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Motherhood in The Hospital

Most women who have never had a baby tend to underestimate the importance and complexity of the first month of motherhood. They seem to regard the process of procreation as one which involves:

(1) being pregnant,

(2) being delivered, and

(3) raising a baby.

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But in between the last two stages there lies the crucial phase of transition which entails recovering from stages. 1 and 2 and preparation for stage 3. This phase is known in medical parlance as the puerperium. It is in many ways more vital that a woman be well prepared for the puerperium than that she be prepared for the delivery itself. Indeed the delivery can and often does occur with no cooperation whatsoever from the mother; it is after the baby is born that her cooperation becomes completely essential.

Although no one has gotten around to emphasizing the importance of this phrase of childbirth to the extent, for example, of referring to it as Puerperium without Fear, there has been a commendable resurgence of interest in certain aspects of it, as evidenced by the growing popularity of breast feeding and rooming-in. And there are many other facets to these exciting early weeks of motherhood with which you should be familiar. Read the following words and discuss the issues with your doctor. Without meaning to belittle natural childbirth, I think you will agree that natural motherhood is an even greater goal to strive for.

The Recovery Room

After having graduated from the labor room and the delivery room, you may be placed in a third strange environment the recovery room, where you will spend the first hour or so of your new motherhood in the company of several other young women who have just undergone the same experience. It may seem frustrating at this juncture to be deprived of the opportunity of fondling your baby or sharing your joy with your husband but medically speaking this further hour of observation is an hour well invested, for it is during this interval that an occasional woman will develop a complication, which will be most promptly observed and treated in this one of the most scrupulously surveyed rooms in the entire hospital. You have to be patient for nine months before having the baby; plan on being patient for another hour before shouting about it. You will probably welcome this respite anyway, for you will have worked hard in labor and there will be a lot of excitement ahead of you. So take advantage of this interlude to get some rest.

Minor Annoyances

Most women expect a certain amount of discomfort during pregnancy and labor, but it usually comes as a surprise to them that there may be some further discomfort associated with the immediate postpartum period. In the average case this discomfort is minimal; it is apt to stem chiefly from the uterus (“afterpain”), the episiotomy, and the breasts. Since it is likely that you will experience some of these sensations, it is well that you be prepared for them.

Afterpains. Afterpains are lower-abdominal cramps, not dissimilar from menstrual cramps, which are due to the continued contractions of the uterus as it strives to shrink down to its non-pregnant size. Immediately after delivery of the baby and the afterbirth the uterus assumes the size of a grapefruit. During the first postpartum week it shrinks further to the size of an orange, and in the ensuing weeks it returns to its normal size, which is similar to that of a lime. This shrinkage is accomplished by contractions of the uterus, which may be felt as cramps of variable severity during the first two days after delivery. These contractions, which are usually less bothersome after the first delivery, are apt to be intensified by nursing - which actually hastens involution of the uterus and thereby prevents bleeding and by the tiny white pills which you may be asked to take for a few days. These pills contain Ergotrate, a powerful oxytocic (from the Greek oxy meaning swift, and tokos meaning birth; this drug is too powerful to be given before birth of the baby) which stimulates the uterus to contract. Afterpains are effectively counteracted by codeine, Darvon, and other mild analgesics.

Episiotomy Pain. Episiotomy pain is very variable. Oftentimes it is negligible, sometimes it is annoying, occasionally it is more than annoying. The degree of pain is determined partly by the location and size of the episiotomy, but by and large it is impossible to explain why some episiotomies hurt more than others. The cause of the pain is that the tissues in this region swell a little and pull against the stitches. This swelling, and hence any discomfort associated with it, usually reaches its peak on about the third postpartum day and then gradually subsides. Healing of the episiotomy is promoted by keeping this area clean and dry. The discomfort is usually relieved by the use of a heat lamp, an anesthetic spray, and, again, codeine or Darvon.

Breast Engorgement. Breast engorgement is an almost universal phenomenon which occurs on the third or fourth postpartum day, when “the milk comes in” At this time the breasts are suddenly filled with milk and may become quite distended, hard, and uncomfortable whether the mother is nursing or not. This condition subsides spontaneously in a day or two, again whether the mother is nursing or not, and it rarely causes significant pain. Simply binding the breasts rather tightly against the chest wall with a breast binder or maternity brassiere is usually sufficient to relieve the discomfort. Ice bags and codeine or Darvon are also helpful. Some doctors prescribe a hormone to prevent lactation in non-nursing mothers. To be effective, this drug should be given immediately after birth, so make sure your obstetrician knows in advance whether you want to breast feed.

Hemorrhoids. Another source of considerable annoyance is hemorrhoids. Hemorrhoids are extremely common in pregnant women. The rectal pressure during labor and the constipation following delivery act to promote swelling of the hemorrhoids in the first postpartum week. Salves and suppositories may relieve the pain; ice packs may decrease the swelling; the most effective therapy is prompt resumption of normal bowel function.

The Bowels. Routinely at many hospitals a laxative is given on the second night after delivery and, if necessary an enema on the following day. It is rare for bowel function to become re-established spontaneously before this time. A nightly laxative is sometimes necessary during the entire hospital stay, for it is difficult to resume daily BMs while spending so much of the day in bed. The discomfort induced by hemorrhoids and the episiotomy also interfere with the process of elimination.

The Bladder. The baby presses on the bladder as it descends through the birth canal, and it may take several hours or even days before the elementary process of urination is completely normal. You will be encouraged to try to void within six or eight hours after delivery and if you cannot you may have to be catheterized. Catheterization involves the passage of a narrow rubber tube into your bladder. Although not the most pleasant experience in the world, it is not really painful. This initial inability to void, when it occurs, usually resolves itself promptly. A second type of bladder dysfunction which occasionally occurs is the inability to empty the bladder completely. This also is a transient affliction which requires catheterization for its relief.

The Blues. It is not uncommon nor unnatural for a woman who has been keyed up for nine months over the prospect of having a baby to feel a little let-down sometime after the long-awaited event takes place. This sequence of events accounts for what is often referred to as “the baby blues.” On or about the third day it is not unusual for a new mother to find herself uncontrollably weeping or unaccountably despondent over her new-found joy. There is no need for a psychiatrist here; this form of heartache is soon self-dispelled. If it persists after you go home, however, you'd better consult your obstetrician.

The Lochia. After delivery of the placenta there remains a fair amount of tissue lining the inside of the uterus, which has to be expelled in the same manner as the endometrium is shed during a menstrual period. Mixed with a little blood, this tissue comprises the lochia, a reddish discharge which may persist for two or three weeks or even as many as six weeks. It should never exceed a menstrual flow in daily volume and quite often it tapers off to mere staining after the first week. If it becomes profuse, your doctor will want to know about it. Needless to say you should wear an exterior type of pad rather than any sort of vaginal tampon at this time.

Serious Complications

If any serious complications are to follow childbirth they will usually show up within the first week. Hemorrhage and infection are the most common types of trouble, and fortunately their incidence has been greatly reduced by modem techniques of delivery. The detection of your blood type, which was done on your initial visit to the doctor, was his first step to assure the ready availability of compatible blood for you in case of hemorrhage. Blood transfusions are simple, safe, and readily available in these days of the modem blood bank. And, of course, the infections or “childbed fever,” which used to claim the life of as many as one out of every four or five puerperal women before the days of Semmelweis and Pasteur, are now largely prevented by aseptic techniques and cured, when they do occur, by the fabulous antibiotic drugs. Other complications, such as phlebitis and mastitis may develop, but they are rare and your doctor is trained to handle them. The average woman having a baby is young and healthy and need not fear complications.

Rooming-in

What It Means. “Rooming-in” means having the baby in the same room as the mother rather than in a nursery down the hall. It is an arrangement which has enjoyed increasing popularity in recent years. In most hospitals it is optional, in some it is mandatory, in others it is forbidden. If it is optional at your hospital you will want to ponder the matter in advance. If you are anxious to have it, you should discuss its availability with the doctor at one of your first office visits. And, too, rooming-in means different things at different hospitals. The strictest rooming-in system involves having the baby with you twenty-four hours a day. Other hospitals offer a “modified” rooming-in plan whereby the baby is with you part of the day and in the nursery during the night and during nap periods.

Pros and Cons. There are several pros and cons to rooming-in. The primary issues include whether or not this is your first baby and how well you feel after the delivery. Since rooming-in implies not only the physical presence of the baby but also the necessity for the mother to minister unto its various needs this experience is probably more valuable to the mothers of firstborns, for it gives them the opportunity to become acquainted with their babies and to learn how to handle them under supervision before taking them home. Taking home a first baby after having seen it only at feeding time in the hospitals often quite a jolt to the mother, one which can be largely circumvented by rooming-in.

But, on the other hand, the new mother needs rest in the hospital and she is going to get far less if the baby is constantly with her. Herein lie the advantages of the so-called modified rooming-in plan mentioned above and often it is wise to defer rooming-in altogether for the first day or two until you are feeling rested and comfortable. Your doctor will help you work out a suitable plan. The situation is a little different for the woman who has children at home, who knows how to change a diaper, and who is to some degree exhausted by the combination of pregnancy and motherhood. She may prefer to enjoy the uninterrupted rest and solitude which she so richly deserves.

Breast Feeding

Breast or Bottle? “Which is better breast feeding or bottle feeding?” This is one of the most common questions asked of the obstetrician. Quite often it is not even posed until after the baby is born. That the question is asked and, even worse, that breast feeding is never seriously considered by many women - this is indeed a fairly sad commentary upon the maternal instincts of American mothers.

Of course breast feeding is better. Have the American woman's breasts become so symbolic of sensuality that their function has actually been forgotten? Not quite, but evidently almost. All womankind used to breastfeed its babies; most European, Asian, African, and South American women still nurse their babies – yet less than half of the mothers in the United States fulfill this normal physiological function. Why? Largely because of a sort of misconceived national attitude toward breast feeding. If an American mother were seen nursing her baby in a public place, or even in her own living room, this would be regarded by many as mildly shocking if not vulgar. Not so, elsewhere. Surely, in the eyes of any truly discerning person, not to mention classic artists through the ages, a mother nursing her infant is one of the most tenderly beautiful sights one can behold.

Vanity probably prevents many a woman from nursing because of the notion that her breasts will droop more if she nurses than if she doesn't. There is absolutely no basis for this. If there is a tendency in this direction, it is more apt to be furthered by the more marked breast engorgement seen in non-nursing mothers.

Yet another reason is the prevalent fear that there will be insufficient milk for the baby. This is obviously nonsense. If it were true, why didn't babies starve to death before bottles were invented?

Nor is there any correlation between the size of a woman's breasts and the abundance of her milk supply. Chinese women, whose breasts are quite small by American standards, are among the best nursers in the world. Many woman claim to prefer artificial feeding because their husbands can get up at night with the baby. It hardly seems necessary to point out that the fathers of breast-fed babies will be called upon to tend to many other nocturnal needs of their children over the years, whereas nighttime feedings last for only SIX to eight weeks.

And finally, there is the career woman who is anxious to return to her job. It is possible to work all day and continue nursing, but not until after six or eight weeks, when the milk supply has become firmly established.

Advantages of Breast Feeding. Why is nursing preferable to bottle feeding? One might simplify the answer to this by stating that woman's milk is, after all, meant for babies and cow's milk for calves, but this answer would be both over-simplified and incomplete. Since the composition of cow's milk is indeed quite different from that of human milk (chiefly in a greater amount of protein and a smaller amount of glucose or sugar), it is necessary to modify cow's milk in order to feed it to a baby. But even with present-day methods of doing this it is impossible to render cow's milk as ideal for babies as human milk. To illustrate this by just one difference, the protein of human milk is mostly lactalbumin, whereas that of cow's milk is mostly casein, the former being easier for a newborn baby to digest. There are also differences in the mineral and vitamin contents and obviously these differences exist because, let me repeat, one type of milk is best for human babies and the other is best for bovine babies.

As noted above, the nursing process hastens involution of the uterus, i.e., its return to normal size. True, the same effect can be wrought by drugs, but this is Nature's way of doing it.

The mother's antibodies to disease - the substances which render her immune to colds and measles and poliomyelitis – are also secreted in her milk; in this way breast feeding helps protect the infant from sickness.

If you have ever seen a friend preparing the formula for her bottle-fed baby you can certainly guess another of the many advantages of nursing: expediency. There is no pouring, no measuring, and no sterilizing.

The very fact that breast milk obviously doesn't have to be sterilized should suggest to you that still another advantage is that breast milk is sterile and hence safer for your baby. And, of course, breast milk is cheaper than store-bought facsimiles.

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I have listed most of the commonly accepted physical advantages to breast feeding. In doing so I have purposefully left till last what is indisputably the greatest single argument for nursing, and that is the emotional factor. The act of nursing brings the mother closer to her child and the child closer to his mother. The instinct to suck is practically the only instinct with which we are born; this instinct is best satisfied by breast feeding. The nursing experience is also pleasurable for the mother. But far more important than these transient physical pleasures which each derives is the indefinable sense of love and security which they share, the one from giving, the other from receiving. Why is the painting of such a scene so beatific? Because it radiates love.

Defense of the Bottle. I have stressed the advantages of breast feeding with the vehemence which I think they deserve, but obviously there is another side to the story. Bottle-fed babies do survive. As a matter of fact, I know of no scientific study which proves that bottle-fed babies suffer significantly in comparison with their breast-fed cousins. To me and to most other thinking obstetricians, however, it just stands to reason that breast feeding is the preferable way to feed a baby.

There are, of course, a few women who cannot or should not nurse – patients with active tuberculosis or diabetes, for example. And once in a long while there is a patient with such markedly inverted nipples that she cannot nurse. If the nipples are at all normal and the patient not acutely ill, there is no physical reason why she cannot nurse.

Failure at Nursing. Why, then, are there women who try to nurse and fail? We have already established the fact that virtually every woman is physically able to nurse successfully. If, therefore, you have inferred that the explanation for most nursing failures is emotional, you couldn't be more right. There are few such vivid examples of the relationship of mind over matter as the phenomenal) of nursing. If a new mother is afraid of her new responsibilities, if she is unduly worried about her health, her marriage, or even (and especially) her milk supply, or if she is even subconsciously leery of this nursing business, she simply will not have enough milk. It's just as simple as that.

Success in nursing is mainly dependent upon and proportional to that vague but undeniable entity known as maternal drive. If you are determined to nurse and your baby is the most important thing in the world to you, you will succeed. If you are ambivalent about nursing, if you are more interested in returning to your job, or if the responsibilities of motherhood seem to overwhelm you, you will fail. In primitive societies all of the women belong to the first category and they all nurse; they are largely unaware that there is an alternative way of feeding a baby. In the stepped-up tempo of our ultra-civilized society - our world of gadgets, psychoanalysts, synthetics, and tranquilizers - all too regrettably many of our young mothers fit into category number two.

Although one might bemoan the modem-day circumstances that mitigate against nursing, one cannot criticize the individual who does not nurse, for the simple reason that it isn't her fault. Sometime early in your pregnancy, you should discuss the possibility of nursing with your obstetrician. If you want to nurse and he believes that you can, then give it a try. There is no harm in trying and you will probably be surprised how easy and natural it is.

The Inconvenience of Nursing. Breast feeding is confining. It is inadvisable, as a general rule, to give a breast-fed baby more than an occasional bottle, for if you do so the baby will come to prefer the bottle, which provides sweeter milk at a faster rate. So you will be pretty much tied down to a three- or four-hour schedule for however long you nurse. This makes nursing inconvenient for the mother of other children and almost impossible for the mother who works. Obviously, a mother can nurse and raise other children at the same time; it just requires a little reshuffling of her daily routine.

How Long to Nurse. How long should you nurse? There is no universally right answer to this. Some aboriginal women nurse their babies for three or four years. Few American women want to continue after the seventh month, when the baby's first teeth appear. Actually any period in excess of three months is ample and laudable. Even a month is worthwhile. One or two weeks is perhaps better than not at all, though it would hardly be sensible to start to nurse with the intention of stopping so soon.

Regulation of Milk Supply. If nursing were difficult there would be far fewer people in the world today. It is an instinctive, natural act which requires little intelligence on the part of either mother or infant. Two basic facts with which you should be acquainted are:

(1) that the act of sucking is important in stimulating the milk to come in, and

(2) that the amount of available milk is automatically regulated by the baby's needs.

In the hospital, the baby is usually put to breast about twelve hours after birth and returned every four hours thereafter. Despite the fact that the baby will get no real milk in return for its efforts during the first few days, It is this sucking stimulus which initiates the onset of true lactation on about the third day.

As for the supply being regulated by the demand, it is important for you to realize that the strongest impetus for milk to re-enter the breasts is complete emptying of the breasts. A big hungry baby, for example, who needs, say, six ounces of milk every four hours, will empty the breast completely every time and this will promote the relatively large supply which this baby needs. But the tiny baby who needs only an ounce or two per feeding will not empty the breasts completely at first, so the production of milk will be slowed down. Nature has a wonderful way of dealing with all these little problems.

Technique of Nursing. So what do you do when about twelve hours after its delivery, the baby is presented to you for nursing? You will want to wash your hands in preparation for the baby's arrival and gently cleanse your nipples with warm water. Then if you put the nipple into the baby's mouth (on top of his tongue) he may begun sucking right away. If he doesn't seem to understand what is expected of him, stroke his cheek with your finger or with the breast itself and this will usually cause the baby to open his mouth and turn his head in the direction of the cheek which has been stroked. For the first few days the baby will probably not show much enthusiasm for two reasons, first because he is not hungry and second because you won't have much milk at this stage. If he tends to fall asleep you should try to waken him by tickling his feet or pretending to withdraw the nipple from his mouth for as mentioned above, it is important for him to suck in order that your milk will come in. If you have any difficulty whatsoever (and most women do) with these initial attempts at nursing, for heaven's sake don't feel embarrassed to ask for help. The nursery nurses are experts in this business.

After each nursing period is finished, prop the baby over your left shoulder or sit him in your lap and gently pat his back with your right hand. This ritual of “burping the baby” will bring up the air which is unavoidably swallowed while nursing, and which otherwise might cause the baby to vomit. Even so there will be occasional regurgitations until the baby masters the business of swallowing. If the entire feeding is lost, it may have to be replaced by bottle.

Frequency of Feedings. During the first few days the breast produces a rather thin yellow substance called colostrum. This is good for the baby too. It is not until the third or fourth day after delivery that the breasts become filled with real milk. The baby is put to breast every four hours and is allowed to suck for five or ten minutes at a time. It is advisable, even in the hospital, to nurse during the night, for this helps to promote lactation. At first only one breast should be offered at each feeding. The duration of each feeding can be increased gradually, in accordance with your doctor's instructions. Nursing is limited to five or ten minutes during the first week lest the nipples become cracked or tender. The baby will empty the breast of about. 90 per cent of its milk in this short time anyway. A variety of ointments can be used to protect tender nipples, but once they become injured by the baby to the point of being cracked, the entire success of the nursing program becomes endangered. It is therefore important that any tenderness or bleeding from the breasts be reported to the doctor immediately.

The obstetrician, the pediatrician, and the nursery nurses will help a new mother in her efforts to establish a satisfactory nursing regime, but in the end the schedule and the technique must be worked out on an individual basis between each mother and her baby. By the end of the first week it is usually safe to permit the baby to remain at breast for fifteen minutes and by the end of the second week twenty minutes.

Bear in mind this delicate balance: More frequent nursing with both breasts will on the one hand tend to increase the milk supply and on the other hand tend to increase the danger of nipple trouble. During the first few weeks it is probably preferable to protect the nipples by shorter, less frequent feedings from one breast only; thereafter the nipples should be tough enough to withstand more sucking.

Once you are home, it is better to nurse your baby “on demand” - i.e., when he cries - rather than sticking to a rigid schedule. Demand feeding can be overdone, of course, for the baby is not hungry every single time he whimpers, and certainly you should not nurse at intervals of less than two hours; but with patience, perseverance, and perception you will soon learn to recognize his needs.

Mind Over Matter. The principal fear of every nursing mother is that she will not have enough milk. For this reason it is customary in most hospitals not to tell the mother whether her baby is gaining weight or losing until shortly before her discharge home. Every newborn baby loses weight during the first few days anyway, no matter how much it is fed, and the knowledge that her baby is losing discourages most women. This discouragement in turn acts to diminish the milk supply still further and a vicious circle is started.

This control of the mind over the milk persists throughout the nursing process. If, for example, a woman nurses at 8 A.M. and then for some reason the baby cries for a few hours and she becomes worried and agitated by this behavior, she will probably have less milk for the baby at noon; if she then goes out to the movies and relaxes for a few hours, she will probably have a super-abundance of milk for the 4 o'clock feeding. This reflex between the brain and the breast eventually becomes so finely conditioned in the successful case that milk literally spurts from the mother's nipple at the sound of her baby's cry.

Breast Support. The need for wearing a bra during the nursing period depends on the size of the breasts. Generally, if the breasts are small a bra is unnecessary. But if the breasts are large or pendulous a good maternity brassiere is in order – night and day if it is more comfortable. These appliances are equipped with a variety of snaps and flaps that permit ready access for the baby without removal of the bra.

Cracked Nipples. The not infrequent combination of tender nipples and vigorous suckling may result in the formation of cracks (fissures) in the nipples, which will interfere with the nursing process. If allowed to progress unattended, this may lead to bleeding from the nipple or actual infection of the breast. As usual, the best treatment is preventative. The nipples must be kept scrupulously clean, a piece of dry gauze may be worn between them and the brassiere between feedings, and any dried milk should be removed from the area before nursing. If the nipples seem at all tender, report this to the nurse, who will provide you with an ointment to help toughen them. An effective old-fashioned remedy is the application of tincture of benzoin to the nipples. at night. A sun lamp may help after you've gone home.

If it actually becomes painful to nurse, a breast shield may be used. A breast shield consists of a conical piece of clear plastic with a rubber nipple attached to its apex. The plastic fits snugly around the nipple, the baby obtains milk by sucking the rubber nipple, and the mother's breast is thereby protected. Usually after using this device for a day or two the mother can resume nursing without further difficulty.

Maternal Infection. If the mother develops any form of infection it will become necessary to suspend nursing for fear of transmitting the infection to the baby. Meanwhile the breasts may be emptied every four hours either by manual expression, by hand pump, or by electric pump, thereby perpetuating the flow of milk. If the infection continues for more than a few days or is accompanied by a high fever, the milk supply may be curtailed to such an extent that later attempts at nursing will be defeated.

If you have to stop nursing suddenly, there is no medicine that will stop the production of milk. Just wear a good bra and, if your breasts are uncomfortable, apply an ice pack and take some aspirin. The discomfort will subside in a day or two.

Bottle Feeding

Advantages. Just as there are advantages to breast feeding, there are, of course, advantages to bottle feeding. The main physical advantage is that anyone can hold a bottle. The father, the nurse, the grandmother, and the baby sitter can all share in the chore, if it is considered a chore, or they can help out if the mother must return to a job. To this extent artificial feeding is less confining, though it might be said in rebuttal that motherhood itself is confining and it is the mother who does most of the feeding anyway, regardless of the method. True, your husband can give the baby a bottle at might, if you can get him out of bed.

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Modern-day formulas are scientifically designed to stimulate the nutritional values of breast milk. Millions of strong, healthy babies are raised every year on formulas prepared by the manufacturer or mixed at home from combinations of canned milk, sugar, and water. And the warmth and love which a baby craves in association with its feeding can be supplied while supporting a bottle too.

Equipment Needed. If you decide to bottle feed your baby you will need a formula and some paraphernalia to put it in and sterilize it with. The formula will be prescribed by your pediatrician. The paraphernalia you will have to buy in advance, preferably before you enter the hospital.

There are many kinds of baby-feeding equipment available. Since you will be using it for many months and probably for more than one baby, get all the advice you can before you buy. As basic prerequisites you will need about nine eight-ounce bottles, plus bottle caps or nipple covers, a sterilizer (or a large soup pot) in which to boil the formula, and a rack which fits into the sterilizer to support the bottles. Other essentials include a funnel, a nipple jar, and a bottle brush.

Preparation. When you were a baby, your mother probably prepared your formula from canned milk, Karo, and water. Now you can buy it already prepared – as a powder to be mixed with water, as a concentrate to be diluted with water, or as a ready-to-serve liquid. Needless to say, there is considerable variation in price. The ready-to-serve liquid, for example, costs seven times as much as the concentrate.

After the formula is bottled, it should be sterilized and kept in the refrigerator. Your mother would then warm it up before offering it to you; most modern babies drink it cold, just as you have learned to do.

Further information about preparing formulas may be found in any one of a number of baby-care books.

Technique. The administration of a bottle to a baby does not require much in the way of tutelage, but in case the experience is new to you, here are a few pointers. Each feeding should take about twenty minutes. The trick to arriving at this approximate interval is to adjust the tightness of the bottle cap and the size of the hole in the nipple to the sucking power of your baby. Don't expect him to take the same amount of formula with each feeding; the quantity will vary with the time of day and his mood of the moment. Don't force him to take that last ounce; he may not want it. Be sure to hold the bottle sufficiently upright so that the nipple is full of milk, not air, and remember to burp him once or twice per feeding. Above all, cuddle him while he's being fed; never prop the bottle.

The Newborn Baby

Helplessness. No matter how many nieces and nephews they might have, most women are surprised by the diminutiveness and helplessness of their first-born children. Newborn babies can't see, they can't make coordinated movements, they can't roll over, and they can't even raise their heads. They are only a little less dependent upon their mothers than they were before they were born. Among the few differences between intrauterine life and the first few weeks outside are that they will suck by instinct, they will breathe through reflex, they will defecate without volition, and they will feel pain. Satisfying their other needs is up to you.

Weight and Length. The weight of babies born at term ranges upward from 5 ½ pounds. The average weight is about 7 ¼ pounds, the average length 20 inches. If a baby weighs less than 5 ½ pounds at birth it is usually categorized as a premature infant.

Initial Appearance. The newborn may also look less beautiful in the flesh than he did in your dreams. As I said earlier, his head may appear misshapen because of its attempt to mold to the size of your pelvis. Various parts of his anatomy, especially the head and the feet, may be asymmetrical because of the particular positions they assumed in the uterus. There may be reddened areas on the baby's cheeks due to the forceps. The hands and feet may be quite blue. And whichever part of him delivered first may be swollen, due to the pressure upon it during labor. All of these physical alterations are transitory; most of them disappear spontaneously within two or three days.

The eyes of a newborn baby are closed most of the time, and they are apt to be a little reddened or swollen by the medicine which is instilled into them in the delivery room. This medicine is used to prevent eye infections due to bacteria in the birth canal.

The umbilical cord is usually clamped or tied about half an inch from the skin of the abdomen. It dries up and falls off all by itself within four to ten days.

The breasts of a newborn, male or female, may be a little swollen (for as long as a month) and there may be actual lactation due to diffusion from the mother s blood stream into the baby's, during the last days of pregnancy, of the hormones which produce lactation in the mother.

There are several soft spots in a baby’s head. The one above the forehead is the largest and most easily felt. These little fontanels, as they are called, and the cracks which run between them enable the skull to increase in size as the baby grows. They do not close completely until about the eighteenth month.

During the early weeks of life the baby may unwittingly scratch his own face. The obvious solution to this is either to trim the baby's fingernails or to wrap them in the sleeves of his shirt.

A few days after birth the skin of the baby may become quite yellow. Unless there is Rh or blood-group trouble this is usually the result of a normal physiological process which involves the destruction of the excess of red blood cells which most babies are born with. This type of jaundice should disappear within a few days. If it persists, call your pediatrician.

Weight Loss. Virtually all babies lose weight during the first few days. This loss is proportional to the weight of the infant; in the case of a seven-pound baby it is apt to be in the neighborhood of eight to ten ounces. The original birth weight is usually reached again by the end of the second week.

Circumcision. If you have a boy you will probably want him circumcised, Almost 99 per cent of parents want this done. The advantages are several. The first is hygienic; the circumcised male is much less likely to develop an infection of the penis. Secondly, the foreskin of an uncircumcised male may someday become swollen so that circumcision becomes an urgent necessity. Thirdly, it is a simple procedure at this age, and much more difficult in later life. And finally, cancer of the penis is known to occur only in uncircumcised men. Circumcision is usually done by the obstetrician when the baby is three to six days old, before discharge from the hospital.

The Premature. If your baby is born prematurely he may be placed in an incubator for a few days. Incubators provide more careful regulation of oxygen and humidity but - even more important - they also provide the scrupulous control of heat which these infants require. The premature infant is less able to control his own body temperature, and he usually tires too easily to permit breast feeding. If your baby is premature he will probably have to remain in the hospital after you leave and until he weighs at least five pounds.

Mistaken Identity. Cases of mistaken identity in the modem nursery are almost unheard of. Most babies are now braceleted at birth with plastic name tags and numbers which defy confusion. The baby's footprints are also taken in many hospitals.

The Pediatrician. The immediate care of a newborn infant falls to the obstetrician, who is quite expert at resuscitating babies and detecting gross abnormalities. Thereafter the obstetrician may elect to take charge of the baby's care in the hospital or he may designate a pediatrician to do so. The rationale for the latter practice is that the obstetrician is trained to take care of pregnant women; he can't be equally expert in the care of babies. If he attempts to assume this function too he becomes the pediatric equivalent of a midwife; in other words, he will be able to cope with the normal situation but will need help if complications arise.

Hospital Routines

The daily routine of a new mother follows a fairly standard pattern in most hospitals. You will probably he kept in bed for about twelve hours if you had regional anesthesia (caudal or spinal); otherwise you'll he up sooner. Limited activity is the rule. Although having a baby does not require any formal convalescence, you will notice a decided loss of stamina during the first weeks and you will find it wise to take advantage of this brief opportunity to rest and be waited upon.

Visiting Hours. The visiting hours will vary from hospital to hospital and will depend somewhat upon whether or not you are rooming-in with your baby and whether you are in a private or semiprivate accommodation. Most hospitals permit visiting by the husband (only) as soon as the patient returns to her room after the delivery. Further visits may be limited to several hours in the evening. No one other than you and the hospital personnel is permitted to fondle the baby for fear of the introduction of infection from outside sources. Children under twelve are excluded from maternity floors for the same reason. To the disappointment of many a proud father, photography of the newborn is often forbidden, to protect the baby from exploding flash bulbs.

Medical Routines. Your finger will probably be pricked in order to determine what effect, if any, the delivery had upon your blood count. An enema may be given in order to get the bowels working again. An analgesic drug such as codeine or Darvon will be available if you are uncomfortable, but you will probably have to ask for it every time if you want it. There is no harm in taking it, however, and no need for you to be in pain, so ask for it as often as you like. It is difficult to sleep in the hospital for many reasons, such as activities in the corridor and cries from the nursery. So don't be afraid to take a sleeping pill at night; you won't become addicted and it is important for you to get your sleep. Naps are encouraged in the daytime too; take advantage of them. The nurse will show you how to take care of your perineum, for it is important that it be kept as clean and dry as possible. Sanitary napkins and belts are usually supplied by the hospital. A heat lamp may be used once or twice a day, too, in order to promote healing of the episiotomy.

The Birth Certificate. The birth registrar will want to know the name you have chosen for the baby within forty-eight hours. It is surprising how difficult this decision often is. In case you have any trouble in this regard, let me give you two personal suggestions. Don't give the baby a family name. If this advice seems strange, let me assure you that it makes good psychiatric sense. Many are the victims of this practice who have unduly suffered from the inane subconscious life-long struggle to emulate their namesakes. And if you can't agree with your husband in the choice of a perfect name (as is usually the case), you can probably agree upon the plan that you name all the girls and he the boys, or vice versa.

Every birth in the United States is registered (by the obstetrician) with the state and federal Bureaus of Vital Statistics. Some states send “birth cards” or unofficial birth certificates to the baby's parents. In order to obtain definitive proof of the birth, however, you must apply for a certified copy of the birth certificate. This is done by writing to the Bureau of Vital Statistics of the state where the birth occurred, stating the baby's name sex? date of birth? parents' names, and the purpose for which the copy is needed.

The exception to this rule: births in New York City, where application must be made to the Bureau of Vital Statistics of the borough in which the birth occurred.

Preparation For Going Home

You will want clothes for yourself and the baby when you leave the hospital. Few women are quite ready to wear their ordinary clothes so soon after delivery, so must swallow their pride and wear a maternity outfit. As for the baby, this is an individual matter. A newborn baby's wardrobe may cost anywhere from $5 to $500, and I've seen a few that must have cost even more. Unless you have a staff of servants to take care of it, it is usually best to buy only the most rudimentary sort of layette. The grandparents and baby showers will provide most of the frills anyway and chances are they will rarely be worn.

The Layette. Under the age of six months a baby needs diapers, safety pins, shirts, nighties, a blanket, and that's all. Most mothers today elect to use disposable diapers, despite their adding to our pollution problems; if you are going to use cloth diapers you will need plastic or rubber panties to go with them. The simplest type of baby shirt is the classic button less model which ties with strings and has tabs which can be pinned to the diaper; six will do. Get half a dozen of the simplest possible flannel or stockinet nighties. Stay away from buttons and zippers and buy everything in size one. A knitted woolen one-piece suit is ideal for win.ter outings. Dresses, hats, stockings, booties, and the like are superfluous items which you will probably use only on special occasions.

The weight of the blankets will depend on the climate where you live. Home-knit ones are perfect. You will also need half-a-dozen mattress pads to put under the baby and a couple of waterproof sheets to cover the mattress.

The baby's bed is a matter of individual choice. If you still have your grandmother's cradle, fine; if you can borrow your neighbor's bassinet, better yet; but if you are going to have to buy something perhaps I can make a suggestion. To begin with, there are bassinets, cribs, youth beds, and adult beds. If you start with a bassinet you may find yourself buying all four – not a very economical approach. Since a baby is just as happy for at least three months in a wicker laundry basket, a dresser drawer, or any similar receptacle, a fancy bassinet is hardly essential. As a matter of fact he will be equally happy in a crib, which can be used for the first four years. He can then be graduated to an adult bed or studio couch, thereby shortening the list from four to two.

Bathinets are also optional equipment. They provide a nice table-height place to bathe the baby and a nice level surface on which to dress him, but it is just as easy to give the bath in a big enamel or plastic tub or even a sink, with a towel on the bottom to prevent slipping. In the bath area prepare a table, tray, or shelf with the toilet articles you will need: swabs, absorbent cotton, baby oil, soap. When not in use, keep the points of the safety pins buried in a cake of soap. Don't forget a diaper pail for under the sink.

Some people seem to feel that a baby carriage is as important as a high chair. Perhaps it is if you live in an apartment. Otherwise, however, I don't see the need for taking a baby out in the winter and a playpen will serve the purpose in the summer.

Baby scales are unnecessary. Weighing a baby after every feeding or even as often as once a day will lead to constant confusion. Healthy babies don't have to be weighed at home; your pediatrician will take care of this. If you can't resist weighing him or if someone insists on buying scales for you, make sure they are balance scales, not spring scales, and don't use them more often than twice a week.

The Final Exam. Just before your discharge from the hospital your doctor may perform a final pelvic examination. Since this is apt to be a moderately uncomfortable procedure at this time, especially in the presence of a healing episiotomy, and since there is little to be gained from it, many doctors prefer to postpone this exam until the postpartum visit in the office. If you have any last-minute problems or questions, however this is the time to ask them.

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Length of Hospital Stay. Years ago the maternity patient remained in the hospital for two or three weeks after delivery. She didn't even get out of bed the first week. It is now known that this protracted convalescence caused more harm than good. In the 1950s and 1960s the new mother stayed in the hospital for a week, but now the hospital room rates are so astronomical that most women go home in three to five days. This still seems precipitate, especially for nursing mothers, so you should stay a few days longer if you can afford it.

Health | Reproduction | Pregnancy


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