Obstetrical Nursing / A Text-Book on the Nursing Care of the Expectant Mother, the Woman in Labor, the Young Mother and Her Baby

by Carolyn Conant Van Blarcom

For the sake of giving her an opportunity to go out, mingle with her friends or enjoy some music or a play, it is often a very good plan to replace one breast feeding, some time in the course of each day, with a bottle feeding. The freedom which this long interval between two nursings gives the mother for diversion and amusement, will usually affect her general condition so favorably that the quality of her milk is better than it otherwise would be, and the baby is benefited as a result. This single supplementary feeding cannot be regarded lightly, however, for it must be prepared with the same cleanliness and accuracy as an artificial diet.

Weaning. One advantage in giving the baby a supplementary bottle, once a day, is that it paves the way for weaning, when the time comes to make this change. Under ordinary conditions, the mother begins to wean her baby about the eighth or tenth month. Having started by replacing one breast feeding, daily, with a bottle feeding, she should gradually increase the number of daily artificial feedings until all of the breast feedings are discontinued by the time the baby is eleven or twelve months old. There are exceptions to this general rule, of course, and under any conditions the weaning should always be directed by a doctor, for the baby will suffer unless it is skillfully done.

If the mother’s milk is satisfactory and the baby is doing well, it is often considered wiser not to discontinue the breast feeding entirely, during the hot summer months, even though the weaning falls due at this time.

It was formerly deemed advisable to wean the baby for any one of several reasons, but at present the only indications for this step which are generally accepted by the medical profession, are: pulmonary tuberculosis, acute infectious diseases in the mother, and pregnancy. Menstruation, which is normally suspended during lactation, was long regarded as incompatible with satisfactory nursing, but it is now known that if the mother is taking proper care of herself and is in generally good condition, the effect of menstruation upon the milk is usually for the duration of the periods only. It may be necessary to supplement the breast feeding with suitably modified cow’s milk during menstruation, but the baby should be put to the breast regularly, just the same, for if the stimulation of the baby’s suckling is discontinued, the temporary reduction in the amount of milk secreted will probably be permanent.

The state of pregnancy, however, is different, for though some women nurse the baby satisfactorily for some months after becoming pregnant, it is not considered advisable to subject a woman to the combined strain of pregnancy and nursing. Moreover, the mother’s milk is usually impoverished during pregnancy and the nursing baby suffers in consequence.

Drying up the Breasts used to be a great bugbear. Lotions, ointments and binders were employed and often a breast pump as well. Various drugs were given by mouth and the patient was more or less rigidly dieted. It is true that some of these measures are still employed and are followed by a disappearance of the milk. But at the same time, the breasts dry up quite as satisfactorily when none of these things is done, provided the baby does not nurse. It is not known what starts the secretion of milk in the mother’s breasts but certain it is that absence of the baby’s suckling prevents it.

If the drying up of the breasts is left to the nurse, as it so frequently is, her wisest course will be to do nothing beyond applying a supporting bandage if the breasts are heavy enough to be uncomfortable. She may rely absolutely upon the fact that the baby’s suckling is the most important stimulation in promoting the activity of the breasts and if this stimulation is not given, or is removed, the secretion of milk will invariably subside in the course of a few days. It is true, that the breasts may be engorged and very uncomfortable for a day or two, and in addition to a supporting bandage the doctor may order sedatives, but the discomfort subsides as the secretion disappears. This is true whether the reason for drying up the breasts is that the baby is still born or has died, or a live baby’s nursing is discontinued.

Naturally, the nurse will not press her patient to drink an extra amount of milk if it is not desirable to promote the activity of the breasts, but, unless otherwise ordered, there is no necessity for placing any other restrictions upon her patient’s diet.

In thinking over the period of lactation, as a whole, it is apparent that the most valuable service which the nurse can offer to the nursing mother, is assistance in planning and living a simple, normal, tranquil life; helping her to eat, sleep, bathe, and exercise and to nurse her baby with unfailing regularity—all for the sake of providing her baby with adequate nourishment. This must be the chief end and aim of her existence.

Normal breast-milk is the ideal baby food and there is no entirely satisfactory substitute. It greatly increases the baby’s chances of living through the first year, and protects him from many diseases.