FOOTNOTES:

[2] Based on U. S. Census Report for 1913; causes arranged in decreasing rank.

CHAPTER VI
PREPARING FOR THE BABY

“If I were asked what I considered the chief requisite for the successful practice of pediatrics I would answer: The education of the mother. It is impossible to do even fairly good work in diseases of children without proper home coöperation. A direction is never followed out so well as when it is understood.”

—Doctor Charles G. Kerley.

“Is it not monstrous that the fate of a new generation should be left to the chances of unreasoning custom, impulse, fancy—joined with the suggestions of ignorant nurses and the prejudiced counsel of grandmothers?

“To tens of thousands that are killed, add hundreds of thousands that survive with feeble constitutions, and millions that grow up with constitutions not so strong as they should be; and you will have some idea of the curse inflicted on their offspring by parents ignorant of the laws of life.”

—Herbert Spencer.

“Even the ordinary workman needs an acquaintance with the nature of his work before an employer will put a task into his hands. But for the right care of children no training in the mothers, nurses, or teachers has been considered essential. Consequently the standard exacted among such persons, instead of being very high, is very low.”

—Doctor Nathan Oppenheim.

Prenatal Hygiene. If any baby could supervise the preparation for his own coming, he would not wait until the last few months before his advent, that is, any baby who had even moderate ambition for his comfort, his happiness, and his efficiency.

Approved Baby Clothing and Bassinet.
Diaper fastening at sides. Bassinet allowing ventilation, with green detachable hood to protect eyes from strong light, and with rod to grasp.

He would begin by selecting his grandparents, who would be high-minded, religious, abstainers, moderate in all their habits, industrious, neither wealthy nor poverty-stricken, and who would bring up his father and his mother as members of a family of children in the same spirit and with foresight for his welfare. He would direct, during their childhood and adolescence, the physical régime of his father and mother, which would be simple, natural, regular, chiefly in the open air, with habitual deep breathing and, especially for his mother, exercises and clothing that would develop the most efficient digestion, breathing capacity, back and trunk muscles, steady nerves, reserve vitality. He would guide their education, which would include a minimum of traditional junk, parrotlike mimicry and discipline, and a maximum of real experience, valuable information, and æsthetic appreciation acquired through personal exploring, experimenting, judging, creating, with a discipline that developed self-direction, self-control, and self-reliance.

He would anticipate that his mother and father, with such a heredity and education, would be high-minded above dissipation and triflings, sensible beyond unhygienic habits in food and in dress, well-poised and superior to pettiness and discords, with a radiant love that maintained an atmosphere of joyousness, graciousness, courage. Having chosen each other because they loved each other, his father and mother would live and work and plan because they loved him. Before they invited him to come, they would have a comfortable home settled, so his mother could give her chief attention to him and be free to live much out-of-doors; they would consult their physician and bring themselves to their best vitality, so he might have the best physical constitution; and they would make any necessary sacrifice of their own desires that he might be undisturbed and thus grow steadily and sturdily until his birthday.

Physical motherhood is a natural, normal biological process. Under a natural, rational régime it should be a happy experience with a minimum of discomfort. The essentials, in brief, of such a régime are:

1. Thorough elimination of the increased amount of waste products, through the skin, lungs, kidneys, and intestines.

2. Strong, flexible trunk muscles.

3. Avoidance of fatigue, undue excitement, unhappiness, muscular strain; continence.

4. Simple, nourishing diet, carefully balanced, anti-toxic, rich in minerals, moderate in quantity, with a moderate amount of liquid.

The mother should of course be under the physician’s direction and observation during the entire period.

Clothing. The essentials are freedom and warmth. Maternity clothing need not be slovenly nor too obviously negligée. Elaborateness may better be expressed in the maternity clothes than upon the baby clothes. For dresses and coats a design with fullness at the sides, in the waist and skirt, with revers, and a high waist line, is especially good. The materials should be plain, or with a small, unobtrusive design. Clothing should be ample enough to encourage rather than prevent a slight perspiration, thus facilitating the elimination of waste.

The weight of the clothing should come from the shoulders. This is important in order to prevent any downward pressure upon the internal organs, as well as to allow for much deep breathing. It is possible by having a one-piece union suit, a brassiere for attachment of hose supporters, a combination corset cover and petticoat, and a one-piece dress.

All the clothing should be comfortably loose, especially any neckbands, sleeves, gloves, which may well be a size larger, as there is a slight swelling during this time. No round garters should be worn, as these impede the circulation in the legs and increase the possibility of varicose veins. The ankles should be well protected, because the blood vessels here are very near the surface and easily chilled, and as the blood returns from the legs to the trunk and internal organs, internal congestion might result from chilling of the lower extremities. Shoes should have low heels to prevent falling and rubber heels to minimize jars.

The corset is a moot question. The woman who has not been accustomed to wearing one is most fortunate now, for she has been developing and training the muscles of the back and trunk, which should be strong and flexible, equal to the special demands made upon them during the last four months and at the birth. If corsets have been the custom, it would be most advisable to discard them three or six months before motherhood is begun, and to give a systematic course of training to these muscles. Some physicians require their patients to discard corsets during this time. Their only possible value is to support the back and the bust, not as support for the abdomen. They may be harmful by crowding the internal organs, pressing any organs out of place, interfering with the fullest deep breathing and internal circulation, keeping the trunk muscles flabby and weak, compressing the breasts; and thereby causing more discomfort to the mother, depriving the baby of sufficient oxygen, making the birth longer and more difficult, and hindering nursing ability. A brassiere or comfortably fitted muslin waist is an adequate bust supporter; or a knitted breast binder is procurable which should be applied loosely enough to cause no compression, which hinders the development of the nursing glands. After the fourth month, the baby rises from the pelvis to the abdomen and the waist increases in size. Ordinary corsets then become especially dangerous. If for any reason a corset is then worn, it should be a special maternity style, such as the Ferris maternity waist. During the last month or two, it is advisable to discard even this corset, and if any support is necessary, to wear an abdominal supporting band, a knitted, shaped band being especially comfortable.

Food. The careful regulation of the diet and food-taking has vastly much to do with the comfort of the mother and the sturdiness of the baby. All the nourishment that the baby receives is derived from the substances that the mother takes in food and drink, which are digested in her system and conveyed from her circulation to his. It is a mistaken idea that the mother is “eating for two” and needs to increase the quantity. No increase in her normal requirement for protein or fat is considered either needed or desirable during the entire nine months, or any increase in carbohydrates until the last three months. The system cannot use the excess, which thereby only makes a greater tax upon the organs of elimination or clogs the system with poisons and overcrowds the abdominal organs. Abundance of mineral, especially lime, phosphorus, iron, and soda is essential. During the last three months there is an increase of about one fifth in the energy requirements, which is best met by an increase in the carbohydrates not to exceed this proportion. The following table gives the average dietetic needs of women:

Sleeping0.4Calories per hour per pound body weight
Sitting quietly (at meals, reading, etc.)0.6”””””
At light muscular exercise (dressing, standing, walking)0.8”””””
At active muscular exercise1.4”””””

For example, for a woman weighing 125 pounds:

Calories
10hoursresting0.4 × 125 × 10500
5”sitting0.6 × 125 × 5375
5”light exercise0.8 × 125 × 5500
4”active exercise1.4 × 125 × 4700
Total for day2075
Protein10%-15%207-311
Fats25%-35%519-539
Carbohydrate50%-60%1037-1245

There is only a fraction of an ounce daily increase in the weight of the baby. A baby weighing 6½ to 7½ pounds at birth is more natural and easier for the mother than a heavy, fat baby, which is produced by overeating, overdrinking, and insufficient exercise.

The toxin-free diet, the quantity at one meal, and the time of meals are matters for careful consideration. During this period there is an increased production of waste, poisonous substances, and gases; at the same time there is often an increased tendency toward constipation. Auto-intoxication consequently results, causing much discomfort from nausea, headaches, dizziness, melancholia, nervousness, irritability. Special care should therefore be taken to select a diet (1)chiefly free from purins, (2)and from stimulants, (3)higher in base-forming than acid-forming elements, (4)with high mineral content, especially lime, and (5)laxative. This is done by omitting, or using very sparingly, meats, coffee, tea, pastry, fried foods, irritating condiments, vinegar; and by including milk, buttermilk made with the Bulgarian tablets, cheese, eggs, nuts, whole-wheat bread, bran bread, green vegetables, salads, fresh and dried fruits, fruit juices, butter, olive oil. Any food that is difficult of digestion, or that produces fermentation or gas, should be omitted.[3]

Enough water should be taken to carry off waste products but not to unduly increase the body fluids or cause flabbiness of tissues. With the diet recommended, less water drinking will be necessary than otherwise, six glasses a day probably being quite ample. This should be taken at intervals, not more than a small glass at one time, and not less than half an hour from meal times; fruit juices or milk may be taken instead of plain water.

Alcohol, even in dilute quantities, is highly injurious to the delicate nerve cells of the body, and should be avoided, particularly during this and the nursing period. Patent medicines usually contain alcohol.

With a well regulated diet, there is less probability of cravings for unusual or abnormal foods; such cravings may be pampered if for wholesome foods; if absurd or abnormal, they should be ignored.

During the last four months, and especially the last two, it is better to take the food in five meals than in three meals. There is less room in the trunk for the stomach to expand in the movements of digestion, and it may easily crowd uncomfortably upon the heart. The heaviest meal should be taken in the middle of the day, and a light supper two or three hours before bedtime, for adequate digestion and comfortable sleep. During the last month, the daily diet may well include one or two pints of milk in some form, because of its ease in digestion.

Bathing. A daily bath is especially important during this period, because there is so much waste and poison to be eliminated. If the pores of the skin are not kept clean and open, the kidneys (the work of which is now much increased) will be overtaxed, or some of the poison will remain in the system, causing headaches, nausea, and other discomforts. Very cold or very hot baths are equally to be avoided. The latter may cause a miscarriage, especially during the first three months. A woman who is accustomed to a daily cold bath may continue this as long as there is a good reaction. Surf bathing is inadvisable because of the low temperature and the muscular strain; bathing in quiet waters is quite safe. The daily bath should be warm enough for cleansing (90°-98° F.), followed by a cool sponge or spray for tonic. A salt bath (one quart of sea or coarse salt dissolved in a tub of water) is a good tonic. Two baths daily are permissible, not remaining in the water more than ten minutes. A vigorous rub with bath mitts, a Turkish towel, or coarse damp salt, is a further aid to skin elimination. Vaginal douches should never be used except on the advice of the physician. For sleeplessness, nervousness, congestion of blood in the head, the neutral (96° F.) sitz bath combined with a hot foot bath will promote the necessary equalizing of the circulation.

Exercise. Exercise now has two important purposes: the elimination of waste, and the strengthening of back and abdominal muscles. The precautions are avoidance of fatigue and of sudden or severe strain upon the abdominal muscles that might produce a miscarriage. During the first three months, the placental attachment is relatively insecure and therefore more easily detached. The certainty of motherhood cannot be established until the third or fourth month, although some presumptive symptoms are manifested earlier. The woman who has left motherhood to chance, and who therefore is not preparing for necessary care during these earlier months, is the more liable to a miscarriage through disregard of due precautions.

The ideal for this period would be complete outdoor living, with two miles of walking each day and plenty of light exercise that could be dropped at the approach of fatigue. Such a gypsy-like experience is often removed from usual living conditions. With a little planning, it could often be approached, however. The investment in such a vacation would yield far richer returns to the baby than an expensive layette, to say nothing of the increased comfort, ease, and happiness of the mother. The extreme antithesis of this ideal would be continuous indoor life with no work to occupy muscles and mind.

The individual mother must plan her environment and her work as nearly as possible to the ideal. Living in the country with good roads has the advantage of outdoors. An outdoor sleeping porch is much to be desired. For indoor sleeping or working, the room should be thoroughly ventilated with a constant current of fresh outdoor air, with the temperature not above 68° F. for working, and from 32° to 60° F. for sleeping. Extra clothing may be worn rather than to keep the windows closed.

A habit of deep breathing of outdoor air for about ten minutes on rising, at bedtime, and at several stated times during the day, will be wonderfully beneficial. The mother is now breathing for two, and the baby needs much oxygen.

Light household work is beneficial. Long standing, lifting, or pulling heavy weights, scrubbing on hands and knees, running up and downstairs, much stooping, working long over a hot stove, the use of a sewing-machine treadle or a washboard, are harmful. If the responsibility of the household work rests upon the mother, she must use her ingenuity to reduce it to its lowest terms of muscular energy.[4]

Walking is the best athletic exercise, two miles a day being desirable. It should be taken in easy stages, stopping to rest when tired, or a part of this distance taken at different times during the day. Golf, tennis, basketball, skating, horseback riding, bicycle riding, swimming, rowing, dancing, surf bathing, long rides over rough roads, involve the risk of overstrain, and should be omitted.

Special Exercises. Clothing should always be very loose, especially around the waist, and the room should be well ventilated, for these exercises.

Breathing Exercises. These should be taken out of doors if possible; otherwise, at an open window. Breathing should be from the diaphragm. Repeat each exercise three to six times, or until fatigue begins.

1. Standing, hands on lowest margin of ribs, thumbs toward back, fingers few inches apart. Blow the breath out slowly, bending body forward at hips and pressing in gently with the hands to force out the air. Return slowly to upright position, breathing in through the nose gently to utmost capacity. Hold breath ten seconds and repeat exercise.

2. Stand erect. Take a deep breath, rising on balls of feet, extending arms out at side, shoulders high, hands clenched and describing small circles, as though boring. Hold ten seconds, then gently drop arms, blowing out the breath as long as possible.

3. Lying on the back, hold one nostril closed and breathe in slowly and deeply through the other. Hold the breath five or ten seconds, close the second nostril, and breathe out through the first. Repeat, breathing in through the first and holding the second closed; hold the breath, close the first, and breathe out through the second. This is a soothing exercise.

Trunk Exercises. Any one not accustomed to these exercises should consult the physician before beginning them during this period. All exercises should be done slowly, with no jerking movements.

For overcoming constipation, improving the tone, elasticity, and strength of the abdominal muscles.

1. Lie flat on the back, arms at the sides. Raise the right arm slowly, keeping it parallel with the body, describing a half circle until it rests on the bed or floor, above the head. Repeat with the left arm. Bring each arm slowly back to position. (Figure 2.)

2. Same position. Raise the right foot, keeping the toes pointed forward, bending the knee until it touches the abdomen. Repeat with the left foot. May be repeated ten times or until fatigued. (Figure 1.)

3. Same position. Bend knees; draw the abdominal wall in and out slowly by muscular effort, without the assistance of deep breathing.

4. Same position. Lift the trunk from the floor, resting the weight on shoulders and hips.

5. Sit or stand, hands on hips. Twist the body slowly to the right and slowly return to position. Repeat, twisting to the left.

6. Walk up and down stairs moderately with a springing step, holding the body erect, shoulders straight, chest expanded, mouth closed, weight on balls of feet.

These simplest and easiest exercises may be continued throughout this period or may be commenced at any time.

The following exercises are more strenuous and should be used cautiously during the first three and last two months by those not accustomed to exercise. The physician should be consulted before using them during this time. They are profitably begun six months beforehand and are valuable for ordinary conditions of life.

7. Lie on the back, arms at sides. Raise both arms together, as in Exercise 1. Bring arms back slowly to sides.

8. Same position. Raise the right foot, toes pointed forward, knee straight till leg is at right angles with trunk; hold position ten seconds and lower foot slowly. Repeat with left foot. Raise both feet together. (Figure 2.)

9. Lying flat on back, hands on chest or clasped behind head, feet held down under a chiffonier or by an attendant, come to sitting position without assistance of hands or elbows. (Figure 4.)

10. Lie on the back, grasp the rounds of the headboard and gently pull the body toward the head of the bed. Push with the feet against the footboard, or other non-resisting surface.

The knee-chest position is a most valuable exercise. It relieves the abdominal pressure, and therefore any swelling in the legs from such pressure, or any prolapsis of internal organs, bearing-down feelings, backache, disturbed pelvic circulation. It may be taken a few minutes at a time, several times a day. Sleeplessness will often be relieved by taking this position for a few minutes and then lying down. Kneel on the floor or other unyielding surface. Lay the side of the face down on this surface, with the shoulder of that side as near the knees as possible, keeping the upper leg from knee to hip at right angles with the floor. Weight may be supported on forearms placed at right angles to the body.

A good posture should always be maintained when sitting or standing; especially avoid letting the chest sink in. Whenever possible in sitting, especially after meals, elevate the feet, thus preventing varicose veins and swelling in the legs.

Sleep. Much sleep is needed. From eight to ten hours’ sleep at night is essential, and a nap or rest in the afternoon, about an hour after the midday meal. By following the régime previously given, undisturbed sleep is likely to be the rule. The mother should sleep alone, and preferably in a room by herself. A little pillow under the small of the back is very comfortable, and during the last four months, an additional pillow under the shoulders.

Teeth, Hair, Eyes. The teeth should have been examined and put in good condition before the beginning of this period. During the entire time they should be brushed carefully after every meal, and the mouth rinsed with an alkaline wash, such as milk of magnesia or soda bicarbonate. The scalp should be massaged every day during the last two months and the two succeeding months, to prevent the hair falling out. The eyes should be examined three months after the birth.

Prenatal Influences. Life begins when the germ cells unite, and from that time the mother is the guardian of a living, though immature child. By the end of the third month the form and features are complete, though in miniature, the weight is about four ounces and the length about three inches. The study of development before birth is called embryology. So far as scientific research has been able to discover, there are no nerve cells connecting the nervous system of the mother with that of the child. Notwithstanding superstitions and folklore to the contrary, it is scientifically known that she cannot give her child a Greek nose by looking at classic pictures, an ape face through seeing some disagreeable sight, or musical genius by attending concerts. Anatomical form and mental traits are matters of heredity, as previously stated, and these factors are settled forever when the germ cells unite. The sex is also determined at that time, apparently depending upon the sex-determining factors in the germ cells. Hundreds of theories (such as the diet or the condition of the parents) have been suggested for influencing the sex of the child, but none of these is as yet proven true, and certainly no such influence can have any effect after the germ cells have united. “Birthmarks,” such as red or blue spots, are probably due to some interference with the blood supply during development.

Approved Crib, Scales, Nursery Table. Holding the Baby, Supporting Head and Back.

The mother is influencing the child during the entire nine months, through the blood supply. If she indulges in fear, anger, melancholy (dark emotions that develop poison in the blood), if she over-eats, or takes alcohol, if she neglects deep breathing, daily bathing, elimination, exercise, she is impoverishing and poisoning the blood supply, and the quality of her child’s bodily and mental characteristics will suffer. If she lives a wholesome life, following a régime that continuously eliminates poisons and gives abundant nourishment and oxygen, with the cultivation of peace, cheer, courage, joy (emotions that promote good circulation and a wholesome blood stream), she is providing good nourishment and enhancing the quality of her child’s life.

It is for the comfort of the mother and for the welfare and beauty of the child that the mother should be sacredly reserved for her work during this and the nursing period.

A normal woman whose physical life through her childhood and adolescence has been well regulated should have an easy experience. A certain amount of discomfort and mental depression is to be accepted as a matter of course, but the greater care now given to physical hygiene would naturally increase health and vitality. Concerts, plays, lectures, and social gatherings (except where these would involve crowds and ill-ventilated, overheated rooms), reading, music, play, should all be part of her life during this time. The joy of anticipation gives the singing heart and makes this a time of beatitude, of weaving of dreams such as no other experience in life can give.

The preparation of the nursery and the baby clothes is part of the joyous experience. This may well begin early, that it may proceed leisurely, without sense of haste, and with its full measure of satisfaction. Simplicity, cleanliness, economy in care, daintiness, are the keynotes.

The Nursery. Room. It is desirable that the baby should have a room alone. If this is not possible, his room should be equipped for the nursery, and only the mother or nurse should sleep in the same room. Sunny exposure is essential. Second floor is preferable, for dryness, and freedom from cats and dogs. A covered, sunny veranda for outdoor sleeping is most desirable. The room should be ventilated from two sides, and preferably with open fireplace.

Floor. Washable, either painted, oiled or waxed, never carpeted. Small size washable rugs.

Walls. Washable, either painted or covered with Sanitas, at least to wainscot four feet high. Soft, plain, neutral tone; buff, warm gray or medium green.

Curtains. Both light and dark shades; sheer, washable curtains, plain or figured scrim; no heavy window draperies or portières.

Heating. Preferably hot-water heater, with open fireplace for occasions. Steam and hot-air systems lack a sufficient amount of moisture, and are subject to sudden changes in temperature. Gas or kerosene stoves consume the oxygen and should not be used in the nursery. Coal stoves should be carefully watched to avoid poisonous gases from imperfect combustion, or sudden changes in temperature. Large open basins of fresh water should be kept in the room in winter, to supply humidity.

Lighting. A dim, shaded light for night use, lit only when needed. Nursery should be dark at night; daylight soft but not darkened, during first two weeks; ordinary lighting thereafter during waking hours, softened but not dark during daytime sleep.