"Solicitude for children is one of the signs of a growing civilization. To cure is the voice of the past; to prevent, the divine whisper of to-day."Kate Douglas Wiggin.
"Solicitude for children is one of the signs of a growing civilization. To cure is the voice of the past; to prevent, the divine whisper of to-day."
Kate Douglas Wiggin.
The Birth Chamber—What to Provide for a Confinement—Ready to Purchase Obstetrical Outfits—Position and Arrangement of the Bed—How to Properly Prepare the Accouchment Bed—The Kelly Pad—The Advantages of the Kelly Pad—Should a Binder Be Used?—Sanitary Napkins—How to Calculate the Probable Date of the Confinement—Obstetrical Table—When Should a Pregnant Woman First Call Upon Her Physician—Regarding the Choice of a Physician—How to Know the Right Kind of a Physician for a Confinement—The Selection of a Nurse—The Difference Between a Trained and a Maternity Nurse—Duties of a Confinement Nurse—The Requisites of a Good Confinement Nurse—The Personal Rights of a Confinement Nurse—Criticizing and Gossiping About Physicians.
The Birth Chamber—What to Provide for a Confinement—Ready to Purchase Obstetrical Outfits—Position and Arrangement of the Bed—How to Properly Prepare the Accouchment Bed—The Kelly Pad—The Advantages of the Kelly Pad—Should a Binder Be Used?—Sanitary Napkins—How to Calculate the Probable Date of the Confinement—Obstetrical Table—When Should a Pregnant Woman First Call Upon Her Physician—Regarding the Choice of a Physician—How to Know the Right Kind of a Physician for a Confinement—The Selection of a Nurse—The Difference Between a Trained and a Maternity Nurse—Duties of a Confinement Nurse—The Requisites of a Good Confinement Nurse—The Personal Rights of a Confinement Nurse—Criticizing and Gossiping About Physicians.
The room in which the confinement is to take place should be selected with care. In many cases there will be no choice for the reason that there will be only one suitable bedroom available. Where practicable however a room having the following accessories, or as many of them as is possible, should be given the preference.
1.—Good light, and a southern exposure.2.—Capable of being well ventilated and well heated if necessary.3.—Running water if plumbing is modern.4.—Fairly large size (not a hallroom).5.—A quiet room, free from street noises.
1.—Good light, and a southern exposure.
2.—Capable of being well ventilated and well heated if necessary.
3.—Running water if plumbing is modern.
4.—Fairly large size (not a hallroom).
5.—A quiet room, free from street noises.
If the house is a private one the room should be on the second floor. If the home is in an apartment housethe confinement chamber should be as far removed from the living-room as circumstances will permit,—especially if there are other children who will make more or less continuous noise.
All unnecessary furniture, pictures and draperies should be taken out of the room a few days before the confinement is due; the room itself, and everything left in it, should be thoroughly cleaned and aired. A small table for holding instruments, sterilizing basins, etc., should be provided and in readiness.
What to Provide For a Confinement.—The following articles should be in readiness at all confinements:—
1.—Douche pan.2.—Bed pan.3.—Douche bag (fountain syringe) with glass douche tube.4.—One rubber sheet 1½ yards square.5.—Two bed pads, one yard square, made of absorbent cotton or old clean cloths, covered with washed cheese cloth and stitched here and there to hold in place.6.—One dozen clean towels.7.—One-half dozen clean sheets.8.—A hot water bottle.9.—One pound absorbent cotton (good quality).10.—Five yards sterile gauze.11.—Four quarts of hot, and as much cold water, that has been boiled.12.—One-half dozen papers assorted safety pins.13.—One box sanitary pads.14.—Four pieces of unbleached cotton or muslin, one and one-quarter yards long.15.—Four ounces powdered boracic acid.16.—Four ounces of brandy or whisky.17.—One jar of white vaseline (unopened).18.—One cake of castile soap.19.—Two or three agate or china hand basins.20.—One slop jar.21.—One pan under bed for after birth.
1.—Douche pan.
2.—Bed pan.
3.—Douche bag (fountain syringe) with glass douche tube.
4.—One rubber sheet 1½ yards square.
5.—Two bed pads, one yard square, made of absorbent cotton or old clean cloths, covered with washed cheese cloth and stitched here and there to hold in place.
6.—One dozen clean towels.
7.—One-half dozen clean sheets.
8.—A hot water bottle.
9.—One pound absorbent cotton (good quality).
10.—Five yards sterile gauze.
11.—Four quarts of hot, and as much cold water, that has been boiled.
12.—One-half dozen papers assorted safety pins.
13.—One box sanitary pads.
14.—Four pieces of unbleached cotton or muslin, one and one-quarter yards long.
15.—Four ounces powdered boracic acid.
16.—Four ounces of brandy or whisky.
17.—One jar of white vaseline (unopened).
18.—One cake of castile soap.
19.—Two or three agate or china hand basins.
20.—One slop jar.
21.—One pan under bed for after birth.
The physician will direct that certain additional articles be provided according to his individual taste andcustom. These will include an antiseptic and ergot; any other requisite found necessary can be sent for, or the physician can supply it, as he invariably has in his bag whatever may be required in complicated cases or in an emergency. All the items enumerated in the above list are absolutely essential, they may not all be used but it would not be safe to undertake a confinement without providing the essential requisites. Many maternity outfits are prepared ready for use and can be obtained at the larger drug stores, costing from $10 to $25. The articles in the above list can be bought for about $6, not including those articles which the patient is assumed to have. The following are samples of the ready-to-purchase outfits:
OUTFIT NO. 11 Sterilized Bed Pad (30 inches square).2 dozen Sterilized Vulva Pads.2 Sterilized Mull Binders (18 inches wide).5 yards Sterilized Gauze.1 pound Sterilized Absorbent Cotton (½ pound).Rubber Sheet, 1½ yards by 2 yards, Sterilized.Douche Pan, Sterilized.1 Tube K-Y Lubricating Jelly.Sterilized Nail Brush.Boric Acid, Powdered.Tinct. Green Soap.Bichloride Tablets.Lysol.Tube Sterilized Tape.PRICE $10.00.OUTFIT NO. 2.2 Sterilized Bed Pads (30 inches square).2 dozen Sterilized Vulva Pads.2 Sterilized Mull Binders (18 inches wide).6 Sterilized Towels.10 yards Sterilized Gauze.1 pound Sterilized Absorbent Cotton (½ pound).Rubber Sheet, 1 yard by 1½ yards, Sterilized.Rubber Sheet, 1½ yards by 2 yards, Sterilized.4 quart Sterilized Douche Bag with glass nozzle.Douche Pan, Sterilized.Sterilized Nail Brush.2 Agate Basins, Sterilized.Safety Pins.2 Tubes Sterilized Petrolatum.1 Tube K-Y Lubricating Jelly.Boric Acid, Powdered.100 grms. Chloroform (Squibb's).Fl. Ext. Ergot.Tinct. Green Soap.Bichloride Tablets.Lysol.Tube Sterilized Tape.Sterilized Soft Rubber Catheter.Sterilized Glass Catheter.Stocking Drawers, Sterilized.Talcum Powder.Bath Thermometer.PRICE $19.50.
OUTFIT NO. 11 Sterilized Bed Pad (30 inches square).2 dozen Sterilized Vulva Pads.2 Sterilized Mull Binders (18 inches wide).5 yards Sterilized Gauze.1 pound Sterilized Absorbent Cotton (½ pound).Rubber Sheet, 1½ yards by 2 yards, Sterilized.Douche Pan, Sterilized.1 Tube K-Y Lubricating Jelly.Sterilized Nail Brush.Boric Acid, Powdered.Tinct. Green Soap.Bichloride Tablets.Lysol.Tube Sterilized Tape.PRICE $10.00.
OUTFIT NO. 1
1 Sterilized Bed Pad (30 inches square).
2 dozen Sterilized Vulva Pads.
2 Sterilized Mull Binders (18 inches wide).
5 yards Sterilized Gauze.
1 pound Sterilized Absorbent Cotton (½ pound).
Rubber Sheet, 1½ yards by 2 yards, Sterilized.
Douche Pan, Sterilized.
1 Tube K-Y Lubricating Jelly.
Sterilized Nail Brush.
Boric Acid, Powdered.
Tinct. Green Soap.
Bichloride Tablets.
Lysol.
Tube Sterilized Tape.
PRICE $10.00.
OUTFIT NO. 2.2 Sterilized Bed Pads (30 inches square).2 dozen Sterilized Vulva Pads.2 Sterilized Mull Binders (18 inches wide).6 Sterilized Towels.10 yards Sterilized Gauze.1 pound Sterilized Absorbent Cotton (½ pound).Rubber Sheet, 1 yard by 1½ yards, Sterilized.Rubber Sheet, 1½ yards by 2 yards, Sterilized.4 quart Sterilized Douche Bag with glass nozzle.Douche Pan, Sterilized.Sterilized Nail Brush.2 Agate Basins, Sterilized.Safety Pins.2 Tubes Sterilized Petrolatum.1 Tube K-Y Lubricating Jelly.Boric Acid, Powdered.100 grms. Chloroform (Squibb's).Fl. Ext. Ergot.Tinct. Green Soap.Bichloride Tablets.Lysol.Tube Sterilized Tape.Sterilized Soft Rubber Catheter.Sterilized Glass Catheter.Stocking Drawers, Sterilized.Talcum Powder.Bath Thermometer.PRICE $19.50.
OUTFIT NO. 2.
2 Sterilized Bed Pads (30 inches square).
2 dozen Sterilized Vulva Pads.
2 Sterilized Mull Binders (18 inches wide).
6 Sterilized Towels.
10 yards Sterilized Gauze.
1 pound Sterilized Absorbent Cotton (½ pound).
Rubber Sheet, 1 yard by 1½ yards, Sterilized.
Rubber Sheet, 1½ yards by 2 yards, Sterilized.
4 quart Sterilized Douche Bag with glass nozzle.
Douche Pan, Sterilized.
Sterilized Nail Brush.
2 Agate Basins, Sterilized.
Safety Pins.
2 Tubes Sterilized Petrolatum.
1 Tube K-Y Lubricating Jelly.
Boric Acid, Powdered.
100 grms. Chloroform (Squibb's).
Fl. Ext. Ergot.
Tinct. Green Soap.
Bichloride Tablets.
Lysol.
Tube Sterilized Tape.
Sterilized Soft Rubber Catheter.
Sterilized Glass Catheter.
Stocking Drawers, Sterilized.
Talcum Powder.
Bath Thermometer.
PRICE $19.50.
These materials, being cleansed and sterilized, are ready for use at any time.
These complete outfits are packed in neat boxes, thus enabling the contents to be kept intact until needed.
The Position and Arrangement of the Bed.—The bed should be a substantial single bed. If a double one is used, prepare the side for the confinement which will permit the physician to use his right hand,—that will be the right side of the patient as she lies in bed. One objection to a double bed is its tendency to sag. This tendency can be obviated however by placing an ironing board under the spring from side to side, or by using shelves from a book case. This expedient will support the mattress, thereby rendering the bed firm and free from any sagging tendency. The position of the bed in the room should be such that the patient will not directly face the window light, nor be in a direct draughtbetween the window and the door. It should be so arranged that the nurse can get easily to either side, consequently it must not be pushed against the wall.
How to Prepare the Accouchment Bed.—Over the mattress place the rubber sheet so that its center will be exactly under the hips of the patient. Pin with large safety pins each corner of the rubber sheet to the mattress; now put the sheet on exactly as you do when making an ordinary bed. On top of the sheet, and in the middle of the bed (again where the patient's hips will rest), place a draw sheet. A draw sheet is a sheet folded once, placed across the bed, and pinned tightly with large safety pins to the mattress at each side. The advantage of this sheet is, that it can be removed when necessary, leaving the original clean sheet on the bed, without disturbing the patient. Be particular not to have the top of the draw sheet higher than the middle of the patient's back. Place the pad,—previously prepared for the purpose,—on the draw sheet and level with the top of the draw sheet.
Most physicians carry with them to all confinements aKelly pad. A Kelly pad is a rubber pad with inflated sides, which is put under the patient's hips, and which retains all the discharges incident to aconfinementso that when it is removed the bed is clean and fresh. The advantage of the Kellypadis twofold; first, it ensures a clean, compact, systematic confinement; second, its use subjects the patient to the least necessary movement at a time when movement is distressing, painful, and frequently dangerous. If a Kelly pad is not used, it is desirable to place under the pad (between the pad and the draw sheet) a piece of oil cloth or rubber sheeting, or a number of newspapers will do. This will prevent, to a considerable degree, the discharges from soaking through the pad on to the draw sheet and sheet and mattress below.
After the confinement is over and the patient is clean, remove the Kelly pad, and the pad below if necessary, or the pad and newspapers if these are used,—place a clean pad under the patient and you are ready to place the binder on if a binder is to be used.
Should a Binder be Used?—Medically a binder is not necessary, neither is it objectionable from a medical standpoint. It is supposed to hold the flaccid, empty womb in place. This it does not do and we are of the opinion, that it, in many instances, according to how it is put on, compresses the womb out of place. The binder is certainly appreciated by most patients because of its snug, comfortable feeling; and in cases when the abdominal wall is fat and the muscles soft, it holds them together in a way that is impossible by the use of any other device. To claim that the binder prevents hemorrhages is absurd. Our personal rule is to put one on if the patient wants one, or if she has previously had one. To be effective, in any sense, the binder should extend from the waist line down to halfway between the hips and knees and should be snugly, but not too tightly pinned.
Sanitary Napkins.—These can be purchased already prepared in most drug stores, or they can be made in the following manner: Take an ordinary grade of cheese cloth, wash it, and when dry, cut it into half yard squares. In the center of each square place a strip, six or eight inches long, of absorbent cotton and fold the gauze lengthwise over it so as to make a pad. These can be used as napkins, and after they are soiled can be burned. It is absolutely wrong to use rags or any old cloths for napkins, as the patient can be infected and made seriously sick by this procedure.
How to Calculate the Probable Date of the Confinement.—The duration of pregnancy extends for 280 days from the end of the last menstruation. Add seven days to the date of the last menstruation, and from that date count ahead nine months, or backward three months and you may have the probable date of the confinement. Should you pass this time you will probably go on for two additional weeks. The reason for this is that the most susceptible time for conception to occur is either during the week following menstruation or a few days before menstruation. If, therefore, you pass the above probable date which was calculated from the end of the last menstruation, it shows that conception did not takeplace during the week following that menstruation; and the assumption will be that it took place a few days before the next menstruation, which will be about two weeks later than the date as calculated above.
If, for example, a pregnant woman was last sick from January 1st to 5th we add seven days to the 5th, which is the 12th, to which we add nine months, which will give us, as the probable date of confinement, October 12th. Should she go a few days over the 12th, the probability is that the confinement will take place on October 26th.
TABLE FOR CALCULATING THE DATE OF CONFINEMENT---------------------------------------------------------------------------------------------------------JAN. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31OCT. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 NOV.---------------------------------------------------------------------------------------------------------FEB. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28NOV. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 DEC.---------------------------------------------------------------------------------------------------------MAR. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31DEC. 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 JAN.---------------------------------------------------------------------------------------------------------APR. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30JAN. 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 FEB.---------------------------------------------------------------------------------------------------------MAY. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31FEB. 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 1 2 3 4 5 6 7 MAR.---------------------------------------------------------------------------------------------------------JUNE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30MAR. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 APR.---------------------------------------------------------------------------------------------------------JULY 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31APR. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 MAY---------------------------------------------------------------------------------------------------------AUG. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31MAY 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 JUNE---------------------------------------------------------------------------------------------------------SEPT. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30JUNE 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 JULY---------------------------------------------------------------------------------------------------------OCT. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31JULY 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 AUG.---------------------------------------------------------------------------------------------------------NOV. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30AUG. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 SEPT.---------------------------------------------------------------------------------------------------------DEC. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31SEPT. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 OCT.---------------------------------------------------------------------------------------------------------
The foregoing table affords us a handy means of finding the probable date of confinement at a glance.
Find the date of the last day of the last menstrual period in the upper row; the date immediately below it is the probable date of confinement.
For example if the last menstrual period was from Jan. 1st to 5th, we find January 5th and below it we note October 12th as the probable date of confinement.
When Should a Pregnant Woman First Call Upon Her Physician?—The earliest indication of pregnancy is the interruption of menstruation. When menstruation fails to appear at its regular time in a young married woman whose past menstrual history is good,—i.e., she has been sick every month regularly and without pain since she began menstruating as a girl,—the assumption would naturally be that she was pregnant. Menstruation may however "miss" one month for other reasons than pregnancy just at this time, as is explained elsewhere, so it is wise to defer a positive assumption on such an important matter. When the second menstruation does not appear, and there are no specific reasons for its failure to appear, it may be safely assumed that pregnancy has taken place. A visit to the family physician one week after the second menstruation should have appeared, or at least long enough to feel absolutely certain that the sickness is not coming around, is not only necessary, but is the essential and correct step to take for a number of very good reasons. If a woman for example has not had a baby, how does she know she can have one? It is quite possible to become pregnant and yet it may be wholly impossible to give birth to a child. It is necessary to be constructed normally, or as near what is regarded as normal as is possible, in order safely to assume the responsibility of carrying a pregnancy to a successful completion. No one but a physician, who is skilled and familiar in the knowledge of what constitutes the proper size, and shape, and quality, and relations, one with another, ofyour bones, and ligaments, and muscles, can tell whether you can safely be permitted to carry a pregnancy to term or not. If the anatomical conditions are not just right; if circumstances from a medical standpoint are not favorable; if your personal risk is too hazardous; if, in other words, medical science should decide that you are one of the very few women who cannot have a baby, is it not of very great importance that you should know this as soon as possible? Does not that fact alone render your early call upon your physician imperative? A physician can bring out facts, relating to the personal and family history, and habits, of the prospective mother, which will enable him to formulate advice which will prove of the highest value from the very beginning of pregnancy. Instructions carried into effect at this early date, as to personal conduct, exercise, diet, etc., will have a distinctly beneficial influence, not only on the patient's health and the character of her confinement, but on the physical vitality of the coming baby.
Regarding the Choice of a Physician.—This is a matter that should receive the most careful consideration. While it is just to admit that every physician is capable of successfully conducting maternity cases, there are certain characteristics in the individual temperament that would seem to indicate that some physicians are better adapted to this special work.
Trustworthiness is an imperative essential in a physician who assumes the responsibility of confinement engagements. He must be clean in his personal habits as well as morally. He should possess the virtue of patience and be tactful, and above all he should be made to feel that he has your implicit confidence. If you will analyze these qualifications you will understand just what they imply. The physician who has the reputation of having the largest practice is not necessarily the man you want, nor does it imply that he is the best fitted to conduct your case to your satisfaction. The fact that he is a very busy man may be distinctly detrimental to your best interests. If the physician has the reputation of being an excellent doctor, but, "You can't always depend on him,—he may be out of town, or he may send his assistant, orsubstitute," you don't want him; it is too important an event to you to take a chance with. Rely rather upon the man who, though his charge may be a little higher, is known to be trustworthy; who will take a personal interest in you, and is known to be patient and capable.
The Selection of a Nurse.—A choice must be made between having a trained nurse and what is known as a maternity, or monthly, nurse. The choice may be dictated by the financial means of the patient. A trained nurse is paid from $25 to $30 per week, while a maternity nurse usually gets $15 per week.
A trained nurse is a graduate from a hospital where she has successfully completed a course of training. She is to be preferred, if she can be afforded, for the reason that she has been trained to obey absolutely the orders of a physician, and because she has the requisite knowledge to detect emergencies, and the necessary skill and experience to enable her to act intelligently of her own initiative in any emergency.
The maternity nurse, on the other hand, has not had an adequate training and is absolutely helpless, so far as medical knowledge is concerned, in a real emergency. Her experience is limited to what she has picked up in the various cases she has had. She, as a rule, has chosen this means of obtaining a living as a result of some domestic financial affliction. She does not understand the laws of sterilization and has not been trained to obey, without question, the instructions of a physician. The maternity nurse follows a routine which she is incapable of modifying to suit the particular case. She has old-fashioned ideas and notions which she carries out as a matter of course, and she overestimates the great importance of her experience to the extent of wholly disregarding the advice of the physician. She assumes the care of the patient and baby, and regards this as her right, and as a result she is frequently responsible for much injury to the mother and child. Despite these objections we have worked with many of these nurses who were to be preferred to trained nurses. It is the individual after all that counts, and if a maternity nurse, though technically untrained, is adaptable, tactful, and will consentto be instructed to the extent of obeying without argument, she can become invaluable, and her skill and experience will carry her creditably over many trying incidents. The objection of the medical profession to an untrained nurse is based, not so much on her lack of ability, as upon her propensity to indiscriminate and indiscreet talk,—they have not been trained to know the value of professional silence, nor have they had the necessary education which would have enabled them to acquire through their experience the knowledge that "silence is golden" at all times. A trained nurse possesses the requisite knowledge, but may have an objectionable individuality. An untrained nurse may have sufficient knowledge, and what she lacks she may make up for in being congenial and adaptable. While the trained nurse strictly attends exclusively to the mother and the baby, a maternity nurse as a rule attends to the household duties in addition. She cooks the meals of the entire family, and dresses and cares for the other children if there is no one else to do it. The duties of a maternity nurse can be specified and agreed upon, and the terms arranged when she is engaged. The duties of a trained nurse are fixed by nursing laws and medical rules and cannot be changed or modified by private agreement. These laws and rules, however, are not sufficiently arbitrary to make it impossible for the nurse to be obliging, courteous, and sincere,—qualifications which every patient has a right to expect, and a right to insist upon from every graduate nurse.
The selection of a nurse should receive careful consideration. She should be known to be honest, honorable, competent, healthy, and personally clean in habits and dress, and she should be tactful, obliging, and she should attend to her own affairs strictly. She should not be a gossip; she should not shirk her work or pry into family affairs that do not concern her; and she should not drag into the conversation her own personal or family secrets.
The nurse has certain rights which the patient should willingly recognize. She is entitled to a comfortable bed, sufficient sleep, good food, and exercise in the open airevery day. These are essential in order that she maintain her own health, as well as keep at the highest point of efficiency.
When you select your physician consult with him regarding your nurse. If you know personally a capable nurse, there is no objection to selecting her, and no physician will oppose this procedure if you assume the responsibility of her capability.
There are many advantages, however, in permitting the physician to provide a nurse. He assumes the responsibility of the nurse's capability, and it is safe to assume he will not recommend one whom he knows to be personally objectionable, or professionally incapable. Every physician acquires certain individual methods in the conduct of maternity cases, which experience has taught him to be successful. A competent knowledge of these methods by the nurse greatly facilitates the details and ensures a harmonious conduct of the entire case,—facts which accrue to the comfort and the well-being of the patient.
It is not out of place here to warn a young wife against being advised by a neighbor or a busybody, as to whom she should select as physician or nurse. You must not depend upon the gossip of the neighborhood. The physician or nurse whom you are told by one of these irresponsible individuals not to take, may be the one above all others whom you should take. When you hear a gossiping woman decry a physician, depend upon it, she owes him something,—most often it is a bill, but it may only be a grudge. There is no class of men in any community who are maligned and abused so much as are physicians. They seem to be the choice victims of the enmity and spite of every malicious feminine tongue. A woman should think twice before she utters a criticism regarding the work of a physician. She would, if she but knew how quickly she brands and advertises herself as irresponsible and lacking in ordinary courtesy and good breeding, as she is not qualified to criticise the professional capability of a physician, nor is she qualified to estimate the extent of the wrong she perpetrates. There is no class of men who do more conscientious work, dayafter day, than do physicians, and there is no class of men who are more deserving of the commendation of the entire community than the thousands of self-sacrificing, underpaid members of the medical profession. Be suspicious therefore when you hear a criticism, and be very, very sure before you utter one,—rather give him the benefit of the doubt and you will do no wrong, and it may be at some future date you will be thankful you did not criticise.
Daily Conduct of the Pregnant Woman—Instructions Regarding Household Work—Instructions Regarding Washing and Sweeping—Instructions Regarding Exercise—Instructions Regarding Passive Exercise—Instructions Regarding Toilet Privileges—-Instructions Regarding Bathing—Instructions Regarding Sexual Intercourse—Clothing During Pregnancy—Diet of Pregnant Women—Alcoholic Drinks During Pregnancy—The Mental State of the Pregnant Woman—The Social Side of Pregnancy—Minor Ailments of Pregnancy—Morning Nausea, or Sickness—Treatment of Morning Nausea, or Sickness—Nausea Occurring at the End of Pregnancy—Undue Nervousness During Pregnancy—The 100 Per Cent. Baby—Headache—Acidity of the Stomach, or Heartburn—Constipation—Varicose Veins, Cramps, Neuralgias—Insomnia—Treatment of Insomnia—Ptyalism, or Excessive Flow of Saliva—Vaginal Discharge, or Leucorrhea—Importance of Testing Urine During Pregnancy—Attention to Nipples and Breasts—The Vagaries of Pregnancy—Contact with Infectious Diseases—Avoidance of Drugs—The Danger Signals of Pregnancy.
Daily Conduct of the Pregnant Woman—Instructions Regarding Household Work—Instructions Regarding Washing and Sweeping—Instructions Regarding Exercise—Instructions Regarding Passive Exercise—Instructions Regarding Toilet Privileges—-Instructions Regarding Bathing—Instructions Regarding Sexual Intercourse—Clothing During Pregnancy—Diet of Pregnant Women—Alcoholic Drinks During Pregnancy—The Mental State of the Pregnant Woman—The Social Side of Pregnancy—Minor Ailments of Pregnancy—Morning Nausea, or Sickness—Treatment of Morning Nausea, or Sickness—Nausea Occurring at the End of Pregnancy—Undue Nervousness During Pregnancy—The 100 Per Cent. Baby—Headache—Acidity of the Stomach, or Heartburn—Constipation—Varicose Veins, Cramps, Neuralgias—Insomnia—Treatment of Insomnia—Ptyalism, or Excessive Flow of Saliva—Vaginal Discharge, or Leucorrhea—Importance of Testing Urine During Pregnancy—Attention to Nipples and Breasts—The Vagaries of Pregnancy—Contact with Infectious Diseases—Avoidance of Drugs—The Danger Signals of Pregnancy.
The young wife will arrange her daily routine according to the physician's instructions, which, by the way, she should faithfully carry out. If you are one of the fortunate many who enjoy reasonably good health, you have doubtless been told to follow a plan very similar to the one we shall now briefly outline.
For the first six months she can safely continue to do her household work. It is to her advantage to do so for many reasons, but especially because it helps to keep her physically in good condition, and because it keeps her mind engaged, thus avoiding a tendency to nervous worry. After the sixth month it is desirable to give up the heavier part of the work. Washing and sweeping should be absolutely prohibited. Moving furniture or heavy trunks must not be done by the prospective mother, but all lightwork can and should be indulged in to the very end. Find time to spend at least one hour and a half in the open air every day. Unless there is a medical reason against active exercise there is nothing so beneficial to the pregnant woman as walking, nor is there any substitute for it. A drive or motor ride into the country, or a car ride around town, is an excellent device against ennui and is highly desirable during this time, but not as a substitute for the daily long walk. A pregnant woman must keep her muscles strong and in good tone if she hopes to do her share toward having a short and easy confinement. She must keep active to ensure perfect action of all her organs—the stomach must digest; the bowels and kidneys must act perfectly; the heart, and lungs, and nerves must be supplied with good blood and fresh air; the appetite must be keen, and the sleep sound. Walking in the open air will do all this and nothing else can, to the same satisfactory degree.
Light passive exercise at home is desirable to those very few who cannot walk in the open air, but at best it is a poor substitute. It is necessary to avoid any exercise or any labor of the following character from the very beginning of pregnancy: stretching, lifting, jarring, jumping, the use of the sewing machine, bicycling, riding, and dancing.
She should continue to employ the same toilet privileges she has been accustomed to except the use of the vaginal douche, which must be stopped from the date of the first missed menstrual period. This is the only safe rule to follow and no exception should be made to it except upon the advice of a physician.
Bathing during the entire course of pregnancy is a highly necessary duty. It is particularly advantageous during the later months because it relieves the kidneys at a time when they are called upon to perform an excess of work. The temperature of the bath should be warm and rapidly cooled at the finish. Brisk rubbing with a course towel will ensure the proper reaction.
Sexual intercourse must be restricted during pregnancy; and it should be wholly abstained from during what would have been the regular menstrual periods, ifpregnancy had not occurred, for the reason that abortion is apt to take place. It is most harmful during the early and late months of pregnancy. Sexual intercourse is distasteful to most and harmful to every pregnant woman.
Clothing During Pregnancy.—The clothing should be so constructed as to relieve any undue pressure on the breasts or abdomen. For this reason it should be suspended from the shoulder. When it is appreciated that clothing supported by the waist crowds the growing womb, and exerts pressure upon the kidneys, and is responsible for many of the kidney complications that occur during pregnancy, no further reason need be given for discarding all clothing, except very light garments, that are not held by some device whose support is from the shoulders. A specially constructed linen waist is made and sold for this purpose. It is fashioned so that all the lower garments and the garters can be fastened to, and supported by it. Corsets should be absolutely discarded from the very first day of pregnancy.
In a large woman with a lax abdomen, a properly made abdominal support will not only be a great comfort but of real advantage. It should exert a support upward by lifting the abdomen, not by constricting it. It should therefore be obtained from a reliable dealer and be made and applied to effect the above object,—otherwise it may do more harm than good.
Diet of Pregnant Women.—Some degree of digestive disturbance and loss of appetite is the rule early in pregnancy. By the fourth month these conditions invariably cease, and the appetite and the ability to digest will greatly improve. The diet from the very beginning of pregnancy should be plain and easily digested. It is not possible to formulate an absolute table of what or what not to eat, as the same foods do not agree equally well with all patients. The individual taste should be catered to within, reason, and the meals should be taken at regular intervals. Articles of diet that experience shows do not agree with the patient should be rigidly excluded from the menu. A varied diet of nutritious character is essential during pregnancy in order to ensure good blood, health, and strength. A monotonous diet, or a diet composed largelyof stale tea, coffee, and cake, is not permissible, and may do untold harm. Pastries and desserts of all kinds should be excluded. In the later weeks of pregnancy, because of the large size of the womb, the diet should be cut down as the stomach is interfered with in the process of digestion. Should the patient at any time during pregnancy experience a loss of appetite, or an actual disgust for food as sometimes occurs, it is preferable to suggest a change of scene and surroundings rather than the use of medicine. A short vacation, a change of table, new scenery, will promptly effect a cure. This condition is mental rather than physical; the patient allows herself to become introspective; the daily routine becomes monotonous and stale; hence a change of a few days will be all that is necessary. If it is not possible for the patient to obtain a change of scene, a complete change of diet for a few days will often tide over the difficulty. We have known patients to take kindly to an exclusive diet of kumyss, or matzoon, or predigested foods, with stale toast or zwieback, to which can be added stewed fruits. Alcoholic drinks should be left out entirely.
The Mental State of the Pregnant Woman.—The coming baby should be the text of many interesting, spontaneous talks between the young couple from the time when it is first known that a new member of the family is on its way. The husband should feel that he is a party to the successful consummation of the little one's journey. He can contribute enormously to this end. It should be his duty, born of a sincere affection and love, to formulate the programme of events which has for its main object the wife's entire mental environment. He should encourage her to live up to the physician's instructions, and arrange details so that she will obtain the proper exercise daily. He should read to her in the evening, and arrange his own business affairs so that he will be with her as much as is possible. In many little ways he can impress upon her the fact that they both owe something to the unborn babe and that each must sacrifice self in its behalf. His principal aim, of course, will be that she will not worry or have cause to worry. He will so direct her mental attitude that she will dwellonly upon the bright side of the picture; she will thus strive to realize the hope that the baby will be strong and healthy, and she will, prompted by his encouragement and devotion, try to do her duty faithfully. Working together in this way, much can be done that means far more than we know of, and in the end the little one comes into the world a welcome baby, created in love and born into the joy of a happy, harmonious, contented home.
The Social Side of Pregnancy.—The social side of the question should not be overlooked or neglected at this time. Here again the imperative necessity arises to warn the young wife against certain individuals who seem to have a predilection toward recounting all the terrible experiences they have heard regarding confinements. It is astonishing to learn how diversified a knowledge some women burden themselves with in this connection. They can recount case after case, with the harrowing details of a well-told tale, and seem to delight in so doing. Every physician has met these women. The young wife must not permit or encourage any reference to her condition. Simply refusing to discuss the question is the only sure method of preventing its discussion. She will find among her friends a few who have her best interests at heart, and these few will strive sincerely to be of real usefulness to her. If she will keep in mind that the most important element in the success of the whole period, and consequently the degree of her own health, happiness, and comfort, as well as that of her unborn baby, is the character of her own thoughts from day to day, and month to month, she will be complete master of the situation. By constantly dwelling on happy thoughts, reading encouraging and inspiring books, admiring and studying good pictures, working with cheerful colors in sunny rooms, exercising, dieting, and sleeping in a well-aired room, she will have no cause to regret her share in the task before her, or the kind of baby she will bring into the world.
Minor Ailments of Pregnancy.—There are certain minor ailments which it would be well to be familiar with lest a little worry should creep into the picture.
Maternity is not only a natural physiological function,but it is a desirable experience for every woman to go through. The parts which participate in this duty have been for years preparing themselves for it. Each month a train of congestive symptoms have taxed their working strength; pregnancy is therefore a period of rest and recuperation,—a physiological episode in the life history of these parts. If any ailment arises during pregnancy it is a consequence of neglect, or injury, for which the woman herself is responsible,—it is not a natural accompaniment of, or a physiological sequence to pregnancy. Find out, therefore, wherein you are at fault, rectify it, and it will promptly disappear.
Morning Nausea or Sickness.—So-called morning nausea or sickness is very frequently an annoying symptom. It is present as a rule during the first two or three months of pregnancy. How is it produced and how can it be remedied?
It is produced most frequently by errors in diet. It may be caused by an unnatural position of the womb or uterus, by nervousness, constipation, or by too much exercise or too little exercise. The physician should be consulted as soon as it is observed to be a regular occurrence. He will eliminate by examination any anatomical condition which might cause it; or will successfully correct any defect found. When the cause is defined his instructions will help you to avoid any error of diet, constipation, or exercise. Many cases will respond to a simple remedy,—a cup of coffee, without milk, taken in bed as soon as awake will often cure the nausea. The coffee must be taken while still lying down,—before you sit up in bed. If coffee is not agreeable any hot liquid, tea, beef tea, clam bouillon, or chicken broth, or hot water may answer the purpose, though black coffee, made fresh, seems to be the most successful. Ten drops of adrenalin three times daily is a very certain remedy in some cases, though this should be taken with your physician's permission only. If the nausea occurs during the day and is accompanied with a feeling of faintness, take twenty drops of aromatic spirits of ammonia in a half glass of plain water or Vichy water. Sometimes the nausea is caused by the gradual increase of the wombitself. This is not usually of a persistent character and disappears as soon as the womb rises in the abdominal cavity at the end of the second month.
Nausea frequently does not occur until toward the end of pregnancy. In these cases the cause is quite different. Because of the size of the womb at this time the element of compression becomes an important consideration. The function of the kidneys, bowels, bladder, and respiration may be more or less interfered with, and it may be desirable to use a properly constructed abdominal support, or maternity corset. These devices support and distribute the weight, and prevent the womb from resting on or compressing, and hence interfering with, the function of any one organ. If the womb sags to one side, thereby retarding the return circulation of the blood in the veins from the leg, it may cause cramps in the leg, especially at night, or it may cause varicose veins, or a temporary dropsy. The correct support will prevent these troublesome annoyances; a properly constructed maternity corset is often quite effective. The diet should receive some special attention when these conditions exist. Any article of diet which favors fermentation (collection of gas) in the stomach or bowel should be excluded. These articles are the sugars, starches, and fats. It can readily be understood that if the bowels should be more or less filled with gas, or if they should be constipated, it will cause, not only great distress, but actual pain. Regulation of the diet, therefore, and exercise (walking best of all) will contribute greatly to the avoidance of these unnecessary sequelae.
It must be kept in mind that the entire apparatus of the body is accommodating a changed condition, and though that condition is a natural one, it requires perfect health for its successful accomplishment. This means a perfect physical and mental condition,—a condition that is dependent upon good digestion, good muscles, healthy nerves, clean bowels, and so on. The slightest deviation from absolute health tends to change the character of the body excretions, the quality of the blood, etc. If the excretions are not properly eliminated, the blood becomes impure, and so we sometimes get itching of the bodysurfaces, especially of the abdomen and genitals; neuralgias, especially of the exposed nerves of the face and head; insomnia and nervousness. These are all amenable to cure, which again means, as a rule, correct diet and proper exercise as the principal remedial agencies.
Undue Nervousness During Pregnancy.—This is very largely a matter of will power. Some women simply will not exert any effort in their own behalf. They are perverse, obstinate, and unreasonable. The measures which ordinarily effect a cure, they refuse to employ. It is useless to argue with them; drugs should never be employed; censure and affection are apparently wasted on them; they cannot even be shamed into obedience. The maternal duty they owe to the unborn child does not seem to appeal to them. We do not know of any way to handle these women and to our mind they are wholly unfit to bring children into the world. Fortunately these women are few in number. The maternal instinct will, and does, guide most women into making sincere efforts to restrain any undue nervous tendency, and to be obedient and willing to follow instructions. There is nothing so beneficial in these cases as an absolutely regulated, congenial, daily routine, so diversified as to occupy their whole time and thought to the exclusion of any introspective possibility. Frequent short changes to the country or seashore to break the monotony, give good results in most of these cases. The domestic atmosphere must also be congenial and the husband should appreciate his responsibility in this respect.
Women of this type should have their attention drawn to the following facts in this connection: While the most recent investigations of heredity prove that a woman cannot affect the potential possibilities of her child, she can seriously affect its physical vitality. The following illustration may render our meaning clear: suppose your child had the inborn qualities necessary to attain a 100 per cent. record of achievement in the struggle of life; anything you may or may not do cannot affect these qualities—the child will still have the ability to achieve 100 per cent. Inasmuch, however, as a mother can affect the health or physical qualities of herchild she is directly responsible, through her conduct, as to whether her child will ever attain the 100 per cent. record, or if it does, she is responsible for the character of its comfort, its health, its enjoyment, all through its life's struggle toward the 100 per cent. achievement record. She may so compromise its physical efficiency that it will succumb to disease as a consequence of the ill health with which its mother unjustly endowed it, even though it possess the ability to attain the 100 per cent. if it lived.
We often see brilliant children who are nervous and physically unfit, and we see others of more ordinary mental achievement who are healthy and robust animals. The one is the offspring of parents possessing unusual mental qualities but who are physically unable or unwilling to render justice to their progeny; the other parents may be less gifted mentally, but they are healthy and they are willing to give their best in conduct and in blood to their babies. Many of these brilliant children never achieve their potential greatness because they fall by the wayside owing to physical inability, while the healthy little animals achieve a greater degree of success because of the physical vitality which carries them through. To achieve a moderate success and enjoy good health is a better eugenic ideal than the promise of a possible genius never attained because of continuous physical inefficiency.
The nervous and willful mother should therefore consider how much depends upon her conduct. It cannot be too frequently reiterated and emphasized that every mother should do her utmost to guard and retain her good health. Good health means blood of the best quality and this is essential to the nourishment of the child. To keep in good health does not mean to obey in one respect and fail in other essentials. It means that you must obey every rule laid down by your physician, willingly and freely in your own interest and in the interest of your unborn babe. In no other way may you hope to creditably carry out the eugenic ideal that "the fit only shall be born."
Headache.—This is a symptom of great importance.If it occurs frequently, without apparent cause, the physician should be consulted at once, as it may indicate a diseased condition of the kidneys, and necessitate immediate treatment. Headaches may, of course, be caused in many ways and most frequently they do not have any serious significance, but they must always be brought to the attention of the physician. As a rule they are caused by errors of diet,—too much sugar, candy, for instance, late and indigestible suppers, indiscriminate eating of rich edibles, etc.,—or they may be products of nervous excitement (too little rest), as shopping expeditions, strenuous social engagements, late hours, etc.
Acidity of the Stomach, and So-Called Heartburn.—These are sometimes in the early months of pregnancy annoying troubles. The following simple means will relieve temporarily: A half-teaspoonful of bicarbonate of soda or baking soda in a glass of water or Vichy water; or a half teaspoonful of aromatic spirits of ammonia in Vichy, or plain water; or a tablespoonful of pure glycerine. The best remedy is one tablespoonful of Philip's Milk of Magnesia taken every night for some time just before retiring.
Heartburn is the result of eating improper food, or a failure to digest the food taken. Starchy foods should be avoided. Meats and fats should be taken sparingly. Avoid also the et ceteras of the table, as pickles, sauces, relishes, gravies, mustard, vinegar, etc. Good results follow dry meals,—meals taken without liquids of any kind. Live on a simple, easily digested, properly cooked diet. Chew the food thoroughly, take plenty of time and be cheerful.
Constipation During Pregnancy.—Most women are as a rule more or less constipated during pregnancy. It is caused by failure to take the proper amount of outdoor exercise, to take enough water daily, to live on the proper diet, to live hygienically, or because of wrong methods of dress. It is most important that the bowels should move thoroughly every day. Pregnancy no doubt aggravates constipation by diminishing intestinal activity. Consequently there is a greater need for activity on the part of the woman, and open air exercise is the best wayto accomplish this. She should eat fruits, fresh vegetables, brown or Graham bread, or bran muffins, figs, stewed prunes, and any article of diet which she knows from experience works upon her bowel. She should drink water freely; a glass of hot water sipped slowly on arising every morning or one-half hour before meals, is good. Mineral waters, Pluto, Apenta, Hunyadi, or one teaspoonful of sodium phosphate, or the same quantity of imported Carlsbad salts in a glass of hot water one-half hour before breakfast, answers admirably. If the salts cannot be taken a three- or five-grain, chocolate-coated, cascara sagrada tablet, may be taken before retiring, but other cathartics should not be taken unless the physician prescribes them. Rectal injections should be avoided as a cure of constipation during pregnancy. They are very apt to irritate the womb and if taken at a time when the child is active, they may annoy it enough to cause violent movement on its part, and these movements may cause a miscarriage. See article on "Constipation in Women."
Varicose Veins, Cramps, and Neuralgia of the Limbs.—When cramps or painful neuralgia occur repeatedly in one or both legs, some remedial measures should be tried. Inasmuch as the cause of this condition is a mechanical one, it would suggest a mechanical remedy. The baby habitually seeks for the most comfortable position, and having found it stays there until conditions render it uncomfortable. He does not consult you in the matter, but he may be subjecting you to untold misery and pain. The child may rest on the mother's nerves or blood-vessels as they enter her body from her lower limbs. If the pressure is sufficient, it can interfere quite seriously with the return blood supply, because veins which carry back to the heart the venous or used blood, are vessels with thin, soft, compressible walls, while arteries which carry blood away from the heart cannot be compressed easily, because their walls are hard and tense. The condition therefore is that more blood is being sent into the limb than is being allowed to return; in this way are produced varicose veins. If these varicose veins burst or rupture we have ulcers, whichmay quickly heal, or they may refuse to heal, and become chronic. A dropsical condition of the leg may follow, and because of interference with the circulation of the blood we get cramps and neuralgias. How can we remedy this painful condition?
Sometimes we don't succeed, but at least we can try. So long as the cause exists, it is self-evident that rubbing the limb with any external application, will not give any permanent relief, though it is well to try. When rubbing, to relieve cramps at night, always rub upward. It is not a condition that calls for medicine of any kind, while hot baths and hot applications will only make the trouble worse. The remedy that promises the quickest and longest relief is for the patient to assume the knee-chest position for fifteen minutes, three times a day, till relief is permanently established. The patient rests on her knees in bed, and bends forward until her chest rests on the bed also. The incline of the body in this position is reversed; hips are highest, the head lowest. The baby will seek a more comfortable position and this new position may relieve the pressure and cure the condition. Doing this three times daily for fifteen minutes gives relief to the leg by reestablishing a normal blood circulation, and very soon the baby finds a new position that does not interfere with its mother's blood supply, and the cramps, and neuralgia and dropsy, and maybe the varicose veins will soon show improvement. Wearing the proper kind of abdominal support may help, as explained on page77. If the varicose veins are bad, it is desirable to wear silk rubber stockings or to bandage the limbs.
Insomnia During Pregnancy.—Insomnia or sleeplessness is sometimes a vexatious complication during pregnancy. It seldom if ever becomes of sufficient importance or seriousness to interfere with the pregnancy or the health of the patient. Nevertheless, a period of sleeplessness lasting for two or three weeks is not a pleasant experience to a pregnant woman. It is most often met with during the latter half of pregnancy.
There can be no question that every case of insomnia has definite cause, and can be relieved if we can find thecause. The only way to find it is to systematically take up the consideration of each case, and this is best done by the physician. He must have patience and tact; you must answer each question truthfully and fully. Your diet, personal conduct, exercise, condition of bowels, mental environment, domestic atmosphere, everything, in fact, which has any relation to you or your nerves, must be inspected with a magnifying glass. Some little circumstance, easily overlooked, of seemingly no importance, may be the cause of the trouble. You may need more outdoor exercise, or you may need less outdoor exercise. You may need more diversion, more variety, or you may need less. You may need a sincere, honest, tactful, patient confidant and friend, or you may need to be saved from your friends. You may be exhausting your vitality and fraying your nerves by social exigencies,—those empty occupations which fill the lives of so many fussy, loquacious females,—echoless, wasted, babbling moments, of supreme important to the social bubbles who ceaselessly chase them but of no more interest to humanity than the wasted evening zephyrs that play tag with the sand eddies on the surface of the dead and silent desert. You may have wandered from the narrow limitations of the diet allowable in pregnancy, or you may be the victim of an objectionably sincere relation who pesters you with solicitous inquiries of a needless character. Whatever it is, rectify it. A good plan to follow on general principles is to take a brisk evening walk with your husband just before bedtime, and at least two hours after the evening meal. Follow this with a sitz bath as soon as you return from the walk.
A sitz bath is a bath taken in the sitting position with the water reaching to the waist line. It should last about fifteen minutes and the water should be comfortably hot. It is sometimes found that this form of bath creates too much activity on the part of the child and defeats the purpose in view. This is apt to be the case in very thin women when the abdomen is not covered by a sufficient layer of fatty tissue. These women will find it advisable to take, in place of the sitz bath, a sponge bath in a warm room, using the water rather cool than hot but ina warm room. Rub your skin briskly but waste no time in getting into bed. A glass of hot milk, before going to bed, or when wakeful during the night, may serve as a preventive. When these measures fail the physician should be called upon to advise and prescribe.
Ptyalism, or an Excessive Flow of Saliva.—This is a common condition in pregnancy, but cannot be prevented. It is of no importance other than that it is a temporary annoyance.
Itching of the abdomen can usually be allayed by a warm alcohol rub, followed by gently kneading the surface of the abdomen with warm melted cocoa butter, just before retiring.
A Vaginal Discharge.—Soon after pregnancy has taken place the woman may notice a discharge. It may be very slight or it may be quite profuse. In some cases it does not exist at all during the entire period. As a rule the discharge is more frequent and more profuse toward the end of pregnancy.
If the discharge exists at any time,—and it is no cause for worry or alarm if it does exist,—inform your physician. He will advise you what to do, because it is not wise for you to begin taking vaginal douches or injections without his knowledge, and at a time when they may do you serious harm. Should itching occur as a result of any vaginal discharge the following remedial measures may be employed:
A solution of one teaspoonful of baking soda to a douche bag of tepid water may be allowed to flow over the parts, or cloths saturated with this mixture may be laid on the itching part. A solution of carbolic acid in hot water (one teaspoonful to one pint of hot water), is also useful, or a wash followed by smearing carbolic vaseline over the itching parts. If your physician should suggest a mild douche for itching of the vagina as the result of a discharge, it may be promptly relieved by using Borolyptol in the water. Buy a bottle and follow directions on the label.
Testing Urine In Pregnancy—Importance of.—One of the most important duties, if not the most important, of both the physician and the patient is to have theurine of the pregnant woman examined every month during the first seven months and every two weeks during the last two months. The urine examined during the first seven months should be the first urine passed on the day it is sent for examination. During the last two months of pregnancy thepatientshould pass all her water into a chamber for an entire day, and take about three ounces of this mixed water for examination. She should measure the total quantity passed during these days and mark it with her name on the label of the bottle. The physician will thus have an absolute record and guide of just how the kidneys are acting, and as they are the most important organs to watch carefully during every pregnancy, the greatest care should be taken to see that failure to note the first symptom of trouble does not take place.
Attention to Nipples and Breast.—The physician should inspect the breasts and nipples of every pregnant woman when she first visits his office. Frequently the nipples are found to have been neglected, probably subjected to pressure by badly fitting corsets or too tight clothing. Instructions gently to pull depressed nipples out once daily, if begun early, will result in marked improvement by the end of pregnancy. During the latter part of pregnancy the breasts should be carefully and thoroughly bathed daily in addition to the daily bath. This special bath should be with a solution of boric acid (one teaspoonful to one pint of water). After the bath apply a thin coating of white vaseline to the nipples. It may be necessary to resort to the following mixture to harden the nipples and to make them stand out so that the child can get them in its mouth: Alcohol and water, equal parts into which put a pinch of powdered alum; this mixture should be put in a saucer and the nipples gently massaged with it twice daily. A depressed nipple may also be drawn out by means of a breast pump. If the nipples are not pulled out the child will be unable to nurse. It may then be necessary to put the child on the bottle and when the nipples are ready he may not take them after being used to the rubber nipple. The breasts may become caked and as a caked breast is a very painfuland serious ailment it is wise to attend to this matter in time.
The Vagaries of Pregnancy.—Certain foolish, old-fashioned ideas, have crept into the minds of impressionable people regarding pregnancy, which are aptly termed vagaries. It is believed by some that if the pregnant woman is the victim of fright, or is badly scared, or witnesses a terrifying or tragic sight, her child will be, in some way, affected by it. If the incident is not of sufficient gravity to cause an abortion or a miscarriage it will not, in any way mark, or affect the shape of the child in the womb.
It is believed by some that a child can be marked by reason of some event occurring to the mother while carrying it. This is not so; a child cannot be marked by any experience or mental impression of the mother. Some believe that the actual character of a child can be changed by influences surrounding the mother while carrying it. The character of a child cannot be changed one particle after conception takes place, no matter how the mother spends her time in the interim.
It should be carefully understood that the character of the baby is entirely different from the physical characteristics of the baby. Were this not so it would be futile on the part of the mother to discipline or sacrifice herself in the interest of her baby. The baby's character will reflect the qualities of the combined union of mother and father. The baby's physical characteristics will largely depend upon the treatment accorded it by the mother during its intro-uterine life. Hence we lay down rules of conduct, diet and exercise in order to produce a good, sturdy animal, while the character or mind of the animal is a part of the fundamental species already created. In other words, no matter how much care you bestow upon a rose bush, its flower will still be a rose,—it may be a better rose, a stronger, sturdier rose, a better smelling and a more beautiful rose, but it is still a rose.
Contact With Infectious Diseases.—The pregnant woman should be warned against the danger of coming in contact with any person suffering from any infectious or contagious diseases. To become the victim of oneof these diseases near the time of labor would be a dangerous complication not only to the mother, but to the child. A woman is more liable to catch one of these diseases during the last month of pregnancy than at any other time. The most dangerous diseases at this period are Scarlet Fever, Diphtheria, Erysipelas, and all diseased conditions where pus is present.
Avoidance of Drugs.—It is a safe rule during pregnancy to avoid absolutely the taking of all medicines unless prescribed by a physician.
The Danger Signals of Pregnancy.—The following conditions may be of very great importance and may be the danger signals of serious coming trouble. They must not therefore be neglected or lightly considered. When any of them make their appearance send for the physician who has charge of your case, at once, and follow his advice whatever it may be.
1. Any escape of blood from the vagina, whether in the form of a sudden hemorrhage or a constant leaking, like a menstrual period.2. Headache, constant and severe.3. Severe pain in the stomach.4. Vertigo or dizziness.5. Severe sudden nausea and vomiting.6. A fever, with or without a chill.
1. Any escape of blood from the vagina, whether in the form of a sudden hemorrhage or a constant leaking, like a menstrual period.
2. Headache, constant and severe.
3. Severe pain in the stomach.
4. Vertigo or dizziness.
5. Severe sudden nausea and vomiting.
6. A fever, with or without a chill.