Physical Difficulties of the Expectant Mother
We cannot reason with our cells, for they know so much more than we
do that they cannot understand us; but though we cannot reason with
them, we can find out what they have been most accustomed to, and
what therefore they are most likely to expect; and we can see that
they get this, as far as it is in our power to give it them, and
may then generally leave the rest to them.
SAMUEL BUTLER.
To far too many women the time when they are carrying a child is a
period of strain and semi-invalidism, a time filled not only with
surprises and difficulties, but too often coloured with actual
distress and ill-health. _This should not be._ The time of prospective
motherhood should be one of buoyancy, health, physical activity and
mental vitality. The low standard of health which the modern woman
tolerates is deplorable.
But to whom can the young mother-to-be turn for advice and assistance?
Such healthy, happy, prospective motherhood does not come by instinct
in our city life. Those around her, older than she, who have had
children of their own may perhaps be able to give her a hint here and
a little piece of advice there, which to some extent may alleviate
her difficulty or pierce with a faint shadow of light the gloom of
perplexity in the ever deepening unknown into which she is entering
for the first time; but nearly all such women have themselves gone
blindly and individually through this period of immense significance
and mystery without having had any rational help from one devoted to
the maintenance of _health_.
Almost every book written to advise the coming mother is written by a
doctor of disease, with very few exceptions by doctors who tolerate
what is, in my opinion, a disgracefully low standard of general health
in women. A distinguished gynecologist who, in cross-examination
before a commission persisted in maintaining that the “daily morning
sickness” which is so prevalent in women who are carrying a child is
“physiologically right and natural” (indeed, he implied almost that it
was necessary) represents an attitude of mind very general and capable
of far-reaching hypnotic injury to the community as a whole.
By far the best and sanest book available for healthy women is one
to which I have already referred, namely _Tokology_, by Dr. Alice
Stockham, but this book has its inaccuracies and its drawbacks, and
even its pages are too much occupied with the wretched and handicapping
troubles which women do experience in large numbers, but _which should
not be_.
Nevertheless, to allow a young girl or woman to enter upon these months
of trial without making clear to her what she has to face, is cruel
indeed. For a sensitive woman the experience, even at its best, and
when most free from incapacities, is yet incredibly and penetratingly
more terrible than she anticipated. The more sensitive and more
conscious she is, the deeper and profounder may be her joy in her
coming motherhood, but, at the same time, the more intense the physical
experiences through which she must pass.
The modern sensitive young woman does not take things blindly and
patiently and with resignation, with a pious belief in her own
inferiority, which may have helped to dull and moderate the sensations
of her grandmothers. The more evolved she is, the more she may be
willing to bow to natural law, but the less is she content to suffer
wanton cruelties imposed upon her by ignorance, stupidity or coercion.
Many are the midwives, maternity nurses and medical practitioners with
whom I have discussed such matters, and from whom, often incognito,
I have asked advice. I may say that _none_ gave _all the necessary_
advice, not one gave one-tenth of what is in this book, only one or two
gave any necessary simple advice in the sympathetic and understanding
fashion desirable, and only one or two appeared to have any clear
_generalizations_ or scientific understanding of the facts about which
I asked. The resignation, the shrugging of the shoulders in the face
of things which would otherwise make one weep, or the cheerful braving
out or pretending that things are not as bad as they are, which is the
general attitude of mind of the maternity nurse is little more helpful
than that of the practitioner. Concerning many of the practical facts
of the later months of pregnancy and actual birth, and the succeeding
weeks of recovery, the properly trained midwife seems on the whole
wiser than the average general practitioner, wiser even than the
specialist who may come at a crisis, but who does not watch his patient
through the succeeding weeks.
Many young women who have recently been mothers have told me of the
mental and physical horror which they then experienced, and of the
added horror that they should feel horror. They have asked me to
generalize, if it is possible, from their cases in such a way as to
help others who enter upon maternity’s difficulties for the first
time, so that they may at least be spared that terrible sense of
isolation and of exceptional failure when they experience one by one
the things which are inevitable, or the things which are, by our
artificial lives, so frequently imposed.
The bearing of a child very often may be complicated by actual disease,
and then requires, of course, expert medical attention. With those who
are in any sense actually ill, and who should be in the hands of a
doctor, I am not here dealing, for, in this respect, as throughout my
other books, I desire only to write of health for the healthy so that
they may have sufficient knowledge to maintain their health and raise
the vitality of the race.
I may say here that, even for the healthiest, it is very advisable, not
only for her first, but for every succeeding pregnancy, that a woman
should be examined and measured by some wise and healthy-minded medical
practitioner or midwife at least once during the first three months
and twice again during the last three months, but that, for the first
baby, it would be better to go at least every month for examination. In
that way, the various insidious disturbances of the excretory system,
and other fundamental things which _may_ go a little wrong, even in an
otherwise healthy woman, can be detected immediately and dealt with.
Many however, find a great difficulty in bringing themselves to do
this.
Undoubtedly it is much better for the prospective mother to go to a
specialist, old enough to be wise and experienced and mellow, and
yet young and virile and active enough to be acquainted with modern
knowledge, and healthy and clean enough to look for and to desire
health and normality in those who come for advice.
This should pre-eminently be the special field for women doctors,
but there is not nearly a sufficient body of them with the necessary
qualifications to meet the requirements of the community, and I should
like to see a new profession created for women who, to the experience
and the training of first-class midwives, have added a sufficient
training in general medicine to be specialized to advise the _healthy_
prospective mother, and to be able to detect at once anything which
should necessitate handing her on to the doctor of disease. Such
practitioners should rank in status somewhere between the cultivated
midwife of gentle birth (such as a Queen Charlotte’s Hospital nurse)
and the medical woman. Thus the prospective mother would be spared
that hard and bitter contact with one who has become myopic in the
observation of disease, and would be able to go to someone specially
trained to encourage health. Meanwhile, as this is but a bright picture
of what may come in the future (and that _will_ come if women make a
sufficient demand for it) it may spare many women distress if I set out
the physical difficulties and peculiarities which are most liable to
occur with a _healthy_ woman.
From the welter of accounts of the effects of pregnancy, I have
disentangled into three groups those which normal women may have to
face. The difficulties are:--
(1) Those nature-imposed; these are essential; they cannot be avoided
by the healthiest woman. They can be perhaps, to some extent,
mitigated. They are things which the coming mother must be helped
through and over; she cannot be saved from them.
(2) Those entirely artificial; these are quite needless and are the
results of either ignorance or our gross disregard of known facts, and
can be entirely eradicated.
(3) Those which are to-day very usual, but which knowledge and a better
mode of life may entirely conquer.
Now to consider first the third group: those which are general, but
which a knowledge could or should conquer.
One of the first signs that she is to become a mother, and one of the
most usual experiences of a young woman when this time begins, is the
daily recurrence of that penetrating nausea and sickness usually after
she has risen in the morning, called “Morning Sickness.” This is so
usual that medical practitioners rely on it to some extent as a sign
of pregnancy. It is described in almost every book for the prospective
mother, and, as I have mentioned (p. 72), it is sometimes even
maintained by distinguished gynecologists as a physiological function,
_i.e._, a normal function.
Now this is a very nauseating and wretched experience to the majority
of women, and it is one which, I maintain, is entirely imposed by
ignorance, wrong living and the general hypnotic effect of others’
perverted views on the woman’s system. In those women whose internal
organs are improperly placed or somewhat malformed, it occurs as a
physiological result of pressure or other disturbance. _In true health
there is no physiological reason whatever for the morning sickness_,
and a woman who lives as she should live during the time of her coming
motherhood need not experience it. This should, in the next generation,
be entirely conquered, because it is to a very large extent caused
by allowing, even forcing to wear corsets, girls when they are still
unformed and developing. Those women who have never worn corsets in
the whole of their lives, and who dress as they should dress, and do
as they should do during the months when they are becoming mothers,
seldom experience morning sickness. Though there are some who, when
they know the child is coming, discard their corsets too late, and
these may still experience this unpleasant feature. The extraordinary
adaptability and vitality in a woman’s system, however, is a remarkable
thing, and even those who begin later in life than they should to train
for motherhood may yet accomplish much.
Granted a healthy, well-formed body, a previous life of normal
activity, sensible attention to the following points will insure
complete freedom from morning sickness in all but the exceptional and
pre-disposed:--
(_a_) Discard every scrap of heavy or constricting clothing,
wearing only the lightest garments hung from the shoulders entirely.
As I said in _Married Love_ the standard of dressing for the
prospective mother, whose garments should be of the lightest wool and
silk if possible, and should be so lightly hung that a butterfly can
walk the length of her body without tearing its wings.
(_b_) Discard all rich, heavy and over-cooked foods, such as
pastries and hot cakes, dried peas and beans, rich game or highly
seasoned dishes, and live as much as possible on uncooked foods and
simple milk puddings, stewed fruit, lightly cooked meat and fish,
with the largest obtainable quantity of very fresh ripe fruit.
(_c_) Start the day not with tea, but with the juice of two or
three oranges squeezed into a tumbler.
If she does these things a normal woman may go through the whole nine
months without experiencing one single moment of nausea, as many a
woman has done.
A retardation of the action of the bowels or constipation is very
frequent, and is a cause of many other ill-effects. A right diet such
as I advise, adding for this purpose honey and brown bread, does much
to prevent it; if it exists in spite of this, take suitable bending
exercises (see also page 72), even a warm hydrostatic douche (using a
douche-can with a little common salt in the water), but do _not_ take
regular drugs or “aperients.”
Another of the very frequent experiences of the mother who is carrying
a child, particularly towards the later months, is the enlargement of
the veins of the legs and ankles and the formation of varicose veins.
These may become very serious if neglected, and even if the woman is
being doctored, unless, at the same time, she regularly follows the
proper healthy method of dieting and living. In addition to the dieting
and clothing described above, which will make her almost certain to be
immune from varicose veins, she should take warm comfortable sitz baths
every evening, and she should lie down for at least half an hour or an
hour in the middle of the day or early evening with her feet raised a
few inches above the level of her head.
One of the most serious difficulties, felt even by those who avoid all
other drawbacks, is sleeplessness, particularly in the last month or
two when the activities of the child may be very disturbing. In this,
much depends on the position in which the child is lying, and sometimes
the position of the child can be improved by massage and manipulation
by a trained midwife or doctor. Something also can be done by the
mother herself through her mental attitude and hand touch on the child,
and also by taking hot sitz baths nightly before going to bed. Still
more, however, is accomplished by right diet, clothes, exercise and
happiness (see also Chapter XII).
The habit of taking aspirin regularly or in large quantities, which too
many women indulge in if sleepless during this time, is extremely bad
both for the child and for the mother. Drugs of any sort should not be
appealed to. If it is possible during these later months, sleep will be
much more refreshing, and the advantage will be very great both to the
coming child and the mother, if her bed can be arranged on a verandah
or out of doors, but it must not be forgotten that towards the end of
the period the expectant mother ought not to be out of ear-shot of
someone.
Now to consider the second group of disabilities; those entirely
the result of artificial outlook and condition. Among these must be
classed the inability to walk any distance or to take part in active
work of any sort. This is partly imposed by the hesitation of a woman
to be seen at this time, and particularly to face the vulgar and
leering attitude of the general public, and it is partly also due to
the general heaviness or strain on the muscles or to the presence of
varicose veins. If these have, by the methods just described, been
almost or entirely avoided, she will find that her natural activity is
much less reduced than it would otherwise be. To walk a mile or two,
or even three miles the day before or even the day of the birth is not
at all beyond what can be expected from an ordinary healthy woman who
lives as she should.
The necessity perpetually to be fussing, to be taking tonics or
drugs or medicines, to be thinking only of herself and never of any
general or greater theme, is also eliminated when the general health
is improved, and any mental or bodily activity which the mother can
indulge in without a sense of strain is advantageous to the child as
well as to herself.
The highly nervous condition and overstrained state of so many modern
women during this time is due entirely to the artificial social lives,
involving late hours, which they try to lead. The mother-to-be should
give up almost all social engagements which keep her out of bed after
9 o’clock. Sleep, fresh air, exercise under the healthiest natural
conditions she can command, coupled with the right diet, will secure
her health and strength throughout the time.
The difficulties, however, about which help is most needed are the
first group, those nature-imposed and inevitable difficulties which
the woman _has_ to face, and which, without instruction in the things
she might do to mitigate them, often lead her to suffer intensely,
though needlessly, and tend to have life-long effects on her health and
appearance. Simple and sometimes obvious precautions are required, and
yet these are almost unknown to the generality of advisers to whom the
prospective mother can turn.
The first and most obvious inmost change that affects her is that
felt in the muscles below the waist, particularly those which run
vertically, and which support, by their elasticity and strength, the
whole front of the body. As the months pass and the child and its
attendant tissues grow, there is a slowly increasing strain on these
muscles. As the enlargement proceeds the skin will also stretch, and
the under-skin and tissues beneath it are finally stretched almost to
breaking-point, stretched sometimes so that they do break apart and
leave ultimate permanent little scars under the skin of the mother.
Few apparently know, but all _should_ know, that this can be almost
entirely avoided (by fortunate women entirely avoided), if the skin
and tissues immediately below it are kept supple by daily rubbing with
olive oil from the fifth month. Perhaps from the fourth month once a
week, and certainly from the fifth month daily, the mother should rub
the lower part of her body and her breasts with a little olive oil.
This will not only have a soothing effect upon the skin, but will
assist its elasticity in such a way that she may return to her virgin
condition without leaving those tell-tale scars which so often mark
a woman, and which many, even highly trained maternity nurses and
doctors, seem to think are inevitable. Such scars _are not inevitable_,
and this very simple precaution, coupled with exercise, will frequently
be sufficient safeguard for the woman who desires to avoid them
altogether.
The same internal growth which enlarges the muscles and strains the
skin will also sometimes press apart the two main vertical muscles in
such a way that there is a tendency for inner tissues to project, and
for the last month or two this may be very uncomfortable without in
any way being dangerous. It is then advisable to wear a small stiff
pad over this and fasten it in place with a narrow, soft elastic band.
The use of a localized plaster very often strains the skin and leaves
scars or makes it sore. It is wise to have the small hard central
bandage wherever there is a tendency to localized projection as will be
self-evident to anyone who experiences it.
The natural darkening of the colour of the skin when it is strained
and stretched as it must be is very displeasing to the eye and,
particularly to a young girl whose beautiful body has been her delight,
may be a cause of great distress and self-repugnance. It is well that
she should be helped over this most anxious time of self-detestation
by the reliable assurance that it is only a temporary phase, and that
if she keeps in good health, and rubs herself with pure oil for two or
three months after birth as well as before, the skin will be entirely
freed from any stained or discoloured appearance, and will return to
its normal condition.
As the months pass, the actual physical weight of the body will
increase, gradually becoming a greater burden, so that long distance
walking and any acute activity such as running or tennis-playing
must become impossible. Nevertheless if the diet and mode of living
suggested above is followed out this will be very much less
embarrassing than is usually experienced.
Many forms of support or maternity corsets are advertised or medically
recommended to assist supporting the weight at such times, but, unless
the woman has any actual slipping of the position of the organs or
any deformity, she is very much better not to take such proffered
assistance for they will form a broken reed, and, as one knows, “the
broken reed pierces the hand.” It is much better for her to strengthen
her own muscles by slow and careful exercise, bending forward until she
touches the ground or as nearly touches the ground as possible; also
lying on her back on the ground and rising without touching the floor
with her hands and arms; also slowly raising the feet forward above the
head while lying on the back, and then allowing them to drop slowly to
the ground, this last exercise being very strengthening to the central
muscles of the body wall (detailed accounts of other useful exercises
will be found in Dr. Alice Stockham’s _Tokology_). So long as there is
no strain upon her, she should exercise throughout the whole of the
time. She would then not need any artificial support, and would be much
better without it.
I have never seen it elsewhere clearly stated, but I have discovered
that one very important reason against corsets is that, however well
shaped and loose they may be, they tend to touch and exert some slight
pressure on the soft tissues at the back of the waist; they must do so,
merely to remain upon the body without dropping off, and this amount
of pressure is sufficient to induce morning sickness (see p. 88) for
the following among other reasons. As the womb grows in the centre of
the body it pushes aside and to the back the many yards of soft tubular
alimentary canal which normally lie coiled in the front of the body,
and, if there is no constriction or pressure, these tend to find room
for themselves round the waist line and to the back, so that there
appears what seems almost like a coil or roll of fat round the waist.
This disposition is very advantageous, however, and should not be
interfered with in the way any corset must interfere, and it greatly
reduces the ungainly frontal size and helps to keep the body better
balanced (see p. 91).
At first the breasts will become firmer and larger and will support
themselves more readily than at any time, but later on their shape
somewhat changes and they tend to fall. They should then have carefully
slung and properly arranged supports looped over the shoulder. Neglect
of this often results in the final and lifelong loss of the beauty of
the bosom, and it is indeed a cruel thing that the average doctor or
nurse appears not to be capable of giving any useful advice on this
point, so that hundreds of thousands of women have not only lost their
beauty, but have been told that it is an inevitable and natural result
of having borne a child. That it is well-nigh inevitable under modern
unaided conditions, may be true. With proper support, proper massage
and treatment afterwards, the ugly breasts need not have been, and need
not be.
A thing which often distresses girls, but which however unsightly it
is while present is a temporary and passing phenomenon, is the sudden
appearance of freckles, even large patches of brown colouring matter,
on the skin during the time the baby is forming. So far as I am aware
nothing can be done to prevent it, and if as sometimes happens these
brown patches even appear on the face, it is a misfortune which must be
endured as stoically as possible, encouraged with the knowledge that it
will entirely pass.
Another curious thing I know one woman experienced, and about which
I am awaiting further evidence, was the apparent transplantation by
the child in the mother of the strong black body hairs of the father.
The result was that during the later months of carrying and for a few
months after birth, the mother’s lower limbs and forearms had a thick
growth of masculine-like hair, which nearly all fell off within six
months after the birth.
The tendency that the coming child has to extract nutriment from the
mother’s tissues often results in the loss or temporary spoiling of two
of her beauties, the beauty of her nails and the beauty of her hair.
These are apt to suffer unless she is warned in time and protects them.
The injury to them probably depends on the withdrawal of the proper
quantity of fat from the tissues. It is, therefore, advisable for the
mother-to-be to rub her nails and hair with some suitable natural oil.
Refined paraffin, almond oil or castor oil for the hair are by far
the best, and for the nails some animal grease such as lanoline, or
perhaps simple vaseline. Expensive concoctions, very much advertised
and claiming wonderful properties, generally owe anything which they
may contain to these ingredients, but more frequently contain little or
nothing of any value, and are often harmful.
The more fundamental, and, alas, almost inevitable result of bearing
a child is that it extracts not only the fat from the system, but the
hardening matter from the teeth. This indeed is, so far as I am aware,
a theft from the mother by the next generation which no knowledge of
its liability can prevent, and which can only be met by a careful
supervision of the mother’s teeth both before and after birth. Women
differ in the amount they lose, but it is, alas, one of the almost
inevitable things that there shall be a certain weakening of the teeth.
Sometimes this will right itself and teeth which shook in their sockets
immediately after the birth may apparently harden again and refix
themselves firmly, but if the weakening takes the form of actual decay,
they must be attended to.
In this respect the diet recommended by Dr. Stockham in _Tokology_,
which advocates the elimination of all calcareous food is perhaps
inadvisable if strictly followed out, because the growing child insists
on mineral matter, and it simply takes it from the mother’s structure
if it does not get it in other ways. I have, therefore, thought it
advisable not entirely to eliminate the wheat and other bone making
materials from the usual diet as Dr. Stockham recommends, but to
maintain a certain proportion of wheat, especially whole wheat, in the
food. Her advice to replace rich dishes by simple rice, stewed fruits,
etc., is certainly wise, and still more important is it to follow her
warm recommendation to eat large quantities of fresh fruit.
One of the perfectly natural, but to the young mother rather
unexpected, results of the changes of the later months is the
alteration which gradually comes in the position of the centre of
gravity of her whole body. She is of course scarcely conscious of
this, and yet it is a point of some importance, because it results
in a certain liability to slip and to fall, particularly coming
downstairs. The danger of such a fall is less to the child, which is
safely surrounded by a buffer of fluid and by the mother’s protective
muscles, but more to the mother herself, who, in falling, may strain or
injure herself. The growth which results in this change in the centre
of gravity comes too rapidly for the system quite perfectly to adjust
itself to it. It will be remembered how long it takes a baby to learn
to balance itself upright upon its feet; the adult mother-to-be has
had a whole lifetime knowing just how to balance, and every muscle
has become adjusted to the centre of gravity in its accustomed place.
The change in the distribution of weight changes the position of the
centre of gravity to some extent, sufficiently at any rate to throw
the co-ordination of many years somewhat out of gear, and it is,
therefore, wise for the expectant mother to take particular care not
to slip or stumble unexpectedly. The sudden and active movement of the
child which may kick or turn with no warning may cause her quite to
lose her balance, particularly if she is on a steep staircase. It is
well, therefore, to make a special point of keeping guard against this
possibility by always having a firm grip on the handrail when going up
or down stairs during the later months of carrying a child.
However well and full of a sense of power and creative vitality she
may be, a woman should take long hours of rest: to bed at nine each
evening and not up till eight o’clock in the morning and taking at
least one hour lying down during the day. During the nine months of
bearing the unborn child, she should remember she is providing it with
_vitality_ every second of the twenty-four hours of each day, and she
should neither have forced upon her, nor should she desire to do, work
which ever tires her, though she should live an active, full, healthy,
happy existence and should be capable of nearly all her normal work and
enjoyments. If she is wise she will work in direct contact with sun-lit
earth. Gardening ensures the truest sense of physical well-being.