THE CARE OF THE BODY
The Bowels--The Kidneys--The Skin--Bathing--Douches--Clothing--
Corsets--The Breasts.
If we stop to think it is only too apparent that the human body is a
machine. We seize energy in one form and convert it into another,
just as truly as do the windmill, the locomotive, and the dynamo. In
the case of the human machine, the latent energy of the food is
turned into the various activities of everyday life. Our bodies
utilize their fuel more perfectly than any machine that man has
invented; but they fail, nevertheless, to do so completely. And just
as the efficiency of an engine cannot be maintained unless the smoke
escapes and the ashes are raked away, so no human being can enjoy
health unless his waste products are promptly removed. The task of
removal, as most of us know, is assumed by our excretory organs,
which include the bowels, the kidneys, the skin, and the lungs.
During pregnancy the mother must get rid not only of her own waste
products, but also of those of the child. The waste products of the
child, if weighed, would not amount to a great deal; but they are by
no means negligible. So far as we can tell, it is chiefly on account
of their peculiar character that they increase the work of the
mother's excretory organs. Whatever the cause, they do increase it,
and experience has taught us that these organs must always be kept in
a healthful condition to protect both the mother and the child from
harm. Consequently a prospective mother who wishes to take proper
care of her body must, in the first place, direct her attention
toward keeping up the normal activity of all the excretory functions.
THE BOWELS.--While pregnant, nine out of ten women suffer from mild
constipation. Those who have been previously troubled with this
complaint may find it aggravated from the outset, but in most
instances it does not appear until after several months have passed.
Constipation is explained by the fact that the enlarged womb presses
against the intestines; and, as the enlargement increases,
constipation generally becomes more pronounced. No doubt there was a
time when women, perhaps unconsciously, counteracted this natural
result of pregnancy by the use of a diet consisting largely of fruit
and vegetables and also by outdoor exercise. Such measures, indeed,
still afford the simplest means of overcoming constipation.
Throughout pregnancy the bowels should move at least once every day.
When they do not, some of the waste material that should be removed
is absorbed by the body and seeks to leave it through the organs that
are already doing their full share of work. For example, under such
conditions, the kidneys, instead of exerting themselves more
vigorously, may become less active than they were.
It is everyone's duty to form the habit of having the bowels move
regularly. Now the most favorable opportunity for assisting the
intestines to empty themselves occurs shortly after meal-time, since
the involuntary movements of the intestines are most active while
digestion is in progress. It should be regarded as an imperative
duty, therefore, to grant Nature such an opportunity every morning
just after breakfast. This should be done at a definite hour, day
after day, even though the inclination is absent; and in many
instances the desired habit will be formed.
A glass of water on going to bed or on getting up has a laxative
effect; and there are other dietary measures which may be employed
with advantage. Thus, coarseness of the food, as we know, stimulates
intestinal activity, and this fact explains the peculiar value of
Graham bread, bran bread, and corn bread. Fresh fruit and vegetables
counteract constipation for two reasons, namely, because they leave
in the bowels a relatively large amount of undigested substance, and
because they contain ingredients that have a specific purgative
action. Such ingredients are especially noteworthy in rhubarb,
tomatoes, apples, peaches, pears, figs, prunes, and berries.
Enemas used as a routine measure are mischievous. They interfere with
the "tone" of the bowel-muscle so that it acts sluggishly and bring
about a condition in which the bowels will not move without
artificial stimulation. At best these irrigations remove no more than
the contents of the lower bowel, and should be employed only when
there is acute and urgent need of clearing out the rectum.
Obstinate constipation is uncommon, and strong purgatives are seldom
needed. If they become necessary, a physician should be consulted as
to what to take. Whenever dietary measures and exercise, which is
discussed in the next chapter, fail to counteract the natural
tendency toward constipation, the prospective mother may generally
resort to "senna prunes" or some equally simple and harmless
household remedy. Senna prunes are prepared as follows: Place an
ounce of dried senna leaves in a jar and pour a quart of boiling
water on them. Allow to stand two or three hours; strain off the
leaves and throw them away. To the liquor add a pound of prunes.
Cover and place on the back of the stove, allowing to simmer until
half the liquor has boiled away. Add a pint of water and sweeten to
taste, preferably with brown sugar. The prunes should be eaten with
the evening meal. The number required must be learned from
experience. Begin with half a dozen, and increase or decrease the
number, as required. The syrup is an even stronger laxative than the
prunes.
THE KIDNEYS.--Any one may judge for herself whether or not the bowels
are doing their work satisfactorily, but not so with the kidneys. For
this purpose the urine must be examined by a physician. In spite of
this fact, considerable responsibility rests upon the prospective
mother, whose duty it is to collect the specimens properly--a detail
that is apt to be neglected. It is impossible to urge too strongly
the importance of saving, at regular intervals, all the urine passed
in twenty-four hours, of protecting it from decomposition, and of
sending a sample to the physician. The intervals may be longer at
first, for the kidneys have very little extra work to do until the
sixth month. Usually, therefore, it is a satisfactory plan to send a
sample for analysis the first of each month during the early half of
pregnancy; but during the latter half one should be sent the first
and the fifteenth of each month.
To estimate the exact amount of urine passed in twenty-four hours and
to protect it properly, in the first place, the vessel in which it
will be collected should be carefully scalded out. As a further
precaution against decomposition, add a teaspoonful of chloroform to
the vessel, which should be kept covered, and not allowed to stand in
a warm room. Unless these details are conscientiously observed,
putrefaction may take place and vitiate the analysis the physician
wishes to make. The precise amount of urine which the kidneys excrete
in twenty-four hours will be determined as follows: At a convenient
time, for example at 8 A.M., empty the bladder and throw the urine
away; this marks the beginning of the observation. Subsequently, save
all the urine passed during the day and night, and finally at 8
o'clock the next morning empty the bladder and add this urine to that
previously collected. The total amount, thus collected, should be
measured.
It is unnecessary to send all the urine to the physician; six ounces,
somewhat less than half a pint, will be enough. But the physician
should know what the total amount was found to be; therefore, a
record of the measurement, the date, and the patient's name should
accompany the sample. If limited to a single fact about the urine, it
would be most helpful to know the amount passed during the twenty-
four hours. In this way, as I have already pointed out, the patient
herself may derive valuable information, for if the urine is scanty
in amount--that is, less than a quart--she should drink more water.
Unscrupulous newspaper advertisements alarm people through incorrect
statements about trouble with the kidneys. For example, they declare
that a sediment in the urine is a sign of disease; but that is false.
The mere act of cooling sometimes causes substances to crystallize
out of perfectly normal urine. Or, putrefactive changes which
frequently take place after the urine has stood for a time may cause
some of its normal constituents to be precipitated. A sediment,
either white, pink, or yellow, may indicate that the urine is too
concentrated, and consequently means that the individual should drink
water more freely; but it generally means nothing more serious. The
really important abnormal constituents of the urine, namely, albumin
and sugar, never form a sediment.
"Pain in the back" is a complaint frequently used to defraud the
public. This symptom does not indicate Bright's disease. It is
generally due to the muscles far away from the kidneys, with which,
usually, the pain has nothing whatever to do. Similarly a desire to
pass the urine frequently does not indicate any disturbance of kidney
function, but is explained by the pressure of the enlarged womb
against the bladder; it is a very annoying, yet a natural, result of
pregnancy.
THE SKIN.--The functions of the skin are at the very foundation of
health. It protects the delicate structures which it covers, assists
in the regulation of the temperature of the body, and excretes waste
products. The excretory function of the skin is always active, but we
are unconscious of this activity except on warm days and at times
when we perspire freely. In the coldest weather, however, the body
throws off what physiologists call the "insensible perspiration." The
most important measures for the care of the skin are those intended
to insure the activity of the sweat glands, namely, bathing and
proper clothing. But before considering these measures, we will
describe certain alterations in the skin which cannot escape the
notice of the prospective mother, and which she is likely to
misinterpret.
On account of the growth of the uterus the abdominal wall is
stretched during pregnancy. To a certain degree the skin yields to
the distention, but it finally cracks, and lines appear which are
commonly called "pregnancy streaks." At first they are delicate and
pink or blue in color; later they become white and more extensive.
The streaks indicate the situation of small breaks in the deeper
layer of the skin, which is less elastic than the upper layer. They
are not painful, and should never cause anxiety. Their size and
number vary with the degree of abdominal distention, which in turn
depends upon various factors, such as the size of the child and the
quantity of amniotic fluid. Although these streaks are most
frequently located upon the lower part of the abdomen, they may
extend to the outer sides of the thighs; and occasionally appear over
the breasts, since they too enlarge during pregnancy. Stretching of
the skin, of course, is not confined to pregnancy; consequently, the
same kind of streaks often appear in people who are growing stout.
Attempts to prevent or limit the pregnancy streaks prove futile.
There is a common belief that they may be prevented by the use of
vaselin, goose-grease, mutton-fat, or some one of a variety of
lotions; but this teaching is not borne out by experience. None of
these applications, however, are harmful, and there can be no
objection to using them except that they cause needless soiling of
the clothing. After the child is born the streaks fade of their own
accord, though they rarely disappear entirely.
In certain localities the skin grows darker during pregnancy. We have
already referred to the deepening of the color around the nipple as
one of the signs of pregnancy; a similar but much less pronounced
discoloration occurs about the navel, which also becomes shallow and
may begin to pout in the latter months of pregnancy. About this time,
with very few exceptions, there appears a more or less intense brown
line which runs downward from the navel in the middle of the abdomen.
Sometimes, though not very often, small dark areas, which have been
called "liver spots," appear elsewhere over the body. The name is
unfortunate, for the spots do not indicate a disorder of the liver.
At present it is generally admitted that alterations in the color of
the skin during pregnancy are due to deposits of iron. This mineral
substance, among others, as we have learned, is required for the
development of the embryo. The child is born with a supply of iron
calculated to meet its needs for about a year. Such a reserve is
necessary, as Bunge has pointed out, because human milk does not
contain enough iron to satisfy the infant's requirements. During
pregnancy, therefore, the mother's blood transports iron to the
placenta, where it can be absorbed into the child's system; and while
being thus transported some of it is deposited in the maternal
tissues. The deposits are especially frequent, as I have mentioned,
in the middle line of the abdomen, on account of the arrangement of
the blood vessels there. Deposits elsewhere may depend upon other
conditions; but whatever their cause the pigmentation vanishes a
short time after the birth.
Alterations in the color of the skin have no effect upon its
excretory function, which, indeed, generally becomes more active
during pregnancy. According to one estimate, the average person
possesses twenty-eight miles of sweat glands. If these figures are
not sufficient to demonstrate the importance of the skin as an
excretory organ, surely no one will fail to be impressed by the
tragic result which in one case followed throwing all the sweat
glands out of action. This was brought about in the case of a young
boy whose body was covered with gold leaf to provide entertainment at
a Parisian festival. The living statue was not exhibited, however,
for shortly after the youth was gilded he became ill and died.
In health more than a pint of water is eliminated through the skin
every day, and along with it waste products are removed from the
body. Exercise, hot drinks, warm weather, and heavy clothing promote
the activity of the sweat glands. Under certain circumstances
physicians endeavor to relieve the kidneys by stimulating their
patients to perspire freely. It should be clear, therefore, that when
a prospective mother naturally perspires it is a good indication.
Attempts to stop the perspiration are always ill advised; rather
should this function be encouraged by keeping the skin in good
condition with baths and warm clothing.
BATHING.--The accumulation of dead skin, grease, dust, and dried
perspiration on the surface of the body hinders the actions of the
sweat glands. Some of this material is wiped off by the clothing, and
more of it is removed by washing with plain water; but the most
effectual cleansing results from a liberal use of warm water and
soap.
Since the prospective mother must throw off the waste products of the
embryo as well as those of her own body, it is obvious that
cleanliness is never more important than during pregnancy. For this
reason she should take a tepid tub bath or shower every day. It is
not necessary that the temperature of the bath be determined with
accuracy or that it be always the same; but generally a temperature
between 80 and 90 degrees F. is found most agreeable. At this
temperature a bath is termed "indifferent," because it is neither
stimulating nor depressing; it is employed purely for cleansing the
body. Every part of the body should be well soaped, and from ten to
fifteen minutes should be given to washing all the exposed surfaces.
The best time for such a bath is just before going to bed, though
there is no objection to taking it during the day, provided that two
hours have passed since the last meal, and that another hour is
permitted to elapse before one goes out of doors or undertakes anything
that requires exertion.
Prolonged hot baths are fatiguing. They draw the blood from the
interior to the surface of the body; and during pregnancy they are
particularly depressing. Vapor and steam baths have a similar action
and should never be taken without the consent of a physician. They
serve admirably for the treatment of rare complications of pregnancy;
but, like medicine, their use should be limited to cases in which
they are clearly indicated.
Unless disagreeable results are noticed, those who have become
accustomed to cold baths may continue to take them during pregnancy,
but others should not. If, however, the temperature of the water is
modified so that it will not produce a shock, no one need omit the
morning plunge or shower which most persons find invigorating.
Sponging answers the same purpose, for the intent of the morning bath
is not to cleanse the body but to arouse the circulation. A thorough
rub-down assists in bringing the blood to the surface of the body.
Bath and massage together thus constitute a kind of skin gymnastics
especially beneficial throughout pregnancy.
Although hot foot-baths have sometimes been thought to cause
miscarriage, there is no good reason for believing they ever do. Sea-
bathing, on the contrary, may be directly responsible for such a
mishap. It is true that pregnant women sometimes indulge in surf-
bathing without harmful results; nevertheless the danger of
miscarriage they assume is not slight. The shock of the low
temperature, the exertion required to keep a firm footing, and the
pounding of the surf against the abdomen are all unfavorable
influences which more than counterbalance any advantage of such a
bath. On the other hand, there is slight risk if any in bathing in a
quiet stream or lake.
DOUCHES.--A great many women have the conviction that the vagina is
not clean and should, therefore, be regularly cleansed by means of
irrigations. This assumption is false and the treatment based upon it
is unnecessary. In structure the walls of the vagina closely resemble
the skin, but unlike the skin they do not contain glands; the vagina,
therefore, has nothing to do with the elimination of waste products
from the body. The secretion which issues from the vagina really
originates in the glands around the mouth of the womb, and serves to
protect the birth-canal against infection from harmful bacteria.
Careful examinations have shown that under normal conditions, which
of course include pregnancy, disease-producing bacteria are absent
from the vagina; in this respect the vagina is even cleaner than the
skin, for disease-producing bacteria are present on the surface of
the body. The vaginal secretion becomes more abundant during
pregnancy, and the increase is interpreted as an additional guarantee
against infection at the time of labor. So far as possible,
therefore, this natural antiseptic should not be disturbed.
The advice to abstain from douches will not be adopted by every
prospective mother without protest, for, as I have said, many women
regard them as necessary to cleanliness. Others who have delicate
skins are occasionally annoyed by the irritation of the vaginal
secretion, which is not only increased during pregnancy but has a
more pronouncedly acid character. Under extraordinary circumstances,
it may be permissible to use douches in the early part of pregnancy,
but it is practically never advisable to do so during the month
preceding the expected date of confinement. Furthermore, at no time
should the use of douches be begun without consulting a physician.
A more rational hygienic measure for the relief of itching and
smarting about the vaginal orifice consists in removing the secretion
as soon as it appears. In other words, the external parts should be
kept clean and dry. Great comfort is often derived from the use of a
"sitz-bath," which may be easily prepared by placing a small tub upon
a low stool and pouring in warm water (about 90 degrees F.) until it
is five or six inches deep. Cold sitz-baths are useful in the treatment
of hemorrhoids. Whether the bath be hot or cold, the treatment should
continue from ten to fifteen minutes, and after it the skin should be
thoroughly dried.
A special form of tub, called a "bidet," has been devised to
facilitate bathing the parts in question. The device is convenient
but expensive, and is certainly not essential. Every purpose will be
served by the small tub, provided the desired temperature of the bath
is properly maintained by changing the water as may be necessary.
CLOTHING.--In these days at least it is not idle to remark that the
first use of clothes is to keep the body warm; all other services
they are made to perform are secondary and relatively unimportant.
There are very good reasons, to be sure, for dressing neatly and even
for dressing in accord with the fashion, so long as the prevailing
styles are not harmful. Odd as it may seem, these are matters which
are not without significance for the physical well-being of a
prospective mother. Neat and comfortable clothing will help her to
overcome a natural inclination to become a "stay-at-home," and on
this account an inconspicuous way of dressing is often more valuable
than medicine. So long as they do not attract attention, most
prospective mothers go out in the day time, mingle with their
acquaintances, and attend public places of amusement. Deference to
fashion, therefore, may contribute substantially to good health.
Yet no prospective mother can afford to forget that first of all her
clothing must keep the body warm. Our clothing confines a cushion of
air which prevents the escape of the heat that we generate. Now,
since dry air conducts heat poorly and moist air conducts it readily,
the underclothes should be made of material that absorbs the
perspiration; otherwise the heat that the body generates is quickly
lost. Woolen garments effectually absorb the perspiration and should
be given the preference. Most persons who cannot wear wool next the
skin must choose cotton, since silk and linen are much more
expensive; there is not in this, however, a serious deprivation.
Cotton undergarments are perfectly hygienic; adapting their weight to
the season of the year, one will find them equally satisfactory in
summer and winter.
Except in summer every inch of the body should be covered with the
underclothing; this means that high-neck and long-sleeve shirts and
long drawers should be worn, for healthful activity of the skin can
thus be best preserved. It is well known to physicians who practice
obstetrics that the kidneys fail in their work more frequently during
the winter than the summer. To my mind, this is chiefly explained by
the way women dress. Even with light clothing the sweat glands
respond actively to the heat of summer and thus relieve the kidneys,
but in cold weather the sweat glands will not remove their share of
the waste products unless the clothing is warm.
Nature generally indicates that the body should be kept warm during
pregnancy. Many prospective mothers complain of perspiring freely;
others, if reproached because they are not clad warmly enough, reply
that they must wear light clothing to keep from perspiring. Thus they
discount or render absolutely ineffective a most important natural
safeguard against serious complications. It cannot be too strongly
emphasized that warm clothing helps to maintain healthful activity of
the kidneys quite as much as a proper amount of exercise and the
drinking of a suitable quantity of water.
The texture of the outer garments should take into account this same
quality of warmth; in other respects in selecting them personal taste
is an excellent guide. Outfitters carry a variety of maternity
garments; patterns for such garments are also sold by dealers, so
that those who cannot afford the ready-made clothes will find it easy
to have them made at home. Alterations in the clothing are compulsory
as pregnancy advances, and should be timely, made in anticipation of
inevitable development rather than in response to it. No prospective
mother need go to the extreme of "Reform Clothes"; her apparel should
illustrate both her good sense and her personal pride.
It is obviously even more harmful during pregnancy than at other
times to cramp the body by the clothing; the chest and the abdomen,
the parts most likely to be compressed, are at such times most in
need of freedom. To a slight degree natural causes always compress
the chest from below upward; and on this account nothing should be
allowed to hamper the expansion of the lungs from side to side. On
the other hand, if the waist is constricted, not the breathing
movements alone but also the growth of the womb will be interfered
with. In order to avoid such disagreeable consequences, and at the
same time to limit the extent of the maternity wardrobe, skirts may
be fitted with practical devices which permit letting out the
waistband as occasion demands. So far as possible, however, all the
clothing should be hung from the shoulders, and under no
circumstances should heavy skirts be worn.
Shoes contribute toward health, or the lack of it, more significantly
than the average person realizes. It is particularly advisable that
prospective mothers should select foot-wear with care, because their
bodies are heavier than usual. The feet are apt to become swollen in
the latter months of pregnancy, and consequently the shoes should be
roomy, but should always fit. To escape the discomfort of tight
shoes, it is generally advisable to wear a shoe an inch longer and
broader than the foot at rest.
High heels have been proved a frequent cause of back-ache; half of
such cases, in all probability, may be thus explained. High heels
tilt the body forward in such a way that the erect posture can be
maintained only by an unnatural tenseness of the back-muscles. Some
strain of this kind is inevitable during the latter months of
pregnancy on account of the enlargement and the position of the womb;
it is reasonable, therefore, to minimize it by wearing low, broad
heels.
Besides being responsible for many cases of backache, high heels add
greatly to the danger of tripping and falling; for this reason alone
they should not be worn. Improper foot-gear and not the joints
themselves deserve the blame for weak ankles. To prevent "turning the
ankle," it is not necessary to restrict oneself to high shoes, but
merely to see that the shoes that are worn have low heels and broad
soles. Such shoes provide a sure, firm footing, and this the
prospective mother particularly needs.
CORSETS.--No question connected with women's dress has provoked so
much discussion as the use of corsets. "Are corsets necessary to
health?" has been differently answered by those who would appear to
be equally competent authorities. In the time of our savage ancestors
we may safely conclude that they were not used; and, therefore, it is
really a question as to whether their continued use for generation
after generation has finally made some support of this kind
indispensable to the average woman. While that matter has not as yet
been settled, it is obvious that custom is really responsible for the
conviction of many women that they appear slovenly without corsets.
On the other hand, not a few women, unmindful of fashion, never wear
them; they testify that they are healthier for doing so. Whether this
be true or not, no one can honestly believe that corsets will soon be
banished; and the practical problem is to distinguish between those
that may do good and those certain to do harm.
During pregnancy the abdomen tends to fall forward and slightly
downward, and though it is in pregnancies after the first that this
tendency is most marked, every prospective mother will be more
comfortable if she wears some sort of support to counteract what
physicians term a "pendulous abdomen." Such a condition can be
prevented by the use of several appliances, and the device best
suited to the case should be chosen. Those who have never become
accustomed to corsets will probably find a corset-waist or an
abdominal supporter the most comfortable and useful. But the average
young woman who has previously employed a sensible, well made, and
loosely fitting corset need make no change until the third or fourth
month of pregnancy. From then on she should wear a corset especially
designed to conform with the changes that naturally occur in the
figure.
There is a plan, wrong in principle, which many adopt. Reasoning that
it will be necessary to change the corset from time to time, and
desiring to practice economy, a number of women purchase the cheapest
corset at hand. This they replace with a larger one of the same style
from time to time. The result is that an improperly fitting garment
is worn continuously; and, in the end, this plan proves almost as
expensive as, and far less suitable than, a proper corset, which
would remain serviceable throughout pregnancy, or at least until a
few weeks before confinement.
Most, and probably all, of the injuries for which corsets are
responsible result from their misuse. Naturally serious consequences
may be expected if they are worn with the design of compressing the
abdomen so as to render pregnancy less noticeable or perhaps to
conceal it altogether. Thus worn, the corset becomes not only an
instrument of torture but a source of danger both to the mother and
to the child. Fortunately there are very few women who fail to
appreciate the risk of thus striving to disguise their condition; and
generally it is the needless discomfort, the trifling ills
thoughtlessly inflicted upon themselves, that prospective mothers
must be taught to avoid.
At present there are manufactured a number of excellent maternity
corsets; but there are also worthless types, and some likely to do
harm. To judge them fairly they must be examined with regard to
several requirements. In the first place the corset should not be
stiff and should always be capable of easy adjustment; it must never
interfere with the activity of any organ. As _enceinte_, the
French word meaning pregnant, signifies, the prospective mother
should be unbound. Tight clothing, as we have already remarked,
hinders the breathing movements; it also interferes with the action
of the heart, and occasionally causes the child to assume an
unfavorable position within the uterus. The adjustment of the
maternity corset to the progressive development of the body is
generally provided for by means of extra lacings down the sides, and
by the insertion of elastic material.
The maternity corset, in the next place, must support the enlarged
uterus. Correctly shaped and worn, it extends well down in front,
fits snugly around the hips, and arches forward so as to conform to
the curve of the abdomen. In place of the arching, or "cupping" as
manufacturers call it, some maternity corsets have attached to their
lower edge limp flaps of a strong fabric which lace together. The
maternity corset-waist also should extend well under the abdomen and
fit snugly around the hips.
Finally, the corset should support the bust; the unpleasant
sensations due to congestion of the breasts can be relieved most
successfully by elevating them. It is exceedingly important, however,
that the upper part of the corset should fit loosely, for otherwise
the development of the breasts may be hindered, and the nipples
depressed. As a further precaution against pressure above and also to
secure the proper amount of support below, it is generally advisable
to begin putting on the corset while lying down. In every case the
corset should be laced from below upward; if laced in the opposite
direction it fails to lift the womb and tends to push all the
abdominal organs downward.
Any kind of corset is likely to become uncomfortable toward the end
of pregnancy; and of course should then be discarded. An abdominal
supporter made of woven linen or rubber is frequently used to
advantage during the last three or four weeks. With the first
pregnancy the supporter is rarely necessary, but with subsequent ones
it is frequently useful as early as the sixth month and is
indispensable later. A substitute for the manufactured supporter can
be made at home. Some such device often facilitates turning in bed,
and on that account may be found even more useful at night than
during the day.
THE BREASTS.--Personal hygiene during pregnancy includes the
preparation of the breasts with a view to success in nursing. All
measures which promote the health of a prospective mother also serve
to equip her for the nursing period; and in that sense the directions
just given for the care of the body, as well as the rules to follow
in the next chapter regarding a wholesome way of living, bear
directly upon lactation. But there are also local measures to be
adopted, some of which, such as supporting the breasts and avoiding
constriction by the clothing, have already been mentioned. Finally,
the nipples must be toughened and, if short or flat, they must be
drawn out, for the best supply of milk will count for nothing if the
infant cannot nurse comfortably.
Some approved method of toughening the nipples so that they will not
be injured by the sucking efforts of the infant, no matter how
vigorous, should be begun eight weeks before the expected date of
confinement; to start earlier will do no harm, but it is quite
unnecessary. A number of procedures have been advocated, but in my
own experience the following simple method is the best. The nipples
are scrubbed for five minutes, night and morning, with soap and warm
water. Generally, a soft brush, such as a complexion-brush, is
satisfactory; but if this is too harsh, at first a wash cloth may be
used. After having been thoroughly scrubbed the nipples are anointed
with lanolin and covered with a small square of clean, old linen to
prevent soiling of the clothing.
Another method widely used, but somewhat less trustworthy, consists
in bathing the nipples and applying a dilute solution of alcohol.
Formerly brandy, whiskey, or cologne were recommended, but at present
the following solution is commonly used. A tablespoonful of powdered
boric acid is added to three ounces of water and thoroughly mixed.
This is poured into a six-ounce bottle, which is then filled with
grain alcohol (95 per cent). The solution is applied twice a day with
a small piece of absorbent cotton.
Well-formed nipples need only be toughened, but depressed nipples
require additional treatment; and this should be begun about the
middle of pregnancy. The old-fashioned way of making the nipple more
prominent was to cover it with the mouth of a bottle which had
previously been warmed. The vacuum created, as the bottle cooled,
drew the nipple out. Similarly, the bowl of a clay pipe was sometimes
placed over the nipple; the patient sucked the stem, the nipple was
drawn into the bowl, and with persistence day after day success was
often attained. A similar and somewhat more aesthetic procedure is
now employed. The nipple is seized between the thumb and finger and
alternately pulled out and allowed to retract. These manipulations,
if faithfully practiced for several months, generally make the nipple
prominent enough for the infant to grasp. Occasionally patients need
to wear a contrivance sold at instrument stores which consists of a
circular piece of wood modeled to fit the breast and perforated in
the middle to accommodate the nipple. The appliance should not be
used unless a physician thinks it necessary.
Directions regarding the care of the breasts are sometimes taken
lightly, yet such care is not a minor duty. Now and then a patient
will pass through pregnancy uneventfully, will be delivered without
difficulty, and will enter upon what promises to be a rapid
convalescence when her recovery is interrupted by the development of
inflammation of the breast. Because such a complication may be
prevented, its appearance is the more to be regretted. Furthermore,
the responsibility for its prevention usually rests with the patient
herself. If she has been conscientious in preparing the nipples and
continues to watch them throughout the nursing period, the annoyance
of an abscess will almost certainly be prevented.