Obstetrical Nursing / A Text-Book on the Nursing Care of the Expectant Mother, the Woman in Labor, the Young Mother and Her Baby

by Carolyn Conant Van Blarcom

Fig. 147.—Baby’s toilet tray equipped with jelly glasses, bottles, celluloid hair receiver for cotton, and a soap dish, containing:
1. Safety pins sticking in cake of soap.
2. Jar for sterile nipples.
3. Jar of sterile water.
4. Jar of boracic acid solution.
5. Nursing bottle.
6. Sterile water to drink.
7. Nursing bottle for water.
8. Small tooth pick swabs.
9. Liquid petrolatum.
10. Gauze mouth swabs.
11. Absorbent cotton.
12. Soap.
(By courtesy of the Maternity Centre Association.)

Each patient is seen by a doctor or a nurse every two weeks until the seventh month of pregnancy, and once a week after the seventh month. At each visit the nurse follows as much of the prescribed routine as is possible; this routine consists of testing for albumen in the urine; taking the systolic blood pressure; listening to the fetal heart; questioning the patient and looking for the objective symptoms of complications. During these visits to the homes the nurses are able also to help their patients assemble entirely satisfactory outfits for the care of their nipples, consisting perhaps of jelly glasses, cheese jars, or handleless cups. And they help to find a place on the shelf where this little equipment may be kept undisturbed and always ready for use. When it comes to the measuring of urine, they explain that the regular size tomato can holds just a quart, and is therefore quite as satisfactory for that purpose as a costly graduated glass measure.

No patient is dismissed for failure to follow advice; the nurse continues her visits, unless the patient positively refuses to admit her, and she continues to advise, adjusting and modifying the ideal routine and persuading the patient to do as much as she can, or will.

If abnormalities develop during pregnancy, the nurse arranges for immediate medical care, either at the patient’s home or in a hospital. If the clinic doctor feels that the patient should have hospital care, but she will not or cannot go to a hospital, she is persuaded to engage a doctor, and a nurse from the Centre helps, as a visiting nurse, to take care of the patient in her own home.

The next responsibility of the nurse is to advise the patient in arranging for care at the time of delivery, this advice being based upon the patient’s physical condition, the circumstances of her home life and the available facilities for care. Although hospital care may be the ideal for all patients, from an obstetrical standpoint, the mother cannot always be removed from her home with safety to the family circle. Her physical and social conditions therefore are considered together; if there is no complicating home problem, it is usual to advise hospital care for primiparæ and for all patients who have, or develop abnormalities, or have a history of previous difficult labors, complications or abnormalities.

Patients who, the doctors think, give promise of having complicated labors and who prefer to remain at home are advised to engage a doctor, and to arrange with the Henry Street Settlement for nursing care at the time of delivery and during the puerperium, as the Maternity Centre nurses do not perform this service.

At one time, however, the Centre provided assistance to patients delivered at home, in the shape of a working housekeeper to discharge the mother’s household duties while she remained in bed the necessary length of time after the baby was born, or in some cases, while she took much needed rest during the latter part of pregnancy. For this purpose the nurses had a list of women who were good housekeepers and clean workers and whose own children were partly grown. These women were glad of an opportunity to do part time work and earn a little extra money. They were paid thirty cents an hour, twenty-five cents for lunch and whatever their carfare amounted to, the patient paying whatever she could afford toward the fund, provided by the Women’s City Club, from which these working housekeepers were paid. This service, which in no wise replaced the nurse’s care, has been temporarily discontinued because of lack of funds, but proved to be so valuable that it will be resumed as soon as possible.

Supervisory postnatal visits are paid to patients, not under the care of the visiting nurse service, who have been under Maternity Centre Association care during pregnancy, as well as to those who have not had this care but are referred to the Centre, by hospitals, upon their discharge. The nurse first visits to satisfy herself that the mother is able to care for her baby and to give any instructions that seem to be necessary. She then visits the patient, or the patient visits the nurse, when she is able, until the baby is a month old, when she is urged to register the baby at a baby health station.

The importance and value of birth-registration is explained to the mother and the nurse endeavors to have a copy of a birth certificate in the mother’s hands before the case is dismissed.

The importance of post-partum examinations, not later than six weeks after delivery, is also impressed upon the patient. Patients who are not to be examined by the doctors who delivered them are given a post-partum examination by a doctor at the Maternity Centre, to make sure that they are dismissed in good condition, or are referred to the proper agency for further care, this being the first step in prenatal care for the next baby.