Simplicity, warmth, and freedom are the essentials in latter-day baby clothes. It is cheaper to make the clothes than to buy them. Excellent and accurate paper patterns can be obtained, giving the quantity of material necessary and suggesting the kind and quality best suited for the purpose. These patterns may be obtained from the Butterick Publishing Company in New York City.
Care of the Newly-Born Baby.—After the nurse has completed her duties with the mother after the confinement, she will prepare to give baby its first bath.
The bath should be given in a warm room. This is a matter that should receive more consideration than has been given it. Nurses do not as a rule attach much importance to this duty, while in reality it is a most important one. I have seen trained nurses make ready to give baby its first bath in rooms, during the night, that were not heated adequately. I am convinced that many babies have been victims of this careless habit to the extent of grafting on them the tendency to catarrhal colds and bronchitis because of undue exposure at this critical period. If one will remember that a baby has just been removed from an environment where the temperature was suitable and constant, to one in which it needs a large degree of artificial heat until such time as it may become accustomed to the change, one may appreciate the risk taken in exposing the child for even a short time. The mother should therefore warn the nurse not to undertake the baby's first bath until the temperature and other conditions are favorable. Many nurses and other individuals have the impression, without knowing why, that the baby should be cleansed and bathed immediately after birth. This is not at all necessary. If the conditions are not favorable, it would be far better to wrap the baby snugly in a warm blanket—first having put a diaper on—and place it in its crib with a hot water bottle near it and defer the bathing until the following forenoon. By that time the baby will be adapted to its new surroundings; its lungs will have become accustomed to the air which it is breathing for the first time; the mother will have been rendered comfortable; in other words, the conditions and the environment will be favorable for the baby and for a better performance of the duty.
The next important feature of the first bath is that it should be done in the quickest time consistent with efficient service. Only the necessary exposure should be indulged in. It is not necessary that the baby should be exposed to the admiring inspection of every member of the household—there will be plenty of time for that without risking the health of the child. A pan of water at a temperature of 100° F. should be placed on a stool in front of the nurse. The nurse should have on a rubber apron, and on top of this, an ordinary apron and a warm bath towel laid over her knees. The child should be gently rubbed with warm sweet oil to remove the vernix caseosa (the greasy substance which is on all babies when born to a lesser or greater extent). Particular attention is to be given to all folds of the skin, as under the arms, in the fold of the neck, in the groin, behind the ears, etc., because in these parts the substance is thickest and if not carefully removed it will cake, and cause painful eruptions and sores, which may bleed and render the infant extremely uncomfortable. It is not necessary to expose the whole body at one time while applying the oil. The lower half may be covered with a warm soft towel while the nurse is oiling the upper part, and vice versa. After the body has been thoroughly oiled it should be cleansed with water at the proper temperature, in which pure castile soap has been dissolved. Absorbent cotton only should be used to wash the baby. All the washing is done with the baby on the nurse's knee; it is not put into the water.
The baby should be mopped dry with sterile gauze, or with a soft sterile towel, the cord dressed and the flannel band adjusted. It should then be completely dressed and put to the nipple and later to sleep.
Dressing the Cord.—The cord should be covered with powder and sterile gauze. The powder to use should be plain subnitrate of bismuth. If there is any reason to use another powder the physician will write a prescription for it according to indications. The subnitrate of bismuth will be found much better than any ordinary talcum or toilet powder, many of which do not make good dressing powders.
Very few nurses know how to dress the cord. It seems to be impossible to impress them with the need of frequent attention to the cord. Fresh powder should be put on every time the diaper is removed, every time the infant urinates, and at other times during the day. The cord should be kept absolutely dry. Putting on powder twice daily will not keep the cord dry and many nurses are too lazy to bother to do it oftener. You cannot make a mistake in putting on too much powder, you can make a serious mistake by not putting on enough. Every time the cord is powdered it should be lifted up, away from the skin of the abdomen, and the powder put below it. The cord should be slightly drawn out and the powder applied round its base where it meets the skin. Many nurses are afraid to touch or handle the cord—they find it easier to neglect it. The mother should see that the nurse dresses the cord at least five times every day.
Applying the Sterile Gauze to the Cord.—A piece of gauze, six inches square is taken, a hole is cut the size of a ten-cent piece out of the center, the cord is drawn through the hole, the gauze folded lengthwise over the cord and then sidewise, and this is held in place by the binder. This piece of gauze will adhere to the cord and will most likely be removed with the cord on the fifth day. If it should fall off, another piece may be put on in the same way.
If the cord does not fall off until very late it is because it has not been attended to rightly or because it was a very thick cord.
Treatment After the Cord Falls Off.—The stump of the cord should be powdered with the same powder used on the cord; a pad two inches square of sterile gauze and quite thick should be held over the stump for a number of days by the abdominal binder. This is used to prevent a possible rupture. After a week the size of the pad may be reduced, but a small pad should be used over the stump of the cord for a month or more.