Some women do not produce much milk while in the hospital, but produce more when they return home. Until there is enough milk for the baby's needs, a supplementary bottle may be given, but only after (never instead of) breast-feeding. Substituting a bottle for breast feeding will actually prevent the development of a steady milk supply since the baby's sucking stimulates the breasts to produce more milk. Frequent nursing, therefore, helps to increase the supply.
It is useful to know before the baby's birth how to press out (express) milk from the breasts. Have a sterilized cup ready. Wash your hands and make sure they are warm. Sit comfortably at a low table with the cup on the table just under your breast. Massage the whole breast with both hands. Then, with thumb and forefinger of one hand, squeeze the milk reservoir deep behind the areola. Slide thumb and forefinger through 90 degrees round the areola and squeeze again, making sure that all the milk sacs are emptied. Meanwhile, with the other hand, massage the breast gently from top, side, and bottom toward the areola. In the hospital, a hand pump may be supplied with instructions on how to use it. Some hospitals use electric pumps. A close-fitting funnel is placed over the nipple, areola, and breast tissue, and the milk is withdrawn by gentle suction produced by the pump. An experienced nurse can provide useful suggestions on the use of the breast pump after the birth of the baby. Such pumps are well worth learning about as they allow the nursing mother increased flexibility, especially if she plans to return to work shortly after the birth of the child.
Engorgement may occur at the beginning of the milk-producing cycle. The milk-making cells enlarge following hormonal stimulus and an increase in the blood supply. The process lasts for two to three days and in many women causes the breasts to swell painfully. Cold compresses and a mild painkiller should relieve the condition. Nurse the baby frequently, applying warm compresses before feeding. Put a little oil on the breast and express gently.
A relaxed attitude is important to correct any insufficiency in the supply of milk. Follow a sensible diet and eat a little more than was necessary during pregnancy. Drink plenty of liquids, about five pints a day, especially before and during nursing. It is very important to drink at least a quart (four 8oz glasses) of milk a day. Get enough sleep and rest whenever possible. Apply hot and cold compresses before nursing. Let the baby nurse frequently, emptying the breasts at every feeding.
To prevent excess milk from gushing out, splash the breasts with cold water before nursing, then express a little milk before putting the baby on the breast. Slow the flow of milk to the baby by pressing against the areola with your forefinger and middle finger. The more milk the baby takes, the more the milk supply is stimulated, so do not let the baby nurse too long, and interrupt feeding frequently.
The milk may begin to "let down" when you hear your baby crying or when you are out and think about the baby. Fold your arms and press your fists firmly against the nipple and areola area until the tingling sensation stops. Lack of muscle firmness can also cause leaking. Splashing the breasts with hot and cold water before each nursing period can improve muscle tone. Make sure your bra fits firmly and always wear it.
Soreness, or even cracks that bleed, may develop if a baby sucks hard or chews the nipple. If this happens, nursing must stop temporarily, and milk from the breasts must be pressed out (expressed) into a sterile container at regular intervals. The milk should then be offered to the baby from a bottle with a small-hole nipple. A mother's sore nipples heal quickly if the baby does not nurse for about 48 hours. Expose the nipples to the air when possible or sit close to an ordinary light for a few minutes. Take a mild painkiller and use an ointment or spray as recommended by the physician. When the cracks have healed, the baby may be nursed again, but only for short periods at the beginning. Express a little milk first so that the baby finds it easier to mouth the nipple.
Consult the physician if a hard area persists in the breast after nursing and massaging; when a red, painful area, like a boil in the early stages, appears; or if your temperature rises suddenly and you start shivering. Physicians do not agree on whether a nursing mother taking antibiotics should continue to breast-feed. Each situation is different so it would be wise to follow your physician's instructions.
Hospitalization - Admission Procedures
The procedures you follow on admission to a hospital vary from one hospital to another, but basically the process is the same in most institutions in the United States.
Care of the Dying - Reaction of Children
A child's reaction to death depends on many factors. A child's first experience with death is often the death of a pet. A child under the age of eight cannot understand that death is irreversible and may expect the mother or father to bring the pet back to life. After the age of eight or nine, the child's understanding is usually as rational as an adult's understanding.
Care of the Dying - Moment of Death
Do not be alarmed if the patient's breathing makes a groaning or croaking sound. It does not mean that he or she is in pain. When a dying patient slips into a coma, the position of the neck and body produces the noise, which can be reduced by gently turning the patient's shoulders or body.
