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

Rest and Sleep. When we studied the bony structures of the female body, we found that as the abdominal tumor of pregnancy increased in size and weight, the body’s centre of gravity changed and the pregnant woman was required to make a constant, though unconscious effort to stand upright. This is probably one reason for the fatigue which expectant mothers so often feel without apparent cause, and for the fact that they are likely to tire rather more easily than usual.

Accordingly, the patient may have to rest frequently during the day, in order to avoid the ill effects of fatigue. She should work and exercise in short periods rather than long, always lying down when tired, and for an hour or two after the noon meal. She must be particularly careful not to be over-active, nor to overexert herself at the time when menstruation would occur were she not pregnant, for fear of bringing on an abortion. This precaution is particularly important during the first four months, the period when abortions occur most frequently.

Since eight hours’ sleep is usually considered necessary to keep the average person in good condition, the pregnant woman cannot expect to progress satisfactorily with less. In fact, it is so important to her general well-being that she should be taught and persuaded to do everything in her power to secure it.

Fresh air during the day and open windows at night; prudent eating; a comfortable bed furnished with warm but light bedding; warm baths; a hot water bag to the feet and a hot drink upon retiring are all conducive to sleep.

But in addition to these, and perhaps of even more import, are cheerfulness and a tranquil, untroubled state of mind. It is well for the nurse to make a mental note of that intangible but influential fact, for she can usually exert a great deal of influence in shaping her patient’s or patients’ moods.

Breasts.—Breast feeding is the most urgent single need of the baby, for whose coming we are making preparation, and practically every mother, excepting those with definite physical disability, can supply this need of her baby’s, if she gives herself proper care both before and after its birth. It is true, that everything that promotes her general health helps to prepare her to nurse the baby, but there is need also for care of the breasts and nipples themselves, to make the nursing satisfactory, and to prevent sore nipples and possibly even breast abscesses.

Briefly, this local care consists of supporting heavy breasts, but avoiding pressure; bringing out flat or retracted nipples and toughening the skin which covers the nipples.

After they become heavy and uncomfortable the breasts may be supported by brassieres, which are snug below the breasts, loose over the breasts themselves and suspended from shoulder straps; or by some such binder as is shown in Figs. [34], [35], and [36], which answers the same purpose.

If the patient’s nipples are flat or retracted, she should begin about the fifth month to make them more prominent in order that the baby may grasp them easily. There are several ways of accomplishing this, all of them in the nature of massage, but whatever is done must be done regularly and persistently. One simple and effective method is to grasp the nipple between the thumb and forefinger, draw it out, hold it for a moment, then release it and allow it to retract. This should be done over and over, two or three times daily. Or the unstoppered opening of a warm bottle may be placed over a flat nipple and held in place until the nipple is drawn up into the neck of the bottle as it cools and forms a vacuum.

The toughening of the nipples should be begun eight weeks before the baby is expected. There are two general methods which seem to give about equally satisfactory results; one is to harden the skin with astringents and the other is to soften it with ointments. In either case, the nipples should first be scrubbed gently with a soft brush or cloth, warm water and soap, for about five minutes night and morning. They may then be rubbed with lanoline, cocoa-butter or vaseline and covered with a piece of clean soft cloth or gauze, to protect the clothing; or they may be bathed with a wash consisting of equal parts of a saturated solution of boracic acid and 95% grain alcohol. Tannin, benzoin and a great variety of astringents are also used, and with satisfactory results. But the essential is to decide upon some method of preparation, of proved value, and then persuade the patient to employ it with faithful regularity.