Chapter 22

NURSING MOTHERS

THE DIET OF NURSING MOTHERS--CARE OF THE NIPPLES--CRACKED NIPPLES--TENDER NIPPLES--MASTITIS IN NURSING MOTHERS--INFLAMMATION OF THE BREASTS--WHEN SHOULD A CHILD BE WEANED?--METHOD OF WEANING--NURSING WHILE MENSTRUATING--CARE OF BREASTS WHILE WEANING CHILD--NERVOUS NURSING MOTHERS--BIRTH MARKS--QUALIFICATIONS OF A NURSERY MAID.

THE DIET OF NURSING MOTHERS.--A nursing mother should eat exactly the same diet as she has always been accustomed to before she became pregnant. If any article of diet disagrees with her she should give up that particular article. She should not experiment; simply adhere to what she knows agreed with her in the past. More, rather than less, should be taken, especially more liquids as they favor milk-making. It is sometimes advisable to drink an extra glass of milk in the mid-afternoon and before retiring. If milk disagrees, or is not liked, she may take clear soup or beef tea in place of it. In a general way milk in quantities not over one quart daily, eggs, meat, fish, poultry, cereals, green vegetables, and stewed fruit constitute a varied and ample dietary to select from.

Every nursing mother should have one daily movement of the bowels; she should get three or four hours' exercise in the open air every day; and she should nurse her child regularly.

The diet of the nursing mother during the period immediately after confinement is given elsewhere.

Alcohol, of all kinds, should be absolutely avoided during the entire period of nursing.

Drugs of every variety, or for any purpose, should never be taken unless by special permission of her physician.

CARE OF THE NIPPLES.--As soon as the mother has had a good sleep after the confinement the nipples should be washed with a saturated solution of [122] boracic acid, and the child allowed to nurse. The milk does not come into the breast for two or three days, but the child should nurse every four hours during that time. There is secreted at this time a substance called colostrum. This is a laxative agent which nature intends the child should have as it tends to move the bowels and at the same time it appeases the hunger of the infant. It also accustoms the child to nursing and gradually prepares the nipples for the work ahead of them.

After each nursing the nipples should be carefully washed with the same solution and thoroughly dried.

CRACKED NIPPLES.--Cracked nipples often result from lack of care and cleanliness. If they are not cared for as described above they are very apt during the first few days to crack. They should never be left moist. They should be washed and dried after every feeding. If the breasts are full enough to leak they should be covered with a pad of sterile absorbent gauze.

Nursing mothers should guard against cracked nipples, as they are exceedingly painful; frequently necessitating a discontinuance of nursing; and may produce abscess of the breast.

TREATMENT OF CRACKED NIPPLES.--In addition to washing the nipples, drying them thoroughly, and placing a pad of dry gauze over them after each feeding, they should be painted with an 8 per cent. solution of nitrate of silver twice daily. Before the next feeding, after the silver has been used, they should be washed with cooled boiled water. If the cracks are very bad it may be necessary to use a nipple-shield over them while nursing for a few days.

TENDER NIPPLES.--Many women complain of the pain caused by the baby when it is first put to the breast. These nipples are not cracked, they are simple hypersensitive. They should be thoroughly cleansed and dried as above and painted with the compound tincture of benzoin. They should be washed off with the boracic acid solution before each feeding. After a few days under this treatment the tenderness will leave them.

MASTITIS IN NURSING MOTHERS.--When inflammation of the breast takes [123] place in a nursing mother it is the result of exposure to cold, or it may result from injury. If infection occurs and an abscess develops, it results from the entrance, through the nipples, or cracks, or fissures in the nipple, of bacteria into the breast. There is fever, with chills and prostration, and very soon it is impossible to nurse the child because of the pain. Nursing should be immediately discontinued, the breast supported by a bandage and the milk drawn, with a breast pump, at the regular nursing intervals. An ice-bag should be constantly applied to the painful area and the bowels kept freely open with a saline laxative. When the fever and the pain subside nursing may be resumed.

If the gland suppurates in spite of treatment it must be freely opened and freely drained.

WEANING

WHEN TO WEAN THE BABY.--Medically there is no exact time at which the baby should be weaned. Certain conditions indicate when it should be undertaken. It is desirable to wean the baby between the tenth and twelfth months. A month or two one way or another will not make much difference if the mother and child are in good condition. It should be weaned between the periods of dentition rather than when it is actively teething. The time of year is important. It would be better to wean it before the hot weather if it is strong and has been accustomed to taking other food than the breast milk. On the other hand it would be decidedly better to defer the weaning until the fall, rather than risk weaning at the tenth or twelfth months if these fall during the height of the hot weather.

METHODS OF WEANING.--The best way to wean is to do it gradually. It is not desirable to take the mother's milk away suddenly unless there is a very good reason for it. The child should be fed small portions of suitable other food at the beginning of the tenth month. By the end of the tenth month he should be taking a feeding two or three times a day of food other than the breast milk. This feeding may be given in a bottle. In some [124] cases the mother may be able to feed the child with a spoon instead of the bottle. The substitute feedings allowable at this age are given in another chapter.

TIMES WHEN RAPID WEANING IS NECESSARY.--There are times when the child must be weaned suddenly, as, for example, at the death of the mother, serious sickness of the mother, or in cases where for any cause the mother suddenly loses her milk. In these cases it is best to wean at once. If an infant refuses to take the bottle under such circumstances, the best plan to adopt, and the wisest one in the long run, is to starve the child into submission. If he gets absolutely nothing but the bottle he will shortly take it without protest. If a meddling individual attempts to feed the child some other food and tries to coax it to take the bottle in the meantime, much harm may result; it is safe only to fight it out for a day or two and win than to half starve the child and lose in the end.

The child should be weaned if it is not gaining in weight. This may indicate a deficient quality of the mother's milk, or it may indicate a lack of proportion between the child and mother. If a robust child is depending upon the nourishment furnished by a mother who is not in good physical condition the milk may not be adequate in quality and quantity. The child will not therefore develop normally and it may be necessary to wean it.

If the mother becomes pregnant it will be necessary to wean, because pregnancy invariably affects the quality of the milk. It is a very good habit to accustom the child to take its daily supply of water from a bottle from a very early age. This procedure will make it easier to wean at any time.

Menstruation is not an indication for weaning as has been explained. If, however, the return of menstruation affects the milk so that it disagrees with, or fails to satisfactorily nourish the child, it may be necessary to wean, but not unless.

The best reason for weaning a child at the twelfth month is that a mother's milk after that time is not adequate in quality for a child of that age. A child at one year of age has grown beyond the capability of its mother[125] to nurse it: nature demands a stronger and a more substantial food than any mother can supply. A mother who nurses her child beyond that period is not only injuring herself, but she is cheating her child. The exception to this rule is, as has been explained, the second summer.

The child will evidence its dissatisfaction with the breast supply if it is not enough; it will not gain in weight, it will be irritable and fretful, it will tug long and tenaciously at the nipple, it will be unwilling to cease nursing after it should have finished, and it will drop the nipple frequently with a dissatisfied cry. These are all signs of insufficient nourishment, and to the observant mother they will at once indicate that the child must be weaned and fed upon a mixed diet.

CARE OF BREASTS WHILE WEANING CHILD.--The process of weaning should cause little or no discomfort. If the weaning is gradual it is necessary to press out enough milk to relieve the tension from time to time. It usually takes three or four days.

If it is necessary to wean abruptly, as it is occasionally, there may be considerable distress. In these cases it is necessary to massage the breasts completely,--until all the milk is out, or as much as it is possible to get out,--then rub the breasts with warm camphorated oil, and bind them firmly. When the breasts are massaged for any reason, the rubbing should be toward the nipple and it should be done gently. If there are any hard lumps, or caked milk, in the breasts, they must be massaged until soft, and the binding renewed. It may be necessary to repeat this process for a number of days. In binding the breasts use a large wad of absorbent cotton at the sides, under the arms, to support the breasts, and another wad between the breasts. This renders the binding more effective; permits the binder to be put on tighter; and prevents it from cutting into the skin. When weaning has to be done quickly the patient should absolutely abstain from all liquids. A large dose of any saline, Pluto, Apenta, or Hunyadi Water, or Rochelle salts, or Magnesium Citrate, should be given every morning for four or five days. [Page 126]

If the weaning is gradually undertaken the child should be allowed to nurse less frequently. One less nursing every second day until two nursings daily are given. Keep the two daily nursings up for one week and then discontinue them, after which the above measures may be adopted. To dry the milk up, the breasts may be anointed with the following mixture: Ext. Belladonna, 2 drams; Glycerine, 2 ounces; Oil of Wintergreen, 10 drops.

NERVOUS NURSING MOTHERS.--Nervousness, considered not as the product of a diseased condition, but as a temperamental quality, is an unfortunate affliction in some nursing mothers. Let us illustrate just how this characteristic is detrimental to the helpless baby. A mother was instructed to give her baby a half teaspoonful of medicine one-half hour after each feeding. She was told how to give it, and how to hold the baby when giving it. She was also told that the baby would not like it, and would try to eject it from its mouth rather than swallow it, and that when it did swallow it, it would make a little choking noise in its throat, but not to mind these, to go ahead and give it, as the baby could not strangle or choke. It was essential to give the baby this medicine, and hence the physician explicitly instructed her in these details. What was the result? On the following day when the physician called, and found the baby much worse, the mother said: "Oh, doctor! I couldn't give the medicine, the baby wouldn't take it, she nearly strangled to death when I tried to give it." The physician asked for the medicine and placing the baby over his knee, gave it without the slightest trouble, much to the mother's amazement. The servant girl who was a hard-headed, cool, Scotch girl, was instructed and shown how to give the medicine, which she did successfully. The mother was temperamentally nervous, was easily excited and became helpless the moment the baby objected, though she was a strong, robust, healthy woman.

Another mother was carefully instructed to drop into the eye of her baby two drops of medicine every four hours. She was told and apparently appreciated the urgent necessity of the medication as her baby's eye [127] was badly infected. She was further told that if she did exactly as shown, the eye would be better in two or three days, and if she did not, the other eye would become infected, and blindness might result. She undertook to carry out the directions faithfully. She absolutely failed, however, to carry out the instructions. Her husband informed the physician on the following day that she became so nervous and excited that she utterly failed to treat the eye once, and when he and a sister offered their assistance she became so unreasonable in her fear that "they might hurt the baby" that it was impossible to do anything with her. Her sister was finally shown how to do it and carried the case through quite successfully.

Inasmuch as this book is intended to convey helpful instruction to every mother, the author would suggest to those of this type the necessity of resisting this tendency. It is a matter of will power, just make up your mind not to be silly and if you find that you cannot trust yourself to follow instructions, let someone else do it. When the physician tells you a certain thing must be done, and that no harm can result, do it, and don't imagine all kinds of impossible happenings.

So much anguish and annoyance is caused in this world by imagining and anticipating trouble, that half the pleasure of life is denied us. You cannot do your whole duty by a helpless baby if you do not reason and act upon sound judgment. Many babies are lost by mothers being afraid to do what should be done, and what they know should be done. It is not what the doctor does that brings a baby through a dangerous sickness; it is the faithfulness of the nurse in carrying out his instructions that is responsible for the outcome. A timid, halting, doubting nurse can quickly undo all a physician hopes to accomplish; while a prompt, faithful nurse, with initiative, and good judgment, can save a little life in a crisis, even in the absence of the physician. Follow instructions implicitly, even though the carrying out of the instructions seem to cause the baby pain and suffering,--it is for the baby's best interest.

[128] BIRTH MARKS.--Much has been written on this subject which a later study of biology and eugenics have shown to be utterly false. Let us consider the actual facts. The baby is already a baby, floating in a fluid of its own manufacture. It has absolutely no connection with its mother except by means of its umbilical cord,--which is composed of blood vessels. The blood in these vessels is the child's blood and never at any time does it even mix with the blood of the mother. It is sent along these vessels into the placenta, or after-birth, in which it circulates in small thin vessels, so close to the mother's blood that their contents can be interchanged. Yet the two streams never actually mix. The carbonic acid and waste products, in the child's blood, are taken up by the mother's blood, and given in exchange oxygen and food, which is returned to nourish the child. There is absolutely no nervous connection between the mother and the child. How then is it possible for the mother to affect her child in any way except insofar as the quality of its nourishment is concerned? Nor can a mother affect her child in any other sense. If the intermingling of blood could affect a child's education we would frequently resort to surgery. In the article on Eugenics, under the heading, "Education and Eugenics," it is explained that the child is "created" at the moment of conception; that absolutely nothing can affect it after it is created; that no influence of the mother or father can in any way affect it for better or worse. A mother cannot create in her child any quality which she may desire no matter how she conducts herself. It was formerly thought that a mother could for example create a musical genius by devoting all her time to the study of music while she carried the unborn child; or that she could make a historian of it if she studied history; or an artist if she studied paintings. We now know this to be wholly wrong and for very excellent reasons.

The mother must realize that the only aid she can bestow upon her unborn child is to give it the best possible nourishment. She must provide good blood because the quality of the maternal blood stream bespeaks a healthy or unhealthy, a fit or unfit, child. Whatever the child is to be is [129] already fixed, its innate characteristics art part of itself. Whether it will have the vitality to develop its inherent possibilities depends, to a great degree, upon its intra-uterine environment,--and its intra-uterine environment depends upon the health of its mother and the quality of the blood she is feeding it upon. After birth its health, its success, its efficiency, depends upon the care it gets and the quality of its mother's milk. A mother therefore must be in good physical and mental health if she hopes to do her full duty as a mother.

QUALIFICATIONS OF A NURSERY MAID.--When a helper, or maid, is employed to aid in caring for the baby, much precaution should be exercised in selecting her. The association of the nursery maid and the child, is necessarity an intimate one, and she should be willing to submit to a medical examination to prove her physical fitness. Her lungs should be examined thoroughly, so also should the condition of her mouth, throat and nose be known. An observant and tactful mother will also find out if there are any other objectionable conditions existing, which would render her unfit for the position. A nursery maid should be naturally fond of children, she should be industrious, and sensible; of quiet tastes and good disposition. Her work should be a pleasure not a task.

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