Happy is the mother, and thrice blessed is the babe when he is able to enjoy the supreme benefits of maternal nursing. The benefits to the child are far reaching; he stands a better chance of escaping many infantile diseases; the whole outlook for health—and even life itself—is greatly improved in the case of the nursing babe, as compared with the prospect of the bottle-fed child. Maternal nursing lays the foundation for sturdy manhood and womanhood.

Out of every one hundred bottle-fed babies, an average of thirty die during the first year, while of the breast-fed babies, only about seven out of every one hundred die the first year. At the same time, nursing the babe delivers the mother from all the work and anxiety connected with the preparation of the artificial food, the dangers and risks of unclean milk, and the ever-present fear of disease attendant upon this unnatural feeding. The mother who nurses her child can look forward to a year of joy and happiness; whereas, if the babe is weaned, she is compelled to view this first year with many fears and forebodings. Mother's milk contains every element necessary for the growth and development of the child, and contains them in just the proportions required to adapt it as the ideal food for that particular child.

HYGIENE OF NURSING MOTHERS

Outings and Exercise. It is most highly important that the nursing mother should be able thoroughly to digest her food; otherwise the flow of milk is likely to contain irritants that will disturb the baby's digestion, even to the point of making him really sick. In order to avoid these complications, exercise and outings are absolutely essential for the mother. A vigorous walk, gardening, light housework or other light athletics, greatly facilitate digestion and increase the bodily circulation, as well as promote deep breathing, all of which are of paramount importance to a good appetite and good digestion.

The Bowels. The bowels should move regularly and normally once or twice during the twenty-four hours. Unfortunately, this is not usually the case: and in this connection we would refer our reader to the chapter on "The Hygiene of Pregnancy," particularly those sections relative to the care of the bowels, recipes for bran bread, lists of laxative foods and other suggestions pertaining to the hygiene of the nursing mother.

Sleep. Nothing less than eight hours sleep will suffice for the nursing mother, and during the day she should take at least one nap with the baby.

Care of the Skin. Salt-rub baths are very beneficial taken once a week. The daily cold-friction rub described elsewhere, will tone up the system and increase digestion and improve the general well being. The soap wash may be taken once a week. The thorough cleansing of the breasts, and the frequent changing of the undergarments, will help to keep the baby happy; for oftentimes it is the odor of perspiration as well as the smell of soiled clothing that spoils the appetite of the baby, causing it to refuse food.

Recreation. Pleasant diversion is very essential for the mother, and should be indulged in at least once a week. The bedtime hours, however, should not be interfered with and the recreation should be selected with a view to amuse, refresh and create a harmless diversion for the mother's mind. Under no circumstances should the mother settle down to the thought: "No, I can't go out any more. I can't leave my baby." You should get away from the baby a short time each day, and go out among your former friends and acquaintances. Many a wrecked home—a shattered domestic heaven—dates its beginnings back to the days when the over-anxious young mother turned her back on her husband and looked only into the face of her (their) child. Nothing should come in between the filial friendship of husband and wife, not even their child. So, dear mother, if you can, go out occasionally, away from the baby, and enjoy the association of your husband and keep in touch not only with his interests, but with the outside world. You will come back refreshed and wonderfully repaid, and the face of the adored infant will appear more beautiful than ever.

DIET OF THE NURSING MOTHER

The general suggestions on diet which we made to the expectant mother are also valuable for the nursing mother. The food should be appetizing, nutritious, and of a laxative nature. Three meals should be eaten: one at seven a. m., one at one p. m. and one about six-thirty at night, with the heaviest meal usually at one p. m. As the mother usually wakens at five o'clock, or possibly earlier, she should be given a glass of milk, cocoa, or eggnog. If she awakens at six, nothing should be taken until the breakfast, which should consist of a good nourishing meal, such as baked potatoes with white sauce, poached eggs, cereal, milk or cocoa, prunes, figs, or a baked sweet apple, with bread and butter, etc.

From that hour until one p. m. only water is taken, and several glasses are urged during this interval. With nothing between meals but water and a little outdoor exercise, a good appetite is created for the one p. m. meal which should abundantly supply and satisfy the hungry mother; and then again, nothing is to be taken between dinner and supper but water. And after the supper hour, a walk out into the cool night air should be enjoyed with the husband and on going to bed about ten p. m., an eggnog or glass of milk may be taken. At the close of the other meals a cup of oatmeal gruel or milk or any other nourishing liquid may be enjoyed.

The eating of food or the drinking of nourishing drinks between the meals not only interferes with digestion and disturbs the mother, but it also upsets the baby; and it is often the reason why the appetite of the mother is so deranged at the meal time, her spirits depressed, and her milk diminished. Plenty of good nourishing food, taken three times a day with an abundance of water drinking between the meals, together with a free happy frame of mind occasioned by the recreation before mentioned, usually produces good milk and plenty of it. A nap between meals will probably produce more milk than eating between meals.

OBJECTIONABLE FOODS

All foods that cause indigestion in the mother or babe should be avoided.

Some mothers continue to eat tomatoes, peaches, sour salads, acid fruits, and it appears in no way to interfere with baby's comfort; but they are the exception rather than the rule. Usually tomatoes, acid salad dressings, and mixed desserts must be avoided. Each mother is a law unto herself. Certainly none of our readers will selfishly continue any food she feels will make her baby cry. All acid fruits, rich desserts, certain coarse vegetables, concoctions of all descriptions such as rarebit, condiments, highly seasoned sauce, etc., should be avoided.

Acid fruitades, such as lemonade, limeade and orangeade, can be taken by a small per cent of nursing mothers; and, since fruit acids are neutralized and alkalized in the process of digestion and assimilation, and since they are the very fruit-drinks we prescribe for patients suffering with an increased acidity, it would appear that they were in every way wholesome for the mother—if they in no way interfere with the baby. Practically, they do as a rule disturb the baby's digestion and should be avoided by those mothers who have found this to be the case.

CAKED BREASTS

During the first week of lactation the milk tubes of the breasts very often become blocked and the breasts become engored with milk, this condition being known as "caked breasts." At this particular time of the baby's life, he takes little more than an ounce of milk at a feed; so, beside the incoming engorgement of milk, an additional burden is thrown upon the milk tubes of the breasts in that they are not entirely emptied each nursing time by the young infant. When the breasts threaten to "cake," immediate steps must be taken to relieve the condition—to empty the breasts—and this is usually accomplished in the following manner: with hands well lubricated with sweet oil or olive oil the nurse begins gentle manipulation of the breasts toward the nipple in circular strokes, with the result that the milk soon begins to ooze out. This massage should be continued until relief is obtained; or the breast pump may be applied. Hard nodules should not be allowed to form or to remain in the breasts. Hot compresses (wrung from boiling water by means of a "potato ricer") may be applied to the caked breast which is protected from the immediate heat by one thickness of a dry blanket flannel. These hot compresses should be removed every three minutes until three have been applied, then an ice water compress is quickly applied, to be followed by more hot ones and then a cold; and so on, until as many as four sets each have been administered.

Gentle massage may again be administered and it will be found that they empty now with greater ease because of the preceding heat. After the breasts have been emptied, and thoroughly washed with soap suds and carefully dried, they should be thickly covered with cotton batting and firmly compressed against the chest wall by a snug-fitted breast binder, which serves the double purpose of relieving pain by not allowing the breasts to sag downward, at the same time preventing an over-abundant secretion of milk by diminishing the blood supply to the glands of the breast. In case the persistent manipulation of the breast and the use of the breast pump do not relieve the condition, and if the repeated effort day after day seems to avail nothing; then, as a rule, we must look for a breast abscess to follow if the breasts are not immediately "dried up." In all such cases of engorgement, the attending physician should be notified at once.

SORE NIPPLES

The nipple must be kept dry between nursings, which should be limited to twenty minutes. Regularity should be maintained. The nipples should never be touched or handled by hands that have not been scrubbed with soap and a nail brush. During the early nursing days they are wet much of the time and are subject to much stress and strain in the "pulling effort" of the baby, as a result of which they become very tender, chapped, cracked, and often bleed. Allowing the baby to go to sleep with the nipple in his mouth also exposes the nipple to unnecessary moisture which increases the possibility of painful cracking. The pain occasioned by nursing at this time is truly indescribable, and is most often the cause of absolute refusal on the part of the mother to nurse her babe—with the result that it is put on the bottle. Again, the fear and dread of being hurt so often tends to diminish the flow of milk. It is entirely possible so to prepare the nipple for this exposure, during the last months of pregnancy, that all this discomfort and pain may be entirely avoided (See chapter, "The Hygiene of Pregnancy").

Before the mother is put to rest after the birth of the baby the breasts are prepared as follows: A thorough cleansing with soap and water is followed by a careful disinfection with alcohol which leaves the nipple perfectly dry. A soft sterile pad is then applied and held in place by a breast binder. Before and after each nursing the nipple and surrounding area is swabbed with boracic acid (saturated solution) and carefully dried by applying a clean, dry, sterile pad.

Painful cracks and fissures are nearly always due to lack of the care described above, and are almost wholly preventable. When the first crack appears and nursing becomes painful, the baby's mouth should not touch the nipple again until healing has taken place. A thorough cleansing with boiled water should be made and then the sterile nipple shield should be applied through which baby will get abundant satisfaction, while the mother is spared the pain, and the nipple has an opportunity to get well.

In the case of sore and cracked nipples, thorough cleansing with boiled water and boracic acid solution follows each nursing seance; and, after careful drying, balsam peru—equal parts with glycerine—may be applied with a tiny piece of sterile gauze or cotton; a sterile cotton pad is then applied to each breast which is held in place by a breast binder.

The nipple shield, when employed, is boiled after each nursing and washed in boracic acid solution just before each nursing. The strictest cleanliness must be observed, and then we hope to bring relief and comfort to the mother, and effect the saving of nature's best food for the baby.

CONSTITUENTS OF MOTHER'S MILK

Mother's milk—that wonderfully adaptable, ever-changing food, so accurately and scientifically suited to the hourly and daily needs of the growing child—is composed of five different parts, totally unlike in every particular, and each part exactly suited to the needs which it supplies. The cream of the milk, as well as the lactose or sugar, builds up the fatty tissues of the body as well as helps provide the energy for crying, nursing, kicking, etc. The proteins (the curd of the milk) are exceedingly important; they are especially devoted to building up the cells and tissues of the body of the growing child. The salts form a very small part of the baby's food, but an important one, for they are needed chiefly for the bones and the blood. The fats, sugars, proteins, and salts, taken together, form the solids of mother's milk, and are held in solution in the proportion of thirteen parts of solids to eighty-seven parts of water; which so holds these solids in solution that the baby can digest and assimilate these necessary food elements. The mother's milk increases in strength day by day and month by month as the baby grows, and is the only perfect infant food on earth.

THE TIME OF THE FIRST FEEDING

Soon after the birth of the baby the wearied mother seeks rest—she usually falls into a quiet, restful slumber; the baby likewise goes to sleep and usually does not awaken for several hours. After six or eight hours the child is put to the breast and he begins to nurse at once, without any special help. This first nursing should be discontinued after four or five minutes, while he is put to the other breast for the same length of time.

If there is difficulty in sucking, a bit of milk may be made to ooze out on the clean nipple, while the baby's lips are pressed to it, after which the nurse gently presses and rubs the breasts toward the nipple. After the nursing, the nipples should be elongated, if necessary, by rubbing, shaping, or breast pump.

The baby gets but little nourishment during the first two days, but that which he does get is essential; for the colostrum—the first milk—is highly laxative in nature and serves the important purpose of cleaning out the intestinal tract of that first tarry, fecal residue, the meconium. This early sucking of the child accomplishes another purpose besides the obtaining of this important laxative—it also reflexly increases the contractibility of the muscles of the womb, which is an exceedingly important service just at this time.

Should the mother or caretaker feel that baby will starve before the milk comes, or that it is necessary to provide "sweetened water;" let us assure them that nothing is needed except what nature provides. Nature makes the babe intensely hungry during these first two days, so that he will suck well, and if he is fed sweetened water, gruel, or anything else, he will not suck forcefully; and so nature's plan for securing extra or increased uterine contractions and the stimulation of the breast glands will be seriously interfered with.

WATER DRINKING

As soon as the new born babe is washed and dressed he is given two teaspoons of warmed, boiled water; and this practice is continued every two hours during the day, until as much as two to four ounces of unsweetened water is taken by the tiny babe during the twenty-four hours. Inanition fever—the fever that sometimes follows a failure to give water to the new born infant—is thus avoided. The bottle from which the water is given should be scalded out each time, the nipple boiled, and just before the "water nursing" the nipple should be swabbed with boracic acid solution.

REGULARITY IN FEEDING

From earliest infancy the baby should be nursed by the "clock," and not by the "squawk." Until he reaches his sixth-month birthday, he is fed with unerring regularity every three hours during the day. Asleep or awake he is put to the breast, while during the night he is allowed to sleep as long over the three-hour period as he will. Babies are usually nursed at night: during the early weeks, at nine o'clock in the evening, at midnight, and at six o'clock in the morning. After four months all nursing after ten p. m. may be omitted.

The baby is ordinarily allowed to remain at the breast for about twenty minutes. He may often be satisfied with one breast if the milk is plentiful; if not, he is given both breasts; and may we add the following injunction? insist that nothing shall go into your baby's mouth but your own breast milk and warm or cool-boiled water; no sugar, whiskey, paregoric, or soothing syrup should be given, no matter how he cries. Never give a baby food merely to pacify him or to stop his crying; it will damage him in the end. More than likely he is thirsty, and milk to him is what bread and meat are to you, neither of which you want when you are thirsty.

POSITION OF MOTHER DURING THE NURSING

A perfectly comfortable position during nursing for both mother and babe is necessary for satisfactory results. During the lying-in period the mother should rest well over on her side with her arm up and her hand under her head, the other hand supports the breast and assists in keeping the nipple in the baby's mouth, as well as preventing the breast from in any way interfering with baby's breathing. A rolled pillow is placed at the mother's back for support.

After the mother leaves the bed, she will find a low chair most convenient when nursing the baby, and if an ordinary chair be used, she will find that a footstool adds greatly to her comfort. Once during the forenoon and once during the afternoon the nursing mother will find it a wonderful source of rest and relaxation if she removes all tight clothing, dons a comfortable wrapper, and lies down on the bed to nurse her babe; and as the babe naps after the feed, she likewise should doze and allow mother nature to restore, refresh, and fit her for restful and happy motherhood.

Worry, grief, fatigue, household cares, loss of sleep, social debauches, emotional sprawls—all debilitate the mother, and usually decrease the flow of milk.

NURSING WHEN ANGRY AND OVERHEATED

Overheating, irritability, and sudden anger, almost invariably tend to raise the blood-pressure, which means the entry into the blood stream of an increased amount of epinephrin, which disturbs the baby greatly, often throwing him into convulsions or other sudden, acute illness.

Menstruation often interferes with the nursing mother, the milk becoming weaker at this time; however, if the infant continues to gain and the mother feels comparatively well, no attention need be paid to this fact.

Another pregnancy demands a drying up of the breast at once, as the tax is too great on the mother.

THE STOOLS

The stools of the breast-fed baby do not require as much attention as those of the bottle-fed child. In cases of constipation, after four months, from one teaspoon up to one-half cup of unsweetened prune juice may be given one hour before the afternoon feed.

In instances of colic with signs of fermentation in the stool, the mother may take several doses (under her physician's orders) of common baking soda; or, if she is constipated, calcined magnesia will usually right the condition. Nature's mother milk is so beautifully adapted to the baby's needs that it is the rule for baby to have perfectly normal stools.

SYMPTOMS OF SUCCESSFUL NURSING

A happy baby is a satisfied baby. He lies quietly in a sleepy, relaxed condition if he has enough to eat, provided he is otherwise comfortable and dry. He awakens at the end of two hours and perhaps cries; but plain, unsweetened, warm, boiled water quenches his thirst, and he lies content for another hour, when he is regularly nursed. He gains on an average of about one ounce a day.

EARMARKS OF UNSUCCESSFUL NURSING

Constant discomfort, vomiting, fretful crying, passing and belching of gas, colicky pain, disturbed sleep, greenish stools with mucus, are among the more prominent earmarks of unsuccessful nursing. These symptoms appearing in a pale, flabby, listless, indifferent or cross baby, with steady loss of weight continued over a period of three or four weeks, point to "nursing trouble;" which, if not corrected, will lead to that much dreaded infantile condition—malnutrition.

Bolting of food or overeating results in vomiting and gas, and thus interferes with normal nursing, as also may tongue-tie. A condition in the mouth, medically known as "stomatitis," and commonly known as "thrush," often gives rise to a fretful cry when nursing is attempted. In the first place, the baby cannot "hold on" to the nipple; while, in the second place, it hurts his inflamed mouth when he makes an effort to nurse.

Long continued nursing covering three-fourths of an hour or more, seizing of the nipple for a moment and then discarding it, apparently in utter disgust, are the earmarks of very scanty milk supply and should receive immediate attention.

AIDS TO THE MILK SUPPLY

Believing that many more mothers than do so should nurse their babies, we have carefully tabulated a number of aids to the milk supply, which we hope will be most earnestly tried before the baby is taken from the breast—for so many, many more bottle-fed babies die during the first year than the breast fed. The dangers of infection, the worry of the food preparation, the uncertainty of results, all call for a most untiring effort on the part of every doctor, nurse, and mother, in their endeavors to secure maternal nursing. The following is a summary of "aids to the milk supply:"

1. Regular periodical sucking of the breasts from the day of baby's birth.

2. Systematic applications of alternate hot and cold compresses, followed by massage to the breasts.

3. Three good nourishing meals each day, eaten with merriment and gladness of heart.

4. A glass of "cream gruel," milk, cocoa, or eggnog at the close of each meal, with a glass just before retiring.

5. Three outings each day in the open air.

6. Nurse the baby regularly and then turn its care over to another, you seek the out of doors and engage in walking, rowing, riding and other pleasurable exercise.

7. Take a daily nap.

8. You can bank on fretting and stewing over the hot cook stove to decrease your milk. It seldom fails to spoil it.

9. Regular body bathing, with cold friction rubs to the skin.

10. A happy, carefree mental state. Nothing dries up milk so rapidly as worry, grief, or nagging.

11. The administration, preferably in the early days, of desiccated bovine placenta; although it may be given at any time during the period of nursing.

WHEN THE BABY SHOULD NOT BE NURSED

As much as we desire maternal nursing for the babe, there do occur instances and conditions which demand a change to artificial feeding, such as the following:

1. A new pregnancy.
2. Mothers with uncontrollable tempers.
3. Cases of breast abscess.
4. Prolonged illness of the mother with high fever.
5. Wasting diseases such as tuberculosis, Bright's disease, heart disease, etc.
6. Maternal syphilis.
7. When maternal milk utterly fails, or is wholly inadequate.

When a maternal anesthetic is to be administered, or in case of inflammation of the breast or during a very short illness not covering more than two or three days, then the breast pump may be used regularly every three hours to both breasts; the baby may be artificially fed and then returned to the breast after the effects of the anesthetic has worn off or the temperature has been normal for twenty-four hours.

There may also appear definite indications in certain children which make it imperative that the nursing child should early be weaned. These manifestations of disordered nutrition and failing health admonish us to put the baby on properly modified milk, or to transfer it to a wet nurse.

These conditions are:

1. Progressive loss in weight.

2. A bad diarrhea of long standing; one which does not yield to the usual remedies, at least not as long as the baby continues to feed from the breast. These diarrheas are especially serious when accompanied by a steady loss in weight.

3. Excessive vomiting accompanied by progressive loss in weight.

THE WET NURSE

Because of the rarity of good, healthy wet nurses, it is always better to attempt to feed the baby with scientifically modified milk (not proprietary foods), good, clean, cow's milk properly modified to suit the weight and age of the child. We put weight first, for we prepare food for so many pounds of baby rather than for the number of months old he is.

If modified food has failed and the best specialist within your reach orders a wet nurse; she must have the following qualifications:

1. She must be free from tuberculosis and syphilis.
2. She should be between twenty and thirty years of age.
3. She should abstain from all stimulants.
4. She should be amiable, temperate, and should sense her responsibility.

If an unmarried mother of her first child is engaged as a wet nurse, she should not be "stuffed" or allowed to overeat, which is commonly the result of moving her from her lower life into more comfortable surroundings, or given ale or beer to increase her milk. She should continue her normal eating, take light exercise, which does not mean the scrubbing of floors or doing the family washing, and live under the same hygienic regime outlined for the nursing mother. Should she be the mother of the second or third illegitimate child, then she is quite likely to be mentally deficient and she should not be engaged. Her own babe will have to be fed artificially as very few mothers can endure the strain of two suckling children.

The baby's own mother should keep general supervision and not turn her babe entirely over to the care of the wet nurse. Remember always that no one in the wide world will ever take the same mother interest in your offspring that can spring from your own mother heart.