In connection with the changes that take place in the uterus, the discharge called lochia should be mentioned. This is quite profuse and bloody at first but if the uterus involutes normally the discharge gradually decreases in amount and fades in color, until by the end of the puerperium it has entirely disappeared.
The Production of Milk. During the first two or three days after the baby is born, the breasts secrete a small amount of yellowish fluid called colostrum, which differs somewhat from the milk that comes later. About the third day the meager amount of colostrum is replaced by milk and as this increases rapidly in amount, the breasts usually become tense and swollen and sometimes painful; but this discomfort generally subsides in a day or two.
The production of milk is definitely stimulated by the baby’s suckling and will not continue for more than a few days without this stimulation, a fact to be remembered if, for any reason, it is desirable to dry up the breasts. The end earnestly to be desired is for the breasts to produce a quantity and quality of milk which will adequately nourish the baby during the first eight or ten months of his life, and with proper care and effort this ideal can nearly always be realized. But if the mother becomes pregnant while nursing her baby—and this sometimes occurs as early as a few weeks after childbirth—the quality of her milk is likely to suffer.
The return of menstruation, however, does not necessarily affect the milk unfavorably, as is so generally believed. It is true that in the ideal course of events, the mother does not menstruate while nursing her baby, that is, for eight or ten months, but it is probable that about one-third of all nursing mothers begin to menstruate about two months after confinement and half of those who do not nurse their babies begin to menstruate in six weeks. A nursing mother may menstruate once and then not again for several months or a year; or she may menstruate regularly and still nurse her baby satisfactorily.
Menstruation is more likely to return early after the birth of the first baby than after those born subsequently. Mothers sometimes wonder whether this early discharge is menstrual or lochial, and though they, themselves, cannot possibly distinguish between them, a physician can easily decide by examination, and in the interest of the mother’s future health it is important that this uncertainty be cleared up.
The loss of weight is one of the striking changes which take place during the puerperium, varying in different women from a total loss of from twelve to fifteen pounds. Fat women lose more than thin women and those who nurse their babies lose more than those who do not. This loss may be somewhat controlled, however, by suitable diet and under most conditions the mother returns to not less than her pre-pregnant weight by the end of the sixth or eighth week. You will recall that there was a general gain in weight, over the entire body, during pregnancy, in addition to the increased weight of the uterus.
If all goes well, your doctor may not call to see you regularly after the first couple of weeks, but he will probably want to make a thorough examination, sometime about five or six weeks after the baby’s birth. As this examination is a very influential factor in securing your future health you should be sure to have it made. A slight abnormality, if detected at this time, may usually be corrected with little difficulty, but if allowed to persist may result in chronic invalidism, or necessitate an operation. In case the uterus is not properly involuted, for example, or the perineum is found to be flabby, a little more rest in bed is indicated; while a uterine misplacement, which seems to occur in about a third of all cases, usually may be corrected by the adjustment of a pessary. Quite evidently, then, it rests with the young mother to coöperate with the doctor in guarding against future ill health, or even operations, by having this final examination made and following whatever course he prescribes, as a result of his inspection.
Most of the discussion in this chapter relates to the care that is given to you by others, in preparing you to take up life anew, perhaps unaided, and assume the care of your baby. As we shall see in the next chapter, the care of your baby, for the next few months, is closely associated with the care which you take of yourself and the regulation of your daily life.
CHAPTER IX
THE MOTHER’S CARE OF HERSELF—FOR THE BABY’S SAKE
Now that you actually have your baby in your arms, soft and warm and lovely, you find yourself looking into those wide, wondering eyes of his and wanting nothing so much as to give him your protection.