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

The nurse who sees the human being beyond the obstetrical case will appreciate the pain which such a conflict causes and by being sympathetic and responsive will try to make it easy for her patient to talk it over. The patient should invariably find her nurse ready to listen and to give assurances of the proved value of the precautions that are being taken to safeguard her and her baby. For not a few women are torn, not alone by the fear that things will go wrong with themselves, but with the fear that harm may come to the baby that they long to take into their arms and keep.

Other women are upset because of a habitual inability to make decisions that will bring about a marked change in their lives. They find it difficult to accept pregnancy because its consummation will definitely alter their state. Life may prove to be more satisfactory because of the baby, or it may be less so. But in any event it cannot be the same and they dread making an irrevokable change.

Still another cause of distress is the current belief as to hereditary influence, and the possible effect upon the unborn child of unsuccessful attempts at abortion which the patient has made early in her pregnancy. Every family has its skeleton of a relative who is “queer,” feeble-minded, epileptic or who has died in a sanitarium or state hospital for the insane. The fear that the child may “strike back” to one of these individuals, and suffer retardation in his mental development, often amounts to little less than an obsession.

The nurse may often dispel such an anxiety by drawing upon even her slender knowledge of embryology and reassure her patient that we know very little about inheritance, but that the evidence is that environment and early training are such important determining factors, that a child is more likely to be affected by the example and guidance of his parents during his first few years than through transmission from their blood.

Attempted abortions during the early months of pregnancy are more common than is generally supposed. Of their effect upon the offspring we know very little. We do know, however, that an attempt to produce an abortion often gives rise to a good deal of secret worry on the part of the expectant mother. It is the nucleus of many a vague depression during pregnancy, not only because of remorse over wrong-doing, but also because of fear that the child who is coming, in spite of the attempt to destroy him, may suffer the consequences. This is another of the anxieties which the patient can seldom bring herself to discuss with her family or even with her physician. But it so occupies her mind that she may allude to it, in a roundabout way, to the nurse who becomes her constant companion, as though describing the act of a friend. The nurse who reads between the lines may often relieve a serious tension caused in this way by discussing the matter casually and impersonally. Above all she must not assume an attitude of disapproval, for it is not within her province to go into the ethics or morality of the act. Her function at this time is solely to give the patient an opportunity to ventilate her thoughts.

Another real cause of worry during pregnancy is the patient’s fear of her own inadequacy to care for and to rear a child in the best possible manner. The idea of assuming the physical care and the moral guidance of another human being is often little less than terrifying to a young woman whose responsibilities in the past have been shared or carried by some one else. Or to the one who has gone through life hunting for, and exaggerating, the difficulties in a situation, before attempting to meet it; and perhaps to the one who is habitually conscientious in all of her relations with other people.

Still another type, and one which presents a much simpler situation, is the expectant or young mother who is scarcely suffering from a mental strain, but has a little let-down in her customary poise and self-control, such as we so often see in convalescents and chronic invalids.

Pregnancy, labor, and the puerperium are normal physiological processes, it is true, but they impose a physical tax and the patient is sometimes physically tired and after labor may suffer something akin to surgical shock.

The physical weariness may be due to an insufficiency on the part of some one of the internal secretions. But in any event the patient feels tired and may show the same sensitiveness or irritability that any of us show when tired and exhausted and she will merit considerable forbearance on the part of those who surround her.

But when we understand, even faintly, the conflicts which are possible in the mental life of the expectant mother—the incompatibility of her age-old maternal instinct and the desires born of our culture and civilization, it is not difficult to see that her adaptive capacity may be sorely tested.