CHAPTER VII.

DIRECTIONS TO THE NURSE DURING THE MONTH.

The nurse will receive from the medical man such directions as the peculiarities of the case seem to demand, but I deem it proper here to give some general instructions. First, in regard to

CARE OF THE MOTHER.

REST is essential to the mother during the month. She should remain in bed nearly all the time for at least two weeks, and should not return to her household duties under a month. Perfect tranquility is essential, that the womb may resume its former size and situation, and that inflammation, ulceration, prolonged debility, pain and excessive discharges be avoided, and that a good form be preserved. As a means of preventing a flabby, pendulous belly, she may also, when she does walk around, wear a utero-abdominal supporter or a well-fitting bandage. If a bandage is worn it should be made of strong linen, cut bias, setting snugly to the form, but not exerting unpleasant pressure. Its breadth should be from twelve to eighteen inches.

The diet of a nursing woman should be both light and nourishing. I would suggest for the first day well-boiled gruel, bread and milk, panada, tea, dry toast and butter, or bread and butter. For the second day, beef tea may be added (F. 58), and she should be served with food four times; the third day she may eat a little chicken or game, and mashed potatoes or rice pudding, and on the fourth day she can partake once of mutton or beef. Arrow root (F. 44), with these articles mentioned, may form part of her diet thereafter, but she may partake of such articles of her former diet as are wholesome and nourishing. The woman must not be starved; she demands food that will allow her to recuperate her strength. Give her as nutritious food as she has appetite for, and can easily digest and assimilate. (F. 58.)

For a BEVERAGE give toast water, barley water, and milk with the chill taken off and a little salt added, tea, cocoa, or chocolate made with one-half milk, new milk and water, cacao and broma, made with a large proportion of milk. Either of these may be freely used as a drink. I have always allowed my patients to drink freely of water from the first, and an occasional cup of coffee is not harmful. When the mother experiences any inconvenience from any articles of diet or drink, she should not hesitate to abandon them, for if they disagree with her they will also disagree with the child. (F. 10, 16, 18, 19, 20, 23, 25, 28.)

The LOCHIAL DISCHARGE, which occurs directly after a lying-in, is at first of a reddish color, and gradually changes to a brownish hue, and afterwards to a greenish shade. It is necessary that there should be some discharge to continue for a week, and it often continues for three weeks more. In some cases it has a disagreeable odor.

ABLUTIONS and cleansings are very necessary at this time. The parts should be carefully cleansed every day, and it is never amiss to use for this purpose a weak solution of chlorinated soda, or carbolic acid, or permangenate of potassa, etc., (F. 153.) They may be used quite weak at first, and afterwards of greater strength, if they do not cause smarting. Tar water is excellent for an injection. The woman should daily assume a position that will facilitate the discharge of the lochia; sometimes get on her knees, or she may occasionally lie on her face and stomach. There should be no bandages applied so as to confine the secretions. A soft sponge and warm water may be used for ablutions at first, or the parts may be bathed with warm water and oat meal gruel; after bathing they should be dried with warm, dry towels; they may then, by means of a piece of linen rag, be anointed with salad oil or vaseline, or other bland oil. Once or twice a day the vagina should be syringed out with some injection. (F. 153, 155.)

TO WASH OR CLEANSE the patient so that the pores of the skin in every part are free and unobstructed, a soft napkin wet with warm soap and water, should be passed underneath the bedclothing, and she should be rubbed all over without any exposure to a draught of air. In some way she should take a sponge bath every day.

The CLOTHING which a patient will wear immediately after a labor has been already, indicated. As some garments worn during labor are not necessarily soiled, they may be worn until the third or fourth day, when the dress should be changed. This may be done without tiring or exposing the patient. Without raising her up you can pull the bedgown down from over each arm, and after removing it from under the body, you can draw down the chemise and remove it from below. You can place her arms in the sleeves of the clean chemise, throw it over her head and pull it down; and put on a clean bedgown in a similar manner, or both may be put on at once.

The BED CLOTHING as well as the body linen should be changed frequently. In changing the upper sheet it should be pulled off from below, and the clean one can be carried down in its place without removing the other bedclothes, by plaiting the lower half of it. To put on a clean under-sheet, plait one side of it, and place that under the patient while she lies on her side, then let her turn on her back or other side onto it, and draw out the plaited part. Care of this kind is necessary until she is able to sit. Have the sheets well aired, and have a proper temperature in the room.

THE LYING-IN ROOM should always be kept well ventilated and rather cool; it is injurious to the patient to have the room kept at a high temperature. Perhaps the ventilation can be secured by having a little fire in the room, and by occasionally leaving the door of the apartment ajar, at the same time being careful to guard against draughts. But visitors remaining in the room, or any additional number of persons, serve to vitiate the air, as well as to prevent the necessary repose of the patient. A sensation of chilliness may be felt by the woman after delivery, and her feet may be cold; if they are, something warm should be applied to them, and sufficient clothing should be on the bed; but afterwards be careful not to overload her with clothes, as well as to avoid having the room overheated.

TOO MUCH LIGHT in the room may be injurious to the eyes of the mother or child, and it is often necessary to darken the room somewhat for a few days.

The lying-in woman will usually be confined to her room for two weeks. After the first fifteen days she may very properly remove to another room adjoining, or near at hand, and during her absence her room and bed may be ventilated by throwing the windows wide open and throwing the bedclothes back. Ordinarily she may, at the end of three weeks, take her meals with the family, but she ought still to lie down occasionally to rest her back. At about this time she may take an airing in a carriage, if the weather be fine.

All lying-in women ought not to be treated alike in regard to DIET, etc. While a light, unstimulating diet is best at first in ordinary cases, the weak and delicate require good, nourishing food from the commencement, such as beef tea, chicken broth, mutton chops, eggs, etc., (F. 57, 58, 59.) Oatmeal gruel increases the secretion of milk, is nourishing and easily digested, at the same time it is simple and bland, and proper for those that are corpulent, or strong and robust, and the same may be said of good cow’s milk. But, as the healthy mother furnishes daily from a quart to a quart and a half, she needs some meat to keep up her strength. Never give stimulants to increase the woman’s strength, or to increase the quantity of milk.

In some cases, after a severe and lingering labor, there is RETENTION OF URINE. If the bladder cannot otherwise be emptied, the catheter must be used every six or eight hours.

The bowels are usually costive after a confinement, and I prefer to give a dose of castor oil the third day. If this or some other aperient is not given, enemas should be administered sufficient to cause evacuations.

The care of the MOTHER’S BREASTS is important. Before the milk is abundantly secreted, she should not be fretted by very frequent ineffectual attempts at nursing, though it may be necessary to draw out the nipple by means of a breast pump. The milk should be drawn out when the breasts become full and distended, and they should not be allowed to remain hard and sore. Apply fomentations; cabbage leaves, wilted in hot vinegar and water, or warm solution of carbolic acid, one part to eighty. If they continue to be swelled and painful use F. 221, 223. It may be necessary to make gentle pressure upon them by means of strips of adhesive plaster, or by a sort of jacket or bandage, that should be prepared especially for the purpose. When the breasts are closely bandaged they should be supported on each side by pads of cotton, so that the pressure will be made equally upon them.

Delay in applying the child to the breasts is often a cause of swelled breasts. After it has been fed for a few days it may refuse to nurse, and if it does nurse the nipple may be quite tender. But, unless for some cause the secretion is to be checked, the effort should be made every two hours to induce the child to draw. You will be more successful in these efforts if you can reduce the heat and swelling. Rub the breasts every four hours with good, warm olive oil, vaseline, or camphorated oil, and keep the excoriated nipple thickly coated with sub-nitrate of bismuth.

The breast should be rubbed, and the child should be nursed regularly, although I do not advise that the child or the mother should be roused from their slumbers; it is better to delay for awhile the usual effort. But, even at first, a child can be nursed with considerable regularity every hour and a half during the day, and twice during the night; and it should be applied alternately to either breast, even if it seems to prefer one to the other.

It is often necessary to wash the breast and nipple with warm water, and dry it with a soft napkin, before applying the babe.

During all the time that the mother nurses the child, the MIND OF THE MOTHER exerts an influence on the latter through her milk. If the mother’s mind is very much disturbed by any apprehensions, fears or anxieties, these perturbations will not only be likely to check the flow of milk, but will alter its quality, and perhaps render it hurtful and dangerous to the infant. The nurse should guard the patient as much as possible from anything causing nervous agitation, fretting, anger, grief, fear, sudden terror, or great anxiety, as these are injurious to the mother, and may be harmful and fatal to the child. Equanimity and cheerfulness of mind on the part of the mother are important at any period of her pregnancy or nursing. I will now give more particular directions in regard to

THE CARE OF THE CHILD.

THE FOOD OF THE CHILD, if it is necessary to feed it at first, may be one-third of new milk and two-thirds of warm water, slightly sweetened. It is not necessary that it should be fed for at least eight hours after birth, and at first the quantity fed it must be small. Except in rare cases the milk furnished by the mother will come soon enough, and in sufficient quantity to supply the wants of the child, and it is best for both that the child should draw it when secreted. For the instruction of the mother, as well as the nurse, I here quote a paragraph upon the nourishment and feeding of the child, not only of the new-born, but also of the subsequent months:

“No form of artificial nourishment can compare with that furnished by the mother. Women should know and consider the probability of disease and death occurring from any other mode, and the difficulties and annoyances to be encountered in the use of artificial food. As a further inducement to her to nurse her own child, she should know that her offspring is sure to imbibe with its milk, deep, earnest affection. The mother who can nurse her own offspring should commence within eight hours after delivery, and in the mean time no trash should be put in its mouth to still its cries, or for any other reason; if it has not been surfeited, it will be disposed to take the breast. It should be placed to the breast before they are gorged with milk, for at that later time the flow is less easy, the parts are more irritable, and the child sucking with greater power, we are more likely to have, as the result, irritated nipples. Nature prompts all animals to suck their mother soon after they are born; we are less liable to have sore, irritated, cracked nipples, and there is less liability to infantile colics, etc., if we follow the guidance of nature and instinct.”

As soon as possible accustom the child to the habit of nursing every two hours. If there is a proper interval between the times of nursing, the child draws with more avidity, actually empties the breast, and obtains that part that contains the most cream. Endeavor also to have the intervals longer at night, so that, from 10 P. M. to 6 A. M., it nurses but once or twice. Still, if it wakes every two or three hours, demands its supply of nourishment, and you cannot otherwise quiet the child, you must indulge it. Do not accustom the child to sleeping on the mother’s breast. If it sleep in its own crib or bed, properly clothed and protected, it is less liable to have its rest disturbed. Avoid the custom of having a young child sleep with old and sickly persons, and also of having them sleep in ill-ventilated rooms, and of covering the child’s face as it sleeps. There is danger that a child may die from want of pure fresh air, from having its face pressed tightly in the embrace of the person with whom it sleeps, from the multiplicity of its clothes, and from the mass of bedclothing used by the mother, as well as from improper food. A child should never be covered to sweat by reason of the warmth of its clothing, or of that of the apartment.

If the mother does not enjoy good health, it may be better for her not to nurse the child at night, but to have it fed once or twice with a little diluted cow’s milk at night, and to nurse it during the day.

The following have been named as CAUSES WHY THE MOTHER CANNOT PROPERLY NURSE THE CHILD:

1. When she cannot have a sufficient quantity of milk.

2. When the supply falls off from some defect which is not remediable.

3. When there is a strong venereal or scrofulous taint in the constitution.

4. When suckling produces an active or painful disease in the mother, as colic, etc.

5. When the mother is subject to great nervous debility; possesses an irascible temperament, and cannot avoid grief and sorrow; and also when she is suffering from certain hereditary chronic diseases.

WHEN A MOTHER CANNOT SUCKLE HER CHILD, if circumstances will allow, a healthy wet-nurse should be procured. Choose one that is of a healthy family; ascertain that there are no eruptions on her skin, or if there be other disease; if she have a plentiful breast of milk, and if it be of a good quality; if she has good nipples, and if her child is born near the time that the one was that she is to nurse. Do not get a nurse that menstruates during suckling, nor one that has a child which is unhealthy, or has a sore mouth or blotches upon the skin.

Very feeble new-born babes cannot take the breast sometimes. In such cases cow’s milk, water and sugar (F. 1) may be given in small quantities at a time, but frequently repeated. If it takes only a teaspoonful at a time it should be repeated every half hour.

Many mothers are unable to obtain the services of a wet-nurse. The milk of a cow is the best substitute, and when this is of ordinary richness, it may be diluted with an equal quantity of water, or thin barley water.

The following are leading principles to guide in giving infant food:

1. Aliment should always be presented to the infant stomach in a fluid form.

2. Bread and other farinaceous substances are generally indigestible in the infant stomach, and may better be excluded from infant feeding.

3. Cow’s or goat’s milk, when pure and modified so as to resemble as much as possible human milk, will generally be found sufficient without any other help to nourish the new-born infant.

4. If cow’s milk is used at first, diluted with twice as much water and slightly sweetened, the proportion of water must be gradually lessened, until after six months the milk may be given undiluted.

5. When good milk from one cow cannot be obtained, and the child does not thrive upon the milk used, condensed milk may properly be substituted.

6. There are various forms of infant food referred to in F. 1, 2, 3, 4, 11, 28, 45, 49, and if one of these is tried and proves satisfactory, it will not be advisable to try new kinds of infant food which are at the present time offered for sale. Milk should be the basis of all infantile food; neither starch, dextrine or glucose sufficiently nourishes without it; but we may use one of these foods without milk for one or two days, in unsettled state of the stomach, with good results. (F. 61.)

THOROUGHLY WASH THE BABE EVERY MORNING from head to foot, using a large wash bowl or nursing basin, half filled with water. First wet the head, then immediately put the body in the bath, and with a sponge or piece of flannel, cleanse the whole body, particularly the armpits, groins, and between the thighs. The skin, after being thus cleansed, must be quickly and thoroughly dried with soft towels, and the parts liable to become sore, powdered; then all parts of the body and limbs should be gently rubbed. During all the time, when the child is but a few days old, it should not be exposed at all to the cold. The water for its bath should be slightly warmer than new milk, and the time occupied in the bathing should be short. Each time, after a passage from the bowels, the parts should be washed with warm water, and if there is any chafing the calamine powder should be applied.

THE NAVAL STRING should receive the attention of the nurse; within an hour of the time it is at first tied, she should examine the dressing to see if there has been any bleeding. If it bleeds, and the doctor is not at hand, retie with a stout cord, drawing it quite tight. Each morning, when the child is bathed, lift up the naval string with the rag dressing and insert a little nice fresh tallow under it. When it is loose remove it, but use no means to cause the separation. The naval is sometimes a little sore, but seldom needs any dressing more than simply vaseline or tallow.

AT NIGHT a child should be entirely undressed, and its clothing replaced by other garments, those that are loose, light, and sufficiently warm for it while it is under the bedclothes. For a very young child the proper night-dress is a loose slip; when older, a pair of drawers, fitting up well around the neck and covering the body and limbs, is a good article. The clothing worn during the day should not be worn at night, and the clothing when soiled should be immediately changed. Whenever the child seems disposed to sleep, this should be encouraged. Never arouse a child suddenly from its sleep. Be careful that there is no unnecessary noises to disturb its sleeping. Time the bathing and dressing so that the little one may not be unnecessarily disturbed. But never give soothing syrups, anodynes for infants, or other nostrums to induce them to sleep. If the child is restless, endeavor to ascertain if there is not some cause that can be removed, such as tight clothing, etc.

PREMATURE INFANTS may, under favorable circumstances and assiduous care, live and thrive. Immediately after birth the child should be placed in a warm bath, and then wrapped in cotton. The baths should be warmer than usual, and must be frequently repeated. Awaken the child every one or two hours to feed it. Milk (woman’s milk is the best) must be given it by a teaspoon. With a view to the better development of the lungs, it may be excited to cry by a slight irritation. Do not bring such children into the open air for several months after the birth, as their passages are readily affected.