to flow with less effort, and if the nipples are small or sunken they are drawn out and developed. Should the nipples be- come tender use the shield entirely. After three or four days the nipple shield is discarded and baby takes the bare nipple at each nursing. The nipple receives the same care after nursing when the nipple shield is used, as if baby took the bare nipple. Nursing. — Every mother should nurse her child, not only for its Avelfare, but for her own good, unless her health interferes. The nursing of the baby causes uter- ine contractions to become stronger, and thus the mother recovers more quickly and completely when she can nurse her child. Mother's milk is a God-given food, which belongs by right of nature to the child, and nurses should use their influence to encourage moth- ers to nurse their babies. It is to be "deplored how many mothers there are who refuse, at first, to nurse their baby, preferring, as they will say, "to raise them on the bottle," so they will not interfere with their pleasure. But often a little persuasion on the part of the nurse, showing these mothers the injustice it is and what it means to the child, and appealing to her maternal instinct, this obstacle is often overcome. A good nurse's influence is very great, and she should use it for good whenever possible. No greater in- 118 heritance can any child receive than good health. In infancy the foundation is laid on which each future life is built. The child is put to the breast eight hours after birth, and not oftener than once in four hours after that until a free flow of milk is established. The breast is first washed off with a one in two thousand bichloride of mercury solution, which is allowed to dry, then the nipples and adjacent parts are washed before each nursing with a saturated solution of boric acid and sterilized absorbent cotton. After each nursing wash the nipple with witch hazel and anoint them with a little borated vaseline, and place a pad of absorbent cotton over each nipple to absorb any milk that may ooze out. If the wet bichloride com- presses are used, omit the vaseline. Feeding the Baby. — If the baby seems hungry in spite of nursing the mother, give it a small quan- tity of boiled water frequently, and do not pay any at- tention to any suggestions with regard to the necessity of feeding it. Nature is a wise provider, and if the in- fant required food earlier, would certainly have pro- vided it. The amount of nourishment obtained the first three days is small. It is not milk, but a thin fluid known as colostrum, which acts on the child's bowels and clears the intestinal tract of the meconium, and is infinitely adapted to the needs of the child. The nursing of the child helps to secure contractions of the uterus, often causing severe pains. As soon as the breast milk comes freely the baby should nurse every two hours, from six a. m. until ten p. m., and twice during the night, usually at one and four a. m., if awake. 119 THE POSITION OF THE MOTHER WHEN NURSING THE CHILD. When Lying Down. — When the mother is lying- clown the child lies flat on the bed, on its side, not on the mother's arm. The mother lies on her side, inclin- iW p^ K* s V ' '■ ' ^ — -^— .— ' -iC5~ - 4 ; x'w ^s^ *r^ . ■ - # Fig-. 37 — Proper position for nursing an infant when lying down. ing slightly forward with the arm thrown backward under the head. In this position the breast is so placed that the child can take hold of the nipple with ease and comfort. The nipple should be pulled out with the thumb and index finger and then washed, and then baby is placed at the breast. A crying baby will not take the breast the first time. Take baby when partly awake, place him in the position described and rub his little head so as to rouse him, the nipple being on the same angle as his mouth, he usually takes it without much trouble. It may be necessary to moisten the nipple with a little sweetened water or a little milk squeezed from the breast, in order to 120 induce the baby to work, but usually a little persever- ance on the part of the nurse is all that is necessary. Sitting Up. — When the mother is able to sit up the infant is held with its little head on its mother's arm Fig. 38. — Proper Position for Nursing an Infant 'When Sitting- Up. in a comfortable position. She should have a low rocker chair without arms, and a foot stool for her foot to rest on. Regularity in Nursing. — Regularity in nursing is very important for two reasons : It aids and es- 121 tablishes proper digestion, and it helps to keep the flow of milk regular in quality and quantity. If the intervals are too long the milk becomes too thin; if too short the milk becomes too rich, and if nursed at irregular intervals the baby's stom- ach is upset. Digestion is the process by means of which food is changed and dissolved so it can be taken up by the blood and carried by the circulation to all parts of the body for its strength and building purposes. When a baby is nursed, the milk on en- tering the stomach meets with the different juices and ferments of the stomach. The hydrochloric acid causes it to curdle. By contraction of the stomach these curds are broken up and finally, dissolved and assimilated. This process takes two hours. Hence the nurse will see the necessity of regularity in nurs- ing. But if nursed regardless of order and regularity, or whenever the child cries, as some foolish mothers do, the stomach will rebel and baby will have indi- gestion and vomit its food ; because its little stomach is crowded ; one nursing is not digested before an- other is taken into the stomach. The milk, too, when baby is nursed irregular, decreases in quantity, and be- comes stronger in fats ; this, too, disagrees with the baby, causing indigestion. The quantity of milk se- creted daily by the mother's breast, usually under nor- mal conditions, depends upon the amount needed, the age of the child. If the mother is healthy, takes suf- ficient out of doors exercise, eats the proper amount of nutritious food, and drinks at least a quart of rich milk a day, she should have sufficient milk for the needs and nourishment of her child. The milk changes in composition and increases in quantity to suit the age and wants of the child. If on the other hand the 122 mother neglects to take the proper amount of exer- cise and fresh air ; does not take the proper kind or amount of nutritious food, nurses the child irregular, the milk will be found wanting in quality and quan- tity. The nurse should impress the importance of the observance of these simple rules on the part of the mother, so as she may be able to nurse her child. It is a duty she owes it. How Often to Nurse the Baby. — After the free flow of milk is established, usually about the fourth day, baby is fed ever}- two hours during the day, from six . a. m., until ten p. m. and two feedings at night, if he is awake. Xever wake a baby at night for food. The night feeding is usually about one and four a m., until baby is five weeks old. From five weeks to twelve weeks, baby is fed every two and a half hours during the day, from six a. m., until ten p. m., and one feeding at night, usually at two a. m. From three to five months every three hours during the day, usual hours, no feeding at night. From five to nine months a child is fed four times a day, and at this age strained cereals and broth are added to the mid-day meal. Babies are creatures of habit, if fed at regular intervals they can be so trained that they will awake or seem hungry only at the regular time of feeding. When the hour for feeding arrives, the child must be fed, and if asleep must be awakened for that purpose. Never wake a child at night for food. When a child that has been so trained cries for food before the regular hour, or awakes hungry at night, it is an indication that the milk is lacking in either quantity or quality. In such a case the analysis of the milk will show the cause. To decide if baby is getting the proper quantity or not, weigh the baby before nurs- 123 ing, allow it to nurse 15 minutes and then weigh it again. If the child's weight after nursing is not in- creased to correspond to the number of ounces it should consume at a feeding, then the milk is defi- cient in quantity and must be increased by the mother taking more liquids and milk producing foods. If the quantity is sufficient, then it is probably due to defici- ent quality, the milk is not rich enough and the physi- cian should be consulted, and the mother should eat foods of richer quality., those that contain more fats. Any deficiency in either quantity or quality will cause the baby to be fretful and restless ; cries frequently and does not seem satisfied after nursing. To Increase the Flow of Milk. — If the milk is de- ficient in quantity it may be increased by the mother taking fluids and milk-producing foods. Milk, if it agrees with the mother, is excellent for her, one pint of cream to two pints of milk, mix them and drink it during the day, between meals and on going to bed. Chocolate is very nutritious. Malt nutrine, soups and even water will increase the supply where the quantity is deficient. But if the quantity is sufficient, but does not seem to satisfy the baby, it is possible it is defi- cient in character, not rich enough to satisfy the child. and in such a case the physician should be consulted, who will take a specimen for microscopical examina- tion to determine the trouble, and give a diet list which will increase the quantity and supply the deficiency. If on the other hand, it is too rich in fats, it will upset the baby's stomach and cause indigestion, and., also. affect the bowels, causing frequent movements. Mixed Feedings. — Sometimes all efforts to increase the mother's milk fails, and the baby must be given something in addition. A child must never be taken 124 from the mother's breast merely beeause the supply is insufficient for its needs. So long as the mother's breast continues to secrete, the child must be given the bene- fit of it, if the mother is healthy and the milk fit for it. Sometimes the milk contains the colostrum which ren- ders it unfit for the baby. Mother's milk is not only of a character that can be easily digested by an infant's partially formed organs, but furnishes the substance needed for the child's growth and development of these organs that is not found in cow's milk or any other food. The deficiency of the nourishment re- quired for the child's growth and development is made up by supplementing the nursings by feedings with modified cow's milk. A bottle is substituted for as many feedings as is necessary. When the breast and bottle feedings are combined, both breasts should be nursed at each nursing. To Dry Up the Milk. — When from any cause it becomes necessary to dry up the milk or decrease the flow, the mother should pursue the opposite course described, "to increase the flow," using very little fluids, and drinking very little, if any, water. The bowels should move freely every day. A tablespoon- ful of epsom salts should be taken before breakfast. Belladonna ointment should be applied to the breast, care being- taken that it does not touch the nipple. A tight bandage is then applied. Cotton should be placed between the breasts and at each side, and a pad over them. This is to even the pressure, and to prevent any binding" or compressing of the tissues. The breast binder should reach from under the arms to a point below the breast, and should be put on as tight as can be borne and pinned with safety pins. A small bandage or strap is pinned in the middle of 125 the breast bandage in the back. The straps are then brought over the shoulders, suspender fashion, and pinned in front, on each side to keep it from slipping down. Or better cut a jacket as shown in illustration. It is more satisfactory and comfortable. The Temperature. — Take the patient's temperature, pulse and respiration in the morning about seven o'clock, at noon and about four o'clock in the after- noon until the case is dismissed. The Lying-in Period.— Most women expect per- mission to be given them to get up on the tenth or eleventh day. There is, however, no fixed rule about getting up at any set time. Not to get up until the tenth day is the customary rule in normal cases, but where the uterus does not contract properly, or there is a large tear in the peri- neum and must heal, a much longer period of time is required, and the longer the patient remains quiet and in bed, the better she will be. But no patient is allowed to sit up until the uterus is well contracted and returns to the pelvic cavity. And the mother should not go up or down stairs until after the third week. Convalescing Period.- — The period of convale- scence from child-birth requires about six weeks. It begins with the expulsion of the placenta, and is the time occupied by the uterus and its appendages in returning to their normal size and condition. There are cases where it ex- ceeds this length of time, and a much longer time is required. Morning Toilet of the Patient. — As soon as the patient awakens in the morning take her 126 ^- — "T^i^x ( < T^l v.. .. '""•••••"... [NAMCLED SCO onO DOUCHE 5=^ 'ig\ 39 — Perfection douche and bed pan. temperature, usually about seven or seven thirty o'clock. After washing her face and hands, and allowing her to brush her teeth, prepare an appe- tizing breakfast and serve as daintily as possible. Breakfast over; baby nursed; the mother has rested, and an hour has elapsed since her breakfast, proceed with the morning toilet. Place your patient o^ the ............. . bed pan and remove the vulva pad, and she should try and have a