TEMPORARY DECREASE IN MILK SUPPLY NO REASON FOR WEANING

There is usually a period after the nurse has gone and the mother is left to herself when the weariness resulting from the fact that her strength has not fully returned, broken sleep, and the worry consequent upon taking care of the baby alone causes the milk to diminish in quantity. This usually means that the mother is overdoing; she has not gained the strength to take care of her household and at the same time produce milk for the baby. It is at this time that many a mother concludes that the baby is starving and is very apt to become discouraged and give up nursing as hopeless. This is a great mistake. It is usually true that the strain of this period is relieved, day by day, as mother and baby gradually become adjusted; her strength returns; slowly but certainly things will grow more comfortable, and with this will come more milk. So that if the mother will only strive to carry herself and the baby past this time she will in all likelihood be able to nurse the baby quite successfully. At least every possible means to this end should be tried before weaning is resorted to.

The return of the menstrual periods is not a sufficient reason for weaning; but a pregnancy demands it, as the mother's strength will hardly be sufficient for this additional strain.

PREMATURE DELIVERY AND THE CARE OF THE PREMATURE BABY

The last two months of prenatal life are very important in the growth of the baby, and every effort should be made to prevent premature birth. Delivery before the proper time may be the result of some of the factors that lead to miscarriage. (See p. 32.) If the physician thinks that labor is about to take place before the proper time, he will probably send the mother to a hospital.

In spite of every effort and for some causes that are unavoidable, a certain number of deliveries occur prematurely. A premature baby is not so well developed at birth as a baby born at full term. The earlier the baby is born, the more difficult it is to keep him alive. A baby born only two or three weeks before the expected date may be quite strong and little different from a full-term baby. A baby born seven or eight or more weeks early may be very small and difficult to save, and occasionally a baby born at full term is exceptionally small and feeble. All babies weighing less than 5 pounds at birth should be treated as if premature. Instructions for care of the premature baby are included here in case the mother has not yet obtained a book on infant care. (These instructions are quoted from the Children's Bureau publication, Infant Care, which may be obtained free on application to the bureau at Washington, D. C.)

Many babies weighing only 2 or 3 pounds at birth can be saved if the proper care is given them. Premature babies born at home are often best cared for in their home surroundings unless a hospital suitably equipped for the care of these small infants is available. Such a hospital will have special rooms for these babies and will have doctors and nurses on the staff who are trained to care for them and who will be able to feed them properly. Great care should be taken to keep the baby warm while he is being carried to the hospital, as chilling at this time decreases the chances of saving his life. He should be wrapped immediately after birth in wool flannel or cotton batting and in several soft wool blankets, and if the hospital is more than a short distance away warm-water bottles should be used to keep him warm during the trip.

Most premature babies are born unexpectedly, and it is wise for every expectant mother to have her equipment for the birth ready two months before the baby is due.

If, as is the case in many communities, a properly equipped hospital is not available, the premature baby must be cared for at home. The advice of a physician specially trained in the care of babies should be obtained at once and followed closely. If a nurse who has been trained in the care of premature babies can be engaged her experience will be a great help to the mother.

In caring for a premature baby there are three main problems which must be kept in mind constantly:

1. How can his body be kept at normal temperature?

2. How can he be protected from infections?

3. How can he best be fed?

KEEPING THE BABY AT NORMAL TEMPERATURE

The premature baby's heat-regulating power is very slight. His body temperature must be maintained for him by having the room in which he is to be born kept warm (80° F.), by preventing exposure, by using proper clothing to prevent loss of heat, and by applying external heat. All this is most important in the first hours and days of life.

CARE IMMEDIATELY AFTER BIRTH

A premature baby may die from exposure unless proper care is given him at once after birth. As soon as he is born he should be wrapped in wool flannel or cotton batting, covering his entire body except his face. This is necessary in order to keep him from losing any of his body heat. (The cord must be protected with a sterile dressing.) He should be put at once into a warm bed which has been prepared for him (see p. 53 for homemade heated bed) in a warm room. His temperature should be taken by rectum soon after birth, and his skin should not be oiled until his temperature is normal (98.6°-99.6° F.), and then only if his general condition is good and the room temperature is not lower than 80° F. He may then be cleaned with warm oil, one part of his body at a time being uncovered. It is much more important to keep him warm than to give him a bath. The complete oil bath need not be given for several hours or even a day or two after birth.

GENERAL CARE

A premature baby should be exposed and handled as little as possible only when it is necessary to oil him, feed him, give him drinking water, or change his diaper. He may be turned over as often as every hour or two, but should not be picked up and handled unnecessarily.

The room in which the premature baby is kept should be ventilated by means of a narrow cloth screen (2 inches or more, according to the climate) at the top of one window, and a temperature of 75° to 80° F. should be maintained steadily, day and night. When the temperature in a room is as high as this, it is apt to be very dry. If a window is kept open, even a small amount of outdoor air coming in will bring with it some moisture. More moisture can be obtained by hanging wet sheets in the room or by keeping a kettle of water boiling on a small stove at a safe distance from the baby. The temperature inside the crib should be between 80° and 90° F. A thermometer should be kept in the crib with the baby so that the temperature in the bed can be known at any time. The baby's body temperature should be taken by rectum every four hours and recorded on a chart. It should be kept between 98.6° and 99.6° F.

CLOTHING

The first clothing that a premature baby wears is usually the wool flannel or cotton batting in which he is wrapped at birth and soft wool blankets. The clothes that have been prepared for him are as a rule much too large, and the mother or nurse must prepare substitutes at once which can be put on and taken off with the least possible handling of the baby. The clothes must fit the baby snugly to provide the necessary warmth but must not be tight. For a week or two after the baby's birth it may be best to continue the use of the cotton batting or wool flannel wrapped closely about the baby's body and to use small squares of cotton batting as diapers. Soon after that, however, small shirts and bands of wool flannel or knitted wool material and small diapers may be used. A few of the regular-sized diapers can be cut down to fit the tiny baby. If the diapers can not be changed without considerable handling of the baby, it is better to continue to use the cotton-batting squares, which can be removed easily.

A sleeveless padded jacket may be used as a wrap. The jacket may be made of two squares of cheesecloth or of some very thin cotton material (18 inches square), with a thick layer of cotton batting stitched between, having a piece of the padded material arranged as a hood, and should be long enough to cover the feet well and wide enough to lap over and be pinned in front. It may be opened at the bottom for changing the baby's diaper. When soiled, such a jacket may be burned and a new one substituted. A small square of wool flannel or soft old blanketing may be used as a wrap instead of the cotton-padded jacket; but, though it is warmer, it is less convenient for changing the diaper without disturbing the baby.

A small-sized sleeping bag made of a double thickness of flannel or very light-weight soft wool material may be used.

None of the baby's wraps should be so tight that his movements are hampered.

HOMEMADE HEATED BED

It sometimes is necessary to prepare an emergency heated bed during delivery of a premature baby. Such a bed may be a small clothes basket or wooden box, prepared as follows: Place a pillow or several layers of folded blanket in the bottom and cover this with a piece of thin rubber sheeting. Spread a cotton sheet or an old

small, soft wool Three warm-water placed in the bed to warm it and the The bed should not

blanket over the rubber sheeting and provide blankets with which to wrap and cover the baby. bottles should be filled with water at 115° F., before the baby is born, and kept in the bed blankets. (Warm bricks may be used instead.) be allowed to get cold before the baby is put into it. After the baby is wrapped in warm blankets and put into the bed, the temperature inside the bed must be kept at 80° to 90° F., but no higher. The warm-water bottles should be refilled (at different times) with water at 110° to 115° F. and kept in the bed, but outside the baby's wraps. If warm bricks are used, they must be wrapped up and placed outside the baby's wraps. Care must be taken not to have them too hot. Such a bed will serve at first until a better one can be arranged.