"Solicitude for children is one of the signs of a growing civilization.
To cure is the voice of the past; to prevent, the divine whisper of
to-day."
KATE DOUGLAS WIGGIN.
PREPARATIONS FOR THE CONFINEMENT
THE BIRTH CHAMBER--WHAT TO PROVIDE FOR A CONFINEMENT--READY TO PURCHASE
OBSTETRICAL OUTFITS--POSITION AND ARRANGEMENT OF THE BED--HOW TO
PROPERLY PREPARE THE ACCOUCHMENT BED--THE KELLY PAD--THE ADVANTAGES OF
THE KELLY PAD--SHOULD A BINDER BE USED?--SANITARY NAPKINS--HOW TO
CALCULATE THE PROBABLE DATE OF THE CONFINEMENT--OBSTETRICAL TABLE--WHEN
SHOULD A PREGNANT WOMAN FIRST CALL UPON HER PHYSICIAN--REGARDING THE
CHOICE OF A PHYSICIAN--HOW TO KNOW THE RIGHT KIND OF A PHYSICIAN FOR A
CONFINEMENT--THE SELECTION OF A NURSE--THE DIFFERENCE BETWEEN A TRAINED
AND A MATERNITY NURSE--DUTIES OF A CONFINEMENT NURSE--THE REQUISITES OF
A GOOD CONFINEMENT NURSE--THE PERSONAL RIGHTS OF A CONFINEMENT
NURSE--CRITICIZING AND GOSSIPING ABOUT PHYSICIANS.
THE BIRTH CHAMBER
The room in which the confinement is to take place should be selected with
care. In many cases there will be no choice for the reason that there will
be only one suitable bedroom available. Where practicable however a room
having the following accessories, or as many of them as is possible, should
be given the preference.
1.--Good light, and a southern exposure.
2.--Capable of being well ventilated and well heated if necessary.
3.--Running water if plumbing is modern.
4.--Fairly large size (not a hallroom).
5.--A quiet room, free from street noises.
If the house is a private one the room should be on the second floor. If
the home is in an apartment house the confinement chamber should be as [62]
far removed from the living-room as circumstances will permit,--especially
if there are other children who will make more or less continuous noise.
All unnecessary furniture, pictures and draperies should be taken out of
the room a few days before the confinement is due; the room itself, and
everything left in it, should be thoroughly cleaned and aired. A small
table for holding instruments, sterilizing basins, etc., should be provided
and in readiness.
WHAT TO PROVIDE FOR A CONFINEMENT.--The following articles should be in
readiness at all confinements:--
1.--Douche pan.
2.--Bed pan.
3.--Douche bag (fountain syringe) with glass douche tube.
4.--One rubber sheet 1½ yards square.
5.--Two bed pads, one yard square, made of absorbent cotton or old
clean cloths, covered with washed cheese cloth and stitched here and
there to hold in place.
6.--One dozen clean towels.
7.--One-half dozen clean sheets.
8.--A hot water bottle.
9.--One pound absorbent cotton (good quality).
10.--Five yards sterile gauze.
11.--Four quarts of hot, and as much cold water, that has been boiled.
12.--One-half dozen papers assorted safety pins.
13.--One box sanitary pads.
14.--Four pieces of unbleached cotton or muslin, one and one-quarter
yards long.
15.--Four ounces powdered boracic acid.
16.--Four ounces of brandy or whisky.
17.--One jar of white vaseline (unopened).
18.--One cake of castile soap.
19.--Two or three agate or china hand basins.
20.--One slop jar.
21.--One pan under bed for after birth.
The physician will direct that certain additional articles be provided
according to his individual taste and custom. These will include an [63]
antiseptic and ergot; any other requisite found necessary can be sent for,
or the physician can supply it, as he invariably has in his bag whatever
may be required in complicated cases or in an emergency. All the items
enumerated in the above list are absolutely essential, they may not all be
used but it would not be safe to undertake a confinement without providing
the essential requisites. Many maternity outfits are prepared ready for use
and can be obtained at the larger drug stores, costing from $10 to $25. The
articles in the above list can be bought for about $6, not including those
articles which the patient is assumed to have. The following are samples of
the ready-to-purchase outfits:
READY-TO-PURCHASE OBSTETRICAL OUTFITS
OUTFIT NO. 1
1 Sterilized Bed Pad (30 inches square).
2 dozen Sterilized Vulva Pads.
2 Sterilized Mull Binders (18 inches wide).
5 yards Sterilized Gauze.
1 pound Sterilized Absorbent Cotton (½ pound).
Rubber Sheet, 1½ yards by 2 yards, Sterilized.
Douche Pan, Sterilized.
1 Tube K-Y Lubricating Jelly.
Sterilized Nail Brush.
Boric Acid, Powdered.
Tinct. Green Soap.
Bichloride Tablets.
Lysol.
Tube Sterilized Tape.
PRICE $10.00.
OUTFIT NO. 2.
2 Sterilized Bed Pads (30 inches square).
2 dozen Sterilized Vulva Pads.
2 Sterilized Mull Binders (18 inches wide).
6 Sterilized Towels.
10 yards Sterilized Gauze.
[Page 64]
1 pound Sterilized Absorbent Cotton (½ pound).
Rubber Sheet, 1 yard by 1½ yards, Sterilized.
Rubber Sheet, 1½ yards by 2 yards, Sterilized.
4 quart Sterilized Douche Bag with glass nozzle.
Douche Pan, Sterilized.
Sterilized Nail Brush.
2 Agate Basins, Sterilized.
Safety Pins.
2 Tubes Sterilized Petrolatum.
1 Tube K-Y Lubricating Jelly.
Boric Acid, Powdered.
100 grms. Chloroform (Squibb's).
Fl. Ext. Ergot.
Tinct. Green Soap.
Bichloride Tablets.
Lysol.
Tube Sterilized Tape.
Sterilized Soft Rubber Catheter.
Sterilized Glass Catheter.
Stocking Drawers, Sterilized.
Talcum Powder.
Bath Thermometer.
PRICE $19.50.
These materials, being cleansed and sterilized, are ready for use at any
time.
These complete outfits are packed in neat boxes, thus enabling the contents
to be kept intact until needed.
THE POSITION AND ARRANGEMENT OF THE BED.--The bed should be a substantial
single bed. If a double one is used, prepare the side for the confinement
which will permit the physician to use his right hand,--that will be the
right side of the patient as she lies in bed. One objection to a double bed
is its tendency to sag. This tendency can be obviated however by placing an
ironing board under the spring from side to side, or by using shelves from
a book case. This expedient will support the mattress, thereby rendering
the bed firm and free from any sagging tendency. The position of the bed in
the room should be such that the patient will not directly face the window
light, nor be in a direct draught between the window and the door. It [65]
should be so arranged that the nurse can get easily to either side,
consequently it must not be pushed against the wall.
HOW TO PREPARE THE ACCOUCHMENT BED.--Over the mattress place the rubber
sheet so that its center will be exactly under the hips of the patient. Pin
with large safety pins each corner of the rubber sheet to the mattress; now
put the sheet on exactly as you do when making an ordinary bed. On top of
the sheet, and in the middle of the bed (again where the patient's hips
will rest), place a draw sheet. A draw sheet is a sheet folded once, placed
across the bed, and pinned tightly with large safety pins to the mattress
at each side. The advantage of this sheet is, that it can be removed when
necessary, leaving the original clean sheet on the bed, without disturbing
the patient. Be particular not to have the top of the draw sheet higher
than the middle of the patient's back. Place the pad,--previously prepared
for the purpose,--on the draw sheet and level with the top of the draw
sheet.
Most physicians carry with them to all confinements a _Kelly pad_. A Kelly
pad is a rubber pad with inflated sides, which is put under the patient's
hips, and which retains all the discharges incident to a confinement so
that when it is removed the bed is clean and fresh. The advantage of the
Kelly pad is twofold; first, it ensures a clean, compact, systematic
confinement; second, its use subjects the patient to the least necessary
movement at a time when movement is distressing, painful, and frequently
dangerous. If a Kelly pad is not used, it is desirable to place under the
pad (between the pad and the draw sheet) a piece of oil cloth or rubber
sheeting, or a number of newspapers will do. This will prevent, to a
considerable degree, the discharges from soaking through the pad on to the
draw sheet and sheet and mattress below.
After the confinement is over and the patient is clean, remove the Kelly
pad, and the pad below if necessary, or the pad and newspapers if these are
used,--place a clean pad under the patient and you are ready to place the
binder on if a binder is to be used. [Page 66]
SHOULD A BINDER BE USED?--Medically a binder is not necessary, neither is
it objectionable from a medical standpoint. It is supposed to hold the
flaccid, empty womb in place. This it does not do and we are of the
opinion, that it, in many instances, according to how it is put on,
compresses the womb out of place. The binder is certainly appreciated by
most patients because of its snug, comfortable feeling; and in cases when
the abdominal wall is fat and the muscles soft, it holds them together in a
way that is impossible by the use of any other device. To claim that the
binder prevents hemorrhages is absurd. Our personal rule is to put one on
if the patient wants one, or if she has previously had one. To be
effective, in any sense, the binder should extend from the waist line down
to halfway between the hips and knees and should be snugly, but not too
tightly pinned.
SANITARY NAPKINS.--These can be purchased already prepared in most drug
stores, or they can be made in the following manner: Take an ordinary grade
of cheese cloth, wash it, and when dry, cut it into half yard squares. In
the center of each square place a strip, six or eight inches long, of
absorbent cotton and fold the gauze lengthwise over it so as to make a pad.
These can be used as napkins, and after they are soiled can be burned. It
is absolutely wrong to use rags or any old cloths for napkins, as the
patient can be infected and made seriously sick by this procedure.
HOW TO CALCULATE THE PROBABLE DATE OF THE CONFINEMENT.--The duration of
pregnancy extends for 280 days from the end of the last menstruation. Add
seven days to the date of the last menstruation, and from that date count
ahead nine months, or backward three months and you may have the probable
date of the confinement. Should you pass this time you will probably go on
for two additional weeks. The reason for this is that the most susceptible
time for conception to occur is either during the week following
menstruation or a few days before menstruation. If, therefore, you pass the
above probable date which was calculated from the end of the last
menstruation, it shows that conception did not take place during the [67]
week following that menstruation; and the assumption will be that it took
place a few days before the next menstruation, which will be about two
weeks later than the date as calculated above.
If, for example, a pregnant woman was last sick from January 1st to 5th we
add seven days to the 5th, which is the 12th, to which we add nine months,
which will give us, as the probable date of confinement, October 12th.
Should she go a few days over the 12th, the probability is that the
confinement will take place on October 26th.
TABLE FOR CALCULATING THE DATE OF CONFINEMENT
-----------------------------------------------------------------
JAN. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
OCT. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
-----------------------------------------------------------------
JAN. 21 22 23 24 25 26 27 28 29 30 31
OCT. 28 29 30 31 1 2 3 4 5 6 7 NOV.
-----------------------------------------------------------------
FEB. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
NOV. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
-----------------------------------------------------------------
FEB. 21 22 23 24 25 26 27 28
NOV. 28 29 30 1 2 3 4 5 DEC.
-----------------------------------------------------------------
MAR. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
DEC. 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
-----------------------------------------------------------------
MAR. 21 22 23 24 25 26 27 28 29 30 31
DEC. 26 27 28 29 30 31 1 2 3 4 5 JAN.
-----------------------------------------------------------------
APR. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
JAN. 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
-----------------------------------------------------------------
APR. 21 22 23 24 25 26 27 28 29 30
JAN. 26 27 28 29 30 31 1 2 3 4 FEB.
-----------------------------------------------------------------
MAY. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
FEB. 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
-----------------------------------------------------------------
MAY. 21 22 23 24 25 26 27 28 29 30 31
FEB. 25 26 27 28 1 2 3 4 5 6 7 MAR.
-----------------------------------------------------------------
JUNE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
MAR. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
-----------------------------------------------------------------
JUNE 21 22 23 24 25 26 27 28 29 30
MAR. 28 29 30 31 1 2 3 4 5 6 APR.
-----------------------------------------------------------------
JULY 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
APR. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
-----------------------------------------------------------------
JULY 21 22 23 24 25 26 27 28 29 30 31
APR. 27 28 29 30 1 2 3 4 5 6 7 MAY
-----------------------------------------------------------------
AUG. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
MAY 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
-----------------------------------------------------------------
AUG. 21 22 23 24 25 26 27 28 29 30 31
MAY 28 29 30 31 1 2 3 4 5 6 7 JUNE
-----------------------------------------------------------------
SEPT. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
JUNE 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
-----------------------------------------------------------------
SEPT. 21 22 23 24 25 26 27 28 29 30
JUNE 28 29 30 1 2 3 4 5 6 7 JULY
-----------------------------------------------------------------
OCT. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
JULY 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
-----------------------------------------------------------------
OCT. 21 22 23 24 25 26 27 28 29 30 31
JULY 28 29 30 31 1 2 3 4 5 6 7 AUG.
-----------------------------------------------------------------
NOV. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
AUG. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
-----------------------------------------------------------------
NOV. 21 22 23 24 25 26 27 28 29 30
AUG. 28 29 30 31 1 2 3 4 5 6 SEPT.
-----------------------------------------------------------------
DEC. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
SEPT. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
-----------------------------------------------------------------
DEC. 21 22 23 24 25 26 27 28 29 30 31
SEPT. 27 28 29 30 1 2 3 4 5 6 7 OCT.
-----------------------------------------------------------------
[68]
The foregoing table affords us a handy means of finding the probable date
of confinement at a glance.
Find the date of the last day of the last menstrual period in the upper
row; the date immediately below it is the probable date of confinement.
For example if the last menstrual period was from Jan. 1st to 5th, we find
January 5th and below it we note October 12th as the probable date of
confinement.
WHEN SHOULD A PREGNANT WOMAN FIRST CALL UPON HER PHYSICIAN?--The earliest
indication of pregnancy is the interruption of menstruation. When
menstruation fails to appear at its regular time in a young married woman
whose past menstrual history is good,--i.e., she has been sick every month
regularly and without pain since she began menstruating as a girl,--the
assumption would naturally be that she was pregnant. Menstruation may
however "miss" one month for other reasons than pregnancy just at this
time, as is explained elsewhere, so it is wise to defer a positive
assumption on such an important matter. When the second menstruation does
not appear, and there are no specific reasons for its failure to appear, it
may be safely assumed that pregnancy has taken place. A visit to the family
physician one week after the second menstruation should have appeared, or
at least long enough to feel absolutely certain that the sickness is not
coming around, is not only necessary, but is the essential and correct step
to take for a number of very good reasons. If a woman for example has not
had a baby, how does she know she can have one? It is quite possible to
become pregnant and yet it may be wholly impossible to give birth to a
child. It is necessary to be constructed normally, or as near what is
regarded as normal as is possible, in order safely to assume the
responsibility of carrying a pregnancy to a successful completion. No one
but a physician, who is skilled and familiar in the knowledge of what
constitutes the proper size, and shape, and quality, and relations, one
with another, of your bones, and ligaments, and muscles, can tell [69]
whether you can safely be permitted to carry a pregnancy to term or not. If
the anatomical conditions are not just right; if circumstances from a
medical standpoint are not favorable; if your personal risk is too
hazardous; if, in other words, medical science should decide that you are
one of the very few women who cannot have a baby, is it not of very great
importance that you should know this as soon as possible? Does not that
fact alone render your early call upon your physician imperative? A
physician can bring out facts, relating to the personal and family history,
and habits, of the prospective mother, which will enable him to formulate
advice which will prove of the highest value from the very beginning of
pregnancy. Instructions carried into effect at this early date, as to
personal conduct, exercise, diet, etc., will have a distinctly beneficial
influence, not only on the patient's health and the character of her
confinement, but on the physical vitality of the coming baby.
REGARDING THE CHOICE OF A PHYSICIAN.--This is a matter that should receive
the most careful consideration. While it is just to admit that every
physician is capable of successfully conducting maternity cases, there are
certain characteristics in the individual temperament that would seem to
indicate that some physicians are better adapted to this special work.
Trustworthiness is an imperative essential in a physician who assumes the
responsibility of confinement engagements. He must be clean in his personal
habits as well as morally. He should possess the virtue of patience and be
tactful, and above all he should be made to feel that he has your implicit
confidence. If you will analyze these qualifications you will understand
just what they imply. The physician who has the reputation of having the
largest practice is not necessarily the man you want, nor does it imply
that he is the best fitted to conduct your case to your satisfaction. The
fact that he is a very busy man may be distinctly detrimental to your best
interests. If the physician has the reputation of being an excellent
doctor, but, "You can't always depend on him,--he may be out of town, or he
may send his assistant, or substitute," you don't want him; it is too [70]
important an event to you to take a chance with. Rely rather upon the man
who, though his charge may be a little higher, is known to be trustworthy;
who will take a personal interest in you, and is known to be patient and
capable.
THE SELECTION OF A NURSE.--A choice must be made between having a trained
nurse and what is known as a maternity, or monthly, nurse. The choice may
be dictated by the financial means of the patient. A trained nurse is paid
from $25 to $30 per week, while a maternity nurse usually gets $15 per
week.
A trained nurse is a graduate from a hospital where she has successfully
completed a course of training. She is to be preferred, if she can be
afforded, for the reason that she has been trained to obey absolutely the
orders of a physician, and because she has the requisite knowledge to
detect emergencies, and the necessary skill and experience to enable her to
act intelligently of her own initiative in any emergency.
The maternity nurse, on the other hand, has not had an adequate training
and is absolutely helpless, so far as medical knowledge is concerned, in a
real emergency. Her experience is limited to what she has picked up in the
various cases she has had. She, as a rule, has chosen this means of
obtaining a living as a result of some domestic financial affliction. She
does not understand the laws of sterilization and has not been trained to
obey, without question, the instructions of a physician. The maternity
nurse follows a routine which she is incapable of modifying to suit the
particular case. She has old-fashioned ideas and notions which she carries
out as a matter of course, and she overestimates the great importance of
her experience to the extent of wholly disregarding the advice of the
physician. She assumes the care of the patient and baby, and regards this
as her right, and as a result she is frequently responsible for much injury
to the mother and child. Despite these objections we have worked with many
of these nurses who were to be preferred to trained nurses. It is the
individual after all that counts, and if a maternity nurse, though
technically untrained, is adaptable, tactful, and will consent to be [71]
instructed to the extent of obeying without argument, she can become
invaluable, and her skill and experience will carry her creditably over
many trying incidents. The objection of the medical profession to an
untrained nurse is based, not so much on her lack of ability, as upon her
propensity to indiscriminate and indiscreet talk,--they have not been
trained to know the value of professional silence, nor have they had the
necessary education which would have enabled them to acquire through their
experience the knowledge that "silence is golden" at all times. A trained
nurse possesses the requisite knowledge, but may have an objectionable
individuality. An untrained nurse may have sufficient knowledge, and what
she lacks she may make up for in being congenial and adaptable. While the
trained nurse strictly attends exclusively to the mother and the baby, a
maternity nurse as a rule attends to the household duties in addition. She
cooks the meals of the entire family, and dresses and cares for the other
children if there is no one else to do it. The duties of a maternity nurse
can be specified and agreed upon, and the terms arranged when she is
engaged. The duties of a trained nurse are fixed by nursing laws and
medical rules and cannot be changed or modified by private agreement. These
laws and rules, however, are not sufficiently arbitrary to make it
impossible for the nurse to be obliging, courteous, and
sincere,--qualifications which every patient has a right to expect, and a
right to insist upon from every graduate nurse.
The selection of a nurse should receive careful consideration. She should
be known to be honest, honorable, competent, healthy, and personally clean
in habits and dress, and she should be tactful, obliging, and she should
attend to her own affairs strictly. She should not be a gossip; she should
not shirk her work or pry into family affairs that do not concern her; and
she should not drag into the conversation her own personal or family
secrets.
The nurse has certain rights which the patient should willingly recognize.
She is entitled to a comfortable bed, sufficient sleep, good food, and
exercise in the open air every day. These are essential in order that [72]
she maintain her own health, as well as keep at the highest point of
efficiency.
When you select your physician consult with him regarding your nurse. If
you know personally a capable nurse, there is no objection to selecting
her, and no physician will oppose this procedure if you assume the
responsibility of her capability.
There are many advantages, however, in permitting the physician to provide
a nurse. He assumes the responsibility of the nurse's capability, and it is
safe to assume he will not recommend one whom he knows to be personally
objectionable, or professionally incapable. Every physician acquires
certain individual methods in the conduct of maternity cases, which
experience has taught him to be successful. A competent knowledge of these
methods by the nurse greatly facilitates the details and ensures a
harmonious conduct of the entire case,--facts which accrue to the comfort
and the well-being of the patient.
It is not out of place here to warn a young wife against being advised by a
neighbor or a busybody, as to whom she should select as physician or nurse.
You must not depend upon the gossip of the neighborhood. The physician or
nurse whom you are told by one of these irresponsible individuals not to
take, may be the one above all others whom you should take. When you hear a
gossiping woman decry a physician, depend upon it, she owes him
something,--most often it is a bill, but it may only be a grudge. There is
no class of men in any community who are maligned and abused so much as are
physicians. They seem to be the choice victims of the enmity and spite of
every malicious feminine tongue. A woman should think twice before she
utters a criticism regarding the work of a physician. She would, if she but
knew how quickly she brands and advertises herself as irresponsible and
lacking in ordinary courtesy and good breeding, as she is not qualified to
criticise the professional capability of a physician, nor is she qualified
to estimate the extent of the wrong she perpetrates. There is no class of
men who do more conscientious work, day after day, than do physicians, [73]
and there is no class of men who are more deserving of the commendation of
the entire community than the thousands of self-sacrificing, underpaid
members of the medical profession. Be suspicious therefore when you hear a
criticism, and be very, very sure before you utter one,--rather give him
the benefit of the doubt and you will do no wrong, and it may be at some
future date you will be thankful you did not criticise.
* * * * *
[75]