Fig. 123.—Ice caps held in place on painful breasts by straight binder with darts pinned in under breasts and supported by shoulder straps of muslin bandage.
Certain it is that breast abscesses are almost never seen where the nurses have this sense of responsibility, and habitually watch the breasts closely and promptly use support and either heat or cold when the breasts become heavy and sensitive.
There are innumerable bandages and methods for supporting heavy breasts, any one of which is efficacious so long as it meets the two chief requirements: to lift the breasts, suspending their weight from the shoulders, and, while fitting snugly below to avoid making pressure at any point, particularly over the nipples. One of the most satisfactory and widely used supports is the Y-bandage, (Figs. [124], [125], [126]), another, the Indian binder (Fig. [127].)
Fig. 124.—Modified Richardson “Y” binder made of two strips of soft muslin, full width of material and 44 inches long, folded into strips of same width as distance from margin of patient’s breast to outer part of areola. One strip is folded in the middle at right angles and pinned to one end of the other strip as indicated. (Figs. [124], [125], [126], with captions, are from The Maternity Hospital, Cleveland, by courtesy of Miss Calvin MacDonald.)
The nurse must on no account massage or pump engorged breasts on her own responsibility, for there is a good deal of evidence to show that any such manipulation tends to increase the amount of the secretion and this in turn increases the engorgement and pain. It is possible, too, that massage may bruise the breasts and thus make them more susceptible to infection.
Mastitis. When infection occurs, the swollen, painful breasts may grow hot and red, the patient may complain of chilliness and have a slight fever, with or without there being an abscess. Even then the general treatment is most frequently found to consist of support; ice or heat; catharsis and restricted fluids, though in some cases the breasts are pumped and nursing is discontinued.
Fig. 125.—Bandage in Fig. [124] applied. The long arm of binder is placed under patient’s shoulders, one end of the Y being brought around the top of the breasts and the other around the lower part, toward the nurse, crossed at right angles under the arm and pinned to long arm of bandage as indicated in Fig. [126]. The nipples are covered with sterile gauze and the upper and lower parts of the Y fastened with a safety pin between the breasts. The remaining length of the long arm is brought across the breasts and fastened with a safety-pin to the opposite side. When the baby nurses this pin is removed as well as the one between the breasts. The entire binder should be snug and held in place by means of shoulder straps, pinned front and back.