TESTING URINE IN PREGNANCY--IMPORTANCE OF.--One of the most important duties, if not the most important, of both the physician and the patient is to have the urine of the pregnant woman examined every month during the[89]

first seven months and every two weeks during the last two months. The urine examined during the first seven months should be the first urine pa.s.sed on the day it is sent for examination. During the last two months of pregnancy the patient should pa.s.s all her water into a chamber for an entire day, and take about three ounces of this mixed water for examination. She should measure the total quant.i.ty pa.s.sed during these days and mark it with her name on the label of the bottle. The physician will thus have an absolute record and guide of just how the kidneys are acting, and as they are the most important organs to watch carefully during every pregnancy, the greatest care should be taken to see that failure to note the first symptom of trouble does not take place.

ATTENTION TO NIPPLES AND BREAST.--The physician should inspect the b.r.e.a.s.t.s and nipples of every pregnant woman when she first visits his office.

Frequently the nipples are found to have been neglected, probably subjected to pressure by badly fitting corsets or too tight clothing. Instructions gently to pull depressed nipples out once daily, if begun early, will result in marked improvement by the end of pregnancy. During the latter part of pregnancy the b.r.e.a.s.t.s should be carefully and thoroughly bathed daily in addition to the daily bath. This special bath should be with a solution of boric acid (one teaspoonful to one pint of water). After the bath apply a thin coating of white vaseline to the nipples. It may be necessary to resort to the following mixture to harden the nipples and to make them stand out so that the child can get them in its mouth: Alcohol and water, equal parts into which put a pinch of powdered alum; this mixture should be put in a saucer and the nipples gently ma.s.saged with it twice daily. A depressed nipple may also be drawn out by means of a breast pump. If the nipples are not pulled out the child will be unable to nurse.

It may then be necessary to put the child on the bottle and when the nipples are ready he may not take them after being used to the rubber nipple. The b.r.e.a.s.t.s may become caked and as a caked breast is a very painful and serious ailment it is wise to attend to this matter in [90]

time.

THE VAGARIES OF PREGNANCY.--Certain foolish, old-fashioned ideas, have crept into the minds of impressionable people regarding pregnancy, which are aptly termed vagaries. It is believed by some that if the pregnant woman is the victim of fright, or is badly scared, or witnesses a terrifying or tragic sight, her child will be, in some way, affected by it.

If the incident is not of sufficient gravity to cause an abortion or a miscarriage it will not, in any way mark, or affect the shape of the child in the womb.

It is believed by some that a child can be marked by reason of some event occurring to the mother while carrying it. This is not so; a child cannot be marked by any experience or mental impression of the mother. Some believe that the actual character of a child can be changed by influences surrounding the mother while carrying it. The character of a child cannot be changed one particle after conception takes place, no matter how the mother spends her time in the interim.

It should be carefully understood that the character of the baby is entirely different from the physical characteristics of the baby. Were this not so it would be futile on the part of the mother to discipline or sacrifice herself in the interest of her baby. The baby's character will reflect the qualities of the combined union of mother and father. The baby's physical characteristics will largely depend upon the treatment accorded it by the mother during its intro-uterine life. Hence we lay down rules of conduct, diet and exercise in order to produce a good, st.u.r.dy animal, while the character or mind of the animal is a part of the fundamental species already created. In other words, no matter how much care you bestow upon a rose bush, its flower will still be a rose,--it may be a better rose, a stronger, st.u.r.dier rose, a better smelling and a more beautiful rose, but it is still a rose.

CONTACT WITH INFECTIOUS DISEASES.--The pregnant woman should be warned against the danger of coming in contact with any person suffering from any infectious or contagious diseases. To become the victim of one of these[91]

diseases near the time of labor would be a dangerous complication not only to the mother, but to the child. A woman is more liable to catch one of these diseases during the last month of pregnancy than at any other time.

The most dangerous diseases at this period are Scarlet Fever, Diphtheria, Erysipelas, and all diseased conditions where pus is present.

AVOIDANCE OF DRUGS.--It is a safe rule during pregnancy to avoid absolutely the taking of all medicines unless prescribed by a physician.

THE DANGER SIGNALS OF PREGNANCY.--The following conditions may be of very great importance and may be the danger signals of serious coming trouble.

They must not therefore be neglected or lightly considered. When any of them make their appearance send for the physician who has charge of your case, at once, and follow his advice whatever it may be.

1. Any escape of blood from the v.a.g.i.n.a, whether in the form of a sudden hemorrhage or a constant leaking, like a menstrual period.

2. Headache, constant and severe.

3. Severe pain in the stomach.

4. Vertigo or dizziness.

5. Severe sudden nausea and vomiting.

6. A fever, with or without a chill.

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CHAPTER VIII

THE MANAGEMENT OF LABOR

WHEN TO SEND FOR THE PHYSICIAN IN CONFINEMENT CASES--THE PREPARATION OF THE PATIENT--THE BEGINNING OF LABOR--THE FIRST PAINS--THE MEANING OF THE TERM "LABOR"--LENGTH OF THE FIRST STAGE OF LABOR--WHAT THE FIRST STAGE OF LABOR MEANS--WHAT THE SECOND STAGE OF LABOR MEANS--LENGTH OF THE SECOND STAGE--DURATION OF THE FIRST CONFINEMENT--DURATION OF SUBSEQUENT CONFINEMENTS--CONDUCT OF PATIENT DURING SECOND STAGE OF LABOR--WHAT A LABOR PAIN MEANS--HOW A WILLFUL WOMAN CAN PROLONG LABOR--MANAGEMENT OF ACTUAL BIRTH OF CHILD--POSITION OF WOMAN DURING BIRTH OF CHILD--DUTY OF NURSE IMMEDIATELY FOLLOWING BIRTH OF CHILD--EXPULSION OF AFTER-BIRTH--HOW TO EXPEL AFTER-BIRTH--CUTTING THE CORD--WASHING THE BABY'S EYES IMMEDIATELY AFTER BIRTH--WHAT TO DO WITH BABY IMMEDIATELY AFTER BIRTH--CONDUCT IMMEDIATELY AFTER LABOR--AFTER PAINS--REST AND QUIET AFTER LABOR--POSITION OF PATIENT AFTER LABOR--THE LOCHIA--THE EVENTS OF THE FOLLOWING DAY--THE FIRST BREAKFAST AFTER CONFINEMENT--THE IMPORTANCE OF EMPTYING THE BLADDER AFTER LABOR--HOW TO EFFECT A MOVEMENT OF THE BOWELS AFTER LABOR--INSTRUCTING THE NURSE IN DETAILS--DOUCHING AFTER LABOR--HOW TO GIVE A DOUCHE--"COLOSTRUM," ITS USES--ADVANTAGES OF PUTTING BABY TO BREAST EARLY AFTER LABOR--THE FIRST LUNCH--THE FIRST DINNER--DIET AFTER THIRD DAY.

WHEN TO SEND FOR THE PHYSICIAN IN CONFINEMENT CASES.--The physician should be notified just as soon as it is known that labor has begun. The adoption of this course is necessary for a number of reasons. It is only just that he should have an opportunity to arrange his work so that he may be at liberty to give his whole time to your case when he is wanted. He may not be at home at the moment, but can be notified, and can arrange to be on hand when your case progresses far enough to need his personal attention.

It will relieve your mind to be a.s.sured that he will be with you in plenty of time. [Page 94]

Don't worry unnecessarily if he does not come immediately when you notify him, provided you notify him at the beginning of labor. There is plenty of time. You have a lot of work to do before he can be of any help. Many women entertain the idea that a physician can immediately perform some kind of miracle to relieve them of all pains at any stage in labor. This is a mistaken idea. No physician can hasten, or would if he could, a natural confinement. He waits until nature accomplishes her work, and he simply watches to see that nature is not being interfered with. If something goes wrong, as it does now and again; or if the pains become too weak, or if the proper progress is not being made, he may help nature or take the case out of her hands and complete the confinement. If it is thought best to do this, there will be plenty of time.

THE PREPARATION OF THE PATIENT AND THE CONDUCT OF ACTUAL LABOR.--It is a.s.sumed that the patient has adhered to the instructions of the physician given during the early days of her pregnancy. These instructions included directions as to exercise, diet, bathing, etc.

Having calculated the probable date of the confinement, it is the better wisdom to curtail all out-of-door visiting, shopping, social engagements, etc.,--everything in fact out-of-doors except actual exercise, for two weeks previous to the confinement date. The usual walk in the open air should be continued up to the actual confinement day. The daily bath may be taken, and it is desirable that it should be taken, up to and on the confinement day.

THE MEANING OF THE TERM "LABOR."--By labor is meant, the task or work involved in the progress by means of which a woman expels from her womb the matured ovum or child. After the child has been carried in the womb for a certain time (estimated to be 280 days) it is ripe, or fully matured, and is ready to be born. The womb itself becomes irritable because it has reached the limit of its growth and is becoming overstretched. Any slight jar, or physical effort on the part of the patient, or the taking of a cathartic, is apt to set up, or begin the contractions which nature has devised as the process of "labor" by which the womb empties itself. [95]

THE BEGINNING OF LABOR.--When the first so-called pains of actual labor begin they are not always recognized as such. The explanation of this seeming paradox is that the "pains" are not always painful. A woman will experience certain undefined sensations in her abdomen; to some, the feeling is as if gas were rumbling around in their bowels; to others, the feeling is as if they were having an attack of not very painful abdominal colic; while others complain of actual pain. The fact that these sensations continue, and that they grow a little worse; and that the day of the confinement is due, or actually here, impresses them that something unusual is taking place; then, and not till then, does the knowledge that labor is really approaching dawn upon them.

In due time one of these new sensations, which const.i.tute the first stage of labor, will be more emphatic; there will be a little actual pain so that she will feel like standing still, holding her breath and bearing down.

That is the first real labor pain and marks the beginning of the second stage of labor, and may be the first absolute sign that will leave no doubt in her mind that labor has begun.

The nurse will now inquire into the condition of the patient's bowels. If they have not already moved freely that day, she will give the patient a rectal injection of one pint of warm soap suds into which one teaspoonful of turpentine is put. After the bowels have been thoroughly cleansed, the patient will be made ready for the confinement. The clothing necessary consists of dressing gown, night gown, stockings and slippers. These are worn as long as the patient is out of bed, when all but the night gown will be discarded. The entire body of the patient, from the waist line to the knees, should be thoroughly cleansed, paying particular attention to the private parts; first with warm water and castile soap, and then rendered aseptic by washing with four quarts warm boiled water into which has been put one teaspoonful of Pearson's Creolin. A soft napkin is then wrung out of water that has been boiled and cooled to a suitable temperature, and laid over the genital region, and held in place by a dry clean napkin, [96]

and allowed to remain there until the physician takes personal charge of the case.

LENGTH OF THE FIRST STAGE OF LABOR.--There is no definite or even approximate length of time for the first stage of labor,--that, you may recall, was the more or less painless stage, or as it has been termed, the "getting-ready" stage. Inasmuch as it is an unimportant and practically painless stage, most patients do not mind it. They continue to be up and around and work as usual.

The first stage of labor is utilized by nature in opening the mouth of the womb.

The second stage of labor is utilized by nature in expelling the child into the outer world.

LENGTH OF THE SECOND STAGE OF LABOR.--After the second stage has begun, the length of time necessary to end the labor, a.s.suming everything is normal, depends upon the strength and frequency of the pains. The stronger and more frequent the pains, the quicker it will be over. First confinements necessarily take longer, because the parts take more time to open up, or dilate, to a degree sufficient to allow the child to be born. In subsequent confinements, these parts having once been dilated yield much easier, thus shortening the time and the pains of this, the most painful, stage of labor. The average duration of labor is eighteen hours in the case of the first child, and about twelve hours with women who have already borne children. The time, however, is subject to considerable variation, in individual cases, as has been pointed out.

CONDUCT OF THE PATIENT DURING THE SECOND STAGE OF LABOR.--She should remain up, out of bed, as long as she possibly can. The object of this is because experience shows that the labor pains are stronger, and more frequent, when in the upright position. Even though this procedure would seem to invite more constant suffering, it must be remember that labor is a physiological, natural process, that there is nothing to fear or dread; and if the patient is in good health, it is to her advantage to have it over soon, rather than to encourage a long drawn out, exhausting labor. When the pains come [97]

she should be told to hold on to something, to hold her breath as long as possible, and to bear down. A good plan is to roll up a sheet lengthwise, and throw it over the top of an open door and let her grasp both ends tightly and bear down; or she can put her arms over the shoulders of the nurse and bear down. Instruct her to hold her breath as long as she can, bearing down all the time, and when she can't hold it any longer, tell her to let up, and then take a quick deep breath and bear down again, repeating this programme until the pain ceases. Tell her specifically to be sure to keep bearing down till the end of the pain, because the most important time, and the few seconds during which each pain does most of its work during the second stage of labor, is at the very end of each pain. When a woman understands that these instructions are for her good, and that they are given with the one purpose of saving her pain, and shortening the length of labor, she will try to obey. Each pain is intended by nature to do a certain amount of work, and each pain will accomplish that work if the woman does not prevent it; and if she does prevent it, she is only fooling herself, because the next pain will have to do what she would not allow the former to do, and so on according to how she acts.

THE CARRIERS OF HERITAGE

[Ill.u.s.tration: Here is the actual bridge from this generation to the next.

Into these two little bodies--the larger not over one-twenty-fifth of an inch in diameter--is condensed the mult.i.tude of characteristics transmitted from one generation to another.

The vital part of the _Ovum_ is the _Nucleus_, which contains the actual bodies that carry heritage--the little grains that are the mother's characteristics--_Chromosomes_. This nucleus is nourished by oils, salts and other inclusions, known as _Cytoplasm_. Floating in the cytoplasm may be found a tiny body known as the _Centrosome_, which acts as a magnet in certain phases of cell development. Around this whole ma.s.s is a _Cell Wall_, more or less resisting and protective.

The _Spermatozoan_ is structurally much different from the ovum, but it also has its nucleus and chromosomes, which carry to the child the transmittable characteristics of the father.

The ovum is usually comparatively large and stationary, and whatever motion is therefore necessary to bring it into contact with the male cell devolves upon the latter, which possesses what is known as a _locomotor tail_. In addition there are usually many sperms to one ovum, so that the chances are that at least one male cell will reach the egg and effect fertilization, and the beginning of a new life.

The diagrams on the opposite page show the actual steps by which the spermatozoan unites with the ovum. It is the very first stage of the process of cell multiplication that results in the offspring.]

THE FORMATION OF A NEW LIFE

[Ill.u.s.tration: _Reproduced by permission from "Genetics," Walters, The Macmillan Co._]

HOW A WILLFUL WOMAN CAN PROLONG LABOR.--For a certain time, during the second stage of labor, a willful, unreasonable woman, can work against nature and save herself a little pain by prolonging the issue; but there will come a time when, the head having reached a certain position, the expulsive pains will be so great that she won't be able to control them and nature then seems to take her revenge. So if a woman holds back, and begins to cry, and scream, when she feels a pain coming, she renders the pain to a large degree negative, she prolongs her labor, adds to the total number of pains, exhausts herself, and endangers the life of her child. It must, however, be remembered in all justice that this is a time when it is much easier to preach than to practice.

Every confinement is a new experience; no matter how many a physician may have seen, there are no two alike. It is one of the interesting [98]

psychological problems in medicine to observe the conduct of women during their first confinement.

Some are calm, exhibiting a degree of self-control that is admirable. They are willing to be instructed, and they recognize that the advice is given for their benefit. They conscientiously try to obey suggestions, and they make praiseworthy efforts to keep themselves under control. They are stoics.