Maternity and care of the baby : notes for mothers / prepared by the Victorian Branch of the British Medical Association and issued by the Commissioner of Maternity Allowances

Prepared by the Victorian Branch of the British Medical Association and issued by the Commissioner of Maiernity Allowances

MATERNITY

AND CARE OF THE BABY

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In a healthy woman with proper care and attention a confinement should be perfectly natural. The natural period of pregnancy in woman is about 280 days.

A simple method of calculating the probable date of confinement is by counting nine calendar months and five days from the last day of the last menstrual period.

Quickening occurs about the middle of pregnancy, but is by no means a reliable guide.

Diet should be simple and nourishing, containing milk, fruit, vegetables, and plenty of simple drinks. Alcohol in any form (wine, beer, or spirts) is harmful, and should not be taken.

The action of the skin should be promoted by taking warm baths and wearing warm clothing. A daily bath for cleanliness is advisable, using warm water in cold weather. The body should not be rubbed with oil or grease.

Dress should be warm, and should not constrict the body. Pressure upon the abdomen by tight or ill-fitting corsets should be specially avoided.

Special attention should be paid to washing the nipples daily during the last three months of pregnancy with warm water and soap. Oil, grease, or ointments should not be used upon breasts or nipples.

Pregnant women should avoid visiting persons suffering from serious or infectious diseases.

It is advisable that all pregnant women should consult a medical practitioner at an early date. Women who are deformed in any way, have abdominal tumours, or who have suffered from spinal or bone disease, should specially have early medical attention.

Miscarriage or premature delivery is more serious than natural confinement at frill time, and is likely to lead to disease of the generative organs. All possible causes of miscarriage should, therefore, be carefully avoided. If a pregnant woman suffers from any of the following symptoms she should at once consult a medical practitioner:—

The room should be bright and well ventilated, with as little furniture as possible. Linoleum should be used m preference to carpet.

There should be a separate single bed with firm mattress for the patient and another for the nurse.

At least two complete changes of bed linen, eight soft turkish towels, a sheet of mackintosh or American cloth 4 feet wide and long enough to go across the bed ; three binders li yards long and 2! inches wide; twelve diapers of soft material; 1 lb. of sterile absorbent wool. All these articles should be kept in a clean special box with lid to protect them from dust.

Several pieces of thread or narrow tape 2 feet long—to be boiled before using.

Water, which should be boiled, and some of which should be allowed to get cold in a clean jug, covered with a clean towel.

AH personal clothing, binders, napkins, towels, cloths, sheets, linen likely to come into contact with the genital organs should be sterilized. This is ejected by washing and then boiling for half an hour, and reboiling every time after using. After drying in fresh air, away from dust, they should be securely packed away in special bos.

At the beginning of labour pains the patient should have a warm bath and have the bowels emptied by an injection.

Should no medical attendant or nurse be present when the baby is born, the attendant should wash her hands well and tie the navel cord in two places, one 2 inches from the baby and the other 2 inches further along the cord ; then cut the cord between the ties. If there is any bleeding from the cut end, the cord should be tied again. The end of the cord attached to child should be covered at once with absorbent wool or piece of clean linen.

Fhe baby’s eyes should be washed with clean water, the child wrapped in a warm shawl, and placed in a basket or cot.

The patient should then be placed on her back, and the afterbirth allowed to come tway naturally. No attempt should be made to get the afterbirth away by pulling upon the cord ; after expulsion the afterbirth should be simply lifted away from the patient and put aside for inspection by the medical attendant.

The attendant should again wash her hands and wash the patient with clean warm water, drying with a clean towel. Diaper should be put on, sheets and nightgown changed, and the binder firmly applied. The patient is to be kept quiet and allowed to rest or go to sleep.

AFTER CONFINEMENT.

For the first, twenty-four hours napkins and diapers should be changed every few hours. The attendant’s hands must be carefully washed before handling the patient.

As the womb does not return to its natural size till eight weeks after confinement, every woman should avoid violent exercise or heavy work during this period.

Urine should he passed about eight hours after confinement and several times a day for the few days, If bladder cannot be emptied at end of twenty-four hours, medical assistance should be obtained.

The nipples should be washed before and after suckling, and have a clean soft cloth placed over them to prevent chafing.

The diet should be light for two or three days after confinement. Stout and other alcoholic beverages should be avoided while suckling ; they decrease rather than increase the milk supply. Plain ordinary food, including milk, fruit and vegetables, is of more value to mother and child than patent or proprietary articles.

Regular out-of-door exercise is the best means to improve the milk supply of the mother.

Bathe children frequently on hot days in cool baths. Comforters must not be used.

Files carry disease germs; protect the child and the food from them with mosquito netting.

All mothers are strongly urged to keep in touch with their doctors or nearest infant Welfare centres in order to k^eeP baby well. .

Babies under 6 lb. weight should only be oiled daily and not bathed until gaining in weight.

The temperature of the bath should be 100 degrees Fahrenheit. Test the water with thermometer or elbow.

Soap baby all over with the hand, wash off soap in bath and dry with soft towel, then dust skin sparingly with powder.

Put baby to the breast early—Jo not wait for the milk to appear. This stimulates the secretion of milk and draws out the nipples.

During the first 24 hours, after mother has had a good rest, baby may be put to both breasts for a few minutes every four hours but not during the night.

If baby cries much give him warm boiled water to drink. Do not give sweetened water, gruel or other substances.

Big babies want more than small babies ; they will refuse more when they have had enough. Die average feeding takes 20 to 25 minutes, each breast being used alternately.

Regularity is essential to success in infant feeding, loo frequent feeding causes crying, colic, and discomfort.

The first duty of a mother is to her baby. No other food can compare with breast milk-

Do not wean baby if the breast milk seems insufficient. Give what breast milk you have and make up deficiency with diluted cow’s milk under direction of doctor or infant welfare nurse.

Never let your breast milk disappear, be it ever so little. It may be the means of saving your baby’s life if summer diarrhoea should occur.

Cow’s milk takes longer to digest than human milk ; therefore, make the interval four hours when giving cow’s milk with the breast.

Signs of sufficient food.—A contented baby, sleeping well, a weekly gain in weight of 6 to 8 ounces up to six months, and 4 to 6 ounces after six months, warm hands and feet, and regular motions.

Signs of insufficient food.—A fretful baby, sleeping badly, with cold hands and feet, constipated or small loose motions, and failure to gain a reasonable amount of weight each week.

If test feedings show that baby is receiving insufficient food, complement the breast milk, after each breast feeding, with cow’s milk under direction.

It is sometimes possible to obtain a return of breast milk by regular suckling even when it ha* been lost. The advice of a doctor or infant welfare nurse should be sought.

REMEMBER.—Never wean baby because there is not enough milk in the breasts. Cow** milk and breast milk may be given together quite well if you give baby four hours to digest the cow’s milk. Do not substitute cow’s milk for one or more drinks from the breast during the day, for if you do you will lose what little breast milk. U^ou have ; give that little every four hours, and it will probably increase in Quantity.

You must not feed baby every time he cries, but feed by the clock, according to the following time-table* even if you have to wake him up :—

* Some babies do well on a four-hourly feeding interval from birth, especially if 8 lb. weight or over.

If the mother has no breast milk, or insufficient breast milk, dean fresh cow's milk is the next best food.

If possible, the milk should be drawn from cows tested with tuberculin and proved free from tuberculosis.

The chief danger of cow’s milk is the germs it contains. Mothers’ milk is free from germs. Cow’s milk, especially in the cities, is often stale and full of germs. This is the chief cause of summer diarrhoea, which kills so many babies in Australia during the summer. It is better to give mixed cow’s milk from a healthy herd than one cow’s milk.

If you are unable to get bottled milk, use an enamelled billy to keep the milk in, or a widemouthed jug with a smooth inside surface and a rounded bottom without comer*.

Boil the billy or jug for ten minutes. Do not use a dirty kitchen cloth to dry it after boiling. Turn it upside down and let it drain before you cover it over ready to receive the milk.

Germs grow more quickly in hot milk than in cold milk; so coo! the milk down directly it is milked, and keep it cold. Use ice if it is possible to do so. If ice is not procurable, stand the jug containing the milk in a basin of cold water, cover the jug with a piece of boiled damp butter cloth, letting the ends of the butter cloth hang down into the water. Put it in a Coolgardie safe or other cooler used for milk only. Keep milk clean, cool and covered from flies.

Never keep milk in the bedroom, on the bedroom window sill, or in the bedroom fireplace. Always keep it outside the bedroom, in the coolest place in the house, where air is moving freely.

Never try to keep milk warm for baby when travelling, or for the feedings at night; for the germs multiply in thousands if the milk is kept warm and it will poison baby.

Unless the doctor orders fresh milk it is safer to scald it. Put the jug containing the milk in a saucepan of cold water, the water being as high in the saucepan as the milk in the jug. Bring the water to the boil and keep it boiling for ten minutes. Then remove the milk, cool it down with running cold water, and keep it as cold as possible in the manner above described.

If baby’s only food is scalded milk mixture, strained and diluted fruit juice such as orange juice, or tomato juice if orange juice cannot be obtained, must be given daily beginning with ane-half teaspoonful in one tablespoonful of warm water, and increasing the juice gradually until the strained juice of one orange or large ripe tomato is given daily.

When giving milk mixture as in following Table i, Cod Liver Oil Emulsion (50 per cent.) should be given with or after each feeding, commencing with a quarter of a teaspoon[ui at the beginning of the second month of age and increasing to half a teaspoonful at the beginning of the fourth month of age. It should be omitted in warm weather, also if cow’s milk very rich in fat is being used.

(To be varied, if necessary, for individual babies, as directed by your doctor or infant welfare nurse,)

Household tablespoons and teaspoons vary and are unreliable, the teaspoon holding about double the amount contained in a standard teaspoon, therefore, if using a household teaspoon it is safer to halve the amount of sugar as stated in tables.

N.B.—Quantity of Mixture.—At the beginning of the third month change the intervals of feeding from three to four hours, thus giving five feedings, each of eleven tablespoonsful in 24 hours. Increase each feeding by one tablespoonful at end of each month. This is an average table and some large babies may need an increase of two tablespoonsful or a little more.

Strength of Mixture.—If the baby is found by weekly weighing not to be gaining weight satisfactorily when taking mixture given in 1 able 1 which contains quantities for a baby of average size, the strength of the mixtures may be increased and given in the proportions shown in Table 2. in the stronger mixtures where milk is very rich, e.g., in country districts, some of the cream may need to be skimmed before using for baby. The stronger mixture should be given under direction of a doctor or infant welfare nurse.

Use only easily cleaned bottles and large rubber teats. No tube should ever be used with tbs bottle. »

Pat battle in cold Water directly baby has finished. Leave "bottle in water until you have time

to thoroughly wash and boil it. To clean the bottle, rinse it thoroughly In cold water directly it has been taken from baby, then wrap it in a clean piece of flannel (to keep it from cracking) cover it with cold water in a clean saucepan, bring the water to the boil, and keep it boiling for five minutes, and leave the bottle in this water until the next feeding,

Hie teat must be boiled with the bottle after each feeding This is the only way to have a bottle and nipple free from germs.

Place the bottle of feeding mixture in vessel of hot water until warm enough to give to baby. Test the heat of the milk mixture by pouring it into a spoon and tasting it. Do not suck the teat.

Babies get thirsty in hot weather. Cold boiled water should be given in summer between the bottles if babies cry. Do not keep this water in the bedroom at night,

Put baby in the open air as early as possible every- morning, and let him have his bare legs and arms exposed to sun lor fifteen minutes at least each day. Do not expose him to sun or heat in hot Weather except in very early morning.

Do not keep baby in the kitchen when you are cooking, or in the wash-house when working there. Much heat makes the child weak.

The only air at night is night air ; therefore give it to baby in a pure state by opening window*

Do ont keep dirty napkins in same room as baby. Put them to soak in water when removed and cover to keep off flies ; afterwards wash and boil them.

Teach baby clean habits by holding him out after each drink. You cannot begin too early.

Do not put too much clothing on baby in hot weather. The binder should be left off as soon as

Long clothes are unnecessary. They interfere with the movement of the legs. Short-coat baby

A shirt, petticoat, cotton dress, and diaper are all the clothes necessary for a baby in hot weather.

Diapers should be of cotton cloth. They should be changed as soon as wet, and should be washed out immediately.

Every time baby’s bowels move, the parts should be well washed, and all the creases about the buttocks should be cleaned out and gently dried. 1 he baby is often made sore because not well washed, because powder is put on while baby is still dirty, and because the diapers are not washed out, but are only dried and put ori again.

BATHING.

. Baby should be regularly bathed every morning before 8 a.m. in water a little warmer than the body (100 deg. F.). Test the heat of the water with a bath thermometer, or by putting your elbow into it. Children have very tender skins, and are easily scalded.

If a baby becomes sick in hot weather, take off all its clothes except the diaper, and put on a night-dress, and put baby in a cot in a shady verandah.

If very feverish, put baby in a cool (not hot) bath, with a cloth wrung out of cold water on the head, and give as much cold boiled water as baby will take.

If baby vomits do not give any food; give sips of cold boiled water only for 24 hours, if he refuses the bottle do not force the child to take it, but give sips of cold boiled water.

Baby vomits and has diarrhoea because some poison has got into the stomach, and these are Nature’s ways of getting rid of the posion.

A dose of castor oil will help Nature. Give a teaspoonful to a baby of six months, and a dessertspoonful to a child of twelve months, unless otherwise directed by your doctor.

If baby has thrush, wipe the mouth out gently with a freshly boiled piece of linen so&Ml in boracic lotion (a teaspoonful to the pint) night and morning.

If buttocks become red, wash them with olive oil after bathing the child, then thoroughly dry the buttocks.

	Sex.	Weight.	Height.
r	Male ..	7.51b.	20.6 inches
	Female	7.1 „	20.5 „
j	Male ..	16 „	25.4
1	Female	15.5 _M	25 „
f	Male . .	20.5 „	29 „
‘5	F eniale	19.8 „	28.5 „
f	Male ..	22.5 „	30 „
	F emaie	22 „	29.5 „
r	Male . .	26.5	32.5 ..
'1	Female	25.5 „	32.5 „
J	Male ..	31 „	35 „
i	F emaie	30 „	35
	Male ..	35	38 „
“i	Female	34 „	38 „
i	Male ..	41 „	42
' 1	Female	40 „	41.5 „
l	Male ..	45 „	44 „
•s	F emaie	44 „	43.5 „
f	Male ..	49.5 „	46.5 „
\	Female	48 „	46 „
i	Male ..	34.5 „	48.4 „
■	Female	53	48 „
(	Male ..	60	50 „
	Female	57.5 „	49.5 „
i	Male ..	66.5 „	52 „
■)	Female	64 „	51.5 „
f	Male ..	72.5 „	54 „
a	Female	70 „	53.5 _M

Office oi the Commissioner of Maternity Ailewaices, Canberra. 1st December, 1928.

*FIRST FOUR WEEKS,	FOUR WEEKS TO SIX MONTHS,
6 a.m.	6 a.rn.
9 a.m.	10 a.m.
12 noon	2 p.m.
3 p.m.	6 p.m.
6 p.m.	10 p.m.
9 p.m.

	Amounts in Total Quantity of Mixture for 24 Hours.
A*®,	Cow; MHk.	Boiled Water.	Sugar of Milk.	If no Milk Sugar use Cane Sugar.	Total Quantity of Mixture (or 24 Hours.	Quantity of Mixture at each Feeding,	Interval between Feedings.	Number of Feedings in 24
	Standard T able-spoonsfui.	Standard T able-spoonsful.	Standard Level Teaspoon sful.	Standard Level Tea- spoonsful.	Standard Table- spoonsful.	Standard Tabie- spoonsful.	Hours.	Hours.
3 days .,	4	8	31	2	12	2 (- 1 oz.)	3	6
7 days ,,	10	20	8	6	30 (=» f pt.)	5	3	6
14 days .,	54\|	211	9	7	36	6 (- 3 ox.)	3	6
21 days ., At beginning of— 2nd month ..	194	22*	10	8	42	7	3	6
21 days ., At beginning of— 2nd month ..	25	25	m	9	50 11 pt.)	8§	3	6
3rd month ,.	27\|	271	121	10	55	ii	4	5
4tb month .,	30	30	131	11	60 (= Hot.)	12 ( == 6 oz.)	4	5
5th month . .	321	321	141	12	65	13	4	5
6th month ..	35	35 .	151	13	70	O r>. 1! -T	4	5

	Amounts in Total Quantity of Mixture for 24 Hours.
Ae«.	Cows Milk,	Boiled Water.	Sugar of Milk.	If no Milk Sugar use Cane Sugar.	Total Quantity of Mixture for 24 Hours.	Quantity of Mixture at each Feeding.	Interval between Feedings.	Number of Feedings in 24
	Standard Tile- spoonsful.	Standard Table-spoonsfu 1.	Standard Level Tea- spoonsful.	Standard Level Teaspoons ful.	Standard Table- spoonsful.	Standard Table- spoonsful.	Hours,	Hours.
At beginning nf— 4tn month ..	40	20	10	8	60 (- lipt.)	12 ( - 6 or.)	4	6
5th month .,	43	22	11	9	65	13	4	6
6th month ,.	46	24	12	10	70	14 (= 7 oz.)	4	6

NOTES FOR MOTHERS

MATERNITY

AND CARE OF THE BABY

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AFTER CONFINEMENT.

BATHING.

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