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

Skin. Under ordinary conditions, the skin serves as a protective covering for the body, helps to regulate the body temperature and acts constantly as an excretory organ. This last function is performed by the sweat glands which open upon the surface of the body, and we are told that there are some twenty-eight miles of these minute, tube-like structures in the skin. These glands should be, and usually are, constantly active and they daily pour upon the surface of the body an oily substance that lubricates the skin and something over a pint of water containing waste matter, that is inimical to health if retained in the body. We are not aware of this constant excretion of fluids, which, therefore, is termed “insensible perspiration,” but it continues even in cold weather and must not be interrupted if health is to be preserved. If the oil, dust, particles of dead skin and the waste material left by dried perspiration are allowed to remain upon the surface of the body, they will clog the pores and gland openings and thus interfere with their functions. The removal of this material, then, is an imperative health measure. This is done automatically, in part, for the fluid evaporates, and much of the solid matter is rubbed off on the clothing. But the most important aids to the skin’s activity are the drinking of plenty of water, deep breathing, exercise and warm baths; baths serving the double purpose of removing waste matter already on the surface, and stimulating the glands to increased activity in giving off still more.

This explains the importance to the expectant mother of thorough and regular bathing, and of keeping her body evenly warm. Most doctors advise a warm, not hot, shower or tub bath every day, with soap used freely over the entire body, followed by a brisk rub. The best time for this warm, cleansing bath, as a rule, is just before retiring, as it is soothing and restful and tends to induce sleep. Very hot baths are fatiguing, particularly during pregnancy, and should never be taken except with the doctor’s permission; but cold baths usually may be continued throughout pregnancy if the patient is accustomed to them and reacts well afterwards. Under these conditions the morning cold plunge, shower or sponge is beneficial, as it stimulates the circulation and thus promotes the activity of the skin. Some doctors forbid tub bathing of any kind after the seventh month, on the ground that as the patient sits in the tub her vagina is filled with water, which may contain infective material. Should labor occur shortly afterward an infection might result. As the patient is heavy and somewhat uncertain on her feet, there is also the danger of her slipping and falling while getting in or out of the tub.

Other doctors permit tub baths throughout pregnancy, up until the onset of labor; while as to hot foot baths, there seems to be no reason for or against them at any time during the nine months.

Bathing in a quiet stream or lake is apparently harmless, but sea bathing, if the surf is rough, is inadvisable because of the impact of the waves upon the abdomen and the general violence of the exercise.

The importance of keeping the body evenly warm throughout pregnancy cannot be overemphasized, for a sudden chilling or wetting may so check the excretory function of the skin as to throw a greater burden upon the kidneys than they can meet, in their effort to eliminate the skin’s share of the body waste. Accordingly, a single chilling will sometimes be enough to precipitate an eclamptic seizure. This may be one reason why we see eclampsia more frequently during cold weather or after a sudden drop in the temperature after warm or mild days.

Bowels. The bowels, also, eliminate a certain amount of toxic material and if they do not move thoroughly at least once a day, deleterious substances are absorbed into the system and an extra tax is placed upon the kidneys in an attempt to excrete them.

Unhappily, a large proportion of pregnant women suffer from constipation, particularly during the later weeks, though women who have always had a tendency of this kind may have trouble from the very beginning of pregnancy. Sluggish peristalsis, due to pressure by the enlarged uterus upon the intestines, is probably the prime cause, though impaired tone of the stretched abdominal muscles also may be a factor.

The bowels should move regularly every day, and to this end the patient should regularly attempt to empty them, immediately after breakfast usually being the best time. The importance of regularity in making the attempt cannot be overemphasized, even though the bowels do not always move.

Exercise, the intake of an abundance of fluids, eating fresh fruit, coarse vegetables and bulky cereals, such as bran, to stimulate peristalsis, and drinking a glass of hot or cold water upon retiring and arising are all laxative in their effect. As the regular use of enemata only tends to lessen intestinal tone, they should not be employed unless ordered by the doctor; nor should the patient take cathartics without the doctor’s order. But she may safely increase the amount of her fluids and the bulk of her food, in order to regulate her bowels, and may also take senna and prunes cooked together. A simple way of preparing prunes for this purpose is to pour a quart of boiling water over an ounce of senna leaves and allow it to stand for about two hours. A pound of well washed prunes should soak over-night in this infusion, which has been strained, and the combination cooked until tender. They may be sweetened with two tablespoons of brown sugar, and the flavor improved by adding a stick of cinnamon or slice of lemon while they are cooking. Half a dozen of these prunes, with some of the syrup, may be taken at the evening meal to start with, and increased or decreased in number as necessary.

Clothes. The chief purpose of clothes under all conditions is to aid in keeping the body warm, thus helping to preserve an even circulation and the activity of the sweat glands. As has been pointed out, this is of especial importance during pregnancy. The expectant mother’s clothes should be not only sufficiently warm, but they should be equally warm over the entire body. They should be light and porous, and fairly loose, so as not to interfere with the circulation or other body functions. There must be no pressure on chest or abdomen; no tight garters, belts, collars or shoes.