TAKING CARE OF THE BABY BEFORE HE COMES
We shall see that taking care of your baby before he is born means
taking such care of yourself throughout pregnancy, that you not only
keep your own body in its usual good running order, but in addition, so
effectively promote the activities of your various organs that you also
keep the baby’s body going, his body that is growing all the time.
Quite reasonably this requires extra work on the part of some of your
organs, particularly those concerned with digestion and the process of
throwing off impurities. The latter is of the greatest possible
importance for in addition to excreting the usual amount of impurities
from your own body you must excrete also those thrown off by your baby.
The amount of waste from him is not large but it seems to be of such a
character that it harms the mother if it is not steadily excreted.
Good digestion and satisfactory excretion are dependent upon a number of
factors and fortunately most of them are within your own control.
Your frame of mind is one of the most important factors of all. I know
that to suggest the cultivation of a cheerful, hopeful mental attitude
is easier said than done. But after all it really is largely a matter of
habit which you can acquire if you set yourself to it, particularly if
you realize that your physical condition will be benefited by your going
through pregnancy happily. And remember that whatever is good for you is
good for your baby.
Continue with the work, amusements and exercise that you are used to and
enjoy, except of course such activities as the doctor may forbid. In
general, try to forget that you are pregnant, so far as you can do this
and still remember to take proper care of yourself.
Above all, don’t worry. Worry will interfere with your sleep and it will
also upset your digestion quite as seriously as will wrong food. Try not
to be too self-centered or too watchful of your symptoms, but at the
same time avoid the dangerous habit of thinking that any unusual
condition which develops is due to your being pregnant, for a sick
pregnancy is not normal.
It will relieve you of a great deal of anxiety if you report to your
doctor everything you do not understand, for the consciousness that he
will know just what to do, if anything is necessary, will help to keep
you from worrying.
It is important, too, for you to get rid of the depressing beliefs in
connection with pregnancy that have come down to us through the ages.
For instance, do not believe for a moment that anything you do, think or
see can “mark” or deform your baby, for remember that after conception
you give him nothing but nourishment. The only communication between you
and the baby is through your and his blood, and blood does not carry
mental impressions. Accordingly, no effects of fear, horror or
unpleasant memories which you may have can possibly reach him. It is
true that once in a while a woman does see something shocking and later
gives birth to a marked or deformed baby. But there is little doubt,
now, that such an occurrence is merely a coincidence. If you will stop
and think for a moment you will realize that most expectant mothers see
or hear or think something unpleasant at some time during pregnancy, and
yet most babies are born without mark or blemish. Anger, fright or
sudden shock may upset your digestion, but it does not directly affect
your baby.
As for that common belief that in “reaching up” the mother may slip the
cord around the baby’s neck—if you will picture for a moment how the
baby lies within the uterus you will realize how impossible this is, for
the mother’s arms have no connection with him or the cord.
So dismiss these doubts and fears from your mind and dwell instead upon
the loveliness of what is in store for you, for, I repeat, your physical
condition will be benefited if you go through pregnancy happily. And
remember again that whatever is good for you is good for your baby.
So your first step toward caring for the little life already within your
charge is to follow the example of Mrs. Wiggs, who constantly wiped the
dust from her rose-colored spectacles.
Now for the more specific details of your care. Of these the question of
your =diet= is of enormous importance.
Let us consider first what your food accomplishes if it is suitable and
conditions are favorable for its use by you and the baby. It should
provide nourishment for your various tissues, as under ordinary
conditions; it should promote the activities of your skin and kidneys,
as well as bowels, since it is through them that the waste from your own
and your baby’s body must be excreted, and your food should be adequate
also, to build and nourish the baby’s body without his having to draw
materials from your tissues. Strange as it may seem, the baby’s physical
needs are supplied before yours are met, and if there are not enough
food materials for you both, your bones, teeth and muscles will be
deprived. Furthermore, taking proper food during pregnancy is an
important step toward preparing yourself to nurse your baby, after he is
born, which is quite as urgent as nourishing him before birth.
To accomplish these ends you not only must eat suitable food, but you
must digest and absorb it as well. This requires that you constantly
guard against overeating, constipation and indigestion of any kind.
Indigestion may be avoided during pregnancy exactly as it is at other
times, by eating proper food, by cultivating a happy frame of mind; by
having sufficient exercise, fresh air, rest and sleep.
If you are accustomed to a fairly simple, well balanced, mixed diet, you
probably will need to make little or no change, except to have the
evening meal light if it has been a hearty one. It may surprise you to
learn that you need not “eat for two,” in quantity, as is so commonly
believed necessary, for during pregnancy you make so much better use of
food materials than usual that an amount and kind of food that keep you
in good condition will be adequate to meet your baby’s needs, too, until
the latter part of pregnancy. On the other hand, it is very unwise for
an expectant mother to cut down her diet, with the idea of keeping the
baby small and thus make labor easy, except under the direction of her
doctor. In general it is the size of the baby’s head that makes labor
easy or difficult, and not the amount of fat distributed over his body.
And if the mother cuts down the minerals in her diet to make the baby
bones soft, the only result is that her own bones and teeth are
softened, because the baby extracts from them enough lime to supply what
the food lacks.
Three meals a day will usually be enough during at least the first half
of pregnancy and they should be taken with clock-like regularity, eaten
slowly and masticated thoroughly. The possible need for slight
additional food during the later weeks may be supplied more
satisfactorily by lunches of milk, cocoa or broth and crackers or toast,
between meals and upon retiring, than by taking larger meals. An
expectant mother who has a tendency to nausea early in pregnancy often
feels better for taking a small lunch regularly five or six times daily
instead of the usual three full meals.
It is of the greatest importance that every pregnant woman drink an
abundance of fluid to act as a solvent for her food and waste material
and promote the activity of her kidneys, skin and bowels. She needs
about three quarts daily, most of which should be water, the remainder
consisting of milk, cocoa, soup and other liquids. Alcohol should not be
taken except upon the doctor’s orders and only moderate amounts of
coffee and tea, unless he gives permission for more.
The expectant mother will be wise to avoid fried food, pastry, rich
desserts, rich salad dressings and any other food which would ordinarily
disagree with her.
Since the enjoyment of one’s meals promotes digestion at all times, the
expectant mother should try to eat the things that she enjoys most and
that agree with her. The average pregnant woman who has no symptoms of
complications will usually be able to supply her own and her baby’s
needs and at the same time keep within the bounds of safety if she
selects her diet from the foods included in the following groups:
=Animal Foods.= Milk and eggs are the most satisfactory, but for the
sake of variety and to tempt her appetite the expectant mother will
usually be allowed to take rather sparingly, and preferably only once a
day, of fish, the various kinds of shell fish, beef, lamb, chicken or
game. Pork, veal and goose should be avoided as a rule, and particularly
by women with whom they ordinarily disagree.
=Soups.= Thin soups and broths have little food value but because of
their appetizing flavor and aroma are an aid to digestion, and
frequently by stimulating a flagging appetite will help the expectant
mother to eat and assimilate more than she would without them. But cream
soups and purées have a high food value and, like thin soups and broths,
also supply a definite amount of fluid which she must have.
=Vegetables.= The group of vegetables generally designated as “leafy”
are of even greater importance to the expectant mother than they are to
the average person. Of these she may safely eat onions, asparagus,
celery, string beans, spinach, and she should make a point of taking a
green salad, such as lettuce, cress or romaine, at least once daily.
Sweet potatoes, white potatoes, rice, peas, Lima beans, tomatoes, beets
and carrots, also, may be eaten with safety, as a rule, but cabbage,
cauliflower, corn, egg-plant, Brussels sprouts, parsnips, cucumbers and
radishes should be taken with great caution and avoided altogether if
they cause gas or any kind of distress.
=Fresh Fruits.= A necessary part of the diet is fresh fruit, and among
those fruits which are both beneficial and usually harmless are apples,
peaches, apricots, pears, oranges, figs, cherries, pineapple, grapes,
plums, strawberries, raspberries, blackberries and grapefruit. These are
more likely to be laxative if eaten alone, as before breakfast and at
bedtime. Cooked fruits are also valuable articles of diet, but are
probably less laxative than raw fruit. Some of the citrous fruits,
oranges, grapefruit or lemons, should be taken daily because they
possess a certain indispensable food value which is peculiar to them.
=Cereals.= For their nourishing and laxative qualities, cereals are
important and their food value is increased by the milk and cream which
are usually taken with them. Cooked cereals should invariably be cooked
longer than the usual directions suggest. Bran, eaten alone as a cereal
or in combination with other grains, is an excellent laxative.
=Breads.= Graham, cornmeal, whole wheat and bran bread are all good, in
general the expectant mother will be on the safe side if she eats
sparingly, if at all, of very fresh or hot breads and hot cakes.
=Desserts.= Desserts are very important for they add to the
attractiveness of most people’s meals, and if wisely chosen and properly
made, may supply a good deal of easily digested nourishment. They may
include, in addition to fresh and cooked fruits and preserves,
ice-cream, a wide variety of custards, creams and puddings made largely
of milk, eggs and some ingredient to give substance and firmness, such
as gelatin, cornstarch, rice, tapioca, farina, arrow-root and similar
materials.
In general the expectant mother should eat an abundance of fruit and
vegetables, taking at least some uncooked fruit and a green salad,
daily, and make sure that her food contains a good deal of residue, such
as is provided by fruit and coarse vegetables. This residue increases
the bulk of the material in the intestines, and this helps to overcome
the tendency toward constipation. As fat is less easily digested than
starchy foods, and more likely to cause nausea during pregnancy, it is
better to eat no more fat than usual but to supply the additional
material which is needed after about the sixth month, by taking a little
more starchy food. However, a slight increase only is necessary, and
this chiefly during the last three or four weeks.
=The Kidneys.= It is scarcely possible to say enough about the
importance of keeping your kidneys in normal working order during
pregnancy, for through them is excreted much of the waste matter from
your baby’s body as well as your own. Sometimes when these impurities
are not thrown off as they should be the expectant mother has
convulsions. You will be glad to know how much you yourself can do
toward preventing convulsions by drinking plenty of water and by
faithfully measuring your urine and taking a specimen to the doctor when
he asks you to. As I said before, you should drink at least three quarts
of fluid every day. Most of this should be water, the remainder being
milk, cocoa, soup, tea, coffee, and so on.
The doctor will probably want you to measure your urine and take a
specimen to him once a month during the first half of pregnancy and
every two weeks afterward, or even every week toward the end. He can
tell by examining the urine whether your kidneys are acting as they
should and if they are not he may save you serious trouble by putting
you to bed for a few days with no nourishment but milk and water.
In preparing a specimen you will need a covered corked vessel large
enough to hold all the urine passed in twenty-four hours, and it must be
thoroughly washed and scalded. The next step is to pass urine, suppose
we say at eight o’clock in the morning, and throw it away. All of the
urine which you pass after this time until eight o’clock the next
morning must be saved in the vessel and kept in a cool place to prevent
its decomposing. If you will put a teaspoonful of chloroform or boracic
acid powder into the vessel it will tend to preserve the urine and will
not injure the specimen. At the end of twenty-four hours the urine
should be shaken to mix it thoroughly and about half a pint poured into
a bottle that has been washed and scalded. Carefully cork and label this
with the date, your name and address and the total amount of urine
passed in the twenty-four hours. The vessel for collecting the urine and
whatever you use as a measure should be reserved for these purposes
only. If you have no tin or glass measure, a regular-size quart tomato
can will prove entirely satisfactory.
If you find, when measuring your urine, that you pass less than a quart
and a half in twenty-four hours, you may know without being told that
this is not enough and that you should drink more water.
=The Skin.= People are likely to think of the skin as being simply a
covering for the body, whereas, in reality, it is a very complicated and
active organ which helps to regulate the body temperature and constantly
throws off impurities, just as the kidneys do. This latter function is
performed by the sweat glands which open upon the surface of the skin as
the “pores,” and we are told that in all there are some twenty-eight
miles of these tiny tube-like structures in the skin. These glands
should be, and usually are, constantly active; they pour upon the
surface of the body an oily substance which keeps the skin soft; they
also excrete something more than a pint of water daily, which contains
impurities that are harmful if retained in the body. We are not aware of
this constant excretion of fluids, which is termed “insensible
perspiration,” but it continues even in cold weather and must not be
stopped if health is to be preserved. If the oil, dust, particles of
dead skin and the waste material left by dried perspiration are allowed
to remain upon the surface of the body they will clog the pores, or
gland openings, and thus interfere with their action. The removal of
this material, then, is necessary to maintain health, and is done
automatically in part for the fluid evaporates and much of the solid
matter is rubbed off on the clothing. The most important aids to the
skin’s activity are the drinking of plenty of water, deep breathing,
exercise and warm baths.
Regular and thorough bathing serves the double purpose of removing waste
matter already on the surface, and of stimulating the glands to
increased activity in giving off still more.
Many doctors advise a warm, not hot, shower or tub bath every day, with
soap used freely over the entire body, followed by a brisk rub. The best
time for this warm, cleansing bath, as a rule, is just before retiring,
as it is soothing and restful, and tends to induce sleep. Very hot baths
are fatiguing, particularly during pregnancy, and should never be taken
except with the doctor’s permission; but cold baths usually may be
continued throughout pregnancy if one is accustomed to them and reacts
well afterwards. Under these conditions the morning cold plunge, shower
or sponge is beneficial, as it stimulates the circulation and thus
promotes the activity of the skin. Some doctors forbid tub bathing of
any kind after the seventh month, on the ground that as the expectant
mother sits in the tub her vagina is filled with unsterile water and
should labor occur shortly afterward an infection, or fever, might
result. And as she is heavy and somewhat uncertain on her feet, there is
also the danger of her slipping and falling while getting in or out of
the tub. Other doctors permit tub baths throughout pregnancy, up until
the onset of labor; while as to hot foot baths, since there seems to be
no reason for or against them at any time during the nine months, they
may be taken or not at will.
Bathing in a quiet stream or lake is apparently harmless but sea
bathing, if the surf is rough, is inadvisable because of the beating of
the waves upon the abdomen and the general violence of the exercise.
The importance of keeping the body evenly warm throughout pregnancy
cannot be overemphasized, for a sudden chilling or wetting may so check
action of the skin as to impose more of a burden upon the kidneys than
they can meet, in their effort to throw off the skin’s share of the body
waste. Accordingly, a single chilling will sometimes be enough to cause
convulsions. This may be one reason why convulsions occur more
frequently during cold weather or after a sudden drop in the temperature
after warm or mild days.
=The Bowels.= The bowels, also, throw off a certain amount of impurities
and if they do not move thoroughly at least once a day these impurities
may be taken into the system and again the kidneys be given extra work.
Unhappily a great many pregnant women are constipated, particularly
during the later weeks, while women who have always had a tendency of
this kind may have trouble with their bowels from the very beginning of
pregnancy. Your bowels should move regularly every day, and to this end
you should attempt to empty them at the same hour each day, immediately
after breakfast being the best time. The importance of regularity in
making the attempt cannot be overemphasized, even though the bowels do
not always move.
The measures which tend to prevent constipation, as already pointed out,
are drinking plenty of fluids, and eating fresh fruit, coarse vegetables
and bulky cereals such as bran; also taking a glass of hot or cold water
just before going to bed and the first thing in the morning. You should
not take enemas or cathartics without your doctor’s order, but you may
safely increase the amount of fluids which you drink and the bulk of
your food, in order to regulate your bowels.
Senna and prunes cooked together prove to be helpful in keeping the
bowels regular and they are entirely harmless. A simple way of preparing
them for this purpose is to pour a quart of boiling water over an ounce
of senna leaves and allow them to stand for about two hours. A pound of
well washed prunes should soak overnight in this liquor, after it has
been strained, and then cooked in it until tender. They may be sweetened
with two tablespoonfuls of brown sugar, and the flavor improved by
adding a stick of cinnamon or slice of lemon while they are cooking.
Half a dozen of these prunes, with some of the syrup, may be taken at
the evening meal to start with, and increased or decreased in number as
necessary.
=Clothes.= The chief purpose of clothes under all conditions is to aid
in keeping the body warm, thus helping to preserve an even circulation
of the blood and the activity of the sweat glands. As has been pointed
out, this is of especial importance during pregnancy. The expectant
mother’s clothes should be not only sufficiently warm, but they should
be equally warm over her entire body. They should be light and porous,
and fairly loose, so as not to interfere with the circulation or other
bodily functions. There must be no pressure on chest or abdomen; no
tight garters, belts, collars or shoes.
The clothes of the mother-to-be, like every other detail of her care,
must be adapted to her surroundings and mode of living. If her house is
well and evenly heated during the cold months, she may quite safely
dress lightly while indoors; if it is not, she should wear underwear
with high neck, long sleeves and drawers, both indoors and out, except
when the weather is warm enough to cause perspiration. At all times,
however, the warmth of her clothing should be suited to the temperature
of the home, the climate and the state of the weather.
Remembering that it is important for you to keep up the diversions and
amusements that you enjoy, it is worth while to have your clothes as
pretty and becoming as possible, for you are much more likely to go
about and mingle with your friends if you feel that you are becomingly
and well dressed. At the same time your clothes should be so made that
their weight will hang from the shoulders instead of from the waistband.
And that brings us to the question of =corsets=, a much discussed
garment. Women who have not been accustomed to wearing corsets will
scarcely feel the need of adopting them during pregnancy except,
perhaps, during the later weeks when the heavy abdomen needs to be
supported for the sake of comfort. This need is felt particularly by
women who have had children and whose abdominal walls are somewhat
weakened in consequence.
If you have been wearing comfortable, well fitting corsets, you probably
will not feel the need of making a change until the third or fourth
month. But by this time the baby will have pushed up out of the lower
pelvis into the abdomen and your corsets then, if you wear any, must be
so constructed that they will not compress nor disguise your figure, but
will provide support and accommodate themselves to an abdomen that is
steadily increasing in size and changing in shape. Such corsets are made
of soft material; have elastic inserts and have lacings at the sides as
well as in the back. They come well down and fit snugly over the hips.
(See Fig. 10.) Some women find comfort in attaching shoulder straps to
their corsets thus suspending some of the abdominal weight from the
shoulders. But as a rule, the most comfortable arrangement is a
short-waisted maternity corset worn with a brassière that supports the
breasts and does not compress the nipples.
I hope this description will make clear to you why the same style
corsets as you ordinarily wear cannot be satisfactory during pregnancy,
no matter how large they are, and may even prove harmful.
[Illustration:
FIG. 10.—Front and side views of a satisfactory maternity corset,
adjusted at the fifth month of pregnancy. (By courtesy of Emma E.
Goodwin, New York.)
]
[Illustration:
FIG. 11.—Front, side and back views of home-made binder for supporting
a heavy, pendulous abdomen during later weeks of pregnancy. It is
adjusted as the expectant mother lies down, the ends being crossed
in the back and pinned to the lower margin of the front, thus giving
additional support.
Also breast-binder made of a straight strip of soft cotton material,
10 or 12 inches wide and 2 yards long. This is crossed in front and
held with safety-pins, the ends being carried over the shoulders and
pinned to the back of the binder. It should be snug below the
breasts but loose over the nipples. The openings over the nipples
show how this binder may be used to support the breasts of the
nursing mother. (From photographs taken at the Maternity Centre
Association, New York.)
]
Even a properly fitting maternity corset may become uncomfortable during
the last few weeks of pregnancy, and have to be replaced by an abdominal
supporter of linen or rubber. And when this stage is reached, even the
woman who has worn no corsets may find that she is more comfortable if
she adopts such a support, particularly at night. There are many
admirable binders on the market, or such an one as is illustrated in
Figs. 11 and 12 may easily be made at home as well as comfortable and
inexpensive stocking supporters, made from tapes or strips of muslin, as
in Fig. 13.
[Illustration:
FIG. 12.—Abdominal binder used in Fig. 11, showing darts at top of
front to fit it over the abdomen.
]
Your =shoes=, also, merit some thought, for your feet will probably be
larger during the latter part of pregnancy, partly because of the
possibility of their being somewhat swollen and partly because the
increased weight of your body tends to spread them. This added weight
also increases the strain put upon the arch and as a result, flat-foot
is fairly common among expectant mothers who have not taken pains to
have their arches well supported. Your shoes would better be an inch
longer than those you ordinarily wear; they should have broad, common
sense heels and fit snugly over the instep, in spite of being full
large. If your shoes are not comfortable you will find yourself tiring
easily and for this reason will tend to take less exercise than you
should.
Another reason for the need of proper shoes is that as pregnancy
advances the expectant mother becomes rather unsteady on her feet, and
broad, firm heels help to make her feel more secure. The heels need not
be flat at first, if you have been accustomed to wearing high ones, for
the sudden lowering of the heels may injure your arches, but as the
weeks wear on you would better adopt moderately low heels. High French
heels should be avoided because they not only increase the difficulty
and discomfort of walking but cause backache, as well, by forcing a
position that adds to the pressure on the lower part of the abdomen.
They increase the risk of turning the ankles, too, and of tripping and
falling, which is a very serious accident for the expectant mother.
[Illustration:
FIG. 13.—Front and back view of home-made stocking supporters made of
webbing or 1–inch strips of muslin and a pair of child’s side
garters. The straps are sewed together in the back, but pinned in
front to permit adjustment as the abdomen enlarges. (By courtesy of
the Maternity Centre Association, New York.)
]
=Fresh Air.= If you realize by this time how important it is to keep
your digestion in good order and promote the activity of all your
excretory organs, you probably suspect how important fresh air and
exercise are to you and your expected baby, because of their effect upon
your entire well-being.
The average individual uses up in a minute’s time the oxygen contained
in four bushels of air, and since the pregnant woman takes in through
her lungs the oxygen for both herself and her baby, she must have a
sufficient quantity of air to supply at least this amount.
Accordingly, you should make a point of spending at least two hours of
each day in the open air. If the weather is so stormy or severe as to
make it undesirable for you to go out from under cover, because of the
danger of getting wet or chilled, you can wrap up well and take your
airing on a protected porch or in a room with all the windows wide open.
But this is only a part of it, for the air in your house or rooms must
be kept fresh all day by being constantly changed; this requires a
steady inpouring of fresh air and outpouring of stale air.
A very good way to accomplish this is to have one or more windows open
slightly, top and bottom, all the time. But there must be no sudden
changes of temperature, nor drafts, for fear of chilling your skin. At
night you should sleep in a room with the windows open, taking care to
be well protected by light, warm coverings.
=Exercise.= Each detail of the expectant mother’s daily routine seems to
be more important than the last. And so when we come to the question of
regular out-of-door exercise we are almost persuaded to believe that
whatever else may be neglected, this is indispensable, since it promotes
digestion, stimulates the activity of the skin and lungs, steadies the
nerves, quiets the mind and promotes sleep. And more than that, walking,
which is probably the most satisfactory form of exercise for her to
take, also strengthens some of the muscles that are used during labor.
But exercise is downright injurious if continued to the point of
fatigue, no matter how little has been taken. Each woman must be a law
unto herself in this matter, therefore, and must be impressed with the
importance of stopping before she is tired. It may be a good plan for
you to start by walking only a short distance at a time, increasing this
gradually until you are able to walk possibly as much as an hour in the
morning and an hour in the afternoon without fatigue.
All violent exercise and sports are of course to be avoided,
particularly swimming, horseback riding and tennis. While motoring and
carriage driving are pleasant diversions, they cannot be classed as
exercise. They should be taken only in comfortable vehicles and over
smooth roads, so that there will be no jarring nor jolting, and the
expectant mother should not do the driving herself.
A certain amount of exercise, in the shape of light housework, may be
taken indoors. This is distinctly beneficial if not continued to the
point of fatigue, both because of the exercise which it provides, and
also the diversion and interest, for these promote mental and physical
health. But this indoor exercise must not interfere with, nor to any
degree replace the daily exercise which you take out of doors; nor must
it include heavy work, such as washing, sweeping, heavy lifting, running
a sewing machine by foot or much running up and down stairs.
However, the amount and kind of work which the expectant mother may
comfortably and safely do, are so related to what she has been
accustomed to, that it is not possible to do more than describe what has
proved of benefit for the average woman.
There are women to whom massage and gymnastics are helpful during
pregnancy when for some reason the out-of-door activities are not
possible or advisable. This might be true of an expectant mother with
heart trouble, for example, or of one who is being kept in bed to
prevent an abortion and accordingly is a matter which is closely
directed by the doctor.
=Traveling.= In general, traveling is less dangerous for the expectant
mother of to-day than formerly because it causes less strain, discomfort
and fatigue than in the old days. But the question cannot be settled
once for all women nor for all stages of pregnancy. Each woman’s general
condition must be considered; her tendency to nausea; the length of the
journey and the ease with which it may be made; also, whether or not she
has ever had or been threatened with an abortion. As a rule, it is
considered wise to avoid traveling during the first sixteen and the last
four weeks of pregnancy, and at the time of the month when menstruation
would ordinarily occur. Certainly a journey should not be undertaken at
any time during pregnancy without a doctor’s permission.
=Rest and Sleep.= When we studied the changes that take place during
pregnancy we found that as the abdomen increased in size and weight the
expectant mother was required to make a constant, though unconscious
effort to stand upright. This is probably one reason for the fatigue
which she so often feels without apparent cause, and why, upon exertion,
she tires more easily than usual.
Accordingly, you may find it necessary to rest frequently during the day
in order to avoid the ill effects of fatigue. It is a good plan to work
and exercise in short periods rather than long, always lying down when
tired, and for an hour or two after the noon meal. You should be careful
not to be over active or to overexert yourself at the time when
menstruation would occur if you were not pregnant, for fear of bringing
on an abortion. This precaution is particularly important during the
first four months, the period when abortions occur most frequently.
Since eight hours’ sleep is usually considered necessary to keep the
average person in good condition, you can scarcely expect to get along
satisfactorily with less. In fact, this is so important to your general
well-being that you should make a serious effort to secure it.
Fresh air during the day and open windows at night; prudent eating; a
comfortable bed furnished with warm but light bedding; warm baths; a hot
water bag to the feet and a hot drink upon retiring are all conducive to
sleep.
But in addition to these, and perhaps of even more importance, are
cheerfulness and a tranquil, untroubled state of mind.
=Breasts.= Breast feeding is the most urgent single need of the baby,
for whose coming we are making preparations, and practically every
mother, excepting those with definite physical disability, can supply
this need of her baby’s if she gives herself proper care both before and
after his birth. You will be glad to know in this connection that
everything that promotes your general health helps to prepare you to
nurse your baby, but there is need also for care of the breasts and
nipples themselves, to make the nursing satisfactory, and to prevent
sore nipples and possibly even breast abscesses.
Briefly, this local care consists of supporting heavy breasts, but
avoiding pressure; bringing out flat or retracted nipples and toughening
the skin which covers them.
After they become heavy and uncomfortable the breasts may be supported
by brassières, which are snug below the breasts, loose over the breasts
themselves and suspended from shoulder straps; or by some such binder as
is shown in Fig. 11, which answers the same purpose.
If your nipples are flat or retracted, you should begin about the fifth
month to make them more prominent in order that when the baby nurses he
may be able to grasp them easily. There are several ways of
accomplishing this, all of them in the nature of massage, but whatever
is done must be done regularly and persistently. One simple and
effective method is to grasp the nipple between the thumb and
forefinger, draw it out, hold it for a moment, then release it and allow
it to retract. This should be done over and over, two or three times
daily. Or the unstoppered opening of a warm bottle may be placed over a
flat nipple and held in place until the nipple is drawn up into the neck
of the bottle as it cools and a partial vacuum is formed.
The toughening of the nipples should be begun eight weeks before the
baby is expected. There are two general methods which seem to give about
equally satisfactory results. One is to soften the skin, and the other
is to harden it. In either case the nipples should first be scrubbed
gently with a soft brush or cloth, warm water and soap, for about five
minutes night and morning. After the scrubbing they should be rubbed
with lanolin, cocoa butter or vaselin and covered with a piece of clean
soft cloth or gauze, to protect the clothing. Or, they may be bathed
with a wash consisting of equal parts of a saturated solution of boracic
acid and 95 per cent alcohol. You will probably have to have a druggist
prepare this for you because of the alcohol.
But no matter which course is followed the care must be regular to be
effective. You will find that matters will be simplified if you will
assemble in one place and keep in readiness the soap, brush and lotion
or ointment which you use each time, using them for no other purpose.
=Care of the Teeth.= It is very important for the expectant mother to
give her teeth scrupulous care from the beginning of pregnancy, for in
addition to the ordinary wear and tear with which we all have to cope,
her tendency to have an acid stomach makes her mouth acid and this is
bad for her teeth. Accordingly, in addition to using dental floss and
brushing your teeth after each meal, you should use an alkaline mouth
wash several times daily, particularly after vomiting and before
retiring, for much damage may be done by the acid secretions in the
mouth if they are allowed to bathe the teeth during the long night
stretches. Common baking soda (a teaspoonful to a tumbler of water),
lime water or milk of magnesia all make excellent mouth washes. It is
important, also, that you consult a dentist as soon as you know that you
are pregnant and have any necessary repairs done promptly, for delay may
be serious.
COMMON DISCOMFORTS DURING PREGNANCY
You may have a number of minor ills and temporary disturbances during
pregnancy which are not serious but capable of making you very
uncomfortable, and which you may sometimes relieve yourself. But should
they be severe or persistent, you should consult your doctor at once.
The most common of these minor discomforts may be grouped as digestive
disturbances and “pressure symptoms.”
Chief among the digestive disturbances are “morning sickness,”
“heartburn,” “distress” and flatulence or “gas.”
“=Morning sickness=” is probably the commonest discomfort of pregnancy
as it occurs in about half of all cases. Because of the expectant
mother’s tendency to nausea during the early months, it may be brought
on by slight causes which would not produce nausea under ordinary
conditions. While it is true that grief, anxiety, fright, shock,
incessant worry, fits of temper or brooding may induce nausea when the
diet is entirely satisfactory, nausea and even vomiting may be caused in
the expectant mother just as they may in any one else by indiscretions
in diet, rapid or overeating. On the other hand, simple, light food
taken in small quantities, five or six times daily, eaten slowly and
masticated thoroughly; the cultivation of a happy frame of mind;
exercise and fresh air all tend to prevent this very uncomfortable
condition.
Prevention is of great importance, as the habit of vomiting is acquired
easily but broken up with difficulty.
When “morning sickness” occurs, however, the sufferer is often relieved
by eating two or three hard, unsweetened crackers or crisp toast,
immediately upon awaking and then lying still for half or three quarters
of an hour. She should then dress slowly, sitting down as much as
possible while doing so, and eat her regular breakfast. Lying flat,
without a pillow for a little while after meals, or whenever having the
slightest feeling of sickness, will frequently prevent, and also relieve
nausea. Sometimes comfort is derived from the use of either hot or cold
applications over the stomach. Some expectant mothers find that they can
prevent nausea by having hot coffee, or even a full breakfast before
arising. But the habit of having breakfast in bed should not be
cultivated lightly, for in spite of yourself it is likely to make you
feel like an invalid, the thing you should carefully avoid. So don’t do
it unless your doctor orders it.
“=Heartburn=,” so called, which is suffered by so many expectant
mothers, has nothing to do with the heart. It is due entirely to too
much acid in the stomach and is usually felt as a burning sensation,
which starts in the stomach and rises into the throat. It may be
prevented, as a rule, by taking a tablespoonful of olive oil or a cupful
of cream or rich milk fifteen or twenty minutes before meals and
avoiding fat and fried food at the meals themselves. Or, it may be
enough simply to avoid eating fats and fatty foods. Since the painful,
burning sensation is directly due to too much acid in the stomach, it
usually may be relieved by taking a tablespoonful of lime water; a
teaspoonful of sodium bicarbonate in water; a small piece of magnesium
carbonate; or a drink of any alkaline water that one fancies.
“=Distress.=” Another common discomfort of pregnancy is called
“distress” by the sufferers themselves, and occurs after eating. It may
be neither heartburn nor pain, but resemble both and make the expectant
mother very miserable. It is usually suffered by women who eat rapidly,
do not chew their food thoroughly or who eat more at one time than the
stomach can hold comfortably. This is one more reason for taking small
amounts of food at a time, eating slowly and masticating thoroughly.
=Flatulence=, or “gas,” may or may not be associated with heartburn, but
is fairly common among expectant mothers, and is rather uncomfortable. A
daily bowel movement is of prime importance in preventing and relieving
flatulence and at the same time foods which form gases should be
carefully omitted from the diet. The chief offenders are parsnips,
beans, corn, fried foods, sweets of all kinds, pastry and very sweet
desserts. Yeast cakes and artificially fermented milk sometimes help to
prevent flatulence.
=Pressure Symptoms.= Under the general heading of pressure symptoms are
several forms of discomfort resulting from pressure of the enlarged
uterus (containing the baby) on the blood-vessels which return from the
lower part of the body, thus interfering with the flow of blood back to
the heart. The commonest pressure symptoms are swollen feet, varicose
veins, hemorrhoids (piles), cramps in the legs and shortness of breath.
They may appear at any time during the last half of pregnancy and they
grow worse as the weeks wear on.
[Illustration:
FIG. 14.—Right-angled position to relieve swelling or varicose veins
of the feet and legs. (By courtesy of the Maternity Centre
Association.)
]
=Swelling of the feet= is very common, and when very slight may not be
serious or particularly uncomfortable. The swelling may be confined to
the back of the ankle, which grows white and shining, or it may extend
all the way up the legs to the thighs. Sitting down, with the feet
resting on a chair, or lying down with the feet elevated on a pillow
will give a certain amount of relief. If the swelling and discomfort are
extreme, the expectant mother may have to go to bed until they subside,
but very often she will be relieved by elevating her feet or assuming
the right-angled position shown in Fig. 14, for even a little while,
several times a day. But while employing these harmless measures to make
yourself comfortable, you must remember that the swelling of your feet
and ankles is one of the symptoms that your doctor wants to know about.
For this reason you should promptly report to him even the slightest
swelling and begin to measure and save your urine for examination.
=Varicose veins= are not peculiar to pregnancy but they are among the
pressure symptoms which frequently appear during the later months,
particularly among women who have borne children. The enlargement of the
veins is not usually serious but it may cause a good deal of discomfort.
While varicose veins may occur in the vulva, they are usually confined
to the legs, and both legs are about equally affected. Sometimes,
however, the veins in the right leg are more distended than those in the
left, or the right side alone may be affected.
Considerable relief may be obtained by keeping off the feet,
particularly by elevating them, and also by the use of elastic bandages.
When an expectant mother finds it difficult or nearly impossible to sit
or lie down for any length of time, she may secure great relief in a few
moments by lying flat on the bed with her legs extended straight into
the air, at right angles to her body, resting against the wall or head
board, as shown in Fig. 14. This right-angled position for five minutes,
three or four times a day, will accomplish wonders in reducing varicose
veins.
A spiral elastic bandage, also, will give comfort and help to prevent
the veins from growing larger, if applied freshly after each time that
the leg is elevated. The most satisfactory bandages, from the standpoint
of expense, comfort and cleanliness, are of stockinette or of flannel
cut on the bias, measuring three or four inches wide and eight or nine
yards long. If made of flannel, the selvages should be whipped together
smoothly so that there is neither ridge nor pucker at the seam. The
bandage should be wrapped around the leg with firm, even pressure,
starting with a few turns over the foot to secure it, and leaving the
heel uncovered, carried up the leg to a point above the highest swollen
vessels. As a rule the bandage may be left off at night.
There are satisfactory elastic stockings on the market, but they are
fairly expensive, often cannot be washed and seem to offer no practical
advantage over the bandages.
Swollen veins in the vulva may be relieved by lying flat and elevating
the hips, or by lying on the side with the hips elevated on a pillow for
a few moments several times a day, as shown in Fig. 15.
[Illustration:
FIG. 15.—Lying on the side with hips elevated to relieve swelling or
varicose veins of the vulva. (By courtesy of the Maternity Centre
Association.)
]
=Hemorrhoids=, or “piles,” are virtually varicose veins which protrude
from the rectum, but, unlike those in the legs, are extremely painful.
As it is the straining in constipation that causes these enlarged veins
to protrude from the rectum, this is one more reason for preventing
constipation, for a pregnant woman whose bowels move freely every day
rarely has hemorrhoids. If hemorrhoids appear, and give pain, the first
step is to soften the fingers with vaselin and gently push the
hemorrhoids back into the rectum. You can do this quite easily for
yourself. You should notify your doctor if you have hemorrhoids, but
while waiting to see him, if you are very uncomfortable you will be
almost certain to find relief in lying down with your hips elevated on
one or two pillows; applying an ice bag to the rectum, or ice-cold
cloths or cloths wrung from equal parts of water and witch hazel.
Sometimes the hemorrhoids are worse during the first few days after the
baby is born but as a rule they disappear when the ultimate cause is
removed, which in this case is pressure made by the baby.
=Cramps in the legs=, numbness or tingling may be caused by pressure of
the large, heavy uterus upon nerves supplying the lower extremities.
Lying down, applying heat and rubbing the painful parts will usually
relieve the discomfort.
=Shortness of breath= is sometimes very troublesome toward the end of
pregnancy, and as may be easily understood, is due to the upward, and
not downward pressure of the uterus. For this reason the discomfort is
made worse by lying down and relieved by one’s sitting up or being well
propped up on pillows or a back rest.
=Vaginal Discharge.= Although the normal vaginal discharge is increased
during the later months of pregnancy you should tell your doctor if your
discharge is very free. You should not take douches to remove it, unless
your doctor orders them, for the normal discharge gives you a certain
amount of protection against infection. If it is irritating or causes
itching or burning you may obtain relief by avoiding the use of soap and
by bathing the uncomfortable parts with water, containing a teaspoonful
of sodium bicarbonate to a pint, or with olive oil.
=Itching of the skin= is a fairly common discomfort, and is possibly a
result of irritating material being excreted by the skin glands and
deposited upon the surface of the body. The local irritation usually may
be relieved, if not very severe, by bathing the uncomfortable areas with
the solution of sodium bicarbonate as above, or a lotion consisting of a
pint of lime water, half an ounce of glycerin and thirty drops of
carbolic acid. It is a good plan, also, to drink more water, in order to
promote the activity of the skin, kidneys and bowels, and thus dilute
the material that may be responsible for the itching and increase its
elimination through all channels.
Some women complain of discomfort caused by the stretching of the skin
over the enlarged abdomen. There is a very old belief that rubbing the
skin with oil will relieve this sensation and also prevent the
appearance of the purplish streaks described in a previous chapter.
There seems to be little foundation for this belief, but if a woman
fancies that she is safer and more comfortable after oiling her abdomen,
there is certainly no reason why she should not do so.
HELPING TO PREVENT COMPLICATIONS
I have described to you the details of personal hygiene which your
doctor is likely to want you to adopt during your months of expectancy,
and some of the simple things that you may do to relieve minor
discomforts when they arise, for having these things in black and white
may make the whole matter a little easier for you.
But there is still more that you can do to help the doctor help you. You
can tell him about any discomfort or any new condition that appears, and
follow his advice instead of talking it over with your family or
friends. This will make it possible for him to prevent serious
complications by treating them in the very beginning.
You have probably learned, in one way or another, that the complications
associated with childbirth that are most serious are infections
(childbed fever), convulsions, abortions or miscarriages and severe
bleeding, but perhaps you have not heard that you, yourself, can help
greatly in the prevention of all of these conditions, in your own case,
and chiefly by little more than exercising good common sense.
Your part in preventing childbed fever, if your baby is to be born at
home, lies in having in readiness a clean room, sterile sheets, towels,
gauze pads, etc., as will be described in the next chapter.
Concerning the other complications we shall say a word here.
=Convulsions.= You can do a great deal toward preventing the condition
that causes convulsions by following the advice about your personal care
that we have just gone over and by making it possible for the doctor to
treat early symptoms promptly. In fact, after looking over the records
of many thousands of mothers who have had prenatal care, it seems almost
safe to say that the expectant mother who follows such a course will not
have convulsions.
One of the commonest of the early symptoms is headache, sometimes
persistent and very severe. Others which you can detect are blurred
vision, spots before the eyes, dizziness, vomiting which is more
persistent or severe than could be called “morning sickness,” puffiness
under the eyes or elsewhere about the face or hands, swelling of the
feet and ankles and severe pain in the stomach. It might be that if you
had even one of these symptoms your doctor would think it worth while to
put you to bed and give you nothing but milk, or only water, for a day
or two, not because you were sick, but to keep you from being so, on the
same principle that you darn a thin place in a stocking to keep a hole
from coming.
In any event, tell your doctor about the symptoms and let him decide
what is to be done, for therein lies your safety.
=Miscarriages.= The question of abortions, miscarriages and premature
births is one of enormous importance, and one about which there is a
good deal of misunderstanding. As to the meaning of the terms, many
women are puzzled to know the difference between them. Doctors are not
likely to use the word miscarriage, but will describe as an abortion a
termination of pregnancy which occurs before the end of the seventh
month and as premature labors those occurring from that time until the
expected date of confinement. In the minds of lay people, however, the
term abortion is often associated with criminal practice, miscarriage
being a term loosely applied to all births occurring before the seventh
month, while the premature baby is the one born after the seventh month
of pregnancy but before the expected date of confinement.
Of all of these accidents, abortions are the most frequent, though in
the nature of things it is impossible to say how often they occur. They
sometimes happen so early in pregnancy that the expectant mother is
unaware of the accident; or if she does know of it she may make the
mistake of taking no notice of it or regard it of so little consequence
that she does not consult a doctor. But such information as is available
suggests that at least one out of every five pregnancies ends in
abortion, the tragedy of this being that it is very largely a
preventable disaster.
Since the ovum is insecurely attached to the uterine lining until the
sixteenth or eighteenth week, an abortion is more likely to occur during
this time than later, while of this period, the second and third months
seem to be the most perilous. Abortions are less likely to happen during
first pregnancies than succeeding ones and their frequency seems to
increase with the number of pregnancies. They occur more often among
women over thirty-five years than in younger ones, and in all cases are
most likely to take place at the time when menstruation would fall due
were the woman not pregnant.
The prevention of abortions is of such obvious importance and there is
so much that you can do to this end, that we shall take up the question
somewhat at length. Preventive treatment really begins very early. In
the discussion about menstruation we referred to the importance of
finding out the cause of painful periods, in the interest of good
obstetrics, since inflammation of the uterine lining or a misplaced
uterus might be responsible for the pain and if neglected might cause an
abortion later on. The correction of such troubles, no matter when they
are discovered, is an early step toward preventing abortions.
But after pregnancy has actually begun, there are certain preventive
measures which have proved to be very effective. A woman who is pregnant
for the first time, and who, therefore, does not know whether she is
likely to have an abortion or not, should avoid such risks as fatigue,
sweeping, lifting or moving heavy objects, running a sewing machine by
foot, running, jumping, dancing, traveling or any action which might jar
or jolt her during the first sixteen or eighteen weeks.
An expectant mother who has had an abortion will have to take even
greater precautions, as she is in more danger than is a woman who has
not had this experience. It is of prime importance, to begin with, that
she have the cause of her previous abortion discovered, and if possible
corrected. And since the accident is most likely to be repeated at about
the same time, or a little earlier, in each succeeding pregnancy it is a
wise precaution for the expectant mother to remain quietly in bed for at
least a week before and after the time when an abortion may be feared.
Complete rest and relaxation are such effective preventive measures that
patients with a tendency to have abortions who have been willing to stay
in bed during most of their pregnancy have sometimes been rewarded by
going through the entire period and in the end giving birth to a normal,
fully developed baby. As out-of-door exercise is clearly impossible in
such cases, it is important that the patient keep her room very well
ventilated all of the time, and possibly, under the doctor’s direction,
have massage or bed exercises.
The marital relation is usually considered inadvisable in all cases
after the eighth month of pregnancy, and among women who have had
abortions or miscarriages it is best omitted throughout the entire
period. This is particularly true of women over thirty-five who are
pregnant for the first time.
To sum it up in a word, your part in preventing an abortion or
miscarriage after pregnancy has begun, consists largely of avoiding
fatigue; resting when tired; avoiding physical shocks such as blows upon
the abdomen, jolts or falls particularly during the first sixteen or
eighteen weeks and at the time when menstruation would ordinarily occur
if you were not pregnant, and avoiding overwork during the later weeks
of pregnancy.
The common symptoms of abortions or miscarriages are bleeding, often
accompanied by recurring pain, beginning in the small of the back and
finally felt as cramps in the lower part of the abdomen. Since
menstruation is suspended during pregnancy you should always regard
bleeding or a bloody discharge as a symptom of a possible miscarriage,
whether you have pain or not. Upon its appearance you should send for
the doctor, go to bed at once and keep absolutely quiet.
Should you be so unfortunate as to have a miscarriage, in spite of all
your precautions, bear in mind that you will need to stay in bed quite
as long afterwards and have the same care as though you had given birth
to a fully developed baby. It is because so many women fail to
appreciate this that abortions and premature births are often followed
by ill health and invalidism. Under proper care, an abortion or
premature labor is not, of itself, any more serious for a woman than a
normal delivery.
=Bleeding= from the vagina, or a sudden increase in the size of the
abdomen with perspiration and a sudden feeling of faintness, may be the
beginning of severe bleeding, or hemorrhage, from any one of a number of
causes, and in such a case the expectant mother should notify her
doctor, go to bed at once and keep quiet until he arrives.
Summing up the whole question of preventing complications, we find that
the following symptoms may be forerunners of serious trouble and
therefore should be watched for and reported to the doctor as soon as
they are noticed:
1. Persistent or severe vomiting.
2. Persistent or severe headache.
3. Dizziness.
4. Blurred vision or the appearance of black spots before the eyes.
5. Puffiness under the eyes, or elsewhere about the face.
6. Swelling of the feet, ankles or hands.
7. Sharp pains, particularly in the stomach.
8. Prolonged failure to feel the baby’s movements after they have once
been felt.
9. Bleeding, or a bloody discharge.
10. Pain in the small of the back followed by cramp-like pains in the
abdomen, before the expected date of confinement.
11. Unwarranted mental depression, anxiety or apprehension.
These are generally accepted as the danger signs of pregnancy, any one
of which, alone or in combination with one or more of the others, is of
importance. In addition to these it really is important that you talk to
your doctor or your nurse freely if you are feeling worried or depressed
about anything at all. Sometimes one feels blue without knowing why, and
if you should feel so during your pregnancy you should not keep it to
yourself but talk it over with your doctor or your nurse.
When all is said and done, what we want for each expectant mother is
little more than that she shall live a normal, regular, wholesome life;
that she shall be able, and what is of equal importance, be willing to
weave into her everyday life the principles of personal care which every
one should adopt; that she shall watch and be watched for symptoms of
complications throughout the entire period of pregnancy, in order that
they may be detected early, speedily treated and serious troubles
thereby prevented.
The adoption of such simple precautions will pave the highroad to health
and happiness for yourself and your baby.