We seem to get back to the principles of personal hygiene as preventives of nausea during pregnancy, for simple, light food, taken in small quantities five or six times daily, eaten slowly and masticated thoroughly; the cultivation of a happy frame of mind; exercise and fresh air all tend to avert this very uncomfortable condition. Its prevention is of great importance, as the habit of vomiting is easily acquired but broken with difficulty. The common causes of nausea, and their prevention, should therefore be explained to the average patient, for she will then be able to help herself in warding it off.
Should “morning sickness” occur, however, it may be relieved in many cases, by eating two or three hard, unsweetened crackers or pieces of toast, with nothing to drink, immediately upon awakening and then lying still afterwards for half or three quarters of an hour. The sufferer should then dress slowly, sitting down as much as possible while doing so, and eat her regular breakfast. Lying flat, without a pillow, and keeping very quiet for a little while after meals, or whenever feeling the slightest premonitory symptom, will frequently prevent, and also relieve nausea, and sometimes comfort is derived from the use of either hot or cold applications to the abdomen. Some patients are relieved by having hot coffee or even a full breakfast before arising.
Heartburn, so called, which is experienced by many pregnant women, has nothing to do with the heart. It is caused solely by an excess of hydrochloric acid in the stomach, and is usually described as a burning sensation first in the stomach, then rising into the throat. It may be prevented, as a rule, by taking a tablespoonful of olive oil, or a cupful of cream or rich milk, fifteen or twenty minutes before meals, and avoiding fat and fried food at the meals immediately following.
This apparent inconsistency in treatment is due to the facts that fat taken into the empty stomach tends to inhibit the secretion of acid, while fat and fatty foods taken with meals tend to prolong their stay in the stomach and this in turn stimulates the secretion of hydrochloric acid, the thing to be avoided.
A patient with a tendency to heartburn will be wise, therefore, if she generally eliminates oils, fats and fatty foods from her meals, and definitely avoids them when the burning occurs. Since the painful, burning sensation is directly due to an excess of acid in the stomach, the obvious step toward relief is to take an alkali at once. A tablespoonful of lime-water is often satisfactory; a teaspoonful of sodium bicarbonate in water; a small piece of magnesium carbonate may be nibbled by itself, or any alkaline water that the patient fancies may be taken.
Distress. There is another form of discomfort, often vague and ill-defined, commonly called “distress” and occurring after eating. It may be neither heartburn nor pain, but resemble both and make the patient very miserable. It is usually seen in women who eat rapidly, do not chew their food thoroughly or eat more at one time than the stomach can hold comfortably. The prevention, naturally, lies in taking small amounts of food slowly and masticating thoroughly.
Flatulence may or may not be associated with heartburn, but it is fairly common and rather uncomfortable. It is usually due to bacterial action in the intestines, which results in the formation of gas. As has been previously explained, the pressure of the enlarged uterus upon the intestines and absence of pressure by the abdominal muscles, retards normal peristalsis, with the result that gas sometimes accumulates to a very uncomfortable extent. It is clear, therefore, that a daily bowel movement is of prime importance in preventing and relieving flatulence, and also that foods which form gas should be carefully excluded from the diet. The chief offenders are parsnips, beans, corn, fried foods, sweets of all kinds, pastry and very sweet desserts. Various intestinal disinfectants are employed, as in non-pregnant states, and also yeast cakes, cultures of Bulgarian bacilli and artificially fermented milk containing bacteria that are antagonistic to the gas-producing forms.
In the opinion of some doctors, flatulence is sometimes an early symptom of toxemia.
Diarrhea. Although diarrhea is not one of the commonest disturbances of pregnancy, neither is it infrequent, and must be borne in mind in connection with digestive troubles. Of course, a pregnant woman may have an attack of diarrhea from the same causes that produce it in any one else, and its relief would be obtained by the usual methods, chiefly the correction of dietetic errors. But on the other hand, it may be due entirely to the uterine pressure on irritable intestines. Like flatulence, it is regarded by some doctors as a possible symptom of toxemia.
Pressure Symptoms. Under the general heading of pressure symptoms are several forms of discomfort resulting from pressure of the enlarged uterus on the veins returning from the lower part of the body, thus interfering with the flow of blood back to the heart. As both the cause and relief of these symptoms are associated with the force of gravity, the nurse will usually know what to do in mild cases without further explanation. In general the heavy abdomen should be supported by a binder or properly fitting corset, the patient should keep off her feet as much as possible and elevate the swollen part.