In certain Northern and Western communities, that were considered fairly representative of those sections, conditions have been studied at some length by agents of the Federal Children’s Bureau. They found that about half of the mothers in those communities had no medical attention whatever in childbirth. Untrained women, friends or neighbors, frequently someone’s grandmother, were in attendance. Or husbands or workmen were pressed into service. A few women were entirely alone in their hour of trial. Scarcely a mother among them received prenatal care and instruction worthy of the name.
In the Southern states, the proportion of women delivered by physicians seems to be even smaller than in the North and West, and in some of the mountain regions the conditions are distressing. From one such locality we learn that when a woman goes into labor the first passing teamster is hailed, or perhaps a member of the family hurries down the road for the nearest tanner or blacksmith, or any one else, who in total ignorance will fearlessly rush in to meet the great emergency. The results of this practice—dismembered infants and badly injured or dead mothers,—are too sickening to describe, but may be imagined by any nurse who has seen good obstetrical work and appreciates its value.
From another mountain region in the South comes the contrast in accounts of the work done by Miss Lydia Holman, founder of the Holman Association, as evidence of what skill and desire may accomplish. Something more than twenty years ago this nurse started volunteer visiting nursing among the mountain people, with no precedent to follow and no Board to direct or advise. But there were sick people all about, people needing care, and Miss Holman was not only trained but eager to nurse them, and after all these qualifications are the chief requisites.
After all these years of self-sacrificing, pioneer work, of which American nurses may justly be proud, Miss Holman has the enviable satisfaction of knowing that she has lessened the perils of childbirth for some 600 women and saved practically all of their babies. Much of this in the simplest, most meagerly equipped mountain homes. She has even managed to have some of the mothers taken to a nearby town for the repair of lacerations which occurred during labor. And she has a little hospital now up on the mountain top, with doctors and nurses, not only caring for sick people, but, among other things, teaching women and girls how to care for infants and children.
A complete maternity service for rural communities would evidently include small hospitals for primiparæ and abnormal cases and to serve as centres from which nurses and doctors would carry on prenatal supervision and instruction, and give skilled attention at birth; followed by visiting nursing of the young mother and her baby. The prenatal supervision in sparsely settled districts might leave much to be desired, because of the impossibility of seeing each patient as often as is wise. But even a little care would be an improvement upon present conditions. In some localities, it has been found possible to teach some of the more intelligent of these rural mothers a good deal about their own supervision. One nurse tells of a very isolated woman who could only be visited at long intervals whom she taught to test her own urine for albumen, explaining its possible significance and seriousness. One day the report card that came by mail indicated that the last test showed albumen. But the card also carried the remark, “Don’t worry about this. I am drinking lots of water, taking nothing but milk for food and will be in to see the doctor on Tuesday.”
This hints at some of the possible adjustments that must be made in meeting the needs of the patient in unusual circumstances. For we are constantly facing the unalterable fact, that no matter where she is, nor what conditions surround her, the individual woman needs care and supervision, and though conditions vary, the general needs of expectant mothers are the same.
This survey of the situation in cities and rural communities gives us a glimpse of what can be done about it—this problem of mothers and babies who need care—and also what is being done, and we begin to sense an answer to the question, “Is anything more possible?”
It is clear that a wide extension of provisions for prenatal care is necessary if all mothers are to be reached; rich, middle-class and poor; in cities, small towns and rural districts alike. We believe that it is possible; and we are sure that wherever provision for prenatal care is made, the achievement of its fine purpose will depend very largely upon the spirit of the individual nurse.
What does it bring to the individual nurse—this survey of the problem as a whole, with the suggestion for its possible solution? The appeal of not a few mothers and babies, only, but of a legion, and of uncounted homes and family circles in danger of being broken. And it brings a suggestion of the immeasurable comfort and influence which the maternity nurse may carry into each home that she enters. For she helps to save lives and health, and through them, homes and family groups, and these are the building blocks of the nation.
For the nurse whose imagination is touched by this appeal, it will exact much—the best and most that she has to give—but in return she will find a deep and enduring satisfaction in her work.