The Prospective Mother, a Handbook for Women During Pregnancy

by J. Morris Slemons

Keeping in mind that whatever benefits the mother will react favorably upon the infant, one should regulate exercise during lactation with regard to the kind and the amount of exercise to which she has been previously accustomed. Walking usually fulfils all the requirements satisfactorily, and there is ordinarily no reason why nursing mothers should not participate in sports that are unattended by violent exertion. Exhausting sports, however, must be shunned, because fatigue has the same injurious effect upon the secretion of milk as lack of exercise.

As might be expected, women who are frail are most susceptible to the strain of nursing, especially if they fail to get sufficient rest. All nursing mothers ought to have at least eight hours of sleep in the twenty-four. The night-feeding, generally advisable for the first six to eight weeks, does not break the mother's rest longer than half an hour if the baby is well trained. But if a baby that has not been properly trained turns night into day and keeps the mother awake for long intervals, the milk will quickly deteriorate. Under such circumstances someone must relieve the mother of the care of the infant during the night; she should not be disturbed even to nurse it. The night-feeding will then be supplied artificially; as will also one feeding during the day in order that the mother may have opportunity for exercise and diversion.

THE SUPPLEMENTARY BOTTLE.—At first glance it may seem that in the suggestion that the infant be given one artificial feeding each day the mother's comfort alone has been considered. As a matter of fact, however, the adoption of the plan benefits mother and infant alike. The diversion and recreation which the mother, thus relieved of her maternal duties for from four to six hours, has time to secure becomes a direct benefit to the infant. Not infrequently by pursuing this plan, mothers who would otherwise be incapable of nursing are assured successful lactation. The child, moreover, having thus become accustomed to the bottle, is much more easily denied the breast when the time for weaning comes.

Objections have been raised to giving the baby even one bottle when the mother has an ample supply of milk, but none of them are valid. Since cow's milk is acknowledged to be less easy of digestion than is human milk, it will occur to someone that there is danger of upsetting the baby by giving it a bottle. But this need not be feared; extensive experience has shown that if an infant is getting human milk of satisfactory quality at all its feedings during the twenty-four hours, save one or two, at these times it will digest properly modified cow's milk without the least inconvenience. Nor is it true that if once a day cow's milk is substituted for that of the mother, the infant will come to prefer the bottle to the breast. There is no danger, on the other hand, that the mother's milk will dry up. Very thorough investigation of these objections has failed to substantiate them in the least.

Of course, it will be necessary in preparing the supplementary feeding to take the same precautions as if the infant were on the bottle exclusively. To avoid contamination of the milk care must be exercised to have everything perfectly clean that comes in contact with it. And it will be necessary also to vary from time to time both the strength and the amount of the feeding. These alterations will be made most successfully if left to the judgment of a physician who is familiar with the development of the infant and who may be guided accordingly.

WEANING.—Occasionally, even before they are delivered, women express the conviction that they will be incapable of nursing. A few mothers who take this attitude, which it would seem is becoming more and more common, make no attempt at nursing, and others give it up after a very short trial. Premature weaning is practiced among the women of two widely different classes: those who are unwilling to deny themselves social pleasures, and those who, because they must earn a living, cannot be encumbered with maternal duties. A still larger class, however, are those mothers who wean the baby for neither of these reasons, but rather because they become discouraged and conclude that there is something wrong with their milk. In this way many infants are weaned without sufficient reason. Before giving up nursing her child a mother should submit several samples of the milk for analysis. If it is unfit for the infant, reliable evidence of the fact will often be secured in this way.

With the exception of tuberculosis, physicians recognize no condition that necessarily unfits a mother for nursing. As we have already seen, pregnancy is generally incompatible with lactation; in the event of conception the mother's milk almost always takes on qualities which render it unsatisfactory for the infant, and yet occasionally pregnancy advances several months before these changes in the milk occur. Meanwhile the infant suffers no inconvenience, and often in these cases the symptoms of threatened miscarriage give the first intimation of the mother's condition. Under all circumstances, however, nursing should cease as soon as the mother recognizes that she is pregnant, for probably no woman is strong enough to provide nourishment for her infant and for the development of the embryo simultaneously.

Menstruation, on the other hand, rarely if ever provides a good and sufficient reason for weaning. In the great majority of instances this function is re-established before lactation ends. There may be a reduction in the amount of milk during menstruation, but if the infant has been given the breast as usual, the supply increases as soon as the period ends. Qualitative disturbances which would render the milk unfit for use are practically never a consequence of menstruation.

It may happen as the infant grows older that the flow of milk will diminish; then the breast feedings will of necessity be more frequently replaced by the bottle, and the question of weaning will settle itself. But if the time of weaning is a matter of choice, it should be approximately coincident with certain notable developments in the infant's digestive functions, which occur toward the end of the first year. The fact that the infant is prepared to take other food is outwardly shown by the appearance of teeth, of which there are usually six or eight at the end of the year.

If the suggestion regarding the daily substitution of one bottle for the mother's milk has been adopted, there will be no difficulty in discontinuing breast-feeding whenever it is desirable; otherwise an infant may raise strong objection to the change. The mother, on the other hand, will not be seriously inconvenienced by the weaning, provided she leaves her breasts alone.