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

Just here it may be helpful to have a word about what is meant by “conflict” and the “mechanism” which produces it. As a starting point there must be a recognition of the fact that the deepest and most influential feminine instinct is maternal—the desire to have and care for a child. It is primal. It has been in women since the dawn of Creation and although in many women it is put down, stifled or complicated by other desires, it cannot be destroyed. Not a few women deny this instinct, but back of their denial is some reason, conscious or unconscious, which is not harmonious with the idea of motherhood. The woman may be selfish, for example; she may be vain and not want to lose her grace and charm through pregnancy.

When some such feeling is strong it conflicts with the deeper one of maternalism and there is a lack of harmony or a “conflict.” It is just that—a conflict or struggle between two emotions and the result is a state of mental unrest. A homely comparison might be found in the digestive disturbance which may follow an effort to cope with two incompatible articles of food at the same time. The patient may have nausea, vomiting, pain or even more severe symptoms. The severity of the symptoms and their effect upon the patient depend somewhat upon the average vigor or stability ordinarily displayed by the digestive tract under a lesser strain. People with so-called delicate digestions may be greatly upset by combinations of food which others are able to cope with and suffer little or no inconvenience.

When a well evolved individual has a desire which results from our culture or civilization (a wish to preserve her grace or her luxuries, for example), that is in conflict with a deeper primal instinct, she will often be able to reason out the situation, and in the case of approaching motherhood, decide that the baby is worth any sacrifice, any inconvenience, and go joyfully through her period of expectancy. She will glory in the consciousness of her ability to realize the supreme purpose of a woman’s creation. In other words she adjusts herself to the situation, harmonizes the discordant desires and is mentally undisturbed.

A less well evolved woman, like a person with a delicate, easily upset digestive tract, will have difficulty in making an adjustment—in harmonizing her instinctive desire for motherhood and her acquired desire for comfort, attention and the things demanded by convention. The conflict may be violent enough to greatly upset her. This is particularly true if the demands of our cultural state make it necessary for the patient to keep this turmoil below the surface with no safety valve to relieve the pressure.

This problem of the mother’s attitude toward the coming of the baby is very general and varied as well. The mothers of families already large and poverty stricken are usually quite frank in expressing their dismay over the expected birth and lament the prospect of this extra burden, but at the same time they decide to make the best of it and they succeed in making a pretty satisfactory adjustment. Moreover, they do not feel the necessity for concealing their feelings or do not “repress” them, and accordingly find some relief in being candid.

The mothers of the middle and upper classes, however, are often surrounded by an atmosphere of conventional codes that are stifling to mental honesty. Accordingly they are less genuine in expressing their true attitude toward the coming child. To many of them—the selfish, self-centered type—the new baby will bring inconvenience rather than hardship. The importance of their ego will be dimmed. There will be a cutting down of luxuries and of freedom for social activities, and increased responsibility with closer confinement to the home. And while they give utterance to joy and pleasure over the prospect of having a baby, this does not quite reflect their inmost feelings.

Not a few women find an outlet for the tension caused by their conflict by being fretful and irritable or through conduct which they would have displayed if annoyed or chagrined about something other than the approaching birth of a child. Because of this outlet they are not so likely to break down.

It is by no means the rôle of the nurse to pry into the affairs of her patients, but she can often become the avenue of ventilation for a patient suffering from a mental conflict, and with very happy results. For one of the most helpful things that such a person can do is to talk, and little by little bring out and put into words the buried thoughts, dreads or shame that may be causing the conflict. Very often the listener will say surprisingly little and will express no definite opinions, but by a sympathetic, responsive attitude encourage the worried person to pour out the content of her mind.

Another source of unrest in the mind of the expectant mother, especially during her first pregnancy, is the fear of death during labor, or the development of complications. She is reluctant to speak of these things to her husband, family or friends, lest they laugh at her or regard her as a coward at the prospect of pain. Or she may be unwilling to distress those who love her by admitting her fear.

Fear of death and disease are very common traits and equally common is the hesitancy we all have in acknowledging them. And so the patient keeps these things to herself and turns them over and over in her mind; buries them and tries to put them out of her thoughts. But they stick. Her fear and her dread color everything that she hears, and very often and unwittingly her friends and relatives make matters worse by recounting the unhappy experiences of other mothers that they have known. At the same time these communicative friends do not tell of the immeasurably greater number of women who have come through safely, nor does the patient dwell upon these in her mind. She remembers the women who had convulsions or fever or a hemorrhage, or the one who died.