DAILY CONDUCT OF THE PREGNANT WOMAN--INSTRUCTIONS REGARDING HOUSEHOLD WORK--INSTRUCTIONS REGARDING WASHING AND SWEEPING--INSTRUCTIONS REGARDING EXERCISE--INSTRUCTIONS REGARDING Pa.s.sIVE EXERCISE--INSTRUCTIONS REGARDING TOILET PRIVILEGES---INSTRUCTIONS REGARDING BATHING--INSTRUCTIONS REGARDING s.e.xUAL INTERCOURSE--CLOTHING DURING PREGNANCY--DIET OF PREGNANT WOMEN--ALCOHOLIC DRINKS DURING PREGNANCY--THE MENTAL STATE OF THE PREGNANT WOMAN--THE SOCIAL SIDE OF PREGNANCY--MINOR AILMENTS OF PREGNANCY--MORNING NAUSEA, OR SICKNESS--TREATMENT OF MORNING NAUSEA, OR SICKNESS--NAUSEA OCCURRING AT THE END OF PREGNANCY--UNDUE NERVOUSNESS DURING PREGNANCY--THE 100 PER CENT. BABY--HEADACHE--ACIDITY OF THE STOMACH, OR HEARTBURN--CONSTIPATION--VARICOSE VEINS, CRAMPS, NEURALGIAS--INSOMNIA--TREATMENT OF INSOMNIA--PTYALISM, OR EXCESSIVE FLOW OF SALIVA--v.a.g.i.n.aL DISCHARGE, OR LEUCORRHEA--IMPORTANCE OF TESTING URINE DURING PREGNANCY--ATTENTION TO NIPPLES AND b.r.e.a.s.t.s--THE VAGARIES OF PREGNANCY--CONTACT WITH INFECTIOUS DISEASES--AVOIDANCE OF DRUGS--THE DANGER SIGNALS OF PREGNANCY.

CONDUCT OF THE PREGNANT WOMAN

The young wife will arrange her daily routine according to the physician's instructions, which, by the way, she should faithfully carry out. If you are one of the fortunate many who enjoy reasonably good health, you have doubtless been told to follow a plan very similar to the one we shall now briefly outline.

For the first six months she can safely continue to do her household work.

It is to her advantage to do so for many reasons, but especially because it helps to keep her physically in good condition, and because it keeps her mind engaged, thus avoiding a tendency to nervous worry. After the sixth month it is desirable to give up the heavier part of the work. Washing and sweeping should be absolutely prohibited. Moving furniture or heavy trunks must not be done by the prospective mother, but all light work can and [76]

should be indulged in to the very end. Find time to spend at least one hour and a half in the open air every day. Unless there is a medical reason against active exercise there is nothing so beneficial to the pregnant woman as walking, nor is there any subst.i.tute for it. A drive or motor ride into the country, or a car ride around town, is an excellent device against ennui and is highly desirable during this time, but not as a subst.i.tute for the daily long walk. A pregnant woman must keep her muscles strong and in good tone if she hopes to do her share toward having a short and easy confinement. She must keep active to ensure perfect action of all her organs--the stomach must digest; the bowels and kidneys must act perfectly; the heart, and lungs, and nerves must be supplied with good blood and fresh air; the appet.i.te must be keen, and the sleep sound. Walking in the open air will do all this and nothing else can, to the same satisfactory degree.

Light pa.s.sive exercise at home is desirable to those very few who cannot walk in the open air, but at best it is a poor subst.i.tute. It is necessary to avoid any exercise or any labor of the following character from the very beginning of pregnancy: stretching, lifting, jarring, jumping, the use of the sewing machine, bicycling, riding, and dancing.

She should continue to employ the same toilet privileges she has been accustomed to except the use of the v.a.g.i.n.al douche, which must be stopped from the date of the first missed menstrual period. This is the only safe rule to follow and no exception should be made to it except upon the advice of a physician.

Bathing during the entire course of pregnancy is a highly necessary duty.

It is particularly advantageous during the later months because it relieves the kidneys at a time when they are called upon to perform an excess of work. The temperature of the bath should be warm and rapidly cooled at the finish. Brisk rubbing with a course towel will ensure the proper reaction.

s.e.xual intercourse must be restricted during pregnancy; and it should be wholly abstained from during what would have been the regular menstrual periods, if pregnancy had not occurred, for the reason that abortion is[77]

apt to take place. It is most harmful during the early and late months of pregnancy. s.e.xual intercourse is distasteful to most and harmful to every pregnant woman.

CLOTHING DURING PREGNANCY.--The clothing should be so constructed as to relieve any undue pressure on the b.r.e.a.s.t.s or abdomen. For this reason it should be suspended from the shoulder. When it is appreciated that clothing supported by the waist crowds the growing womb, and exerts pressure upon the kidneys, and is responsible for many of the kidney complications that occur during pregnancy, no further reason need be given for discarding all clothing, except very light garments, that are not held by some device whose support is from the shoulders. A specially constructed linen waist is made and sold for this purpose. It is fashioned so that all the lower garments and the garters can be fastened to, and supported by it. Corsets should be absolutely discarded from the very first day of pregnancy.

In a large woman with a lax abdomen, a properly made abdominal support will not only be a great comfort but of real advantage. It should exert a support upward by lifting the abdomen, not by constricting it. It should therefore be obtained from a reliable dealer and be made and applied to effect the above object,--otherwise it may do more harm than good.

DIET OF PREGNANT WOMEN.--Some degree of digestive disturbance and loss of appet.i.te is the rule early in pregnancy. By the fourth month these conditions invariably cease, and the appet.i.te and the ability to digest will greatly improve. The diet from the very beginning of pregnancy should be plain and easily digested. It is not possible to formulate an absolute table of what or what not to eat, as the same foods do not agree equally well with all patients. The individual taste should be catered to within, reason, and the meals should be taken at regular intervals. Articles of diet that experience shows do not agree with the patient should be rigidly excluded from the menu. A varied diet of nutritious character is essential during pregnancy in order to ensure good blood, health, and strength. A monotonous diet, or a diet composed largely of stale tea, coffee, and [78]

cake, is not permissible, and may do untold harm. Pastries and desserts of all kinds should be excluded. In the later weeks of pregnancy, because of the large size of the womb, the diet should be cut down as the stomach is interfered with in the process of digestion. Should the patient at any time during pregnancy experience a loss of appet.i.te, or an actual disgust for food as sometimes occurs, it is preferable to suggest a change of scene and surroundings rather than the use of medicine. A short vacation, a change of table, new scenery, will promptly effect a cure. This condition is mental rather than physical; the patient allows herself to become introspective; the daily routine becomes monotonous and stale; hence a change of a few days will be all that is necessary. If it is not possible for the patient to obtain a change of scene, a complete change of diet for a few days will often tide over the difficulty. We have known patients to take kindly to an exclusive diet of k.u.myss, or matzoon, or predigested foods, with stale toast or zwieback, to which can be added stewed fruits. Alcoholic drinks should be left out entirely.

THE MENTAL STATE OF THE PREGNANT WOMAN.--The coming baby should be the text of many interesting, spontaneous talks between the young couple from the time when it is first known that a new member of the family is on its way.

The husband should feel that he is a party to the successful consummation of the little one's journey. He can contribute enormously to this end. It should be his duty, born of a sincere affection and love, to formulate the programme of events which has for its main object the wife's entire mental environment. He should encourage her to live up to the physician's instructions, and arrange details so that she will obtain the proper exercise daily. He should read to her in the evening, and arrange his own business affairs so that he will be with her as much as is possible. In many little ways he can impress upon her the fact that they both owe something to the unborn babe and that each must sacrifice self in its behalf. His princ.i.p.al aim, of course, will be that she will not worry or have cause to worry. He will so direct her mental att.i.tude that she will dwell only upon the bright side of the picture; she will thus strive to[79]

realize the hope that the baby will be strong and healthy, and she will, prompted by his encouragement and devotion, try to do her duty faithfully.

Working together in this way, much can be done that means far more than we know of, and in the end the little one comes into the world a welcome baby, created in love and born into the joy of a happy, harmonious, contented home.

THE SOCIAL SIDE OF PREGNANCY.--The social side of the question should not be overlooked or neglected at this time. Here again the imperative necessity arises to warn the young wife against certain individuals who seem to have a predilection toward recounting all the terrible experiences they have heard regarding confinements. It is astonishing to learn how diversified a knowledge some women burden themselves with in this connection. They can recount case after case, with the harrowing details of a well-told tale, and seem to delight in so doing. Every physician has met these women. The young wife must not permit or encourage any reference to her condition. Simply refusing to discuss the question is the only sure method of preventing its discussion. She will find among her friends a few who have her best interests at heart, and these few will strive sincerely to be of real usefulness to her. If she will keep in mind that the most important element in the success of the whole period, and consequently the degree of her own health, happiness, and comfort, as well as that of her unborn baby, is the character of her own thoughts from day to day, and month to month, she will be complete master of the situation. By constantly dwelling on happy thoughts, reading encouraging and inspiring books, admiring and studying good pictures, working with cheerful colors in sunny rooms, exercising, dieting, and sleeping in a well-aired room, she will have no cause to regret her share in the task before her, or the kind of baby she will bring into the world.

MINOR AILMENTS OF PREGNANCY.--There are certain minor ailments which it would be well to be familiar with lest a little worry should creep into the picture.

Maternity is not only a natural physiological function, but it is a [80]

desirable experience for every woman to go through. The parts which partic.i.p.ate in this duty have been for years preparing themselves for it.

Each month a train of congestive symptoms have taxed their working strength; pregnancy is therefore a period of rest and recuperation,--a physiological episode in the life history of these parts. If any ailment arises during pregnancy it is a consequence of neglect, or injury, for which the woman herself is responsible,--it is not a natural accompaniment of, or a physiological sequence to pregnancy. Find out, therefore, wherein you are at fault, rectify it, and it will promptly disappear.

MORNING NAUSEA OR SICKNESS.--So-called morning nausea or sickness is very frequently an annoying symptom. It is present as a rule during the first two or three months of pregnancy. How is it produced and how can it be remedied?

It is produced most frequently by errors in diet. It may be caused by an unnatural position of the womb or uterus, by nervousness, constipation, or by too much exercise or too little exercise. The physician should be consulted as soon as it is observed to be a regular occurrence. He will eliminate by examination any anatomical condition which might cause it; or will successfully correct any defect found. When the cause is defined his instructions will help you to avoid any error of diet, constipation, or exercise. Many cases will respond to a simple remedy,--a cup of coffee, without milk, taken in bed as soon as awake will often cure the nausea. The coffee must be taken while still lying down,--before you sit up in bed. If coffee is not agreeable any hot liquid, tea, beef tea, clam bouillon, or chicken broth, or hot water may answer the purpose, though black coffee, made fresh, seems to be the most successful. Ten drops of adrenalin three times daily is a very certain remedy in some cases, though this should be taken with your physician's permission only. If the nausea occurs during the day and is accompanied with a feeling of faintness, take twenty drops of aromatic spirits of ammonia in a half gla.s.s of plain water or Vichy water. Sometimes the nausea is caused by the gradual increase of the [81]

womb itself. This is not usually of a persistent character and disappears as soon as the womb rises in the abdominal cavity at the end of the second month.

Nausea frequently does not occur until toward the end of pregnancy. In these cases the cause is quite different. Because of the size of the womb at this time the element of compression becomes an important consideration.

The function of the kidneys, bowels, bladder, and respiration may be more or less interfered with, and it may be desirable to use a properly constructed abdominal support, or maternity corset. These devices support and distribute the weight, and prevent the womb from resting on or compressing, and hence interfering with, the function of any one organ. If the womb sags to one side, thereby r.e.t.a.r.ding the return circulation of the blood in the veins from the leg, it may cause cramps in the leg, especially at night, or it may cause varicose veins, or a temporary dropsy. The correct support will prevent these troublesome annoyances; a properly constructed maternity corset is often quite effective. The diet should receive some special attention when these conditions exist. Any article of diet which favors fermentation (collection of gas) in the stomach or bowel should be excluded. These articles are the sugars, starches, and fats. It can readily be understood that if the bowels should be more or less filled with gas, or if they should be constipated, it will cause, not only great distress, but actual pain. Regulation of the diet, therefore, and exercise (walking best of all) will contribute greatly to the avoidance of these unnecessary sequelae.

It must be kept in mind that the entire apparatus of the body is accommodating a changed condition, and though that condition is a natural one, it requires perfect health for its successful accomplishment. This means a perfect physical and mental condition,--a condition that is dependent upon good digestion, good muscles, healthy nerves, clean bowels, and so on. The slightest deviation from absolute health tends to change the character of the body excretions, the quality of the blood, etc. If the excretions are not properly eliminated, the blood becomes impure, and so we sometimes get itching of the body surfaces, especially of the abdomen [82]

and genitals; neuralgias, especially of the exposed nerves of the face and head; insomnia and nervousness. These are all amenable to cure, which again means, as a rule, correct diet and proper exercise as the princ.i.p.al remedial agencies.

UNDUE NERVOUSNESS DURING PREGNANCY.--This is very largely a matter of will power. Some women simply will not exert any effort in their own behalf.

They are perverse, obstinate, and unreasonable. The measures which ordinarily effect a cure, they refuse to employ. It is useless to argue with them; drugs should never be employed; censure and affection are apparently wasted on them; they cannot even be shamed into obedience. The maternal duty they owe to the unborn child does not seem to appeal to them.

We do not know of any way to handle these women and to our mind they are wholly unfit to bring children into the world. Fortunately these women are few in number. The maternal instinct will, and does, guide most women into making sincere efforts to restrain any undue nervous tendency, and to be obedient and willing to follow instructions. There is nothing so beneficial in these cases as an absolutely regulated, congenial, daily routine, so diversified as to occupy their whole time and thought to the exclusion of any introspective possibility. Frequent short changes to the country or seash.o.r.e to break the monotony, give good results in most of these cases.

The domestic atmosphere must also be congenial and the husband should appreciate his responsibility in this respect.

Women of this type should have their attention drawn to the following facts in this connection: While the most recent investigations of heredity prove that a woman cannot affect the potential possibilities of her child, she can seriously affect its physical vitality. The following ill.u.s.tration may render our meaning clear: suppose your child had the inborn qualities necessary to attain a 100 per cent. record of achievement in the struggle of life; anything you may or may not do cannot affect these qualities--the child will still have the ability to achieve 100 per cent. Inasmuch, however, as a mother can affect the health or physical qualities of her[83]

child she is directly responsible, through her conduct, as to whether her child will ever attain the 100 per cent. record, or if it does, she is responsible for the character of its comfort, its health, its enjoyment, all through its life's struggle toward the 100 per cent. achievement record. She may so compromise its physical efficiency that it will succ.u.mb to disease as a consequence of the ill health with which its mother unjustly endowed it, even though it possess the ability to attain the 100 per cent. if it lived.

We often see brilliant children who are nervous and physically unfit, and we see others of more ordinary mental achievement who are healthy and robust animals. The one is the offspring of parents possessing unusual mental qualities but who are physically unable or unwilling to render justice to their progeny; the other parents may be less gifted mentally, but they are healthy and they are willing to give their best in conduct and in blood to their babies. Many of these brilliant children never achieve their potential greatness because they fall by the wayside owing to physical inability, while the healthy little animals achieve a greater degree of success because of the physical vitality which carries them through. To achieve a moderate success and enjoy good health is a better eugenic ideal than the promise of a possible genius never attained because of continuous physical inefficiency.

The nervous and willful mother should therefore consider how much depends upon her conduct. It cannot be too frequently reiterated and emphasized that every mother should do her utmost to guard and retain her good health.

Good health means blood of the best quality and this is essential to the nourishment of the child. To keep in good health does not mean to obey in one respect and fail in other essentials. It means that you must obey every rule laid down by your physician, willingly and freely in your own interest and in the interest of your unborn babe. In no other way may you hope to creditably carry out the eugenic ideal that "the fit only shall be born."

HEADACHE.--This is a symptom of great importance. If it occurs [84]

frequently, without apparent cause, the physician should be consulted at once, as it may indicate a diseased condition of the kidneys, and necessitate immediate treatment. Headaches may, of course, be caused in many ways and most frequently they do not have any serious significance, but they must always be brought to the attention of the physician. As a rule they are caused by errors of diet,--too much sugar, candy, for instance, late and indigestible suppers, indiscriminate eating of rich edibles, etc.,--or they may be products of nervous excitement (too little rest), as shopping expeditions, strenuous social engagements, late hours, etc.

ACIDITY OF THE STOMACH, AND SO-CALLED HEARTBURN.--These are sometimes in the early months of pregnancy annoying troubles. The following simple means will relieve temporarily: A half-teaspoonful of bicarbonate of soda or baking soda in a gla.s.s of water or Vichy water; or a half teaspoonful of aromatic spirits of ammonia in Vichy, or plain water; or a tablespoonful of pure glycerine. The best remedy is one tablespoonful of Philip's Milk of Magnesia taken every night for some time just before retiring.

Heartburn is the result of eating improper food, or a failure to digest the food taken. Starchy foods should be avoided. Meats and fats should be taken sparingly. Avoid also the et ceteras of the table, as pickles, sauces, relishes, gravies, mustard, vinegar, etc. Good results follow dry meals,--meals taken without liquids of any kind. Live on a simple, easily digested, properly cooked diet. Chew the food thoroughly, take plenty of time and be cheerful.

CONSTIPATION DURING PREGNANCY.--Most women are as a rule more or less constipated during pregnancy. It is caused by failure to take the proper amount of outdoor exercise, to take enough water daily, to live on the proper diet, to live hygienically, or because of wrong methods of dress. It is most important that the bowels should move thoroughly every day.

Pregnancy no doubt aggravates constipation by diminishing intestinal activity. Consequently there is a greater need for activity on the part of the woman, and open air exercise is the best way to accomplish this. [85]

She should eat fruits, fresh vegetables, brown or Graham bread, or bran m.u.f.fins, figs, stewed prunes, and any article of diet which she knows from experience works upon her bowel. She should drink water freely; a gla.s.s of hot water sipped slowly on arising every morning or one-half hour before meals, is good. Mineral waters, Pluto, Apenta, Hunyadi, or one teaspoonful of sodium phosphate, or the same quant.i.ty of imported Carlsbad salts in a gla.s.s of hot water one-half hour before breakfast, answers admirably. If the salts cannot be taken a three- or five-grain, chocolate-coated, cascara sagrada tablet, may be taken before retiring, but other cathartics should not be taken unless the physician prescribes them. Rectal injections should be avoided as a cure of constipation during pregnancy. They are very apt to irritate the womb and if taken at a time when the child is active, they may annoy it enough to cause violent movement on its part, and these movements may cause a miscarriage. See article on "Constipation in Women."

VARICOSE VEINS, CRAMPS, AND NEURALGIA OF THE LIMBS.--When cramps or painful neuralgia occur repeatedly in one or both legs, some remedial measures should be tried. Inasmuch as the cause of this condition is a mechanical one, it would suggest a mechanical remedy. The baby habitually seeks for the most comfortable position, and having found it stays there until conditions render it uncomfortable. He does not consult you in the matter, but he may be subjecting you to untold misery and pain. The child may rest on the mother's nerves or blood-vessels as they enter her body from her lower limbs. If the pressure is sufficient, it can interfere quite seriously with the return blood supply, because veins which carry back to the heart the venous or used blood, are vessels with thin, soft, compressible walls, while arteries which carry blood away from the heart cannot be compressed easily, because their walls are hard and tense. The condition therefore is that more blood is being sent into the limb than is being allowed to return; in this way are produced varicose veins. If these varicose veins burst or rupture we have ulcers, which may quickly heal,[86]

or they may refuse to heal, and become chronic. A dropsical condition of the leg may follow, and because of interference with the circulation of the blood we get cramps and neuralgias. How can we remedy this painful condition?

Sometimes we don't succeed, but at least we can try. So long as the cause exists, it is self-evident that rubbing the limb with any external application, will not give any permanent relief, though it is well to try.

When rubbing, to relieve cramps at night, always rub upward. It is not a condition that calls for medicine of any kind, while hot baths and hot applications will only make the trouble worse. The remedy that promises the quickest and longest relief is for the patient to a.s.sume the knee-chest position for fifteen minutes, three times a day, till relief is permanently established. The patient rests on her knees in bed, and bends forward until her chest rests on the bed also. The incline of the body in this position is reversed; hips are highest, the head lowest. The baby will seek a more comfortable position and this new position may relieve the pressure and cure the condition. Doing this three times daily for fifteen minutes gives relief to the leg by reestablishing a normal blood circulation, and very soon the baby finds a new position that does not interfere with its mother's blood supply, and the cramps, and neuralgia and dropsy, and maybe the varicose veins will soon show improvement. Wearing the proper kind of abdominal support may help, as explained on page 77. If the varicose veins are bad, it is desirable to wear silk rubber stockings or to bandage the limbs.

INSOMNIA DURING PREGNANCY.--Insomnia or sleeplessness is sometimes a vexatious complication during pregnancy. It seldom if ever becomes of sufficient importance or seriousness to interfere with the pregnancy or the health of the patient. Nevertheless, a period of sleeplessness lasting for two or three weeks is not a pleasant experience to a pregnant woman. It is most often met with during the latter half of pregnancy.

There can be no question that every case of insomnia has definite cause, and can be relieved if we can find the cause. The only way to find it [87]

is to systematically take up the consideration of each case, and this is best done by the physician. He must have patience and tact; you must answer each question truthfully and fully. Your diet, personal conduct, exercise, condition of bowels, mental environment, domestic atmosphere, everything, in fact, which has any relation to you or your nerves, must be inspected with a magnifying gla.s.s. Some little circ.u.mstance, easily overlooked, of seemingly no importance, may be the cause of the trouble. You may need more outdoor exercise, or you may need less outdoor exercise. You may need more diversion, more variety, or you may need less. You may need a sincere, honest, tactful, patient confidant and friend, or you may need to be saved from your friends. You may be exhausting your vitality and fraying your nerves by social exigencies,--those empty occupations which fill the lives of so many fussy, loquacious females,--echoless, wasted, babbling moments, of supreme important to the social bubbles who ceaselessly chase them but of no more interest to humanity than the wasted evening zephyrs that play tag with the sand eddies on the surface of the dead and silent desert. You may have wandered from the narrow limitations of the diet allowable in pregnancy, or you may be the victim of an objectionably sincere relation who pesters you with solicitous inquiries of a needless character. Whatever it is, rectify it. A good plan to follow on general principles is to take a brisk evening walk with your husband just before bedtime, and at least two hours after the evening meal. Follow this with a sitz bath as soon as you return from the walk.

A sitz bath is a bath taken in the sitting position with the water reaching to the waist line. It should last about fifteen minutes and the water should be comfortably hot. It is sometimes found that this form of bath creates too much activity on the part of the child and defeats the purpose in view. This is apt to be the case in very thin women when the abdomen is not covered by a sufficient layer of fatty tissue. These women will find it advisable to take, in place of the sitz bath, a sponge bath in a warm room, using the water rather cool than hot but in a warm room. Rub your skin [88]

briskly but waste no time in getting into bed. A gla.s.s of hot milk, before going to bed, or when wakeful during the night, may serve as a preventive.

When these measures fail the physician should be called upon to advise and prescribe.

PTYALISM, OR AN EXCESSIVE FLOW OF SALIVA.--This is a common condition in pregnancy, but cannot be prevented. It is of no importance other than that it is a temporary annoyance.

Itching of the abdomen can usually be allayed by a warm alcohol rub, followed by gently kneading the surface of the abdomen with warm melted cocoa b.u.t.ter, just before retiring.

A v.a.g.i.n.aL DISCHARGE.--Soon after pregnancy has taken place the woman may notice a discharge. It may be very slight or it may be quite profuse. In some cases it does not exist at all during the entire period. As a rule the discharge is more frequent and more profuse toward the end of pregnancy.

If the discharge exists at any time,--and it is no cause for worry or alarm if it does exist,--inform your physician. He will advise you what to do, because it is not wise for you to begin taking v.a.g.i.n.al douches or injections without his knowledge, and at a time when they may do you serious harm. Should itching occur as a result of any v.a.g.i.n.al discharge the following remedial measures may be employed:

A solution of one teaspoonful of baking soda to a douche bag of tepid water may be allowed to flow over the parts, or cloths saturated with this mixture may be laid on the itching part. A solution of carbolic acid in hot water (one teaspoonful to one pint of hot water), is also useful, or a wash followed by smearing carbolic vaseline over the itching parts. If your physician should suggest a mild douche for itching of the v.a.g.i.n.a as the result of a discharge, it may be promptly relieved by using Borolyptol in the water. Buy a bottle and follow directions on the label.