Nursing Woman

NURSING WOMAN, a woman who gives her breast milk wholly or partially for the feeding of other people's children. As a widely spread phenomenon, this institution is known since the most ancient times. Nursing women are mentioned in the fairy tales of all peoples, in Homer, etc. Nursing women play a noticeable role in foundling homes, in the history of which there are curious data on the regime for nursing women, methods of feeding their children, etc. Thus, in the Moscow and St. Petersburg foundling homes (the oldest documents on nursing women date back to 1797), a nursing woman usually fed only one child; but in summer, when women went to field work, the number of nursing women was sharply reduced, and each had to feed a second child (a "second child"); sometimes two nursing women fed 5 children, etc. In one year, 10,000–11,000 nursing women entered each of these homes; the money, goods, and food allowance they received was subjected to the most careful regulation. The reasons for turning to nursing women may be the absence of a biological mother, her illness, physiological or physical obstacles (absence or extreme insufficiency of milk), deformities or underdevelopment of the breast, nipple, and finally socio-domestic conditions, such as the previously widespread in bourgeois circles evasion of mothers from breastfeeding their children. Nursing women serve children's institutions, especially foundling homes, hospitals, etc., primarily for feeding sick children. The widespread propaganda of breastfeeding by a mother and the successes in artificial feeding, along with a change in the social setup, have significantly reduced the need for nursing women both in individual families and in institutions. The requirements imposed on nursing women are significantly higher than those on a nursing mother. In this regard, all those few diseases which prevent a mother from breastfeeding her own child (tuberculosis in a severe form, mental diseases, some acute infectious diseases) are all the more contraindicated for nursing women. But for nursing women, there is still a whole range of diseases and physical deficiencies which do not prevent a biological mother from breastfeeding. Besides tuberculosis, syphilis, and gonorrhea, these include skin and infectious diseases (e.g., trachoma), severe anemia, hysteria, as well as chronic constitutional diseases, such as heart defects, diabetes, kidney inflammation, and moreover insufficient development of the mammary glands and nipple. The choice of a nursing woman is complicated by the fact that a whole range of diseases may exist in a latent state in her and escape diagnosis. Some help in this regard is provided by the nursing woman's anamnesis and her family, and especially the mandatory examination of the nursing woman's child. Exceptional attention must be paid to syphilis, for which repeated R.W. (Wassermann reaction) must be performed on her. On the other hand, in order to prevent the child from infecting the nursing woman, the child and its parents must also undergo a thorough clinical examination and R.W. Due to the difficulty of determining syphilis in newborns (it often remains hidden until the 12th–14th week and longer), a negative R.W. by itself is not yet fully conclusive. Therefore, it is recommended not to take a nursing woman until two months have passed after childbirth, when the congenital syphilis of the child of the woman under examination may already manifest. In addition, in institutions, there is an increasingly decisive transition now to expressing the nursing woman's milk instead of breastfeeding. In the same way, in families, one should refrain from breastfeeding until the results of a comprehensive examination of both the nursing woman and the child are known. The most thorough check must also be made regarding tuberculosis, which even in the initial stages excludes the admission of a woman to feed another person's child. Besides health, other qualities of the nursing woman are of essential importance, especially good development of the breast, the shape and size of the nipple. As for the amount of milk secreted, external examination of the breast, checking by pressing on the breast, local increase in body temperature, development of the venous network on the breast are certainly not accurate indicators, and only a more prolonged observation with weighing the child before and after feeding can establish the amount of milk given by the nursing woman. The best check is also the appearance and development of the nursing woman's own child being fed. Besides the amount of milk, its quality is also essential, which is determined by laboratory and microscopic examination of its physical and chemical properties, namely specific gravity, fat content, protein, and sugar. However, a single analysis of milk does not give a completely correct judgment about it, since the composition of breast milk, even in a normal state, is subject to significant fluctuations depending on various circumstances (whether the sample is taken in the morning, evening, before or after feeding). The difficulty of analyzing breast milk and the variability of its composition force one practically to neglect chemical and physical analysis when choosing a nursing woman and to rely only on the amount of milk in the nursing woman's breast and the development of her own child on this milk. The age of the nursing woman's child is not of essential importance. The requirement that both infants be necessarily of the same age, judging by numerous observations, does not have much basis. What is more important is that the amount of milk of the nursing woman corresponds to the needs of the child being fed. Therefore, in those cases where the nursing woman's own child is strong and vigorous, while the other child is weak and will not be able to suck out all the milk of the nursing woman, and when at the same time insufficient attention is paid to emptying the breast by expressing, stagnation of milk may occur, which will lead to a decrease in its secretion and even its complete disappearance. In such a case, it is especially useful for the nursing woman to feed her own child along with the other child, since he will restore the function of the breast. Complete emptying of the nursing woman's breast, maintaining and developing her lactation capacity can also be achieved by expressing. The latter represents a great advantage for preventing infection from either side, and the lactation capacity of the nursing woman, as experience shows, does not decrease, often lasting up to 2 years. Finally, in recent years, milk depots have been formed, receiving breast milk from different women for feeding children in an institution or for distribution. Is the milk of a nursing woman equivalent to maternal milk, and what influence do their biological differences have? This problem is still not sufficiently studied despite a fairly large literature. In any case, the presence of protective bodies (antibodies) and various additional substances in breast milk has been established: enzymes, vitamins, and their composition and quantity are not the same not only in different women, but also in the same woman at different times and under different conditions. The difference in the biological properties of the milk of a biological mother and a strange woman has not yet been scientifically established, and empirically it is only known that such a qualitative difference (at the same amount) really exists. Therefore, maternal milk cannot always be replaced with the same success by the milk of any woman, but no precise criteria regarding the quality of milk when choosing a nursing woman can yet be established. As for the nutrition and general living conditions of the nursing woman, they naturally do not differ from the regime of a nursing mother; for example, food must be fresh, varied, and according to the taste of the nursing woman, to whom one should not impose unfamiliar dishes. Excessive consumption of milk and fluids leads to loss of appetite. Depending on the amount of milk given, food should amount to 4,200–4,800 calories. Familiar but not difficult work, alternating with rest and sufficient sleep, is absolutely obligatory. Finally, due attention must be paid to the hygiene of the nursing woman regarding cleanliness of the body, underwear, clothing, etc. The question of the working conditions of nursing women and the protection of their child stands apart. The children of nursing women, who in most cases are also "illegitimate," gave an exceptionally high mortality rate in pre-revolutionary Russia. Attempts by the state to protect their interests in Western countries did not yield practical results. However, even in the general labor legislation of the USSR, there are no special guarantees for the child left by the mother when she is hired privately as a nursing woman, which is a known gap. When a nursing woman is admitted to institutions, the admission of her child is obligatory for the latter, and its feeding is provided for by the instruction of the NKOZdrav dated May 20, 1924. The nursing woman's child must be maintained in the institution on general terms with other children. This same instruction regulates the working conditions of nursing women working by hire in institutions for the protection of maternity and infancy. Nursing women perform certain, lighter works in the institution, with a 6-hour workday and not less than a 6-hour night break between feedings; absence of a nursing woman from the institution is allowed only for a short time outside feeding hours with the permission of a doctor. Nursing women undergo periodic comprehensive medical examinations and are subject to the rules of internal order of the institution. Otherwise, general legal norms of labor legislation apply to nursing women, and in addition to wages according to the established Medsantrud tariff grade (and in some institutions also special payment for milk by weight), they receive food, accommodation, underwear, etc. Membership of nursing women in the trade union (Medsantrud) depends on their previous social status and other individual conditions.