Chapter 6

Sachets are a real luxury in the drawers of the baby's bureau. Atkinson's sachets are the best, though Colgate's violet is very delicate and pleasant. Put one or two amongst the little shirts, and some among the knitted blankets, but mostly have them in the dresses, and be sure when you take out a clean dress, or slip, to take the sachet and slide it into the neck of the slip that will be worn tomorrow. Nothing can be more attractive than a clean, sweetly smelling baby, and, _per contra_, nothing is more disgusting than a wet, sour, cold, crying baby. If he be wet and sour he will surely have cold feet and hands, and as surely will he cry. Poor little thing! It is his only way of expressing his opinion of the state of his toilette.

It is very pretty, when the baby is fresh and clean, and has on a fine slip with lace edging the sleeves, to tie around the wrist, outside of the sleeve, a piece of pink or blue ribbon. Make a nice little bow and let the lace fall over the fat little hands, like a frill. Be careful not to tie the ribbon too tight, and keep it clean. If it becomes soiled or wet, take it off directly.

A lap protector is made by covering a piece of rubber cloth about 14 inches square with several thicknesses of old blanket. To cover this have some slips like pillow cases, of linen or cotton, plain or fancy, as the lady may have time or money. Slip the "protector" in its case, and lay it on your own, or any one else's, lap who wishes to hold the baby, and it perfectly protects from all wetting.

TABLE FOR ESTIMATING THE PROBABLE DURATION OF PREGNANCY

Two hundred and eighty days, forty weeks, ten lunar months, or nine calendar months are here estimated as the usual duration of pregnancy (the actual computed average being 276-2/3 days). The exact day of conception (_not_ the fertile coition), can never be accurately determined; the only date from which conception can be dated, and the probable confinement day predicted with some chance of certainty, is the first day of the last menstrual flow, adding to this one week (seven days) for the average duration of the flow (with a few days lee-way). We count nine calendar months forward, and have the approximate date of the expected confinement. The most ready method is to add seven days to the first day of the last menstrual flow, count back three months, and add one year, when we have the future date when, or about when, delivery may be expected.

An _exact_ estimate is but guess work; errors of one or two weeks either way may be made by the most experienced, as in cases where conception occurred shortly before the next menstrual period, which did not then appear.

The present table is constructed on the above principle, the second column representing the day of quickening, nineteen weeks after the beginning of the last menstruation, with seven days added; and the third column still twenty weeks later. The date of quickening is still more variable than that of delivery, from one to four weeks.

Intermediate dates may be fixed by adding the necessary number of days to each column. Thus, for Jan. 11th, the second column should read 31st of May, and the third column, October 18th, and so on.

Beginning of last Quickening. Confinement. Menstruation.

Jan. 1st.........May 20th.........Oct. 8th. Feb. 1st.........June 20th.........Nov. 8th. March 1st.........July 18th.........Dec. 4th. April 1st.........Aug. 18th.........Jan. 6th. May 1st.........Sept. 17th.........Feb. 5th. June 1st.........Oct. 8th.........March 8th. July 1st.........Nov. 17th.........April 7th. Aug. 1st.........Dec. 18th.........May 8th. Sept. 1st.........Jan. 18th.........June 6th. Oct. 1st.........Feb. 17th.........July 8th. Nov. 1st.........March 20th.........Aug. 8th. Dec. 1st.........April 19th.........Sept. 7th.

ARTICLES FOR THE MOTHER'S USE.

Perhaps it is not necessary to say why it is better to use old sheets for the bed of a parturient woman, but I will repeat that old ones are to be preferred, and really new ones, that is, only once washed, never used. New towels are of course objectionable, as being too harsh. If the patient likes a rough towel, use a regular bath towel, if you can get it. Be careful, never to let loose and wet ends of the wash cloth drag along exposed parts of the body. It is a good plan to sew your wash cloth into a bag, and to slip your hand inside, and work with it put on like a mitten. A rubber or fibre sponge is to be preferred. Keep one for the face, neck, arms, and hands, and another for the feet and legs. The vulva is bathed best by means of a fountain syringe used as an irrigator, and a little sterilized gauze twisted around your dressing forceps. The gauze can be changed as often as necessary, and is much more satisfactory than anything else, especially if there has been a laceration.

The square of rubber sheeting, single width, is most useful. For the confinement the bed should be made by first spreading over the mattress the wide rubber sheet, over this put an old blanket, then the under sheet; upon the right side of the bed, where most likely the woman will lie, place the square of rubber, over that the old comfortable, four double, and hold all in place with a sheet folded like a hospital "draw-sheet." This must be firmly tucked in at the sides under the mattress. It will seldom be found necessary to change the under sheet, if the bed is made this way, and the rubber square is drawn carefully away, with the comfortable and draw sheet, when it is time to make the patient clean and dry after the birth. It is a good plan now to tear this square in two, and keep one piece directly under the clean draw sheet for the first few days. This saves much washing.

An old blanket and a small one will be found invaluable for all sorts of things--for example, to spread over the shoulders and chest when the bandage is being pinned; to warm and wrap up the feet and legs, if they show any signs of being cold; to cover one knee and part of the body when using the irrigator, which when there has been _any_ laceration, is a delicate piece of business, as every nurse knows. Always fold up this invaluable and constant friend, and put it in some handy but inconspicuous place; it _is_ a friend, and a good one; but it is not a beautiful object to look upon, and others not knowing its virtues would think you untidy if it was in a noticeable place. The fountain syringe is absolutely indispensable; and, though it may seem unnecessarily large, yet I think a four-quart bag better than any of the smaller sizes. To be sure, you never might need four quarts in the bag, but it is so much easier managed, so much less liable to spill over, if you have a large bag and put it only half or three-quarters full. Then, too, you get so much more force if you have more water in the bag, you need not use it all. A Davidson syringe is very nice for some things that a fountain syringe could not be used for. Oil enemas, for instance, also nutritive enemas. After an oil enema be sure to wash your syringe _thoroughly_ with a strong solution of washing soda or ammonia, else you will find the rubber of the bulb and tubing becoming pasty, and your syringe will be utterly spoiled. The paper basin is very light and easily handled and much to be preferred to a large china affair, which may easily slide from warm, wet, slippery hands.

I often wonder that the women of our day, who are so sensible in many things, should have abandoned the fashion of short night gowns, which our grandmothers always provided for themselves at these times. I remember asking one lady, when talking over what she would need for her first baby, and for herself, at the time of its birth, if she had not something short and plain that she could wear. She looked very thoughtful for a moment and then said that she thought she did have _one_ night-dress that did not have a ruffle or embroidery around the bottom. She could wear that. It certainly is not from motives of economy that our wealthy patients do not have these most sensible of garments. I think they know nothing about them, and they should have their virtues explained to them. A pocket could be added to this garment, I think, and it would be a real comfort to a woman. I know it would be to a nurse, who usually has to hunt up the ever missing pocket handkerchief a dozen times a day. Men always have pockets in their night-shirts, and they are not sick half as much as the women. I wonder why women do not imitate this most sensible custom. If your patient will not let you cut off any of her old night-dresses, you must use the long ones, of course, and change them as often as necessary.

Bandages should always be made of soft unbleached muslin; double is best, though I have used them of the single fold, and hemmed, but they are firmer if double. They should be wide enough to come down to the great trochanters, and up to a place two inches above the umbilicus; long enough to fit the woman before she became pregnant. She has likely some measure, or could get it from her dress-maker. Women vary so much, it is hard to give an exact measure in inches, but you might begin with a bandage fifty inches long, and if the ends are too long, cut them off, and turn in the edges of the cloth and overhand it neatly.

Obstetrical binders, or bandages are now seldom put on a parturient woman, but in case they are to be used, I give the best kind I know of. They are sometimes made to order, but I never knew one of these to fit, or wash well.

The method of their application is of course taught in the schools. The nurse should always know from the doctor, or the prospective patient, if binders are to be worn, and instructions given as to how to make them. Four or six will be enough.

Two or three yards of soft, unbleached muslin for breast-bandages should be provided in case they are needed. A six-tailed bandage is, I think, the best for this purpose. Tear down the first two "tails" to within three inches of the others, and these passing over the shoulders, and fastening to others, which are adjusted over the breasts, keep the whole bandage in place.

It is not necessary to speak of the napkins or pads; these are universally used, and readily bought, sterilized, and ready for use. All sterilization is so thoroughly taught in the schools, I have taken proficiency in this particular for granted.

There should always be a disinfectant or antiseptic of some sort on hand.

Carbolic I-30, Platt's chlorides, permanganate of potash, or something that will answer the purpose; bichloride of mercury, etc. You must find out from the physician which he prefers, and of what strength.

I must not forget to say that when you go to see you prospective patient, and she shows you the room she expects to occupy, it would be well to cast your eyes about for some rug, that you can, if necessary, turn wrong side out and spread at the side of the bed. Some doctors are very neat about their work, but some are-- well, perhaps I better not say it; we must not criticise the doctors.

But sometimes it is best to have protection for the floor, it gives the nurse a comfortable feeling quite beyond description to know, that, no matter what may happen, the carpet will not be ruined.

XII

AS TO WASHING THE BABY

In the first place get together everything you will need for the bath and subsequent dressing. Have the clothes all laid in order over a chair-back before an open fireplace, or over a radiator, or if no better expedient suggest itself, fill bottles with hot water, or get a hot water bag and fill that, and lay it _over_ the clothes arranged in the order you will need them, beginning the pile with the dress and having the band the last. Have _two_ large, soft towels and keep them warm. If possible, have an apron made of rubber cloth to tie about your waist. At your side, on the floor, have a small blanket ready to lay over the rubber apron when needed. Put your baby basket where you can reach it, be sure that it contains all the things you will need--sponge, soap, powder, pins, vaseline, etc., and an extra diaper or two. Now get the tub (tin) and pour in the water until it is about four inches deep. Have the water no warmer than 100 degrees F. Bath thermometers are made that are quite cheap, and a great convenience; one should always be at hand, as no nurse should ever trust her feelings as to whether the water is hot enough or not. Always test any water to be used for the sick or the delicate with a thermometer. Another point a nurse should be most careful about, is to be careful that her hands are warm before she takes the baby, as her cold hands on his warm flesh will surely make him scream.

All being now ready, take the baby and sit down with him, spreading the blanket over your knees as you do so, and having the tub just in front of you on another chair. The sponge is best to use for the washing, but a piece of old table damask is very good. Wash the eyes very carefully first, then the face, and dry on the towel. Now hold the baby's head over the tub and give that a good washing with soap on your bare hand, and rinse it well with plenty of water, always holding the left hand under the head and neck. Bring him back on your lap and thoroughly dry his head, then wash and dry the ears carefully.

When you get this far you may undress the baby completely, being most careful yet not taking any unnecessary time. When he is quite ready for the tub, grasp him firmly with the right hand, letting the buttocks rest in the palm of the hand, the fingers being outspread, and the thumb coming up almost to the pubic bone. With the left hand hold the head and shoulders. Lower him _very_ gently into the water. Any sudden movement is most injurious, as a baby must never cry when the band is off, if it can be avoided. He will often put out both hands as if trying to catch hold of something. If he seems frightened at the same time, and cries violently, let the buttocks rest on the bottom of the tub, and with the right hand hold both of his, and he will be comforted.

I think it well to wash the whole body with your bare hand, well soaped. Be careful to wash under the arms, in the bend of the elbows, the groins, and under the knees, rinse him with the wash cloth or sponge, and now lay one warm towel on your lap, and take up the baby just as you put him in, slowly, and without shock, and lay him in the warm towel. Lay the second one over him, and draw over all the blanket, wrapping him up warm and snug. Put your hand inside the blanket and dry him. This can be easily and quickly done without at all uncovering the child. Pass the hand with a slight squeezing movement over each arm and leg, and over the front of the body. When this is done, you must undo the blanket, and take the upper towel and dry most carefully all the creases, and powder everywhere, especially if he is very fat. Get down to the very bottom of every crease, and be sure it is dry and powdered. Lay over the navel a compress of absorbent cotton, unless the child is over four weeks old, and over this the band, which should be unhemmed, and wide enough to extend from the hip to the armpit. Lay the palm of your right hand firmly over band and pad and turn the child carefully, holding your right hand still under him, and with the left, clear away all damp towels, and then straighten out the band that is wrinkled under one side. Keep your knees close together. Now take away the right hand, and see that the baby's knees are on the right side of your knee, and the elbows well over the other side of your lap. Now you have the baby where he can kick, but he can't wriggle or spring off your lap. See that the back is dry, rub it a little with your hand, and powder. Look carefully in the deep dimple just at the coccyx and see if it is clean. Now pin the band snugly, but not too tight. Use the smallest safety pins, and never pin directly over the spine. Sometimes the abdomen is very large and it will be necessary to make two little tucks in the lower edge of the band in front to make it fit snugly.

While the baby is still on his stomach, lay in place the diaper, and next the shirt, which should be open in the front, and the pinning blanket. Lay all of these just as they should be, as regards the back, and turn him, being careful to hold all the clothes in place. If he is liable to chafe, or the movements of the bowels are in any way irritating, use vaseline about the buttocks. Now put the arms in the shirt sleeves and tie or button it up, and then pin the petticoat or pinning blanket. Lay an extra diaper folded many times under him, and fold the pinning blanket just in three, bring the hem up to the waist and pin in place.

The dress goes on feet first. Slip it on over the pinning blanket, and pass the right hand up under the buttocks, and with the left, pull the dress into place, put the little hands in the sleeves, and get it perfectly straight and smooth over the chest. Now pass the fore-finger of the left hand down inside of all the clothes, beginning at the neck, until you find the band (the first garment), take a small safety pin or any small ornamental pin, and pin thoroughly through everything. This last pin I consider most necessary, as it keeps the dress, shirt, band and all in place. Turn the baby over once more and put a similar pin in the back of the dress, being very careful to get at the band. While the baby is in this position put the blanket he wears during the day over him, and a final turn brings him around, and he is washed and dressed all but his mouth, which must be carefully washed with clean, warm water or borax and water. This should be also done many times each day, if the mouth is sore, and always a sharp watch kept for white patches on lips, cheeks and tongue. If the baby has hair to brush, it is well to brush it. It makes him look very cunning, but if he is tired or sleepy, do not trouble him. This washing and dressing should not occupy more than twenty minutes, I have done it in fifteen where the baby was very well behaved.

Be sure that the room is warm and that the windows and doors are kept closed. Do not allow admiring relatives to come and go, opening and shutting the doors as they do so. If they want to see the operation, let them come and stay. A baby should never be bathed in a tub until the stump of the cord is off and the navel well and strong. If there is any inclination to pouting of the navel, wash the child on your lap and do not take off the band until the rest of the baby is all washed, dried, and powdered. Then take off band and compress, and put on fresh ones as quickly as possible, turn the child and pin as before directed.

In taking the clothing off, it is not necessary to turn the child at all, the band being the only thing pinned in the back.

N. B.--This method of bathing is for a normally healthy child, from the time it is one week old, until it is six months or more.

Until the stump of the cord has sloughed off, a baby should never be put into the tub. If after the stump has sloughed there seems to be any protrusion, or indeed any ulcerated look about the naval, it is best to bathe the child on your lap. In all such cases undress the baby as previously directed, until you come to the band (flannel belly band). Wash, rinse, wipe and powder him, being careful to make every part absolutely clean and dry. If the band is soiled or wrinkled, or out of shape in any way, remove it and put on a fresh one--looking every day, after three days, to see if the stump has come off--and if it is still adherent, being most careful not to disturb it in any way. Apply the fresh band immediately. Turn the baby on its stomach, and when the back is exposed, wash and rub the back gently with your warm hand. If the band does not need changing, unpin it, rub the back, pin it up again, and proceed in dressing as before. When the cord is once fairly off, and the navel smooth and clean, you can put the baby into the tub, very gently, slowly, and cautiously, remembering that a sudden movement on your part may, in fact, always will make him scream, and screaming with no band or compress on is for a baby a very frequent cause of umbilical hernia. If the cord is small when the child is born, there will be less danger of hernia, but if it be a large one, then beware! It will not always be your fault if the baby's navel is not small and flat when you are leaving your case, but you will always be blamed for it, if it is not. Notice carefully every morning when you bathe the child if there is any umbilical protrusion, and report it without delay to your doctor, if there is any, no matter how slight. This is not, however, the place to treat of umbilical hernia, and we will go on with the washing, If the child's skin is very tender, chafing easily, wash with castile soap suds, rinse and dry carefully, after every time he urinates, as well as when you bathe him. Powder with talcum powder. Sometimes no powder will do it any good, then try vaseline. If that will not do, ask the doctor if you can try oxide of zinc ointment. Ordinarily, extreme care in washing, drying and powdering will be sufficient, but it must be done every time the diaper is changed. In this, as in other things, eternal vigilance is absolutely necessary.

When the baby is about two or three weeks old, it is a good plan to put some alcohol into the water in which he is bathed--two or three ounces to the amount of water used in bathing. Have a small bowl of cooler water, 70 degrees to 80 degrees, for the face, and after that is washed, add a tablespoonful of alcohol to that also, for the head. It helps to toughen the skin, and prevents the baby from taking cold so easily.

If the baby seems much frightened by being put into the tub, spread a bath towel or small thin blanket over it and have someone hold his hands, so that he will not clutch so wildly at everything, then lower him into the water, towel and all, and he will not notice it so much.

I know of no place where deftness of handling shows to such advantage as with a baby. He knows well enough if he is handled properly or not, and his fretful cry, or violent screams, will tell you without delay if he is not comfortable.

Once more, let me impress upon the minds of all who read this, the necessity of having everything used about the tub and subsequent dressing, warm. Anything cold will make the little one scream, and I think all nurses will agree with me, that there is no more nervous work than washing and dressing a baby who is crying (and once he begins, he is only too apt to keep it up during the entire time). This is especially true if a weak, ignorant mother is made nervous by the noise, or a doting grandmother hovers about, making remarks about "new fashioned ways," and wondering why this child should cry when his mother was always so good, as a baby, in her bath.

Now, as to the time of washing a baby. The morning is unquestionably the time, but if the baby be very young (less than two weeks) and has been wakeful during the night, I would let him have his nap, even if it did delay you and interfere with your plan of work. If he sleeps he is comfortable, and, unless for some more serious reason than the bath, he ought not to be disturbed. This, for babies in private practice. Hospital babies cannot be so tenderly cared for. When there are ten or eleven to be washed in one morning, choose, of course, the ones that are awake, as far as you can, but there will always be one or two sleepy, warm little ones about whom you will have some twinges of conscience as you begin to wash their faces, but the work presses so, it must be done.