HYGIENE OF NORMAL PREGNANCY
The time of confinement can never be accurately determined, because the
onset of labor is purely an accident, dependent on many factors.
Furthermore, conception does not take place necessarily at the time of
intercourse, and we have no means of knowing whether conception occurred
_just after_ the last period present or _just before_ the first period
missed. So there is always a possible error of three weeks.
Pregnancy in the human family normally lasts from 275 to 280 days, and
the approximate date of confinement can be obtained by the following
convenient rules:
1. Take the first day of the last menstruation, count back three months
and add seven days.
2. Or, assuming that quickening occurs at the seventeenth week, count
ahead twenty-two weeks from the day on which quickening was observed.
3. Or, count two weeks from the day of lightening.
4. Or, with a pelvimeter, get the length of the fœtus by Ahlfeld’s rule
(measure from symphysis to breech of child, subtract two cm. for
thickness of abdominal wall and multiply by two. The result is the
length of the child in centimeters) and compare with fifty centimeters,
which is the average length of a mature child. After the seventh month,
the child in utero grows at the rate of about 1 cm. a week (0.9 cm.).
5. Or, by the tape, according to Spiegelberg’s standard of growth, as
previously mentioned.
The hygienic rules to be observed during pregnancy are founded on three
basic principles: (1) To watch attentively the different organs and see
that they functionate normally; (2) To eliminate all those conditions
that favor the premature expulsion of the egg; and (3) To provide, so
far as possible, for the normal gestation and the physiological delivery
of the child. These factors will be taken up in detail.
=The Diet.=—The appetite is usually somewhat increased, but it is
unnecessary to indulge the stomach on the ground that the mother “must
eat for two.” Longings, however, should be gratified so far as the
demand is not for unwholesome things. Food should be simple and plainly
cooked. Meat is permitted in moderation unless some organic change
exists to contraindicate it. Rich pastries and gravies should be
avoided, but cereals, fruits and vegetables should be used in abundance.
It may be better to eat four times a day instead of three. Fluids should
be taken freely, from one to two quarts daily. Milk is especially
valuable, and alkaline, natural and charged waters, such as Vichy and
seltzer, are useful. Wine, beer and other alcohols should not be taken,
or if the patient is habituated to their use, the amount should be
restricted on account of danger to the pregnancy and danger to the
child.
In contracted pelves it is sometimes desired to furnish a special diet,
with the idea of controlling the size of the child (see Prochownick’s
Diet, p. 332) but this is an emergency. Certain books on maternity,
designed for popular reading, advocate diets that are supposed, by
depriving the child of lime salts, to keep its bones soft and make the
labor easy. If it succeeds, the child will be injuriously affected. If
it does not succeed, the claim is false.
=Exercise.=—Exercise should be taken, but it should not be violent, nor
attended by risk. Golf, swimming, tennis, dancing, horseback or bicycle
riding and fast driving in automobiles should be forbidden, lest
abortion follow. General exhaustion must be avoided and all conditions
that even approximate traumatism. Walking and slow driving are best, and
housework is excellent up to a mild degree of fatigue. Travel should be
restricted. If exercise is not feasible, massage will furnish the
required stimulation to the circulation. The menstrual epochs are
peculiarly favorable to abortive influences.
=The Bowels.=—Most women have a tendency to constipation during
pregnancy. Many times this can be corrected by increasing the
“roughening” in the food; more vegetables and fruits, bran bread and
muffins, whole wheat bread, spinach, beans, carrots, turnips, peas and
especially potatoes, baked and eaten, skin and all. Prunes, figs, and
dates are valuable aids. Agar may be eaten three or four times daily.
Russian oil (liquid petrolatum), taken in tablespoon doses three times
daily, is an adjuvant, and finally, some form of cascara or aperient
pill may be taken, if necessary.
Violent cathartics should not be used at all, and enemas as little as
possible; only when _quick_ results are necessary.
=Heartburn.=—Heartburn is a frequent complication, especially in the
later months. It is due to an inordinate secretion of acid in the
stomach. Soda mint tablets, bicarbonate of soda, and magnesia, in cake
or as milk of magnesia, will relieve. The magnesia is also a laxative.
=The kidneys= require particular care during pregnancy, and in every
case the urine should be examined monthly, up to the fifth month, and
every two weeks thereafter, until the last six weeks, when a weekly test
should be made.
The amount passed in twenty-four hours should be measured. Three pints
is an average quantity. Albumin, sugar, and casts must be looked for and
reported. Albumin may or may not be a serious symptom. Casts are
significant of nephritis and indicate danger. Sugar may be lactose and
be derived from the milk secreted in the breast. Edema of feet, hands
and eyelids must always be investigated, with the possibility in mind,
of heart and kidney lesions. Blindness, dizzy spells, headaches and
spots before the eyes are always alarming symptoms until their innocence
is established.
Through constant watchfulness of the urine, many cases of eclampsia may
be averted.
=Bathing= is more important in pregnancy than at other times. The more
the skin secretes, the less the burden on the kidneys. The skin must be
kept warm, clean, and active. Then again, during pregnancy the skin is
often unusually sensitive and only the mildest soaps and blandest
applications can be used. The water must be neither hot nor cold, but
just a comfortable temperature. Cold bathing, whether shower, plunge, or
sitz, must be denied. Sea bathing is also unwise. The warm tub bath of
plain water or with bran answers all conditions until the expected labor
is near, then the warm shower or sponge bath should be substituted, lest
germs from the bath water enter the vagina.
If the kidneys need aid, a hot pack may be used; but in all cases,
frequent rubbing of the skin with a coarse towel should follow the bath.
=The dress= must be warm, loose, simple and suspended from the
shoulders. To prevent chilling, wool or silk, or a mixture of both,
should be worn next to the skin,—light in summer and heavy in winter.
The patient must be sensibly clad in broad, loose, low-heeled shoes.
There should be no constriction about chest or abdomen. Circular garters
must not be worn. If a corset is insisted upon, it must support the
abdomen from below and _lift it up_. No corset is admissible that pushes
down on the abdomen. This is especially true if the woman has borne one
or more children and has a pendulous abdomen. The breasts may get heavy
and require the rest and ease supplied by a properly fitting bust
supporter.
=Fainting= is an annoying symptom in some women. It may come when
quickening is first perceived, or from the excitement of crowds, or from
hysteria. It usually passes quickly. The pallor is not deep, the pulse
is not affected, and consciousness is not lost. It does not affect the
ovum. Heart trouble should be excluded, and the daily habits of dress,
diet, and bowels investigated. Smelling salts will usually suffice for
the attack.
=The abdominal walls= may be strengthened by appropriate exercise before
and after gestation, so that the muscles will preserve their tone. After
delivery nursing the child will help greatly in the preservation of the
waist line and figure, by aiding involution.
About the seventh month in primiparas, the abdomen gets very tense and
in places the skin is stretched until it gives way and forms striæ. This
tightness can be relieved to a considerable degree by inunctions of
cocoanut oil or albolene.
Pain in the abdomen at this time may be due to mechanical distention, to
strain on the muscles, to stretching of operative adhesions, to gas,
constipation, or appendicitis. The physician should be informed of it.
In every case, constipation, swelling of feet, hands or eyelids,
blurring of vision, ringing in the ears, vomiting, persistent backache,
or the passage of blood, no matter how slight, should be reported to the
doctor.
=The Breasts=.—There should be no pressure on the glands and they should
be warmly covered. The nipples must be kept clean and soft by soap and
water, and about a month before the labor is expected, the nipple should
be anointed with albolene or cocoanut oil and rubbed and pulled for a
few minutes every night. This removes the crusts and dried secretions
that collect on the nipple and prepare it for the macerating action of
the baby’s mouth. No alcohol or strongly astringent washes should be
used. Injuries must be avoided. If the nipples become tender they may be
protected from external irritation by the lead nipple shield or by a
wooden shield with a hollow center, such as Williams recommends.
=Leucorrhœa.=—This is one of the commonest discomforts of pregnancy, and
the sense of uncleanliness, if the discharge is excessive, as well as
the resulting irritation, may demand attention. It must be kept in mind,
however, that the normal vaginal discharge of a healthy pregnant woman
is strongly germicidal and should not be douched away without definite
indications.
Vaginal douches of warm boric acid solution will do for cleanliness, but
the douche bag must not be higher than the waist. Stronger and more
antiseptic solutions are potassium permanganate 1:5000, or chinosol
1:1000. A suppository may be used, consisting of extract belladonna, gr.
ss; tannic acid, gr. v, and boroglyceride dr. ss.
=Sexual intercourse= is distasteful to most pregnant women, but
sometimes the inclination is intensified.
Coitus often causes much pelvic discomfort and may be an influential
factor in producing abortion. It should be forbidden during the early
months, at all menstrual epochs, and for at least two weeks before
labor. The uterus may be infected by germs beneath the foreskin and
hæmorrhage may follow the act if the placenta is low. In healthy
persons, at the instance of the female, intercourse in moderation is
permissible.
=The mental condition= should be placid without either excitement or
fatigue. Anxiety should be dissipated by cheerful company and
surroundings. Judicious amusement is desirable and a congenial
occupation, but neighbors who tell frightful tales of disaster in labor,
or nurses who relate the details of their critical cases, are equally to
be avoided.
Many women of neurotic temperament dread the labor desperately. They are
sure that death impends and they dwell with tragic interest on the
stories of complicated cases related by thoughtless or malicious
neighbors. The nurse can do much to allay these apprehensions by
cheerfulness, optimism, and gentleness. Her buoyant temperament will
drive away the patient’s fears just as effectively as the assurances of
the physician.
Great allowances must be made for attacks of irritability, for the
changes going on in the woman’s pelvis keep her in a capricious and
whimsical condition. A good book to read at this time is, the
“Prospective Mother,” by Slemons.
=The subject of maternal impressions= is the cause of much anxiety
during pregnancy. It is safe to assure the mother that it is nearly
impossible to mark her child by emotional stress. There is no
demonstrable nervous communication between mother and child, and most of
the deformities that occur and are attributable to shock, etc., can be
explained by our knowledge of intrauterine changes. Furthermore, the
same deformities occur in lower animals, to which it is difficult to
ascribe such high nervous organization.
Many of the birthmarks, supposedly due to shock, occur too late in the
pregnancy to affect the child, even if it were possible, for the child
is completely formed before the fourteenth week.
=The Determination of Sex.=—It is not possible to know in advance of
delivery whether the child will be a male or a female. It is equally
impossible to determine or even to influence the sex of the coming
child. Many theories have been advanced, and much talent has been wasted
in trying to solve this problem.
Reasoning by analogy from the facts obtained from lower animals, the sex
of the child is unalterably decided the moment conception occurs. The
responsibility for the decisions seems to lie with the male cell. All we
really know is that the sexes appear in the ratio of 100 girls to 106
boys.