PART II MOTHERHOOD (Part 7)

more or. less depleted hat read by the double burden they have carried. For these reasons three weeks in bed are better than two, and (245) 246 MOTHERHOOD Re-estab- lishing nervous and physi- cal tone unless a woman is very strong three will probably leave her in still better condition. For three or four days after delivery, the mother should be kept very quiet, lying most of the time on her back, especially if the discharge is profuse. Vis- itors should not be allowed to see her for at least a day or two. Quiet and rest re-establish the nervous and physical tone within a short time, and the rapid con- valescence is as remarkable as Nature's other methods of adjustment to changed conditions. Bathing parts with a mild dis- infectant Cleanli- ness and comfort DRESSINGS The napkins should be removed every three or four hours, for the first day. After that, every eight hours will be often enough. Each time they are changed, and after urination, the' genitals should be bathed with a mild disinfectant. This may be a bichloride solution made with one part of the I -iooo preparation with four parts of water. This bathing should consist chiefly of pouring the water gently over the parts, while the patient is still on the bed-pan, and then drying them before adjust- ing the fresh pad. This bathing will make for cleanliness and comfort, will remove disagreeable odors, and hasten the healing process. A separate piece of cloth should be put under the body before the bed-pan is used, and with the fre- quent changing of the pads, the bathing and the use of squares laid over the draw-sheet, it will be found possible to have a tidy bed, without too much extrava- gance in the way of laundry. BREASTS Care should be taken to cover the breasts, because, since at this time the glands begin to exercise* their MOTHER AND CHILD 247 function of secreting milk, they are more susceptible to cold. An inflammatory condition may set up, and Protection become very painful, and by keeping a light-weight breasts bit of flannel over the breasts from the first, the dan- ger is avoided. It is well to keep a clean cloth — linen or cotton — over the nipples all the time, and to wash them with boracic acid solution after each feeding. The milk is manufactured by glands in the breasts, and it must be remembered that the nipples lead into cieanii- as well as out of these glands. If they are not kept breasts clean and covered, or if particles of the milk are al- lowed to remain on them and to decompose, the danger of infection is very great. An abscess is caused by infection, from some such reason, or because the milk within the breast is allowed to accumulate and become caked. If lumps are noticed in the breasts, the attention of the doctor should be called to them. Gentle mas- When sage will generally soften them, but unskilled manipula- fo™mS tion may be more harmful than beneficent. The mas- sage should be given with the palm of the hand, being a gentle circular motion from the base of the breast toward the nipple. If there is any tendency toward engorgement of the breasts, the baby should be put to nurse with especial I en- regularity, and in extreme cases the milk may have to be drawn out with a pump. Pumping tends to in- crease, rather than to restrict, the flow, however, so it should be a last resort. Liquids may be largely elim- inated from the diet, and if the child is a healthy one, this difficulty will soon be overcome by his necessary appetite. There is rarelv anv excuse for the formation of an Proper « .,,''.,. . rr^i care does abscess in the breast, if proper care is given. The away with bunches should be reported to the physician as soon as abscess 248 MOTHERHOOD Chapped or cracked breasts Washing the breast after each feeding Other treatment Care in treatment they appear, and they generally yield to massage. If they become inflamed, ice-bags are ordered, the bowels are kept open by the use of laxatives, and the child is taken from the breast. The chief danger lies in delay in telling the doctor of the trouble, and in beginning treatment. If the breasts have had no treatment during con- finement, and if the nipples are flattened at all so that there is constant tension during nursing, they some- times become chapped or cracked. This is intensely painful, especially since the baby must still be put to the breast so that the milk shall not accumulate. The prevention of this condition, as well as one of the cures, is cleanliness, which means that the nipple should be washed after each feeding, and in case any ointment or solution is applied, washing before feed- ing is also necessary. If the difficulty is slight, boracic acid ointment used after each nursing will often be sufficient. Painting the nipple with white of egg, applied in several coats is a help, because it shuts out the air, and gives the fissure a chance to heal. The same treatment may be tried with compound tincture of benzoin, but if the condition is obstinate, the doctor will probably touch it with a solution of nitrate of silver, twenty grains to the ounce, which greatly hastens the healing process. Two treatments daily are sufficient, and if left to an attendant, it should be done either with a camel's-hair brush, or with a very small swab of cotton twisted about a wooden toothpick. The solution should not be allowed to flow over the entire nipple, but only over the cracked surface. The effect of its use is to cauterize the edges of the fissure, and thus to make a fresher wound, which tends to heal more easily. MOTHER AND CHILD 249 Unless the flow of milk is excessive, the breast may be given entire rest for twenty-four hours, which will often effect an entire cure. If this is not the result, some provision must be made to draw off the milk from the breast, because of the danger of abscess resulting from an over-accumulation. The use of a nipple-shield relieves the tension when the babv nurses. This covers the nipple with a glass The, rr , & nipple bell, having a rubber mouthpiece very like that of a shield nursing bottle. The disadvantage of its use is that the baby may become accustomed to the longer rubber nipple, and so may take the breast more reluctantly or refuse it altogether at first. DIET The diet of the mother for the first two days should be liquid. Milk is the best food, both because it is the most nourishing, and because it helps to increase the supply in the breasts. Tea and coffee tend to check Jittfltbor the milk supply, so they should not be taken unless the milk is secreted in excess. Cocoa, gruel, and soups will vary the fare, which may be increased after forty- eight hours to semi-solids, i. e., eggs, soft toast, cus- tards, etc., and after the first movement of the bowels, regular diet is allowable. If the bowels have moved just before the baby's birth, there need be no uneasiness if there is no evac- uation for two or three days. Then the doctor will order either a cathartic or an injection, and very often J^olv-eis after solid foods and fruits are given the stools will be regular and natural. The same care should be taken after confinement as before, to regulate the bowels, and to avoid the ills of persistent constipation. The daily care of the mother should be what is given an ordinary bed-patient. The daily bath, the 250 MOTHERHOOD Daily care changing of bed-linen, and the putting her room in order should be attended to before the baby's bath is given. It is much more essential for the mother to start in her day with the cheer that attends clean- liness, fresh air, and order than for the child to have early attention. It is perfectly safe to give her a full Rubs and bath, between blankets, on the fifth day, and before baths that alcohol rubs and sponging will freshen her each day. There may be interested neighbors or relatives who will insist that her hair must not be combed for a week after delivery, and that all bathing is danger- Advice of ous. It is to be hoped that their counsel will not be neig ors f0|jowe(j jt js qUif-e unnecessary to neglect the patient in any particular, and if she is clean and decently cared for her recovery will be hastened rather than retarded. THE BA3Y'S BATH It is well to plan to give the bath at about the same time if possible each day. This should always be before rather than after feeding; and preferably before, because the child can be put to the breast immediately after the bath. Before taking the baby from his bed everything Every- needed for the bath should be collected and put in essafynfoCr Place- The basket holds the needles and thread, the the bath pUls anc[ tne bands, tightly rolled, and it may stand hand on a table or chair near the bath-tub. The powder and the cup containing a tepid boric solution should be at hand, with the soap, face .cloth, and towel. The bath-tub need not be full, as that makes it very heavy to lift, and there is no advantage in a quantity of water for a baby who is presumably clean. MOTHER AND CHILD 251 The clean clothing may conveniently hang over the back of the rocking-chair that one sits in, if it The cioth- has a post or projection at one side. If not, #iey eafyreach should be within easy reach on a towel-rack or chair, and should be placed with the gown and petticoat underneath, then the shirt and diaper, and the band on top, in the order they will be needed. It is well to have an extra blanket or flannel The square kept especially for bathing, or one can use fla"0n1^1 a flannel apron, which is particularly convenient after the baby begins taking tub baths. For the first days he will have a simple sponging, and we must remember in giving it that he is not a simple 11 1111 sponging in used to the temperature of the cold world, but that the baby's he has been kept at 98.80 F. for the nine months first days preceding his birth, and we must protect him very carefully from draughts. The temperature of the room should be 75 ° and that of the water about ioo° F. The latter can be fairly tested with the bared elbow. In holding the baby the chair must be low, be- How to cause the feet should be placed firmly on the ground, hold the with the knees together, letting the baby's head and {^uSin^16 shoulders lie firmly on the lap. him It does not matter if the child's legs are not sup- ported, but he can be much more comfortably held if the lap is firm and flat. If the knees separate he will go into the hollow between them and can not be as easily handled. Placing him then in this position on the bath blanket, remove the clothing, rolling him gently from Roil side to side to unfasten the little garments. The Hftier shock to a baby, and in fact to an adult as well, is dressing"* much less if he is rolled than if he is lifted bodily. the baby . or patient The dress and petticoat are unfastened and taken off together, down over the feet. After the shirt is off 252 MOTHERHOOD Don't dab at the baby, but wash sensibly Washing the upper parts of his body Washing the trunk and legs one corner of the blanket should be thrown over him, to protect him as much as possible while the band and diaper are removed. A diaper should always be laid underneath during the bath so that the bath blanket or apron may not be soiled and wet. Then he should be snugly wrapped and his face washed with the clear water. A baby should never be dabbled at as if he were breakable china. Take the damp cloth firmly over the hand, and wash his face as you would your own. In drying any portion of his tx)dy the- skin should be patted rather than rubbed with the towel, for it is very delicate and a baby resents any approach to rough usage. After the face is washed and dried the water should be made soapy. Do not rub the soap directly on the cloth, for in that way you Use more on his skin than is at all necessary. The head, neck, and ears should now be washed, rinsed, and dried, and this must be carefully done, because the thatch of down over the little head re- tains the dampness longer than other parts of the body. Next come the arms, one uncovered at a time, keeping the chest and the rest of the body wrapped in the blanket all the while. Now with the left hand hold the edge of the blanket up a bit away from his body, so that he is entirely covered and protected, but so that there is also a space between him and the covering. With the cloth you can then wash the entire body without letting the air strike directly .on it. Turning him over directly on his stomach, a position which a baby almost invariably enjoys, wash the back in the same way. The legs can be exposed, as the arms were, for they are generally being exercised so rapidly that they will not feel the cooler temperature. MOTHER AND CHILD 263 Care must be taken to wash off all traces of powder, and to cleanse carefully all the creases of the body, just as was done with the oil in the first bath. THE CORD-DRESSING If the doctor is paying daily visits, and there is not a graduate nurse in charge, the bandage and D° not cord-dressing should not be disturbed unless the bandage doctor's orders have been given concerning it. In ,v"thout that case the routine of the bath is the same except orders that no bathing can be done under the band. If the doctor is not coming regularly, and wishes the cord dressed or the bandage changed, great care Most must be taken. The dressing will not need to come t^eTtment off unless it is moist. In that case it must be re- dre^lng^ placed by a fresh piece of sterilized cotton or linen, and no ointment or solution should be used on it. If there is no person in authority to consult, and the cord seems to be discharging, or if the odor from it is very offensive, a little boracic acid powder will probably dry it up and is the safest treatment that can be given. The question of powder is one on which persons disagree, but we may strike a happy mean and use Moderate it moderately. While the baby is lying on his stom- p^der ach draw the puff across his neck and down his back, following it with the hand, so that there is no ap- parent trace of the powder left on the body. "When the puff is used under his arms protect his face with the hand, the back of it placed against his chin. ORDER OF DRESSING Now put on the shirt — we are assuming that the band has been left on. Put your fingers up through 254 MOTHERHOOD To put on the baby's shirt the sleeves, and pull the baby's hand through, first slipping in the arm furthest from you, then turning him over and drawing the shirt under him. Never try to push a child's or an invalid's hand through a long sleeve. Either put your hand through to meet his or gather it up into small compass, with the fingers through the opening. After trying both ways it will be easy to understand the prohibition. Place the diaper under the buttocks before using the powder, which must not be put on in excess. It The Flannel Petticoat and Dress Putting on the diaper only cakes in the groins and irritates more than it soothes. After using the puff, rub the hand over the thighs and buttocks to brush away any superfluous powder. A very good way to put on a diaper is to turn down the upper edge of the triangle — the part that lies under the baby — about two inches, so that it will be double at the baby's back. Bring the ends around and grasp the edges between the thumb and middle finger. Now twist the ends lightly, put them between the legs, and bring up the point of the MOTHER AND CHILD 255 triangle to fasten. Turn the hand holding the diaper, and put the pin in so that it comes out on the side where the middle finger is, and not against the baby's flesh. The diaper can be held as tightly as necessary, about the and there is no danger of pricking the child. Care pm must be taken, however, not to pin it too tight, since Care Slipping on the Flannel Petticoat and Dress diapers which bind a baby closely are often respon- sible for nausea. Xow turn him over and fold up the doubled portion. A diaper well put on in this way will never become loosened or drop off. Slip the flannel petticoat inside the dress and put them on together over the feet, not over the head. 256 MOTHERHOOD To put on the flannel petticoat and dress In this way the baby needs to