PREPARATIONS FOR THE CONFINEMENT
The Birth Chamber—What to Provide for a Confinement—Ready to Purchase Obstetrical Outfits—Position and Arrangement of the Bed—How to Properly Prepare the Accouchment Bed—The Kelly Pad—The Advantages of the Kelly Pad—Should a Binder Be Used?—Sanitary Napkins—How to Calculate the Probable Date of the Confinement—Obstetrical Table—When Should a Pregnant Woman First Call Upon Her Physician—Regarding the Choice of a Physician—How to Know the Right Kind of a Physician for a Confinement—The Selection of a Nurse—The Difference Between a Trained and a Maternity Nurse—Duties of a Confinement Nurse—The Requisites of a Good Confinement Nurse—The Personal Rights of a Confinement Nurse—Criticizing and Gossiping About Physicians.
THE BIRTH CHAMBER
The room in which the confinement is to take place should be selected with care. In many cases there will be no choice for the reason that there will be only one suitable bedroom available. Where practicable however a room having the following accessories, or as many of them as is possible, should be given the preference.
1.—Good light, and a southern exposure.
2.—Capable of being well ventilated and well heated if necessary.
3.—Running water if plumbing is modern.
4.—Fairly large size (not a hallroom).
5.—A quiet room, free from street noises.
If the house is a private one the room should be on the second floor. If the home is in an apartment house
the confinement chamber should be as far removed from the living-room as circumstances will permit,—especially if there are other children who will make more or less continuous noise.
All unnecessary furniture, pictures and draperies should be taken out of the room a few days before the confinement is due; the room itself, and everything left in it, should be thoroughly cleaned and aired. A small table for holding instruments, sterilizing basins, etc., should be provided and in readiness.
What to Provide For a Confinement.—The following articles should be in readiness at all confinements:—
1.—Douche pan.
2.—Bed pan.
3.—Douche bag (fountain syringe) with glass douche tube.
4.—One rubber sheet 1½ yards square.
5.—Two bed pads, one yard square, made of absorbent cotton or old clean cloths, covered with washed cheese cloth and stitched here and there to hold in place.
6.—One dozen clean towels.
7.—One-half dozen clean sheets.
8.—A hot water bottle.
9.—One pound absorbent cotton (good quality).
10.—Five yards sterile gauze.
11.—Four quarts of hot, and as much cold water, that has been boiled.
12.—One-half dozen papers assorted safety pins.
13.—One box sanitary pads.
14.—Four pieces of unbleached cotton or muslin, one and one-quarter yards long.
15.—Four ounces powdered boracic acid.
16.—Four ounces of brandy or whisky.
17.—One jar of white vaseline (unopened).
18.—One cake of castile soap.
19.—Two or three agate or china hand basins.
20.—One slop jar.
21.—One pan under bed for after birth.
The physician will direct that certain additional articles be provided according to his individual taste and
custom. These will include an antiseptic and ergot; any other requisite found necessary can be sent for, or the physician can supply it, as he invariably has in his bag whatever may be required in complicated cases or in an emergency. All the items enumerated in the above list are absolutely essential, they may not all be used but it would not be safe to undertake a confinement without providing the essential requisites. Many maternity outfits are prepared ready for use and can be obtained at the larger drug stores, costing from $10 to $25. The articles in the above list can be bought for about $6, not including those articles which the patient is assumed to have. The following are samples of the ready-to-purchase outfits:
READY-TO-PURCHASE OBSTETRICAL OUTFITS
OUTFIT NO. 1
1 Sterilized Bed Pad (30 inches square).
2 dozen Sterilized Vulva Pads.
2 Sterilized Mull Binders (18 inches wide).
5 yards Sterilized Gauze.
1 pound Sterilized Absorbent Cotton (½ pound).
Rubber Sheet, 1½ yards by 2 yards, Sterilized.
Douche Pan, Sterilized.
1 Tube K-Y Lubricating Jelly.
Sterilized Nail Brush.
Boric Acid, Powdered.
Tinct. Green Soap.
Bichloride Tablets.
Lysol.
Tube Sterilized Tape.
PRICE $10.00.
OUTFIT NO. 2.
2 Sterilized Bed Pads (30 inches square).
2 dozen Sterilized Vulva Pads.
2 Sterilized Mull Binders (18 inches wide).
6 Sterilized Towels.
10 yards Sterilized Gauze.
1 pound Sterilized Absorbent Cotton (½ pound).
Rubber Sheet, 1 yard by 1½ yards, Sterilized.
Rubber Sheet, 1½ yards by 2 yards, Sterilized.
4 quart Sterilized Douche Bag with glass nozzle.
Douche Pan, Sterilized.
Sterilized Nail Brush.
2 Agate Basins, Sterilized.
Safety Pins.
2 Tubes Sterilized Petrolatum.
1 Tube K-Y Lubricating Jelly.
Boric Acid, Powdered.
100 grms. Chloroform (Squibb's).
Fl. Ext. Ergot.
Tinct. Green Soap.
Bichloride Tablets.
Lysol.
Tube Sterilized Tape.
Sterilized Soft Rubber Catheter.
Sterilized Glass Catheter.
Stocking Drawers, Sterilized.
Talcum Powder.
Bath Thermometer.
PRICE $19.50.
These materials, being cleansed and sterilized, are ready for use at any time.
These complete outfits are packed in neat boxes, thus enabling the contents to be kept intact until needed.
The Position and Arrangement of the Bed.—The bed should be a substantial single bed. If a double one is used, prepare the side for the confinement which will permit the physician to use his right hand,—that will be the right side of the patient as she lies in bed. One objection to a double bed is its tendency to sag. This tendency can be obviated however by placing an ironing board under the spring from side to side, or by using shelves from a book case. This expedient will support the mattress, thereby rendering the bed firm and free from any sagging tendency. The position of the bed in the room should be such that the patient will not directly face the window light, nor be in a direct draught
between the window and the door. It should be so arranged that the nurse can get easily to either side, consequently it must not be pushed against the wall.
How to Prepare the Accouchment Bed.—Over the mattress place the rubber sheet so that its center will be exactly under the hips of the patient. Pin with large safety pins each corner of the rubber sheet to the mattress; now put the sheet on exactly as you do when making an ordinary bed. On top of the sheet, and in the middle of the bed (again where the patient's hips will rest), place a draw sheet. A draw sheet is a sheet folded once, placed across the bed, and pinned tightly with large safety pins to the mattress at each side. The advantage of this sheet is, that it can be removed when necessary, leaving the original clean sheet on the bed, without disturbing the patient. Be particular not to have the top of the draw sheet higher than the middle of the patient's back. Place the pad,—previously prepared for the purpose,—on the draw sheet and level with the top of the draw sheet.
Most physicians carry with them to all confinements a Kelly pad. A Kelly pad is a rubber pad with inflated sides, which is put under the patient's hips, and which retains all the discharges incident to a confinement so that when it is removed the bed is clean and fresh. The advantage of the Kelly pad is twofold; first, it ensures a clean, compact, systematic confinement; second, its use subjects the patient to the least necessary movement at a time when movement is distressing, painful, and frequently dangerous. If a Kelly pad is not used, it is desirable to place under the pad (between the pad and the draw sheet) a piece of oil cloth or rubber sheeting, or a number of newspapers will do. This will prevent, to a considerable degree, the discharges from soaking through the pad on to the draw sheet and sheet and mattress below.
After the confinement is over and the patient is clean, remove the Kelly pad, and the pad below if necessary, or the pad and newspapers if these are used,—place a clean pad under the patient and you are ready to place the binder on if a binder is to be used.
Should a Binder be Used?—Medically a binder is not necessary, neither is it objectionable from a medical standpoint. It is supposed to hold the flaccid, empty womb in place. This it does not do and we are of the opinion, that it, in many instances, according to how it is put on, compresses the womb out of place. The binder is certainly appreciated by most patients because of its snug, comfortable feeling; and in cases when the abdominal wall is fat and the muscles soft, it holds them together in a way that is impossible by the use of any other device. To claim that the binder prevents hemorrhages is absurd. Our personal rule is to put one on if the patient wants one, or if she has previously had one. To be effective, in any sense, the binder should extend from the waist line down to halfway between the hips and knees and should be snugly, but not too tightly pinned.
Sanitary Napkins.—These can be purchased already prepared in most drug stores, or they can be made in the following manner: Take an ordinary grade of cheese cloth, wash it, and when dry, cut it into half yard squares. In the center of each square place a strip, six or eight inches long, of absorbent cotton and fold the gauze lengthwise over it so as to make a pad. These can be used as napkins, and after they are soiled can be burned. It is absolutely wrong to use rags or any old cloths for napkins, as the patient can be infected and made seriously sick by this procedure.
How to Calculate the Probable Date of the Confinement.—The duration of pregnancy extends for 280 days from the end of the last menstruation. Add seven days to the date of the last menstruation, and from that date count ahead nine months, or backward three months and you may have the probable date of the confinement. Should you pass this time you will probably go on for two additional weeks. The reason for this is that the most susceptible time for conception to occur is either during the week following menstruation or a few days before menstruation. If, therefore, you pass the above probable date which was calculated from the end of the last menstruation, it shows that conception did not take
place during the week following that menstruation; and the assumption will be that it took place a few days before the next menstruation, which will be about two weeks later than the date as calculated above.
If, for example, a pregnant woman was last sick from January 1st to 5th we add seven days to the 5th, which is the 12th, to which we add nine months, which will give us, as the probable date of confinement, October 12th. Should she go a few days over the 12th, the probability is that the confinement will take place on October 26th.
TABLE FOR CALCULATING THE DATE OF CONFINEMENT
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JAN. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
OCT. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 NOV.
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FEB. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
NOV. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 DEC.
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MAR. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
DEC. 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 JAN.
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APR. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
JAN. 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 FEB.
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MAY. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
FEB. 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 1 2 3 4 5 6 7 MAR.
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JUNE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
MAR. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 APR.
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JULY 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
APR. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 MAY
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AUG. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
MAY 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 JUNE
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SEPT. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
JUNE 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 JULY
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OCT. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
JULY 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 AUG.
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NOV. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
AUG. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 SEPT.
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DEC. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
SEPT. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 OCT.
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The foregoing table affords us a handy means of finding the probable date of confinement at a glance.
Find the date of the last day of the last menstrual period in the upper row; the date immediately below it is the probable date of confinement.
For example if the last menstrual period was from Jan. 1st to 5th, we find January 5th and below it we note October 12th as the probable date of confinement.
When Should a Pregnant Woman First Call Upon Her Physician?—The earliest indication of pregnancy is the interruption of menstruation. When menstruation fails to appear at its regular time in a young married woman whose past menstrual history is good,—i.e., she has been sick every month regularly and without pain since she began menstruating as a girl,—the assumption would naturally be that she was pregnant. Menstruation may however "miss" one month for other reasons than pregnancy just at this time, as is explained elsewhere, so it is wise to defer a positive assumption on such an important matter. When the second menstruation does not appear, and there are no specific reasons for its failure to appear, it may be safely assumed that pregnancy has taken place. A visit to the family physician one week after the second menstruation should have appeared, or at least long enough to feel absolutely certain that the sickness is not coming around, is not only necessary, but is the essential and correct step to take for a number of very good reasons. If a woman for example has not had a baby, how does she know she can have one? It is quite possible to become pregnant and yet it may be wholly impossible to give birth to a child. It is necessary to be constructed normally, or as near what is regarded as normal as is possible, in order safely to assume the responsibility of carrying a pregnancy to a successful completion. No one but a physician, who is skilled and familiar in the knowledge of what constitutes the proper size, and shape, and quality, and relations, one with another, of
your bones, and ligaments, and muscles, can tell whether you can safely be permitted to carry a pregnancy to term or not. If the anatomical conditions are not just right; if circumstances from a medical standpoint are not favorable; if your personal risk is too hazardous; if, in other words, medical science should decide that you are one of the very few women who cannot have a baby, is it not of very great importance that you should know this as soon as possible? Does not that fact alone render your early call upon your physician imperative? A physician can bring out facts, relating to the personal and family history, and habits, of the prospective mother, which will enable him to formulate advice which will prove of the highest value from the very beginning of pregnancy. Instructions carried into effect at this early date, as to personal conduct, exercise, diet, etc., will have a distinctly beneficial influence, not only on the patient's health and the character of her confinement, but on the physical vitality of the coming baby.
Regarding the Choice of a Physician.—This is a matter that should receive the most careful consideration. While it is just to admit that every physician is capable of successfully conducting maternity cases, there are certain characteristics in the individual temperament that would seem to indicate that some physicians are better adapted to this special work.
Trustworthiness is an imperative essential in a physician who assumes the responsibility of confinement engagements. He must be clean in his personal habits as well as morally. He should possess the virtue of patience and be tactful, and above all he should be made to feel that he has your implicit confidence. If you will analyze these qualifications you will understand just what they imply. The physician who has the reputation of having the largest practice is not necessarily the man you want, nor does it imply that he is the best fitted to conduct your case to your satisfaction. The fact that he is a very busy man may be distinctly detrimental to your best interests. If the physician has the reputation of being an excellent doctor, but, "You can't always depend on him,—he may be out of town, or he may send his assistant, or
substitute," you don't want him; it is too important an event to you to take a chance with. Rely rather upon the man who, though his charge may be a little higher, is known to be trustworthy; who will take a personal interest in you, and is known to be patient and capable.
The Selection of a Nurse.—A choice must be made between having a trained nurse and what is known as a maternity, or monthly, nurse. The choice may be dictated by the financial means of the patient. A trained nurse is paid from $25 to $30 per week, while a maternity nurse usually gets $15 per week.
A trained nurse is a graduate from a hospital where she has successfully completed a course of training. She is to be preferred, if she can be afforded, for the reason that she has been trained to obey absolutely the orders of a physician, and because she has the requisite knowledge to detect emergencies, and the necessary skill and experience to enable her to act intelligently of her own initiative in any emergency.
The maternity nurse, on the other hand, has not had an adequate training and is absolutely helpless, so far as medical knowledge is concerned, in a real emergency. Her experience is limited to what she has picked up in the various cases she has had. She, as a rule, has chosen this means of obtaining a living as a result of some domestic financial affliction. She does not understand the laws of sterilization and has not been trained to obey, without question, the instructions of a physician. The maternity nurse follows a routine which she is incapable of modifying to suit the particular case. She has old-fashioned ideas and notions which she carries out as a matter of course, and she overestimates the great importance of her experience to the extent of wholly disregarding the advice of the physician. She assumes the care of the patient and baby, and regards this as her right, and as a result she is frequently responsible for much injury to the mother and child. Despite these objections we have worked with many of these nurses who were to be preferred to trained nurses. It is the individual after all that counts, and if a maternity nurse, though technically untrained, is adaptable, tactful, and will consent
to be instructed to the extent of obeying without argument, she can become invaluable, and her skill and experience will carry her creditably over many trying incidents. The objection of the medical profession to an untrained nurse is based, not so much on her lack of ability, as upon her propensity to indiscriminate and indiscreet talk,—they have not been trained to know the value of professional silence, nor have they had the necessary education which would have enabled them to acquire through their experience the knowledge that "silence is golden" at all times. A trained nurse possesses the requisite knowledge, but may have an objectionable individuality. An untrained nurse may have sufficient knowledge, and what she lacks she may make up for in being congenial and adaptable. While the trained nurse strictly attends exclusively to the mother and the baby, a maternity nurse as a rule attends to the household duties in addition. She cooks the meals of the entire family, and dresses and cares for the other children if there is no one else to do it. The duties of a maternity nurse can be specified and agreed upon, and the terms arranged when she is engaged. The duties of a trained nurse are fixed by nursing laws and medical rules and cannot be changed or modified by private agreement. These laws and rules, however, are not sufficiently arbitrary to make it impossible for the nurse to be obliging, courteous, and sincere,—qualifications which every patient has a right to expect, and a right to insist upon from every graduate nurse.
The selection of a nurse should receive careful consideration. She should be known to be honest, honorable, competent, healthy, and personally clean in habits and dress, and she should be tactful, obliging, and she should attend to her own affairs strictly. She should not be a gossip; she should not shirk her work or pry into family affairs that do not concern her; and she should not drag into the conversation her own personal or family secrets.
The nurse has certain rights which the patient should willingly recognize. She is entitled to a comfortable bed, sufficient sleep, good food, and exercise in the open air
every day. These are essential in order that she maintain her own health, as well as keep at the highest point of efficiency.
When you select your physician consult with him regarding your nurse. If you know personally a capable nurse, there is no objection to selecting her, and no physician will oppose this procedure if you assume the responsibility of her capability.
There are many advantages, however, in permitting the physician to provide a nurse. He assumes the responsibility of the nurse's capability, and it is safe to assume he will not recommend one whom he knows to be personally objectionable, or professionally incapable. Every physician acquires certain individual methods in the conduct of maternity cases, which experience has taught him to be successful. A competent knowledge of these methods by the nurse greatly facilitates the details and ensures a harmonious conduct of the entire case,—facts which accrue to the comfort and the well-being of the patient.
It is not out of place here to warn a young wife against being advised by a neighbor or a busybody, as to whom she should select as physician or nurse. You must not depend upon the gossip of the neighborhood. The physician or nurse whom you are told by one of these irresponsible individuals not to take, may be the one above all others whom you should take. When you hear a gossiping woman decry a physician, depend upon it, she owes him something,—most often it is a bill, but it may only be a grudge. There is no class of men in any community who are maligned and abused so much as are physicians. They seem to be the choice victims of the enmity and spite of every malicious feminine tongue. A woman should think twice before she utters a criticism regarding the work of a physician. She would, if she but knew how quickly she brands and advertises herself as irresponsible and lacking in ordinary courtesy and good breeding, as she is not qualified to criticise the professional capability of a physician, nor is she qualified to estimate the extent of the wrong she perpetrates. There is no class of men who do more conscientious work, day
after day, than do physicians, and there is no class of men who are more deserving of the commendation of the entire community than the thousands of self-sacrificing, underpaid members of the medical profession. Be suspicious therefore when you hear a criticism, and be very, very sure before you utter one,—rather give him the benefit of the doubt and you will do no wrong, and it may be at some future date you will be thankful you did not criticise.
CHAPTER VII
THE HYGIENE OF PREGNANCY.
Daily Conduct of the Pregnant Woman—Instructions Regarding Household Work—Instructions Regarding Washing and Sweeping—Instructions Regarding Exercise—Instructions Regarding Passive Exercise—Instructions Regarding Toilet Privileges—-Instructions Regarding Bathing—Instructions Regarding Sexual Intercourse—Clothing During Pregnancy—Diet of Pregnant Women—Alcoholic Drinks During Pregnancy—The Mental State of the Pregnant Woman—The Social Side of Pregnancy—Minor Ailments of Pregnancy—Morning Nausea, or Sickness—Treatment of Morning Nausea, or Sickness—Nausea Occurring at the End of Pregnancy—Undue Nervousness During Pregnancy—The 100 Per Cent. Baby—Headache—Acidity of the Stomach, or Heartburn—Constipation—Varicose Veins, Cramps, Neuralgias—Insomnia—Treatment of Insomnia—Ptyalism, or Excessive Flow of Saliva—Vaginal Discharge, or Leucorrhea—Importance of Testing Urine During Pregnancy—Attention to Nipples and Breasts—The Vagaries of Pregnancy—Contact with Infectious Diseases—Avoidance of Drugs—The Danger Signals of Pregnancy.
CONDUCT OF THE PREGNANT WOMAN
The young wife will arrange her daily routine according to the physician's instructions, which, by the way, she should faithfully carry out. If you are one of the fortunate many who enjoy reasonably good health, you have doubtless been told to follow a plan very similar to the one we shall now briefly outline.
For the first six months she can safely continue to do her household work. It is to her advantage to do so for many reasons, but especially because it helps to keep her physically in good condition, and because it keeps her mind engaged, thus avoiding a tendency to nervous worry. After the sixth month it is desirable to give up the heavier part of the work. Washing and sweeping should be absolutely prohibited. Moving furniture or heavy trunks must not be done by the prospective mother, but all light
work can and should be indulged in to the very end. Find time to spend at least one hour and a half in the open air every day. Unless there is a medical reason against active exercise there is nothing so beneficial to the pregnant woman as walking, nor is there any substitute for it. A drive or motor ride into the country, or a car ride around town, is an excellent device against ennui and is highly desirable during this time, but not as a substitute for the daily long walk. A pregnant woman must keep her muscles strong and in good tone if she hopes to do her share toward having a short and easy confinement. She must keep active to ensure perfect action of all her organs—the stomach must digest; the bowels and kidneys must act perfectly; the heart, and lungs, and nerves must be supplied with good blood and fresh air; the appetite must be keen, and the sleep sound. Walking in the open air will do all this and nothing else can, to the same satisfactory degree.
Light passive exercise at home is desirable to those very few who cannot walk in the open air, but at best it is a poor substitute. It is necessary to avoid any exercise or any labor of the following character from the very beginning of pregnancy: stretching, lifting, jarring, jumping, the use of the sewing machine, bicycling, riding, and dancing.
She should continue to employ the same toilet privileges she has been accustomed to except the use of the vaginal douche, which must be stopped from the date of the first missed menstrual period. This is the only safe rule to follow and no exception should be made to it except upon the advice of a physician.
Bathing during the entire course of pregnancy is a highly necessary duty. It is particularly advantageous during the later months because it relieves the kidneys at a time when they are called upon to perform an excess of work. The temperature of the bath should be warm and rapidly cooled at the finish. Brisk rubbing with a course towel will ensure the proper reaction.
Sexual intercourse must be restricted during pregnancy; and it should be wholly abstained from during what would have been the regular menstrual periods, if
pregnancy had not occurred, for the reason that abortion is apt to take place. It is most harmful during the early and late months of pregnancy. Sexual intercourse is distasteful to most and harmful to every pregnant woman.
Clothing During Pregnancy.—The clothing should be so constructed as to relieve any undue pressure on the breasts or abdomen. For this reason it should be suspended from the shoulder. When it is appreciated that clothing supported by the waist crowds the growing womb, and exerts pressure upon the kidneys, and is responsible for many of the kidney complications that occur during pregnancy, no further reason need be given for discarding all clothing, except very light garments, that are not held by some device whose support is from the shoulders. A specially constructed linen waist is made and sold for this purpose. It is fashioned so that all the lower garments and the garters can be fastened to, and supported by it. Corsets should be absolutely discarded from the very first day of pregnancy.
In a large woman with a lax abdomen, a properly made abdominal support will not only be a great comfort but of real advantage. It should exert a support upward by lifting the abdomen, not by constricting it. It should therefore be obtained from a reliable dealer and be made and applied to effect the above object,—otherwise it may do more harm than good.
Diet of Pregnant Women.—Some degree of digestive disturbance and loss of appetite is the rule early in pregnancy. By the fourth month these conditions invariably cease, and the appetite and the ability to digest will greatly improve. The diet from the very beginning of pregnancy should be plain and easily digested. It is not possible to formulate an absolute table of what or what not to eat, as the same foods do not agree equally well with all patients. The individual taste should be catered to within, reason, and the meals should be taken at regular intervals. Articles of diet that experience shows do not agree with the patient should be rigidly excluded from the menu. A varied diet of nutritious character is essential during pregnancy in order to ensure good blood, health, and strength. A monotonous diet, or a diet composed largely
of stale tea, coffee, and cake, is not permissible, and may do untold harm. Pastries and desserts of all kinds should be excluded. In the later weeks of pregnancy, because of the large size of the womb, the diet should be cut down as the stomach is interfered with in the process of digestion. Should the patient at any time during pregnancy experience a loss of appetite, or an actual disgust for food as sometimes occurs, it is preferable to suggest a change of scene and surroundings rather than the use of medicine. A short vacation, a change of table, new scenery, will promptly effect a cure. This condition is mental rather than physical; the patient allows herself to become introspective; the daily routine becomes monotonous and stale; hence a change of a few days will be all that is necessary. If it is not possible for the patient to obtain a change of scene, a complete change of diet for a few days will often tide over the difficulty. We have known patients to take kindly to an exclusive diet of kumyss, or matzoon, or predigested foods, with stale toast or zwieback, to which can be added stewed fruits. Alcoholic drinks should be left out entirely.
The Mental State of the Pregnant Woman.—The coming baby should be the text of many interesting, spontaneous talks between the young couple from the time when it is first known that a new member of the family is on its way. The husband should feel that he is a party to the successful consummation of the little one's journey. He can contribute enormously to this end. It should be his duty, born of a sincere affection and love, to formulate the programme of events which has for its main object the wife's entire mental environment. He should encourage her to live up to the physician's instructions, and arrange details so that she will obtain the proper exercise daily. He should read to her in the evening, and arrange his own business affairs so that he will be with her as much as is possible. In many little ways he can impress upon her the fact that they both owe something to the unborn babe and that each must sacrifice self in its behalf. His principal aim, of course, will be that she will not worry or have cause to worry. He will so direct her mental attitude that she will dwell
only upon the bright side of the picture; she will thus strive to realize the hope that the baby will be strong and healthy, and she will, prompted by his encouragement and devotion, try to do her duty faithfully. Working together in this way, much can be done that means far more than we know of, and in the end the little one comes into the world a welcome baby, created in love and born into the joy of a happy, harmonious, contented home.
The Social Side of Pregnancy.—The social side of the question should not be overlooked or neglected at this time. Here again the imperative necessity arises to warn the young wife against certain individuals who seem to have a predilection toward recounting all the terrible experiences they have heard regarding confinements. It is astonishing to learn how diversified a knowledge some women burden themselves with in this connection. They can recount case after case, with the harrowing details of a well-told tale, and seem to delight in so doing. Every physician has met these women. The young wife must not permit or encourage any reference to her condition. Simply refusing to discuss the question is the only sure method of preventing its discussion. She will find among her friends a few who have her best interests at heart, and these few will strive sincerely to be of real usefulness to her. If she will keep in mind that the most important element in the success of the whole period, and consequently the degree of her own health, happiness, and comfort, as well as that of her unborn baby, is the character of her own thoughts from day to day, and month to month, she will be complete master of the situation. By constantly dwelling on happy thoughts, reading encouraging and inspiring books, admiring and studying good pictures, working with cheerful colors in sunny rooms, exercising, dieting, and sleeping in a well-aired room, she will have no cause to regret her share in the task before her, or the kind of baby she will bring into the world.
Minor Ailments of Pregnancy.—There are certain minor ailments which it would be well to be familiar with lest a little worry should creep into the picture.
Maternity is not only a natural physiological function,
but it is a desirable experience for every woman to go through. The parts which participate in this duty have been for years preparing themselves for it. Each month a train of congestive symptoms have taxed their working strength; pregnancy is therefore a period of rest and recuperation,—a physiological episode in the life history of these parts. If any ailment arises during pregnancy it is a consequence of neglect, or injury, for which the woman herself is responsible,—it is not a natural accompaniment of, or a physiological sequence to pregnancy. Find out, therefore, wherein you are at fault, rectify it, and it will promptly disappear.
Morning Nausea or Sickness.—So-called morning nausea or sickness is very frequently an annoying symptom. It is present as a rule during the first two or three months of pregnancy. How is it produced and how can it be remedied?
It is produced most frequently by errors in diet. It may be caused by an unnatural position of the womb or uterus, by nervousness, constipation, or by too much exercise or too little exercise. The physician should be consulted as soon as it is observed to be a regular occurrence. He will eliminate by examination any anatomical condition which might cause it; or will successfully correct any defect found. When the cause is defined his instructions will help you to avoid any error of diet, constipation, or exercise. Many cases will respond to a simple remedy,—a cup of coffee, without milk, taken in bed as soon as awake will often cure the nausea. The coffee must be taken while still lying down,—before you sit up in bed. If coffee is not agreeable any hot liquid, tea, beef tea, clam bouillon, or chicken broth, or hot water may answer the purpose, though black coffee, made fresh, seems to be the most successful. Ten drops of adrenalin three times daily is a very certain remedy in some cases, though this should be taken with your physician's permission only. If the nausea occurs during the day and is accompanied with a feeling of faintness, take twenty drops of aromatic spirits of ammonia in a half glass of plain water or Vichy water. Sometimes the nausea is caused by the gradual increase of the womb
itself. This is not usually of a persistent character and disappears as soon as the womb rises in the abdominal cavity at the end of the second month.
Nausea frequently does not occur until toward the end of pregnancy. In these cases the cause is quite different. Because of the size of the womb at this time the element of compression becomes an important consideration. The function of the kidneys, bowels, bladder, and respiration may be more or less interfered with, and it may be desirable to use a properly constructed abdominal support, or maternity corset. These devices support and distribute the weight, and prevent the womb from resting on or compressing, and hence interfering with, the function of any one organ. If the womb sags to one side, thereby retarding the return circulation of the blood in the veins from the leg, it may cause cramps in the leg, especially at night, or it may cause varicose veins, or a temporary dropsy. The correct support will prevent these troublesome annoyances; a properly constructed maternity corset is often quite effective. The diet should receive some special attention when these conditions exist. Any article of diet which favors fermentation (collection of gas) in the stomach or bowel should be excluded. These articles are the sugars, starches, and fats. It can readily be understood that if the bowels should be more or less filled with gas, or if they should be constipated, it will cause, not only great distress, but actual pain. Regulation of the diet, therefore, and exercise (walking best of all) will contribute greatly to the avoidance of these unnecessary sequelae.
It must be kept in mind that the entire apparatus of the body is accommodating a changed condition, and though that condition is a natural one, it requires perfect health for its successful accomplishment. This means a perfect physical and mental condition,—a condition that is dependent upon good digestion, good muscles, healthy nerves, clean bowels, and so on. The slightest deviation from absolute health tends to change the character of the body excretions, the quality of the blood, etc. If the excretions are not properly eliminated, the blood becomes impure, and so we sometimes get itching of the body
surfaces, especially of the abdomen and genitals; neuralgias, especially of the exposed nerves of the face and head; insomnia and nervousness. These are all amenable to cure, which again means, as a rule, correct diet and proper exercise as the principal remedial agencies.
Undue Nervousness During Pregnancy.—This is very largely a matter of will power. Some women simply will not exert any effort in their own behalf. They are perverse, obstinate, and unreasonable. The measures which ordinarily effect a cure, they refuse to employ. It is useless to argue with them; drugs should never be employed; censure and affection are apparently wasted on them; they cannot even be shamed into obedience. The maternal duty they owe to the unborn child does not seem to appeal to them. We do not know of any way to handle these women and to our mind they are wholly unfit to bring children into the world. Fortunately these women are few in number. The maternal instinct will, and does, guide most women into making sincere efforts to restrain any undue nervous tendency, and to be obedient and willing to follow instructions. There is nothing so beneficial in these cases as an absolutely regulated, congenial, daily routine, so diversified as to occupy their whole time and thought to the exclusion of any introspective possibility. Frequent short changes to the country or seashore to break the monotony, give good results in most of these cases. The domestic atmosphere must also be congenial and the husband should appreciate his responsibility in this respect.
Women of this type should have their attention drawn to the following facts in this connection: While the most recent investigations of heredity prove that a woman cannot affect the potential possibilities of her child, she can seriously affect its physical vitality. The following illustration may render our meaning clear: suppose your child had the inborn qualities necessary to attain a 100 per cent. record of achievement in the struggle of life; anything you may or may not do cannot affect these qualities—the child will still have the ability to achieve 100 per cent. Inasmuch, however, as a mother can affect the health or physical qualities of her
child she is directly responsible, through her conduct, as to whether her child will ever attain the 100 per cent. record, or if it does, she is responsible for the character of its comfort, its health, its enjoyment, all through its life's struggle toward the 100 per cent. achievement record. She may so compromise its physical efficiency that it will succumb to disease as a consequence of the ill health with which its mother unjustly endowed it, even though it possess the ability to attain the 100 per cent. if it lived.
We often see brilliant children who are nervous and physically unfit, and we see others of more ordinary mental achievement who are healthy and robust animals. The one is the offspring of parents possessing unusual mental qualities but who are physically unable or unwilling to render justice to their progeny; the other parents may be less gifted mentally, but they are healthy and they are willing to give their best in conduct and in blood to their babies. Many of these brilliant children never achieve their potential greatness because they fall by the wayside owing to physical inability, while the healthy little animals achieve a greater degree of success because of the physical vitality which carries them through. To achieve a moderate success and enjoy good health is a better eugenic ideal than the promise of a possible genius never attained because of continuous physical inefficiency.
The nervous and willful mother should therefore consider how much depends upon her conduct. It cannot be too frequently reiterated and emphasized that every mother should do her utmost to guard and retain her good health. Good health means blood of the best quality and this is essential to the nourishment of the child. To keep in good health does not mean to obey in one respect and fail in other essentials. It means that you must obey every rule laid down by your physician, willingly and freely in your own interest and in the interest of your unborn babe. In no other way may you hope to creditably carry out the eugenic ideal that "the fit only shall be born."
Headache.—This is a symptom of great importance.
If it occurs frequently, without apparent cause, the physician should be consulted at once, as it may indicate a diseased condition of the kidneys, and necessitate immediate treatment. Headaches may, of course, be caused in many ways and most frequently they do not have any serious significance, but they must always be brought to the attention of the physician. As a rule they are caused by errors of diet,—too much sugar, candy, for instance, late and indigestible suppers, indiscriminate eating of rich edibles, etc.,—or they may be products of nervous excitement (too little rest), as shopping expeditions, strenuous social engagements, late hours, etc.
Acidity of the Stomach, and So-Called Heartburn.—These are sometimes in the early months of pregnancy annoying troubles. The following simple means will relieve temporarily: A half-teaspoonful of bicarbonate of soda or baking soda in a glass of water or Vichy water; or a half teaspoonful of aromatic spirits of ammonia in Vichy, or plain water; or a tablespoonful of pure glycerine. The best remedy is one tablespoonful of Philip's Milk of Magnesia taken every night for some time just before retiring.
Heartburn is the result of eating improper food, or a failure to digest the food taken. Starchy foods should be avoided. Meats and fats should be taken sparingly. Avoid also the et ceteras of the table, as pickles, sauces, relishes, gravies, mustard, vinegar, etc. Good results follow dry meals,—meals taken without liquids of any kind. Live on a simple, easily digested, properly cooked diet. Chew the food thoroughly, take plenty of time and be cheerful.
Constipation During Pregnancy.—Most women are as a rule more or less constipated during pregnancy. It is caused by failure to take the proper amount of outdoor exercise, to take enough water daily, to live on the proper diet, to live hygienically, or because of wrong methods of dress. It is most important that the bowels should move thoroughly every day. Pregnancy no doubt aggravates constipation by diminishing intestinal activity. Consequently there is a greater need for activity on the part of the woman, and open air exercise is the best way
to accomplish this. She should eat fruits, fresh vegetables, brown or Graham bread, or bran muffins, figs, stewed prunes, and any article of diet which she knows from experience works upon her bowel. She should drink water freely; a glass of hot water sipped slowly on arising every morning or one-half hour before meals, is good. Mineral waters, Pluto, Apenta, Hunyadi, or one teaspoonful of sodium phosphate, or the same quantity of imported Carlsbad salts in a glass of hot water one-half hour before breakfast, answers admirably. If the salts cannot be taken a three- or five-grain, chocolate-coated, cascara sagrada tablet, may be taken before retiring, but other cathartics should not be taken unless the physician prescribes them. Rectal injections should be avoided as a cure of constipation during pregnancy. They are very apt to irritate the womb and if taken at a time when the child is active, they may annoy it enough to cause violent movement on its part, and these movements may cause a miscarriage. See article on "Constipation in Women."
Varicose Veins, Cramps, and Neuralgia of the Limbs.—When cramps or painful neuralgia occur repeatedly in one or both legs, some remedial measures should be tried. Inasmuch as the cause of this condition is a mechanical one, it would suggest a mechanical remedy. The baby habitually seeks for the most comfortable position, and having found it stays there until conditions render it uncomfortable. He does not consult you in the matter, but he may be subjecting you to untold misery and pain. The child may rest on the mother's nerves or blood-vessels as they enter her body from her lower limbs. If the pressure is sufficient, it can interfere quite seriously with the return blood supply, because veins which carry back to the heart the venous or used blood, are vessels with thin, soft, compressible walls, while arteries which carry blood away from the heart cannot be compressed easily, because their walls are hard and tense. The condition therefore is that more blood is being sent into the limb than is being allowed to return; in this way are produced varicose veins. If these varicose veins burst or rupture we have ulcers, which
may quickly heal, or they may refuse to heal, and become chronic. A dropsical condition of the leg may follow, and because of interference with the circulation of the blood we get cramps and neuralgias. How can we remedy this painful condition?
Sometimes we don't succeed, but at least we can try. So long as the cause exists, it is self-evident that rubbing the limb with any external application, will not give any permanent relief, though it is well to try. When rubbing, to relieve cramps at night, always rub upward. It is not a condition that calls for medicine of any kind, while hot baths and hot applications will only make the trouble worse. The remedy that promises the quickest and longest relief is for the patient to assume the knee-chest position for fifteen minutes, three times a day, till relief is permanently established. The patient rests on her knees in bed, and bends forward until her chest rests on the bed also. The incline of the body in this position is reversed; hips are highest, the head lowest. The baby will seek a more comfortable position and this new position may relieve the pressure and cure the condition. Doing this three times daily for fifteen minutes gives relief to the leg by reestablishing a normal blood circulation, and very soon the baby finds a new position that does not interfere with its mother's blood supply, and the cramps, and neuralgia and dropsy, and maybe the varicose veins will soon show improvement. Wearing the proper kind of abdominal support may help, as explained on page [77]. If the varicose veins are bad, it is desirable to wear silk rubber stockings or to bandage the limbs.
Insomnia During Pregnancy.—Insomnia or sleeplessness is sometimes a vexatious complication during pregnancy. It seldom if ever becomes of sufficient importance or seriousness to interfere with the pregnancy or the health of the patient. Nevertheless, a period of sleeplessness lasting for two or three weeks is not a pleasant experience to a pregnant woman. It is most often met with during the latter half of pregnancy.
There can be no question that every case of insomnia has definite cause, and can be relieved if we can find the
cause. The only way to find it is to systematically take up the consideration of each case, and this is best done by the physician. He must have patience and tact; you must answer each question truthfully and fully. Your diet, personal conduct, exercise, condition of bowels, mental environment, domestic atmosphere, everything, in fact, which has any relation to you or your nerves, must be inspected with a magnifying glass. Some little circumstance, easily overlooked, of seemingly no importance, may be the cause of the trouble. You may need more outdoor exercise, or you may need less outdoor exercise. You may need more diversion, more variety, or you may need less. You may need a sincere, honest, tactful, patient confidant and friend, or you may need to be saved from your friends. You may be exhausting your vitality and fraying your nerves by social exigencies,—those empty occupations which fill the lives of so many fussy, loquacious females,—echoless, wasted, babbling moments, of supreme important to the social bubbles who ceaselessly chase them but of no more interest to humanity than the wasted evening zephyrs that play tag with the sand eddies on the surface of the dead and silent desert. You may have wandered from the narrow limitations of the diet allowable in pregnancy, or you may be the victim of an objectionably sincere relation who pesters you with solicitous inquiries of a needless character. Whatever it is, rectify it. A good plan to follow on general principles is to take a brisk evening walk with your husband just before bedtime, and at least two hours after the evening meal. Follow this with a sitz bath as soon as you return from the walk.
A sitz bath is a bath taken in the sitting position with the water reaching to the waist line. It should last about fifteen minutes and the water should be comfortably hot. It is sometimes found that this form of bath creates too much activity on the part of the child and defeats the purpose in view. This is apt to be the case in very thin women when the abdomen is not covered by a sufficient layer of fatty tissue. These women will find it advisable to take, in place of the sitz bath, a sponge bath in a warm room, using the water rather cool than hot but in
a warm room. Rub your skin briskly but waste no time in getting into bed. A glass of hot milk, before going to bed, or when wakeful during the night, may serve as a preventive. When these measures fail the physician should be called upon to advise and prescribe.
Ptyalism, or an Excessive Flow of Saliva.—This is a common condition in pregnancy, but cannot be prevented. It is of no importance other than that it is a temporary annoyance.
Itching of the abdomen can usually be allayed by a warm alcohol rub, followed by gently kneading the surface of the abdomen with warm melted cocoa butter, just before retiring.
A Vaginal Discharge.—Soon after pregnancy has taken place the woman may notice a discharge. It may be very slight or it may be quite profuse. In some cases it does not exist at all during the entire period. As a rule the discharge is more frequent and more profuse toward the end of pregnancy.
If the discharge exists at any time,—and it is no cause for worry or alarm if it does exist,—inform your physician. He will advise you what to do, because it is not wise for you to begin taking vaginal douches or injections without his knowledge, and at a time when they may do you serious harm. Should itching occur as a result of any vaginal discharge the following remedial measures may be employed:
A solution of one teaspoonful of baking soda to a douche bag of tepid water may be allowed to flow over the parts, or cloths saturated with this mixture may be laid on the itching part. A solution of carbolic acid in hot water (one teaspoonful to one pint of hot water), is also useful, or a wash followed by smearing carbolic vaseline over the itching parts. If your physician should suggest a mild douche for itching of the vagina as the result of a discharge, it may be promptly relieved by using Borolyptol in the water. Buy a bottle and follow directions on the label.
Testing Urine In Pregnancy—Importance of.—One of the most important duties, if not the most important, of both the physician and the patient is to have the
urine of the pregnant woman examined every month during the first seven months and every two weeks during the last two months. The urine examined during the first seven months should be the first urine passed on the day it is sent for examination. During the last two months of pregnancy the patient should pass all her water into a chamber for an entire day, and take about three ounces of this mixed water for examination. She should measure the total quantity passed during these days and mark it with her name on the label of the bottle. The physician will thus have an absolute record and guide of just how the kidneys are acting, and as they are the most important organs to watch carefully during every pregnancy, the greatest care should be taken to see that failure to note the first symptom of trouble does not take place.
Attention to Nipples and Breast.—The physician should inspect the breasts and nipples of every pregnant woman when she first visits his office. Frequently the nipples are found to have been neglected, probably subjected to pressure by badly fitting corsets or too tight clothing. Instructions gently to pull depressed nipples out once daily, if begun early, will result in marked improvement by the end of pregnancy. During the latter part of pregnancy the breasts should be carefully and thoroughly bathed daily in addition to the daily bath. This special bath should be with a solution of boric acid (one teaspoonful to one pint of water). After the bath apply a thin coating of white vaseline to the nipples. It may be necessary to resort to the following mixture to harden the nipples and to make them stand out so that the child can get them in its mouth: Alcohol and water, equal parts into which put a pinch of powdered alum; this mixture should be put in a saucer and the nipples gently massaged with it twice daily. A depressed nipple may also be drawn out by means of a breast pump. If the nipples are not pulled out the child will be unable to nurse. It may then be necessary to put the child on the bottle and when the nipples are ready he may not take them after being used to the rubber nipple. The breasts may become caked and as a caked breast is a very painful
and serious ailment it is wise to attend to this matter in time.
The Vagaries of Pregnancy.—Certain foolish, old-fashioned ideas, have crept into the minds of impressionable people regarding pregnancy, which are aptly termed vagaries. It is believed by some that if the pregnant woman is the victim of fright, or is badly scared, or witnesses a terrifying or tragic sight, her child will be, in some way, affected by it. If the incident is not of sufficient gravity to cause an abortion or a miscarriage it will not, in any way mark, or affect the shape of the child in the womb.
It is believed by some that a child can be marked by reason of some event occurring to the mother while carrying it. This is not so; a child cannot be marked by any experience or mental impression of the mother. Some believe that the actual character of a child can be changed by influences surrounding the mother while carrying it. The character of a child cannot be changed one particle after conception takes place, no matter how the mother spends her time in the interim.
It should be carefully understood that the character of the baby is entirely different from the physical characteristics of the baby. Were this not so it would be futile on the part of the mother to discipline or sacrifice herself in the interest of her baby. The baby's character will reflect the qualities of the combined union of mother and father. The baby's physical characteristics will largely depend upon the treatment accorded it by the mother during its intro-uterine life. Hence we lay down rules of conduct, diet and exercise in order to produce a good, sturdy animal, while the character or mind of the animal is a part of the fundamental species already created. In other words, no matter how much care you bestow upon a rose bush, its flower will still be a rose,—it may be a better rose, a stronger, sturdier rose, a better smelling and a more beautiful rose, but it is still a rose.
Contact With Infectious Diseases.—The pregnant woman should be warned against the danger of coming in contact with any person suffering from any infectious or contagious diseases. To become the victim of one
of these diseases near the time of labor would be a dangerous complication not only to the mother, but to the child. A woman is more liable to catch one of these diseases during the last month of pregnancy than at any other time. The most dangerous diseases at this period are Scarlet Fever, Diphtheria, Erysipelas, and all diseased conditions where pus is present.
Avoidance of Drugs.—It is a safe rule during pregnancy to avoid absolutely the taking of all medicines unless prescribed by a physician.
The Danger Signals of Pregnancy.—The following conditions may be of very great importance and may be the danger signals of serious coming trouble. They must not therefore be neglected or lightly considered. When any of them make their appearance send for the physician who has charge of your case, at once, and follow his advice whatever it may be.
1. Any escape of blood from the vagina, whether in the form of a sudden hemorrhage or a constant leaking, like a menstrual period.
2. Headache, constant and severe.
3. Severe pain in the stomach.
4. Vertigo or dizziness.
5. Severe sudden nausea and vomiting.
6. A fever, with or without a chill.
CHAPTER VIII
THE MANAGEMENT OF LABOR
When to Send for the Physician in Confinement Cases—The Preparation of the Patient—The Beginning of Labor—The First Pains—The Meaning of the Term "Labor"—Length of the First Stage of Labor—What the First Stage of Labor Means—What the Second Stage of Labor Means—Length of the Second Stage—Duration of the First Confinement—Duration of Subsequent Confinements—Conduct of Patient During Second Stage of Labor—What a Labor Pain Means—How a Willful Woman Can Prolong Labor—Management of Actual Birth of Child—Position of Woman During Birth of Child—Duty of Nurse Immediately Following Birth of Child—Expulsion of After-birth—How to Expel After-birth—Cutting the Cord—Washing the Baby's Eyes Immediately After Birth—What to Do with Baby Immediately After Birth—Conduct Immediately After Labor—After Pains—Rest and Quiet After Labor—Position of Patient After Labor—The Lochia—The Events of the Following Day—The First Breakfast After Confinement—The Importance of Emptying the Bladder After Labor—How to Effect a Movement of the Bowels After Labor—Instructing the Nurse in Details—Douching After Labor—How to Give a Douche—"Colostrum," Its Uses—Advantages of Putting Baby to Breast Early After Labor—The First Lunch—The First Dinner—Diet After Third Day.
When to Send for the Physician in Confinement Cases.—The physician should be notified just as soon as it is known that labor has begun. The adoption of this course is necessary for a number of reasons. It is only just that he should have an opportunity to arrange his work so that he may be at liberty to give his whole time to your case when he is wanted. He may not be at home at the moment, but can be notified, and can arrange to be on hand when your case progresses far enough to need his personal attention. It will relieve your mind to be assured that he will be with you in plenty of time.
Don't worry unnecessarily if he does not come immediately when you notify him, provided you notify him at the beginning of labor. There is plenty of time. You have a lot of work to do before he can be of any help. Many women entertain the idea that a physician can immediately perform some kind of miracle to relieve them of all pains at any stage in labor. This is a mistaken idea. No physician can hasten, or would if he could, a natural confinement. He waits until nature accomplishes her work, and he simply watches to see that nature is not being interfered with. If something goes wrong, as it does now and again; or if the pains become too weak, or if the proper progress is not being made, he may help nature or take the case out of her hands and complete the confinement. If it is thought best to do this, there will be plenty of time.
The Preparation of the Patient and the Conduct of Actual Labor.—It is assumed that the patient has adhered to the instructions of the physician given during the early days of her pregnancy. These instructions included directions as to exercise, diet, bathing, etc.
Having calculated the probable date of the confinement, it is the better wisdom to curtail all out-of-door visiting, shopping, social engagements, etc.,—everything in fact out-of-doors except actual exercise, for two weeks previous to the confinement date. The usual walk in the open air should be continued up to the actual confinement day. The daily bath may be taken, and it is desirable that it should be taken, up to and on the confinement day.
The Meaning of the Term "Labor."—By labor is meant, the task or work involved in the progress by means of which a woman expels from her womb the matured ovum or child. After the child has been carried in the womb for a certain time (estimated to be 280 days) it is ripe, or fully matured, and is ready to be born. The womb itself becomes irritable because it has reached the limit of its growth and is becoming overstretched. Any slight jar, or physical effort on the part of the patient, or the taking of a cathartic, is apt to set up, or begin the contractions which nature has devised as the process of "labor" by which the womb empties itself.
The Beginning of Labor.—When the first so-called pains of actual labor begin they are not always recognized as such. The explanation of this seeming paradox is that the "pains" are not always painful. A woman will experience certain undefined sensations in her abdomen; to some, the feeling is as if gas were rumbling around in their bowels; to others, the feeling is as if they were having an attack of not very painful abdominal colic; while others complain of actual pain. The fact that these sensations continue, and that they grow a little worse; and that the day of the confinement is due, or actually here, impresses them that something unusual is taking place; then, and not till then, does the knowledge that labor is really approaching dawn upon them.
In due time one of these new sensations, which constitute the first stage of labor, will be more emphatic; there will be a little actual pain so that she will feel like standing still, holding her breath and bearing down. That is the first real labor pain and marks the beginning of the second stage of labor, and may be the first absolute sign that will leave no doubt in her mind that labor has begun.
The nurse will now inquire into the condition of the patient's bowels. If they have not already moved freely that day, she will give the patient a rectal injection of one pint of warm soap suds into which one teaspoonful of turpentine is put. After the bowels have been thoroughly cleansed, the patient will be made ready for the confinement. The clothing necessary consists of dressing gown, night gown, stockings and slippers. These are worn as long as the patient is out of bed, when all but the night gown will be discarded. The entire body of the patient, from the waist line to the knees, should be thoroughly cleansed, paying particular attention to the private parts; first with warm water and castile soap, and then rendered aseptic by washing with four quarts warm boiled water into which has been put one teaspoonful of Pearson's Creolin. A soft napkin is then wrung out of water that has been boiled and cooled to a suitable temperature, and laid over the genital region, and held
in place by a dry clean napkin, and allowed to remain there until the physician takes personal charge of the case.
Length of the First Stage of Labor.—There is no definite or even approximate length of time for the first stage of labor,—that, you may recall, was the more or less painless stage, or as it has been termed, the "getting-ready" stage. Inasmuch as it is an unimportant and practically painless stage, most patients do not mind it. They continue to be up and around and work as usual.
The first stage of labor is utilized by nature in opening the mouth of the womb.
The second stage of labor is utilized by nature in expelling the child into the outer world.
Length of the Second Stage of Labor.—After the second stage has begun, the length of time necessary to end the labor, assuming everything is normal, depends upon the strength and frequency of the pains. The stronger and more frequent the pains, the quicker it will be over. First confinements necessarily take longer, because the parts take more time to open up, or dilate, to a degree sufficient to allow the child to be born. In subsequent confinements, these parts having once been dilated yield much easier, thus shortening the time and the pains of this, the most painful, stage of labor. The average duration of labor is eighteen hours in the case of the first child, and about twelve hours with women who have already borne children. The time, however, is subject to considerable variation, in individual cases, as has been pointed out.
Conduct of the Patient During the Second Stage of Labor.—She should remain up, out of bed, as long as she possibly can. The object of this is because experience shows that the labor pains are stronger, and more frequent, when in the upright position. Even though this procedure would seem to invite more constant suffering, it must be remember that labor is a physiological, natural process, that there is nothing to fear or dread; and if the patient is in good health, it is to her advantage to have it over soon, rather than to encourage a long drawn out, exhausting labor. When the pains come
she should be told to hold on to something, to hold her breath as long as possible, and to bear down. A good plan is to roll up a sheet lengthwise, and throw it over the top of an open door and let her grasp both ends tightly and bear down; or she can put her arms over the shoulders of the nurse and bear down. Instruct her to hold her breath as long as she can, bearing down all the time, and when she can't hold it any longer, tell her to let up, and then take a quick deep breath and bear down again, repeating this programme until the pain ceases. Tell her specifically to be sure to keep bearing down till the end of the pain, because the most important time, and the few seconds during which each pain does most of its work during the second stage of labor, is at the very end of each pain. When a woman understands that these instructions are for her good, and that they are given with the one purpose of saving her pain, and shortening the length of labor, she will try to obey. Each pain is intended by nature to do a certain amount of work, and each pain will accomplish that work if the woman does not prevent it; and if she does prevent it, she is only fooling herself, because the next pain will have to do what she would not allow the former to do, and so on according to how she acts.
THE CARRIERS OF HERITAGE
Here is the actual bridge from this generation to the next.
Into these two little bodies—the larger not over one-twenty-fifth of an inch in diameter—is condensed the multitude of characteristics transmitted from one generation to another.
The vital part of the Ovum is the Nucleus, which contains the actual bodies that carry heritage—the little grains that are the mother's characteristics—Chromosomes. This nucleus is nourished by oils, salts and other inclusions, known as Cytoplasm. Floating in the cytoplasm may be found a tiny body known as the Centrosome, which acts as a magnet in certain phases of cell development. Around this whole mass is a Cell Wall, more or less resisting and protective.
The Spermatozoan is structurally much different from the ovum, but it also has its nucleus and chromosomes, which carry to the child the transmittable characteristics of the father.
The ovum is usually comparatively large and stationary, and whatever motion is therefore necessary to bring it into contact with the male cell devolves upon the latter, which possesses what is known as a locomotor tail. In addition there are usually many sperms to one ovum, so that the chances are that at least one male cell will reach the egg and effect fertilization, and the beginning of a new life.
The diagrams on the opposite page show the actual steps by which the spermatozoan unites with the ovum. It is the very first stage of the process of cell multiplication that results in the offspring.
THE FORMATION OF A NEW LIFE
How a Willful Woman Can Prolong Labor.—For a certain time, during the second stage of labor, a willful, unreasonable woman, can work against nature and save herself a little pain by prolonging the issue; but there will come a time when, the head having reached a certain position, the expulsive pains will be so great that she won't be able to control them and nature then seems to take her revenge. So if a woman holds back, and begins to cry, and scream, when she feels a pain coming, she renders the pain to a large degree negative, she prolongs her labor, adds to the total number of pains, exhausts herself, and endangers the life of her child. It must, however, be remembered in all justice that this is a time when it is much easier to preach than to practice.
Every confinement is a new experience; no matter how many a physician may have seen, there are no two
alike. It is one of the interesting psychological problems in medicine to observe the conduct of women during their first confinement.
Some are calm, exhibiting a degree of self-control that is admirable. They are willing to be instructed, and they recognize that the advice is given for their benefit. They conscientiously try to obey suggestions, and they make praiseworthy efforts to keep themselves under control. They are stoics.
Others collapse at once; they go to pieces under the slightest excuse, and frequently without as much as an excuse. As soon as the pain begins, they willfully ignore all the instructions given and desperately and foolishly try to escape what they cannot escape. In this unreasonable selfishness they resent advice, and at the same time they implore you to "do something" for them. There is absolutely no excuse for this kind of conduct; and any prospective mother who, because of a willful trait in her disposition, refuses to profit by the kindly professional advice of her physician or nurse, should at least have some consideration for her unborn babe. It may seem unkind to criticise the conduct of any woman at such a time. It is not prompted by a lack of patience or justice however. These women permit, in spite of every assurance to the contrary, an unreasonable fear to overwhelm them; and because of this fear they refuse to be guided into a path of conduct that will save them suffering and shorten the pains which they complain of. It is our conviction that if a woman would try to follow the advice of the physician at this time, at least half of all the seeming suffering would be avoided. We are glad to be able to truthfully state that this type of woman is vastly in the minority.
When the second stage has advanced far enough, the patient will decide to go to bed. It may be necessary to put her in bed earlier, if her pains are very strong, as there is always a possibility of suddenly expelling the child under the influence of a strong pain. She will, as previously stated, discard all clothing, except her night gown, which can be folded up to her waist line and let down as far as necessary after the confinement is over. The obvious advantage of this arrangement is
that the gown remains unsoiled, and saves what would be needless trouble if it proved necessary to change the night gown at a time when the tired-out patient needs rest. Much aid may be afforded the woman at this stage by twisting an ordinary bed sheet and putting it around one of the posts or bars of the foot of the bed. The patient may then pull on the ends during the pain; she may also find much comfort and aid by bracing her feet on the foot of the bed while pulling. It is desirable to instruct the nurse to press on the small of the back during these pains. Some women appreciate a hot water bottle in this region. If the pains are hard the patient may perspire freely; it is always refreshing occasionally to wipe the face and brow off with a cloth wrung out of cold water. Cramps of the limbs may be relieved by forcibly stretching the leg and pulling the foot up toward the knee. From this time until the child and after-birth are born the physician will take active charge of the case.
The Management of the Actual Birth of the Child.—Near the end of the second stage of labor it will be observed that the pains have grown strong, expulsive, and more frequent. Very soon the advancing head will begin to push outward the space between the front and back passage; the rectum is pushed outward and the lips of the vagina open. If an anesthetic is to be used these are the pains that call for it. A few drops may be dropped singly on a small clean handkerchief held up by the middle over the nose, its ends falling over the face. A few drops will just take the edge off the pains, and render them quite bearable. As soon as the pain is over the patient should rest, relax completely, and not fret and exhaust herself worrying about the pains to come. It is astonishing how much actual rest a woman can get between pains if she will only try; and it is astonishing how much concentrated mischief a willful, unreasonable woman can do in the same time. She will not try to rest, but cries and moans and pleads for chloroform, until she succeeds in giving everyone except the physician and nurse the impression that she is suffering unnecessarily. Her husband or her mother,
whichever is present, gets nervous; they begin to wonder if the physician is really trying to help; assume a long, sad, serious face! forget their promise to look cheerful, and mayhap offer sympathy to the woman. It is a trying moment and needs infinite patience and tact. The physician attends strictly to his duty, which will now be to guard the woman against exerting too great a force during the last few pains. About this time, or before it in many instances, the "waters will break." This means simply that the bag or membrane in the contents of which the child floated burst because of the pressure of a pain. This is a perfectly natural procedure and should not cause any worry: simply ignore it as if it had no bearing on the labor in any way. As soon as the oncoming head has dilated the passage sufficiently, so that the edges of the entrance to the vagina will slip over the head without tearing, the physician allows the head to be born. It takes some time to do this, and he must hold the head back until just the right moment. It is best not to let the head slip through at the height of a pain, or rupture is sure to occur. Wait till it will slip through as a pain is dying out, and if you have waited long enough and handled the head skillfully, the conditions will be just right at a certain moment to permit this without tearing the parts. There are some cases where a tear, and a good tear, is impossible to guard against. It is not a question of patience, or tact, or skill; it is a combination of conditions which patience, tact, and skill are powerless against.
Position of Woman During Birth of Child.—The position of the woman is a matter of choice and is not contributory to the results at all. She can lie on her back, which is the ordinary way, or on her side, as the physician or the patient prefer. As soon as the head is born the physician should see that the cord is not round the child's neck; if it is, release it. The shoulders will most likely be born with the next or succeeding pain. The physician will permit the lower shoulder to slip over the soft parts first; this is done by retarding the upper shoulder by pushing it gently behind the pubic bone of the mother. When the shoulders are through, the
rest of the body of the child slips out without effort.
Duty of Nurse Immediately Following Birth of Child.—As soon as the child is born the nurse should sit by the side of the mother and hold the womb until the after-birth is expelled. The womb can be easily felt in the lower part of the woman's abdomen as a hard mass. It feels about the size of an extra large orange. The object of holding it is to prevent the possibility of an internal hemorrhage. It can be readily appreciated that the interior of a womb, immediately after a child is born, is simply a large bleeding wound. So long as the womb remains firmly contracted there is very little chance for an extensive bleeding to take place. As a rule the womb remains sufficiently contracted to preclude a hemorrhage until the after-birth is out. After the after-birth is expelled, the womb usually closes down firmly and the liability to bleed is very much reduced. Because there is a distinct chance or tendency for the womb to bleed freely during the time the after-birth remains in, it is customary, as stated above, to watch it closely and to hold it securely. It is best held with the right hand. The fingers should surround the top of the womb and exert a slight downward pressure. Should it show any tendency to dilate or fill with blood, get it between the fingers and the thumb and squeeze it, pushing downward at the same time.
Expulsion of After-Birth.—The after-birth is usually expelled in about twenty minutes after the child is born. Great care should be experienced in its expulsion. It should not be pulled at any stage of its expulsion. If it does not come easily give it a longer time,—it takes time for the womb to detach itself from the after-birth; and some after-births are very firmly attached. Eventually it will come out with a little encouragement in the way of frictional massage of the womb through the abdominal walls. If the membranes remain in the womb after the body of the after-birth is out, do not pull on them. Take the after-birth up in the palm of your hand and turn or twist it around, and keep turning it around gently, thereby loosening the membranes from the womb instead of pulling them, which would surely break them, leaving
the broken ends in the womb, and, as a result, the chance of developing serious trouble.
The patient should now be given one teaspoonful of the fluid extract of ergot, which should be repeated in an hour. Should there be an excessive flow of blood after this period it may be again repeated at the third hour.
Cutting the Cord.—As soon as the child is born, and of course long before the after-birth is expelled, the physician will tie the cord. This is best done at two places, one about two inches from the child, and the other two or three inches nearer the mother. Cut the cord about one-half inch beyond the first ligature, which will be between the two ligatures. The cord should be tied with sterile tape made for the purpose, or heavy twisted ligature silk, or a narrow, ordinary, strong tape, previously boiled. It should be tied firmly and inspected a number of times within one hour of its birth. It is possible for a baby to lose enough blood from a cord badly tied to cause its death. A very good way to ensure against such an accident is to cut the cord one inch from the ligature nearest the baby, then turn this inch backward and retie with the same ligature, thus making a double tie at the same spot. Cut the cord with scissors that have been boiled and reserved for this purpose.
Washing Baby's Eyes and Mouth Immediately After Birth.—As soon after birth as is practicable, wash the baby's eyes with a saturated solution of boracic acid.
Immediately after the eyes have been washed the physician will drop into them a solution of silver nitrate, three drops of a two per cent. solution in each eye, or argyrol, three drops 20 per cent. solution. This precaution is taken against possible infection during labor and, as explained elsewhere, it is a preventive against certain diseased conditions which, if present, would result in blindness.
The physician should then wind a little sterile cotton round his moistened little finger, dip it in the boracic solution, and holding the baby up by the feet head down, insert this finger into the throat, thus clearing it of mucus. The tongue and mouth may be gently washed with the same solution.
After the baby has cried lustily as an evidence of life and strength, he should be wrapped up in a warm blanket quickly, and immediately put in a cozy basket in a warm place, and left there undisturbed, with his eyes shaded from the light until the nurse is ready to attend to him. The baby should be laid on his right side.
Conduct Immediately Following Labor.—As soon as the physician is satisfied that the patient is well enough to be left in care of the nurse or attendant, every effort should be made to favor a long, refreshing sleep. Nothing will contribute to the patient's well-being so much as a quiet, restful sleep after labor. The nurse will therefore take the baby into another room, fix the mother comfortably, and give her a glass of warm milk,—draw the shades or lower the light and tell the tired-out mother to go to sleep. As a rule she will sleep easily, as she is sore and exhausted.
After-Pains.—In women who have had children the womb does not as a rule contract down as firmly as after the first confinement. This condition permits of slight relaxation of the muscular wall, at which times there is a slight oozing of blood. This blood collects and forms clots in the uterine cavity which acts as irritants, exciting contractions in the effort to expel them. These contractions cause what are commonly known as "after-pains." These pains last until the womb is free from blood-clots. They may be severe the first twenty-four hours and then gradually die out during the following two or three days. Ordinarily in uncomplicated confinements they rarely annoy the patient longer than a few hours. It is a rare exception to observe them after the first confinement.
Rest and Quiet After Labor.—Sometimes the birth chamber is the rendezvous for all the inquisitive ladies in the neighborhood. No one should be permitted in the lying-in chamber until the patient is sitting up, except the husband and the mother. This should be made an absolute rule in every confinement. This is a period that demands the maximum of uninterrupted rest and repose. The world and all its concerns should remain a blank to a woman during the whole period of her confinement. This is the only successful means of
obtaining mental rest. The husband and mother should be instructed to present themselves just often enough to demonstrate their interest in the welfare of the patient and the baby.
Position of the Patient After Labor.—After delivery a woman should be instructed to lie on her back, without a pillow, for the first night. On the following morning she may have a pillow, but she must remain on her back for the first week. Sometimes an exception may be made to this rule by letting the patient move around on the side, with a pillow supporting the back, on the fourth day. These exceptional cases are those whose womb has contracted firmly, as shown by the quick change in the amount and color of the lochia. Women should be told why they must remain on their backs as explained in the chapter: "How long should a woman remain in bed?"
The Lochia.—The discharge which occurs after every labor is called the lochia. Its color is red for the first four or five days; for the succeeding two or three days it is yellow; for the remainder of its existence it is of a whitish color. It lasts from ten days to three weeks.
The odor of the lochia is at first that of fresh blood; later it has the odor peculiar to these parts. If at any time the odor should become foul or putrid it is a danger signal to which the nurse should immediately draw the physician's attention.
If the amount of the lochia should be excessive it should be investigated.
The Events of the Day Following Labor.—We will assume that the patient enjoyed a long sleep and wakes up refreshed, and with a thankful feeling that all is over and that baby is safely here. She will want to see and caress baby, of course. Lay the baby down in bed beside her and let her love and mother it. Tell her not to lift it, for the strain might injure her, then quietly steal away for ten or fifteen minutes, for these are precious, sacred moments. Motherhood—that angel spirit, whose influence every human heart has felt—that guards and guides the world in its sheltering arms—is born in its divine sense, into the heart of every woman for the
first time, as she gazes in ecstasy and wonder at her first-born. She feels that she has begotten a trust,—a trust direct from her Creator, and she makes a silent resolve, as she gently and timidly feels the softness of baby's cheek, that she will watch over it, and guide it, and do all a mother can for it, with God's help. It is good for the race that mothers do feel this way: and it is good for all concerned that they be given the opportunity to be so inspired.
Just as gently take the baby away at the expiration of the allotted time. Take it with a cheerful, smiling word, and do not comment upon mother's happy, thoughtful face, she will quickly collect herself and enter into the spirit of quiet congratulation that should now permeate the home.
The First Breakfast After Labor.—If the patient has passed a comfortable night, feels well, and is free from temperature, and has a normal pulse, breakfast will consist of a cup of warm milk, or a cup of cocoa made with milk, a piece of toasted bread, and a light boiled egg; or if preferred a cereal with milk and toasted bread. This will be the breakfast for the two following days also. The milk, or the cocoa (whichever is taken), must be sipped, while the attendant supports the patient's head. The cereal, or the egg (whichever is taken), must be fed to the patient out of a spoon. The patient must not make any physical effort to help herself; she must remain relaxed. Even when she sips her milk, or cocoa, she must not make any effort to raise her head; the nurse must support its entire weight. This will be the absolute routine of every meal until the physician gives permission to change the procedure. It is a waste of time to formulate rules only to disobey them.
Shortly after breakfast the patient's toilet should be attended to. She should have her hair combed, and her face and hands washed. The hair on the right half of her head should be combed while the head rests on the left side, and vice versa. The water used for washing the hands and face should be slightly warmed. It is best to keep the hair braided and to consult the wishes of the patient as to the frequency of combing it.
The Importance of Emptying the Bladder After Labor.—An effort should be made now to have the patient urinate. This is very important at this time, as it is not an uncommon experience to find that the abdominal muscles are so worn out and overstrained with the fatigue of labor that they refuse to act when an effort is made to urinate. As a consequence the bladder becomes distended and may have to be emptied by other means. This condition is a temporary and a painless one, and will rectify itself in a day or two; meantime, if this accident has occurred, it is essential that the bladder should be emptied from time to time until the patient can do it herself. To test this function place the patient on the bed pan into which a pint of hot water has been put, and give her a reasonable time to make the effort to pass her water. Should she fail, take an ordinary small bath towel and wring it out of very hot water, just as hot as she can tolerate, and spread it over the region of the bladder and genitals: if there is running water in the room, turn it on full and let it run while the towel is in position as above. If the bladder is full, there is a peculiar, irresistible desire to urinate when one hears running water. If this effort fails, report the fact to the physician when he makes his daily call; he will draw the urine and it will be part of his daily duty to give specific instructions regarding this function until nature reëstablishes it.
No particular attention need be paid to the bowels for the first two days. On the morning of the third day, if they have not acted of their own accord, the physician will give the necessary instructions to move them. The means necessary to accomplish the first movement after a confinement is a matter of choice. The old-time idea was to use castor oil, and while other remedies are now more or less fashionable, castor oil is still an excellent agent. Enemas are frequently used, but their use is questionable in this instance, inasmuch as a movement has not taken place for three days, the object is to clean out the whole length of the intestinal tract, and an enema is limited to part of the large intestine only,—according to how it is given. If the small
intestines are not thoroughly emptied, particles of food may remain there, and if so, they will putrify and the patient runs the risk of developing gas,—sometimes to an enormous extent. This affliction is painful, and dangerous, and nearly always unnecessary. It is always, therefore, more safe, and more desirable, to use some agent by the mouth, and we know of no better one than castor oil; and as castor oil can be so masked as to be practically tasteless at any drug-store soda fountain there can be small objection to it. My custom is to send the nurse or husband with an empty glass to the drug store to have the mixture made there and brought back ready for use. We have frequently obtained it in this way and given it to the patient without her knowing what it was. The best time to give castor oil is two hours after a meal, and two hours before the next meal—i.e., on an empty stomach. It works quicker and does not nauseate when the stomach is empty.
Instructing the Nurse in Details.—The nurse will attend to the patient's discharges by changing the napkins frequently. The bruised parts should be washed twice daily, for the first three or four days. If the nurse is a trained graduate nurse a few directions will suffice. If she is not a trained nurse the physician should be explicit in his instructions. It would be better if he actually showed her just how he wanted this work done. The best way to cleanse the vulvæ or privates is to take an ordinary douche bag at the proper height (about three feet) and allow the solution (1 to 2,000 bichlorid) to run over the parts into the douche pan, but do not touch any part of the patient with the nozzle of the douche bag. While she is directing the water with the left hand she should have a piece of sterile cotton in the right hand with which she will gently mop the parts. This method ensures disengaging any clotted blood and is aseptic. Dry the parts afterwards with a soft sterile piece of gauze and apply a clean sterile napkin.
Douching After Labor.—A nurse should never give a vaginal douche without instructions from the physician. Douches are not necessary in the convalescence of ordinary uncomplicated confinement cases. When it is
necessary to give vaginal douches after a confinement, there are good reasons why they should be given, and it is therefore absolutely essential that they should be given properly, and with the highest degree of aseptic precautions. If these rules are not observed, the danger of causing serious trouble is very great, and as the physician is directly responsible for the conduct of the case, he should in justice to himself and his patient, do the douching himself.
How to Give a Douche.—The proper way to give a vaginal douche after a confinement, when the parts are bruised and lacerated, and when, as a consequence, the possibility of infection is very great, is as follows:
Instruct the nurse to boil and cool about two quarts of water and have another kettle of water boiling. Boil the douche bag and its rubber tubing and the glass douche tube (do not use the hard rubber nozzle that comes with the ordinary douche bag). Drain off the water after it has boiled for ten minutes, but instruct the nurse not to touch the bag or tube, to leave them in the pan, covered, till the physician uses them. When the physician calls, place the patient on a clean warm douche pan while he is sterilizing his hands and making the solution ready. While he is douching the patient the nurse will hold the bag. The bag should not be held higher than two feet above the level of the patient.
Advantages of Putting Baby to the Breast Early After Birth.—The patient can now take, and will likely be ready for, an hour's nap. After the rest it is desirable to put the baby to the nipple, first carefully cleaning the nipple with a soft piece of sterile gauze dipped in a saturated solution of boracic acid. The reasons for this are as follows:
1st. There is in the breasts of every woman after confinement a secretion known as "colostrum" which has the property of acting as a laxative to the child, in addition to being a food.
2nd. It is advisable that the child's bowels should move during the first twenty-four hours and the colostrum was put there partly for that purpose.
3rd. The act of suckling has a well-known influence
on the womb, in that it distinctly aids in contracting it, and thereby expelling blood-clots and small shreds of the after-birth which might cause trouble if left in.
4th. By nursing the colostrum out of the breasts, it will favor and hasten the secretion of milk.
5th. It is frequently easier for the baby to get the nipple before the breast is full of milk, and having once had the nipple it will be easier to induce him to take it again when it is more difficult to get.
The First Lunch After Labor.—Lunch will be next in order, and that should consist of a clear soup,—chicken broth, mutton broth, beef broth with a few Graham wafers or biscuits, and a cup of custard or rice pudding. This will be the lunch for the two following days also. The same precautions are to be observed in giving this as were observed with breakfast and as will be observed with all other meals as clearly stated before, and repeated again, so that no mistake may be made. In the middle of the afternoon the patient can take a cup of beef tea or a cup of warm milk.
The First Dinner After Labor.—Dinner will consist of more broth, or a plate of clear consomme with a dropped egg, or a cereal, a little boiled rice with milk, and stewed prunes, or a baked apple.
After the bowels have moved, on the third day, and provided the temperature and pulse have been normal since the confinement, the patient can be put on an ordinary mixed diet, particulars regarding which are given on page [121] under the heading "Diet for the nursing mother."
CHAPTER IX
CONFINEMENT INCIDENTS
Regarding the Dread and Fear of Childbirth—The Woman Who Dreads Childbirth—Regarding the Use of Anesthetics in Confinements—The Presence of Friends and Relatives in the Confinement Chamber—How Long Should a Woman Stay in Bed After a Confinement?—Why Do Physicians Permit Women to Get Out of Bed Before the Womb Is Back in Its Proper Place?—Lacerations, Their Meaning and Their Significance—The Advantage of an Examination Six Weeks After the Confinement—The Physician Who Does Not Tell All of the Truth
Regarding the More or Less Prevalent Dread or Fear of Childbirth.—Much has been written, and much more could be written upon this subject. Inasmuch as this book is largely intended for prospective mothers to read and profit thereby, and is not for physicians and nurses whose actual acquaintance with confinement work would render such comments superfluous, it will not be out of place to consider this phase of the subject briefly, from a medical standpoint. When one considers that "a child is born every minute" as the saying goes, and which is approximately true, and at the same time remembers that statistics prove, as near as can be estimated, that there is only one death of a mother in twenty thousand confinements, it would really seem as though we were "looking for trouble" to even regard the subject as worthy of the smallest consideration. It is much more dangerous to ride five miles on a railroad, or on a street car, or even take a two-mile walk,—the percentage possibility of accident is decidedly in your favor to stay at home and have a baby. Almost any disease you can mention has a higher, a much higher fatality percentage than the risks run by a pregnant
woman. The real justification for actual fear of serious trouble is so small that it barely exists. These are facts that cannot be argued away by any specious if or and. Why, therefore, should there be any real fear?
Did you ever hear of the remarks made by a famous philosopher who was given a dinner by his friends in celebration of his 85th birthday? In replying to the eulogisms of his friends he said in part:
"As I look back into those blessed years that have faded away, I can recall a lot of troubles and many worries as well as much happiness and pleasure, and thinking of it all this evening I can truthfully say my worst troubles and worries never happened."
So it is with the woman who for weeks or months has made her own life wretched, and possibly the life of her husband and friends, the same in imagining all kinds of dreadful things that never take place. It is undoubtedly an exhibition of weakness, an evidence of failure in the development of self-control. Childbirth is a natural process,—there is nothing mysterious about it. If you do your part you have no cause to fear,—the very fact, however, that you entertain a dread of it, shows that you are not doing your part. One of the saddest parts of life, one of the real tragedies of living, is the fact that most of us have to live so long before we really begin to profit by our experiences. Could we only be taught to learn the lesson of experience earlier, when life is younger and hope stronger, we would have so much more to live for and so many more satisfied moments to profit by. One of the most valuable lessons experience can teach any human being is not to worry and fret about the future. You can plant ahead of yourself a path of roses and be cheerful, or you can plant a bed of thorns and reap a thorny reward. Cultivate the spirit of contentment, devote all your energy to making the actual present comfortable. Don't fret about what is going to bother you next week, because, as the philosopher said, most of the troubles we anticipate and worry about never occur, but the worry kills.
Regarding the Use of Anesthetics in Confinements.—Anesthetics are as a rule given in all
confinements that are not normal. To make this statement more plain it may be said, that, when it is necessary to use instruments, or to perform any operation of a painful character, it is the invariable rule to give anesthetics. As to the wisdom of giving an anesthetic when labor is progressing in a normal and satisfactory manner, there is a difference of opinion. Much depends upon the disposition of the patient and the viewpoint of the physician in charge of the case. It is a fact that a large number of confinements are easy and are admitted to be so, by the patients themselves, and in which it would be medically wrong to give an anesthetic. In a normal confinement, however, when the pains are particularly severe and the progress slow, there is no medical reason why an anesthetic could not be given to ease the pain. In these cases it is not necessary to render the patient completely unconscious. Sufficient anesthetic to dull each pain is all that is necessary, and as this can be accomplished with absolute safety by the use of an anesthetic mixture of alcohol, ether and chloroform, there can be no possible objection to it. The use of an anesthetic, however, is a matter that must be left entirely to the judgment of the physician as there are frequently good reasons why it should not be given under any circumstances.
The Presence of Friends and Relatives in the Confinement Chamber.—It is a safe rule to exclude every one from the confinement room during the later stages of labor. Sometimes it is desirable to make an exception to this rule in the interest of the patient, by permitting the mother or husband to remain. If this exception is made, however, they must be told to conduct themselves in a way that will tend to keep the patient in cheerful spirits. They must not sympathize, or go around with solemn, gloomy faces. Cheerfulness and an encouraging word will tide over a trying moment when the reverse might prove disastrous.
Practically the same rule applies to the entire period of convalescence during which time the patient is confined to bed. This is a very important episode in a woman's life and the consequences may be serious if it is misused in any way. Friends and relatives do not appreciate the
absolute necessity of guarding the patient from small talk and gossip, and an unwitting remark may cause grave mental distress, which may retard the patient's convalescence and disastrously affect the quality and quantity of her milk, thereby injuring the child.
How Long Should a Woman Stay in Bed After a Confinement?—To answer this question by stating a specific number of days would be wrong, because, few women understand the need for staying in bed after they feel well enough to get up. If any answer was given, it should be at least fourteen days, and it would be nearer the truth medically to double that time. Let us consider what is going on at this period. The natural size of the unimpregnated womb is three by one and three-quarter inches, and its weight is one to two ounces. The average size of the pregnant womb just previous to labor is twenty by fourteen inches, and its weight about sixteen ounces. We have, therefore, an increase of about 600% to be got rid of before it assumes again its normal condition. This decrease cannot be accomplished quickly by any known medical miracle. Nature takes time and she will not be hurried: she will do it in an orderly, perfect manner if she is allowed to. The womb will again find its proper location and will resume its work, in a painless, natural way, in due time, if all goes well. The uterus or womb is held in its place by two bands or ligaments, one on either side, and is supported in front and back by the structures next to it. These bands keep the womb in place in much the same way as a clothes pin sits on a clothes line, and it will retain its proper place provided everything is just right. After labor, it is large and top heavy. If you put a weight on the top of a clothes pin as it sits on a clothes line, what will take place? It will tilt one way or the other, and if the weight is heavy, it will turn completely over. So long as the woman lies in bed the womb will gradually shrink back to its proper size and place; if she sits up or gets out of bed too soon, the weight of the womb, being top heavy, will cause it to tilt and sag out of its true position. As soon as it does this the weight of the bowels and other structures above will push and crowd it further
out of place. This crowding and tilting interferes with the circulation in the womb and its proper contraction is interfered with, and thus is laid the foundation for the multitude of womb troubles that exist.
It is a mechanical as well as a medical problem. Being partly mechanical, it is subject to the rules that govern mechanical problems. The importance of this dual process will be appreciated by considering the following fact. Many medical conditions tend to cure or rectify themselves because nature is always working in our behalf if we give her a chance. Take for example an ordinary cold. You can have a very severe cold and you can neglect it, and in spite of your neglect you will get well. It is not wise to neglect colds, nevertheless, it is true that nature will cure, unaided, a great many diseased conditions, if she has half a chance. This, to a very large extent, is the secret of Christian Science, yet the principle is known to everyone. A mechanical condition, on the other hand, has absolutely no tendency to get well of its own accord, or without mechanical aid. This is why Christian Science cannot cure a broken leg. It is this principle that makes diseases of the womb so persistent, and so stubborn of cure. When a womb once becomes slightly displaced, the tendency always is for it to grow worse and never to cure itself. The longer it lasts the worse it gets. Its cure depends upon mechanically putting it back in place and holding it long enough there to permit nature to reëstablish its circulation, and by toning and strengthening it so that when the mechanical support is taken away it will retain its position. There is no other possible way of doing it. Now since it has been proved that nature takes many days to contract a pregnant womb, a woman is taking a risk, and inviting trouble by getting out of bed before that time.
Why Do Physicians Permit Women to Get Up Before the Womb is Back in its Proper Place?—Without offering the excuse that a woman will not stay in bed as long as a physician knows she should, there is, however, a large degree of truth in this excuse. And we are of the opinion that, if a physician made it a rule to keep all his confinement cases in bed for one month,
he would very soon find himself without these patients.
Experience has taught us, however, that it is safe, under proper restrictions, and in uncomplicated confinements, to allow patients to sit up in bed on the 12th and in certain cases on the 10th day, and to get out of bed on the 12th or 14th day. When the patient is allowed to sit up, out of bed, it should not be for longer than one or two hours, and during that time she should sit in a comfortable rocking or Morris chair, which should be placed by the side of the bed. Each day the time can be lengthened, and the distance of the chair from the bed increased. This procedure gives her the opportunity to walk a little further each day, thereby to test her strength and ability to use her limbs. On the fourth day, if all has gone well, she may stay up all day and she may walk more freely about the room. She should be just to herself, however. As soon as she is fatigued she should not make any effort to try to "work it off." When a feeling of fatigue appears she should rest completely. If she has any pain or distress she should acquaint the physician with it at once. She should not try to hide anything on the mistaken idea that "it isn't much." She does not know, and she is not supposed to know what the pain may mean; it may be exceedingly significant. Many women have saved themselves needless suffering, and their husbands unnecessary expenditure of money, by calling the physician's attention to conditions, which in time would have been serious, and would have necessitated long, expensive treatment.
Lacerations During Confinement, Their Meaning and Their Significance.—The only interest a laceration or a tear has to a physician, is whether the laceration or tear is of sufficient importance to need surgical interference. The laceration can take place at the mouth of the womb, or on the outside, between the vagina and rectum.
Those of the mouth of the womb always take place, in every confinement, to some degree. They are never given any attention at the time of the confinement, unless under extraordinary circumstances, such as a more or less complete rupture of the womb, and this is such a
rare accident that most physicians practice a lifetime and never see or hear of one single case. Those on the outside are always attended to immediately after labor, or should be, unless they are very extensive and the patient is not in condition to permit of any immediate operative work. In such a case it is best to leave it alone until the patient is in condition to have it operated on at a later date.
It is distinctly preferable to have it attended to immediately after labor when it is possible, and it is possible in a very large percentage of the cases. The explanation of this is because it is practically painless then, owing to the parts having been so stretched and bruised that they have little or no feeling. If it is left for a day or two and then repaired, it will be more painful, because the parts will have regained their sensitiveness. Another good reason in favor of immediate repair is that a much better and quicker union will take place than if postponed.
When a patient is torn, but not to the degree necessary to stitch, it is to her advantage to be told to lie on her back and keep her knees together for twelve hours, thus keeping the torn edges together and at rest, thereby favoring quick and healthy repair of the tear. Some physicians go as far as to bind the patient's knees together so she cannot separate them during sleep.
It is the custom of every conscientious physician to request every woman he confines to report at his office six or eight weeks after labor. The reason for this is to find out by examination the character and extent of the lacerations of the mouth of the womb. No physician can tell at the time of labor just how much damage has been done, because the mouth of the womb, at the time of labor, is so stretched and thinned out, that it is impossible to tell. After the womb has contracted to about its normal size, it is a very simple matter for any physician to tell exactly the character and extent of the lacerations. Most of these tears need absolutely no attention; there are a few however that do. This is a very important matter for two very good reasons.
1st. Every woman should know, and is entitled to
know, just what condition she is in, because if she has been torn to an extent that needs attention, and is left in ignorance of it, her physical health may be slowly and seriously undermined and the cause of it may not be understood or even guessed at. A woman who becomes nervous and irritable, loses vim and vitality, has headaches, backaches and anemia, and no symptoms, or few, that point to disease of the womb, will suffer a long time before she seeks relief of the right kind, and will be astonished and outraged when she is told that it all results from a bad tear of her womb that she knew nothing about.
2nd. A physician should in justice to himself insist on this late examination, because if a woman is told, at some subsequent time, by another physician that she is badly torn, and she was not told of it by the physician who confined her, she is very apt to form an unjust opinion of his work and to entertain an unfriendly feeling toward him as a man.
Some physicians also, to their discredit, are not slow in permitting an unjust opinion of a colleague to be spread around, by preserving a silence, when an explanation would result in an entirely different opinion by the patient. They permit it to be inferred that the physician was responsible for the tear, when such is not the case. No physician on earth can prevent a tear of the mouth of the womb and this should be explained to the patient. Where the physician is at fault is in the failure to examine his patients when it is possible to tell that a tear of any consequence exists. If such an examination is made, he is in a position to state that a tear exists of sufficient extent to justify careful attention. Immediate operation is seldom necessary, and if the patient is comparatively young, it may not be wise to operate, because if pregnancy takes place within a reasonable time the womb will again tear. She should be told, however, that should she not become pregnant during the next three years she should be examined from time to time, and if the condition of her womb, or her health suggest it, she should have the tear attended to. If after this explanation she neglects herself she must blame
herself, she will at least have no cause to harbor any resentment against her physician who has done all any physician is called upon to do under the circumstances. Another important reason for finding out the character of the laceration is because these lacerations of the mouth of the womb frequently cause sterility.
CHAPTER X
NURSING MOTHERS
The Diet of Nursing Mothers—Care of the Nipples—Cracked Nipples—Tender Nipples—Mastitis in Nursing Mothers—Inflammation of the Breasts—When Should a Child Be Weaned?—Method of Weaning—Nursing While Menstruating—Care of Breasts While Weaning Child—Nervous Nursing Mothers—Birth Marks—Qualifications of a Nursery Maid.
The Diet of Nursing Mothers.—A nursing mother should eat exactly the same diet as she has always been accustomed to before she became pregnant. If any article of diet disagrees with her she should give up that particular article. She should not experiment; simply adhere to what she knows agreed with her in the past. More, rather than less, should be taken, especially more liquids as they favor milk-making. It is sometimes advisable to drink an extra glass of milk in the mid-afternoon and before retiring. If milk disagrees, or is not liked, she may take clear soup or beef tea in place of it. In a general way milk in quantities not over one quart daily, eggs, meat, fish, poultry, cereals, green vegetables, and stewed fruit constitute a varied and ample dietary to select from.
Every nursing mother should have one daily movement of the bowels; she should get three or four hours' exercise in the open air every day; and she should nurse her child regularly.
The diet of the nursing mother during the period immediately after confinement is given elsewhere.
Alcohol, of all kinds, should be absolutely avoided during the entire period of nursing.
Drugs of every variety, or for any purpose, should never be taken unless by special permission of her physician.
Care of the Nipples.—As soon as the mother has had a good sleep after the confinement the nipples should be
washed with a saturated solution of boracic acid, and the child allowed to nurse. The milk does not come into the breast for two or three days, but the child should nurse every four hours during that time. There is secreted at this time a substance called colostrum. This is a laxative agent which nature intends the child should have as it tends to move the bowels and at the same time it appeases the hunger of the infant. It also accustoms the child to nursing and gradually prepares the nipples for the work ahead of them.
After each nursing the nipples should be carefully washed with the same solution and thoroughly dried.
Cracked Nipples.—Cracked nipples often result from lack of care and cleanliness. If they are not cared for as described above they are very apt during the first few days to crack. They should never be left moist. They should be washed and dried after every feeding. If the breasts are full enough to leak they should be covered with a pad of sterile absorbent gauze.
Nursing mothers should guard against cracked nipples, as they are exceedingly painful; frequently necessitating a discontinuance of nursing; and may produce abscess of the breast.
Treatment of Cracked Nipples.—In addition to washing the nipples, drying them thoroughly, and placing a pad of dry gauze over them after each feeding, they should be painted with an 8 per cent. solution of nitrate of silver twice daily. Before the next feeding, after the silver has been used, they should be washed with cooled boiled water. If the cracks are very bad it may be necessary to use a nipple-shield over them while nursing for a few days.
Tender Nipples.—Many women complain of the pain caused by the baby when it is first put to the breast. These nipples are not cracked, they are simple hypersensitive. They should be thoroughly cleansed and dried as above and painted with the compound tincture of benzoin. They should be washed off with the boracic acid solution before each feeding. After a few days under this treatment the tenderness will leave them.
Mastitis in Nursing Mothers.—When inflammation of
the breast takes place in a nursing mother it is the result of exposure to cold, or it may result from injury. If infection occurs and an abscess develops, it results from the entrance, through the nipples, or cracks, or fissures in the nipple, of bacteria into the breast. There is fever, with chills and prostration, and very soon it is impossible to nurse the child because of the pain. Nursing should be immediately discontinued, the breast supported by a bandage and the milk drawn, with a breast pump, at the regular nursing intervals. An ice-bag should be constantly applied to the painful area and the bowels kept freely open with a saline laxative. When the fever and the pain subside nursing may be resumed.
If the gland suppurates in spite of treatment it must be freely opened and freely drained.
WEANING
When to Wean the Baby.—Medically there is no exact time at which the baby should be weaned. Certain conditions indicate when it should be undertaken. It is desirable to wean the baby between the tenth and twelfth months. A month or two one way or another will not make much difference if the mother and child are in good condition. It should be weaned between the periods of dentition rather than when it is actively teething. The time of year is important. It would be better to wean it before the hot weather if it is strong and has been accustomed to taking other food than the breast milk. On the other hand it would be decidedly better to defer the weaning until the fall, rather than risk weaning at the tenth or twelfth months if these fall during the height of the hot weather.
Methods of Weaning.—The best way to wean is to do it gradually. It is not desirable to take the mother's milk away suddenly unless there is a very good reason for it. The child should be fed small portions of suitable other food at the beginning of the tenth month. By the end of the tenth month he should be taking a feeding two or three times a day of food other than the breast milk. This feeding may be given in a bottle. In some cases
the mother may be able to feed the child with a spoon instead of the bottle. The substitute feedings allowable at this age are given in another chapter.
Times When Rapid Weaning is Necessary.—There are times when the child must be weaned suddenly, as, for example, at the death of the mother, serious sickness of the mother, or in cases where for any cause the mother suddenly loses her milk. In these cases it is best to wean at once. If an infant refuses to take the bottle under such circumstances, the best plan to adopt, and the wisest one in the long run, is to starve the child into submission. If he gets absolutely nothing but the bottle he will shortly take it without protest. If a meddling individual attempts to feed the child some other food and tries to coax it to take the bottle in the meantime, much harm may result; it is safe only to fight it out for a day or two and win than to half starve the child and lose in the end.
The child should be weaned if it is not gaining in weight. This may indicate a deficient quality of the mother's milk, or it may indicate a lack of proportion between the child and mother. If a robust child is depending upon the nourishment furnished by a mother who is not in good physical condition the milk may not be adequate in quality and quantity. The child will not therefore develop normally and it may be necessary to wean it.
If the mother becomes pregnant it will be necessary to wean, because pregnancy invariably affects the quality of the milk. It is a very good habit to accustom the child to take its daily supply of water from a bottle from a very early age. This procedure will make it easier to wean at any time.
Menstruation is not an indication for weaning as has been explained. If, however, the return of menstruation affects the milk so that it disagrees with, or fails to satisfactorily nourish the child, it may be necessary to wean, but not unless.
The best reason for weaning a child at the twelfth month is that a mother's milk after that time is not adequate in quality for a child of that age. A child at one year of age has grown beyond the capability of its
mother to nurse it: nature demands a stronger and a more substantial food than any mother can supply. A mother who nurses her child beyond that period is not only injuring herself, but she is cheating her child. The exception to this rule is, as has been explained, the second summer.
The child will evidence its dissatisfaction with the breast supply if it is not enough; it will not gain in weight, it will be irritable and fretful, it will tug long and tenaciously at the nipple, it will be unwilling to cease nursing after it should have finished, and it will drop the nipple frequently with a dissatisfied cry. These are all signs of insufficient nourishment, and to the observant mother they will at once indicate that the child must be weaned and fed upon a mixed diet.
Care of Breasts While Weaning Child.—The process of weaning should cause little or no discomfort. If the weaning is gradual it is necessary to press out enough milk to relieve the tension from time to time. It usually takes three or four days.
If it is necessary to wean abruptly, as it is occasionally, there may be considerable distress. In these cases it is necessary to massage the breasts completely,—until all the milk is out, or as much as it is possible to get out,—then rub the breasts with warm camphorated oil, and bind them firmly. When the breasts are massaged for any reason, the rubbing should be toward the nipple and it should be done gently. If there are any hard lumps, or caked milk, in the breasts, they must be massaged until soft, and the binding renewed. It may be necessary to repeat this process for a number of days. In binding the breasts use a large wad of absorbent cotton at the sides, under the arms, to support the breasts, and another wad between the breasts. This renders the binding more effective; permits the binder to be put on tighter; and prevents it from cutting into the skin. When weaning has to be done quickly the patient should absolutely abstain from all liquids. A large dose of any saline, Pluto, Apenta, or Hunyadi Water, or Rochelle salts, or Magnesium Citrate, should be given every morning for four or five days.
If the weaning is gradually undertaken the child should be allowed to nurse less frequently. One less nursing every second day until two nursings daily are given. Keep the two daily nursings up for one week and then discontinue them, after which the above measures may be adopted. To dry the milk up, the breasts may be anointed with the following mixture: Ext. Belladonna, 2 drams; Glycerine, 2 ounces; Oil of Wintergreen, 10 drops.
Nervous Nursing Mothers.—Nervousness, considered not as the product of a diseased condition, but as a temperamental quality, is an unfortunate affliction in some nursing mothers. Let us illustrate just how this characteristic is detrimental to the helpless baby. A mother was instructed to give her baby a half teaspoonful of medicine one-half hour after each feeding. She was told how to give it, and how to hold the baby when giving it. She was also told that the baby would not like it, and would try to eject it from its mouth rather than swallow it, and that when it did swallow it, it would make a little choking noise in its throat, but not to mind these, to go ahead and give it, as the baby could not strangle or choke. It was essential to give the baby this medicine, and hence the physician explicitly instructed her in these details. What was the result? On the following day when the physician called, and found the baby much worse, the mother said: "Oh, doctor! I couldn't give the medicine, the baby wouldn't take it, she nearly strangled to death when I tried to give it." The physician asked for the medicine and placing the baby over his knee, gave it without the slightest trouble, much to the mother's amazement. The servant girl who was a hard-headed, cool, Scotch girl, was instructed and shown how to give the medicine, which she did successfully. The mother was temperamentally nervous, was easily excited and became helpless the moment the baby objected, though she was a strong, robust, healthy woman.
Another mother was carefully instructed to drop into the eye of her baby two drops of medicine every four hours. She was told and apparently appreciated the
urgent necessity of the medication as her baby's eye was badly infected. She was further told that if she did exactly as shown, the eye would be better in two or three days, and if she did not, the other eye would become infected, and blindness might result. She undertook to carry out the directions faithfully. She absolutely failed, however, to carry out the instructions. Her husband informed the physician on the following day that she became so nervous and excited that she utterly failed to treat the eye once, and when he and a sister offered their assistance she became so unreasonable in her fear that "they might hurt the baby" that it was impossible to do anything with her. Her sister was finally shown how to do it and carried the case through quite successfully.
Inasmuch as this book is intended to convey helpful instruction to every mother, the author would suggest to those of this type the necessity of resisting this tendency. It is a matter of will power, just make up your mind not to be silly and if you find that you cannot trust yourself to follow instructions, let someone else do it. When the physician tells you a certain thing must be done, and that no harm can result, do it, and don't imagine all kinds of impossible happenings.
So much anguish and annoyance is caused in this world by imagining and anticipating trouble, that half the pleasure of life is denied us. You cannot do your whole duty by a helpless baby if you do not reason and act upon sound judgment. Many babies are lost by mothers being afraid to do what should be done, and what they know should be done. It is not what the doctor does that brings a baby through a dangerous sickness; it is the faithfulness of the nurse in carrying out his instructions that is responsible for the outcome. A timid, halting, doubting nurse can quickly undo all a physician hopes to accomplish; while a prompt, faithful nurse, with initiative, and good judgment, can save a little life in a crisis, even in the absence of the physician. Follow instructions implicitly, even though the carrying out of the instructions seem to cause the baby pain and suffering,—it is for the baby's best interest.
Birth Marks.—Much has been written on this subject which a later study of biology and eugenics have shown to be utterly false. Let us consider the actual facts. The baby is already a baby, floating in a fluid of its own manufacture. It has absolutely no connection with its mother except by means of its umbilical cord,—which is composed of blood vessels. The blood in these vessels is the child's blood and never at any time does it even mix with the blood of the mother. It is sent along these vessels into the placenta, or after-birth, in which it circulates in small thin vessels, so close to the mother's blood that their contents can be interchanged. Yet the two streams never actually mix. The carbonic acid and waste products, in the child's blood, are taken up by the mother's blood, and given in exchange oxygen and food, which is returned to nourish the child. There is absolutely no nervous connection between the mother and the child. How then is it possible for the mother to affect her child in any way except insofar as the quality of its nourishment is concerned? Nor can a mother affect her child in any other sense. If the intermingling of blood could affect a child's education we would frequently resort to surgery. In the article on Eugenics, under the heading, "Education and Eugenics," it is explained that the child is "created" at the moment of conception; that absolutely nothing can affect it after it is created; that no influence of the mother or father can in any way affect it for better or worse. A mother cannot create in her child any quality which she may desire no matter how she conducts herself. It was formerly thought that a mother could for example create a musical genius by devoting all her time to the study of music while she carried the unborn child; or that she could make a historian of it if she studied history; or an artist if she studied paintings. We now know this to be wholly wrong and for very excellent reasons.
The mother must realize that the only aid she can bestow upon her unborn child is to give it the best possible nourishment. She must provide good blood because the quality of the maternal blood stream bespeaks a healthy or unhealthy, a fit or unfit, child. Whatever the
child is to be is already fixed, its innate characteristics art part of itself. Whether it will have the vitality to develop its inherent possibilities depends, to a great degree, upon its intra-uterine environment,—and its intra-uterine environment depends upon the health of its mother and the quality of the blood she is feeding it upon. After birth its health, its success, its efficiency, depends upon the care it gets and the quality of its mother's milk. A mother therefore must be in good physical and mental health if she hopes to do her full duty as a mother.
Qualifications of a Nursery Maid.—When a helper, or maid, is employed to aid in caring for the baby, much precaution should be exercised in selecting her. The association of the nursery maid and the child, is necessarity an intimate one, and she should be willing to submit to a medical examination to prove her physical fitness. Her lungs should be examined thoroughly, so also should the condition of her mouth, throat and nose be known. An observant and tactful mother will also find out if there are any other objectionable conditions existing, which would render her unfit for the position. A nursery maid should be naturally fond of children, she should be industrious, and sensible; of quiet tastes and good disposition. Her work should be a pleasure not a task.
CHAPTER XI
CONVALESCING AFTER CONFINEMENT
The Second Critical Period in the Young Wife's Life—The Domestic Problem Following the First Confinement.
The first three or four months following the first confinement is the second important period in the young wife's life. In one sense it is the most critical period. The first important period you will remember we stated to be the first few months after marriage. During these months the young wife passed through the period of adaptation. She found out that matrimony was not all sunshine and happiness. She learned that her husband was not the paragon she had idealized. She discovered his human side. She met daily trials and annoyances incident to domestic life. She found her level, and, in finding it, she discovered herself. She is not very safely anchored yet but she is trying to succeed and the future promises well. Some day she awakes to the knowledge that she is pregnant and a multitude of new speculations enter into the situation. She finds she must go on striving and hoping and praying that she may have the strength and courage to do her part. Time passes, and if she is an ordinary woman she scarcely does justice to herself. Her duties are exacting, and her physical condition is not given the study and care which she ought to give it. She does not understand the importance of the hygiene of pregnancy, and the day of the confinement finds her more or less exhausted, and worn out. She passes through the crisis of maternity, however, and spends the customary ten days in bed. At the end of that period the nurse and physician leave her to face the most important problem of life alone. She is a mother, and has in her exclusive charge a human life.
Let us exactly understand what the real situation is. It would not further the object of this book or help in the solution of the problem the author has in mind to depict
a false situation. We must concede the following facts to be true, if we understand the subject:
1. That the mothers of the human race are, in the vast majority, the poor.
2. That they are uneducated in the sense that they are not versed in the science of hygiene and sanitation, and consequently health preservation.
3. That even the fairly well educated are innocently ignorant of the science of heredity, environment, hygiene, sanitation and health preservation.
4. That to benefit the majority we must depict conditions as they exist among the poor, and reason from that standard.
Such books as have been written on this subject have based their facts upon too high a plane. Their remedies are beyond the means and the understanding of the average poor mother. Their analogies are based upon conditions that exist among the better class. The average poor housewife gets no practical assistance or help from their deductions, because her environment precludes any utilization of the data furnished; the data is not practical in her particular case.
Our young mother is in all probability a physically and mentally immature girl. She most likely entered the marriage relationship without a real understanding of its true meaning, or even a serious thought regarding its duties or its responsibilities. She was not taught the true meaning of motherhood before actual maternity was thrust upon her. She has probably innocently acquired habits which are detrimental to her health and her morals; and she has no conception of the fundamental duties of a homemaker. Yet into the keeping of this woman a human life has been given.
Her home surroundings are not such as to inspire confidence or from which to elicit encouragement. It has been a struggle to make ends meet; to keep the peace; to be hopeful and cheerful. If she has succeeded in keeping her home neat and clean and comfortable, it has been at the expense of her not too robust constitution. If she has made efforts to observe the amenities of life, to be true as wife, companion and confidant, it
has taxed her nerves, her courage and her vitality. She has frequently been at the breaking point but she has kept up because she felt it was her duty, and because there was nothing else to do.
As she rests from her weary labor during the first long days after getting out of bed, the loneliness of it all crushes her. She is weak, nervous, and discouraged, and her white, wan face, with its tired, appealing eyes, bespeaks her anemic and hopeless condition. She is only a child herself, yet fate has crowned her with the holy diadem of motherhood. There are thousands of such mothers and yet posterity need not despair. This is just the beginning, and from such beginnings have sprung the heroes of the race. If the reader has carefully read the chapter on Heredity she will understand that the temporary condition of this mother is not important so far as the destiny of the child is concerned. The really important question is, How will this mother develop? The environment of the child depends upon the conditions with which its mother surrounds it. If she is a failure, the child's environmental influences will be unfavorable; if she proves worthy of her trust, if she progresses and masters her difficulties; if she is a good mother and a good homemaker the child's surroundings and influences will be favorable to the full development of its hereditary endowment. But it must be remembered that even an unfavorable environment need not prevent the hereditary promise from dominating the life of the individual.
To return to our girl mother, upon whose slender shoulders the weight of a great responsibility rests,—we wish to concede that her burden is great. Her home duties are rendered more onerous because of her physical weakness and disability. The strain of nursing her fretful child is taxing her vitality and her nerves to the limit. Her disposition is imposed upon by the exactions of an uncomprehending husband. She is inclined to fretfulness and melancholia by the seeming uncharitableness of fate and fortune. Her moments of introspection are almost bitter. It is a critical period,—she has reached the breaking point.
Such moments are apt to be epochal. The turning of the wheel of fortune will decide the destiny of a human soul.
It may be a friend who will supply the needed inspiration that will revitalize hope, and courage, and the determination to succeed. Or it may be a prayer, breathed in the silence of despair that will inspire the courage to fight on, and change the complexion of life.
Once again we would advise such a young wife to calmly think matters over; to find out "what she is working for"; to assemble her ideals and to "know what she wants." There is nothing organically wrong. It is a condition, not a disease. She is discouraged, despondent, nervous and weak. The discouragement, despondency, and nervousness is a result of reduced physical vitality and lack of system. She is not efficient because she is not a trained worker. She is easily discouraged because anemia or bloodlessness fails to supply the oxygen necessary to a fight. There is no period in a woman's life when she is more apt to fall into a rut than at this time. Every element, spiritual and physical, which is necessary to stagnation and indifference is present, and it will take a bold and brave effort to resist the temptation to failure which has encompassed her.
How can we suggest a remedy? She must first regain her health. She has simply a condition to combat, not a disease, and a definite system, a well laid out plan strictly adhered to will effect the result. She must regain her health, because, without health, she cannot hope to be efficient in work or agreeable in disposition, and she owes both to herself, to her husband and to her child. She must get out of doors. She must walk in the open air. There is absolutely nothing in life that will effect so miraculous a transformation in a discouraged, tired, weary and sick woman, as systematic daily walks in the open air. She must walk briskly, however, and she must desire to get well. We cannot get well if we do not wish to get well. One who walks with a purpose will walk erect, firmly and briskly; she will hold her chest up, and will breathe deeply, and she will drink in hope, and health, and happiness. It takes time to regain strength after
the strain of pregnancy and labor. Many women complain that they feel weak and do not regain strength quickly, but they make no effort. They must make a beginning. Sitting around waiting for it to come will not bring it. If they cannot walk a mile, they must walk half that distance to begin with; the five mile walk will follow in time. Many young mothers get into the habit of taking baby out in his carriage for an airing, and regard this as exercise for themselves. They join the baby brigade and parade up and down the block, or select a sunny spot where there are others on a like quest, and sit around exchanging confidences. These outings usually degenerate into gossiping parties and are a dangerous and questionable practice. They are no doubt good for the baby, but they are morally and physically bad for the young mother. This daily habit is called exercise, but it is in no sense physical exercise. The young mother should select a certain time each day, immediately after a nursing when baby is likely to sleep, and devote this period to walking. One hour each day will accomplish much in regaining and establishing health and strength, and appetite for the mother. No indoor work can take the place of a walk out of doors. It is a duty on the part of the nursing mother to do this. It will enable her to supply better milk; it will banish her tendency to nervousness; it will ensure a good appetite, good spirits, and sound sleep. It will make her a better mother and a better wife. Many young wives sow the first seeds of discontent, and ultimate failure during the natural depression that follows maternity.
She must adopt system in the performance of her household duties. A good plan is to set aside a certain definite time for meals, when to begin cooking and when to end washing the dishes. Then arrange regarding the general household duties. Make a schedule for a week devoting each day to a certain task so that at the end of the week all the essential work will have been completed. By systematizing work in this way a great deal of ground can be covered and as time passes it will become easier, as many helpful ways will suggest themselves whereby time will be economized.
Adopt a system with the baby. Many mothers are worn-out, nervous wrecks for no other reason than a lack of system in the management of the daily life of their offspring. If system is not adopted in feeding and caring for an infant it becomes irritable. To a sick, tired, weary mother an irritable child is an unspeakable torture. Begin right. Give it adequate, but no unnecessary attention. Nurse it every two hours, and at no other time. Wake it to nurse at its regular time. It will in a few days acquire the habit of feeding regularly and will sleep between feedings. Do not overfeed it. Remember babies never die from starvation, but many do by overkindness, and overfeeding is the most prolific cause of infant mortality known. Read the article on "How long should a baby nurse?" Keep the baby clean, comfortable and happy and you will not have a fretful child, but one that will be a constant inspiration and incentive to you.
Find time to rest, take a mid-day nap. Get off occasionally to the country or the sea shore for a day or two. Keep up your interest in your personal appearance, be neat and clean, and invite the attention of your husband during the evening hour. Don't let him grow away from you. Be cheerful, encourage him to tell of his hopes and plans, and show an interest in his health and in his work. Do not forget the dominating influence on your efficiency, and on your happiness which the study habit possesses. Interest yourself in some art, cultivate your mind, and soon, sooner than you think, you will have forgotten your troubles and you will have regained your health.
There is no other way to do it. There is no royal way in which it can be done which is not open to the poorest mother.
An ocean voyage, a trip to Europe, a society Doctor, a professional masseur, beauty experts and miracle workers cannot accomplish more than you can in your poor apartment, if you "go about it in the right way and in the right spirit." Keep in mind always, that: "failure exists only in acknowledging it." Every task that is worth while is won by self-sacrifice, by self-abnegation, by patient, persistent, enthusiastic effort, and in no other way. The joy of consummation is reward enough for all human sacrifice.