THE NURSING MOTHER
The Breasts--Human Milk--The Technique of Nursing--Hygiene of the
Mother: Diet; Psychic Influence; Recreation and Rest--The
Supplementary Bottle--Weaning.
When the obstetrician pays his final visit the mother usually has
ready a number of questions, most of which anticipate difficulties in
the care of the baby. At that time, however, minute and far-reaching
directions cannot always be given. Unforeseen peculiarities in the
development of the child may modify such general principles for the
management of infants as could be laid down in advance. With a few
exceptions, therefore, mothers require during the early years of a
baby's life skilled advice as to his upbringing--advice for which
neither instinct nor haphazard counsel is a safe substitute. It is an
excellent plan, and one which is becoming more and more popular, to
have a physician supervise the care of the baby through the period of
most active growth. According to this plan, the mother, even though
her baby is well and developing as it should, consults the physician
at regular intervals, once a month for example, and upon these
occasions secures help in solving problems which are certain to
present themselves. Such an arrangement shows a merited appreciation
of the proverbial "ounce of prevention," and when serious
difficulties do arise materially counteracts the tendency to panic
which is exhibited by so many young mothers.
Among the problems which the mother must solve, that of nutrition
outranks all others in importance; and unless the infant is nourished
with human milk, it also exceeds them in perplexity. For, although
great advances have been made in artificial feeding, science has not
yet removed all the intricacies and dangers involved in the use of
the bottle. On the other hand, mothers who nurse their babies rarely
meet with difficulty. Human milk is perfectly adapted to the wants of
the infant; and all substitutes, though carefully designed to
duplicate it, are only partially successful. We have learned how to
modify cow's milk so that in chemical constituents, at least, it is a
very close imitation of human milk; but human milk possesses, in
addition to its chemical properties, other desirable qualities which
cannot be instilled into an artificial food. We must agree,
therefore, that attempts to disseminate a wider knowledge of the
correct principles of bottle-feeding do not have the highest aim. Our
real need is a vastly greater proportion of women who nurse their
children.
THE BREASTS.--For success in nursing the first essential is healthful
breasts. With this the largeness or smallness of a breast has nothing
to do, for size is no more an index of its capacity for producing
milk than is the weight of a woman an index of her energy. The breast
is not a warehouse, but a factory, with very limited storage capacity
for its product. Differences of size are generally to be explained by
the variable amount of fatty-tissue the breast contains. And so far
as the secretion of milk is concerned the fat is entirely passive; it
fills in the space between the glandular elements; and a layer of fat
just beneath the skin protects the glands against external influences
that otherwise might disturb their activity. Stripped of their fatty
envelope the structures which actually secrete the milk and convey it
to the nipple resemble a miniature cluster of grapes. Each tiny,
spherical gland corresponds to one of the grapes and contains a
cavity lined with cells which manufacture the milk. From this cavity
the milk flows through a microscopic tube which unites with similar
tubes to form a larger one; this in turn joins others of its kind;
and so on, until ultimately the milk enters a relatively large duct--
the figurative stem of the cluster--which conducts the milk to its
destination. There are from ten to fifteen of these terminal ducts;
each drains a separate group of glands, but all end in the nipple.
Shortly after conception the breasts become congested; in consequence
they enlarge, become tender, and begin to show swollen veins beneath
the skin. The most significant alteration, however, occurs in the
cells which line the glands; these increase in size at first; and
then, by a process of cell division, their number multiplies. After
pregnancy has advanced six to eight weeks these cells begin to
elaborate the thin, watery fluid called colostrum. Contrary to
popular belief, the quantity of colostrum is not prophetic of the
character of the milk; there is no ill-omen, to be sure, in a
plentiful secretion, but a meager one is quite as likely to be
followed by successful lactation. At present we are unable to predict
by any means either the quantity or the quality of the milk which a
prospective mother will produce.
Some writers contend that influences which come into play during
girlhood ultimately affect the capacity of the breast for making
milk; for example, irregular habits in youth and the wearing of
improper styles of clothing are said to be particularly detrimental
influences. Of course, a healthful mode of life at the time when a
girl is approaching maturity reacts favorably upon her development in
every way, and naturally enough the breasts share this benefit; but
the relation between unhygienic habits at about the time of puberty
and a subsequent deficiency in lactation has been exaggerated by many
writers. It is impracticable, certainly, to institute special
measures to prepare the breasts for their function until the need of
such measures is clearly evident. Throughout pregnancy clothing about
the breasts should be loosely worn. If the nipples are not already
prominent they should be drawn out; and about six or eight weeks
before confinement is expected they should be given the treatment
described in Chapter V.
For the first day or so after the infant begins to nurse its efforts
have a tendency to injure the skin which covers the nipple; and
unless measures to render the nipple resistant have been previously
adopted, nursing may cause the mother considerable discomfort.
Moreover, it is extremely important throughout lactation to keep the
skin covering the nipple free from abrasions, for if it cracks
bacteria have thus an opportunity to enter the glands and set up an
acute inflammation which may result in the formation of an abscess.
This complication is to be avoided, not only because of the
unpleasant symptoms which attend it, but also because for the time it
brings the usefulness of the breast to an end. Fortunately an abscess
seldom impairs the breast permanently.
At any period of lactation there may be an overproduction of milk. In
this event the breasts are likely to become distended, hard, and very
tender. Most frequently "caked breasts," as this condition is called,
develop a few days after delivery, when the secretion of milk is just
beginning, for at first the secretion is more plentiful than need be.
Generally twenty-four hours later there is an adjustment between the
supply of nourishment and the natural demands of the infant.
Occasionally a longer interval elapses before the breast is
completely emptied at each nursing.
Formerly it was customary, whenever the breasts became tense and
uncomfortable, to express an excess of milk by means of massage; but
this mode of treatment lost favor as soon as physicians realized that
massage stimulated the glands to greater activity. Drawing the milk
with a breast-pump has a somewhat similar though less potent
influence, and, because pumping often affords relief when the breasts
are distended, there is rarely any objection to it. In the light of
modern experience, however, most physicians prefer to avoid
manipulation of the breast so far as possible, and generally resort
to other measures to relieve the mother's discomfort. Thus most
patients are made comfortable if an appropriate bandage is used to
transfer the weight of the breasts from the arm-pits and the front of
the chest to the bones of the shoulder-girdle. It may be necessary
also in some cases to swathe the breasts in warm cloths; in others
cold applications are more acceptable; the choice between these
methods will vary with the time of year, and usually may be left to
the patient herself. Now and then medicine will be employed to
relieve the pain, but the administration of drugs to diminish the
production of milk is inadvisable. It is never very long before the
amount of milk becomes adjusted to the infant's wants, and then
distention disappears spontaneously. No artifice can bring about the
adjustment as ideally as nature does.
During the later months of lactation the liability of the breasts to
over-filling is slight, provided the infant empties them regularly
and completely. Nevertheless, so long as a mother is nursing her
child she must be careful to keep the breasts in a healthful
condition. They require support, yet must not be compressed. And they
should be covered with clothing which will adequately protect them
from sudden changes of temperature. This latter precaution, perhaps,
requires more emphasis than formerly, on account of the present
popularity of motoring; for the chill which one experiences when
driving fast may have a very unpleasant effect upon a nursing mother
unless her breasts are carefully protected. Occasionally fever and
neuralgic pains in the breasts are caused by motoring, or by exposure
to the air-current from an electric fan playing directly upon them.
But even under these circumstances an abscess need not be feared
unless the nipples are sore.
_Human Milk_.--Between the time of birth and the beginning of
lactation there is always an interval during which the breasts
secrete colostrum, just as they do throughout pregnancy. Although the
nutritional value of this fluid is not great, it is doubtful if
colostrum serves any other essential purpose than as nourishment.
Possibly it also stimulates the intestines to expel the material
which has collected within, them during fetal development, yet we
know the bowels will move without a purgative; and often do so long
before the infant is placed at the breast. Typically, the secretion
of milk begins the third day after delivery; yet in perfectly normal
patients it may appear as early as the second or as late as the
fifth, and occasionally lactation does not begin until the baby is
more than a week old.
As to what starts the secretion of milk we have only a vague idea;
but we know that when the flow is once established its continuation
depends primarily upon the sucking efforts of the infant. If nursing
is discontinued the secretion dwindles and the breasts dry up. On the
other hand, the strong, persistent stimulus of the infant's suckling
gradually brings the secretion to a high degree of efficiency. Within
the first two weeks, therefore, the daily secretion increases from a
few ounces to a pint or more. Subsequently the output fluctuates
between one and two quarts daily, according to the demands made upon
the breasts; the secretion is larger, consequently, if there are
twins. Astounding yields of milk have been recorded, as in the case
of a wet-nurse in a German institution who nursed a number of infants
and became capable of supplying three to four quarts daily.
That newborn infants thrive better on human milk than on any other
nourishment is a conviction that must come home to every one who has
had even a limited experience. It keeps the babies in health, serves
to make them grow, and promotes the development of all their organs
as nothing else will. Because there are present in this fluid all the
elements necessary for nutrition, physiologists have called it a
perfect food. Quantitatively its most important ingredient is water,
which constitutes about 86 per cent. of its weight. It also contains
about 7 per cent. of milk-sugar, 4 per cent. of butter fat, 2 per
cent. of protein, and 0.2 per cent. of mineral matter.
The milk of all animals contains a relatively small quantity of
mineral matter; judged from this standpoint, the mineral matter would
seem of minor importance, but it is actually as vital as any other
constituent. Without it the bones would hot harden properly; and
other services which it performs are absolutely essential to life. As
we should expect, human milk contains all the mineral ingredients
necessary for the development of the infant; indeed, with the single
exception of iron, they are present in the precise amounts in which
they are needed. In this omission, however, nature is guilty of no
oversight, since the infant has already been provided by the time of
birth with a rich supply of iron.
THE TECHNIQUE OF NURSING.--Since the mother should have opportunity
to recuperate from the fatigue of labor, physicians generally
recommend that an interval of at least twelve hours elapse between
the birth of the infant and the time it is first put to the breast.
Moreover, the best interests of the infant demand that it be kept
warm and left undisturbed while becoming accustomed to its new
environment. There is no immediate need of food; and if there were,
nature does not fit the mother to supply it, for at this time the
breasts contain merely small quantities of colostrum.
Some babies nurse vigorously at the outset, but later, discouraged
because they get so little, become indifferent and restless, or even
decline to take the breast. And the mother, who is handicapped by
inexperience and by the awkwardness of nursing in a recumbent
position, often feels desperate. Fortunately technical difficulties
are confined to the first few days, and, trying as they sometimes
are, no one should be discouraged or imagine that she is incapable of
nursing; for practically every woman who persists will succeed.
For a week or ten days the mother will nurse in the recumbent
posture. She turns to one side or the other, according as the right
or left breast is used, and holds the corresponding arm to receive
and support the baby, which will lie beside her. Then with the
opposite hand she holds the breast, placing her thumb above and her
fingers below so as to keep it from the baby's face, for only in this
way can the infant breathe freely. One must also remember that the
infant draws the milk into the terminal ducts chiefly with the back
of its mouth, and drains the ducts by compressing the base of the
nipple with its jaws; the infant therefore should take into its mouth
not only the nipple, but also the areola, the area of deeply colored
skin round about it. Mothers frequently disregard these directions,
and the failure of their infants to nurse properly may be thus
explained, for it is impossible to secure undisturbed nursing unless
they are obeyed.
Generally the breasts are employed alternately, but both may be used
at each nursing if one is insufficient. To fix the duration of the
nursings arbitrarily is impossible; from ten to fifteen minutes
generally proves satisfactory, but in each case systematic
observations of the change in the baby's weight, of the character of
its stools, and of its general condition must determine how long to
leave it at the breast. The common error, unfortunately, is to be
over-indulgent, and, as a result, infants are more frequently ill
because the nursings are too long, than too short. Furthermore, the
duration of the feedings can never be gauged accurately if the infant
is allowed to nap while nursing.
The successful training of a baby begins with the development of
regular habits of nursing. The old-fashioned custom of allowing the
baby to nurse whenever it cried, tacitly--and incorrectly--assumed
that it could have no other sensation than hunger. As a matter of
fact an infant may have pain from overfeeding. Again, it may be
thirsty, or uncomfortable from the pricking of a pin, from the
monotony of one position, from a soiled napkin, or from neglect of
many simple details in its care. Any of these things make a baby cry,
for it has no other means by which it can express disapproval.
So long as the breasts contain colostrum the nursings should be at
least three hours apart during the day; at night it is preferable not
to disturb the mother at all. As soon as milk appears the interval is
usually shortened to two hours during the day. In many cases,
however, the three-hour interval will be retained even after the milk
appears, for otherwise the infant may not become hungry and will fail
to nurse as strongly as it should. The following schedule is adapted
to the average infant:
Age Interval During Total Number
the Day of Feedings
From 1st to 4th week 2 hours 9
" 4th " 8th " 2-1/2 " 8
" 2nd " 4th month 3 " 7
" 4th " 10th " 3 " 6
" 10th " 12th " 4 " 5
After the first few days most young infants require one feeding in
the middle of the night, which is usually given about 2 A.M. The day
feedings then begin at 6 A.M., and are repeated at regular intervals
until 9 or 10 P.M. The daily bath should be scheduled so that a
feeding will be due just after the bath has been completed. If asleep
when the next succeeding feeding falls due, the infant should not be
waked, but at other times nothing should interfere with the
regularity of the schedule. Occasionally there may be difficulty in
getting the child to nurse during the day, but it must be taught to
do so; otherwise it will want to nurse throughout the night.
At no time should an infant remain in the bed with its mother after
it has finished nursing; at night this rule must be rigidly enforced,
for mothers have been known to fall asleep and smother the baby, an
accident known as over-lying. Infants can frequently be trained to go
without feeding in the middle of the night even when a month old; and
such training is always advisable, since it affords the mother
opportunity for six or eight hours' continuous sleep.
Before and after each nursing the mothers' nipple should be cleansed
with a solution of boric acid made by placing a tablespoonful of the
powder in a tumbler which is then filled with water. Such cleansing
protects the breasts against infection, a complication which the
nursing mother must spare no pains to prevent. Now and then, in spite
of conscientious efforts to harden them, the nipples become sore. If
they crack, the baby's mouth must not come in direct contact with
them, since nursing with a cracked nipple is a common source of a
gathered breast. Fortunately when a nipple cracks we may employ a
shield, obtainable at any drug-store, which enables the infant to
nurse without any danger to the mother. Most babies will take the
shield as well as the breast itself; nevertheless, its use should be
discontinued as soon as the nipple heals, for while the shield is
used the secretion of milk is not stimulated as vigorously as when
the infant nurses directly from the breast. In the rare cases in
which the shield cannot be used satisfactorily the infant must be
taken from the breast temporarily and given a bottle. Radical as this
advice may appear, the mother must consent to follow it, for, as I
have pointed out, to permit an infant to nurse a cracked nipple is
extremely hazardous. When treatment is begun promptly the cracks will
generally heal within twenty-four hours.
HYGIENE OF THE MOTHER.--Since the mammary glands manufacture their
product from the constituents of the mother's blood and their
activity is controlled by her nerves, it is clear that her physical
condition and her state of mind will influence the secretion of milk.
Intelligent women who understand this desire to know how they should
live that they may best insure an ample supply of good milk.
Fortunately the first important step toward success has been taken
when a mother wishes to nurse her baby; but there are also necessary
wholesome food, habits conducive to health, and a mind free from
worry.
It is unfortunate that current beliefs throw many restrictions about
nursing-mothers which are unreasonable and unsupported by scientific
investigation. There was a time when mothers did not question their
ability to nurse, they assumed this duty as a matter of course.
Indeed, they were compelled to do so, since refined methods of
artificial feeding had not as yet been devised. Among the
agricultural class, even to-day, it is exceptional for mothers to
fail to nurse their children, if they are provided with the ordinary
comforts of life. But women who live at the higher tension of city
life are frequently unsuccessful, because they are more inclined to
be nervous or because they disregard, among other things, the need of
fresh air, plain food, or regular habits. It is wrong to suppose that
elaborate rules of conduct are necessary for nursing mothers; the
instruction they require is simple and scarcely different from that
to be given anyone who desires good health. If she lead a wholesome
existence a woman will not only nurse her child successfully but will
gain in strength.
_Diet_.--In manufacturing centers, where a large proportion of
the women are employed in confining work, the percentage of mothers
who are able to nurse their children is exceedingly small;
consequently the infant mortality is very high. Better nourishment
for the mother, it has seemed, would render her more capable of
successful lactation, and would decrease or even eliminate badly
executed artificial feeding, and would therefore reduce the death
rate among the babies. In a few foreign cities the idea has been put
into practice. Free restaurants have been established for working
mothers, and they have thus been enabled to perform their maternal
duties much more successfully. Incidentally it has been shown that
nourishment may be supplied mother and infant at a smaller cost than
proper artificial food for the infant alone.
The quantity of nourishment required by nursing mothers is not so
large as might be expected, and in many instances it is over-feeding
rather than under-feeding that must be guarded against. Very accurate
observations have been made which indicate that during the early
weeks of nursing no more food is needed than at other times; in all
probability this remains true throughout the whole period of
lactation. Over-eating, as many of us know, is a frequent cause of
indigestion. It is of the first importance, therefore, that nursing
mothers should not take more food than they can assimilate, for
indigestion will provoke disturbances in the milk which in turn will
make the baby uncomfortable. For a similar reason mothers should have
their meals at regular intervals.
As a rule the appetite is a reliable guide not only as to how much to
eat, but also as to the choice of food, for without exception what is
good for the mother is good also for the child. Generally the diet
should be a mixed one, consisting of milk, gruels, soups, vegetables,
bread, and meat. In order that monotony may not dull the appetite, no
one article of food should be employed continuously. With this
exception food should be selected with regard only for its
wholesomeness and digestibility. All food is milk-making food; no
sharp distinctions between the various kinds can be recognized. Milk,
because it contains all the elements necessary for perfect nutrition,
is particularly wholesome. Water also, since it forms such a large
proportion of their milk, should be taken freely by nursing mothers.
Generally it proves advantageous to take milk or some other
nutritious drink between meals and again before retiring at night,
but the danger of ruining in this way the appetite for solid food
must not be overlooked.
It ought to be unnecessary to say that a nursing mother should deny
herself any article of food, no matter how much she may want it, if
she knows it will disagree with her; but she must remember also that
the same article of food will not necessarily disagree with other
mothers. Generalizations of this kind are largely responsible for the
wrongful tendency to reject from the dietary many altogether harmless
articles. There would be little left for a nursing mother to eat if
she avoided every article of food which one person or another assures
her will damage her milk.
No belief regarding what a nursing mother should eat is held more
widely, I suppose, than that she should abstain from salads,
tomatoes, and fruits which contain acid. This view is erroneous. The
very idea upon which it is based is incorrect, since acids are
neutralized as soon as they pass from the stomach to the intestines
and cannot enter the milk. With certain persons some varieties of
fruit invariably cause indigestion. Lactation does not correct such
an individual peculiarity, and a nursing mother who knows she
possesses it will act accordingly. Occasionally those who have no
such idiosyncrasy worry after they have eaten something which
contains an acid because they have heard it will do harm. In such
cases it is the mental state of the woman which disturbs her milk and
upsets the baby. With the exception of those who have such an
idiosyncrasy and those inclined to worry, nursing mothers may partake
of fruits and salads with impunity.
There are vegetables, of which the onion and turnip are good
examples, that contain ingredients that find their way unaltered into
the milk. So long as these do not disturb the mother their presence
has no unfavorable influence upon the child. Similarly a number of
substances appear in the milk when administered as medicine to the
mother. In one way this is fortunate, for under certain circumstances
it provides a very satisfactory method of treating unhealthy children
without giving the medicine directly. In another respect, however, it
is a disadvantage, for it sometimes interferes with giving the mother
purgatives, which she may need. So far as possible, therefore, the
taking of medicine should be limited during lactation, and certainly
no drug should be employed without the advice of a physician.
Time and again some drug, some beverage, usually one that contains
alcohol, or some special article of food has been recommended as a
means of increasing an inadequate secretion of milk, but thus far all
attempts in this direction have failed of general application. There
are at present on the market widely advertised preparations for which
astounding efficiency is claimed. None of them, however, has a
definite or consistent value; and it is unfortunately true that no
substance has yet been discovered that has the specific action of
increasing the production of milk.
_Psychic Influence_.--Although the nerves of the breast which
regulate the secretion of milk do their work whether the mother wills
it or not, her state of mind has an influence over the process, just
as it has over digestion. No one doubts that our minds influence our
digestions as has been so clearly proved by the skillful experiments
of Pawlow, an eminent Russian physiologist. Cheerfulness promotes
perfect assimilation of the food, whereas mental depression decreases
the secretion of the digestive juices or checks them altogether. In a
similar way, perhaps, we shall some day have explained to us the
unquestioned fact that mothers who maintain a happy disposition nurse
their babies efficiently, while those who are inclined to worry often
experience real or imaginary troubles with lactation.
The most striking manifestations of such psychic influences are those
in which, as a result of some strong passion or deep sorrow, the
secretion of milk suddenly ceases altogether. Fortunately such
effects occur rarely and are never permanent. After a few hours at
most the secretion is reestablished; and if there are alterations in
the quality of the milk, these will correct themselves just as
quickly.
More common, and therefore much more important, are cases in which,
because the mother allows herself day after day to worry over one
thing or another, the secretion of milk suffers permanent disturbance
in quantity or in quality. Sometimes worrying lest the milk will be
unsatisfactory causes it to become so. Generally, however,
unnecessary anxiety for the baby is to blame. Again and again, when
there is really nothing out of the way, inexperienced mothers make
themselves miserable because they fear something may go wrong. Such a
state of mind always invites trouble; not infrequently it is the
direct cause of insufficient or unwholesome milk. The self-assurance
gained through taking care of the first baby is responsible more than
anything else for the greater success mothers have in nursing
subsequent children.
The mother who is nursing her first baby should take success for
granted, and never mistrust her ability to succeed. If the physician
has been asked to visit the baby regularly, as was suggested at the
beginning of this chapter, he will quickly detect the evidence of
failure should failure be imminent. His opinions should be accepted
and his directions followed, for by so doing the mother will most
readily acquire the assurance which is so necessary to success. The
habit, easily fallen into, of paying attention to promiscuous advice
is unwholesome, for such advice is injudiciously given and is usually
incorrect. More often than not the counsel of well-meaning friends
only serves to perplex and distress the mother.
_Recreation and Rest_.--Next to worry no influence upon
lactation is more detrimental than neglect of recreation and rest.
Both are very necessary to a nursing mother, for without them she
will soon begin to exaggerate minor troubles and even to worry though
nothing is wrong. A mother who has the care of a baby added to other
responsibilities may have extraordinary difficulty in finding time
for outdoor exercise, for congenial companionship, or for diversion
of any kind. Occasionally it may seem almost impossible even to get
time for sleep, a necessity so fundamental to health that, as we
should expect, a mother deprived of it would fail utterly in nursing
her infant. Difficult as it may seem, however, the mother must find
time for recreation, for if she does not there will follow
disturbances, generally in the quantity, or sometimes in the quality,
of her milk.
Keeping in mind that whatever benefits the mother will react
favorably upon the infant, one should regulate exercise during
lactation with regard to the kind and the amount of exercise to which
she has been previously accustomed. Walking usually fulfils all the
requirements satisfactorily, and there is ordinarily no reason why
nursing mothers should not participate in sports that are unattended
by violent exertion. Exhausting sports, however, must be shunned,
because fatigue has the same injurious effect upon the secretion of
milk as lack of exercise.
As might be expected, women who are frail are most susceptible to the
strain of nursing, especially if they fail to get sufficient rest.
All nursing mothers ought to have at least eight hours of sleep in
the twenty-four. The night-feeding, generally advisable for the first
six to eight weeks, does not break the mother's rest longer than half
an hour if the baby is well trained. But if a baby that has not been
properly trained turns night into day and keeps the mother awake for
long intervals, the milk will quickly deteriorate. Under such
circumstances someone must relieve the mother of the care of the
infant during the night; she should not be disturbed even to nurse
it. The night-feeding will then be supplied artificially; as will
also one feeding during the day in order that the mother may have
opportunity for exercise and diversion.
THE SUPPLEMENTARY BOTTLE.--At first glance it may seem that in the
suggestion that the infant be given one artificial feeding each day
the mother's comfort alone has been considered. As a matter of fact,
however, the adoption of the plan benefits mother and infant alike.
The diversion and recreation which the mother, thus relieved of her
maternal duties for from four to six hours, has time to secure
becomes a direct benefit to the infant. Not infrequently by pursuing
this plan, mothers who would otherwise be incapable of nursing are
assured successful lactation. The child, moreover, having thus become
accustomed to the bottle, is much more easily denied the breast when
the time for weaning comes.
Objections have been raised to giving the baby even one bottle when
the mother has an ample supply of milk, but none of them are valid.
Since cow's milk is acknowledged to be less easy of digestion than is
human milk, it will occur to someone that there is danger of
upsetting the baby by giving it a bottle. But this need not be
feared; extensive experience has shown that if an infant is getting
human milk of satisfactory quality at all its feedings during the
twenty-four hours, save one or two, at these times it will digest
properly modified cow's milk without the least inconvenience. Nor is
it true that if once a day cow's milk is substituted for that of the
mother, the infant will come to prefer the bottle to the breast.
There is no danger, on the other hand, that the mother's milk will
dry up. Very thorough investigation of these objections has failed to
substantiate them in the least.
Of course, it will be necessary in preparing the supplementary
feeding to take the same precautions as if the infant were on the
bottle exclusively. To avoid contamination of the milk care must be
exercised to have everything perfectly clean that comes in contact
with it. And it will be necessary also to vary from time to time both
the strength and the amount of the feeding. These alterations will be
made most successfully if left to the judgment of a physician who is
familiar with the development of the infant and who may be guided
accordingly.
WEANING.--Occasionally, even before they are delivered, women express
the conviction that they will be incapable of nursing. A few mothers
who take this attitude, which it would seem is becoming more and more
common, make no attempt at nursing, and others give it up after a
very short trial. Premature weaning is practiced among the women of
two widely different classes: those who are unwilling to deny
themselves social pleasures, and those who, because they must earn a
living, cannot be encumbered with maternal duties. A still larger
class, however, are those mothers who wean the baby for neither of
these reasons, but rather because they become discouraged and
conclude that there is something wrong with their milk. In this way
many infants are weaned without sufficient reason. Before giving up
nursing her child a mother should submit several samples of the milk
for analysis. If it is unfit for the infant, reliable evidence of the
fact will often be secured in this way.
With the exception of tuberculosis, physicians recognize no condition
that necessarily unfits a mother for nursing. As we have already
seen, pregnancy is generally incompatible with lactation; in the
event of conception the mother's milk almost always takes on
qualities which render it unsatisfactory for the infant, and yet
occasionally pregnancy advances several months before these changes
in the milk occur. Meanwhile the infant suffers no inconvenience, and
often in these cases the symptoms of threatened miscarriage give the
first intimation of the mother's condition. Under all circumstances,
however, nursing should cease as soon as the mother recognizes that
she is pregnant, for probably no woman is strong enough to provide
nourishment for her infant and for the development of the embryo
simultaneously.
Menstruation, on the other hand, rarely if ever provides a good and
sufficient reason for weaning. In the great majority of instances
this function is re-established before lactation ends. There may be a
reduction in the amount of milk during menstruation, but if the
infant has been given the breast as usual, the supply increases as
soon as the period ends. Qualitative disturbances which would render
the milk unfit for use are practically never a consequence of
menstruation.
It may happen as the infant grows older that the flow of milk will
diminish; then the breast feedings will of necessity be more
frequently replaced by the bottle, and the question of weaning will
settle itself. But if the time of weaning is a matter of choice, it
should be approximately coincident with certain notable developments
in the infant's digestive functions, which occur toward the end of
the first year. The fact that the infant is prepared to take other
food is outwardly shown by the appearance of teeth, of which there
are usually six or eight at the end of the year.
If the suggestion regarding the daily substitution of one bottle for
the mother's milk has been adopted, there will be no difficulty in
discontinuing breast-feeding whenever it is desirable; otherwise an
infant may raise strong objection to the change. The mother, on the
other hand, will not be seriously inconvenienced by the weaning,
provided she leaves her breasts alone.
Until recently mothers were advised to employ a very elaborate
treatment for drying up the breasts. The diet was restricted, and as
far as possible liquids of every kind were forbidden; strong
purgatives were administered daily; and, in addition, the breasts
were covered with some ointment, swathed in cotton, and tightly
compressed with a bandage. Fortunately, we now realize that none of
these measures are required. When nursing is discontinued the breasts
are apt to become distended and uncomfortable. They require support
while the distention lasts, which is never very long, and if they
become painful, medicine may be employed to give relief. But other
measures, some of which occasionally do harm, are absolutely
unnecessary, for, at whatever period of lactation the breasts cease
to be used, they dry up spontaneously.
GLOSSARY
[Footnote: The Century Dictionary has been freely used for these
definitions.]
ABNORMAL.--Irregular; deviating from the natural or standard type.
ABORTIFACIENT.--Whatever is used to produce an abortion.
ABORTION.--The expulsion of the embryo during the first four months
of pregnancy.
AFTER-BIRTH.--The mass of tissue expelled from the uterus at the end
of labor. It includes the placenta, the umbilical cord, and the
membranes of the ovum.
ALIMENTARY CANAL.--The digestive tract. It begins with the mouth,
includes the stomach and the intestines, and ends with the rectum.
AMNIOTIC FLUID.--The liquid inclosed within the amniotic membrane.
AMNIOTIC MEMBRANE.--The innermost of the two membranes which envelop
the embryo; the lining membrane of the closed sac familiarly called
"the bag of waters."
ANEMIA.--A deficiency of some of the constituents of the blood.
ANATOMY.--The science which deals with the structure of the body.
ANTISEPTIC.--Anything which destroys bacteria.
AREOLA.--The colored, circular area about the nipple.
ARTERY.--A vessel through which the blood flows away from the heart.
ASEPSIS.--The exclusion of disease-producing bacteria.
ASEPTIC.--Free from injurious bacteria.
ASPHYXIA.--The extreme condition caused by lack of oxygen in the
blood, brought about by interrupted breathing.
ASSIMILATION.--The process by which living creatures digest and
absorb nutriment so that it becomes part of the substance composing
them.
ATROPHY.--To waste away.
AUTO-INTOXICATION.--Poisoning by material formed within one's body.
BACTERIA (the plural of bacterium).--Exceedingly minute, spherical,
oblong, or cylindrical cells which are concerned in putrefactive
processes. Some varieties cause disease.
BACTERIAL DECOMPOSITION.--Putrefaction brought about by the action of
bacteria.
BIOLOGY.--The science which deals with the phenomena of life.
BIRTH-CANAL.--The passage through which the child enters the world.
It is composed of the uterus and the vagina, and is surrounded by the
pelvic bones.
BLADDER.--A thin, distensible sack acting as a reservoir for the
urine between the time it is secreted by the kidneys and leaves the
body.
BREECH.--The buttocks.
CESAREAN OPERATION.--The operation by which the child is taken out of
the uterus by an incision through the abdominal wall.
CALORIE.--The unit ordinarily employed by scientists to measure heat.
CAPILLARIES.--The minute blood vessels which form a network between
the terminations of the arteries and the beginnings of the veins.
CARBOHYDRATE.--Any one of a group of chemical substances of which
starch and sugar are the most familiar members.
CARBONIC ACID GAS.--An animal waste product eliminated in the breath.
In daylight plants absorb it energetically from the atmosphere
through their leaves, and decompose it, assimilating the carbon, and
returning the oxygen to the air.
CARTILAGE.--A firm, elastic tissue; gristle. From this material many
of the bones develop.
CATHETERIZE.--To empty the bladder by means of a tube-like instrument
which is introduced into the passage through which the urine normally
leaves the bladder.
CELL.--One of the microscopical structural units which make up our
bodies.
CELL-DIVISION.--The process by which a single cell becomes two cells.
CEREBRUM.--The portion of the brain which is the seat of mental
activity.
CHORIONIC MEMBRANE.--The outermost of the two membranes which
surround the embryo.
CHROMATIN.--A substance within the nucleus of a cell which has a
special affinity for certain staining agents.
CHROMOSOMES.--One of the pieces into which the chromatin is broken
during the act of cell-division.
CLINICAL.--Pertaining to the sick-bed.
COLOSTRUM.--The fluid secreted by the breasts during pregnancy and
for two or three days after the birth of the child.
CONTRACTION.--The act by which the muscle fibers of the uterus become
shorter and press upon its contents.
CURETTAGE.--Scraping out the lining of the uterus.
DELIVERY.--The birth of the child.
DIAGNOSIS.--The determination of either normal or abnormal states of
the body.
DIAPHRAGM.--The muscular partition between the chest and the abdomen.
DIETETIC.--Pertaining to the diet.
DUCT.--A tube which conveys the secretion from a gland.
EMBRYO.--The offspring before it has assumed the distinctive form and
structure of the parent.
ENEMA.--A quantity of fluid injected into the rectum.
ENGAGEMENT.--The entrance of the fetus into the birth-canal.
ETHNOLOGY.--The science which deals with the character, customs, and
institutions of races of men.
EUGENICS.--The science which deals with the improvement of the human
race by better breeding. (Davenport.)
EXCRETION.--Waste substance thrown off from the body.
FEBRILE.--Attended with fever.
FETUS.--The unborn child after the third month of development.
FOOD-STUFF.--Anything used for the sustenance of man.
FUNCTION.--The discharge of its duty by any organ of the body.
GASTRIC JUICE.--The digestive fluid secreted by the wall of the
stomach.
GERMINAL CELLS.--The structural units from which a new individual
takes origin. The cell contributed by the mother is called an egg-
cell or ovum; that contributed by the father, a spermatozoon.
GESTATION.--Same as pregnancy.
GLAND.--An organ which separates certain substances from the blood,
and pours out a material, usually fluid, peculiar to itself.
HYGIENE.--That department of medical knowledge which relates to the
preservation of health; sanitary science.
INANITION.--The condition which results from insufficient
nourishment.
INFECTION.--A disease due to bacteria.
INTESTINE.--The bowels; the long membranous tube extending from the
stomach to the rectum.
INVOLUTION.--The process by which the uterus returns after child-
birth to its former size and position.
LACTATION.--The secretion of milk.
LIGAMENT.--A band of tissue serving to bind one part of the body to
another.
LIGATURE.--Anything that serves for tying a blood-vessel.
LOCHIA.--The discharge continuing for several weeks after the birth
of a child.
LOTION.--Any liquid holding in solution medicinal substances intended
for application to the skin.
LUNAR MONTH.--A month of twenty-eight days.
MAMMAL.--The highest order of animal, namely, one which suckles its
young.
MAMMARY.--Relating to the breast.
MASTICATION.--The act of chewing.
MENOPAUSE.--The permanent abolishment of the menstrual process, which
generally occurs between the 45th and the 50th years.
MICRO-ORGANISMS.--Bacteria and other living agents of disease which
are visible only with the aid of the microscope.
MISCARRIAGE.--The termination of pregnancy prior to the seventh
month.
MUCOUS MEMBRANE.--The lining of certain cavities of the body, such as
the mouth, stomach, intestine, uterus, etc.
MUCUS.--The material manufactured by the glands in a mucous membrane.
MUSCLE-FIBERS.--The muscle-cells.
NARCOTICS.--Drugs which produce sleep.
NITROGEN.--One of the chemical elements.
NUCLEUS.--A clearly defined area found in every cell which seems to
be its seat of government.
OBSTETRICS.--The branch of medicine which deals with the treatment
and care of women during pregnancy and child-birth.
OVARY.--The organ which contains the egg-cells or ova.
OVIDUCTS.--Two tubes, each of which leads from the neighborhood of
one of the ovaries; both terminate in the uterus.
OVUM.--An egg: the cell contributed by the mother to her offspring.
OXYGEN.--One of the chemical elements.
PATHOLOGY.--The branch of medicine which deals with the altered
structure and activity of diseased organs.
PEPSIN.--A ferment found in the digestive juice secreted by the
stomach.
PELVIC FLOOR.--The muscles, ligaments, and other tissues which form
the bottom of the basin inclosed between the hips.
PELVIS.--The bony ring formed chiefly by the hip bones. Posteriorly
the ring is completed by the sacrum.
PERINEUM.--The region extending backward from the outlet of the
vagina to the rectum; it is the most essential part of the pelvic
floor.
PHYSIOLOGY.--Scientific knowledge of the manner in which the various
parts of the body perform their duties.
PIGMENT.--Any coloring matter.
PLACENTA.--The organ through which the communication between the
mother and the offspring is established. One of its surfaces is
attached to the wall of the uterus; at about the middle point of the
other surface the umbilical cord takes its origin.
PRENATAL.--Pertaining to the period before birth.
PROTEIN.--A food-stuff which is distinguished by the fact that it
contains nitrogen and is a tissue builder.
PROTOPLASM.--The living substance in the cells which compose our
bodies.
PUBERTY.--Sexual maturity in human beings.
PUBIC BONES.--The part of the pelvis which forms an arch in front of
the bladder.
PUERPERIUM.--The same as the lying-in period.
RETINA.--The innermost coat of the eye-ball and the one which
receives visual impressions.
RICKETS.--A disease of infancy characterized by softening of the
bones.
SECRETION.--The product of the activity of a gland.
SEDIMENT.--The material which settles to the bottom of any liquid.
SPERMATOZOON (plural spermatozoa).--The microscopic cell contributed
by the male parent, which stimulates the ovum to begin its
development.
SUPPOSITORY.--A medicinal substance made into the form of a cone to
be introduced into the rectum.
TERM.--The time of expected delivery.
THERAPEUTIC.--Concerned with the treatment of disease.
THYMUS GLAND.--A structure located behind the breast bone near the
root of the neck. Only traces of it are found in adult life.
TISSUE.--An aggregation of similar cells in a definite fabric, as
muscle, nerve, gland, etc.
TUBES.--The oviducts.
UMBILICAL CORD.--The structure carrying the blood vessels which pass
between the placenta and the child's navel.
UTERUS.--The womb: a hollow muscular organ designed to receive,
protect, nourish, and expel the product of conception.
VAGINA.--The canal through which the child passes from the uterus
into the world.
VEIN.--A vessel through which the blood flows back to the heart.
VERNIX.--The fatty substance deposited over the skin of the newly
born infant.
VIABLE.--Capable of living.
VILLI (singular villus).--The microscopic, finger-like processes
which hang from one of the surfaces of the placenta and are
surrounded by the mother's blood.
VISCERA.--The internal organs which occupy the cavities of the chest
and the abdomen.
VULVA.--The folds of tissue which surround the outlet of the vagina.
End of Project Gutenberg's The Prospective Mother, by J. Morris Slemons