Fig. 120.—Protecting cracked nipples by having the baby nurse through a shield. (From photograph taken at Johns Hopkins Hospital.)
It is sometimes the practice to swab the baby’s mouth with boric soaked cotton or gauze before each nursing, but many doctors hold that this is injurious to the delicate mucous lining of the baby’s mouth. The opinions for and against this routine seem to be about equally prevalent.
Fig. 121.—Nipple shield used in Fig. 120.
If the nipples become painful or cracked, one can easily understand that continued suckling would only aggravate the condition and increase the danger of infection. But the baby must nurse, if possible, and so in the majority of cases a nipple shield is used (Figs. [120]–[121]) as a protection, and after nursing the fissures or abraded areas are painted with bismuth and castor oil paste; compound tincture of benzoin; balsam of Peru; argyrol, silver nitrate or sometimes only alcohol. The application is made with sterile swabs prepared by twisting a wisp of cotton about the end of a toothpick. If the crack or abrasion is extensive enough to cause bleeding, even nursing through a shield is sometimes, but not necessarily discontinued, while the other treatment is the same as for a nipple that does not bleed.
Sound, uninjured nipples, then, are to be kept clean and protected from infection and those which are abraded or cracked are to be kept clean and also protected against further injury.
Lactation. About the third or fourth day after delivery, when milk replaces colostrum, the breasts become swollen, engorged and often very painful, and not infrequently, a hard, sensitive lump or “cake” may be felt. The growing tendency, now, is merely to support these heavy breasts by means of a binder which has straps passing over the shoulders, in order to hold them up without making pressure (Fig. [122]) and to apply ice caps or hot compresses to the painful areas. It used to be customary to massage and pump caked breasts, to apply pressure and various kinds of lotions or ointments. Though one, or all of these measures are still employed, in some cases, the general practice is to avoid manipulating the breasts but to empty them regularly by the baby’s nursing; support them and allow Nature to make an adjustment between the amount secreted and the amount withdrawn.
Fig. 122.—A simple method of supporting heavy breasts by means of three folded towels; one fastened about the waist, one over each shoulder, crossing front and back.
Free purging is sometimes employed and the amount of fluids reduced until the engorgement and discomfort subside. This happy issue is practically always reached if the baby nurses regularly and satisfactorily, as there is a spontaneous adjustment between the amount secreted by the mother and that withdrawn by the baby. But as abscesses may follow in the wake of caked breasts, particularly if the nipples are sore, it is of great importance that the nurse watch closely for the first evidence of painful lumps. The prompt application of a supporting bandage and ice bags (Fig. [123]) or hot compresses will, in the majority of cases, give speedy and complete relief. So widely is this believed that many doctors regard the care of the breasts, including the prevention of breast abscesses, as a nursing question, entirely, and conversely are likely to regard the occurrence of a breast abscess as an evidence of careless nursing.