PRECAUTIONS AND SUGGESTIONS TO PREGNANT WOMEN.
THERE is a hygiene of pregnancy which the enceinte female should
observe, for by so doing, she will not only make the period of her
gestation less onerous to herself, but she will be able to materially
contribute toward the accomplishment of a natural childbirth. Although
pregnancy is a physiological process, the conditions in the female
economy, under which this is carried on, are at variance with those
which are to be found in the unimpregnated state, and as a consequence
it rationally follows that the pregnant female should endeavor to
conform to the demands which the altered relations require.
If the pregnant woman is properly clothed to begin with, she will
greatly mitigate some of the symptoms which very often mar her
well-being. The clothing should neither be too heavy in summer, nor
too light in winter, she must dress so as to conform to the season
and feel comfortable; but by all means the chest and abdomen should
be kept free from pressure, the skirts must be supported from the
shoulders, and the corset also, should be dispensed with, and a waist
worn instead, one that partly answers the purpose of a corset, and
to which the skirts can be fastened or buttoned at the same time. I
have no respect nor patience for those women who desire to conceal by
tight lacing, the appearance of their pregnancy. Motherhood, whether
active or prospective, is a divine function, and as creatures are
the instruments of the Creator, there is nothing to be ashamed of by
those who have complied with the usages of civilized peoples, and
wherever an exhibition of pregnancy becomes indelicate, a person who
hopes or expects to be a mother should not be. If a woman has the true
characteristics to make a good mother, she cannot, nor will she trifle
with her own health or that of her child; in truth, mothers cannot
begin too soon to consider the welfare of their offspring.
To guard against taking cold is one of the maxims, that the pregnant
woman should heed, especially during the last half of gestation when
the prominence of the abdomen shortens the skirts in front and removes
them off from the limbs. Flannel drawers properly adapted to the limbs
and worn underneath the muslin ones affords the best protection that
can be adopted, and it replaces cumbersome skirts. Sudden extreme
variations of temperature should also be avoided, like going from an
overheated apartment into the cold outside air, or into another cold
chilly room. In making these changes, one should gradually cool off,
and then by putting on additional clothing, wraps or shawls, the danger
of taking cold may be removed. Hot coffee or tea or hot alcoholic
beverages are equally as dangerous as overheated apartments, for
anything which stimulates the circulation of the blood in an inordinate
degree is liable to produce a congestion of the placenta, and thus
incite an abortion; hence fevers of all kinds are known to have brought
about an expulsion of the fetus. On the whole, either very hot or very
cold temperatures are to be avoided, for instance, prolonged staying
in cold weather or lengthened exposure to the rays of the sun should
be prudently guarded against by the pregnant female. Of course this is
not to be construed as meaning, that she should not partake of exercise
in the open fresh air—far from it, but the exercise shall not be
forced or driven, it shall at all times be voluntary and passive, so
that when a tired feeling comes on, she can rest and refresh herself.
The best time for these little walks is in the morning and evening
in the summer season and in the middle of the day in cold weather. A
rough, uneven walk should be avoided because she may stumble; jolting
in either street cars or wagon is equally pernicious. A great deal of
stair climbing is injurious, and when it becomes necessary it must be
done slowly; running the sewing machine has caused many miscarriages.
Avoid running, jumping, riding on horseback, and lifting heavy weights,
hanging laundried clothes on lines, in fact everything that can strain
the muscles, bear down, increase the intra-abdominal pressure and
excite the nervous system.
The prospective mother must resign her amusements at evening
entertainments in crowded halls or theaters, in which the air becomes
foul and overheated from large congregations of persons. Here she is
also threatened to be jostled and jammed, and perhaps injured in other
ways. Her sleeping apartments should be thoroughly ventilated through
the day, and coition, if not entirely suspended, at least restrained
and only passively exercised, for any excess of this nature is not only
injurious to the child, but may cause a miscarriage. It is not expected
that the pregnant woman should sit in the arm chair during the period
of gestation, far from it, but it is even greatly desired that she
continue her usual vocation. Exercise of a passive nature is always
wholesome, and for this reason it will be conducive to good health
if enough work is done over every day to keep the system in gentle
activity; the domestic duties of a household will or should always
furnish that. All good women take a pride in their household affairs,
if they do not they are not good; and those who boast that they never
put their hands to anything in the house, have mistaken their vocation
as women, and are either indolent or worthless, and often both. No one
should boast of idleness, rather be ashamed of it. Employment makes
character; it gives buoyancy to the spirit and tranquillity of mind.
The influence that an equable temperament exercises over the nervous
development of the unborn child may eventually be demonstrated by its
resistance to the shock of diseases which superinduce convulsions and
death. It is not advisable to sleep during the day, it is better to
retire early after a light supper, so as to rest a few hours before
midnight. This makes one fresh and spry in the morning, being on hand
early in the morning, it gives ample time to dispose of domestic
duties, and thus avoid confusion and rushing during the day.
Cleanliness is one of the cardinal virtues of the pregnant woman—as
pregnancy will be followed with childbirth, and as cleanliness is but
another name for _antiseptic_, and that will guard against childbed
fever, the importance of _cleanliness_ springs at once into unusual
prominence. No person can be filthy and slovenly during the entire
period of gestation, and then at the moment of confinement become
clean, even if in the last moment the person becomes bathed and
brushed, everything else around and about her is soiled and dirty,
unless she be taken to a lying-in home. Cleanliness must be cultivated,
and finally it becomes second nature. The daily ablution of the
external genitals should not be neglected, and general bathing in water
not altogether too warm, say 90 to 94 degrees F., twice a week will
prove beneficial in many ways. The linen that is worn, and that which
is in the bed should be kept sweet and clean, and cleaner than ever on
the day of confinement.
The mammæ of the pregnant woman are sometimes very painful; as
pregnancy advances they enlarge, the lacteal glands become congested
and swollen. To relieve this I recommend the application of a liniment
of equal parts camphorated oil, laudanum, and tincture of belladonna
gently applied several times a day. The breasts should always be extra
well covered with flannel so as not to take cold in them, otherwise an
abscess may form in them long before the child is born. If the nipples
are sensitive it is advisable to begin to harden them during the last
few months of gestation. Tannate of glycerine is perhaps the best thing
to apply for this purpose; it is best done by means of a small camel’s
hair brush. If the nipples are sunken into the breast, and too short
for subsequent use for the baby, it is well to draw them out by means
of a breast pump, the bowl of a new clay pipe, or by employing a bottle
from which the air has been replaced by filling it with hot water and
then pouring it out; the mouth of the hot bottle is applied over the
depressed nipple, and as it cools off, the vacuum thus formed draws the
nipple out.
Nausea and vomiting in pregnancy is often so annoying and weakening
that the strength of the patient becomes seriously threatened, and
hence some measures must be employed to counteract it. A great
variety of agents have been suggested for this purpose. Tincture of
nux vomica in two or three drop doses every three or four hours is a
useful remedy; the oxalate of cerium is another valuable agent for
this purpose, in five to ten grain doses three times a day, but a more
valuable remedy than any other that I know, is the Femina vaginal
capsule, to be used every night at bedtime, and in severe cases, also
in the morning.
Salivation is not constantly an attendant upon pregnancy, but when it
does occur it is weakening and debilitating. There are many remedies
for this disorder, but one of the most effectual ones is an occasional
dose of Epsom salts, say a teaspoonful in a half tumbler of water every
other morning, so as to produce free discharges from the bowels; when
salts are found objectionable, the Femina laxative syrup taken in doses
that have a similar effect will be a most excellent substitute.
Constipation is one of the most common derangements of the pregnant
woman; it is the rule in which the exceptions are few and far between.
I do not include those cases of costiveness which are habitual, and
which are to be attributed to carelessness in not responding to
nature’s call when there is an inclination, but to those in which
constipation is contemporaneous with pregnancy. We have already seen
the sympathy between the stomach and other organs in pregnancy, and
that a similar derangement should exist between the uterus and rectum
is not at all unreasonable, and, indeed, it can be explained in that
way. In the early months of pregnancy, the torpor of the bowels may be
due to the general derangement which follows digestive disturbances;
in the latter months, the enlarged uterus presses against the large
intestines, so as to obstruct more or less the descent of the feces
into the rectum. This torpor of the bowels should not be allowed to
be unrelieved, for if permitted to continue it may not only induce
a miscarriage, but it is apt to cause fever, headache and loss of
appetite. Harsh cathartics must not be employed; and if a simple enema
of warm water early every morning does not give the desired relief, I
would recommend a daily dose of Femina laxative syrup. If it is found
that in attempting to administer an enema, the fluid is immediately
returned, then it will probably be owing to lumps of fecal matter
which clog up the rectum; this will likely give rise to more or less
straining or bearing down in the back passage, and to pains in the
pelvis and lower limbs, all of which is not without danger of exciting
premature labor pains; the fecal lumps must be removed even if it
becomes necessary to use the finger.
Diarrhea is the opposite condition of things, namely a looseness of
the bowels. This may be occasioned by improper food, cold or any other
cause capable of producing diarrhea when pregnancy does not exist.
Habitual costiveness is often followed by diarrhea from the irritation
which the hardened feces excite. A dose of castor oil is sometimes an
efficient remedy for this variety of diarrhea, but when the disease
becomes obstinate and painful, the following remedy can always be
depended upon for relief:—
Take: Tr. of catechu.
Tr. of kino, of each 4 drams
Paregoric 1 ounce
Chalk mixture 2 ounces
Mix and take a tablespoonful every four hours until relieved.
Bladder trouble is not infrequent in the early and last stages of
pregnancy; the causes of this were pointed out when the symptoms of
pregnancy were inquired into. Recipe No. V is sometimes very useful to
relieve this irritability, or a Femina vaginal capsule introduced into
the vagina every night at bedtime, is sure to give the desired relief.
The kidneys of pregnant women should not be neglected. On this question
Dumas, an eminent French authority, says: “Physiological pregnancy,
by modifying the quality and quantity of the blood is a predisposing
general cause of albuminuria or Bright’s disease. But to produce the
last a cause must be added, and this may be due to a true pathological
state of the blood, a morbid condition of the kidney, an accidental
cause or mechanical pressure exerted by the uterus, where it has
acquired a sufficient size.” If the pregnant woman notices that her
urine becomes thick and foamy, that her head aches and her limbs swell,
she should pay particular attention to keep her bowels free, and
besides drink a cupful of buchu tea every night at bedtime.
Palpitation of the heart is a source of great annoyance to some women
in the earlier months of pregnancy. Women of a nervous temperament
and those who are of a full plethoric habit are most likely to suffer
from distressing palpitation. Nervous women should take ten grains of
bromide of sodium in half tumbler of water at bedtime, and only a very
light supper, while those who are full blooded should keep their bowels
freely opened and remove all pressure from the chest and abdomen by
wearing the clothing loose.
Pain in the abdomen walls from the sixth to the ninth month is
particularly apt to occur in the first pregnancy. The abdominal walls
offer a firm resistance to the growth of the uterus, and being thus put
on the stretch by the combined development of the child and the womb,
the muscles and skin become excessively tender and painful. I have
recommended for this complaint:—
Take: Tr. of opium (laudanum).
Glycerine, of each 1 ounce
Mix and apply by means of gentle friction every night at bedtime or
night and morning.
Itching of the external organs will sometimes make the life of the
pregnant woman miserable. I have seen it in so aggravated a form that
the constant scratching to which the patient had recourse in the hope
of being relieved, lacerated the parts so that they became ulcerated.
The causes of this condition are numerous, the patient from motives of
delicacy conceals her suffering until she can endure it no longer. It
also happens that pregnancy has nothing at all to do with the itching
for it may be due to diabetes, inattention to personal cleanliness, the
presence of small parasitic insects, acrid discharges from the vagina,
or from pinworms in the rectum.
If owing to parasites, mercurial ointment will cure the disease, if
from vaginal discharges warm vaginal douches in which the Femina
antiseptic tablets are dissolved will be the efficient remedy, and
after a thorough ablution, the application by means of a camel’s hair
brush of a solution of cocaine will relieve the itching.
Hemorrhoids, or piles, frequently torment the pregnant female beyond
reasonable endurance. Piles may be either external or internal, in
either case they are exceedingly apt to be very painful. When they
occur in pregnancy they are due, in the first place, to an obstruction
to the free return of blood to the heart by the enlarged uterus
pressing on the large venous trunks and secondly, to constipation,
which as we have learned is so frequently an attendant upon pregnancy.
If the piles bleed it may give temporary relief, but if the bleeding
occurs too frequently, the patient becomes pale and weak from the loss
of blood. I know of no painful and troublesome malady in which the
application of a little common sense has greater brilliant results than
in piles, yet of all maladies, with perhaps the exception of catarrh of
the nose, it is the most abused by senseless and meddlesome doctoring.
The first step to engage the attention of the patient is to regulate
the bowels and overcome the constipation; the passages must be kept
soft and soluble, unless this is accomplished all the other efforts
fail. The constipation must be partly relieved by proper dieting, and
partly by suitable remedies. A simple bland diet, for a short time at
least, is very useful; bread and milk, thin milk gruel, fruits and
vegetables are to be preferred; abstain from solids, from meat and eggs
and everything of the nature of beer and wine or alcohol, even coffee
is irritating; while the disease is at its height eat sparingly of
everything, but drink plenty of water, warm or cold, but not iced cold.
The bowels should be regulated by taking a mild, efficient laxative,
none being better than the Femina laxative syrup. Another precaution,
very essential to success, is that after each stool the parts are
gently bathed and washed with tepid or cool water by means of a soft
sponge; gentle pressure can be exerted at the same time so as to assist
the piles to return into the rectum. If they cannot be returned in
this manner, the patient must learn to use her index finger and with
it oiled with a little sweet oil or vaseline the piles are gradually
shoved back into the rectum which alone relieves the suffering, because
it relieves the strangulation and swelling which the sphincter muscle
of the rectum causes. The pushing back after each stool and even
between times is one of the essential features of a successful home
treatment for piles, and it must be kept up for years, if necessary, to
insure comfort and to guard against a relapse. Better than plain oil or
vaseline is the nutgall ointment to be had at any drug store, but if
the pain and distress continue use the following recipe:—
Take: Cocaine.
Ex. Belladonna, of each 10 grains
Vaseline 4 drams
Mix and make into an ointment; apply to the piles at bedtime or
whenever they come down and have to be returned; a few days in bed
will materially aid in the recovery.
The diet of the pregnant female should be made a special study for
upon the regimen of food not only depends her immediate comfort, but
its ultimate effect on the process of parturition is equally marked.
I do not agree with the opinion, laid down by some of the highest
authorities, that “as far as eating and drinking is concerned, the
pregnant woman may continue her accustomed diet.” I believe that there
is a diet peculiarly adapted to the pregnant woman and very beneficial
to her if she lives up to it. Stimulants of every kind are not good;
wine, beer, whisky and even strong coffee and tea, as well as highly
seasoned food, salty or sour salads should not be eaten.
How very often does it happen that a very strong, muscular, robust,
healthy young woman, who, during her entire period of gestation, was
in the best of health and spirits, and from whom, from all appearances
one may predict that she will have an “easy time” in her confinement,
quite the opposite occurs. And why as a matter of fact and experience
is this not so, is indeed an interesting inquiry. I believe that the
answer to this question can be made so plain and reasonable, that a
mere statement of a few simple facts will make it apparent.
The process of delivery, presupposes the contraction of the uterus and
the descent of the child down into the pelvic canal and its further
passage through the floor of the pelvis.
The pelvic floor (see page 228) forms the bottom of the pelvic canal
through which the child must be forced. The vagina is the opening
through this floor, and this is composed of the muscles and membranes
of the vagina, the skin, two layers of fascea, the triangular ligaments
of the bladder and a group of interlacing muscles. In the birth of
the child all these tissues are forced to relax to such an extent,
that the vaginal canal (or the vagina) will be sufficiently widened or
dilated to allow the child to pass through into the world. A moment’s
reflection will at once make clear, that in a strong muscular person,
the resistance to the necessary dilatation will become correspondingly
great, because the muscles are so strong and tense. I have attended
some women where the muscles under the excitement of labor pains felt
as tense and hard, as though they were made of strong india rubber.
It is apparent that the muscular resistance that is offered by these
strong, tense muscles, clearly obstructs and delays the passage or
birth of the child and it makes the strongest labor pains of no avail.
And experience teaches, that the progress of labor is slow and the
delivery generally prolonged until the pains and physical suffering of
many hours, exhaust and relax the muscular resistance so that the child
is allowed to pass. If the above truths were generally understood and
generally recognized they might be guarded against by a proper dietetic
regulation, and thus an infinite amount of suffering could be avoided.
Painless childbirth is only relative, and in the absolute meaning of
the term it is not true, and for this reason, that severe contractions
of the womb are always painful, and extreme tension of tissues and
muscles such as the passage of the child will occasion in its passage
through the soft parts is also more or less painful and there is no
natural childbirth possible without both these factors being present.
Painless childbirth in its absolute sense, as a scientific fact, is not
true, but to assure a comparatively painless childbirth in accordance
with scientific facts which are capable of demonstration is not only
reasonable but absolutely true.
The term “food” is understood to be all those substances, solid and
liquid, which are used for the process of nutrition. For our present
purpose foods may be divided into three classes: _carbo-hydrates_,
_albuminoids_, and _phosphates_.
The carbo-hydrates furnish fat and warmth, as an example we have
starch, sugar, and fats. Persons who are fed principally upon this
class become warm and fat, but will lack muscle and nerve.
The albuminoids are also termed nitrogenous substances, and constitute
the muscle making material. They are derived both from animal and
vegetable sources, and in their most concentrated form we find them
in eggs, milk or cheese, and in meats also in certain meals; wheat,
for instance, contains fourteen per cent of nitrate or muscle-making
material.
Phosphates are generally taken into the system as phosphate of lime
contained in certain foods we eat, as fish, lobster, beef, Southern
corn, peas and beans, barley, sweet potatoes and oats.
It is obvious from what was said of painful and prolonged childbirth,
that the pregnant woman should avoid as much as possible nitrogenous
or muscle-making food; she must starve her muscular system as much as
it is possible for her to do, and the result will be that her muscles
will become soft and relaxable and that means a comparatively easy or
painless childbirth. In Europe, the peasantry who eat meat sparingly or
very seldom, have comparatively little pain, because vegetables enter
largely into their daily diet; the same is true in Asiatic countries
where the staple is rice, the throes of labor are very light. The
squaws of our Indian tribes are remarkable for the little pain they
suffer in childbirth and for the shortness of its duration, and the
recuperation is also a speedy one, for an Indian woman will travel or
be about in a few days after her confinement with her pappoose on her
back.
I would recommend to the pregnant woman to live as much as it is
possible for her to do on a fruit and vegetable diet. Her meals must
be taken at regular intervals, otherwise derangement of the stomach is
sure to follow. Excess in eating even the plainest kind of food must be
studiously avoided, and all food must be eaten slowly and thoroughly
masticated. Wheaten bread or rice and milk diluted with water should
form the main diet. Thoroughly cooked garden vegetables and fresh, ripe
fruit like apples, grapes, peaches, plums, etc., should be used in
summer, and some of the same fruits canned in winter, or dried fruits
slowly simmered until they are soft; it is always better to soak dried
fruit for several hours or overnight before it is put over to boil.