GENERAL HYGIENIC MEASURES
The Need of Fresh Air--Outdoor Exercise--Massage and Gymnastics--The
Influence of Work upon Pregnancy--Relaxation and Rest--Is Traveling
Harmful?--Mental Diversion.
Besides the hygienic measures described in the preceding chapter,
whose observance should be recognized as more or less obligatory,
there are more general questions of conduct, such as exercise,
relaxation, mental occupation, and amusement, which are also
important. These measures, although frequently determined merely by
personal inclination or by the force of circumstances, nevertheless
exert a tremendous influence upon health. This fact a prospective
mother is likely to realize, for she is certain to consider not only
her own welfare but also that of the expected child; and she is
consequently concerned about details of conduct that most persons
would regard as trivial. She may, indeed, be too conscientious. Well-
meaning friends, sometimes in reply to her questions and sometimes
without solicitation, offer her a great deal of advice. Their
counsel, aside from the fact that some of it may be misleading, may
have the effect of prescribing so many rules that, if she followed
them all, she would never lose sight of the fact that she is
pregnant. Such a degree of self-consciousness is certain to make her
unduly apprehensive. The proper attitude of mind is quite the
opposite; so far as possible the prospective mother should forget
that she is pregnant. This state of mind is really the more rational,
for if a woman's daily life has previously been in accord with such
simple rules of health as everyone should adopt, the existence of
pregnancy calls for very slight changes.
It does not, for example, condemn her to inactivity and seclusion,
for it is advisable to lead a moderately active life during
pregnancy. Of course, such obvious indiscretions as prolonged
exertion, violent exercise, and fatiguing journeys should be avoided,
for transgression of the laws of health brings its own punishment,
generally in the form of discomfort, more quickly, and often more
severely, during pregnancy than at other times. Yet, on the whole, it
is more frequently necessary to emphasize to prospective mothers what
they should do than what they should avoid. This happens to be the
case because, as a rule, they are inclined to become recluses. For
fear of attracting attention they often wish to give up outdoor
exercise during the day; they stay away from public places of
amusement, and deny themselves other pleasures to which they have
been accustomed. Against this tendency they must be warned, for if
they yield to it they will surely be the worse off both physically
and mentally. Every prospective mother should make up her mind to
enjoy recreation out of doors regardless of comments.
THE NEED OF PURE AIR.--Outdoor life has been so urgently advocated of
late that the public has come to appreciate its benefits almost as
fully as do physicians. The existence of pregnancy does not lessen,
but rather enhances, the value of fresh air; in order to enjoy the
best health during this period one should spend at least two hours
out of doors every day. Neither the season of the year nor the state
of weather should modify this obligation. If the sun is shining the
"airing" is more delightful, but it should be taken in bad weather
also, on a protected porch or in a room with the windows wide open.
Even when the injunction to be regularly out of doors is observed
women are accustomed to spend the greater portion of the day in the
house, and on that account special attention must be given to keeping
the air of the house pure. Ventilation takes care of itself in
summer, when the windows are open, but in cold weather, when in our
anxiety to keep the temperature comfortable we may overlook the need
of fresh air, it demands close attention. The necessity of
ventilation at all times is due, of course, to the composition of the
atmosphere and to the changes produced in it as we breathe.
The air about us is a mixture of gases, of which oxygen and nitrogen
are the most important. Although nitrogen, which constitutes four-
fifths of the atmosphere, is taken into our lungs in breathing, we
make no use of it, but breathe it out in precisely the same condition
as we take it in. As chemically combined in the food-stuff known as
protein, nitrogen is indispensable to animal life; but our bodies
make no use of the gaseous form of nitrogen. Oxygen, on the other
hand, supports life; and though it forms less than one-fifth of the
atmospheric air, it is present in ample amount for our needs. After
we draw air into our lungs, the oxygen it contains is absorbed by the
blood and used by the tissues. In return our tissues give up a waste
product, carbonic acid gas, which is thrown off by the lungs. It is
interesting to observe that the carbonic acid gas which animals
exhale supports the life of plants, and that the plants, under the
influence of sunlight, give back pure oxygen to the atmosphere.
Obviously, the complementary relation exhibited here is of mutual
benefit.
The average person uses about four bushels of air a minute.
Consequently, rooms that are occupied must be constantly replenished
with fresh air; otherwise the point is quickly reached where the
occupants are breathing an atmosphere that is not only poor in oxygen
but saturated with carbonic acid gas and other impurities conveyed by
the breath. Foul air such as this causes headache, dizziness,
faintness, nausea, and occasionally even more serious disturbances.
Those who live in "close" rooms day after day grow pale and languid;
their appetite fails and some of their natural power of resistance
against illness is lost. Many people are unhealthy simply because
they neglect to supply their living quarters with a steady stream of
air from the outside.
While it is impossible to keep the air in any room as pure as the
outside atmosphere, perfectly satisfactory ventilation can be easily
arranged. Some of the impure air in a house is always escaping of its
own accord and its place is taken by air from the outside. Thus, the
cracks around the windows and doors let bad air out and good air in;
and, besides, most building materials are porous. These natural
paths, however, must be supplemented. The simplest device for
ventilation, which is also the best, consists in opening a window at
the top and bottom. The width of the opening may be regulated so as
to permit the air in the room to change without occasioning
disagreeable drafts; if necessary the current may be broken by a
screen of some pervious material placed in the opening.
The bed-room should always be supplied with plenty, of fresh air,
which "quiets the nerves" and helps one to sleep soundly.
Furthermore, the temperature of the bed-room should be lower than the
temperature of rooms occupied during the day. Both these requisites
will be properly met by leaving a window open at night, which may be
done throughout the year in most climates, if one puts on enough
covering. There is no danger of catching cold from sleeping with the
window open; on the contrary, breathing fresh air day and night is
one of the best ways to prevent colds.
OUTDOOR EXERCISE.--Outdoor exercise is indispensable to good health.
It benefits not only the muscles, but the whole body. By this means
the action of the heart is strengthened, and consequently all the
tissues receive a rich supply of oxygen. Exercise also promotes the
digestion and the assimilation of the food. It stimulates the sweat
glands to become more active; and, for that matter, the other
excretory organs as well. It invigorates the muscles, strengthens the
nerves, and clears the brain. There is, indeed, no part of the human
machine that does not run more smoothly if its owner exercises
systematically in the open air; and during normal pregnancy there is
no exception to this rule. Only in extremely rare cases--those,
namely, in which extraordinary precautions must be taken to prevent
miscarriage--will physicians prohibit outdoor recreation and,
perhaps, every other kind of exertion. Under such circumstances the
good effects that most persons secure from exercise should be sought
from the use of massage.
The amount of exercise which the prospective mother should take
cannot be stated precisely, but what can be definitely said is this--
she should stop the moment she begins to feel tired. Fatigue is only
one step short of exhaustion--and, since exhaustion must always be
carefully guarded against, the safest rule will be to leave off
exercising at a point where one still feels capable of doing more
without becoming tired. Women who have laborious household duties to
perform do not require as much exercise as those who lead sedentary
lives; but they do require just as much fresh air, and should make it
a rule to sit quietly out of doors two or three hours every day. It
will be found, furthermore, that the limit of endurance is reached
more quickly toward the end of pregnancy than at the beginning; a few
patients will find it necessary to stop exercise altogether for a
week or two before they are delivered.
Walking is the best kind of exercise, but long tramps are inadvisable
during pregnancy, except for those who have previously been
accustomed to them. Most women who are pregnant find that a two or
three-mile walk daily is all they enjoy, and very few are inclined to
indulge in six miles, which is generally accepted as the upper limit.
Perhaps the best way to measure a walk is by the length of time it
consumes. Accordingly, a very sensible plan is to begin with a walk
just long enough not to be fatiguing and to increase it by five
minutes each day until able to walk an hour without becoming
overtired. It is always advisable not to crowd the exercise of a day
into a single period but rather to take it in several installments,
for example, an hour in the morning, and another in the afternoon.
Under all circumstances, it must never be forgotten that the feeling
of fatigue is a peremptory signal to stop, no matter how short the
walk has been.
Very few outdoor sports can be unconditionally recommended to a
prospective mother. Because athletic exercise is either too violent
or else jolts or jars the body a great deal, it is especially
dangerous in the early months of pregnancy--the only time when it is
likely to be at all attractive. Croquet, alone, perhaps, is free from
these objections. Although golf and tennis are by no means certain to
bring on miscarriage, they involve a risk which, slight though it may
perhaps be, will not be assumed by cautious women.
Horseback riding during pregnancy is injurious. We occasionally hear
of women who have ridden horseback without immediate harmful
consequences, but they have nevertheless exposed themselves to danger
unnecessarily. It is better to give up skating and dancing also than
to run the risk of accident, especially since these diversions are
attended with some danger of falling. In a general way, whenever the
question of entering into any kind of recreation must be decided, it
is wise to err on the conservative side rather than risk overstepping
the limit of endurance and having to pay a penalty more or less
severe.
Carriage riding cannot take the place of walking and can scarcely be
classed as exercise; it is wholesome, nevertheless, because it takes
the participant out of doors and provides a change of scene. Certain
details, however, should be carefully observed; thus, a safe horse, a
carriage that rides easily, and smooth roads should be selected.
Similar advice pertains to motoring; with smooth roads, a cautious
driver, and a comfortable machine, short rides in an automobile are
not harmful. Carriage riding and motoring are particularly
serviceable as a means of getting outdoor diversion during the last
few weeks of pregnancy.
MASSAGE AND GYMNASTICS.--If a prospective mother is obliged to stay
in bed several weeks, massage may be useful; otherwise there is no
necessity for this treatment. Whenever required, massage should if
possible be given by an experienced masseuse. If this is out of the
question and the patient must rely upon one of her friends, it should
be understood that "general massage" is needed; in other words, one
part of the body after another should be gone over systematically.
With an inexperienced masseuse, however, it will be safer not to
massage the abdomen, since awkward, vigorous, or prolonged
manipulations in that locality may provoke painful uterine
contractions. Rubbing the breasts also can do no good; on the
contrary, it may do harm by bruising them.
The best time of day to have massage is in the morning, at least an
hour after breakfast. The duration of the treatment will depend upon
the patient; it should always cease as soon as she begins to feel
tired. After one has become accustomed to it, massage may generally
be continued for an hour. The room in which it is given should be
cool, and after the treatment has been completed the patient should
be wrapped warmly and left undisturbed for half an hour.
Gymnastics, like massage, are useless to those who can enjoy outdoor
exercise. Walking more perfectly strengthens the muscles which take
part in the act of birth than any system of "home calisthenics" that
has been suggested. In some conditions which make walking inadvisable
the use of calisthenics will be helpful. These exercises generally
consist in breathing movements and in movements of the extremities,
especially the legs, which bring into play the same abdominal muscles
that are used at the time of delivery. A detailed description of the
exercises is here purposely omitted, since gymnastics should not be
used unless advised by a physician, who should watch their effect and
thus be guided as to whether the patient should continue them.
THE INFLUENCE OF WORK UPON PREGNANCY.--No single influence is more
unfavorable to comfort and health during pregnancy than is idleness,
so that every prospective should occupy herself with congenial work
and fitting diversions. The kind of occupation makes no essential
difference, so long as it does not overtire either the body or the
mind. Since most women are absorbed in the affairs of the home, it
may be well to begin by saying that the existence of pregnancy by no
means requires the abandonment of domestic duties. On the contrary,
when it is convenient, the prospective mother should have a share in
the housework. She should not undertake everything that is to be done
about the house, for no matter how small the household there are
certain duties too laborious for her to attempt; these will be easily
recognized and turned over to someone else. Even with regard to those
tasks which lie within her strength she should use a little
forethought to prevent unnecessary steps.
All kinds of violent exertion should be avoided--a rule which at once
excludes sweeping, scrubbing, laundry work, lifting anything that is
heavy, and going up and down stairs hurriedly or frequently. The use
of a sewing machine is also emphatically forbidden. Treadle work is
known to be one cause of swollen feet, of varicose veins, and of
aches and pains in the legs or the abdomen. If a prospective mother
has to do her own sewing, the machine should be fitted with a hand
attachment or motor. Except for the possibility of straining the
eyes, there is no objection to sewing by hand.
Besides the activities that should be excluded because they may be
harmful, every housekeeper will find enough to keep her busy. It is
generally not a small task to suggest what others shall do and to see
that orders are properly carried out; consequently those who take no
part in the actual work may retain an absorbing interest in their
domestic affairs by directing them. Such direction, indeed, should,
toward the end of pregnancy, constitute the mother's sole
participation in the housework.
In a general way the amount and the kind of work that a woman may be
permitted to undertake during pregnancy depend upon what she has been
used to. It is not unlikely that anyone who is unaccustomed to manual
labor may injure her health and cause the pregnancy to end
prematurely if she undertakes hard work. On the other hand, women of
the working classes sometimes continue at their occupations to the
natural end of pregnancy without harmful consequences. It is
undeniable, however, that among this class miscarriages are more
frequent than among the well-to-do. Furthermore, the average birth-
weight of mature infants whose mothers have remained at work during
the last three months of pregnancy is ten per cent. less than the
average birth-weight of infants among the leisure class. This matter
of the baby's weight is not always serious in itself, but indicates
in the case of working women who are pregnant the existence of a
strain that sometimes leads to serious accidents.
The employment of women during pregnancy and immediately thereafter
is regulated by law in many countries. For example, the laws of
Holland, Belgium, England, Portugal, and Austria prohibit the
employment of women in factories during the last four weeks of
pregnancy or the four weeks following childbirth. Such employment is
unlawful in Switzerland for two weeks before and six weeks after
childbirth. There is no legal regulation of the employment of
pregnant women in either Germany or Norway, but the laws of both
countries forbid them to return to work until six weeks after they
have been delivered. Among civilized nations Turkey, Russia, Spain,
Italy, France, and the United States make no attempt to regulate
employment either before or after childbirth.
Of course there are strong sentimental reasons for relieving
prospective mothers of the necessity of earning a living, but there
are also excellent hygienic reasons against many kinds of employment.
For example, it should be unlawful to employ them in chemical
industries where, owing to their condition, they are especially
liable to be injured by the materials which they handle. Jacobi
states that the worst occupation for pregnant women is working with
metals, in particular lead; more than half of them suffer miscarriage
or premature confinement. Furthermore, the health of the child may be
endangered if the prospective mother does hard work of any kind. This
is true chiefly because she does not have appropriate intervals of
relaxation, for it is a firmly established principle that a
prospective mother must be free to rest the moment she begins to feel
tired. The least, therefore, that can be done to better prevalent
conditions among women who must work during pregnancy is to require
by law a reduction in the number of their working hours, and to
protect them from the necessity of earning a living for two months
after they have been delivered.
RELAXATION AND REST.--During the early months of pregnancy many women
complain that they feel enervated, and tire quickly even when they do
things which were formerly done with ease; this experience is so
common that it can scarcely be considered other than natural.
Curiously enough this is also the period during which the attachment
of the ovum to the womb is relatively insecure, and therefore the
inclination to be quiet is justified by the prevailing anatomical
conditions. No prospective mother should struggle against the
inclination to rest; she should yield to it in spite of the advice to
the contrary which older women are apt to give. Furthermore, it is
especially important about the time when a menstrual period would
ordinarily be expected to be guided by this impulse not to be active,
since overexertion then, more than at other times, is apt to be
followed by miscarriage. Except in rare cases the observance of this
precaution is less urgent after the fourth month, when the ovum has
become more securely attached to the womb. But again, toward the end
of pregnancy the development of the mother's body necessitates a
comparatively large amount of rest; patients who continue to exert
themselves may expect to suffer from shortness of breath and a number
of other annoyances.
In order to save needless steps and to avoid confusion and worry, it
is always helpful to map out beforehand what must be done in the
course of the day. Ideally, such a schedule should set apart
intervals for relaxation and rest. In the morning, for example, while
the housework is in progress, it is important to stop occasionally,
if only for a few moments, and lie down on a couch. After the midday
meal it is advisable to undress and go to bed. Even though one does
not fall asleep, an hour or two of complete relaxation will be
beneficial. A nap in the afternoon does not interfere with sleeping
at night provided plenty of exercise has been taken during the day.
In this way walking in the late afternoon or early evening helps to
secure a good night's rest.
During the first six or seven months, pregnancy, in itself, does not
cause sleeplessness, but later, as a natural result of the
enlargement of the womb, there are several disagreeable symptoms
which may cause broken rest at night. In the later months the weight
of the womb requires women to sleep on the side, and for some of them
this position is awkward at first. Frequently the pressure makes it
necessary to get up several times during the night to empty the
bladder. In a few cases also the compression of the chest interferes
somewhat with breathing. When insomnia is due to the pressure of the
womb against neighboring parts of the body, it can be partially
counteracted by getting into a comfortable position; but it is also
necessary to have the surroundings as conducive to sleep as possible.
Thus anyone will be much more likely to rest well if the bed-room is
large and well ventilated, if the mattress is comfortable, and if the
coverings are warm without being heavy. Finally, not the least
important detail is to occupy a single bed, so that it is possible to
turn over without fear of disturbing someone else.
In most instances, however, the inability to sleep during pregnancy--
and indeed at any time--is due to a faulty frame of mind. With
reference to the average man or woman, in his very helpful book "Why
Worry," Walton says, "it is futile to expect that a fretful,
impatient, and overanxious frame of mind, continuing through the day
and every day, will be suddenly replaced at night by the placid and
comfortable mental state which shall insure a restful sleep." Like
everyone else, the prospective mother must stop thinking when she
retires, otherwise the blood will not be diverted from the brain as
it must be to fall asleep. To aid in bringing about this condition a
number of expedients may be employed. For example, a warm bath, warm
sheets, or a hot-water bottle placed against the feet all help to
draw the blood from the brain to other parts of the body. Similarly,
a warm glass of milk or a small portion of easily digestible solid
food taken just before retiring will help to make one drowsy; on the
other hand, over-eating at the evening meal or later is not an
infrequent cause of wakefulness.
The use of narcotics is rarely necessary in the early months of
pregnancy, and the simple measures just mentioned will also generally
be found sufficient in the later months. But these procedures, or any
other except the use of strong drugs, will be ineffective unless the
individual knows how to get into the proper state of mind. This means
not only that she must be able to banish worries, regrets, and
forebodings; she must also have acquired confidence in whatever
method she employs. She must convince herself that she can sleep, or
at least that _it makes no difference if she cannot_. This
independent spirit, which is very essential, can be confidently
assumed, for if she does not sleep well it can be made up during the
next day or at least the next night. Having adopted this attitude,
and having assumed a comfortable position, which should be retained
as long as possible, the attention should be concentrated upon the
thought, "I am getting sleepy, I am going to sleep." Under these
circumstances she can hypnotize herself and "produce the desired
result more often than by watching the proverbial sheep follow one
another over the wall."
IS TRAVELING HARMFUL?--Traveling has been made so easy and alluring
that nowadays long journeys are undertaken with scarcely more concern
than was once felt when the people of neighboring towns exchanged
visits. Thus modern facilities have introduced a new factor into the
problem of the way to live during pregnancy. It is a well-known fact
that traveling is sometimes attended with risk to the prospective
mother, though the danger is exaggerated in the popular estimation.
For this the newspapers are chiefly to blame. They inform the public
of the cases in which embarrassing situations have arisen, but there
is no record of the thousands of pregnant women who travel without
any mishap.
What the effect of traveling is likely to be is very difficult to
predict under any circumstances, and the question cannot be answered
at all unless the specific conditions presented by each case are
taken into account. In a general way the points to be considered are
the vigor of the patient, the period of pregnancy at which she has
arrived, and the character of the journey she wishes to undertake.
Prudent women will never attempt to decide this question for
themselves, but will always obtain professional advice. The
disapproval of the physician, no doubt, will sometimes cause keen
disappointment; but conservative advice is the best and should always
be followed.
To be on the safe side a prospective mother who has previously had a
miscarriage should not travel at any time during pregnancy; others
are not obliged to follow this stringent rule except during the first
sixteen and the last four weeks of pregnancy. In the former period
there is some danger of miscarriage because traveling may cause
separation of the relatively loose attachment of the ovum. In the
latter period the muscle-fibers of the womb are usually irritable and
therefore the rolling of a ship or the jolting of a car may set up
painful contractions which in some instances expel the fetus.
Generally there is the least risk of accident between the eighteenth
and the thirty-second weeks, though patients should be careful even
during this interval not to travel at the time when a menstrual
period would ordinarily be expected.
The length of the journey and the ease with which it can be made are
also important features to be considered. Obviously there will be
less danger of mishap from a short trip than from a long one; if
possible, therefore, long journeys by rail should be broken so as to
afford opportunity for rest. Railroad trips which do not exceed two
or three hours are generally not so fatiguing that they must be
prohibited, provided the individual is perfectly well. Traveling by
boat is less tiresome than traveling by rail and, if equally
convenient, the boat should be given the preference. Long automobile
tours are attended with considerable risk of miscarriage and,
therefore, are forbidden.
MENTAL DIVERSION.--As a rule good health prevails throughout
pregnancy; it would be enjoyed even more frequently if many
prospective mothers did not think so much about the fact that they
are pregnant. For this deplorable self-consciousness the spirit of
the age is in part to blame; there never was a time, in all
probability, when people took such a keen interest in all matters
pertaining to health. It is also true, however, that fuller
instruction is needed now because the temptations to depart from a
regular, temperate way of living have notably increased.
At all events the point has now been reached where the average man or
woman knows something of anatomy, physiology, and the laws of
hygiene. Such knowledge should be helpful, and generally is, but if
it causes anyone to think incessantly about the workings of the body,
to that person it is detrimental. We all know such individuals. They
are made miserable because they scrutinize functions, like the
beating of the heart, that go on automatically and should be left
unobserved, or they minutely analyze their feelings and misinterpret
normal sensations as the evidence of disease.
The tendency to be introspective is especially pronounced in women
who are pregnant, and this is readily explained by the reciprocal
relations between the mind and the body. If the prospective mother
correctly interpreted the changes which occur in her body, as well as
the sensations for which these changes are responsible, she would
escape the uneasiness of mind that causes many sorts of discomfort.
It is unfortunately true, however, that her lack of familiarity with
the facts about pregnancy and her belief in unfounded traditions
frequently lead to the misinterpretation of natural conditions. An
anxious frame of mind also causes real ailments to assume an
importance out of all proportion to their actual significance.
Patients who have followed my advice to place themselves in the care
of a physician as soon as they clearly recognize the existence of
pregnancy will receive his assistance in properly estimating the
significance of what they notice. This service is by no means the
least the obstetrician renders his patients. His opinion should
always be sought when symptoms are not understood; but it is not
unusual for patients to bring to the doctor's attention many
complaints that would pass unnoticed if they taught themselves to
restrain the imagination, to refrain from pessimistic reflections,
and to divert their thoughts from themselves to outside affairs.
Generally it is during the early months of pregnancy that patients
are most likely to be self-centered, and consequently suffer from
many annoyances that either proceed from or are exaggerated by this
faulty frame of mind. During this period a prospective mother is not
fully aware of the meaning of pregnancy. Toward the twentieth week,
however, she perceives the movements of the child and her thoughts
are turned to it instinctively. About this time many of the
discomforts of pregnancy disappear and there ensues a period of
unusually good health. Perhaps it would be going too far to give this
more wholesome altruistic mental attitude the entire credit for the
relatively better health of the second half of pregnancy, but without
doubt it is a most important factor.
Such then is the influence of the mind over the body that anyone who
wishes to cultivate good health must correct the faulty habit of
always thinking of herself. The most suitable form of diversion will
depend upon personal taste. Domestic duties absorb the attention of
most prospective mothers, but domestic duties should not occupy them
exclusively. Outdoor recreation is necessary and serves the double
purpose of strengthening mind and body. Public amusements should also
be patronized; no prospective mother has the right to sacrifice
herself to pride. Music, the various arts, a systematic course of
reading, the acquisition of a foreign language--all these are
commendable forms of diversion, and others will occur to anyone.
Obviously the avocation will be most happily chosen if it directs the
attention into channels likely to lead to the greatest pleasure.