RECAPITULATION.
To give a woman the greatest immunity from suffering during pregnancy, prepare her for a safe and comparatively easy delivery, and insure a speedy recovery, all hygienic conditions must be observed.
The dress must give:
1. Freedom of movements;
2. No pressure upon any part of the body;
3. No more weight than is essential for warmth, and both weight and warmth evenly distributed.
These requirements necessitate looseness, lightness and warmth, which can be obtained from the union under-clothes, a princess skirt and dress, with a shoe that allows full development and use of the foot. While decoration and elegance are desirable, they should not sacrifice comfort and convenience.
Let the diet be light, plain and nutritious. Avoid fats and sweets, relying mainly upon fruits and grains that contain little of the mineral salts. By this diet bilious and inflammatory conditions are overcome, the development of bone in the fetus lessened, and muscles necessary in labor nourished and strengthened.
Exercise should be sufficient and of such a character as will bring into action gently every muscle of the body; but must particularly develop the muscles of the trunk, abdomen and groin, that are specially called into action in labor. Exercise, taken faithfully and systematically, more than any other means assists assimilative processes and stimulates the organs of excretion to healthy action.
Bathing must be frequent and regular. Unless in special conditions the best results are obtained from tepid or cold bathing which invigorates the system, and overcomes nervousness. The sitz-bath is the best therapeutic and hygienic measure within the reach of the pregnant woman.
Therefore, to establish conditions which will overcome many previous infractions of law, dress naturally and physiologically; live much of the time out of doors; have abundance of fresh air in the house; let exercise be sufficient and systematic; pursue a diet of fruit, rice and vegetables; regular rest must be faithfully taken; abstain from the sexual relation. To those who will commit themselves to this course of life, patiently and persistently carrying it out through the period of gestation, the possibilities of attaining a healthy, natural, painless parturition will be remarkably increased.
If the first experiment should not result in a painless labor, it, without doubt, will prove the beginning of sound health. Persisted in through years of married life, the ultimate result will be more and more closely approximated, while there will be less danger of post partum diseases; and better and more vigorous children will be produced.
Then pregnancy by every true woman will be desired, and instead of being a period of disease, suffering and direful forebodings, will become a period of health, exalted pleasure and holiest anticipations. Motherhood will be deemed the choicest of earth’s blessings; women will rejoice in a glad maternity, and for any self-denial will be compensated by healthy, happy, buoyant, grateful children.
Elizabeth Cady Stanton, in a lecture to ladies, thus strongly states her views regarding maternity and painless parturition: “We must educate our daughters to think that motherhood is grand, and that God never cursed it. That the curse, if it be one, may be rolled off, as man has rolled away that of labor; as it has been rolled from the descendants of Ham. My mission among women is to preach this new gospel. If you suffer, it is not because you are cursed of God, but because you violate his laws. What an incubus it would take from woman could she be educated to know that the pains of maternity are no curse upon her kind. We know that among the Indians the squaws do not suffer in childbirth. They will step aside from the ranks, even on the march, and return in a short time bearing with them the new-born child. What an absurdity, then, to suppose that only enlightened Christian women are cursed.
“But one word of fact is worth a volume of philosophy; let me give you some of my own experience. I am the mother of seven children. My girlhood was spent mostly in the open air. I early imbibed the idea that a girl is just as good as a boy, and I carried it out. I would walk five miles before breakfast, or ride ten on horseback. After I was married, I wore my clothes sensibly. Their weight hung entirely on my shoulders. I never compressed my body out of its natural shape. When my first four children were born, I suffered very little. I then made up my mind that it was totally unnecessary for me to suffer at all; so I dressed lightly, walked every day, lived as much as possible in the open air, ate no condiments, and took proper care of myself. The night before the birth of the child I walked three miles. The child was born without a particle of pain. I bathed it and dressed it myself, and it weighed ten and one-half pounds. The same day I dined with the family. Everybody said I would surely die, but I never had a moment’s inconvenience from it. I know this is not being delicate and refined, but if you would be vigorous and healthy, in spite of the diseases of your ancestors, and your own previous disregard of nature’s laws, try it.”
Every woman can not attain to as perfect health as Mrs. Stanton, for all have not as good conditions of heredity, nor did all learn early that “A girl is as good as a boy.” Mothers in earnest for the best good of their children, will by constant purpose and deliberate effort, approximate the high standard she established, and emulate her example in using the means to enhance desired results.
“For life is not to live, but to be well.”
CHAPTER XIII.
PARTURITION.
The hour arrives, the moment wished and feared;
The child is born by many a pang endured!
And now the mother’s ear has caught his cry;
Oh! grant the cherub to her asking eye!
Labor is effected by dilatation of the cervix uteri and contraction of the uterine and abdominal muscles. This dilatation is the first stage. In the second, expulsive efforts occur, causing the advance and birth of the child. The action of the uterus in expelling the fetus is analagous to that of the rectum in expelling its contents. In each case the abdominal muscles powerfully co-operate with the peristaltic action of the organ. Uterine contractions, once established, continue intermittently until the contents are expelled. These contractions are usually attended and recognized by pain. They are called labor pains.
It is well established by physiologists that the suffering attendant upon labor is abnormal, and only a result of the violation of nature’s laws; that by a more or less thorough compliance with those laws, most women can approximate to a condition in which there shall be no suffering in childbirth.
A few days preceding labor, there is usually a muco-sanguineous discharge from the vagina. This is called the show. It indicates dilatation of the cervix and relaxation of the vagina. It is often accompanied by malaise and restlessness, and in some by headache and loss of appetite.
In 96 per cent. of all cases, the head of the child is the presenting part. At first the long diameter of the head is in the oblique diameter of the pelvis; as it passes the pelvic brim, it turns so as to lie across from back to front, the chin pressing upon the breast, and the crown of the head advancing. The first pains are grinding, scattered and irregular, felt mostly in the anterior portion of the pelvis and groin. With these, dilatation of the os progresses, which is often accompanied by severe sufferings, especially when diseased conditions exist. Afterward the pains are in the abdomen. As the head advances there is great suffering in back, hips and groin, with a disposition to bear down.
This disposition need never be urged by attendant, nor forced by the patient. Old ladies often say, “Bear down! make an effort!” supposing that this will facilitate labor. The fact is that these attempts to assist nature are retarding instead of helpful, and are often the cause of accidents. Nature indicates all effort essential to progress.
The bag of waters consists of the membranes which enclose the fetus and liquor-amnii.
Protruding through the os, when dilatation is effected, it precedes the head, prepares the way for it, and lessens the liability of contusion of the soft parts. These membranes usually rupture with an expulsive effort, before the close of the labor. The uterus then contracts firmly on the body of the child, and labor advances rapidly to completion. In rapid labor, however, the bag is sometimes expelled entire with the child.
The physician requires the assistance of but one attendant besides the husband. This should be an educated nurse or a friend, who can command herself in emergencies. The old time custom of having a neighborhood party on the occasion of an increase of the family, has happily gone out of date.
When this custom was in vogue both patient and physician were often seriously annoyed by the crowd of neighbors who thronged the house. Many times the grand “set out” for the table was so expensive as to take the whole month’s salary of the working man, while perhaps the “doctor’s bill” remained long unpaid.
Conversation should be cheery and foreign to the occasion. Obscene anecdotes and direful childbirth experiences should be avoided. During the entire process of parturition, the patient should have the advantage of pleasant, comfortable and sanative surroundings. Her mind should be free from care and anxiety. The best in the house should be appropriated to her use. Her room should be light and airy.
Every necessity and convenience should be in readiness for the occasion. Provide two yards of rubber cloth for protecting the bed, a fountain syringe, a hot water bottle, safety pins, antiseptic absorbent cotton, glycerine, arnica, ammonia, carbolic and castile soap, calenduline, olive oil, and cosmoline. Also have an abundant supply of soft rags. They should be large and clean. Remove the seams and buttons. Old sheets torn in quarters or pillow slips are the most desirable.
Make the bed as if one were going to sleep in it. Place the rubber cloth over the under sheet. Cover it with an old quilt or comfort that will wash easily. Have the bed set out from the wall so that both sides can be used. Prepare the side for the patient that will enable the physician to use the right hand.
Let the patient wear the garments she desires to have on after confinement, having care to protect them by folding back smoothly, and fastening a sheet loosely about the waist. After labor begins, she should take only liquid food. The bladder should be relieved frequently. If the bowels have not been moved within twenty-four hours, a copious enema of warm water should be taken.
Until the last stage, the patient can assume any position affording the most comfort. Usually, she is inclined to change frequently, sitting, lying, walking and even kneeling. When expulsive efforts occur, she ordinarily prefers to recline upon her back, with knees flexed and hips elevated. At this time, she naturally pushes with her feet, and pulls with her hands. A padded box should be firmly fixed at the foot of the bed for the feet. She can grasp the hand of an assistant, or have some reliable mechanical contrivance for her hands. The simplest is a strip of new muslin, ten inches wide, put around the foot of the bed, and tied, leaving it the desired length for a good purchase. In a prolonged labor, the obstetric harness is the most valuable assistance. This is a padded belt for the back, with straps extending to the knees and feet. From the knees are counter straps, with handles for the hands. With this simple contrivance, a physician requires less assistance.
Supporting the perineum is not only absolutely unnecessary, but also apt to be exceedingly injurious. Meddlesome midwifery is always to be deprecated. A natural labor needs no manual local interference. Although many authors and teachers recommend support to the perineum in the last stages, yet more ruptures may be attributed to this practice than to leaving it entirely untouched. A Canadian physician asserts that he has attended 1,700 women in confinement without giving support to the perineum, and yet in no case did rupture occur.
When the head is born receive it in the hand and support it until the shoulders are expelled. If the next contraction does not bring them, put a finger in the axilla of the child, and make slight traction. The whole body will soon be born. Pass both hands under the child and lay it as far from the mother as possible without stretching the cord. Place it upon the right side, shoulders and head slightly elevated. Wipe any mucus there may be from mouth and nostrils. Cover baby with a warm, soft flannel. Make the mother comfortable. Change her position, straighten the bed, put dry cloths to her, give her a drink, etc., leaving the infant until the pulsation has entirely ceased in the cord. This will require from ten minutes to half an hour.
Usually, as the child is ushered into the world, it sets up a lusty cry, indicating that respiration is established. Crying is not essential, as some authors claim, and the prompt covering usually causes it to desist. If it does not breathe at once, a little brisk spatting on the breast and thigh may establish respiration. If this is not effectual, dash cold water in the face and on the chest. Still failing, artificial respiration must be established. To do this, close the nostrils with two fingers, blow into the mouth, and then expel the air from the lungs by gentle pressure upon the chest. Continue this as long as any hope of life remains.
Sever the cord when pulsation has entirely ceased in it. Use a dull pair of scissors, cutting about two inches from the child’s navel. Following these directions, no tying is essential. This method has its advantages. By tying, a small amount of blood is retained in vessels peculiar to fetal life. This blood by pressure or irritation may prevent perfect closure of the foramen ovale, and be a cause of hemorrhage. Besides, it must be absorbed in the system, causing jaundice and aphtha, so common in young babes. Prejudices exist against adopting this treatment, as it is contrary to that usually adopted.
I first heard of this manner of treating the cord in 1870. It was so clearly explained that I was convinced that leaving the cord untied would result in great gain to the child. Still, my education and habit had been to the contrary, and my prejudices prevented my venturing upon the new method. A few years after this I met a German physician who had not tied a cord in eighteen years. He said: “Don’t be afraid; your babies will do better, and there is less danger of losing them.” I tested it and proved to my own satisfaction that it is the best method. One has only to recollect to wait until the pulsation in the cord ceases entirely, and sever as before stated.
By no means wash and dress the baby as soon as it is born. Consider the marvelous change that has taken place in all its functions. Respiration is established and the blood, instead of going to the placenta for oxygenation, goes to the lungs; the stomach and all the organs of digestion and elimination are brought into action; the skin, also, with its innumerable perspiratory ducts, begins its work. Give nature time to establish these processes before the system is taxed by being washed and dressed. An Indian papoose might be plunged into water at once without detriment, but no white baby of this country has sufficient vitality to safely undergo this shock. Rub the baby all over with olive oil, cover warmly, and leave it to rest and sleep.
While the baby is resting the mother demands especial attention. Contractions of the uterus will soon be renewed to expel the placenta. Usually these do not recur for half an hour, and it may be two hours before the after-birth is expelled. Should there be no hemorrhage and the walls of the uterus contract, there is no cause for uneasiness.
For expelling the placenta contractions can be induced by laying upon the bowels cloths wrung from cold water, or by manipulating the abdomen after dipping the hands in cold water. Also, the patient may blow into her closed hand, or give a slight cough. If there is hemorrhage, the vein of the umbilical cord should be injected with cold water. This, in many cases, removes a retained placenta. This valuable suggestion is a fact unknown to many practitioners. The placenta does not adhere as often as some suppose. If attached there is seldom danger from delay in removal, unless there is hemorrhage. After it is expelled it should be burned or buried.
The mother must be bathed in tepid water, sponging carefully her back, abdomen, thighs and perineum. Lay a cloth to the vulva wrung from a lotion of arnica, one tablespoonful to a quart of water. If there is soreness in the pelvic region a compress wet in the same lotion can be worn.
The parturient woman requires no bandage. If a compress is needed a towel can be pinned around to keep it in place. Also, if there is discomfort from undue enlargement and relaxation of the abdomen, a bandage applied loosely will give relief. Otherwise no bandage is essential. The common belief that it restores a woman’s form is a mistake. She returns to her former size better without than with it. If worn at all snug it is likely to cause inflammation that will produce bloating. It also presses the uterus down in the pelvis and in the relaxed condition of all the parts may cause prolapsus uteri. The frequency with which prolapsus occurs may justly be attributed to the unnatural pressure thus exerted. A parturient woman makes a more speedy and excellent recovery without the bandage.
After the bath, change the soiled quilts and cloths for fresh ones. Apply a large cloth over the arnica cloth at the vulva, make the bed look tidy, and leave the patient to rest. The house should be made quiet and every means used to encourage complete repose. If it is night, let the attendants retire and darken the room, the nurse remaining within call.
In case of thirst let her have cold or hot water, weak tea or thin gruel, as she feels inclined. Ordinarily she needs no remedies. Nature simply demands rest. Only a few years since a woman was not allowed to go to sleep until she had taken a bowl of panada and the inevitable dose of castor oil. One woman told me she dreaded the castor oil more than having the baby. It is unnecessary and likely to produce harm. For a few days torpidity of the bowels is natural, and if forced to action, inflammation and piles are likely to result. Surgeons have long been familiar with this same state of the bowels in other cases. Constipation is the natural sequence of amputation or fractures. The system rallies to meet one great demand and temporary torpidity of the bowels may be expected. Do not be influenced to take any drug. Simply rest. Surely at no time in one’s life is rest so sweet.
The long months of anticipation, doubt and endurance are over, the hour long feared has culminated in the bestowment of a gift which an angel might receive with rapture. A babe, the object of woman’s profoundest and most sacred passion has been given her for her very own, to nourish, guide, develop and instruct, of which even death cannot rob her. A solemn joy beyond words fills her soul, which none should needlessly disturb.
He comes—she clasps him; to her bosom pressed,
He drinks the balm of life, and drops to rest.
CHAPTER XIV.
DYSTOCIA.
In difficult labor a physician’s skill and knowledge is imperatively demanded. Yet a few practical hints for emergencies may be advantageous.
Presence of mind, with the knowledge given in the preceding chapter, will enable even an inexperienced person, in the chance absence of the doctor, to conduct a case of natural labor satisfactorily.
Prolonged and difficult labor may occur when one has not had the benefit of the “fruit diet” and other hygienic measures herein recommended, or who on account of disease and deformity, has not been able to accomplish desired results. In malformations of the pelvis, in face or shoulder presentations, placenta previa, etc., surgical interference will be required.
Muscular contractions may be inefficient or the os slow to dilate from rigidity. Caustic treatment, so prevalent for ulceration, destroys the natural elasticity of the cervix. Severe and prolonged suffering without dilatation is often the consequence. (See Chap. XXI.) Few women realize the injury done by the prevalent use of caustic treatment. One lady told me that she had been treated by eleven physicians, every one using similar measures. At last in despair she “gave up doctoring,” and by hygienic methods had attained to a comfortable degree of health. The time must come when people will protest against the burning of mucous surfaces as they now protest against blistering and bleeding, which only a few years since were universal.
The head advancing may meet with resistance from dryness, heat, and rigidity of external parts.
The hot sitz-bath is the best temporary means to overcome rigidity of both os and vulva, and to relieve pains that are neuralgic in character. Seat the patient in a sitz-bath tub, containing very hot water, her feet also in a hot foot bath. Envelop her with blankets and increase the temperature of the water by pouring in hot water as she can bear it. Let her remain until profuse perspiration is induced. Dry her under the blankets and let her lie down without removing them. Sometimes she can remain in the bath an hour with advantage, though a shorter time is usually sufficient. The pains entirely or partially subside, and she seldom fails to fall into a refreshing sleep. Local relaxation will be accomplished, the pains assume an effective character, and a speedy termination of the case can be expected. To accomplish the desired result, the bath must be hot, not warm, and continued until perspiration is induced. When prolonged labor is caused by rigidity of the soft parts, good and speedy results are sure to follow. The following cases prove the value of the hot bath:
Mrs. N—— engaged my services for her seventh confinement, stating that I might expect a tedious case, as in all previous labors the skill of physicians had been baffled. She had lingered in labor from 48 to 96 hours, attended with convulsions and other distressing symptoms; several times had been delivered with instruments. Summons came for me on a bright June morning at 5 o’clock. She had had irregular pains all night, was very nervous and had great dread of her sufferings, having no hope of relief for at least two days. I found no dilatation, and no real contractions were taking place.
I gave her remedies, hoping to arrest the suffering until relaxation could be produced, and left her. At 10 o’clock I returned, armed with one of Dickens’ novels, for a two days’ pastime. Found the pains increased in severity, attended with rigidity of os, still no dilatation, but pressure of the uterus upward. Although a woman of great self-control, she could not repress the most piercing screams with each pain. A hot sitz-bath was administered, increasing the temperature until most copious perspiration was induced, after which, enveloping her in blankets, I bade her sleep, while I sat down to Dickens.
She obeyed orders, slept soundly, having contractions every fifteen minutes, when she would rouse and exclaim, “What relief!” “Heaven surely can be no sweeter than this rest!” “What a blissful change!” I would say, “Don’t talk, don’t bear down, sleep all you can,” and still read Dickens. About one o’clock expulsive pains came on. Examination revealed full dilatation of cervix, and head advancing. At 3:30 P. M. the child was born, no spasms, no instruments, and no medicine had been required. This is only one of many that I have seen relieved in the same way, and always find the bath effectual where there is no deformity of the pelvis. I am confident that this hot bath, if generally used, would save thousands of instrumental deliveries.
Mrs. N. was a very grateful patient, and believes that the same means would have given relief in former labors, as the first symptoms were the same. The only unpleasant sequel in the case was, the novel remained unfinished.
Mrs. L——, primapara, aged thirty-three, a severe, tedious labor, with slow dilatation. Gave the hot bath with the happiest effect; patient, nurse, and all but the husband went to sleep. Contractions continued, accompanied by profuse perspiration, but for two hours did not awaken the patient. Expulsive efforts finally setting in, labor was completed in one hour. It was, however, almost immediately followed by violent hemorrhage inducing fainting. Examination revealed the placenta attached, the fibers so closely adhering to the uterus that the least attempt at removal caused the greatest suffering. The placenta was grasped and partially brought down into the cervix. By this interference the hemorrhage was arrested, and the placenta allowed to remain for about twelve hours, when it was expelled without any assistance. The patient made a rapid recovery.
At first I feared that the excessive relaxation from the bath caused the flowing, but became convinced that it was only exposure of the bloodvessels from the partial adhesion of the placenta. Its removal from the body of the womb allowed the organ to contract upon the exposed bloodvessels, and consequently the hemorrhage ceased.
The hot bath is also effectual for flagging pains that are annoying and worrying, and “seem to do no good.” In such cases the patient takes a long rest after the bath, and real contractions and expulsive efforts may not occur for hours or even days. This gives nature time to overcome all obstacles, and the final termination is more satisfactory.
Ergot and cohosh are administered by physicians of all schools for insufficient contractions. These cause violent uterine contractions and great expulsive efforts. If the soft parts are relaxed, labor will be facilitated. If not, great injury may be done. Rupture of the uterus and laceration of the perineum are frequently the consequence. The effects after confinement are liable to be even more disastrous. Among these are violent hemorrhage, puerperal peritonitis which runs a rapid course, cellulitis, milk leg, nervous chills, gathered breasts, etc. These drugs are well understood to be poisonous to any one in a normal state. Surely no reason can be given why a parturient woman may hope to escape their dire effects. Without doubt they lay the foundation for many chronic uterine ailments. Please mark the following, which are only a few of the toxicological symptoms of these drugs taken by a person in health.
Ergot induces rigors, pinched, pale countenance, extreme anxiety, great fear of death, violent headache, stupor, loss of voluntary motion, spasmodic jerking, sudden paralysis, debility and fainting, cold, dry, shriveled skin, knotted veins, tongue cold, livid and pale, vomiting violent, enlargement and pain in the liver, watery diarrhea, swelling of the limbs with cold surface, violent, cramp-like, intermittent pains in the pelvis and groin, hemorrhage, congestion of the womb, local gangrene.
Macrotis, or black cohosh, causes weak but rapid pulse, pains in the back with debility, rheumatic pains in the muscles, limbs seem powerless, drawing pains with trembling, great restlessness, headache with soreness of the eyes and of the base of the brain, heat and pain in the top of the head, dimness of vision with objects floating before the eyes, prickling of the skin, cold extremities, bruised feeling all over, dizziness, loss of memory, great nervousness resulting in hysteria, vomiting, leucorrhea, hemorrhage, etc. Both of these drugs are violent in their action and poisonous in the doses usually administered in labor.
It is rare that one recovers entirely from their effects. They cause uterine inflammation, ulceration, displacement, etc., that are accompanied by amaurosis, loss of memory, headache and many nervous symptoms which are ignorantly attributed to the “last confinement.” Rupture of the cervix, for which ladies so often must be treated in these days, is frequently the result of rapid forced labor by the use of these drugs. As you value good health, never take these remedies in poisonous doses. If uterine contractions can not be increased by the hot bath or cold compresses placed on the abdomen, an attenuated dose of the drug will be followed with as speedy results as a cup full of the infusion or a drachm of fluid extract, and the toxicological effect will be avoided.
Protest positively and persistently against taking a poisonous dose of ergot or black cohosh. Better wait for nature than suffer the effects that are sure to follow.
Instruments will rarely be called in use if women learn the laws of life and obey them. Malformed and diseased as women are, instruments are resorted to far more frequently than necessary. There is a feeling in the profession that dextrous instrumental delivery often saves women suffering, and consequent nervous prostrations. Most women, on the contrary, have a horror of forceps, and this, with the temporarily increased suffering aggravates rather than lessens the prostration. Remember, the physician has selfish temptations for instrumental interference. It entitles him to an extra fee, it saves him time, and possibly gives him eclat as an accoucheur.
In most cases where instruments are now used, speedy results could be obtained from the hot sitz-bath, without danger of subsequent difficulties. Occasionally a case may require instruments, but the experience of many successful physicians, especially the women in the profession, proves that if there is careful preparatory treatment, artificial delivery need seldom be called in requisition. In several hundred obstetric cases in my own practice, instruments were never required where the previous preparation of the patient had been under my own direction.
Women have it in their power to produce such healthful conditions that obstetrical instruments shall be known only in tradition.
CHAPTER XV.
POST PARTUM DISEASES.
“Mysterious to all thought,
A mother’s prime of bliss,
When to her eager lips is brought
Her infant’s thrilling kiss.”
Proper bathing and diet are as essential after as before confinement. At least once a day the patient requires a bath. Ordinarily use tepid water. Sponge and dry a portion of the body at a time, keeping the balance protected. If there is heat in the back, bathe it several times a day. Should the patient be nervous and uneasy, try dry hand friction. A compress, too, is often serviceable, worn across the back for two or three hours, followed by bathing and rubbing. The breasts should be bathed frequently, and the colder the water the better. This prevents sensitiveness to cold, and may consequently prevent gathered breasts. Three to five days after confinement the patient can be put into a sitz-bath with benefit. Let the temperature of the water be from 85° to 95°. This bath is restful, cleansing and restorative, and is really as beneficial after as before parturition. A woman can often sit in a bath for a few moments when the same time spent in a chair would prove injurious.
Change the linen of bed and person daily, and the napkins every three or four hours. Keep the room light and well ventilated. The temperature of the room should never exceed 70°. A few years since not a ray of light or a breath of fresh air was allowed in the parturient room, and if the woman was to touch cold water, it was deemed sure death. In some parts of this country, within twenty years, the bed even was not changed for nine days after confinement. With frequent bathing and a constant supply of fresh air the patient will not be sensitive to cold, and inflammation and other post partum diseases will in consequence be rare.
The vagina must be syringed at least twice a day with water in which there are a few drops of carbolic acid. Use a fountain syringe, and have the patient recline over a bed pan. Thus the parts will be kept cleansed, and carbolic acid prevents septic poisoning. If the bowels do not move naturally by the third or fourth day, give an enema, one quart of tepid water. The regimen advised in this book having been followed, one will rarely be troubled with constipation. Beware of cathartics. Most of them have a specific action upon the uterus as well as upon the bowels, and will do harm. This is notably the case with aloes and podophyllum.
The food must be simple in character and easy of digestion, especially until after the milk is established. Bran or graham gruel is the very best food the first day or two. Having been withheld from the diet during pregnancy, on account of containing the phosphates which have a tendency to harden the bones, it should now be taken for that very purpose.
Many are prejudiced against graham gruel, yet it has been proven that most women relish it better than anything else after labor. In the Home of the Friendless, Leavenworth, Kan., are many cases of confinement every year. Almost universally the inmates are prejudiced against graham in any form, and rarely taste it before confinement. A former matron had been a nurse in a Water Cure. Invariably she brought a bowl of graham gruel to the mother a few hours after delivery. She never had one express any repugnance to it. On the contrary, they would say, “That tastes good;” “That goes right to the spot;” “Can any one eat too much of anything that is so good?” and similar expressions, showing that there was an actual relish for the dish. The gruel should be made thin at first, and without cream or milk. After a few days it can be made thick like mush, and eaten with fruit or cream and sugar. New milk, wheatlet, cracked wheat, barley, oatmeal, graham gems, fruit, etc., can be added to the diet as desired.
There is no need of milk fever. Women have been led to expect more or less constitutional disturbance accompanying the advent of the milk. With the bathing and diet recommended above, even if she has not had the best conditions during pregnancy, one hardly realizes any change in the system at that time. When patients were fed on brandy panada, wine whey, strong tea, and beef broth, were kept in unventilated rooms, deprived of water externally and internally, and besides were poisoned with drugs, it is no wonder they had milk fever, and were liable to other post partum diseases.
The child should be placed to the breast several times a day, even if there seems to be no milk. The act of nursing stimulates secretion, prevents engorgement, and from sympathetic relation causes uterine contractions. When the breasts become filled and are knotty and tender, bathe them in hot water and have them drawn. If the child does not empty them sufficiently, the nurse or some member of the family should do it. This is better than a breast pump, and can be easily done by remembering to lap the tongue around the nipple until it meets the upper lip.
The old tradition used to be that a woman, on no account, must leave her bed before the ninth day. No matter how well she felt, the nine days must be spent in bed. There is no positive rule. One must be guided by her strength. Probably few women can expect to be about before four or five days. The cases where they can leave their beds earlier than that are exceptional.
Mammary abscess, or inflammation of the breast, often called “gathered” or “bealed” breast, is usually ushered in with a chill, succeeded by feverish symptoms. Darting pains are felt in the breast, which, as the disease progresses, extend to the arm-pits. The breasts swell, become hard and tender to the touch—even nursing is painful. If pus forms, the skin becomes dark red, the enlarged breast softens, accompanied by a throbbing pain. The patient is feverish, nervous, irritable, has irregular chills, night sweats, debility, etc.
Hot fomentations should be used promptly and thoroughly at the first threatening symptoms. Wring a cloth out of an infusion of phytolacca, and keep hot by applying the water bottle containing a small quantity of very hot water. If too much water is put into the bottle it is made uncomfortably heavy. If the fresh root cannot be obtained, use the fluid extract, ten drops to a pint of water. Keep the breast well drawn and persevere in the hot applications; suppuration can usually be prevented. Farmers know the value of phytolacca, and use it with their new milch cows in case of caked bag.
Aconite should be taken internally if there is alternate chill and fever, with thirst and throbbing pulse, one drop of tincture in ten tablespoons of water, a spoonful every half hour.
Bryonia, 2d.—Constant aching in the bones and soreness of the flesh. Dose, six pellets every hour.
Use only liquid food until the disease is surely arrested. Keep quiet and have plenty of fresh air. Unless the suppuration is very deep the breast should never be lanced.
For excoriated nipples, bathe in a warm borax lotion, two grains to one cup of soft water; after which apply carbolated cosmoline or calenduline. If the base of the nipple is deeply cracked, before using the cosmoline, wash with a solution of nitrate of silver, one grain to two ounces of water. Protect with a shield while the child is nursing. None of the above preparations are harmful to the child, except the nitrate of silver, and the cases where this is needed are rare.
For insufficient milk, drink freely of new warm milk. Have it brought to the bed, and drink at least a pint. Take it one or two hours before breakfast. If milk cannot be obtained possessing animal warmth, take new milk, add one-tenth water, and heat over a water bath to a temperature of 120 degrees. Cheese makers testify that the addition of water prevents rennet from coagulating the casein. In the stomach also, warm water prevents the pepsin from curdling the milk. If it is as warm as the stomach, and does not coagulate, it will be taken up by the absorbents and conveyed directly to the blood, without going through the process of digestion. Mothers who have a great aversion to milk, learn to cultivate a decided relish for it for the sake of the child.
Dr. R. P. Harris, in speaking of milk as a diet for delicate mothers, says: “Those who with ordinary food invariably fail to nurse longer than a few weeks, are capable by this diet of becoming not only good nurses, but also of gaining flesh while secreting the milk in abundance. When a delicate mother of eighty-six pounds’ weight, who had failed after a month with each of three infants, is enabled by it to nurse a child eighteen months, and gain at the same time nineteen pounds, the diet must be an effective one.” The article next best for promoting the secretion of milk is cocoa or chocolate, prepared with plenty of milk.
Every form of malt and spirituous liquors should by all means be avoided. They derange the nervous and digestive systems of both mother and babe. Custom, happily, has to a large extent done away with the idea that “nursing women must have ale or beer.” To those who still maintain this view, I would recommend the study of the question, whether the help expected is at all commensurate with the danger incurred of a pernicious appetite being cultivated in both mother and child.
Good digestion is usually all that is essential for an abundant flow of milk. The food should be simple but nutritious. Depend upon grains and fruits mainly, and by no means exclude the bran from the wheat flour. The saline elements in the bran not only stimulate digestion, but excite the secretion of milk as well. Try the experiment of feeding an Alderney cow upon fine flour, excluding the bran. By the lack of milk you will prove that the bran contains elements pre-eminently stimulating to lacteal secretions.
Oysters eaten raw or slightly cooked are said to increase the flow of milk. Honey, too, often proves invaluable. With bread and gems, instead of the carbonaceous butter, eat honey. It stimulates all the secretions. It is evident that foods rich in phosphates are the best to increase lactiferous flow. Therefore, study well the food table in Chapter IX, and partake of foods which were avoided in pregnancy.
In the first days after confinement, if the milk is slow to secrete, apply bruised castor bean leaves.
For excessive flow of milk, once or twice a day use hot fomentations upon the breast, and apply cosmoline, in which there is a trace of camphor. Avoid salt and liquid food. Wear folds of cotton batting over the breast. In either insufficient or excessive flow of milk, guard against pressure of clothing. It is absolutely essential that the blood should circulate freely to and from the breasts.
(No one thing more frequently causes atrophied breasts in any woman than the pressure of corsets and padding ordinarily worn. It is not unusual for a fine development of the breast to result from the removal of all pressure, accompanied by bathing daily with cold water, and following the bath by friction. Should this fail, an apparatus on the principle of dry-cupping is used. This seldom fails of giving the desired results.)
After pains often accompany the contraction of the uterus. It is not true that women never have them with the first child and always have them subsequently. Like most of the sufferings of maternity, they are the effect of abnormal conditions. Women, who, in two or three confinements have suffered days with after pains, threatened with spasms and not relieved except by chloroform, have by previous preparation recovered without a twinge of pain.
After pains usually occur periodically every ten or fifteen minutes. They are cramp-like pains accompanied by a feeling as if pricked by many needles. They make one very impatient and nervous, depriving her of needed rest. They are often the result of poisonous doses of ergot taken during labor. The hot water bag or hot fomentations will usually give relief. Must be very hot and kept hot, consequently dry heat is to be preferred. Administering a hot sitz-bath is also excellent treatment. If relief is not obtained, and the physician is not within call, inhale ether moderately. Do not take it internally.
The lochia is the flow from the vagina which occurs after confinement. At first it has the appearance of fresh blood, then becomes lighter in color, and finally is only a glairy mucus. This varies greatly in amount and duration. As a rule the healthier the woman, and more natural the labor, the less the flow. Cases have come to my knowledge where there was no sanguineous flow, and the patient made a rapid recovery. It is said that healthy squaws have no flow of blood with menstruation, or after delivery. If there is no constitutional disturbance, there need be no anxiety about a scanty flow. If caused by a chill, fever or inflammation, etc., prompt attention will be required, according to accompanying symptoms.
Metrorrhagia, or profuse flow, often requires treatment before medical aid can be secured. Hot fomentations, hot sitz-bath and hot vaginal injections are the very best applications. Recently the medical profession recognize that heat is better than cold, to arrest hemorrhage. In surgery, hot water is applied to exposed bleeding vessels. Cases are known where hot vaginal injections have instantly arrested bleeding that had resisted applications of ice, styptics and the tampon.
A lady in Michigan, during the menopause, was taken suddenly with violent hemorrhage. For seven days and nights everything was tried in vain to arrest the bleeding. She became cold and clammy, had frequent fainting spells, and death seemed imminent. An old nurse came to take care of her over night. She set aside the physician’s potions and applications. She filled the big wood stove with bricks, and as fast as they were heated wrapped them in wet cloths and put them about the patient, who thus obtained her first sleep for days. The hot bricks were kept to her four days and nights. There was no return of hemorrhage. She made a rapid recovery.
If there are clots, retained placenta or membranes, or any foreign growth present in the uterus, they must be removed by surgical interference, before uterine contractions can be effected and maintained.
Pelvic peritonitis, puerperal or child-bed fever. “There is a word of fear that I shall pronounce when I utter the name of Puerperal Fever; for there is almost no acute disease that is more terrible than this. The small pox itself, which reduces the fairest form of humanity to a mass of breathing corruption, can not be looked upon with greater dread. Child-bed fever, like an inexorable Atropos, cuts the thread of life for those to whom Clotho and Lachesis would give the longest span.
“There is something so touching in the death of a woman who has recently given birth to a child; something so mournful in the disappointment of cherished hopes; something so pitiful in the deserted condition of the new-born, helpless creature, forever deprived of those tender cares and caresses necessary to it, that the hardest heart is not found insensible to the catastrophe. It is a sort of desecration for an accouchee to die.”
Thus feelingly writes Prof. Meigs, of Philadelphia, of this disease, the very thoughts of which strike terror to the stoutest heart. This disease is an inflammation of the uterus and its peritoneal covering, and often extends to the entire membrane lining the abdominal cavity, and possibly involves all the pelvic viscera.
The attack ordinarily commences from the third to the ninth day after delivery. Previous to this, the patient has seemed all right, when suddenly, often apparently without cause, she is taken with a chill. Rigors more or less severe extend up and down the spinal column. Clothing does not seem to impart any warmth. Almost simultaneously with the chill, periodical pains will be felt in the womb, and if there is not much constitutional disturbance, may be taken for after pains. Usually, however, they are accompanied by great soreness and tenderness in the pelvis; the abdomen soon bloats and becomes tympanitic; the legs are flexed to relieve the tension; the weight of the clothes, even, cannot be borne. The milk dries up, the lochia cease, there is headache, great thirst, increase of temperature, a quick, wiry or bounding pulse.
All of these appalling symptoms are accompanied by great anxiety of mind and distressed expression of countenance. A dark circle forms about the eyes, which are sunken, the nose pinched, and the lips drawn, and the face is flushed or very pale. The course of this dread disease is extremely rapid. “It will not unfrequently happen that she shall die within thirty-six or forty-eight hours from the onset of the malady, and some cases terminate fatally even in eight hours. They are to be cured promptly or not at all. Such a malady as this hurries with hot and furious haste to a turn, beyond which there is not and cannot be any useful therapia.”
Perhaps I shall be condemned for picturing to the sensitive imagination of the pregnant woman the possible dangers of this dread disease. Her attendants will look out for it, and she should not be led to anticipate it. For two reasons, however, she should be forewarned:
First, that she may at once summon her medical attendant.
Second, that the causes of this disease being known, she may avoid them.
Do not delay one moment in calling your physician. Having the symptoms indicated, procrastination is suicidal. The doctor would better come ten times for a nervous chill or after-pains, if by chance the mistake should be made, than that you should fail once to notify him of an attack of puerperal fever.
Under improved methods of treatment this disease does not terminate fatally as frequently as formerly.
The causes of this disease are:
First. The inflammatory condition of the system before delivery. If the fruit diet has obviated this, there is nothing to fear.
Second. The use of ergot in confinement. Puerperal fever following poisoning by ergot is very rapid in its course, and soon terminates in gangrene. If this drug were banished from practice, child-bed fever would be rare.
Third. Contusions and bruises from instruments not handled dextrously cause inflammation.
Fourth. The use of cathartics, tonics, stimulants and other drugs after delivery.
It is within the power of every woman that she shall not be subject to these causes of puerperal fever.
Some late teachers claim that all child-bed fever is pyæemia, blood-poisoning, and can not be avoided. Why is it, then, that it is notably absent in those who have led a hygienic life? Why is it that those physicians who insist on preparatory treatment seldom meet with it in their practice? Others claim that the disease is contagious, and that the poison can be conveyed by physician and nurse.
Dr. W. S. Playfair, of London, who gives to this disease the name of Puerperal Septicæmia, says: “The whole tendency of recent investigations is daily rendering it more and more certain that obstetricians have been led into error by the special violence and intensity of the disease, and that they have erroneously considered it to be something special to the puerperal state, instead of recognizing in it a form of septic disease, practically identical with that which is familiar to surgeons under the name of pyæmia or septicæmia.
“If this view be correct, the term ‘puerperal fever,’ conveying the idea of a fever such as typhus or typhoid, must be acknowledged to be misleading, and one that should be discarded as only tending to confusion.
“According to this theory, the so-called puerperal fever is produced by the absorption of septic matter into the system. It is not essential that the poison should be peculiar or specific; for, just as in surgical pyæmia, any decomposing organic matter either originating within the generative organs of the patient herself, or coming from without, may set up this morbid action.”
The treatment of peritonitis should be prompt and thorough. Sweat the patient as soon as possible. Place several steaming bricks or ears of boiled corn about her. Frequent hot enemas by rectum and vagina are beneficial. If gangrene threatens, it is often arrested by the application of a yeast and charcoal poultice. Take any good lively yeast, make a sponge of corn meal and graham flour, equal parts. When light, add two tablespoons of charcoal to one pint, put on to a large cloth covered with thin gauze and lay over the entire abdomen. Must be changed frequently, not allowing it to get dry. An injection should be given per rectum every three hours, of weak carbolic soapsuds.
The nutriment should be diluted hot milk, or oatmeal gruel. Small pieces of ice will be grateful.
When these directions are followed faithfully, accompanied by appropriate remedies, most cases can be saved.
Even if it should be proven that this disease is septic poisoning, a healthy tone of the organs resists the absorption of the foreign agent,which proves a poison. In twenty years of general practice I never had a fatal case outside of the hospital. My experience emphasizes what I have stated, that the hygienic life and habits, and the avoidance of drugs and instruments go far toward preventing child-bed fever.
CHAPTER XVI.
INFANTS.—THEIR CARE AT BIRTH AND DURING EARLY INFANCY.
“What am I?
An infant crying in the night;
An infant crying for the light;
And with no language but a cry.”
—Tennyson.
What more helpless and dependent than the newborn infant! A human soul, with all the possibilities of life, yet of itself it cannot supply its slightest need.
No wonder that so great a wealth of maternal love is called forth in administering to such helplessness! No wonder that the mother’s heart is humbled at the greatness of her mission as special guardian of the little one! May divine love and wisdom aid and guide her!
The newborn babe has had a sleep, at least a rest. It has entered upon its new life, and all the functions of the body are well established.
The first thing in lending a helping hand to the little stranger is to give him a bath. This is done ordinarily by using soap and warm water. The vernix caseosa, a thick, white, unctuous material that usually covers the child, and is abundant in the axilla and groin, is much more easily and thoroughly removed by cleansing it entirely with some oily substance. For this purpose olive oil or lard can be used. It should be applied with a soft, worn piece of flannel, keeping the child well covered. When it is entirely clean, rub all over with a fresh piece of flannel, and the skin is left in a soft, smooth condition.
R. P. Harris, M. D., says: “As the vernix caseosa is readily miscible with pure lard, and can be easily removed by its means, the practice prevails with many obstetricians in the United States of ordering the infant well anointed, and then wiped from head to foot with soft rags, until all the vernix disappears, and the skin retains an oily trace, not enough to soil the clothing. By this means water is avoided, and with it much risk of taking cold; the skin is left much less sensitive, after the sudden change which it is made to endure at birth than when subject to soap and water.”
Dress the navel with absorbent antiseptic cotton. Put a piece three or four inches square on the left side of the abdomen, just above the navel, the remnant of the cord laid upon it, with its cut end pointing to the left, and upward—the cotton arranged to embrace the base of the cord, and another piece of cotton the same size placed over the cord, the whole kept in place by a soft flannel band. This is preferable to linen. It absorbs the secretion more readily, making less liability of an unpleasant odor. It is kept in place better, and the cord comes off much sooner. Can often be entirely removed the fourth day. There needs to be no grease or oil upon the cotton. After the separation of the cord, the navel should be dressed with a little simple cerate or cosmoline, and still use the absorbent cotton.
Any pouching of the navel can be relieved by using a thin slice of cork or a piece of thick pasteboard two inches in diameter. Wrap it with several thicknesses of linen and place it outside of the cotton, applying the bandage sufficiently snug to keep it in place.
The Clothing of the child should be soft, warm, light, loose, and easily adjusted. Superfluous garments should be avoided, and waistbands dispensed with.
Activity is so natural to child-life that it seems almost life itself. Months before it is born a babe is in ceaseless motion, and after birth it is never still during its waking hours. This activity is synchronous with its development and should be encouraged rather than hindered. A child’s dress, while it serves the purposes of warmth, protection and adornment, should in no way prevent this activity.
Only a few years since, the dress for all infants was cut low in the neck and with short sleeves. A sensible reform made it fashionable to protect the necks and arms of the little ones. It is equally as essential and is just as desirable a reform, that the dress should be so constructed that the natural activity of any part of the body is not hindered. To accomplish this the skirts must be shortened and all bands abolished. Is there any reason why a child’s clothes should be so long that they are a burden to him and an inconvenience to all who handle him?
Many mothers, noting their babies’ constant struggle for exercise, frequently uncover their feet in order to give them an opportunity to kick and stretch. It is not unusual, also, for them to get them out of long clothes by the time they are three months old.
One lady writes that she tried making her baby’s first clothes very short. They were only twenty-seven inches in the entire length, from the shoulder to the hem at the bottom. This experiment proved so satisfactory that she says she will never put long dresses on a child again. Not only was her baby so much more comfortable, but he was so much more easily handled that she felt repaid in the comfort it was to herself. Aside from this, there was no necessity of making short clothes for him until he walked, which was a saving in time and money.
A new-born child requires the following garments:
A Shirt and Band Combined: This should be made of soft flannel or knitted wool. If of flannel, turn hems but once, and cross-stitch down smoothly. Finish the neck and arm’s eye with a button-hole stitch, using silk or worsted. Lay a fold in back of shirt, to make it fit the child, and stitch down smoothly and lap in front and fasten as if it were a band. The shirt has this advantage over the ordinary band, that it cannot wrinkle up if the napkin is pinned to it as it should be. One-half yard of thirty-six inch flannel will make four shirts. This garment is worn mainly to keep the dressing upon the navel in place, and can be discarded when that necessity no longer exists.
Foot blanket: Made of flannel, twenty-seven inches square, and hemmed on three sides. Lay a double box-plait in the center of fourth (or upper) side, stitch down one inch, and face the same width, with a strip of cotton, cut bias. Fasten over the diaper with a small safety-pin. This garment protects other clothing and wraps the feet up nicely until the child is large enough to wear socks. If the weather is cold woolen socks are advisable from the first. However, it is not absolutely necessary, and some mothers dispense with it altogether.
A Flannel Skirt: Is made with long sleeves, and is cut from the same pattern as a night-dress or day-slip. Fine, all-wool flannel is generally used for this skirt, but I would recommend the use of the eider-down flannel, which is also so desirable for baby cloaks. The outside dress can be made as a Mother Hubbard, or slip, and where taste inclines, it may be of finest material and exquisite embroidery. Besides the diaper, the flannel skirt and slip are all the clothes a young baby actually requires. The skirt should be put inside of the dress and the two put on the child at the same time.
Thus an infant may be dressed in less than five minutes, instead of the long, tedious process of the customary dress.
Once clothing a baby in this simple fashion, one would never be inclined to again adopt the long full skirts, the bands and pins, that are a torture to infants and trying to the patience of the mother.
The same general principle may be followed for a child’s wardrobe until he is put into drawers; then these require to be attached to a light waist without sleeves.
The first few months the child’s feet are most comfortable in crocheted socks. The first shoes may be made like moccasins, of broadcloth or chamois skin. A lady in Cincinnati makes many of the latter for the trade, supporting her children and an invalid husband by their sale.
These directions for infants’ clothing are so simple that many may think they are not worth following, but when we see the little ones bandaged and burdened as we do, is it not time to make a protest that will reach every mother? A child’s dress should always serve the purposes of protection and warmth without any hindrance to its activity and development.
Habits of cleanliness can be taught every child. The clumsy diaper can be dispensed with by the time it is three or four months old. Let the mother practice holding out her baby immediately after nursing it, and it will easily be taught to urinate at this time, and also to have a passage from the bowels at a stated time in the morning and evening. The actual comfort secured to mother and child through this habit, more than repays for the labor and patience in securing it. Teach your children to be cleanly. A dirty child is a mother’s disgrace. When a child begins to creep and walk, the diaper (necessarily large and bulky) has to be pinned too tightly for comfort and health, in order to keep it in place.
A bath may be given to the child every day or every other day. By the time it is two months old, it can be put into a bath daily. Should remain in the water not more than five minutes. The temperature should not exceed 90°, and it is quite as well to accustom the child to a lower temperature gradually. Don’t trust the hand to determine the heat. Always have a thermometer. Do not bathe a child immediately after nursing. Avoid the use of soap. A child’s skin is naturally oily, and should be preserved so.