LIST OF ILLUSTRATIONS

“The Caress” by Gari Melchers[Frontispiece]
Chapter III.
FIG. PAGE
1.Diagram of pelvis[21]
2.Side view of female generative organs[23]
3.Front view of female generative organs[25]
4.Diagram of human ovum[26]
5.Front view of breast[32]
Chapter IV.
6.Diagram showing process of cell division[36]
7.Diagram of baby, cord, membranes and placenta within the uterus[38]
8.Appearance of the baby at different stages of development[40]
9.Position of baby in the uterus just before birth[42]
Chapter V.
10.Front and side views of maternity corsets[59]
11.Front, side and back views of home-made abdominal binder and breast bandage, applied[60]
12.Abdominal binder used in Fig. [11][61]
13.Front and back views of home-made stocking supporters[62]
14.Right-angled position for relief of swollen feet and legs[71]
15.Lying with hips elevated to relieve swelling of vulva[73]
Chapter VI.
16.Leggings for use at the baby’s birth[88]
17.Pad made of newspapers, to protect bed[90]
18.Pattern for baby’s petticoat[92]
19.Pattern for baby’s dress[93]
20.Outfit of satisfactory baby clothes[94]
21.Baby’s toilet tray[96]
Chapter VII.
22.Diagram showing cervix in process of being dilated[101]
23.Drawing showing descent of baby during birth[104]
24.Helping the baby to breathe[111]
Chapter VIII.
25.Supporting heavy breasts with straight binder[118]
26.Supporting heavy breasts by means of three folded towels[119]
27.Indian binder for heavy breasts[120]
28.Protecting nipples with sterile gauze[121]
29.Position of mother and baby while nursing in bed[123]
30.Using shield to protect sore nipples, while nursing baby[124]
31.Nipple shield used in Fig. [30][125]
32 to 38, inclusive.Bed exercises[128] to 131
39.Knee chest position[132]
40.Walking on all fours[133]
Chapter X.
41.Baby’s weight chart[151]
42.Diagram of first teeth[153]
43.Appearance of fresh cord immediately after birth[154]
44.Appearance of cord four days after birth[155]
45.Appearance of navel after cord has dropped off[155]
46.Appearance of normal, well healed navel[156]
47.Preparing the baby’s milk[169]
48.Position in which to hold baby and bottle for feeding[172]
49.Holding baby upright after feeding to prevent colic[173]
50.Putting the baby into his bath[185]
51.Supporting the baby’s head above water while giving bath[186]
52.Dry, sterile cord dressing[189]
53.Flannel band over cord dressing[190]
54.Putting on the straight diaper[191]
55.The diaper in Fig. [54] applied[192]
56.The Sutton poncho[198]
57.Method of carrying baby to support back and head[200]
58.Training the baby to use a chamber[202]
59.Elbow cuffs to prevent thumb sucking[203]
60.Immersing baby for bran or mustard bath[209]
61.Putting the baby into a wet pack[210]
62.The baby in a wet pack[211]
63.Diagrams showing successive steps in giving pack[212]
64.Giving the baby an enema[217]
65.Quilted robe for the premature baby[220]
66.Bed for premature baby improvised from a clothes basket[221]
67.The baby in a basket, ready to travel[224]

GETTING READY

TO BE A MOTHER

CHAPTER I
GETTING READY TO BE A MOTHER

How does it seem to you—the coming of a baby?

Does it seem the most amazing of miracles, so stirring in its beauty and mystery that you are eager to make ready and prepare for it fitly?

Or have you, perhaps, come to share the general feeling that motherhood is a natural state which one accepts when it comes, but need not prepare for?

This attitude seems to go back to a very old and deeply rooted conviction that, as women always have had babies and have had them through the working of one of Nature’s laws that has been operating over and over throughout the ages, they doubtless will continue to have them in the same old way, and the entire matter may well be left to take care of itself. As to the baby, when he comes, one may expect that the ability to care for him will come too.

Because of this reasoning, or lack of it, it has been a fairly general custom for the woman who expected a baby to seek her doctor’s aid only when she went into labor, or shortly beforehand, and to give no thought to the care of her baby until he was born. All too often the mother has died, because of this tardy care, been injured or become an invalid, while equally sad things have happened to the baby—and needlessly so.

But now, happily, a great change is taking place in the realm of mothers and babies. We still realize, of course, that childbearing is a natural function, but we know that conditions must be made favorable for the smooth working of this natural law if all is to be well; that for the sake of both mother and baby it is of urgent importance to give thought and care to the baby during the nine months before he is born.

There is little doubt that the most critical period in one’s life is the first ten months—the nine months before birth and the first month afterward—and that the care which is given during these months influences one’s physical state, for good or ill, throughout all the rest of life. In the light of this knowledge, women are more and more generally seeking and being given “prenatal care,” which is care before the baby is born, together with advice and instructions which fit them to assume motherhood safely and successfully.

Ideal prenatal care would really begin during the expectant mother’s own infancy, for the chances of a normal pregnancy, labor and lying-in period are greatly increased by good care during the early years of life. But for the time being we shall have to content ourselves with an effort to extend, as widely as possible, the care that is now known to be beneficial for expectant mothers from the beginning of pregnancy.

This prenatal care is undertaken in much the same spirit in which one makes a garden, for example. We know, of course, that plants which are neglected sometimes grow and blossom satisfactorily, though one would not think of depending upon them to do so. But we have learned that plants that are given the care and protection that they need are almost certain to flourish and bloom after the manner of their kind.

Experience teaches, however, that this care must be regular and sustained and always given for the twofold purpose of preserving the plants from injury as well as nourishing them. Accordingly we put them in good soil, to begin with, and then give water, sunshine or shade, according to their respective needs, and we take care to protect them from the destructive effects of harmful insects, blights, weeds or anything which may be unfavorable to their healthy progress. We do not close our eyes to the fact that these harmful conditions are possible. Instead, we are anxious to find out all about them—what causes them and how to recognize them—in order that we may prevent or remove them before they do serious damage.

Many women, nowadays, are taking just that kind of attitude toward motherhood. They begin by consulting a doctor as soon as they know that they are pregnant, because they appreciate the importance of doing so. They study eagerly the questions relating to motherhood; the structure and workings of those parts of their own bodies which are concerned with the baby’s creation; how he evolves within them; what he needs during those nine months of development; what practices, what conditions are bad for the baby and themselves; what they can do to avoid or correct these and how they can help to make things go smoothly.

The women who face the facts of motherhood in this way generally go through the entire adventure normally and successfully, as Nature intended they should. More than this, those women who place themselves under a doctor’s care from the beginning of, or early in, pregnancy, are greatly reassured to find out how much can be done to safeguard them, and they do not have that fear of the approaching birth which is suffered by so many women who do not know nor understand what is going on.

The results of the painstaking work and study which have been carried on to increase the comfort and safety of mothers and babies have made it possible for the doctors to plan something of a routine which they find advisable for their patients to adopt. To begin with, it is quite plain that the first need of every expectant mother is examination and measurement, early in pregnancy, by a good physician. The information thus obtained helps the doctor to foretell the kind of labor that his patient is likely to have, and by planning for it ahead of time he is often able to save her much harm and suffering. An early examination also enables the doctor to discover and correct any slight trouble which may exist at that time and which might grow worse if not treated, and to advise his patient about the general care which he wishes her to take of herself throughout pregnancy. In regard to this care, doctors are generally agreed that the average woman needs to do little more than observe the ordinary rules of personal hygiene, which as a matter of fact, should be followed by all of us; that is, she should live a simple, regular life as to diet, fresh air, exercise, rest, sleep, diversions, etc. This all sounds simple enough and as a matter of course, but it is usually overlooked in spite of being of the most urgent importance to both mother and baby.

This advice varies in little things, here and there, among different doctors, but in the main it is about the same the world over, where thought is being given to the care of expectant mothers. For no matter where they are or what their status, their needs in general are the same. They need a doctor’s supervision and they need to practice the principles of personal hygiene.

Accordingly, in addition to making an early examination and giving instructions about the regulation of her daily life, the doctor usually wants to see his patient and make certain observations every little while during pregnancy, just to make sure that everything is going as it should and to be in a position to discover the earliest and slightest symptoms of complications.

In the old days there were certain complications associated with childbirth which the doctors did not know how to prevent and sometimes could not cure—complications which were bad for both mother and baby. But now they know a great deal about both preventing and curing even the most serious of these complications. They have discovered, for one thing, that many conditions which give serious trouble during labor, or soon afterwards, actually have their beginnings during pregnancy, and sometimes very early.

Quite evidently, then, it means a great deal to the expectant mother to have the doctor discover and treat these complications before they have had time to become serious. But he can give early treatment only if he knows about the symptoms of the trouble when they first appear. Some of these symptoms may be detected by the expectant mother herself after they have been explained to her, but some of them can be discovered only by a doctor or a nurse. That is why it is important for the doctor to see his patient at frequent intervals during pregnancy; about once a month during the first half and every two weeks afterwards.

He sees her for much the same reasons that the housewife looks over the contents of her darning basket—not once and for all time, but regularly, once a week, over and over and over. She searches each time not for holes alone, but for thin places, too; an occasional broken thread or the beginning of a “run,” knowing how much trouble she will save herself, later on, by promptly repairing the smallest break or evidence of wear. She knows quite well that there are no more holes because she looks for them, than there are if she does not, and that failure to look for them will not keep the holes from being there nor from growing larger. No more does the expectant mother develop a complication because she is examined, nor does an existing condition cease to exist because she is not examined; and yet some women still take just that illogical attitude toward examinations and supervision during pregnancy.

One factor which keeps some expectant mothers from seeking medical care is the well-meaning but dangerous counsel so freely offered by older women who claim fitness to advise by virtue of having had several children of their own. Their lack of success, as evidenced by miscarriages, stillbirths, children dying in early infancy, as well as injuries and disabilities of their own, is usually overlooked as they press their superstitions and remedies upon the inexperienced and bewildered younger woman. When disaster follows, as it so often does, it is very likely to be ascribed to the will of God, and the mother’s needless sacrifice does not even serve as a warning to others who are in line for the same kind of advice.

Another obstacle to adequate prenatal care is sometimes found in the husband who considers it entirely reasonable to secure expert advice upon the subject of cattle-raising, let us say, or the care and running of his automobile or about his investments, but who has a conviction that it is normal and natural for women to have children without making what he considers a fuss about it. He may cherish, too, a suspicion that it is not altogether good for his wife to be thinking too much about her condition. His mother never began bothering until the baby came.

On the other hand, many husbands show the tenderest solicitude for their wives throughout pregnancy and would be only too eager to have them enjoy all the benefits of prenatal care, if they only knew and understood about it. The expectant mother will be wise, therefore, if she undertakes to convince her husband, if need be, that her occupation of bearing and rearing children merits quite the same thoughtful attention as his work, to which he devotes his best powers.

How easy and worth while this may be was demonstrated a couple of years ago at a county fair which was attended by a very intelligent farmer and his wife. The farmer was interested in hog-raising and both he and his wife accepted without question the fact that success in this enterprise could be achieved only through serious study and the most painstaking care. But as to childbearing, if they thought of it at all, they looked upon it as simply one of those natural functions which always had and doubtless always would take care of itself.

When this couple reached the fair the farmer entered one of his fine animals in a prize-winning contest and as there was a baby contest, too, the wife entered their little son. In due time the judges inspected the various contestants and it was found that point by point the farmer’s hog measured up to all of the standards of perfection for his kind and easily won the first prize. Not so with the baby; point by point he fell below even a moderate average of what a baby should be and was outranked by many of his more robust infant competitors.

As various admirers discussed hog-raising with the farmer, it became quite evident that he had carefully studied the question and had applied to his occupation the most approved methods of which he could learn. But when the doctors and nurses at the baby contest talked with the crestfallen mother about her baby, who had seemed right enough to her, they found that she knew little or nothing of the business of being a mother; that it had never occurred to her nor to her husband that she might profit by care and instruction about herself and her baby both before and after he was born. As might be expected, she had been unable to nurse him and on the whole he proved to be a pretty poor specimen of a baby, with a dismal outlook as to health.

Since the mother was then in an early stage of another pregnancy, the doctor talked it all over with her and her husband. He convinced them that such thoughtful and painstaking care as they had devoted successfully to hog-raising were equally effective when applied to baby-raising. As a result, the expectant mother, with her husband’s whole-hearted approval, placed herself under the care and supervision which she found were available through a prenatal clinic in her vicinity.

The happy sequel to that story is that when another fair was held, a year later, the farmer entered another one of his hogs and the wife her new baby, and that this baby held his own with the hog by taking a prize, too.

So sincerely do doctors now believe in the urgency of having all maternity patients under supervision and care during the nine months before the baby comes and the first several weeks afterwards, that they not only care for those women who come to their offices, but also give of their knowledge and skill to organizations engaged in prenatal and maternity work. These organizations may be visiting nurse associations, prenatal clinics, health centers or dispensaries. As the doctors are assisted by nursing staffs they are able to offer protection, through these channels, to a very large number of mothers and babies.

Among the women who are cared for by such organizations, or by doctors in their private practice, there is an enormous reduction in the occurrence of convulsions, for example, abortions, miscarriages, stillbirths, infections (childbed fever), and prolonged and difficult labors. Or, to put it the other way round, good care started during early pregnancy and continued throughout labor and the lying-in period gives both mother and baby enormously increased chances to live and enjoy good health. One reason why the baby is so much better off is that good care practically always enables his mother to nurse him, for, except in extremely rare cases when there is a definite physical disability, as tuberculosis for example, every mother can nurse her baby if she really wants to and if she, the doctor and nurse bend all their energies to accomplish this happy end. A baby who is not breast-fed is defrauded of a protection which is rightfully his, and usually because someone has failed to do all in his or her power.

Organizations which include doctors and nurses who can give skilled care to maternity patients are increasing in scope and number throughout cities, towns and rural districts in all parts of the country. This makes us hope that before long good care during pregnancy, childbirth and young motherhood will be available to every woman in the land. But quite as earnestly do we also hope that every woman in the land who is looking forward to motherhood will seek this care. Certain it is that the expectant mother who does seek care, whether from a doctor in his office or through a prenatal clinic, is approaching her motherhood in the only way that is safe for herself and her baby. She should realize, however, that although the doctors can accomplish a great deal through examinations and advice, they can give the full benefits of their skill only to those women who do their part by following instructions faithfully, week after week, throughout nine months. The doctor cannot live his patient’s life for her; he can plan and advise her ever so wisely, but this counts for very little unless she lives as he directs.

The young woman who sees her motherhood as a coveted privilege, crowded with happy possibilities, who is willing to bear its inconveniences and take the necessary precautions to insure a satisfactory outcome, is very likely to go through her experience in good health and buoyant spirits. And in the end she will have not only the ecstasy of possessing a beautiful, well baby who has every prospect of continuing so, but as the years pass she will have the satisfaction of knowing that she is a better, more helpful, more companionable mother because of being in good health herself.

That is the point of good maternity care—future well-being as well as immediate safety for both mother and baby—and it rests with each woman to decide for herself if she is to have such care.

CHAPTER II
SIGNS THAT A BABY IS COMING

The woman who wants a baby and is in a position to have one is usually eager to know how she can tell when a baby is coming. She wants to know because the baby’s coming means so much to her and also in order that she may know when to consult a doctor.

I am sorry to have to admit, at the outset, that making this important discovery is far from being a simple matter. One would suppose, after all these ages, during which countless babies have been born and countless pregnancies have been observed by doctors and others, that there would be some known way of finding out definitely, at an early date, whether or not a baby was coming. But strangely enough, there is no positive evidence of the baby’s existence within his mother’s body until eighteen or twenty weeks after his life there has begun.

On the other hand, so many symptoms of pregnancy are known to women, the world over, that very often an expectant mother is correct when she suspects at an early date that she is pregnant, particularly if she has already had a child. But as the well-known symptoms are much like those of various conditions other than pregnancy, even experienced mothers sometimes believe themselves pregnant when they are not. The reverse is true also, for we occasionally hear of a woman who fails to recognize the meaning of the changes which she notices in herself, and is unaware of being pregnant up to the very time of going into labor.

And so we find that there are some signs of pregnancy which are only possible, since they may be caused by some other conditions; others which may be accepted as probable, and a few signs which are positive because they are never due to any cause but pregnancy.

The possible signs can all be detected by the expectant mother, herself, and may be described as follows:

1. Stopping of Menstruation. This is usually the first symptom noticed. Although it is possible for the periods to be stopped by any one of several other causes, the missing of two successive periods, after intercourse, is a strong indication of pregnancy in a healthy woman of the childbearing age, whose menses have been regular.

2. Changes in the Breasts. These, also, occur early. The breasts usually increase in size and firmness, and many women complain of throbbing, tingling or pricking sensations and a feeling of tightness and fullness. The breasts may be so tender that even slight pressure is painful. The nipples become larger and more prominent; they and the colored circle of skin around them grow darker, while the veins and the glands that feel like little lumps under the skin become more noticeable. If, in addition to these symptoms, it is possible for a woman who has not had children to squeeze from her nipples a pale yellowish fluid, called colostrum, she may feel almost certain that she is pregnant. But it must be remembered that these symptoms, also, may be due to causes other than pregnancy; that even milk in the breasts may be present in a woman who has borne children, for months, or possibly years, after the birth of her last baby.

3. “Morning sickness,” as the name suggests, is nausea, sometimes accompanied by vomiting, from which many expectant mothers suffer the first thing in the morning. This varies from a little nausea, when first raising her head, to repeated attacks of vomiting during the day and even during the night. As a rule, however, the discomfort is experienced during the early part of the day only. Morning sickness may set in immediately after conception, but begins about the sixth week, as a rule, and lasts until the third or fourth month. It occurs in about half of all pregnancies and is particularly common among women who are pregnant for the first time. On the other hand, one must not forget that many non-pregnant women suffer from nausea in the morning; many women go through pregnancy without any such disturbance, while others are entirely comfortable in the morning but nauseated during the latter part of the day.

4. Frequent Urination. There is usually a desire to pass urine frequently during the first three or four months of pregnancy, after which the tendency disappears, but returns during the later months. The desire may be due in part to nervousness, but is largely caused by pressure made upon the bladder by the growing baby, and not by kidney trouble, as is sometimes believed. For pressure on the outside of the bladder gives much the same sensation as is experienced when the bladder is full of urine. After the baby grows to such a size that he pushes up into the abdomen (we shall describe this later), he does not press upon the bladder and therefore ceases to create a desire to urinate until the last month or six weeks before he is born when he sinks back into the pelvis.

5. Increased discoloration of the colored parts of the skin is another early symptom of pregnancy. In addition to the deepened tint of the nipples and the circles around them, a dark streak appears upon the lower part of the abdomen, extending upward toward the umbilicus, or navel. There are also the yellowish, irregularly shaped blotches which sometimes appear upon the face and neck; dark circles under the eyes and pinkish or bluish streaks on the abdomen.

6. “Quickening” is the name which is commonly given to the mother’s first feeling of the baby’s movements. It occurs about the eighteenth or twentieth week, and is regarded by some doctors as a positive sign of pregnancy and by others as merely a possible sign. The sensation is compared to a very slight quivering, or tapping, or to the fluttering of the wings of a bird as it is held in one’s hand. Beginning very gently, these movements grow more vigorous, as time goes on, until they become very troublesome toward the latter part of pregnancy, amounting then to sharp kicks and blows. Women who have had children can usually distinguish between quickening and the somewhat similar sensation caused by the movement of gas in the intestines; but a woman pregnant for the first time may be deceived.

There are many other possible symptoms of pregnancy, but their value is very uncertain and as we have seen, even the ones described above are not entirely dependable. But if you have missed two periods; if your breasts have grown larger and firmer; if your nipples are stiffer and more prominent and you can squeeze colostrum from them, you may be reasonably certain that a baby is coming.

The probable signs of pregnancy are more apparent to the doctor than to the expectant mother, but there are two which you may easily detect:

1. Enlargement of the abdomen, which is a very important sign, may be noticed about the third month. At this stage a rounded mass may be felt in the abdomen which steadily increases in size as the weeks and months slip by. Rapid enlargement of the abdomen in a woman of childbearing age may be taken as fair, but not positive, evidence that she is carrying a baby. However, complete reliance cannot be placed in this sign, since it is possible for the abdomen to be enlarged by a tumor, by dropsy, or by fat.

2. Painless contractions of the uterus (or womb, within which the baby lies) begin during the early weeks of pregnancy and occur at intervals of five or ten minutes throughout the entire period. The expectant mother may not be conscious of these contractions during the early months, but later she can detect them by placing her hand upon her abdomen and feeling the uterus, beneath it, grow first hard and then soft, as it contracts and relaxes. But the probable signs of pregnancy, like the possible symptoms, may occur in women who are not pregnant, and accordingly the appearance of any one of them alone, is not of great significance.

The positive signs of pregnancy, of which there are three, are not apparent until the eighteenth or twentieth week. They relate to the baby, but with one exception they cannot be detected by the expectant mother. However, they are of such moment that you will be interested to know what they are.

1. Hearing and counting the baby’s heart beat is unmistakable evidence of the baby’s existence. The doctor sometimes hears this by resting his ear upon the mother’s abdomen and sometimes by listening through a stethoscope.

2. Ability to feel the outline of the baby’s body is also a positive sign of pregnancy, if the head, buttocks, back and extremities are unmistakably made out through the mother’s abdominal wall.

3. Feeling the movements of the baby is accepted as a third positive sign of pregnancy. There is some difference of opinion concerning the value of “quickening,” alone, as a positive sign, but if the baby’s movements are felt by the doctor, also, through the mother’s abdominal wall, or by vaginal examination, there can be no doubt that a baby is there. Feeling these movements some time after the eighteenth or twentieth week, by placing a hand upon the abdomen, is the one positive sign which the expectant mother may detect for herself.

Some Other Changes in the Mother’s Body While the Baby Grows. In addition to the signs and symptoms which we have just described, there are a good many other changes which will take place in your own body, in the course of the baby’s development, and you will want to learn about some of them in order that you may know what to expect.

The abdomen. Of course, the steady enlargement of the abdomen and the alteration in its shape, as pregnancy advances, is the change that you will be most conscious of. As the abdomen grows larger, the skin which covers it is stretched more and more tightly with the result that the tissues just under the surface sometimes give way, or split and form pale pink or bluish streaks. These streaks, which are called striæ, grow white and glistening after the baby is born, so that the abdomen of an expectant mother who has had children, will show silvery streaks from earlier pregnancies and also the bluish ones recently formed. These streaks are of no consequence and I mention them simply because you are almost certain to notice them and may wonder what they are. They may appear upon the hips, thighs and breasts as well as upon the abdomen, if the skin over these parts is greatly stretched.

The umbilicus (navel) is deeply indented during about the first three months of pregnancy, but afterwards the pit steadily grows shallower and by the seventh month, it is level with the surface of the abdomen. After this time the navel may protrude, in which state it is described as a “pouting umbilicus.”

An increase in the vaginal discharge is another change which you may notice during the latter months of pregnancy.

The changes in the skin consist chiefly of the increased discoloration over various parts of the body, which was mentioned among the possible signs of pregnancy. The degree of this discoloration varies with the complexion of the individual, as blonds may be tinted but slightly more than usual, while the discolored areas on a brunette may become almost black. As the skin glands become more active, there is also an increase in perspiration and sometimes the hair becomes much more luxuriant during pregnancy.

Changes in the digestive tract are the morning sickness already described, and constipation. The latter is suffered by at least one half of all pregnant women and is due chiefly to pressure made upon the intestines by the enlarged uterus, though weakening of the stretched abdominal muscles may be one cause. Constipation is most troublesome during the latter part of pregnancy. There may be, also, heartburn, acid stomach and intestinal indigestion giving rise to gas, diarrhea and cramps. The so-called “cravings” of pregnancy are not so common in real life as they are in rumor, but the expectant mother may show unexpected likes and dislikes for certain dishes, possibly because of her tendency to be nauseated. Her appetite may be very capricious during the early weeks and become almost ravenous later on.

The bones and teeth may grow softer during pregnancy, if the expectant mother does not eat proper food, and as a result we hear of the old beliefs that each baby costs the mother a tooth and that broken bones heal slowly during pregnancy. Both of these occurrences are entirely unnecessary, and may be prevented by eating suitable food, as will be explained in the chapter on nutrition.

The carriage, or mode of walking, is somewhat affected by pregnancy because of the increased size and weight of the abdomen. In an effort, to hold herself erect, the expectant mother throws back her head and shoulders and finally assumes a gait that may be described as a waddle, being particularly noticeable in short women.

You hear a good deal about the thyroid gland these days, so you may as well know that it is very often enlarged during pregnancy and thus may form a swelling on the front part of the neck. If you notice it you might tell your doctor but it need not worry you for it will almost certainly return to its normal size after the baby comes.

When to Expect the Baby. Now that you are familiar with the most apparent changes which will take place in your body during pregnancy, you are probably on tiptoe to find out as nearly as possible the date upon which to expect the baby. Unfortunately we cannot foretell the exact date, for the very simple reason that we have no way of knowing just when pregnancy begins. Quite evidently, then, not knowing when it begins we cannot figure out the exact date upon which pregnancy will end in the baby’s birth. But we do know that labor usually begins about ten lunar months, or forty weeks, or from 273 to 280 days, after the beginning of the last menstrual period. Thus the approximate date of the baby’s arrival may be estimated by counting forward 280 days or backward 85 days from the first day of the last period. Or, what is perhaps simpler and amounts to the same thing, one may add seven days to the first day of the last period and count back three months. For example, if the last period began on June 3, the addition of seven days brings us to June 10, while counting back three months from this, indicates March 10 as the approximate date upon which the baby may be expected.

This is probably as satisfactory as any method of estimation, but at best it is only approximate, being accurate in about one case in twenty. However, it comes within a week of being correct in half the cases; and is within two weeks of the actual date in eighty per cent. of all pregnancies.

Still another method is to count forward twenty or twenty-two weeks from the day upon which you first feel the baby move. This “quickening,” as we have seen, usually occurs about the eighteenth or twentieth week, but is so irregular that it is not wholly reliable. The possibility of figuring out the date of the baby’s arrival is made still more uncertain by the fact that there is evidently considerable variation in the length of entirely normal pregnancies. Many healthy children are born before ten lunar months have elapsed since the last menstrual period, while more births occur after than on the expected date. The first pregnancy is usually shorter than later ones, and women who are well nourished and well cared for usually have longer pregnancies than those who are not.

Taking it as a whole, the average woman has unusually good health during pregnancy. She may feel some weariness during the first few months and she may lose a little weight, but during the latter part of the period her general health is improved and there is an increase of flesh, not alone in the abdomen, but over the entire body, sometimes amounting to twenty-five or thirty pounds. She loses about fifteen pounds of the increased weight when the baby is born, and still more during the weeks immediately following, when her body returns to about its original condition. But very often the experience of pregnancy is so beneficial that the improved state of health and nutrition which accompany it become permanent.

CHAPTER III
WHERE THE BABY’S LIFE BEGINS

As you plan for the care of your baby during the nine months before he is born, you will want to know something of the place where his life begins; where one tiny cell is so miraculously stimulated and nourished that it finally develops into a beautiful little body. Not only will you find all of this of absorbing interest, but a general idea of the structures and workings of those parts of your body where the baby lives and grows will help you better to understand some of the doctor’s precautions and to give yourself intelligent care while your body performs its supreme function.

To begin with, there is the pelvis. This is a very irregular, bottomless, bony basin, or curved canal, within which lie the reproductive or generative organs to be described presently. The pelvis is really composed of four bones which are entirely separate in early life but firmly welded into one rigid structure in adults. I mention this because many women believe that labor pains are caused by a spreading or opening of these bones, whereas, as we shall see presently, the pains are really due to the strong contractions of the muscles of the uterus (or womb) in which the baby lies, which force the baby down through this inflexible ring. You may see in Fig. [1] how the pelvis is placed in the body, being interposed between the spinal column, which it supports, and the thighs upon which it rests. We can feel two of its prominent points on either side below the waist, as our hips, and we rest upon two other projections while in the sitting position.

Fig. 1.—Diagram showing the structure of the pelvis and its position in the body, the inlet being heavily outlined.

This bony canal is drawn in, or narrowed about midway in its length so that it is broader above and below than it is in the middle. You are likely to bear the doctors speak of this narrow part as the inlet. I thought you would be interested to know about this for it is largely in order to discover the size and shape of the inlet that the doctor is so anxious to make certain examinations and measurements.

The wide part of the pelvis above the inlet is called the upper, or false pelvis, while the smaller cavity below is known as the true pelvis. During the early part of pregnancy the baby lies in the true pelvis, but as pregnancy advances and he grows larger, he pushes up through the inlet into the larger pelvis where he remains until he is born. When that time comes he must pass down through the inlet again on his way into the world. If this opening is about the usual size and shape and the baby is of an average size, he will usually pass through with comparatively little trouble. But if the inlet is smaller than normal or of an unusual shape, it may be difficult, or even impossible, for the head of a normal-sized baby to pass through without the doctor’s assistance. You can see how important it is, therefore, for the doctor to know beforehand about the size and shape of the pelvic inlet, since it enables him to plan to help with the birth, if necessary, thus saving mother and baby from exhausting themselves in trying to do the impossible. In the old days many mothers and babies were injured, and sometimes even lost their lives, because doctors did not know about measuring the pelvis and planning ahead of time for a difficult labor. But now they know how to make things easier and safer.

It is worth mentioning here that proper care during infancy and childhood, with proper food, fresh air and exercise, helps to promote normal development of the pelves of little girls, and this in turn tends to make childbirth normal for these children when they grow up and are ready to have babies of their own.

The Generative or Reproductive Organs. The pelvis is an interesting structure but not nearly so interesting as the generative organs which lie within it: the uterus (or womb), tubes and ovaries. These, with the vagina, are often called the internal genitalia because they are inside the body. The pelvis practically remains rigid and inactive throughout pregnancy and labor, but the ovaries and the uterus are constantly active and are concerned with an undertaking which is so utterly amazing that it is far beyond our powers of understanding. We can only look on and wonder.

Fig. 2.—Drawing showing the structure and relation of the female generative organs, as viewed from the side. (Drawn by Max Brödel. Used by permission of A. J. Nystrom and Co., Chicago.)

The uterus, or womb, in which the baby develops, is a firm little mass of muscle, which, in its non-pregnant state, is much the shape of a slightly flattened pear, about three inches high, an inch and a quarter wide at its broadest point, three quarters of an inch thick, and weighs about two ounces. We usually speak of the main part of the uterus as the body: the round top as the fundus and the smaller part of the organ, below, as the neck or cervix. This important little organ is placed about the middle of the true pelvis, with the upper end pointing slightly forward. (See Fig. [2].) It is more or less swung in this position by being attached to ligaments instead of to any fixed part, the ligaments, in turn being attached to the sides of the pelvis. This explains why the uterus may move about, tip forward or backward, and how, by a stretching of the ligaments that hold it, it is able to grow and push upwards as pregnancy advances.

Within the body of the uterus is a flat cavity which is somewhat triangular in shape, with an opening at each of the three corners. The two upper openings lead into the tubes, which will be described in a moment, while a third opening leads down into the cervix, the lower end of the cervix, in turn, protruding into the vagina. The upper and lower ends of the cervix are drawn in as though with a draw string so that they are scarcely more than small round holes. These are called the internal os and the external os. Fig. [3] gives an idea of how the cavity of the uterus and the cervix would look from the front, with the tubes reaching out from the upper corners of the uterus, and the cervix opening into the vagina. The uterus is lined with a soft mucous lining something like the lining of one’s mouth. Bear this in mind, for this lining represents, in part, the soil in which the tiny human seed is planted and through which its roots draw nourishment.

The Fallopian tubes are two little muscular passage ways, about five inches long, which extend from the two upper corners of the uterine cavity toward the sides of the pelvis. The tubes are very small where they arise from the uterus, but gradually grow larger toward their free ends and finally spread out into wide, funnel-shaped openings that lead directly into the abdominal cavity. The tubes, also, are lined with a mucous membrane but of a most surprising kind. Its surface is covered with tiny hair-like projections which make it something like a brush with very soft, moist bristles. These little hairs are in constant motion, waving and sweeping along in much the same way that a field of wheat waves and sweeps in the wind. Remember about this, too, for it has something to do with the very beginning of the baby.

Fig. 3.—Diagram showing the structure and relation of the female generative organs, as seen from the front.

The Ovaries. Very near and a little below the flaring, open ends of the tubes are the ovaries, the sex glands of the female. There is one on each side, held in place by ligaments and they are about the size and shape of almonds. In the ovaries are embedded the ova, or eggs, the female germ cells which are concerned with producing the baby and also with the function of menstruation.

Fig. 4.—Diagram of human ovum.

Just a word about what is meant by “a cell.” It is simply a tiny mass of jelly-like substance, called protoplasm, contained in a thin membrane or skin and is so small that it can be seen only through a microscope. In its unmatured state the ovum is a single cell, about ¹⁄₁₂₅ of an inch in diameter. In the protoplasm there is a spot called the nucleus and within this a smaller one called the nucleolus, or the germinal spot. These are long names and you need not remember them unless you want to, but glance at Fig. [4] which shows an ovum and you will see that in its general structure it is much like a hen’s egg, for the latter has a yolk within the white and on the yolk a tiny speck or germinal spot. The formation of each woman’s full quota of ova, fifty thousand or more, is probably complete at the time of her birth.

The vagina is a muscular tube, or passage way, leading from the outside of the body to the cervix, which you will remember is the lower part of the uterus. The vagina slopes upward from its opening and instead of meeting the cervix evenly it meets it almost at right angles and encases it like a sheath for about half an inch. Fig. [2] shows how these organs would appear if we were looking at them from the side.

The Bladder. If you will glance again at Fig. [2], you will see that just in front of the vagina there is a tiny passage leading up to a sac which also is in front of the vagina, and since in this picture it is practically empty, it lies below the uterus. This sac is the bladder and you can readily understand that as the uterus enlarges during pregnancy, it presses upon the bladder and this pressure on the outside gives the same sensation as is produced by pressure from the inside when the bladder is filled with urine. That is why the expectant mother has such a constant desire to urinate during the early weeks of pregnancy, before the uterus pushes up into the abdomen, and also during the later weeks, as well as during labor, when the bladder is being pressed upon by the baby’s head.

The Rectum. In the same picture you will see the rectum which lies just behind the uterus and vagina and which terminates in the anus. Between the rectum and the vagina is a thick triangular mass of muscle, called the perineum, which practically forms a floor to the pelvis, the bony basin without a bottom.

The external genitalia, sometimes called the vulva, really have nothing to do with the creation of the baby, but you will better understand some of the care that is given you if you know a little about them, too. Between the thighs, where they join the body, are two thick folds of flesh, called the labia and between these lie the perineum, just mentioned, and the openings from the rectum, vagina and bladder as shown in Fig. [2].

Now that we have something of an idea of the structure of the organs concerned with the creation of the baby, we shall want to learn about the usual activities of these interesting little parts, before the baby begins his life within them.

Puberty or Adolescence. You know, of course, that girls are incapable of becoming mothers until after what is termed puberty, or adolescence, and by these terms we mean the period during which childhood develops into sexual maturity, and the individual becomes capable of reproduction. The age at which puberty occurs varies with climate, race and occupation and with different individuals of the same status. But the average for girls, in temperate climates, is from the twelfth to the sixteenth year and for boys from the fourteenth to the seventeenth year. Girls in southern climates sometimes mature as early as the eighth or ninth year while in colder regions puberty may be delayed until they are eighteen or twenty years old.

The occurrence of puberty marks the establishment of ovulation and menstruation, two functions which are usually performed once a month during the childbearing period.

Ovulation, which probably occurs about midway between the menstrual periods, is simply the name which has been given to the principal function of the ovary and may be defined as the development of the ovum, or egg, and its expulsion, when mature, from the ovary. As the entire human body has its origin in this tiny ovum, its career and course of development are of momentous importance to us, and at the same time furnish a tale of absorbing interest. The ovaries are packed full of these tiny egg-like cells, which probably lie dormant, as stated before, until the girl reaches puberty. Then they begin to develop and grow and push their way from the inside of the ovary to the surface where they look more or less like blisters. When an ovum reaches the surface of the ovary, a thin membrane which contains it, bursts, and it is suddenly expelled into the abdominal cavity. You will remember that the ovary is very near the funnel-like end of the tube, so, when the little cell is shot out of the ovary, it finds itself floating around quite close to this wide opening. Some of the ova that are projected into the abdominal cavity are doubtless lost, but others find their way into the near-by mouth of the tube, and if not fertilized by uniting with a male cell, which we shall explain presently, they pass down the tube into the uterus and are finally carried out in the menstrual flow. It is probable that as a rule only one ovum ripens and escapes from the ovary each month from puberty until the menopause or change of life.

The interesting thing about all of this is that each time an ovum does mature and is discharged from the ovary, the lining of the uterus becomes thicker and softer in order to facilitate the attachment of the ovum, if it is fertilized, this attachment being necessary if a baby is to develop. This preparation of the uterine lining is often, and very appropriately, referred to as “nest-building.”

Menstruation, which is the evidence of sexual maturity, is a monthly hemorrhage from the uterus, escaping through the vagina, and it normally recurs regularly throughout the childbearing period, except during pregnancy and while the young mother nurses her baby. The length of this childbearing period is about thirty years and continues from puberty until the menopause. The frequency of the menstrual periods varies from twenty-one to thirty days but the normal interval between periods is twenty-eight days, which is the length of what is called the “menstrual cycle.” Thus it is usually a lunar month from the beginning of one period to the next one, making thirteen menstrual periods during each calendar year. The complete course of a menstrual cycle consists of four stages, which, it is believed, occur somewhat as follows:

The first, or constructive stage, lasts about seven days. It is during this stage that the preparations are made to receive the ovum traveling down the tube. The entire uterus becomes congested with blood and is somewhat enlarged and softened as a result, while its lining grows red, thick and velvety. If the ovum remains unfertilized, which is usually the case, it does not attach itself to this elaborately prepared lining, but passes out with the uterine discharges and all of this preparation not only goes for naught but must be undone.

The second stage, therefore, which lasts about five days, is the destructive stage and is the period we speak of as menstruation. During this period the extra tissue which has been formed in the uterus is broken down; it mixes with the blood that oozes from the congested lining and together they pour from the vagina as the menstrual flow.

The third or reparative stage, which follows, occupies about three days during which time the uterus and its lining return to their normal state.

The fourth, or quiescent stage, now follows and lasts twelve or fourteen days. This is the time remaining before Nature, with unwearying patience, begins all over again to prepare for the reception and attachment of the next matured ovum, in ease of its possible fertilization. And so it goes, month after month and year after year.

It is very important for a woman who is suffering from painful menstruation to consult a doctor about correcting the cause, in the interests of her future childbearing, if for no other reason, for this is one step toward preparing a good soil in which to plant the seed from which a baby may grow. For example, a misplacement of the uterus is a frequent cause of painful menstruation and if it remains uncorrected may make conception impossible; or if conception perchance does take place, the malposition of the uterus may, later, be the cause of an abortion or miscarriage. Inflammation of the lining of the uterus is another cause of menstrual difficulty and if allowed to persist, may interfere later on with the normal development and nourishment of the baby.

The menopause, also termed the climacteric, or the change of life, marks the permanent stopping of menstruation and ability to bear children. This ordinarily occurs between the ages of forty and fifty, the majority of women ceasing to menstruate during their forty-sixth year.

The most favorable age for motherhood to begin is a subject of considerable interest to most women. When it is considered from all standpoints, social, ethical, spiritual as well as physical, the most favorable age for motherhood to begin seems to be sometime in the early twenties. Children have been born to little girls nine years old and to women over sixty, but the extremes of the reproductive years are not favorable periods for childbearing.

Now a word about the breasts. They appear to be merely large, soft masses of fat, one on each side of the chest, having no connection with the pelvic organs. But in reality they are very complicated glands and strangely enough, though no one knows why, their activities are controlled by the activities of the generative organs down in the pelvis. Certain it is that their function is very important to the baby, for the breasts are the factories in which nourishment is produced to nourish him during the first few months after he is born.

Fig. 5.—Front view of breast, showing areola; openings from milk ducts and the glands beneath the skin.

If we could look inside of the breasts we should see that in structure they are much like several clusters of grapes in which the stems and grapes are hollow. The milk is formed in the tiny sacs corresponding to the grapes, and pours into the little tubes conforming to the stems; these empty into a central tube, opening upon the surface of the nipple from which the baby will extract his nourishment. If you will look at Fig. [5] you will see in that picture of the front of a breast, that a part of it apparently has been magnified to show these openings of the milk ducts. There are about fifteen or twenty of them in each nipple. The picture shows also the little glands which appear as small lumps under the skin around the nipple, both in the dark circle called the areola and in the white skin surrounding it.

Summing up this chapter briefly, we find that the pelvis is an irregular, bony canal or basin, drawn in about the middle, thus forming the upper, or false pelvis and lower or true pelvis, neither of which has a bottom. The opening between these two basins is called the inlet, while the lower margin of the true pelvis is called the outlet, but it is the inlet that is of particular importance during childbirth. In the center of the lower pelvis and swung upon ligaments attached to its sides is the uterus, whose lower part, called the cervix, extends downward into the vagina; while reaching out from the upper corners of the uterus are the tubes, and near their open ends, one on each side, are the ovaries filled with germ cells called ova. The bladder lies in front of the uterus and vagina and the rectum behind, while below is the perineum, forming a floor to the pelvic cavity. Every four weeks during the childbearing years an ovum is expelled from one of the ovaries into the abdominal cavity and the uterus regularly prepares to receive it in case of its fertilization, but if it is not fertilized the ovum is lost and menstruation occurs.

We see, too, that although the breasts are situated remotely from the pelvic organs they are really very important accessories, since they provide milk to nourish the baby after his life within the uterus is terminated by his birth.

CHAPTER IV
HOW THE BABY DEVELOPS BEFORE HE IS BORN

Now that we know something of the place where the baby’s life begins and how the way is prepared for his growth, we are ready to follow the interesting course of events that occur from the time the seed, a tiny egg-like cell, bursts from an ovary until the beautiful, fully developed baby comes into the world.

You will remember that when the ovum is expelled from an ovary it may float about in the abdominal cavity and be lost or it may enter the near-by mouth of a tube. Also that if it enters a tube it is carried downward toward the uterine cavity by the sweeping motion of the hair-like projections on the lining of the tube. This journey of the ovum through the tube is of enormous consequence, for during its course occur the events which decide whether the ovum shall, like most of its fellows, be simply swept along to no end and lost, or whether by chance it is to receive the mysterious impulse which begins the development of a new human being. The amazing power which enables this cell to reproduce itself, and to develop with unbelievable complexity is acquired somewhere in the tube, usually in the upper end, by meeting and fusing with a spermatozoon, the germinal cell of the male.

The spermatozoa are attracted to the ovum much as bits of metal are drawn to a magnet, but although the ovum that is destined to be fertilized is surrounded by several spermatozoa, only one actually enters and fuses with it.

This fusion is termed fertilization, or, in lay parlance, conception, and the instant at which it occurs marks the beginning of pregnancy. The establishment of this fact is of considerable importance, since it does away with any possible controversy concerning the time at which a new life begins. The origin of the baby is exactly coincident with the fusion of the male and female cells. Furthermore, the sex of the child and any inherited traits and characteristics are also established at this decisive moment. No amount of dieting, exercise or mental effort on the part of the expectant mother can alter or influence them in the smallest degree, for the father has made his complete contribution toward the creation of the new being and the mother, also, has made hers, except for nourishment which she provides throughout pregnancy.

All told, probably more than five hundred theories have been advanced to explain what it is that decides of which sex the forthcoming child is going to be. But as the results of applying these theories have scarcely borne out the claims of their advocates, they are given but scant attention to-day.

The present belief regarding the causation of sex is that although there is but one kind of ovum, there are two kinds of spermatozoa, one capable of producing a male and the other a female child, but the sex-determining form of the male cell that fertilizes any one ovum is a matter of the merest chance. Statistics show that more male than female babies are born, the usual proportion being about 105 boys to 100 girls among those who are carried to “term” or the end of pregnancy. Among abortions and prematurely born babies there is also a larger number of boys than girls, but as more boys than girls die in infancy, the two sexes about even up in the number of those living to adult life.

Concerning the time of the month when conception is most likely to occur, there is a wide difference of opinion. Some doctors think that the most favorable period is just before or just after menstruation, while others believe that conception is most likely to take place about midway between the menstrual periods.

Fig. 6.—Diagram indicating process of cell division.

Returning to the ovum which meets a spermatozoon in the course of its journey down the tube, we find that as soon as a spermatozoon enters an ovum it disappears and is completely absorbed, and, as the ovum in turn is instantly possessed of new powers, through the presence of the male cell, the result of this union is an entirely new cell. But instead of continuing its existence as a single cell, the fertilized ovum divides into two cells; these two into four; the four into eight and so on until a clustering mass of cells is formed which looks something like a mulberry. If you will look at Fig. [6] you will see what happens as this cell division progresses and also that in time the cells rearrange themselves in such a way as to leave a space in the center of the mass so that it becomes a little sac with a cluster of cells at one point, which hangs toward the center, called the internal cell mass. This will interest you because it is from cells at one point in this little cluster that the baby begins to develop, together with the cord, bag of waters and afterbirth, to be described later.

While these changes are taking place, the entire mass is being carried slowly down the tube toward the uterus by the sweeping motion of the soft little hairs on the lining of the tube. It is steadily growing, and by the time it reaches the uterus the mass is about the size of the head of a pin. As you will remember, the lining of the uterus prepares each month to receive the fertilized ovum, becoming soft and thick. The cell mass floats around for a little while after it reaches the uterine cavity and then resting at some point, sinks down into the soft lining and is completely buried.

From now on the cells which compose the mass rapidly increase in number and very shortly cease to be all of one kind. These different kinds of cells rearrange themselves and grow in such a manner that some of them begin to form the different parts of the baby’s body and others develop into two thin membranes that finally enclose the baby in a double sac. He is attached to the inner surface of the sac; the space which he does not occupy is filled with fluid and the sac itself is attached to the uterine lining at the point where the cell mass happened to stop and bury itself.

This sac is what you have heard called the “bag of waters,” but the doctors refer to it as the membranes. As it enlarges and pushes out into the uterine cavity it still consists of two thin membranes except where it is attached to the uterus, at which point it grows into a thick, spongy mass of blood-vessels. These blood-vessels divide and branch out in a tree-like fashion and burrow into the uterine wall. As you will see later, it is through this mass of branching blood-vessels that the baby virtually eats and breathes and gives off waste materials during the nine months of his life within the uterus. The doctors refer to the mass as the placenta but you have heard it called the “afterbirth,” because it is expelled after the baby is born.

Fig. 7.—Diagram showing the developing baby, at an early stage, with cord, membranes and placenta, within the uterine cavity.

As the baby’s development advances the part by which he is connected with the placenta lengthens out into what is called the umbilical cord. There are blood-vessels in this cord through which blood constantly flows back and forth, carrying nourishment to the baby from his mother and waste matter from his little body to the placenta where it is taken up by her blood. But this exchange of materials takes place through thin membranes and consequently the blood of the mother and baby never mingle. Fig. [7] will give you an idea of how the sac of membranes, with the baby hanging inside, grows out into the uterine cavity; how at the point where the membranes are attached to the uterus the blood-vessels have developed into the thick, spongy placenta and how the baby is connected with it by means of the cord. In Fig. [8] you may see how the baby changes in appearance as the weeks of pregnancy go by. At the end of the fourth month he really looks quite like the baby that we are so eagerly preparing for.

If we follow his development within the uterus month by month, we find that by the end of the first lunar month, or fourth week, the baby’s body is about ½ inch long and looks about as is suggested in the third little outline in Fig. [8].

At the end of the second month, or eighth week, his head is fairly well shaped; bones are beginning to develop, webbed hands and feet are formed and the little body is about 1 inch long.

At the end of the third month, or twelfth week, his entire body shows marked development and is about 3½ inches long. His fingers and toes are separated and bear soft nails; the teeth are forming, the eyes have lids and the umbilical cord has taken definite form.

At the end of the fourth month, or sixteenth week, in addition to the development of all parts a fine, soft hair appears over the body; there is a black, tarry substance, called meconium, in the baby’s intestines and he measures about 6 inches in length and weighs perhaps ¼ pound.

Fig. 8.—Appearance of the baby at different stages, early in his development.

By the end of the fifth month, or twentieth week, the baby has grown and developed markedly. He is now covered with skin on which are occasional patches of a greasy, cheesy substance called vernix caseosa, and though there is some fat beneath the skin his face looks old and wrinkled. A certain amount of hair has appeared upon the head and the eyelids are opening. It is usually during the fifth month that the expectant mother first feels her baby move, this sensation being commonly referred to as “quickening.” He is now about 10 inches long and weighs about 9 ounces.

By the end of the sixth month or twenty-fourth week, the baby is about 12 inches long and weighs possibly 1½ pounds. He is thin and wrinkled in appearance and if born at this time will attempt to breathe and move his limbs but will perish in a short time.

By the end of the seventh month, or twenty-eighth week, he still looks thin and scrawny; his skin is reddish and is well covered with the cheesy vernix caseosa. If born at this stage, the baby will move quite vigorously and cry feebly, but he is not likely to live for any length of time. He is now about 14 inches long and weighs about 2¾ pounds.

By the end of the eighth month, or thirty-second week, the baby has grown to about 17 inches in length and 4 pounds in weight, but continues to look thin and old and wrinkled. His nails do not extend beyond the ends of his fingers but are firmer in texture; the soft, downy hair begins to disappear from his face but the hair on his head is more abundant. If born at this stage, the baby will have a fair chance to live, provided he is given painstaking care. This is true in spite of the old belief, still widely current, that a seven months’ baby is more likely to live than one born at eight months (meaning calendar months). The fact is that after the twenty-eighth week the probability of the baby’s living increases greatly with each added week of life within the uterus. His growth during the latter part of pregnancy is rapid, for he gains nine tenths of his weight after the fifth month and one half of his weight during the last eight weeks of uterine life.

At the end of the ninth month, or thirty-sixth week, the increased amount of fat under the baby’s skin has given a plumper, rounder contour to the entire body; the aged look has passed and his chances for life have greatly increased. He weighs about 5½ pounds at this stage and is perhaps 18 inches long.

The end of the tenth month, or fortieth week, usually marks the end of pregnancy. Fig. [9] will show you how the baby lies in the uterus just before birth, curled up into the smallest possible space.

Fig. 9.—The usual position of the baby just before he is born.

The average normally developed baby has grown to a length of about 20 inches and weighs about 7¼ pounds, boys usually being about three ounces heavier than girls, but there may be a variation of weight among entirely normal, healthy babies from a minimum of 5 pounds to as high as 11 pounds or more. Newborn babies very seldom weigh more than 12 pounds, in spite of legends and rumors to the contrary.

The size of the baby is affected by the race of his parents; colored babies, for example, averaging a smaller weight than white babies. And, as might be expected, the size of the parents is likely to be reflected in their infants, large parents tending to have large children and vice versa.

The number of children which the mother has previously borne is also a factor, since the first child is usually the smallest, the size of those following showing an increase with the mother’s age up to her twenty-eighth year, if her pregnancies do not occur at too frequent intervals.

Twins. Sometimes a woman gives birth to more than one baby at the same time. When there are two they are called twins; triplets when there are three; quadruplets, quintuplets and sextuplets respectively, when there are four, five and six babies within the uterus at once. Six is the largest accredited number on record.

It is estimated that twins occur once in ninety pregnancies and triplets once in about seven thousand cases. The tendency seems to be inherited, as is evidenced by the number of twins and triplets to be found among relatives.

Twins are often prematurely born and each is likely to be smaller than a baby resulting from a single pregnancy, but their combined weight is greater than the weight of one normal baby.

Extra-uterine Pregnancy. Another departure from the normal pregnancy is when the baby develops outside of the uterus. Although in the normal course of events the fertilized ovum travels down the tube and becomes attached to the uterine lining, it is possible for it to stop, and more or less completely develop at any point along the way. This is called an extra-uterine pregnancy, since it occurs outside of the uterus. If the baby develops in one of the ovaries, it is termed an ovarian pregnancy, and a tubal pregnancy if it develops in a tube, this being the most frequent variety of extra-uterine pregnancies. Only about one out of a hundred such pregnancies continue throughout the allotted period, and accordingly, a live baby, capable of living for any length of time, seldom results.

To sum up a normal pregnancy, we find that in the course of ten lunar months following the fertilization of an ovum, the uterus grows from a small, flattened pelvic organ, 3 inches in length, to a large muscular sac, about 15 inches long occupying the abdominal cavity. It increases its weight sixteen times, that is, from 2 ounces to 2 pounds, while the capacity of the uterine cavity is multiplied five hundred times. Within the uterus is a baby weighing about 7¼ pounds; a placenta weighing perhaps 1¼ pounds and approximately a quart of fluid. The baby is attached to the placenta by means of a jelly-like cord about as thick as one’s first finger and 20 inches long; baby, placenta, cord and fluid all being contained in a thin, but strong sac frequently called the bag of waters, but by the doctors termed the membranes. The total weight of the uterus and its contents at the end of pregnancy is usually about 15 pounds.

Throughout the baby’s life within the uterus, the placenta virtually acts as his digestive organs, lungs, kidneys and bowels. Bear this in mind, and you will realize why, in taking care of yourself you are taking care of your baby while his body is being built and getting itself into running order to take up life as a separate being. The full realization that whatever is good for you is good for your baby will make you eager to give yourself the care that is outlined in the next chapter.

CHAPTER V
TAKING CARE OF THE BABY BEFORE HE COMES

We shall see that taking care of your baby before he is born means taking such care of yourself throughout pregnancy, that you not only keep your own body in its usual good running order, but in addition, so effectively promote the activities of your various organs that you also keep the baby’s body going, his body that is growing all the time.

Quite reasonably this requires extra work on the part of some of your organs, particularly those concerned with digestion and the process of throwing off impurities. The latter is of the greatest possible importance for in addition to excreting the usual amount of impurities from your own body you must excrete also those thrown off by your baby. The amount of waste from him is not large but it seems to be of such a character that it harms the mother if it is not steadily excreted.

Good digestion and satisfactory excretion are dependent upon a number of factors and fortunately most of them are within your own control.

Your frame of mind is one of the most important factors of all. I know that to suggest the cultivation of a cheerful, hopeful mental attitude is easier said than done. But after all it really is largely a matter of habit which you can acquire if you set yourself to it, particularly if you realize that your physical condition will be benefited by your going through pregnancy happily. And remember that whatever is good for you is good for your baby.

Continue with the work, amusements and exercise that you are used to and enjoy, except of course such activities as the doctor may forbid. In general, try to forget that you are pregnant, so far as you can do this and still remember to take proper care of yourself.

Above all, don’t worry. Worry will interfere with your sleep and it will also upset your digestion quite as seriously as will wrong food. Try not to be too self-centered or too watchful of your symptoms, but at the same time avoid the dangerous habit of thinking that any unusual condition which develops is due to your being pregnant, for a sick pregnancy is not normal.

It will relieve you of a great deal of anxiety if you report to your doctor everything you do not understand, for the consciousness that he will know just what to do, if anything is necessary, will help to keep you from worrying.

It is important, too, for you to get rid of the depressing beliefs in connection with pregnancy that have come down to us through the ages.

For instance, do not believe for a moment that anything you do, think or see can “mark” or deform your baby, for remember that after conception you give him nothing but nourishment. The only communication between you and the baby is through your and his blood, and blood does not carry mental impressions. Accordingly, no effects of fear, horror or unpleasant memories which you may have can possibly reach him. It is true that once in a while a woman does see something shocking and later gives birth to a marked or deformed baby. But there is little doubt, now, that such an occurrence is merely a coincidence. If you will stop and think for a moment you will realize that most expectant mothers see or hear or think something unpleasant at some time during pregnancy, and yet most babies are born without mark or blemish. Anger, fright or sudden shock may upset your digestion, but it does not directly affect your baby.

As for that common belief that in “reaching up” the mother may slip the cord around the baby’s neck—if you will picture for a moment how the baby lies within the uterus you will realize how impossible this is, for the mother’s arms have no connection with him or the cord.

So dismiss these doubts and fears from your mind and dwell instead upon the loveliness of what is in store for you, for, I repeat, your physical condition will be benefited if you go through pregnancy happily. And remember again that whatever is good for you is good for your baby.

So your first step toward caring for the little life already within your charge is to follow the example of Mrs. Wiggs, who constantly wiped the dust from her rose-colored spectacles.

Now for the more specific details of your care. Of these the question of your diet is of enormous importance.

Let us consider first what your food accomplishes if it is suitable and conditions are favorable for its use by you and the baby. It should provide nourishment for your various tissues, as under ordinary conditions; it should promote the activities of your skin and kidneys, as well as bowels, since it is through them that the waste from your own and your baby’s body must be excreted, and your food should be adequate also, to build and nourish the baby’s body without his having to draw materials from your tissues. Strange as it may seem, the baby’s physical needs are supplied before yours are met, and if there are not enough food materials for you both, your bones, teeth and muscles will be deprived. Furthermore, taking proper food during pregnancy is an important step toward preparing yourself to nurse your baby, after he is born, which is quite as urgent as nourishing him before birth.

To accomplish these ends you not only must eat suitable food, but you must digest and absorb it as well. This requires that you constantly guard against overeating, constipation and indigestion of any kind. Indigestion may be avoided during pregnancy exactly as it is at other times, by eating proper food, by cultivating a happy frame of mind; by having sufficient exercise, fresh air, rest and sleep.

If you are accustomed to a fairly simple, well balanced, mixed diet, you probably will need to make little or no change, except to have the evening meal light if it has been a hearty one. It may surprise you to learn that you need not “eat for two,” in quantity, as is so commonly believed necessary, for during pregnancy you make so much better use of food materials than usual that an amount and kind of food that keep you in good condition will be adequate to meet your baby’s needs, too, until the latter part of pregnancy. On the other hand, it is very unwise for an expectant mother to cut down her diet, with the idea of keeping the baby small and thus make labor easy, except under the direction of her doctor. In general it is the size of the baby’s head that makes labor easy or difficult, and not the amount of fat distributed over his body. And if the mother cuts down the minerals in her diet to make the baby bones soft, the only result is that her own bones and teeth are softened, because the baby extracts from them enough lime to supply what the food lacks.

Three meals a day will usually be enough during at least the first half of pregnancy and they should be taken with clock-like regularity, eaten slowly and masticated thoroughly. The possible need for slight additional food during the later weeks may be supplied more satisfactorily by lunches of milk, cocoa or broth and crackers or toast, between meals and upon retiring, than by taking larger meals. An expectant mother who has a tendency to nausea early in pregnancy often feels better for taking a small lunch regularly five or six times daily instead of the usual three full meals.

It is of the greatest importance that every pregnant woman drink an abundance of fluid to act as a solvent for her food and waste material and promote the activity of her kidneys, skin and bowels. She needs about three quarts daily, most of which should be water, the remainder consisting of milk, cocoa, soup and other liquids. Alcohol should not be taken except upon the doctor’s orders and only moderate amounts of coffee and tea, unless he gives permission for more.

The expectant mother will be wise to avoid fried food, pastry, rich desserts, rich salad dressings and any other food which would ordinarily disagree with her.

Since the enjoyment of one’s meals promotes digestion at all times, the expectant mother should try to eat the things that she enjoys most and that agree with her. The average pregnant woman who has no symptoms of complications will usually be able to supply her own and her baby’s needs and at the same time keep within the bounds of safety if she selects her diet from the foods included in the following groups:

Animal Foods. Milk and eggs are the most satisfactory, but for the sake of variety and to tempt her appetite the expectant mother will usually be allowed to take rather sparingly, and preferably only once a day, of fish, the various kinds of shell fish, beef, lamb, chicken or game. Pork, veal and goose should be avoided as a rule, and particularly by women with whom they ordinarily disagree.

Soups. Thin soups and broths have little food value but because of their appetizing flavor and aroma are an aid to digestion, and frequently by stimulating a flagging appetite will help the expectant mother to eat and assimilate more than she would without them. But cream soups and purées have a high food value and, like thin soups and broths, also supply a definite amount of fluid which she must have.

Vegetables. The group of vegetables generally designated as “leafy” are of even greater importance to the expectant mother than they are to the average person. Of these she may safely eat onions, asparagus, celery, string beans, spinach, and she should make a point of taking a green salad, such as lettuce, cress or romaine, at least once daily. Sweet potatoes, white potatoes, rice, peas, Lima beans, tomatoes, beets and carrots, also, may be eaten with safety, as a rule, but cabbage, cauliflower, corn, egg-plant, Brussels sprouts, parsnips, cucumbers and radishes should be taken with great caution and avoided altogether if they cause gas or any kind of distress.

Fresh Fruits. A necessary part of the diet is fresh fruit, and among those fruits which are both beneficial and usually harmless are apples, peaches, apricots, pears, oranges, figs, cherries, pineapple, grapes, plums, strawberries, raspberries, blackberries and grapefruit. These are more likely to be laxative if eaten alone, as before breakfast and at bedtime. Cooked fruits are also valuable articles of diet, but are probably less laxative than raw fruit. Some of the citrous fruits, oranges, grapefruit or lemons, should be taken daily because they possess a certain indispensable food value which is peculiar to them.

Cereals. For their nourishing and laxative qualities, cereals are important and their food value is increased by the milk and cream which are usually taken with them. Cooked cereals should invariably be cooked longer than the usual directions suggest. Bran, eaten alone as a cereal or in combination with other grains, is an excellent laxative.

Breads. Graham, cornmeal, whole wheat and bran bread are all good, in general the expectant mother will be on the safe side if she eats sparingly, if at all, of very fresh or hot breads and hot cakes.

Desserts. Desserts are very important for they add to the attractiveness of most people’s meals, and if wisely chosen and properly made, may supply a good deal of easily digested nourishment. They may include, in addition to fresh and cooked fruits and preserves, ice-cream, a wide variety of custards, creams and puddings made largely of milk, eggs and some ingredient to give substance and firmness, such as gelatin, cornstarch, rice, tapioca, farina, arrow-root and similar materials.

In general the expectant mother should eat an abundance of fruit and vegetables, taking at least some uncooked fruit and a green salad, daily, and make sure that her food contains a good deal of residue, such as is provided by fruit and coarse vegetables. This residue increases the bulk of the material in the intestines, and this helps to overcome the tendency toward constipation. As fat is less easily digested than starchy foods, and more likely to cause nausea during pregnancy, it is better to eat no more fat than usual but to supply the additional material which is needed after about the sixth month, by taking a little more starchy food. However, a slight increase only is necessary, and this chiefly during the last three or four weeks.

The Kidneys. It is scarcely possible to say enough about the importance of keeping your kidneys in normal working order during pregnancy, for through them is excreted much of the waste matter from your baby’s body as well as your own. Sometimes when these impurities are not thrown off as they should be the expectant mother has convulsions. You will be glad to know how much you yourself can do toward preventing convulsions by drinking plenty of water and by faithfully measuring your urine and taking a specimen to the doctor when he asks you to. As I said before, you should drink at least three quarts of fluid every day. Most of this should be water, the remainder being milk, cocoa, soup, tea, coffee, and so on.

The doctor will probably want you to measure your urine and take a specimen to him once a month during the first half of pregnancy and every two weeks afterward, or even every week toward the end. He can tell by examining the urine whether your kidneys are acting as they should and if they are not he may save you serious trouble by putting you to bed for a few days with no nourishment but milk and water.

In preparing a specimen you will need a covered corked vessel large enough to hold all the urine passed in twenty-four hours, and it must be thoroughly washed and scalded. The next step is to pass urine, suppose we say at eight o’clock in the morning, and throw it away. All of the urine which you pass after this time until eight o’clock the next morning must be saved in the vessel and kept in a cool place to prevent its decomposing. If you will put a teaspoonful of chloroform or boracic acid powder into the vessel it will tend to preserve the urine and will not injure the specimen. At the end of twenty-four hours the urine should be shaken to mix it thoroughly and about half a pint poured into a bottle that has been washed and scalded. Carefully cork and label this with the date, your name and address and the total amount of urine passed in the twenty-four hours. The vessel for collecting the urine and whatever you use as a measure should be reserved for these purposes only. If you have no tin or glass measure, a regular-size quart tomato can will prove entirely satisfactory.

If you find, when measuring your urine, that you pass less than a quart and a half in twenty-four hours, you may know without being told that this is not enough and that you should drink more water.

The Skin. People are likely to think of the skin as being simply a covering for the body, whereas, in reality, it is a very complicated and active organ which helps to regulate the body temperature and constantly throws off impurities, just as the kidneys do. This latter function is performed by the sweat glands which open upon the surface of the skin as the “pores,” and we are told that in all there are some twenty-eight miles of these tiny tube-like structures in the skin. These glands should be, and usually are, constantly active; they pour upon the surface of the body an oily substance which keeps the skin soft; they also excrete something more than a pint of water daily, which contains impurities that are harmful if retained in the body. We are not aware of this constant excretion of fluids, which is termed “insensible perspiration,” but it continues even in cold weather and must not be stopped if health is to be preserved. If the oil, dust, particles of dead skin and the waste material left by dried perspiration are allowed to remain upon the surface of the body they will clog the pores, or gland openings, and thus interfere with their action. The removal of this material, then, is necessary to maintain health, and is done automatically in part for the fluid evaporates and much of the solid matter is rubbed off on the clothing. The most important aids to the skin’s activity are the drinking of plenty of water, deep breathing, exercise and warm baths.

Regular and thorough bathing serves the double purpose of removing waste matter already on the surface, and of stimulating the glands to increased activity in giving off still more.

Many doctors advise a warm, not hot, shower or tub bath every day, with soap used freely over the entire body, followed by a brisk rub. The best time for this warm, cleansing bath, as a rule, is just before retiring, as it is soothing and restful, and tends to induce sleep. Very hot baths are fatiguing, particularly during pregnancy, and should never be taken except with the doctor’s permission; but cold baths usually may be continued throughout pregnancy if one is accustomed to them and reacts well afterwards. Under these conditions the morning cold plunge, shower or sponge is beneficial, as it stimulates the circulation and thus promotes the activity of the skin. Some doctors forbid tub bathing of any kind after the seventh month, on the ground that as the expectant mother sits in the tub her vagina is filled with unsterile water and should labor occur shortly afterward an infection, or fever, might result. And as she is heavy and somewhat uncertain on her feet, there is also the danger of her slipping and falling while getting in or out of the tub. Other doctors permit tub baths throughout pregnancy, up until the onset of labor; while as to hot foot baths, since there seems to be no reason for or against them at any time during the nine months, they may be taken or not at will.

Bathing in a quiet stream or lake is apparently harmless but sea bathing, if the surf is rough, is inadvisable because of the beating of the waves upon the abdomen and the general violence of the exercise.

The importance of keeping the body evenly warm throughout pregnancy cannot be overemphasized, for a sudden chilling or wetting may so check action of the skin as to impose more of a burden upon the kidneys than they can meet, in their effort to throw off the skin’s share of the body waste. Accordingly, a single chilling will sometimes be enough to cause convulsions. This may be one reason why convulsions occur more frequently during cold weather or after a sudden drop in the temperature after warm or mild days.

The Bowels. The bowels, also, throw off a certain amount of impurities and if they do not move thoroughly at least once a day these impurities may be taken into the system and again the kidneys be given extra work.

Unhappily a great many pregnant women are constipated, particularly during the later weeks, while women who have always had a tendency of this kind may have trouble with their bowels from the very beginning of pregnancy. Your bowels should move regularly every day, and to this end you should attempt to empty them at the same hour each day, immediately after breakfast being the best time. The importance of regularity in making the attempt cannot be overemphasized, even though the bowels do not always move.

The measures which tend to prevent constipation, as already pointed out, are drinking plenty of fluids, and eating fresh fruit, coarse vegetables and bulky cereals such as bran; also taking a glass of hot or cold water just before going to bed and the first thing in the morning. You should not take enemas or cathartics without your doctor’s order, but you may safely increase the amount of fluids which you drink and the bulk of your food, in order to regulate your bowels.

Senna and prunes cooked together prove to be helpful in keeping the bowels regular and they are entirely harmless. A simple way of preparing them for this purpose is to pour a quart of boiling water over an ounce of senna leaves and allow them to stand for about two hours. A pound of well washed prunes should soak overnight in this liquor, after it has been strained, and then cooked in it until tender. They may be sweetened with two tablespoonfuls of brown sugar, and the flavor improved by adding a stick of cinnamon or slice of lemon while they are cooking. Half a dozen of these prunes, with some of the syrup, may be taken at the evening meal to start with, and increased or decreased in number as necessary.

Clothes. The chief purpose of clothes under all conditions is to aid in keeping the body warm, thus helping to preserve an even circulation of the blood and the activity of the sweat glands. As has been pointed out, this is of especial importance during pregnancy. The expectant mother’s clothes should be not only sufficiently warm, but they should be equally warm over her entire body. They should be light and porous, and fairly loose, so as not to interfere with the circulation or other bodily functions. There must be no pressure on chest or abdomen; no tight garters, belts, collars or shoes.

The clothes of the mother-to-be, like every other detail of her care, must be adapted to her surroundings and mode of living. If her house is well and evenly heated during the cold months, she may quite safely dress lightly while indoors; if it is not, she should wear underwear with high neck, long sleeves and drawers, both indoors and out, except when the weather is warm enough to cause perspiration. At all times, however, the warmth of her clothing should be suited to the temperature of the home, the climate and the state of the weather.

Remembering that it is important for you to keep up the diversions and amusements that you enjoy, it is worth while to have your clothes as pretty and becoming as possible, for you are much more likely to go about and mingle with your friends if you feel that you are becomingly and well dressed. At the same time your clothes should be so made that their weight will hang from the shoulders instead of from the waistband.

And that brings us to the question of corsets, a much discussed garment. Women who have not been accustomed to wearing corsets will scarcely feel the need of adopting them during pregnancy except, perhaps, during the later weeks when the heavy abdomen needs to be supported for the sake of comfort. This need is felt particularly by women who have had children and whose abdominal walls are somewhat weakened in consequence.

If you have been wearing comfortable, well fitting corsets, you probably will not feel the need of making a change until the third or fourth month. But by this time the baby will have pushed up out of the lower pelvis into the abdomen and your corsets then, if you wear any, must be so constructed that they will not compress nor disguise your figure, but will provide support and accommodate themselves to an abdomen that is steadily increasing in size and changing in shape. Such corsets are made of soft material; have elastic inserts and have lacings at the sides as well as in the back. They come well down and fit snugly over the hips. (See Fig. [10].) Some women find comfort in attaching shoulder straps to their corsets thus suspending some of the abdominal weight from the shoulders. But as a rule, the most comfortable arrangement is a short-waisted maternity corset worn with a brassière that supports the breasts and does not compress the nipples.

I hope this description will make clear to you why the same style corsets as you ordinarily wear cannot be satisfactory during pregnancy, no matter how large they are, and may even prove harmful.

Fig. 10.—Front and side views of a satisfactory maternity corset, adjusted at the fifth month of pregnancy. (By courtesy of Emma E. Goodwin, New York.)

Fig. 11.—Front, side and back views of home-made binder for supporting a heavy, pendulous abdomen during later weeks of pregnancy. It is adjusted as the expectant mother lies down, the ends being crossed in the back and pinned to the lower margin of the front, thus giving additional support.
Also breast-binder made of a straight strip of soft cotton material, 10 or 12 inches wide and 2 yards long. This is crossed in front and held with safety-pins, the ends being carried over the shoulders and pinned to the back of the binder. It should be snug below the breasts but loose over the nipples. The openings over the nipples show how this binder may be used to support the breasts of the nursing mother. (From photographs taken at the Maternity Centre Association, New York.)

Even a properly fitting maternity corset may become uncomfortable during the last few weeks of pregnancy, and have to be replaced by an abdominal supporter of linen or rubber. And when this stage is reached, even the woman who has worn no corsets may find that she is more comfortable if she adopts such a support, particularly at night. There are many admirable binders on the market, or such an one as is illustrated in Figs. [11] and 12 may easily be made at home as well as comfortable and inexpensive stocking supporters, made from tapes or strips of muslin, as in Fig. [13].

Fig. 12.—Abdominal binder used in Fig. [11], showing darts at top of front to fit it over the abdomen.

Your shoes, also, merit some thought, for your feet will probably be larger during the latter part of pregnancy, partly because of the possibility of their being somewhat swollen and partly because the increased weight of your body tends to spread them. This added weight also increases the strain put upon the arch and as a result, flat-foot is fairly common among expectant mothers who have not taken pains to have their arches well supported. Your shoes would better be an inch longer than those you ordinarily wear; they should have broad, common sense heels and fit snugly over the instep, in spite of being full large. If your shoes are not comfortable you will find yourself tiring easily and for this reason will tend to take less exercise than you should.

Another reason for the need of proper shoes is that as pregnancy advances the expectant mother becomes rather unsteady on her feet, and broad, firm heels help to make her feel more secure. The heels need not be flat at first, if you have been accustomed to wearing high ones, for the sudden lowering of the heels may injure your arches, but as the weeks wear on you would better adopt moderately low heels. High French heels should be avoided because they not only increase the difficulty and discomfort of walking but cause backache, as well, by forcing a position that adds to the pressure on the lower part of the abdomen. They increase the risk of turning the ankles, too, and of tripping and falling, which is a very serious accident for the expectant mother.

Fig. 13.—Front and back view of home-made stocking supporters made of webbing or 1–inch strips of muslin and a pair of child’s side garters. The straps are sewed together in the back, but pinned in front to permit adjustment as the abdomen enlarges. (By courtesy of the Maternity Centre Association, New York.)

Fresh Air. If you realize by this time how important it is to keep your digestion in good order and promote the activity of all your excretory organs, you probably suspect how important fresh air and exercise are to you and your expected baby, because of their effect upon your entire well-being.

The average individual uses up in a minute’s time the oxygen contained in four bushels of air, and since the pregnant woman takes in through her lungs the oxygen for both herself and her baby, she must have a sufficient quantity of air to supply at least this amount.

Accordingly, you should make a point of spending at least two hours of each day in the open air. If the weather is so stormy or severe as to make it undesirable for you to go out from under cover, because of the danger of getting wet or chilled, you can wrap up well and take your airing on a protected porch or in a room with all the windows wide open.

But this is only a part of it, for the air in your house or rooms must be kept fresh all day by being constantly changed; this requires a steady inpouring of fresh air and outpouring of stale air.

A very good way to accomplish this is to have one or more windows open slightly, top and bottom, all the time. But there must be no sudden changes of temperature, nor drafts, for fear of chilling your skin. At night you should sleep in a room with the windows open, taking care to be well protected by light, warm coverings.

Exercise. Each detail of the expectant mother’s daily routine seems to be more important than the last. And so when we come to the question of regular out-of-door exercise we are almost persuaded to believe that whatever else may be neglected, this is indispensable, since it promotes digestion, stimulates the activity of the skin and lungs, steadies the nerves, quiets the mind and promotes sleep. And more than that, walking, which is probably the most satisfactory form of exercise for her to take, also strengthens some of the muscles that are used during labor. But exercise is downright injurious if continued to the point of fatigue, no matter how little has been taken. Each woman must be a law unto herself in this matter, therefore, and must be impressed with the importance of stopping before she is tired. It may be a good plan for you to start by walking only a short distance at a time, increasing this gradually until you are able to walk possibly as much as an hour in the morning and an hour in the afternoon without fatigue.

All violent exercise and sports are of course to be avoided, particularly swimming, horseback riding and tennis. While motoring and carriage driving are pleasant diversions, they cannot be classed as exercise. They should be taken only in comfortable vehicles and over smooth roads, so that there will be no jarring nor jolting, and the expectant mother should not do the driving herself.

A certain amount of exercise, in the shape of light housework, may be taken indoors. This is distinctly beneficial if not continued to the point of fatigue, both because of the exercise which it provides, and also the diversion and interest, for these promote mental and physical health. But this indoor exercise must not interfere with, nor to any degree replace the daily exercise which you take out of doors; nor must it include heavy work, such as washing, sweeping, heavy lifting, running a sewing machine by foot or much running up and down stairs.

However, the amount and kind of work which the expectant mother may comfortably and safely do, are so related to what she has been accustomed to, that it is not possible to do more than describe what has proved of benefit for the average woman.

There are women to whom massage and gymnastics are helpful during pregnancy when for some reason the out-of-door activities are not possible or advisable. This might be true of an expectant mother with heart trouble, for example, or of one who is being kept in bed to prevent an abortion and accordingly is a matter which is closely directed by the doctor.

Traveling. In general, traveling is less dangerous for the expectant mother of to-day than formerly because it causes less strain, discomfort and fatigue than in the old days. But the question cannot be settled once for all women nor for all stages of pregnancy. Each woman’s general condition must be considered; her tendency to nausea; the length of the journey and the ease with which it may be made; also, whether or not she has ever had or been threatened with an abortion. As a rule, it is considered wise to avoid traveling during the first sixteen and the last four weeks of pregnancy, and at the time of the month when menstruation would ordinarily occur. Certainly a journey should not be undertaken at any time during pregnancy without a doctor’s permission.

Rest and Sleep. When we studied the changes that take place during pregnancy we found that as the abdomen increased in size and weight the expectant mother was required to make a constant, though unconscious effort to stand upright. This is probably one reason for the fatigue which she so often feels without apparent cause, and why, upon exertion, she tires more easily than usual.

Accordingly, you may find it necessary to rest frequently during the day in order to avoid the ill effects of fatigue. It is a good plan to work and exercise in short periods rather than long, always lying down when tired, and for an hour or two after the noon meal. You should be careful not to be over active or to overexert yourself at the time when menstruation would occur if you were not pregnant, for fear of bringing on an abortion. This precaution is particularly important during the first four months, the period when abortions occur most frequently.

Since eight hours’ sleep is usually considered necessary to keep the average person in good condition, you can scarcely expect to get along satisfactorily with less. In fact, this is so important to your general well-being that you should make a serious effort to secure it.

Fresh air during the day and open windows at night; prudent eating; a comfortable bed furnished with warm but light bedding; warm baths; a hot water bag to the feet and a hot drink upon retiring are all conducive to sleep.

But in addition to these, and perhaps of even more importance, are cheerfulness and a tranquil, untroubled state of mind.

Breasts. Breast feeding is the most urgent single need of the baby, for whose coming we are making preparations, and practically every mother, excepting those with definite physical disability, can supply this need of her baby’s if she gives herself proper care both before and after his birth. You will be glad to know in this connection that everything that promotes your general health helps to prepare you to nurse your baby, but there is need also for care of the breasts and nipples themselves, to make the nursing satisfactory, and to prevent sore nipples and possibly even breast abscesses.

Briefly, this local care consists of supporting heavy breasts, but avoiding pressure; bringing out flat or retracted nipples and toughening the skin which covers them.

After they become heavy and uncomfortable the breasts may be supported by brassières, which are snug below the breasts, loose over the breasts themselves and suspended from shoulder straps; or by some such binder as is shown in Fig. [11], which answers the same purpose.

If your nipples are flat or retracted, you should begin about the fifth month to make them more prominent in order that when the baby nurses he may be able to grasp them easily. There are several ways of accomplishing this, all of them in the nature of massage, but whatever is done must be done regularly and persistently. One simple and effective method is to grasp the nipple between the thumb and forefinger, draw it out, hold it for a moment, then release it and allow it to retract. This should be done over and over, two or three times daily. Or the unstoppered opening of a warm bottle may be placed over a flat nipple and held in place until the nipple is drawn up into the neck of the bottle as it cools and a partial vacuum is formed.

The toughening of the nipples should be begun eight weeks before the baby is expected. There are two general methods which seem to give about equally satisfactory results. One is to soften the skin, and the other is to harden it. In either case the nipples should first be scrubbed gently with a soft brush or cloth, warm water and soap, for about five minutes night and morning. After the scrubbing they should be rubbed with lanolin, cocoa butter or vaselin and covered with a piece of clean soft cloth or gauze, to protect the clothing. Or, they may be bathed with a wash consisting of equal parts of a saturated solution of boracic acid and 95 per cent alcohol. You will probably have to have a druggist prepare this for you because of the alcohol.

But no matter which course is followed the care must be regular to be effective. You will find that matters will be simplified if you will assemble in one place and keep in readiness the soap, brush and lotion or ointment which you use each time, using them for no other purpose.

Care of the Teeth. It is very important for the expectant mother to give her teeth scrupulous care from the beginning of pregnancy, for in addition to the ordinary wear and tear with which we all have to cope, her tendency to have an acid stomach makes her mouth acid and this is bad for her teeth. Accordingly, in addition to using dental floss and brushing your teeth after each meal, you should use an alkaline mouth wash several times daily, particularly after vomiting and before retiring, for much damage may be done by the acid secretions in the mouth if they are allowed to bathe the teeth during the long night stretches. Common baking soda (a teaspoonful to a tumbler of water), lime water or milk of magnesia all make excellent mouth washes. It is important, also, that you consult a dentist as soon as you know that you are pregnant and have any necessary repairs done promptly, for delay may be serious.