single spurt of blood, but bleeding will cease immediately if the cord is tied tight. If bleeding from the baby's navel should not stop altogether, the cord should be tied again nearer the baby without disturbing the first tie. The cord dressing should be put in place at once. The baby should then be covered with a light, warm, and soft blanket, removed to a place of safety while the mother is being taken care of, and kept warm.

The separation of the afterbirth usually takes place within 10 to 30 minutes. Sometimes it takes as much as two hours, but the process must not be hurried, unless under the doctor's directions. Sometimes the mother can help by straining as she did to bring the child; but unless the doctor or nurse has arrived it is better to be patient and wait for the contents of the uterus to be expelled naturally. All the soiled pads and dressings and everything that has been expelled should be saved for the doctor's inspection.

After the soiled pads have been removed, the region around the vagina is carefully washed with sterile warm water, pieces of sterile gauze or cotton pledgets being used for this purpose. An abdominal binder and one of the sanitary pads are then put on. All the soiled dressings are removed and the pad beneath the mother renewed. If, after all is over, the mother suffers from a nervous chill, as often happens, she need not be alarmed. A hot-water bag at her feet, a glass of hot milk, and a blanket will soon warm her, and she will usually be ready to fall asleep to rest after the fatigue of the labor.

There is always a considerable discharge of blood just after the birth. The attendant can help to stop this bleeding. Sitting on the bed, facing the foot of the bed with the hands on the mother's abdomen, she will feel for the uterus, which will be a rather large, soft mass just under the navel, and will massage it gently, passing the thumb over the front of the organ, while the fingers surround it. This will cause the muscles of the uterus to contract and will help to stop the bleeding. The massage should be begun gently, as soon as the child is born. Then the uterus will stay very tightly contracted and firmer to the touch, and in the long run a great amount of blood will be saved. While the attendant is caring for the baby, either the mother herself can be rubbing the lower abdomen or someone else in the family can help temporarily. Cracked ice, wrapped in gauze, may be laid over the uterus to help in the contractions, and sometimes putting the baby to breast will serve the same purpose. These measures are especially necessary if the amount of bleeding seems excessive and the doctor has not arrived.

When the doctor comes, he will repair any lacerations (tears) that may have occurred during the baby's birth.

FIRST CARE OF THE NEWBORN

Immediately after the baby is born his eyes should be carefully wiped free from mucus or blood with the pledgets of sterile clean absorbent cotton which were prepared beforehand. (See mother's supplies, p. 24.) A separate piece of cotton should be used for each eye and should be discarded as soon as it has been used once. Wipe from the nose outward without opening the lid. At this time also the lips and nose should be wiped clean and the nurse's or doctor's little finger, wrapped with a piece of moist cotton, should be passed into the child's mouth and any accumulated mucus removed by an outward sweep of the finger.

NITRATE OF SILVER FOR THE BABY'S EYES

As soon after birth as possible the eyelids should again be wiped clean of mucus, and two drops of a silver preparation which the doctor or nurse will provide should be put into each of the baby's eyes, the lids being gently opened so that the medicine will get inside the eye. (Nitrate of silver in 1 per cent solution is put up in ampules for this purpose.) This care is necessary in all cases because a baby's eyes may become infected during the passage through the birth canal, and this infection sometimes leads to an eye disease of the newborn, called ophthalmia neonatorum, which may cause blindness. The treatment is simple and perfectly harmless and is certain to prevent the infection from developing. If, however, the treatment is not given and symptoms of the disease appear (namely, redness, swelling of the lids, and a discharge from beneath them), the mother should not lose an hour in placing the baby in the hands of the best doctor she can find. The eyes may be saved by a few hours' care, but treatment to be efficient must be begun at once; neglect may doom the baby to lifelong blindness or at best to imperfect vision. It is the law in all the States except one that this condition must be reported to the health authorities.

In bathing the eyes always use a different piece of cotton or gauze for each eye, and in case of any infection use the greatest care not to infect one eye from the other. The germs may be carried by the fingers, the towels, the cotton, or any other article that has touched the infected eye.

BATHING THE BABY

The newborn baby's skin is covered with a cheeselike substance, which is the more easily removed if it is first oiled with olive oil, liquid petrolatum, or petroleum jelly. The baby may then be wrapped warmly and put in a safe place until the mother has been attended to, after which the baby may be bathed. The water should be of a temperature that feels comfortable to the bare elbow of the nurse. After the skin is thoroughly but very gently washed with Castile soap (care should be taken not to get soap into the eyes) it should be patted dry with warm and very soft old towels. A square of sterile gauze, with a hole for the cord, is placed over the navel. This square is folded back to cover the cut end of the cord, or a second pad is placed over the cut end. The dressing is held in place with the flannel binder already prepared. Unless this dressing becomes wet or soiled it is not necessary to change it for a few days. The stump of the cord will usually shrivel and fall off within a week. After this happens the navel will be dressed in the same manner until it is entirely healed.

THE BABY'S STOOLS

The first discharges from a newborn baby's bowels are known as meconium. They are very dark green, thick and sticky, with little or no odor. These soon change to the normal yellow stools of the healthy baby after he begins to be fed. If any blood is seen in the stool of a newborn baby, the fact should be reported to the doctor immediately.

LYING-IN PERIOD

The time just after childbirth, when maternal nursing begins and the organs connected with childbirth return to the condition they were in before pregnancy, is called the lying-in period. The change in the uterus, called the involution, is the most important. The uterus dwindles in weight from about 2 pounds to about 2 ounces and sinks down to its original position in the pelvic cavity. The length of time required for these changes to take place is shorter with nursing than with nonnursing mothers, but complete involution commonly takes five or six weeks. If lacerations (tears) or other accidents have occurred during childbirth, involution may take longer. It is plain, then, that the mother, no matter how well she may feel, needs a certain time of rest before she is fully able to take up her ordinary occupations and pleasures, which, if she goes back to them too early, may slow up or stop the natural restorative processes. Most women are allowed to sit up in a chair for an hour on the tenth day. Usually they may walk about the room after two weeks, and by the end of the month they will be allowed to go up and down stairs; but in all cases it is well for the mother to refrain from full activity for six weeks. After six weeks the doctor should make a final internal (vaginal) examination to be sure that all is as it should be and will direct the proper treatment in case anything is wrong.

For some time after the baby's birth there is a discharge from the vagina. This discharge, which is called the lochia, at first is pure blood, but later becomes quite brown in color. It is likely to increase somewhat as the mother gets about, and this is an additional reason for lengthening the period of rest and quiet after childbirth.

In a small percentage of cases the monthly periods may return at once, but in the vast majority of cases menstruation is not established until a month or two after nursing has stopped. Nursing the baby does not prevent conception, even though menstruation has not begun again.

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NURSING THE BABY

It is the first duty of every mother to nurse her baby. Every doctor, nurse, or other attendant should insist that the mother nurse her baby and should do everything possible to start the secretion of milk, to promote it, or even to bring it back if for any reason it has stopped. It is true that not all mothers are able to nurse their babies, even when they would gladly do so, but the cases in which maternal nursing is impossible, at least for a few weeks, are very uncommon. There are only a few good reasons for not nursing an infant under 6 months old. Chief among them are tuberculosis in the mother and the beginning of another pregnancy.

ADVANTAGES OF BREAST FEEDING OVER ARTIFICIAL FEEDING

Mother's milk gives the baby the greatest help in the complicated and difficult task of growing, and it also makes the baby more resistant to the various sicknesses to which he may be exposed. Satisfactory nursing greatly increases his chances for growing up. Besides, it is easier to nurse the baby than to feed him otherwise. To make bottle feeding safe requires scrupulous and constant care. To secure a supply of pure milk, to keep it at the proper temperature, to have it properly prepared for the baby's use, to change the composition of the milk in accordance with the baby's changing needs, to keep all the utensils used in the care and preparation of the baby's feedings absolutely clean, to have the bottles and nipples scrubbed and sterilized, call for constant care and attention even when the baby is thriving. But when, as is often the case, the baby does not thrive, the difficulties of artificial feeding are greatly multiplied. Too often artificially-fed babies pass their first 6 or 12 months in a series of unfortunate feeding experiments, with the result that the growth of the organs, the functions, and the general development are retarded.

COLOSTRUM

At the birth of the baby there is, in by far the majority of cases, no milk in the mother's breasts. The secretion that is in the breasts at that time is called colostrum. The mother's milk does not usually come for two or three days, sometimes longer, after the baby is born. The colostrum has a laxative effect on the baby and for that reason is valuable during the first days of his life. After the mother has