GETTING READY
TO BE A MOTHER
[Illustration]
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[Illustration:
_From the painting by Gari Melchers._
THE CARESS
]
THE BEGINNING
“Where did I come from, where did you pick me up?” the baby asked its
mother.
She answered, half crying, half laughing, and clasping the baby to her
breast:
“You were hidden in my heart as its desire, my darling.
“You were in the dolls of my childhood’s games: and when with clay I
made the image of my god every morning, I made and unmade you then.
“You were enshrined with our household deity, in his worship I worshiped
you.
“In all my hopes and my loves, in my life, in the life of my mother you
have lived.
“In the lap of the deathless spirit, who rules our home, you have been
nursed for ages.
“When, in girlhood, my heart was opening its petals, you hovered as a
fragrance about it.
“Your tender softness bloomed in my youthful limbs like a glow in the
sky before sunrise.
“Heaven’s first darling, twin-born with the morning light, you have
floated down the stream of the world’s life, and at last you have
stranded on my heart.
“As I gaze on your face mystery overwhelms me; you who belong to all who
have become mine.
“For fear of losing you I hold you tight to my breast. What magic has
snared the world’s treasure in these slender arms of mine?”
From “The Crescent Moon” (child poems), by Rabindranath Tagore.
GETTING READY TO BE A MOTHER
_A Little Book of Information and Advice for the Young Woman Who is
Looking Forward to Motherhood_
BY
CAROLYN CONANT VAN BLARCOM, R.N.
AUTHOR OF “OBSTETRICAL NURSING,” “THE MIDWIFE IN ENGLAND”
_Formerly Assistant Superintendent and Instructor in Obstetrical Nursing
and the Care of Infants and Children at the Johns Hopkins Hospital
Training School for Nurses. Honorary Member of the Midwives’ Institute,
England._
WITH AN INTRODUCTION BY
J. CLIFTON EDGAR, M.D.
_Emeritus Professor of Obstetrics and Clinical Midwifery in the Cornell
University Medical College; Consulting Obstetrician to Bellevue
Hospital; Surgeon to the Manhattan Maternity and Dispensary; Consulting
Obstetrician to the New York Maternity, Jewish Maternity, and Greenwich
General Hospitals._
AND
FREDERICK W. RICE, M.D.
_Associate Professor of Obstetrics, New York University and Bellevue
Hospital Medical College; Attending Obstetrician to Bellevue Hospital;
Assistant Surgeon to the Manhattan Maternity and Dispensary; Assistant
Surgeon to St. Bartholomew’s Clinic and Hospital._
_WITH SEVENTY ILLUSTRATIONS_
New York
THE MACMILLAN COMPANY
1922
_All Rights Reserved_
PRINTED IN THE UNITED STATES OF AMERICA
COPYRIGHT, 1922,
BY THE MACMILLAN COMPANY.
Set up and electrotyped. Published December, 1922.
TO
THE BABY,
UPON WHOSE WELLBEING
DEPENDS THE FUTURE
OF THE RACE
PREFACE
The young woman who is looking forward to motherhood is very often torn
by sharply conflicting emotions. Her eagerness to have a baby and her
happy anticipations may be dimmed by fears and misgivings, by
superstitious and erroneous beliefs born of an ignorance that is little
less than pathetic. A little information about physiological functions
and an explanation of some of the facts of motherhood prove to be very
reassuring to the mystified, uninformed young woman.
There is, too, the immeasurably important question of the expectant
mother’s personal hygiene—the general scheme of her living in such a way
as to promote her own and her baby’s welfare—concerning which the
average young woman is almost wholly ignorant.
But the busy doctor, who gives of himself, impartially, to a large
number of patients, often finds it difficult to discuss with each one,
in a leisurely, reassuring way, the facts that he would like to have her
grasp, the misinformation he would like to dispel and the small but
influential details of her daily life that he wishes her to consider. It
is just such simple information and such details of personal hygiene
that I have attempted to set forth in this little book, with the hope
that it may help the expectant mother intelligently and confidently to
do her part in making ready for the baby; and to spend the period of her
expectancy in a happy frame of mind, free from haunting anxieties. And I
have given some space to a description of the course of the baby’s
development in order that his mother might have an abiding sense of his
reality and his need of her protecting care from the very moment of his
origin.
In no sense does this book replace the doctor’s care, for it is merely a
composite of the advice about simple, everyday little things which the
majority of obstetricians give to the average, normal woman. I have
stressed the fact that the first need of both mother and baby, from the
beginning of pregnancy, is supervision by a physician and that such
advice as these pages offer is of value only as it forms a part of his
personal care.
I have drawn information from “The Practice of Obstetrics,” by J.
Clifton Edgar, M. D.; “Obstetrics,” by J. Whitridge Williams, M. D.;
“The Prospective Mother,” by J. Morris Slemons, M. D.; “The Diseases of
Infants and Children,” by J. P. Crozer Griffith, M. D. and “The Newer
Knowledge of Nutrition,” by E. V. McCollum, Ph. D., Sc. D. I am deeply
indebted to Dr. J. Clifton Edgar, Dr. Frederick W. Rice and Dr. John W.
Harris for helpful advice and criticisms and to Miss Louise A. Schofield
for editorial assistance. Practical suggestions have been generously
contributed by other doctors, and by nurses, in this country and Canada,
whose effective work is inspired by their belief that the future welfare
of our race depends upon the care given to-day to maternity patients and
their babies.
CAROLYN CONANT VAN BLARCOM.
149 East 40th Street
New York City
INTRODUCTION
The childbearing function is a wonderfully complex physiological
phenomenon. It affects and is influenced by almost every organ and
tissue in the human body.
The body of the female child from the earliest weeks of its life in its
mother’s womb, while receiving nourishment from her body, through
infancy and the years of childhood to maturity is being gradually molded
and developed for the special carrying out of this one function—the
crowning and most vital act of woman.
Although the childbearing function is the origin and source of the human
race, existing throughout the ages, the processes connected with it have
only in recent years been clearly understood.
Our present-day knowledge of the processes connected with childbirth
makes it easy to understand how, in the early ages of the human race,
the function was a normal function, with little or no danger to mother
or child. But with the gradual growth of the race, with the beginning of
the struggle for existence and the appearance and spreading of disease,
all interfering with the natural growth and development of the body, the
function of child bearing ceased to be a normal function, as designed by
its Maker, and became one fraught with dangers to both mother and child.
Nevertheless, through ignorance of these changes brought on by
civilization, the idea that the function is a normal process, the risk
slight and fatalities infrequent and when occurring, inevitable, is the
almost universal belief to-day.
The dangers to the life of the mother and child in the carrying out of
this function are well known to the medical profession, as well as the
fact that for the most part they are preventable. Yet in spite of this
knowledge, each year brings forth, unchanging, its toll in fatalities
and countless numbers of invalid mothers, with the inevitable destroying
factor of the happiness of the home.
Statistics are available to show that less than half of all pregnancies
are normal and that the illness and loss of human life, from causes
associated with childbirth, are distressingly and needlessly high.
Failure to get these facts to the public; failure to teach lay women the
dangers to be avoided and the methods of protection, is one very
important reason why there has been no decrease in the high mortality
rates.
During the past ten years, maternity hospitals and private and public
health bodies, in various parts of the country, have obtained wonderful
results, locally, in reducing infant and maternal mortality, by giving
to large groups of prospective mothers information concerning the common
dangers associated with childbirth and how they might best be prevented.
If every expectant mother, no matter what her status or location,
followed the simple, practical advice which this book offers, the rate
of illness and death among our mothers and babies would be materially
lessened.
This book, therefore, so complete in its information on every subject
pertaining to the mother during pregnancy and confinement and of the
care of the newborn infant, should be far reaching in its beneficial
results.
It is a book containing knowledge which every physician must admit that
expectant mothers should have, and which a large number of expectant
mothers are now earnestly seeking for their own protection and that of
their newborn.
J. CLIFTON EDGAR, M. D.
FREDERICK W. RICE, M. D.
New York City
November, 1922
CONTENTS
PAGE
PREFACE xi
INTRODUCTION, BY J. CLIFTON EDGAR, M.D., AND FREDERICK W.
RICE, M.D. xiii
CHAPTER
I GETTING READY TO BE A MOTHER 1
II SIGNS THAT A BABY IS COMING 11
III WHERE THE BABY’S LIFE BEGINS 20
IV HOW THE BABY DEVELOPS BEFORE HE IS BORN 34
V TAKING CARE OF THE BABY BEFORE HE COMES 46
VI MAKING READY FOR THE BABY 82
VII THE BABY’S ARRIVAL 98
VIII THE BABY’S MOTHER 114
IX THE MOTHER’S CARE OF HERSELF—FOR THE BABY’S SAKE 138
X THE MOTHER’S CARE OF HER BABY 148
XI THE NUTRITION OF MOTHER AND BABY 226
LIST OF ILLUSTRATIONS
“The Caress” by Gari Melchers _Frontispiece_
_Chapter III._
FIG. PAGE
1. Diagram of pelvis 21
2. Side view of female generative organs 23
3. Front view of female generative organs 25
4. Diagram of human ovum 26
5. Front view of breast 32
_Chapter IV._
6. Diagram showing process of cell division 36
7. Diagram of baby, cord, membranes and placenta
within the uterus 38
8. Appearance of the baby at different stages of
development 40
9. Position of baby in the uterus just before
birth 42
_Chapter V._
10. Front and side views of maternity corsets 59
11. Front, side and back views of home-made
abdominal binder and breast bandage,
applied 60
12. Abdominal binder used in Fig. 11 61
13. Front and back views of home-made stocking
supporters 62
14. Right-angled position for relief of swollen
feet and legs 71
15. Lying with hips elevated to relieve swelling
of vulva 73
_Chapter VI._
16. Leggings for use at the baby’s birth 88
17. Pad made of newspapers, to protect bed 90
18. Pattern for baby’s petticoat 92
19. Pattern for baby’s dress 93
20. Outfit of satisfactory baby clothes 94
21. Baby’s toilet tray 96
_Chapter VII._
22. Diagram showing cervix in process of being
dilated 101
23. Drawing showing descent of baby during birth 104
24. Helping the baby to breathe 111
_Chapter VIII._
25. Supporting heavy breasts with straight binder 118
26. Supporting heavy breasts by means of three
folded towels 119
27. Indian binder for heavy breasts 120
28. Protecting nipples with sterile gauze 121
29. Position of mother and baby while nursing in
bed 123
30. Using shield to protect sore nipples, while
nursing baby 124
31. Nipple shield used in Fig. 30 125
32 to 38, Bed exercises
inclusive. 128 to 131
39. Knee chest position 132
40. Walking on all fours 133
_Chapter X._
41. Baby’s weight chart 151
42. Diagram of first teeth 153
43. Appearance of fresh cord immediately after
birth 154
44. Appearance of cord four days after birth 155
45. Appearance of navel after cord has dropped
off 155
46. Appearance of normal, well healed navel 156
47. Preparing the baby’s milk 169
48. Position in which to hold baby and bottle for
feeding 172
49. Holding baby upright after feeding to prevent
colic 173
50. Putting the baby into his bath 185
51. Supporting the baby’s head above water while
giving bath 186
52. Dry, sterile cord dressing 189
53. Flannel band over cord dressing 190
54. Putting on the straight diaper 191
55. The diaper in Fig. 54 applied 192
56. The Sutton poncho 198
57. Method of carrying baby to support back and
head 200
58. Training the baby to use a chamber 202
59. Elbow cuffs to prevent thumb sucking 203
60. Immersing baby for bran or mustard bath 209
61. Putting the baby into a wet pack 210
62. The baby in a wet pack 211
63. Diagrams showing successive steps in giving
pack 212
64. Giving the baby an enema 217
65. Quilted robe for the premature baby 220
66. Bed for premature baby improvised from a
clothes basket 221
67. The baby in a basket, ready to travel 224
GETTING READY
TO BE A MOTHER
CHAPTER I
GETTING READY TO BE A MOTHER
How does it seem to you—the coming of a baby?
Does it seem the most amazing of miracles, so stirring in its beauty and
mystery that you are eager to make ready and prepare for it fitly?
Or have you, perhaps, come to share the general feeling that motherhood
is a natural state which one accepts when it comes, but need not prepare
for?
This attitude seems to go back to a very old and deeply rooted
conviction that, as women always have had babies and have had them
through the working of one of Nature’s laws that has been operating over
and over throughout the ages, they doubtless will continue to have them
in the same old way, and the entire matter may well be left to take care
of itself. As to the baby, when he comes, one may expect that the
ability to care for him will come too.
Because of this reasoning, or lack of it, it has been a fairly general
custom for the woman who expected a baby to seek her doctor’s aid only
when she went into labor, or shortly beforehand, and to give no thought
to the care of her baby until he was born. All too often the mother has
died, because of this tardy care, been injured or become an invalid,
while equally sad things have happened to the baby—and needlessly so.
But now, happily, a great change is taking place in the realm of mothers
and babies. We still realize, of course, that childbearing is a natural
function, but we know that conditions must be made favorable for the
smooth working of this natural law if all is to be well; that for the
sake of both mother and baby it is of urgent importance to give thought
and care to the baby during the nine months before he is born.
There is little doubt that the most critical period in one’s life is the
first ten months—the nine months before birth and the first month
afterward—and that the care which is given during these months
influences one’s physical state, for good or ill, throughout all the
rest of life. In the light of this knowledge, women are more and more
generally seeking and being given “prenatal care,” which is care before
the baby is born, together with advice and instructions which fit them
to assume motherhood safely and successfully.
Ideal prenatal care would really begin during the expectant mother’s own
infancy, for the chances of a normal pregnancy, labor and lying-in
period are greatly increased by good care during the early years of
life. But for the time being we shall have to content ourselves with an
effort to extend, as widely as possible, the care that is now known to
be beneficial for expectant mothers from the beginning of pregnancy.
This prenatal care is undertaken in much the same spirit in which one
makes a garden, for example. We know, of course, that plants which are
neglected sometimes grow and blossom satisfactorily, though one would
not think of depending upon them to do so. But we have learned that
plants that are given the care and protection that they need are almost
certain to flourish and bloom after the manner of their kind.
Experience teaches, however, that this care must be regular and
sustained and always given for the twofold purpose of preserving the
plants from injury as well as nourishing them. Accordingly we put them
in good soil, to begin with, and then give water, sunshine or shade,
according to their respective needs, and we take care to protect them
from the destructive effects of harmful insects, blights, weeds or
anything which may be unfavorable to their healthy progress. We do not
close our eyes to the fact that these harmful conditions are possible.
Instead, we are anxious to find out all about them—what causes them and
how to recognize them—in order that we may prevent or remove them before
they do serious damage.
Many women, nowadays, are taking just that kind of attitude toward
motherhood. They begin by consulting a doctor as soon as they know that
they are pregnant, because they appreciate the importance of doing so.
They study eagerly the questions relating to motherhood; the structure
and workings of those parts of their own bodies which are concerned with
the baby’s creation; how he evolves within them; what he needs during
those nine months of development; what practices, what conditions are
bad for the baby and themselves; what they can do to avoid or correct
these and how they can help to make things go smoothly.
The women who face the facts of motherhood in this way generally go
through the entire adventure normally and successfully, as Nature
intended they should. More than this, those women who place themselves
under a doctor’s care from the beginning of, or early in, pregnancy, are
greatly reassured to find out how much can be done to safeguard them,
and they do not have that fear of the approaching birth which is
suffered by so many women who do not know nor understand what is going
on.
The results of the painstaking work and study which have been carried on
to increase the comfort and safety of mothers and babies have made it
possible for the doctors to plan something of a routine which they find
advisable for their patients to adopt. To begin with, it is quite plain
that the first need of every expectant mother is examination and
measurement, early in pregnancy, by a good physician. The information
thus obtained helps the doctor to foretell the kind of labor that his
patient is likely to have, and by planning for it ahead of time he is
often able to save her much harm and suffering. An early examination
also enables the doctor to discover and correct any slight trouble which
may exist at that time and which might grow worse if not treated, and to
advise his patient about the general care which he wishes her to take of
herself throughout pregnancy. In regard to this care, doctors are
generally agreed that the average woman needs to do little more than
observe the ordinary rules of personal hygiene, which as a matter of
fact, should be followed by all of us; that is, she should live a
simple, regular life as to diet, fresh air, exercise, rest, sleep,
diversions, etc. This all sounds simple enough and as a matter of
course, but it is usually overlooked in spite of being of the most
urgent importance to both mother and baby.
This advice varies in little things, here and there, among different
doctors, but in the main it is about the same the world over, where
thought is being given to the care of expectant mothers. For no matter
where they are or what their status, their needs in general are the
same. They need a doctor’s supervision and they need to practice the
principles of personal hygiene.
Accordingly, in addition to making an early examination and giving
instructions about the regulation of her daily life, the doctor usually
wants to see his patient and make certain observations every little
while during pregnancy, just to make sure that everything is going as it
should and to be in a position to discover the earliest and slightest
symptoms of complications.
In the old days there were certain complications associated with
childbirth which the doctors did not know how to prevent and sometimes
could not cure—complications which were bad for both mother and baby.
But now they know a great deal about both preventing and curing even the
most serious of these complications. They have discovered, for one
thing, that many conditions which give serious trouble during labor, or
soon afterwards, actually have their beginnings during pregnancy, and
sometimes very early.
Quite evidently, then, it means a great deal to the expectant mother to
have the doctor discover and treat these complications before they have
had time to become serious. But he can give early treatment only if he
knows about the symptoms of the trouble when they first appear. Some of
these symptoms may be detected by the expectant mother herself after
they have been explained to her, but some of them can be discovered only
by a doctor or a nurse. That is why it is important for the doctor to
see his patient at frequent intervals during pregnancy; about once a
month during the first half and every two weeks afterwards.
He sees her for much the same reasons that the housewife looks over the
contents of her darning basket—not once and for all time, but regularly,
once a week, over and over and over. She searches each time not for
holes alone, but for thin places, too; an occasional broken thread or
the beginning of a “run,” knowing how much trouble she will save
herself, later on, by promptly repairing the smallest break or evidence
of wear. She knows quite well that there are no more holes because she
looks for them, than there are if she does not, and that failure to look
for them will not keep the holes from being there nor from growing
larger. No more does the expectant mother develop a complication because
she is examined, nor does an existing condition cease to exist because
she is not examined; and yet some women still take just that illogical
attitude toward examinations and supervision during pregnancy.
One factor which keeps some expectant mothers from seeking medical care
is the well-meaning but dangerous counsel so freely offered by older
women who claim fitness to advise by virtue of having had several
children of their own. Their lack of success, as evidenced by
miscarriages, stillbirths, children dying in early infancy, as well as
injuries and disabilities of their own, is usually overlooked as they
press their superstitions and remedies upon the inexperienced and
bewildered younger woman. When disaster follows, as it so often does, it
is very likely to be ascribed to the will of God, and the mother’s
needless sacrifice does not even serve as a warning to others who are in
line for the same kind of advice.
Another obstacle to adequate prenatal care is sometimes found in the
husband who considers it entirely reasonable to secure expert advice
upon the subject of cattle-raising, let us say, or the care and running
of his automobile or about his investments, but who has a conviction
that it is normal and natural for women to have children without making
what he considers a fuss about it. He may cherish, too, a suspicion that
it is not altogether good for his wife to be thinking too much about her
condition. His mother never began bothering until the baby came.
On the other hand, many husbands show the tenderest solicitude for their
wives throughout pregnancy and would be only too eager to have them
enjoy all the benefits of prenatal care, if they only knew and
understood about it. The expectant mother will be wise, therefore, if
she undertakes to convince her husband, if need be, that her occupation
of bearing and rearing children merits quite the same thoughtful
attention as his work, to which he devotes his best powers.
How easy and worth while this may be was demonstrated a couple of years
ago at a county fair which was attended by a very intelligent farmer and
his wife. The farmer was interested in hog-raising and both he and his
wife accepted without question the fact that success in this enterprise
could be achieved only through serious study and the most painstaking
care. But as to childbearing, if they thought of it at all, they looked
upon it as simply one of those natural functions which always had and
doubtless always would take care of itself.
When this couple reached the fair the farmer entered one of his fine
animals in a prize-winning contest and as there was a baby contest, too,
the wife entered their little son. In due time the judges inspected the
various contestants and it was found that point by point the farmer’s
hog measured up to all of the standards of perfection for his kind and
easily won the first prize. Not so with the baby; point by point he fell
below even a moderate average of what a baby should be and was outranked
by many of his more robust infant competitors.
As various admirers discussed hog-raising with the farmer, it became
quite evident that he had carefully studied the question and had applied
to his occupation the most approved methods of which he could learn. But
when the doctors and nurses at the baby contest talked with the
crestfallen mother about her baby, who had seemed right enough to her,
they found that she knew little or nothing of the business of being a
mother; that it had never occurred to her nor to her husband that she
might profit by care and instruction about herself and her baby both
before and after he was born. As might be expected, she had been unable
to nurse him and on the whole he proved to be a pretty poor specimen of
a baby, with a dismal outlook as to health.
Since the mother was then in an early stage of another pregnancy, the
doctor talked it all over with her and her husband. He convinced them
that such thoughtful and painstaking care as they had devoted
successfully to hog-raising were equally effective when applied to
baby-raising. As a result, the expectant mother, with her husband’s
whole-hearted approval, placed herself under the care and supervision
which she found were available through a prenatal clinic in her
vicinity.
The happy sequel to that story is that when another fair was held, a
year later, the farmer entered another one of his hogs and the wife her
new baby, and that this baby held his own with the hog by taking a
prize, too.
So sincerely do doctors now believe in the urgency of having all
maternity patients under supervision and care during the nine months
before the baby comes and the first several weeks afterwards, that they
not only care for those women who come to their offices, but also give
of their knowledge and skill to organizations engaged in prenatal and
maternity work. These organizations may be visiting nurse associations,
prenatal clinics, health centers or dispensaries. As the doctors are
assisted by nursing staffs they are able to offer protection, through
these channels, to a very large number of mothers and babies.
Among the women who are cared for by such organizations, or by doctors
in their private practice, there is an enormous reduction in the
occurrence of convulsions, for example, abortions, miscarriages,
stillbirths, infections (childbed fever), and prolonged and difficult
labors. Or, to put it the other way round, good care started during
early pregnancy and continued throughout labor and the lying-in period
gives both mother and baby enormously increased chances to live and
enjoy good health. One reason why the baby is so much better off is that
good care practically always enables his mother to nurse him, for,
except in extremely rare cases when there is a definite physical
disability, as tuberculosis for example, every mother can nurse her baby
if she really wants to and if she, the doctor and nurse bend all their
energies to accomplish this happy end. A baby who is not breast-fed is
defrauded of a protection which is rightfully his, and usually because
someone has failed to do all in his or her power.
Organizations which include doctors and nurses who can give skilled care
to maternity patients are increasing in scope and number throughout
cities, towns and rural districts in all parts of the country. This
makes us hope that before long good care during pregnancy, childbirth
and young motherhood will be available to every woman in the land. But
quite as earnestly do we also hope that every woman in the land who is
looking forward to motherhood will seek this care. Certain it is that
the expectant mother who does seek care, whether from a doctor in his
office or through a prenatal clinic, is approaching her motherhood in
the only way that is safe for herself and her baby. She should realize,
however, that although the doctors can accomplish a great deal through
examinations and advice, they can give the full benefits of their skill
only to those women who do their part by following instructions
faithfully, week after week, throughout nine months. The doctor cannot
live his patient’s life for her; he can plan and advise her ever so
wisely, but this counts for very little unless she lives as he directs.
The young woman who sees her motherhood as a coveted privilege, crowded
with happy possibilities, who is willing to bear its inconveniences and
take the necessary precautions to insure a satisfactory outcome, is very
likely to go through her experience in good health and buoyant spirits.
And in the end she will have not only the ecstasy of possessing a
beautiful, well baby who has every prospect of continuing so, but as the
years pass she will have the satisfaction of knowing that she is a
better, more helpful, more companionable mother because of being in good
health herself.
That is the point of good maternity care—future well-being as well as
immediate safety for both mother and baby—and it rests with each woman
to decide for herself if she is to have such care.