Fig. 119.—Sterile gauze held in place over nipples by means of adhesive strips and tapes. (From photograph taken at Bellevue Hospital.)
The Care of the Breasts. There is a wide difference of opinion about the proper care of the breasts, also, but here again, although the details vary, the ultimate objects of the care are always the same, namely: to facilitate the baby’s nursing, promote the mother’s comfort and prevent breast abscesses. These ends are usually accomplished by keeping the nipples clean and intact and by giving support and rest to heavy, painful breasts.
The patient who has cared for her nipples during the latter part of pregnancy will usually have little or no trouble with them during the period of lactation, if the care is continued. But this attention is imperative.
It is very generally customary to have the nipples bathed before and after each nursing with a saturated solution of boracic acid, in either water or alcohol, using sterile pledgets and forceps, and to keep them clean between nursings by applying sterile gauze. This gauze may be held in place by means of a breast binder or by tapes tied through the ends of narrow strips of adhesive plaster, four being applied to each breast. (Fig. [119].) Strips of adhesive plaster about five inches long are folded over at one end, two adhesive surfaces being in contact for about an inch. Through a hole in the folded end a narrow tape or bobbin is tied and the strips applied to the breast, beginning at the margin of the areola and extending outward. The free ends of the tapes are tied over squares of sterile gauze, between nursings, and untied to expose the nipple at nursing time.
Lead shields are sometimes used to protect the healthy nipple and not infrequently are applied to cracked nipples, being held in place by means of a breast binder. The secretion of milk which escapes into the shield is acted upon by the metal and the result is a lead wash which continuously bathes the nipple. The shields should be scrubbed with sapolio and boiled once daily.
Another method, and one widely employed, is to anoint the nipple after nursing with sterile albolene or a paste of sterile bismuth and castor oil, and apply squares of sterile paraffin paper. These bits of paper are pressed into place and held for a moment by the nurse’s hand, the warmth of which softens and moulds them to the breast after which they remain in place. In some instances the bismuth and castor oil paste is wiped off, with a sterile pledget, before nursing and in others it is not.
In some hospitals, neither gauze nor paper is used, the nipples being protected by putting sterile night-gowns on the patients.
The purpose of all of these methods is to keep the nipples clean, and here again the patient must be cautioned against infecting herself. No amount of care on the nurse’s part will protect the patient if she touches her nipples with her fingers.
The nurse will appreciate the reason for all of this painstaking care if she calls to mind the fact that the breast tissues are highly vascular and excessively active at this time and therefore very susceptible to infection, and also that the baby’s suckling is often very vigorous and accompanied by a good deal of chewing and gnawing of the nipples. Unless the nipples have been toughened, and sometimes even when they have, the skin becomes abraded or cracked as a result of the baby’s suckling, thus creating a portal of entry for infecting organisms, in addition to the milk ducts which lead back into the breast tissues. Unless the nipples are kept clean, constantly, they may become infected by organisms from the baby’s mouth or on the patient’s hands, bedding or gown with a breast abscess as a result. The important thing, then, is to keep the nipples clean and not allow anything unsterile, excepting the baby’s mouth, to come in contact with them at any time.
