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CHAPTER IX

CONFINEMENT INCIDENTS

REGARDING THE DREAD AND FEAR OF CHILDBIRTH--THE WOMAN WHO DREADS CHILDBIRTH--REGARDING THE USE OF ANESTHETICS IN CONFINEMENTS--THE PRESENCE OF FRIENDS AND RELATIVES IN THE CONFINEMENT CHAMBER--HOW LONG SHOULD A WOMAN STAY IN BED AFTER A CONFINEMENT?--WHY DO PHYSICIANS PERMIT WOMEN TO GET OUT OF BED BEFORE THE WOMB IS BACK IN ITS PROPER PLACE?--LACERATIONS, THEIR MEANING AND THEIR SIGNIFICANCE--THE ADVANTAGE OF AN EXAMINATION SIX WEEKS AFTER THE CONFINEMENT--THE PHYSICIAN WHO DOES NOT TELL ALL OF THE TRUTH

REGARDING THE MORE OR LESS PREVALENT DREAD OR FEAR OF CHILDBIRTH.--Much has been written, and much more could be written upon this subject. Inasmuch as this book is largely intended for prospective mothers to read and profit thereby, and is not for physicians and nurses whose actual acquaintance with confinement work would render such comments superfluous, it will not be out of place to consider this phase of the subject briefly, from a medical standpoint. When one considers that "a child is born every minute"

as the saying goes, and which is approximately true, and at the same time remembers that statistics prove, as near as can be estimated, that there is only one death of a mother in twenty thousand confinements, it would really seem as though we were "looking for trouble" to even regard the subject as worthy of the smallest consideration. It is much more dangerous to ride five miles on a railroad, or on a street car, or even take a two-mile walk,--the percentage possibility of accident is decidedly in your favor to stay at home and have a baby. Almost any disease you can mention has a higher, a much higher fatality percentage than the risks run by a [112]

pregnant woman. The real justification for actual fear of serious trouble is so small that it barely exists. These are facts that cannot be argued away by any specious if or and. Why, therefore, should there be any real fear?

Did you ever hear of the remarks made by a famous philosopher who was given a dinner by his friends in celebration of his 85th birthday? In replying to the eulogisms of his friends he said in part:

"As I look back into those blessed years that have faded away, I can recall a lot of troubles and many worries as well as much happiness and pleasure, and thinking of it all this evening I can truthfully say my worst troubles and worries never happened."

So it is with the woman who for weeks or months has made her own life wretched, and possibly the life of her husband and friends, the same in imagining all kinds of dreadful things that never take place. It is undoubtedly an exhibition of weakness, an evidence of failure in the development of self-control. Childbirth is a natural process,--there is nothing mysterious about it. If you do your part you have no cause to fear,--the very fact, however, that you entertain a dread of it, shows that you are not doing your part. One of the saddest parts of life, one of the real tragedies of living, is the fact that most of us have to live so long before we really begin to profit by our experiences. Could we only be taught to learn the lesson of experience earlier, when life is younger and hope stronger, we would have so much more to live for and so many more satisfied moments to profit by. One of the most valuable lessons experience can teach any human being is not to worry and fret about the future. You can plant ahead of yourself a path of roses and be cheerful, or you can plant a bed of thorns and reap a th.o.r.n.y reward. Cultivate the spirit of contentment, devote all your energy to making the actual present comfortable. Don't fret about what is going to bother you next week, because, as the philosopher said, most of the troubles we antic.i.p.ate and worry about never occur, but the worry kills.

REGARDING THE USE OF ANESTHETICS IN CONFINEMENTS.--Anesthetics are as a rule given in all confinements that are not normal. To make this [113]

statement more plain it may be said, that, when it is necessary to use instruments, or to perform any operation of a painful character, it is the invariable rule to give anesthetics. As to the wisdom of giving an anesthetic when labor is progressing in a normal and satisfactory manner, there is a difference of opinion. Much depends upon the disposition of the patient and the viewpoint of the physician in charge of the case. It is a fact that a large number of confinements are easy and are admitted to be so, by the patients themselves, and in which it would be medically wrong to give an anesthetic. In a normal confinement, however, when the pains are particularly severe and the progress slow, there is no medical reason why an anesthetic could not be given to ease the pain. In these cases it is not necessary to render the patient completely unconscious. Sufficient anesthetic to dull each pain is all that is necessary, and as this can be accomplished with absolute safety by the use of an anesthetic mixture of alcohol, ether and chloroform, there can be no possible objection to it.

The use of an anesthetic, however, is a matter that must be left entirely to the judgment of the physician as there are frequently good reasons why it should not be given under any circ.u.mstances.

THE PRESENCE OF FRIENDS AND RELATIVES IN THE CONFINEMENT CHAMBER.--It is a safe rule to exclude every one from the confinement room during the later stages of labor. Sometimes it is desirable to make an exception to this rule in the interest of the patient, by permitting the mother or husband to remain. If this exception is made, however, they must be told to conduct themselves in a way that will tend to keep the patient in cheerful spirits.

They must not sympathize, or go around with solemn, gloomy faces.

Cheerfulness and an encouraging word will tide over a trying moment when the reverse might prove disastrous.

Practically the same rule applies to the entire period of convalescence during which time the patient is confined to bed. This is a very important episode in a woman's life and the consequences may be serious if it is misused in any way. Friends and relatives do not appreciate the [114]

absolute necessity of guarding the patient from small talk and gossip, and an unwitting remark may cause grave mental distress, which may r.e.t.a.r.d the patient's convalescence and disastrously affect the quality and quant.i.ty of her milk, thereby injuring the child.

HOW LONG SHOULD A WOMAN STAY IN BED AFTER A CONFINEMENT?--To answer this question by stating a specific number of days would be wrong, because, few women understand the need for staying in bed after they feel well enough to get up. If any answer was given, it should be at least fourteen days, and it would be nearer the truth medically to double that time. Let us consider what is going on at this period. The natural size of the unimpregnated womb is three by one and three-quarter inches, and its weight is one to two ounces. The average size of the pregnant womb just previous to labor is twenty by fourteen inches, and its weight about sixteen ounces. We have, therefore, an increase of about 600% to be got rid of before it a.s.sumes again its normal condition. This decrease cannot be accomplished quickly by any known medical miracle. Nature takes time and she will not be hurried: she will do it in an orderly, perfect manner if she is allowed to. The womb will again find its proper location and will resume its work, in a painless, natural way, in due time, if all goes well. The uterus or womb is held in its place by two bands or ligaments, one on either side, and is supported in front and back by the structures next to it. These bands keep the womb in place in much the same way as a clothes pin sits on a clothes line, and it will retain its proper place provided everything is just right. After labor, it is large and top heavy. If you put a weight on the top of a clothes pin as it sits on a clothes line, what will take place? It will tilt one way or the other, and if the weight is heavy, it will turn completely over. So long as the woman lies in bed the womb will gradually shrink back to its proper size and place; if she sits up or gets out of bed too soon, the weight of the womb, being top heavy, will cause it to tilt and sag out of its true position. As soon as it does this the weight of the bowels and other structures above will push and crowd it further out [115]

of place. This crowding and tilting interferes with the circulation in the womb and its proper contraction is interfered with, and thus is laid the foundation for the mult.i.tude of womb troubles that exist.

It is a mechanical as well as a medical problem. Being partly mechanical, it is subject to the rules that govern mechanical problems. The importance of this dual process will be appreciated by considering the following fact.

Many medical conditions tend to cure or rectify themselves because nature is always working in our behalf if we give her a chance. Take for example an ordinary cold. You can have a very severe cold and you can neglect it, and in spite of your neglect you will get well. It is not wise to neglect colds, nevertheless, it is true that nature will cure, unaided, a great many diseased conditions, if she has half a chance. This, to a very large extent, is the secret of Christian Science, yet the principle is known to everyone. A mechanical condition, on the other hand, has absolutely no tendency to get well of its own accord, or without mechanical aid. This is why Christian Science cannot cure a broken leg. It is this principle that makes diseases of the womb so persistent, and so stubborn of cure. When a womb once becomes slightly displaced, the tendency always is for it to grow worse and never to cure itself. The longer it lasts the worse it gets. Its cure depends upon mechanically putting it back in place and holding it long enough there to permit nature to reestablish its circulation, and by toning and strengthening it so that when the mechanical support is taken away it will retain its position. There is no other possible way of doing it. Now since it has been proved that nature takes many days to contract a pregnant womb, a woman is taking a risk, and inviting trouble by getting out of bed before that time.

WHY DO PHYSICIANS PERMIT WOMEN TO GET UP BEFORE THE WOMB IS BACK IN ITS PROPER PLACE?--Without offering the excuse that a woman will not stay in bed as long as a physician knows she should, there is, however, a large degree of truth in this excuse. And we are of the opinion that, if a physician made it a rule to keep all his confinement cases in bed for one month, [Page 116] he would very soon find himself without these patients.

Experience has taught us, however, that it is safe, under proper restrictions, and in uncomplicated confinements, to allow patients to sit up in bed on the 12th and in certain cases on the 10th day, and to get out of bed on the 12th or 14th day. When the patient is allowed to sit up, out of bed, it should not be for longer than one or two hours, and during that time she should sit in a comfortable rocking or Morris chair, which should be placed by the side of the bed. Each day the time can be lengthened, and the distance of the chair from the bed increased. This procedure gives her the opportunity to walk a little further each day, thereby to test her strength and ability to use her limbs. On the fourth day, if all has gone well, she may stay up all day and she may walk more freely about the room.

She should be just to herself, however. As soon as she is fatigued she should not make any effort to try to "work it off." When a feeling of fatigue appears she should rest completely. If she has any pain or distress she should acquaint the physician with it at once. She should not try to hide anything on the mistaken idea that "it isn't much." She does not know, and she is not supposed to know what the pain may mean; it may be exceedingly significant. Many women have saved themselves needless suffering, and their husbands unnecessary expenditure of money, by calling the physician's attention to conditions, which in time would have been serious, and would have necessitated long, expensive treatment.

LACERATIONS DURING CONFINEMENT, THEIR MEANING AND THEIR SIGNIFICANCE.--The only interest a laceration or a tear has to a physician, is whether the laceration or tear is of sufficient importance to need surgical interference. The laceration can take place at the mouth of the womb, or on the outside, between the v.a.g.i.n.a and r.e.c.t.u.m.

Those of the mouth of the womb always take place, in every confinement, to some degree. They are never given any attention at the time of the confinement, unless under extraordinary circ.u.mstances, such as a more or less complete rupture of the womb, and this is such a rare accident [117]

that most physicians practice a lifetime and never see or hear of one single case. Those on the outside are always attended to immediately after labor, or should be, unless they are very extensive and the patient is not in condition to permit of any immediate operative work. In such a case it is best to leave it alone until the patient is in condition to have it operated on at a later date.

It is distinctly preferable to have it attended to immediately after labor when it is possible, and it is possible in a very large percentage of the cases. The explanation of this is because it is practically painless then, owing to the parts having been so stretched and bruised that they have little or no feeling. If it is left for a day or two and then repaired, it will be more painful, because the parts will have regained their sensitiveness. Another good reason in favor of immediate repair is that a much better and quicker union will take place than if postponed.

When a patient is torn, but not to the degree necessary to st.i.tch, it is to her advantage to be told to lie on her back and keep her knees together for twelve hours, thus keeping the torn edges together and at rest, thereby favoring quick and healthy repair of the tear. Some physicians go as far as to bind the patient's knees together so she cannot separate them during sleep.

It is the custom of every conscientious physician to request every woman he confines to report at his office six or eight weeks after labor. The reason for this is to find out by examination the character and extent of the lacerations of the mouth of the womb. No physician can tell at the time of labor just how much damage has been done, because the mouth of the womb, at the time of labor, is so stretched and thinned out, that it is impossible to tell. After the womb has contracted to about its normal size, it is a very simple matter for any physician to tell exactly the character and extent of the lacerations. Most of these tears need absolutely no attention; there are a few however that do. This is a very important matter for two very good reasons.

1st. Every woman should know, and is ent.i.tled to know, just what [118]

condition she is in, because if she has been torn to an extent that needs attention, and is left in ignorance of it, her physical health may be slowly and seriously undermined and the cause of it may not be understood or even guessed at. A woman who becomes nervous and irritable, loses vim and vitality, has headaches, backaches and anemia, and no symptoms, or few, that point to disease of the womb, will suffer a long time before she seeks relief of the right kind, and will be astonished and outraged when she is told that it all results from a bad tear of her womb that she knew nothing about.

2nd. A physician should in justice to himself insist on this late examination, because if a woman is told, at some subsequent time, by another physician that she is badly torn, and she was not told of it by the physician who confined her, she is very apt to form an unjust opinion of his work and to entertain an unfriendly feeling toward him as a man.

Some physicians also, to their discredit, are not slow in permitting an unjust opinion of a colleague to be spread around, by preserving a silence, when an explanation would result in an entirely different opinion by the patient. They permit it to be inferred that the physician was responsible for the tear, when such is not the case. No physician on earth can prevent a tear of the mouth of the womb and this should be explained to the patient. Where the physician is at fault is in the failure to examine his patients when it is possible to tell that a tear of any consequence exists.

If such an examination is made, he is in a position to state that a tear exists of sufficient extent to justify careful attention. Immediate operation is seldom necessary, and if the patient is comparatively young, it may not be wise to operate, because if pregnancy takes place within a reasonable time the womb will again tear. She should be told, however, that should she not become pregnant during the next three years she should be examined from time to time, and if the condition of her womb, or her health suggest it, she should have the tear attended to. If after this explanation she neglects herself she must blame herself, she will at least have no[119]

cause to harbor any resentment against her physician who has done all any physician is called upon to do under the circ.u.mstances. Another important reason for finding out the character of the laceration is because these lacerations of the mouth of the womb frequently cause sterility.

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CHAPTER X

NURSING MOTHERS

THE DIET OF NURSING MOTHERS--CARE OF THE NIPPLES--CRACKED NIPPLES--TENDER NIPPLES--MASt.i.tIS IN NURSING MOTHERS--INFLAMMATION OF THE b.r.e.a.s.t.s--WHEN SHOULD A CHILD BE WEANED?--METHOD OF WEANING--NURSING WHILE MENSTRUATING--CARE OF b.r.e.a.s.t.s WHILE WEANING CHILD--NERVOUS NURSING MOTHERS--BIRTH MARKS--QUALIFICATIONS OF A NURSERY MAID.

THE DIET OF NURSING MOTHERS.--A nursing mother should eat exactly the same diet as she has always been accustomed to before she became pregnant. If any article of diet disagrees with her she should give up that particular article. She should not experiment; simply adhere to what she knows agreed with her in the past. More, rather than less, should be taken, especially more liquids as they favor milk-making. It is sometimes advisable to drink an extra gla.s.s of milk in the mid-afternoon and before retiring. If milk disagrees, or is not liked, she may take clear soup or beef tea in place of it. In a general way milk in quant.i.ties not over one quart daily, eggs, meat, fish, poultry, cereals, green vegetables, and stewed fruit const.i.tute a varied and ample dietary to select from.

Every nursing mother should have one daily movement of the bowels; she should get three or four hours' exercise in the open air every day; and she should nurse her child regularly.

The diet of the nursing mother during the period immediately after confinement is given elsewhere.

Alcohol, of all kinds, should be absolutely avoided during the entire period of nursing.

Drugs of every variety, or for any purpose, should never be taken unless by special permission of her physician.

CARE OF THE NIPPLES.--As soon as the mother has had a good sleep after the confinement the nipples should be washed with a saturated solution of [122]

boracic acid, and the child allowed to nurse. The milk does not come into the breast for two or three days, but the child should nurse every four hours during that time. There is secreted at this time a substance called colostrum. This is a laxative agent which nature intends the child should have as it tends to move the bowels and at the same time it appeases the hunger of the infant. It also accustoms the child to nursing and gradually prepares the nipples for the work ahead of them.

After each nursing the nipples should be carefully washed with the same solution and thoroughly dried.

CRACKED NIPPLES.--Cracked nipples often result from lack of care and cleanliness. If they are not cared for as described above they are very apt during the first few days to crack. They should never be left moist. They should be washed and dried after every feeding. If the b.r.e.a.s.t.s are full enough to leak they should be covered with a pad of sterile absorbent gauze.

Nursing mothers should guard against cracked nipples, as they are exceedingly painful; frequently necessitating a discontinuance of nursing; and may produce abscess of the breast.

TREATMENT OF CRACKED NIPPLES.--In addition to washing the nipples, drying them thoroughly, and placing a pad of dry gauze over them after each feeding, they should be painted with an 8 per cent. solution of nitrate of silver twice daily. Before the next feeding, after the silver has been used, they should be washed with cooled boiled water. If the cracks are very bad it may be necessary to use a nipple-shield over them while nursing for a few days.

TENDER NIPPLES.--Many women complain of the pain caused by the baby when it is first put to the breast. These nipples are not cracked, they are simple hypersensitive. They should be thoroughly cleansed and dried as above and painted with the compound tincture of benzoin. They should be washed off with the boracic acid solution before each feeding. After a few days under this treatment the tenderness will leave them.

MASt.i.tIS IN NURSING MOTHERS.--When inflammation of the breast takes [123]

place in a nursing mother it is the result of exposure to cold, or it may result from injury. If infection occurs and an abscess develops, it results from the entrance, through the nipples, or cracks, or fissures in the nipple, of bacteria into the breast. There is fever, with chills and prostration, and very soon it is impossible to nurse the child because of the pain. Nursing should be immediately discontinued, the breast supported by a bandage and the milk drawn, with a breast pump, at the regular nursing intervals. An ice-bag should be constantly applied to the painful area and the bowels kept freely open with a saline laxative. When the fever and the pain subside nursing may be resumed.

If the gland suppurates in spite of treatment it must be freely opened and freely drained.

WEANING