The Prospective Mother, a Handbook for Women During Pregnancy

by J. Morris Slemons

The best time of day to have massage is in the morning, at least an hour after breakfast. The duration of the treatment will depend upon the patient; it should always cease as soon as she begins to feel tired. After one has become accustomed to it, massage may generally be continued for an hour. The room in which it is given should be cool, and after the treatment has been completed the patient should be wrapped warmly and left undisturbed for half an hour.

Gymnastics, like massage, are useless to those who can enjoy outdoor exercise. Walking more perfectly strengthens the muscles which take part in the act of birth than any system of "home calisthenics" that has been suggested. In some conditions which make walking inadvisable the use of calisthenics will be helpful. These exercises generally consist in breathing movements and in movements of the extremities, especially the legs, which bring into play the same abdominal muscles that are used at the time of delivery. A detailed description of the exercises is here purposely omitted, since gymnastics should not be used unless advised by a physician, who should watch their effect and thus be guided as to whether the patient should continue them.

THE INFLUENCE OF WORK UPON PREGNANCY.—No single influence is more unfavorable to comfort and health during pregnancy than is idleness, so that every prospective should occupy herself with congenial work and fitting diversions. The kind of occupation makes no essential difference, so long as it does not overtire either the body or the mind. Since most women are absorbed in the affairs of the home, it may be well to begin by saying that the existence of pregnancy by no means requires the abandonment of domestic duties. On the contrary, when it is convenient, the prospective mother should have a share in the housework. She should not undertake everything that is to be done about the house, for no matter how small the household there are certain duties too laborious for her to attempt; these will be easily recognized and turned over to someone else. Even with regard to those tasks which lie within her strength she should use a little forethought to prevent unnecessary steps.

All kinds of violent exertion should be avoided—a rule which at once excludes sweeping, scrubbing, laundry work, lifting anything that is heavy, and going up and down stairs hurriedly or frequently. The use of a sewing machine is also emphatically forbidden. Treadle work is known to be one cause of swollen feet, of varicose veins, and of aches and pains in the legs or the abdomen. If a prospective mother has to do her own sewing, the machine should be fitted with a hand attachment or motor. Except for the possibility of straining the eyes, there is no objection to sewing by hand.

Besides the activities that should be excluded because they may be harmful, every housekeeper will find enough to keep her busy. It is generally not a small task to suggest what others shall do and to see that orders are properly carried out; consequently those who take no part in the actual work may retain an absorbing interest in their domestic affairs by directing them. Such direction, indeed, should, toward the end of pregnancy, constitute the mother's sole participation in the housework.

In a general way the amount and the kind of work that a woman may be permitted to undertake during pregnancy depend upon what she has been used to. It is not unlikely that anyone who is unaccustomed to manual labor may injure her health and cause the pregnancy to end prematurely if she undertakes hard work. On the other hand, women of the working classes sometimes continue at their occupations to the natural end of pregnancy without harmful consequences. It is undeniable, however, that among this class miscarriages are more frequent than among the well-to-do. Furthermore, the average birth- weight of mature infants whose mothers have remained at work during the last three months of pregnancy is ten per cent. less than the average birth-weight of infants among the leisure class. This matter of the baby's weight is not always serious in itself, but indicates in the case of working women who are pregnant the existence of a strain that sometimes leads to serious accidents.

The employment of women during pregnancy and immediately thereafter is regulated by law in many countries. For example, the laws of Holland, Belgium, England, Portugal, and Austria prohibit the employment of women in factories during the last four weeks of pregnancy or the four weeks following childbirth. Such employment is unlawful in Switzerland for two weeks before and six weeks after childbirth. There is no legal regulation of the employment of pregnant women in either Germany or Norway, but the laws of both countries forbid them to return to work until six weeks after they have been delivered. Among civilized nations Turkey, Russia, Spain, Italy, France, and the United States make no attempt to regulate employment either before or after childbirth.

Of course there are strong sentimental reasons for relieving prospective mothers of the necessity of earning a living, but there are also excellent hygienic reasons against many kinds of employment. For example, it should be unlawful to employ them in chemical industries where, owing to their condition, they are especially liable to be injured by the materials which they handle. Jacobi states that the worst occupation for pregnant women is working with metals, in particular lead; more than half of them suffer miscarriage or premature confinement. Furthermore, the health of the child may be endangered if the prospective mother does hard work of any kind. This is true chiefly because she does not have appropriate intervals of relaxation, for it is a firmly established principle that a prospective mother must be free to rest the moment she begins to feel tired. The least, therefore, that can be done to better prevalent conditions among women who must work during pregnancy is to require by law a reduction in the number of their working hours, and to protect them from the necessity of earning a living for two months after they have been delivered.

RELAXATION AND REST.—During the early months of pregnancy many women complain that they feel enervated, and tire quickly even when they do things which were formerly done with ease; this experience is so common that it can scarcely be considered other than natural. Curiously enough this is also the period during which the attachment of the ovum to the womb is relatively insecure, and therefore the inclination to be quiet is justified by the prevailing anatomical conditions. No prospective mother should struggle against the inclination to rest; she should yield to it in spite of the advice to the contrary which older women are apt to give. Furthermore, it is especially important about the time when a menstrual period would ordinarily be expected to be guided by this impulse not to be active, since overexertion then, more than at other times, is apt to be followed by miscarriage. Except in rare cases the observance of this precaution is less urgent after the fourth month, when the ovum has become more securely attached to the womb. But again, toward the end of pregnancy the development of the mother's body necessitates a comparatively large amount of rest; patients who continue to exert themselves may expect to suffer from shortness of breath and a number of other annoyances.

In order to save needless steps and to avoid confusion and worry, it is always helpful to map out beforehand what must be done in the course of the day. Ideally, such a schedule should set apart intervals for relaxation and rest. In the morning, for example, while the housework is in progress, it is important to stop occasionally, if only for a few moments, and lie down on a couch. After the midday meal it is advisable to undress and go to bed. Even though one does not fall asleep, an hour or two of complete relaxation will be beneficial. A nap in the afternoon does not interfere with sleeping at night provided plenty of exercise has been taken during the day. In this way walking in the late afternoon or early evening helps to secure a good night's rest.