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

But 17,000 dead mothers and 200,000 dead babies, most of whom might have lived, are not all that enter into the annual erection of this national monument to neglect. There are also the unrecorded and uncounted victims of little or no obstetrical care who have had too much vigor to succumb completely and die, and who, therefore, live on through years of wretched invalidism. Sometimes, it is true, their disability is slight, so slight as to be uninteresting, and of no statistical importance. But to the woman herself, who must resume the functions of mother, homemaker, wife and general utility person, the disability may be enough to make life endlessly dreary and discouraging. And yet, she is perhaps only just below the physical level upon which she could live her life with joy and eagerness; and proper care when the baby came would have left her upon that level.

The effect of the mother’s impairment reaches far beyond her own invalidism, for such women are not as well able to rear and care for their children satisfactorily as are fresh, buoyant mothers. Whatever makes for good obstetrics, therefore, makes for a better race, and, as we shall see later, measures that tend to improve the health of the race tend to lessen the hazards of childbearing.

Ideal prenatal care, then, would really begin during the expectant mother’s own infancy, but we must be content here with a description of the care that is advisable, and desired, for expectant mothers from the beginning of pregnancy.

There is considerable difference of opinion among physicians concerning the stage of pregnancy at which it is desirable to see the expectant mother for the first time, and the frequency of subsequent observations. But the growing tendency is for the doctor to see his patient as early as possible, for the preliminary examination, and to follow a fairly uniform routine in the kind and frequency of subsequent observations, and in the personal hygiene which the patient is advised to adopt.

Thus, it has become generally customary to see the patient, take her temperature, pulse and blood pressure and make a urinalysis once a month during the first half of pregnancy, and then every two weeks until the onset of labor, or possibly once a week toward the end. These periodic examinations keep the physician constantly informed about his patient’s condition, and frequently disclose very early symptoms of a complication which is easily amenable to treatment at that stage, but which might prove serious if allowed to progress unchecked. Albumen in the urine, for example, or an increase in the blood pressure, in a woman who had no other symptoms, would suggest the advisability of watching for further symptoms of toxemia; while an elevation of temperature, even though the patient was not uncomfortable, might lead to the early discovery of tuberculosis, pyelitis or some other infection not otherwise apparent.

It is this stitch in time that means so much to the pregnant woman and her expected baby.

But the most painstaking obstetrician requires the co-operation of his patient in innumerable little ways, if she is to have the fullest benefits of his skill; for it is not so much what the doctor advises that counts as how the patient lives.

It is at this point that nurses are more and more being given opportunity for immensely gratifying service. A private patient who is in the care of an obstetrician is, of course, supervised and instructed by her doctor. But there are other patients—women who cannot afford this individual care, but who need care none the less. And it is these expectant mothers that nurses are helping the doctors to instruct in the principles of right living, and are watching for danger signs, through visiting nurse societies, out-patient departments of hospitals and through prenatal clinics.

The character and extent of the instruction and supervision given by the nurses is, of course, decided by the medical board of her organization, and is often affected by the conditions under which the work is conducted. The nurses in a rural community, for example, may take blood pressures and test urine for albumen, while in cities, rich in doctors and medical institutions, these observations might not be among their duties.

In addition to this definite relation to expectant mothers, nurses are meeting them, unofficially and informally, at every turn; women who are needing, but not receiving, care from a doctor or an organization; women who are puzzled or troubled over their condition, but do not know where nor how to obtain advice; women who could employ a physician but do not appreciate the importance of his care.