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

The character, amount and intervals of the baby’s feeding are definitely ordered by the doctor, but the many factors which influence the baby’s nutrition are so largely a matter of nursing that the nurse has grave responsibilities in connection with his nourishment.

After other conditions have been made favorable, the factors which determine the character of the baby’s food are the kind and amount of food materials which are needed by his growing body and the powers of his digestive organs. If he is given less food than he needs at each stage of his progress he will not be properly nourished; but if he is given food materials in quantities, proportions or character which are beyond the power of his immature alimentary tract to digest, he not only will not be properly nourished but probably will be made ill.

There are three methods of nourishing the baby: breast feeding, artificial feeding and a combination of the two, termed mixed or supplementary feeding.

Breast Feeding. From all standpoints, maternal nursing under normal conditions is the most satisfactory method of infant feeding. If the breast milk is suitable it meets all of the baby’s requirements and the proportion and character of its constituents are exactly suited to his digestive powers.

Fig. 167.—Proper method of carrying baby to support head and back. (From photograph taken at Johns Hopkins Hospital.)

In order that the nursing be entirely satisfactory, the condition of both mother and baby must be favorable to its success. The preparation and care of the mother have been described: her general condition and state of nutrition; the care and condition of her nipples, flat or retracted nipples being brought out if possible, and if not, the nursing facilitated by the use of a shield. If the baby’s diaper is wet or soiled, it should be changed before he is put to the breast, partly to make him comfortable and partly to avoid disturbing him after his feeding. His mouth is gently swabbed with boric soaked cotton, if this is ordered, he is wrapped in a little blanket and carried to his mother dry and warm and comfortable. (Fig. [167].) Although nursing is an instinct, the baby sometimes has to learn or to acquire the habit which is one reason for putting him to the breast during those first two or three days when he obtains little or no actual food. (See Chapter XVI.) As he expresses the milk by a squeezing and suction made possible only when the nipple is well back in his mouth, he must take into his mouth practically the entire pigmented area which surrounds the nipple. To do this he lies in the curve of his mother’s arm as she turns slightly to one side, and holds her breast away from his nostrils in order that he may breathe freely.

Sometimes even when other conditions are favorable, the baby is unable to nurse because of some physical disability. He may be too feeble; have a cleft palate or find suckling painful because of an abrasion of the mucous membrane which occurred when his mouth was bathed just after birth. The manner in which the baby nurses, therefore, may be significant and should be carefully noted and described to the doctor.

There is a difference of opinion among doctors concerning the interval between feedings which is most satisfactory. Some have the baby nurse every four hours and others every three hours during the early months of life. It is believed by some doctors that although a baby who is fed on a four-hour schedule may regain his birth weight more slowly than the baby who is fed every three hours, he suffers less from digestive disturbances and ultimately makes an entirely satisfactory gain in weight. Another point in favor of the four-hour interval is the longer period of freedom which this gives to the mother and this may influence her willingness to nurse her baby. But other doctors, both pediatricians and obstetricians, feel that the four-hour interval is too long for most babies.

Whether the baby shall nurse from one or both breasts at each feeding is another moot question. Some doctors believe that the results are better if both breasts are partially emptied at each nursing, while others feel that the function of the breasts is more satisfactorily promoted by completely emptying one breast at a time, at alternate nursings. Although the baby should pause every four or five minutes to prevent his nursing too rapidly, which is a common cause of colic, neither he nor his mother should be allowed to sleep during the nursing periods. When he has finished, he should be taken up very gently and placed in his crib and left to sleep. If he is nursing satisfactorily, he will be sleepy and contented after nursing and will sleep for two or three hours afterwards; he will seem generally good humored and comfortable while awake; he will have good color; gain weight steadily and have two or three normal bowel movements daily. The normal stool in breast fed babies is bright yellow, smooth and with no evidences of undigested food.