Many of the minor difficulties encountered by the nursing mother can be avoided by proper preparation of the breasts during the early months. Depressed nipples will have been drawn out and formed into proper shape, slack muscles toned up and the circulation of the blood been improved by cold sponging.
The skin of the nipple itself will have been hardened by gentle persistent scrubbing.
If these precautions have been neglected, and the mother arrives at her confinement with depressed nipples, sire still need not despair. It is not too late to improve them, though skill and perseverance may be necessary. Before feeding baby the nipples may be gently drawn out with a breast pump until sufficiently elevated for the baby to take. In some cases it may be necessary to use a nipple shield for the first half of the feed, but every effort should be made to put the baby to the nipple itself as soon as possible, or the milk glands will lack the natural and comforting stimulation of baby's sucking.
Cracked nipples should never be neglected, as they form a channel by which infection can reach the deeper tissues. At the first feeling of soreness, Friar's balsam should be applied.
This is a simple but effective remedy, and often no further measures need be taken.
When a dressing of any kind is applied, the nipples should be carefully washed with soap and water before feeding.
Scrupulous cleanliness must be observed, for if germs gain entrance, mastitis (inflammation of the breast) of varying degree is caused.
A baby should never be weaned because of this, but the doctor should be consulted as to treatment, the principles of which are rest to the affected part and the prevention of an accumulation of milk by proper emptying of the breasts. In acute cases the baby may have to be taken from the inflamed breast altogether and fed from the one side only. In these cases, after feeding baby from the one breast, the milk should be removed from the other by manual expression or by the pump. The latter is usually the best method, as it does not stimulate the glands to action to the same extent as the manual method of expression, and is therefore not so likely to increase the inflammation; also it is not so painful.
Hot, dry wool applied every three or four hours, and a firm, well-supporting bandage, are often sufficient to prevent the spread of inflammation. If the doctor orders hot fomentations, a hole must be cut for the nipple, or the skin is liable to become tender. Hot fomentations are likely to lessen the secretion of milk, and it is therefore best not to have them on too long. It is a good plan to apply one, changing every five minutes, for half an hour, afterwards leaving hot, dry wool in place until the next feed time, when the course of hot fomentations can be repeated.
Even when a definite abscess has formed, which must be opened and drained, it is seldom necessary to wean the baby, though great care must be exercised when putting the baby back to the breast after the scar is completely healed. The baby should be put to the bad side for one minute only at each feed time, increasing the time day by day. It is usually about seven to ten days before the baby can be safely allowed to suck for the full ten minutes.
Leaking nipples are usually due to lack of muscle tone and not to an oversupply of milk. It is often difficult for the mother with leaking nipples to believe that she has not enough for her baby, but it is often the case, and can be demonstrated by test weighing. The breasts must be toned up by alternate hot and cold sponging, and by massage. The mother's general health must receive attention, her diet be regulated, and a definite amount of exercise performed. The discomfort can be relieved by the wearing of glass reservoirs, but these are purely a palliative measure, and will not cure the trouble. Scrupulous cleanliness is essential, as the sodden state of the skin is liable to cause cracks.
During the first few days of lactation the milk may accumulate quickly and in excess of the baby's needs, causing much discomfort. In this case it is sometimes wise to give baby the one breast only, drawing a little off from the other by expression, using the pump if necessary to start the flow, as the breasts will be very tender. If there is no danger of overfeeding, the baby should be certainly put to both breasts, as his sucking will empty them more completely than the pump or expression. A supporting bandage, well padded with cotton-wool, must be worn, and the mother's intake of fluid reduced until her milk supply is more normal. Hot fomentations are a great relief, and by temporarily reducing the secretion of milk usually end the trouble, but a doctor should be consulted if the condition continues or if the mother's temperature rises.
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