The Prospective Mother, a Handbook for Women During Pregnancy

by J. Morris Slemons

Formerly it was customary, whenever the breasts became tense and uncomfortable, to express an excess of milk by means of massage; but this mode of treatment lost favor as soon as physicians realized that massage stimulated the glands to greater activity. Drawing the milk with a breast-pump has a somewhat similar though less potent influence, and, because pumping often affords relief when the breasts are distended, there is rarely any objection to it. In the light of modern experience, however, most physicians prefer to avoid manipulation of the breast so far as possible, and generally resort to other measures to relieve the mother's discomfort. Thus most patients are made comfortable if an appropriate bandage is used to transfer the weight of the breasts from the arm-pits and the front of the chest to the bones of the shoulder-girdle. It may be necessary also in some cases to swathe the breasts in warm cloths; in others cold applications are more acceptable; the choice between these methods will vary with the time of year, and usually may be left to the patient herself. Now and then medicine will be employed to relieve the pain, but the administration of drugs to diminish the production of milk is inadvisable. It is never very long before the amount of milk becomes adjusted to the infant's wants, and then distention disappears spontaneously. No artifice can bring about the adjustment as ideally as nature does.

During the later months of lactation the liability of the breasts to over-filling is slight, provided the infant empties them regularly and completely. Nevertheless, so long as a mother is nursing her child she must be careful to keep the breasts in a healthful condition. They require support, yet must not be compressed. And they should be covered with clothing which will adequately protect them from sudden changes of temperature. This latter precaution, perhaps, requires more emphasis than formerly, on account of the present popularity of motoring; for the chill which one experiences when driving fast may have a very unpleasant effect upon a nursing mother unless her breasts are carefully protected. Occasionally fever and neuralgic pains in the breasts are caused by motoring, or by exposure to the air-current from an electric fan playing directly upon them. But even under these circumstances an abscess need not be feared unless the nipples are sore.

Human Milk.—Between the time of birth and the beginning of lactation there is always an interval during which the breasts secrete colostrum, just as they do throughout pregnancy. Although the nutritional value of this fluid is not great, it is doubtful if colostrum serves any other essential purpose than as nourishment. Possibly it also stimulates the intestines to expel the material which has collected within, them during fetal development, yet we know the bowels will move without a purgative; and often do so long before the infant is placed at the breast. Typically, the secretion of milk begins the third day after delivery; yet in perfectly normal patients it may appear as early as the second or as late as the fifth, and occasionally lactation does not begin until the baby is more than a week old.

As to what starts the secretion of milk we have only a vague idea; but we know that when the flow is once established its continuation depends primarily upon the sucking efforts of the infant. If nursing is discontinued the secretion dwindles and the breasts dry up. On the other hand, the strong, persistent stimulus of the infant's suckling gradually brings the secretion to a high degree of efficiency. Within the first two weeks, therefore, the daily secretion increases from a few ounces to a pint or more. Subsequently the output fluctuates between one and two quarts daily, according to the demands made upon the breasts; the secretion is larger, consequently, if there are twins. Astounding yields of milk have been recorded, as in the case of a wet-nurse in a German institution who nursed a number of infants and became capable of supplying three to four quarts daily.

That newborn infants thrive better on human milk than on any other nourishment is a conviction that must come home to every one who has had even a limited experience. It keeps the babies in health, serves to make them grow, and promotes the development of all their organs as nothing else will. Because there are present in this fluid all the elements necessary for nutrition, physiologists have called it a perfect food. Quantitatively its most important ingredient is water, which constitutes about 86 per cent. of its weight. It also contains about 7 per cent. of milk-sugar, 4 per cent. of butter fat, 2 per cent. of protein, and 0.2 per cent. of mineral matter.

The milk of all animals contains a relatively small quantity of mineral matter; judged from this standpoint, the mineral matter would seem of minor importance, but it is actually as vital as any other constituent. Without it the bones would hot harden properly; and other services which it performs are absolutely essential to life. As we should expect, human milk contains all the mineral ingredients necessary for the development of the infant; indeed, with the single exception of iron, they are present in the precise amounts in which they are needed. In this omission, however, nature is guilty of no oversight, since the infant has already been provided by the time of birth with a rich supply of iron.

THE TECHNIQUE OF NURSING.—Since the mother should have opportunity to recuperate from the fatigue of labor, physicians generally recommend that an interval of at least twelve hours elapse between the birth of the infant and the time it is first put to the breast. Moreover, the best interests of the infant demand that it be kept warm and left undisturbed while becoming accustomed to its new environment. There is no immediate need of food; and if there were, nature does not fit the mother to supply it, for at this time the breasts contain merely small quantities of colostrum.

Some babies nurse vigorously at the outset, but later, discouraged because they get so little, become indifferent and restless, or even decline to take the breast. And the mother, who is handicapped by inexperience and by the awkwardness of nursing in a recumbent position, often feels desperate. Fortunately technical difficulties are confined to the first few days, and, trying as they sometimes are, no one should be discouraged or imagine that she is incapable of nursing; for practically every woman who persists will succeed.

For a week or ten days the mother will nurse in the recumbent posture. She turns to one side or the other, according as the right or left breast is used, and holds the corresponding arm to receive and support the baby, which will lie beside her. Then with the opposite hand she holds the breast, placing her thumb above and her fingers below so as to keep it from the baby's face, for only in this way can the infant breathe freely. One must also remember that the infant draws the milk into the terminal ducts chiefly with the back of its mouth, and drains the ducts by compressing the base of the nipple with its jaws; the infant therefore should take into its mouth not only the nipple, but also the areola, the area of deeply colored skin round about it. Mothers frequently disregard these directions, and the failure of their infants to nurse properly may be thus explained, for it is impossible to secure undisturbed nursing unless they are obeyed.

Generally the breasts are employed alternately, but both may be used at each nursing if one is insufficient. To fix the duration of the nursings arbitrarily is impossible; from ten to fifteen minutes generally proves satisfactory, but in each case systematic observations of the change in the baby's weight, of the character of its stools, and of its general condition must determine how long to leave it at the breast. The common error, unfortunately, is to be over-indulgent, and, as a result, infants are more frequently ill because the nursings are too long, than too short. Furthermore, the duration of the feedings can never be gauged accurately if the infant is allowed to nap while nursing.