Part 6 (1/2)

In the first place get together everything you will need for the bath and subsequent dressing. Have the clothes all laid in order over a chair-back before an open fireplace, or over a radiator, or if no better expedient suggest itself, fill bottles with hot water, or get a hot water bag and fill that, and lay it _over_ the clothes arranged in the order you will need them, beginning the pile with the dress and having the band the last.

Have _two_ large, soft towels and keep them warm. If possible, have an ap.r.o.n made of rubber cloth to tie about your waist.

At your side, on the floor, have a small blanket ready to lay over the rubber ap.r.o.n when needed. Put your baby basket where you can reach it, be sure that it contains all the things you will need--sponge, soap, powder, pins, vaseline, etc., and an extra diaper or two. Now get the tub (tin) and pour in the water until it is about four inches deep. Have the water no warmer than 100 degrees F. Bath thermometers are made that are quite cheap, and a great convenience; one should always be at hand, as no nurse should ever trust her feelings as to whether the water is hot enough or not.

Always test any water to be used for the sick or the delicate with a thermometer. Another point a nurse should be most careful about, is to be careful that her hands are warm before she takes the baby, as her cold hands on his warm flesh will surely make him scream.

All being now ready, take the baby and sit down with him, spreading the blanket over your knees as you do so, and having the tub just in front of you on another chair. The sponge is best to use for the was.h.i.+ng, but a piece of old table damask is very good.

Wash the eyes very carefully first, then the face, and dry on the towel. Now hold the baby's head over the tub and give that a good was.h.i.+ng with soap on your bare hand, and rinse it well with plenty of water, always holding the left hand under the head and neck.

Bring him back on your lap and thoroughly dry his head, then wash and dry the ears carefully.

When you get this far you may undress the baby completely, being most careful yet not taking any unnecessary time. When he is quite ready for the tub, grasp him firmly with the right hand, letting the b.u.t.tocks rest in the palm of the hand, the fingers being outspread, and the thumb coming up almost to the pubic bone. With the left hand hold the head and shoulders. Lower him _very_ gently into the water. Any sudden movement is most injurious, as a baby must never cry when the band is off, if it can be avoided. He will often put out both hands as if trying to catch hold of something. If he seems frightened at the same time, and cries violently, let the b.u.t.tocks rest on the bottom of the tub, and with the right hand hold both of his, and he will be comforted.

I think it well to wash the whole body with your bare hand, well soaped. Be careful to wash under the arms, in the bend of the elbows, the groins, and under the knees, rinse him with the wash cloth or sponge, and now lay one warm towel on your lap, and take up the baby just as you put him in, slowly, and without shock, and lay him in the warm towel. Lay the second one over him, and draw over all the blanket, wrapping him up warm and snug. Put your hand inside the blanket and dry him. This can be easily and quickly done without at all uncovering the child. Pa.s.s the hand with a slight squeezing movement over each arm and leg, and over the front of the body. When this is done, you must undo the blanket, and take the upper towel and dry most carefully all the creases, and powder everywhere, especially if he is very fat. Get down to the very bottom of every crease, and be sure it is dry and powdered. Lay over the navel a compress of absorbent cotton, unless the child is over four weeks old, and over this the band, which should be unhemmed, and wide enough to extend from the hip to the armpit. Lay the palm of your right hand firmly over band and pad and turn the child carefully, holding your right hand still under him, and with the left, clear away all damp towels, and then straighten out the band that is wrinkled under one side.

Keep your knees close together. Now take away the right hand, and see that the baby's knees are on the right side of your knee, and the elbows well over the other side of your lap. Now you have the baby where he can kick, but he can't wriggle or spring off your lap. See that the back is dry, rub it a little with your hand, and powder. Look carefully in the deep dimple just at the coccyx and see if it is clean. Now pin the band snugly, but not too tight.

Use the smallest safety pins, and never pin directly over the spine. Sometimes the abdomen is very large and it will be necessary to make two little tucks in the lower edge of the band in front to make it fit snugly.

While the baby is still on his stomach, lay in place the diaper, and next the s.h.i.+rt, which should be open in the front, and the pinning blanket. Lay all of these just as they should be, as regards the back, and turn him, being careful to hold all the clothes in place. If he is liable to chafe, or the movements of the bowels are in any way irritating, use vaseline about the b.u.t.tocks. Now put the arms in the s.h.i.+rt sleeves and tie or b.u.t.ton it up, and then pin the petticoat or pinning blanket. Lay an extra diaper folded many times under him, and fold the pinning blanket just in three, bring the hem up to the waist and pin in place.

The dress goes on feet first. Slip it on over the pinning blanket, and pa.s.s the right hand up under the b.u.t.tocks, and with the left, pull the dress into place, put the little hands in the sleeves, and get it perfectly straight and smooth over the chest. Now pa.s.s the fore-finger of the left hand down inside of all the clothes, beginning at the neck, until you find the band (the first garment), take a small safety pin or any small ornamental pin, and pin thoroughly through everything. This last pin I consider most necessary, as it keeps the dress, s.h.i.+rt, band and all in place.

Turn the baby over once more and put a similar pin in the back of the dress, being very careful to get at the band. While the baby is in this position put the blanket he wears during the day over him, and a final turn brings him around, and he is washed and dressed all but his mouth, which must be carefully washed with clean, warm water or borax and water. This should be also done many times each day, if the mouth is sore, and always a sharp watch kept for white patches on lips, cheeks and tongue. If the baby has hair to brush, it is well to brush it. It makes him look very cunning, but if he is tired or sleepy, do not trouble him.

This was.h.i.+ng and dressing should not occupy more than twenty minutes, I have done it in fifteen where the baby was very well behaved.

Be sure that the room is warm and that the windows and doors are kept closed. Do not allow admiring relatives to come and go, opening and shutting the doors as they do so. If they want to see the operation, let them come and stay. A baby should never be bathed in a tub until the stump of the cord is off and the navel well and strong. If there is any inclination to pouting of the navel, wash the child on your lap and do not take off the band until the rest of the baby is all washed, dried, and powdered.

Then take off band and compress, and put on fresh ones as quickly as possible, turn the child and pin as before directed.

In taking the clothing off, it is not necessary to turn the child at all, the band being the only thing pinned in the back.

N. B.--This method of bathing is for a normally healthy child, from the time it is one week old, until it is six months or more.

Until the stump of the cord has sloughed off, a baby should never be put into the tub. If after the stump has sloughed there seems to be any protrusion, or indeed any ulcerated look about the naval, it is best to bathe the child on your lap. In all such cases undress the baby as previously directed, until you come to the band (flannel belly band). Wash, rinse, wipe and powder him, being careful to make every part absolutely clean and dry. If the band is soiled or wrinkled, or out of shape in any way, remove it and put on a fresh one--looking every day, after three days, to see if the stump has come off--and if it is still adherent, being most careful not to disturb it in any way. Apply the fresh band immediately. Turn the baby on its stomach, and when the back is exposed, wash and rub the back gently with your warm hand. If the band does not need changing, unpin it, rub the back, pin it up again, and proceed in dressing as before. When the cord is once fairly off, and the navel smooth and clean, you can put the baby into the tub, very gently, slowly, and cautiously, remembering that a sudden movement on your part may, in fact, always will make him scream, and screaming with no band or compress on is for a baby a very frequent cause of umbilical hernia. If the cord is small when the child is born, there will be less danger of hernia, but if it be a large one, then beware! It will not always be your fault if the baby's navel is not small and flat when you are leaving your case, but you will always be blamed for it, if it is not. Notice carefully every morning when you bathe the child if there is any umbilical protrusion, and report it without delay to your doctor, if there is any, no matter how slight. This is not, however, the place to treat of umbilical hernia, and we will go on with the was.h.i.+ng, If the child's skin is very tender, chafing easily, wash with castile soap suds, rinse and dry carefully, after every time he urinates, as well as when you bathe him.

Powder with talc.u.m powder. Sometimes no powder will do it any good, then try vaseline. If that will not do, ask the doctor if you can try oxide of zinc ointment. Ordinarily, extreme care in was.h.i.+ng, drying and powdering will be sufficient, but it must be done every time the diaper is changed. In this, as in other things, eternal vigilance is absolutely necessary.

When the baby is about two or three weeks old, it is a good plan to put some alcohol into the water in which he is bathed--two or three ounces to the amount of water used in bathing. Have a small bowl of cooler water, 70 degrees to 80 degrees, for the face, and after that is washed, add a tablespoonful of alcohol to that also, for the head. It helps to toughen the skin, and prevents the baby from taking cold so easily.

If the baby seems much frightened by being put into the tub, spread a bath towel or small thin blanket over it and have someone hold his hands, so that he will not clutch so wildly at everything, then lower him into the water, towel and all, and he will not notice it so much.

I know of no place where deftness of handling shows to such advantage as with a baby. He knows well enough if he is handled properly or not, and his fretful cry, or violent screams, will tell you without delay if he is not comfortable.

Once more, let me impress upon the minds of all who read this, the necessity of having everything used about the tub and subsequent dressing, warm. Anything cold will make the little one scream, and I think all nurses will agree with me, that there is no more nervous work than was.h.i.+ng and dressing a baby who is crying (and once he begins, he is only too apt to keep it up during the entire time). This is especially true if a weak, ignorant mother is made nervous by the noise, or a doting grandmother hovers about, making remarks about ”new fas.h.i.+oned ways,” and wondering why this child should cry when his mother was always so good, as a baby, in her bath.

Now, as to the time of was.h.i.+ng a baby. The morning is unquestionably the time, but if the baby be very young (less than two weeks) and has been wakeful during the night, I would let him have his nap, even if it did delay you and interfere with your plan of work. If he sleeps he is comfortable, and, unless for some more serious reason than the bath, he ought not to be disturbed.

This, for babies in private practice. Hospital babies cannot be so tenderly cared for. When there are ten or eleven to be washed in one morning, choose, of course, the ones that are awake, as far as you can, but there will always be one or two sleepy, warm little ones about whom you will have some twinges of conscience as you begin to wash their faces, but the work presses so, it must be done.

A baby should not be bathed just after nursing, or when he is hungry. Yet, most little babies go to sleep at the breast, and very often do not waken until they are once more ready for eating.