CHAPTER XII
THE NURSING MOTHER
The Breasts—Human Milk—The Technique of Nursing—Hygiene of the
Mother: Diet; Psychic Influence; Recreation and Rest—The
Supplementary Bottle—Weaning.
When the obstetrician pays his final visit the mother usually has ready a number of questions, most of which anticipate difficulties in the care of the baby. At that time, however, minute and far-reaching directions cannot always be given. Unforeseen peculiarities in the development of the child may modify such general principles for the management of infants as could be laid down in advance. With a few exceptions, therefore, mothers require during the early years of a baby's life skilled advice as to his upbringing—advice for which neither instinct nor haphazard counsel is a safe substitute. It is an excellent plan, and one which is becoming more and more popular, to have a physician supervise the care of the baby through the period of most active growth. According to this plan, the mother, even though her baby is well and developing as it should, consults the physician at regular intervals, once a month for example, and upon these occasions secures help in solving problems which are certain to present themselves. Such an arrangement shows a merited appreciation of the proverbial "ounce of prevention," and when serious difficulties do arise materially counteracts the tendency to panic which is exhibited by so many young mothers.
Among the problems which the mother must solve, that of nutrition outranks all others in importance; and unless the infant is nourished with human milk, it also exceeds them in perplexity. For, although great advances have been made in artificial feeding, science has not yet removed all the intricacies and dangers involved in the use of the bottle. On the other hand, mothers who nurse their babies rarely meet with difficulty. Human milk is perfectly adapted to the wants of the infant; and all substitutes, though carefully designed to duplicate it, are only partially successful. We have learned how to modify cow's milk so that in chemical constituents, at least, it is a very close imitation of human milk; but human milk possesses, in addition to its chemical properties, other desirable qualities which cannot be instilled into an artificial food. We must agree, therefore, that attempts to disseminate a wider knowledge of the correct principles of bottle-feeding do not have the highest aim. Our real need is a vastly greater proportion of women who nurse their children.
THE BREASTS.—For success in nursing the first essential is healthful breasts. With this the largeness or smallness of a breast has nothing to do, for size is no more an index of its capacity for producing milk than is the weight of a woman an index of her energy. The breast is not a warehouse, but a factory, with very limited storage capacity for its product. Differences of size are generally to be explained by the variable amount of fatty-tissue the breast contains. And so far as the secretion of milk is concerned the fat is entirely passive; it fills in the space between the glandular elements; and a layer of fat just beneath the skin protects the glands against external influences that otherwise might disturb their activity. Stripped of their fatty envelope the structures which actually secrete the milk and convey it to the nipple resemble a miniature cluster of grapes. Each tiny, spherical gland corresponds to one of the grapes and contains a cavity lined with cells which manufacture the milk. From this cavity the milk flows through a microscopic tube which unites with similar tubes to form a larger one; this in turn joins others of its kind; and so on, until ultimately the milk enters a relatively large duct— the figurative stem of the cluster—which conducts the milk to its destination. There are from ten to fifteen of these terminal ducts; each drains a separate group of glands, but all end in the nipple.
Shortly after conception the breasts become congested; in consequence they enlarge, become tender, and begin to show swollen veins beneath the skin. The most significant alteration, however, occurs in the cells which line the glands; these increase in size at first; and then, by a process of cell division, their number multiplies. After pregnancy has advanced six to eight weeks these cells begin to elaborate the thin, watery fluid called colostrum. Contrary to popular belief, the quantity of colostrum is not prophetic of the character of the milk; there is no ill-omen, to be sure, in a plentiful secretion, but a meager one is quite as likely to be followed by successful lactation. At present we are unable to predict by any means either the quantity or the quality of the milk which a prospective mother will produce.
Some writers contend that influences which come into play during girlhood ultimately affect the capacity of the breast for making milk; for example, irregular habits in youth and the wearing of improper styles of clothing are said to be particularly detrimental influences. Of course, a healthful mode of life at the time when a girl is approaching maturity reacts favorably upon her development in every way, and naturally enough the breasts share this benefit; but the relation between unhygienic habits at about the time of puberty and a subsequent deficiency in lactation has been exaggerated by many writers. It is impracticable, certainly, to institute special measures to prepare the breasts for their function until the need of such measures is clearly evident. Throughout pregnancy clothing about the breasts should be loosely worn. If the nipples are not already prominent they should be drawn out; and about six or eight weeks before confinement is expected they should be given the treatment described in Chapter V.
For the first day or so after the infant begins to nurse its efforts have a tendency to injure the skin which covers the nipple; and unless measures to render the nipple resistant have been previously adopted, nursing may cause the mother considerable discomfort. Moreover, it is extremely important throughout lactation to keep the skin covering the nipple free from abrasions, for if it cracks bacteria have thus an opportunity to enter the glands and set up an acute inflammation which may result in the formation of an abscess. This complication is to be avoided, not only because of the unpleasant symptoms which attend it, but also because for the time it brings the usefulness of the breast to an end. Fortunately an abscess seldom impairs the breast permanently.
At any period of lactation there may be an overproduction of milk. In this event the breasts are likely to become distended, hard, and very tender. Most frequently "caked breasts," as this condition is called, develop a few days after delivery, when the secretion of milk is just beginning, for at first the secretion is more plentiful than need be. Generally twenty-four hours later there is an adjustment between the supply of nourishment and the natural demands of the infant. Occasionally a longer interval elapses before the breast is completely emptied at each nursing.