j4nnouncement 
NATIONAL HEALTH SERIES 
In order to provide the general public with authoritative 
books on health at low cost, the National Health Council has 
arranged with the Funk & Wagnails Company for the publi- 
cation of The National Health Series. This series will 
contain twenty books on all phases of human health, written 
by the leading authorities in the United States. 
Man and the Microbe: How The Human Machine; How die 
Communicable Diseases are Con- Body Functions. By W. 
trolled By C.-B. A. Winslow, Howell, PhD., M.D., LL.D., 
Dr. P, H.; Professor of Public Sc.D.; Associate Director, School 
Health, Yale School of Medicine. of Hygiene and Public Health, 
, ... Johns Hopkins University. 
wit°h scrtption11^11^1' anatom? anS 
" VfSXatton.PreTenU°n g-T S 
The Baby's Health. By Richard Th0 Yeuno Child's Health. By 
A. Bolt, M.D., Gr. P. H.; Di- Henry L. K. Shaw, M.D.; Clin- 
rector, Medical Service, Amen- }oal profegSorj Diseases of Chil- 
ean Child Health Association. dren, Albany Medical College. 
How to care for the baby so How to care for the health of 
that it will be healthy, will de- tile runabout child from two to 
velop properly, and be strong and six years of age. 
free from disease. The chi|d In school; Care of 
personal Hvoiene- The Rules Its Health. By Thomas D. Wood, 
fnr Livtag By Allan I M.D.; Professor of Physical Edu- 
McLaughlin, M.D.: Surgeon 9*tio"' ,Tea9hers Colle«e' Colum- 
Uiuted States Public Health bia University. 
Servile Promotion of health habits in 
Practical suggestions a. to how about* 
to apply personal hygiene to pro- acuy now io gu 
mote health and get the most out Tuberculosis; Nature, Treat- 
of ijfe ment, and Prevention, by Linsly 
~ TTzvwr R. Williams, M.D.; Managing 
Community Health, How to Director, National Tuberculosis 
Obtain and Preserve It By D. Association. 
B. Armstrong, M.D.; Sc.D.; Ex- Covers the whole fleld of tuber- 
ecutive Officer of the National cuIogls> the cause, spread, treat- 
Health Council. ment, prevention and duties of 
An outline of what the com- citizens, patients, and the com- 
munity should do for the health munity. 
of its citizens and what each Tho Qu(Jst f(jr HeaIth; 
person to make his K Jg and who can Help gecure 
community a healthy place. It By Janl6g A Tobey, M.S.; 
Cancer; Nature, Diagnosis, and Administrative Secretary, Nation- 
Cure. By Francis Carter Wood, al Health Council 
M.D.; Director, Institute for A statement of what health is. 
Cancer Research, Columbia Uni- how it may be obtained, and a 
versity, description of the actual help 
The best statement about can- which the government. States, 
oer ever written for the laity. municipalities, physicians, and 
It tells what it is and how to voluntary health agencies can 
know it and have it cured. give to individuals. National health series 
(Continued) 
Love and Marriage: Normal Your Mind and You; Mental 
Sex Relations; By T. W. Gallo- Health. By Frankwood E. Wil- 
way, Ph.D., Litt.D.; Associate liams, M.D., Medical Director, 
Director of Educational Measures. National Committee for Mental 
American Social Hygiene Asso- Hygiene, and George K. Pratt, M.D. 
elation. Describes how your mind can 
The various elements, biologi- a friend or enemy and how 
cal, social, and sexual, which can jje enlisted as your ally, 
make up a successful and happy 
married life. Taking Care of Your Heart. 
Food for Health's Sake; What By T. Stuart Hart, M.D., Presi- 
to Eat By Lucy H. Gillett, dent. Association for the Preven- 
M.A., Superintendent of Nutri- tion and Relief of Heart Disease, 
tion. Association for Improving New York. 
the Condition of the Poor, New How to avoid an(j prevent heart 
York. troubles, which form the lead- 
An outline of what and how to ing cause of death in this 
eat for maximum efficiency and country, 
health building. 
Health of the Worker; How to The Expectant Mother; Care of 
Safeguard It. By Lee K. Frankel Her Health. By R. L. DeNor- 
Ph.D.; Chairman, National Health mandie, M.D.; Specialist, Bos- 
Council. ton. Mass. 
Hygiene and sanitation in The health care needed during 
factory and shop and how in- pregnancy in order that both 
dustrial workers can protect and mother and baby may be healthy 
promote their health. and well. 
Exercises for Health. By Lenna 
L. Meanes, M.D., Medical Direc- Home Care of the Sick; By 
tor. Women's Foundation for Clara D. Noyes, R. N.; Director 
Health. of Nursing, American Red Cross. 
Illustrative material giving to What to do in the home when 
individuals the type of exercise illness is present. Practical sug- 
gest suited to each one's per- gestions for the care of the sick, 
sonal needs. 
Venereal Diseases; Their Med- Adolescence; Educational and 
ical. Nursing, and Community Hygienic Problems. By Maurice 
Aspects. By W. F. Snow, M.D., A. Bigelow, PhD.; Professor of 
General Director, American So- Biology and Director School of 
cial Hygiene Association. Practical Arts. Teachers College, 
A non-technical discussion of Columbia University. 
cause, spread, treatment, cure. The scientific and sociological 
and prevention of each of these aspects of adolescence to explain 
diseases and related social hy- the proper transition from child- 
giene Questions. hood to adult life. 
THE NATIONAL HEALTH SERIES 
20 Volumes I8mo. Flexible Fabrikoid. Average number of pages, 70. 
Price per set, $6.00 net; per volume, 30c. net 
FUNK & WAGNALLS COMPANY, Publishers 
NEW YORK and LONDON NATIONAL HEALTH COUNCIL 
Direct Members 
American Child Health Association, 
370 Seventh Avenue, New York City. 
American Public Health Association, 
370 Seventh Avenue, New York City. 
American Red Cross, 
17th Street between D and E, Washington, D. C. 
American Social Hygiene Association, 
370 Seventh Avenue, New York City. 
American Society for the Control of Cancer, 
370 Seventh Avenue, New York City. 
Conference of State and Provincial Health Authorities of 
North America, 
Care of State Department of Health, Lansing, Mich. 
National Committee for Mental Hygiene, 
370 Seventh Avenue, New York City. 
National Committee for the Prevention of Blindness, 
130 East 22d Street, New York City. 
National Organization for Public Health Nursing, 
370 Seventh Avenue, New York City. 
National Tuberculosis Association, 
370 Seventh Avenue, New York City. 
Conference Members 
United States Public Health Service, 
Washington, D. C. 
United States Children's Bureau, 
Washington, D. C. 
Associate Members 
American Association of Industrial Physicians and Surgeons, 
Care of Dr. W. A. Sawyer, Eastman Kodak Co., 
Rochester, N. Y. 
Women's Foundation for Health, 
370 Seventh Avenue, New York City. 
OFFICERS 
Lee K. Frankel, Chairman. 
William F. Snow, M.D., Vice-Chairman. 
James L. Fieser, Recording Secretary. 
Linsly R. Williams, M.D., Treasurer. 
STAFF 
A. J. Lanza, M.D., Executive Officer. 
James A. Tobey, Administrative Secretary. 
Thomas C. Edwards, Business Manager. 
Elizabeth G. Fox, Washington Representative. 
Offices of the National Health Council 
Administrative:-370 Seventh Avenue, New York City. 
Washington:-17th and D Streets, N. W., Washington, D. C. THE EXPECTANT 
MOTHER 
CARE OF HER HEAL.TH 
BY 
ROBERT L. DeNORMANDIE 
M.D?, F.A.C.S. 
Instructor in Obstetrics, Harvard Medical School 
THE NATIONAL HEALTH SERIES* 
EDITED BY 
THE NATIONAL HEALTH COUNCIL 
FUNK & WAGNALLS COMPANY 
NEW YORK AND LONDON 
1924 Copyright, 1924, by 
FUNK & WAGNALLS COMPANY 
Printed in the United Statee of America 
Published, May, 1924 
Copyright Under the Articles of the Copyright Convention 
of the Pan-American Republics and the I ] 
United States, August II, 1910. IX. INTRODUCTION 
The entire program of what we may designate 
as the new public-health movement is focused about 
the child. The hopes of mankind for a future race, 
more virile, less susceptible to infection, better de- 
veloped, and better balanced to meet both the pleas- 
ures and strains of life, depend in great measure 
upon the circumstances of the earliest formative 
years of childhood. But even to a greater degree, 
the future welfare of our nation depends upon the 
circumstances that surround the child before birth- 
his inheritance of physical and mental character- 
istics, his opportunities for normal development and 
for normal nutrition while yet in the mother's womb. 
This is simply the equivalent of saying that much 
in these directions depends upon the knowledge of 
the mother as to the proper details of her personal 
hygiene during the pregnant state. She should 
know what to do, what to eat, when and how much 
to sleep, when to exercise, when to rest. She must 
know what things she should at once call to the 
physician's attention. Above all, she needs to be 
reassured; she needs to understand what phenomena 
of pregnancy are normal and what are abnormal. 
She needs to be delivered from the harassing, ter- 
rifying, false beliefs and superstitions that are con- 
stantly thrust before her by ill-advised, thought- 
less relations and friends of her own sex. 
In this one of the series of the National Health 
Council's little booklets on health, Dr. DeNormandie 
does just these things-in clear, simple, understand- 
able language, compactly and interestingly writ- INTRODUCTION 
ten. He is preeminently qualified to do so. For 
years a prominent leader in obstetrics, a teacher as 
well as a practitioner, deeply interested in the 
broader aspects of obstetrics in its relation to public 
health, hospital service, district nursing, and the 
practise of medicine, he has studied the problems 
of pregnancy from every angle. The essential de- 
tails that his long experience has taught him to be 
of greatest value to the expectant mother are all 
to be found within the brief confines of this little 
book. 
Eugene R. Kelley, M. D. 
Commissioner of Public Health 
of 
The Commonwealth of Massachusetts. 
Boston, March, 1924. CONTENTS 
I-Diagnosis of Pregnancy i 
II-Duration of Pregnancy 4 
III- Determination of Sex 7 
IV- Hygiene of Pregnancy 8 
Diet-Exercise-Fresh air and recreation- 
Rest - Sleep - Baths - Bowels - Kidneys - 
Skin-Breasts - Clothing - Teeth - Hair - 
Intercourse-Maternal impressions-Visits to 
the physician. 
V-Discomforts and Ills of Preg- 
nancy 24 
Nausea and vomiting-Salivation-Heartburn, 
gas, flatulence-Increase in weight-Varicose 
veins-Hemorrhoids-Cramps in the legs- 
Relaxation of the pelvic joints-Leucorrhea- 
Pendulous or relaxed abdomen. 
VI-Complications of Pregnancy ... 30 
Miscarriage-Toxemias of pregnancy-Bleed- 
ing in pregnancy-Sepsis, puerperal fever, child- 
bed fever. 
VII-Preparations for Delivery ... 37 
Home or hospital-Choosing a nurse-Sup- 
plies for the mother 
VIII-Labor 42 
Cause of labor-Preparation of the patient- 
Course of labor-Anesthetics in labor. CONTENTS 
IX-The Baby 48 
X-Convalescence 51 
Rest, visitors-Diet-Bowels-Urine-Involu- 
tion of uterus-Nursing-Exercises, binder- 
Getting up-Return of menstruation-Final 
examination. 
XI-Conclusion 57 THE EXPECTANT MOTHER 
CHAPTER I 
DIAGNOSIS OF PREGNANCY 
THE DIAGNOSIS of pregnancy usually is a 
comparatively easy matter, but in a few cases it 
is, in the early weeks, one of the most difficult diag- 
noses to make; therefore in some cases the pa- 
tient is frankly told the difficulty and asked to re- 
turn for further examination in a month's time. 
The first sign that makes a woman suspect that 
she may have become pregnant is the non-appear- 
ance of her menstruation. In a woman of the child- 
bearing age who previously has been regular in 
her monthly periods, this cessation of the menstru- 
ation is a most important and suggestive sign. Coin- 
cident with this stopping of the menstruation, the 
breasts become enlarged and firm, tender, with prick- 
ling sensations, or as many women describe it, 
"pins and needles sticking into them." In those 
women who have these sensations at a menstrual 
period this symptom, of course, carries not so 
much weight as in those women who have never 
before experienced it. 
Shortly after a menstruation has been skipped, 
morning nausea, a feeling of distress or active vom- 
iting,'may occur. It occurs so frequently that women 
have come to look upon it as one of the signs of 
pregnancy. It is true, however, that many women 
do not have this nausea, and they do not have to 
have it in order to be pregnant, as so many women 
1 2 
THE EXPECTANT MOTHER 
think they must. A certain, tho small, proportion of 
cases have no nausea in the morning and feel un- 
usually well, but do have a marked nausea in the 
late afternoon and early evening. 
Usually within the first four or five weeks the 
woman notices that she passes her water more fre- 
quently and often has to get up in the night to 
void. These four signs, the non-appearance of men- 
struation, the changes in the breasts, the morning 
nausea, the changes in the passing of the urine, are 
regarded as the presumptive signs of pregnancy. 
One or all of these signs may be present the first 
time the patient presents herself to her doctor for 
a diagnosis of pregnancy. Usually the patient her- 
self has made the diagnosis, but the definite diag- 
nosis of pregnancy can be made only by a vaginal 
examination. 
The importance of this first vaginal examination 
is underestimated by almost all patients. Every 
woman who suspects that she has become pregnant 
should, as soon as she has skipped her first period, 
go to a physician and have him make a pelvic ex- 
amination in order to establish definitely, if possi- 
ble, that she is pregnant. This examination not 
only establishes that she is or is not pregnant in 
most cases, but it determines whether the pelvic 
organs are in normal condition. The uterus, the 
organ in which pregnancy develops, is a movable 
organ, and in many women it takes a position back- 
wards in the pelvis which, if not rectified early in 
pregnancy, may cause serious complications in the 
first few months. It is by this examination that 
many early miscarriages may be avoided; abnormal 
conditions in the pelvis are discovered, and treat- 
ment, if necessary, can at once be carried out. Few 
women who think themselves pregnant present 
themselves to their physician or to the clinic early DIAGNOSIS OF PREGNANCY 
3 
enough. They assume that their nausea can not be 
helped; they assume that nothing need be done for 
at least the first four or five months of their preg- 
nancy. This is a wrong attitude to take, for careful 
pelvic examinations will do much to rule out many 
of the complications that come in pregnancy, and 
will lower the number of early miscarriages which 
we know are of frequent occurrence. Early super- 
vision will tend to keep patients in better physical 
condition. The diagnosis of pregnancy in this early 
stage is not absolute, ever; but the probability us 
so great that it is fair to tell a patient that she is 
pregnant and then proceed to tell her the various 
points that she should know in regard to the hygiene 
of pregnancy. 
The positive signs of pregnancy, feeling the baby 
move and hearing the heart beat, can not always be 
found until the fifth month, and sometimes it is even 
later before these signs are absolutely certain. CHAPTER II 
DURATION OF PREGNANCY 
THE DURATION of pregnancy is ten menstrual 
periods of twenty-eight days each. That is 
the probable duration of pregnancy, but if we know 
the date of conception there is less uncertainty as 
to the exact date of delivery. The average length 
of pregnancy, where the beginning can be dated 
from a single intercourse, varies from 273 to 275 
days. The most satisfactory way to reckon the ap- 
proximate date of delivery is to take the first day of 
the last menstrual period, count back on the calendar 
three months, and add to this date seven to ten 
days. The date obtained in this way gives only 
the approximate date that delivery may be expected. 
At no time should the patient be given to under- 
stand that delivery will take place on that date; for 
altho it sometimes does happen that labor starts 
on the day that is reckoned, many more times the 
estimated date is wrong, and the patient may be 
delivered a week or so early or late. The point 
to be remembered is that the date chosen is only 
approximate, that everything should be ready for 
delivery at least three weeks before that date, but 
under no circumstances should the patient be alarmed 
if she goes over a few days. Patients must be made 
to realize that pregnancy is reckoned as beginning 
close to the last menstrual period. It is perfectly 
possible, however, that pregnancy did not begin 
until just before the next menstruation, and that 
menstruation was either stopped entirely or ma- 
4 DURATION OF PREGNANCY 
5 
terially altered in its characteristics; that is, it was 
either a day or so short, or if a patient was in the 
habit of flowing profusely it was a much less pro- 
fuse menstruation than usual. If a patient can defi- 
nitely say that there was no opportunity for con- 
ception to have occurred until a certain date, then 
the beginning of pregnancy is reckoned from that 
known date of intercourse. In all cases where, be- 
cause of various circumstances, it is known that the 
pregnancy can be reckoned from one date, the pa- 
tient should frankly tell her physician what that 
date is, and then there will be no annoying expec- 
tancy during the last weeks of pregnancy. 
The fact that patients often become pregnant 
two to three weeks after the last menstruation ex- 
plains in the great majority of cases the "overtime" 
or "late cases." Many unnecessary operations are 
done and much mental' distress is caused by for- 
getting this simple but not too well-known fact. 
Undoubtedly there are a few well-authenticated 
cases of a pregnancy going over the allotted number 
of days-the so-called "post-mature infants." In 
these cases the greatest importance is to be placed 
on the careful supervision of the patient at the very 
end of pregnancy to determine whether or not the 
child that is in the uterus is becoming too large. 
When such cases occur, careful supervision and 
good judgment will determine whether any operative 
procedure is necessary, but without careful super- 
vision serious results occur. These cases are on the 
whole rare, and most of them are explained, as I 
have suggested, by the fact that the patient became 
pregnant shortly before the expected date of her 
next period, rather than shortly after the last period 
which occurred. 
In contrast to the post-mature child is the pre- 
mature child, which means that the fetus is expelled 6 
THE EXPECTANT MOTHER 
from the uterus before its allotted 280 days. The 
earlier the baby is expelled from the uterus before 
the 280 days, the less is the chance of that baby 
surviving. The old saying that an eight-months 
baby will die while a seven-months baby will live is 
an entire fallacy, and is based upon the fact that an 
eight-months baby in many cases looks much like 
a full term child, and the necessary care, oversight, 
and careful nursing are not given the eight-months 
baby, while everybody appreciates how slender a 
hold on life the seven-months baby has, and there- 
fore treats it with all possible care, surrounding it 
with every help to support life until it can itself do 
so readily, and its premature days are past. CHAPTER III 
DETERMINATION OF SEX 
MANY mothers, and nof a few fathers, are anx- 
ious for the physician to try to tell them the 
sex of the child before it is born, and many ask if 
there is some way whereby the sex of the child can 
be settled before a pregnancy is begun. In all prob- 
ability the sex of the fetus is determined the moment 
impregnation takes place. How that can be in any 
way determined beforehand is absolutely unknown. 
Many theories have been expounded, but up to the 
present time all have been exploded. The deter- 
mination of the sex before the child is born is based 
purely on the rate of the fetal heart as counted by 
listening to it through the mother's abdomen. At 
best it is only a guess, and the guess is based on the 
fact that in a large series of cases, if the fetal heart 
is slow, about 120 beats to the minute, the majority 
of these babies will be boys; while if the fetal heart 
is around 140 beats to the minute, the majority of 
these babies will be girls. 
Do not believe what your talkative friends tell 
you, that a boy is carried thus and a girl thus, for 
it is all idle gossip. And do not believe physicians 
who tell you positively of the sex. A story is told 
of a physician in regard to this question. He al- 
ways finds out the sex wanted and then writes down 
in his book of cases the opposite sex. If the wished- 
for sex is obtained, well and good-he is a prophet; 
if not, he turns to his book and says, "No, it is 
written here the opposite." Again he is a prophet. 
But do not believe these stories. There is no way 
of predetermining the sex of a child. 
7 CHAPTER IV 
HYGIENE OF PREGNANCY 
IN THE past few years great improvement has 
been made in the care of the pregnant woman. 
The good results of this care have been demon- 
strated in thousands upon thousands of cases; and 
it is well established that no woman in the country 
should go through pregnancy without careful medi- 
cal supervision throughout its entire duration. 
The chief point for a pregnant patient to remem- 
ber is that she must have a generous mixed diet, 
and by a mixed diet we mean that her diet should 
contain the essential elements that go to make up 
a well-balanced ration. She should have proteids, 
fats, carbohydrates, a liberal amount of water, and 
a satisfactory amount of minerals. In the early 
weeks of her pregnancy, when nausea is present, she 
will find that marked relief will be given if she 
eats six small meals a day rather than the accustomed 
three. The old saying that a pregnant woman must 
eat for two has long ago been exploded. We are 
all apt to eat much more than is necessary in order 
to keep the human system in good physical condi- 
tion, and if the pregnant patient adds greatly to her 
diet, she puts on an unnecessary amount of weight 
and imposes upon her organs, especially her kidneys, 
an abnormal burden. 
The pregnant patient ought not to eat any one 
food that she knows will upset her digestion, but 
she must not listen to the tales of friends, relatives, 
and neighbors that she must eat this or must not 
Diet 
8 HYGIENE OF PREGNANCY 
9 
eat that kind of food. The proteid food puts the 
greatest strain on the kidneys, and, as we shall see 
later, in the latter part of pregnancy a lowered 
amount of proteid diet is advisable in many cases. 
That is the reason why, in the latter half of preg- 
nancy, patients are advised to have red meat only 
once a day and not to eat meat, fish, and eggs every 
day throughout their pregnancy. 
The fats and carbohydrates tend to make the 
patient very fat, and if this type of food is eaten 
to excess, marked indigestion at times may be caused 
and sugar may appear in the urine. It is for this 
reason that the patient is advised against a markedly 
increased diet. Fruits, vegetables, the leafy vege- 
tables, add to the water intake and the mineral sub- 
stances that are needed during a pregnancy. Milk 
also adds to the mineral matter needed. Salads with 
dressings can be eaten with impunity, provided the 
digestion is not upset. Every pregnant woman 
should drink at least eight glasses of water or 
liquids in the twenty-four hours. Only one cup of 
coffee and one cup of tea, if any, should be drunk in 
a day. All forms of alcohol should be omitted. 
Exercise 
A proper amount of exercise is essential. The 
safest form of exercise is, without a doubt, walk- 
ing. How many miles or how long she should walk 
each day is entirely a problem that she must set- 
tle with the help of her physician. Some patients 
walk two, three, or four miles a day with obvious 
improvement in their general condition, while a 
half-mile walk is too much for others. A sugges- 
tion for patients is that after a walk, if they come 
back and lie down for half to three-quarters of an 
hour and then get up feeling refreshed, they have 
not walked too much, and a few days later they 10 
THE EXPECTANT MOTHER 
can walk a little farther; but if they come back and 
after the rest get up feeling fatigued, they have 
walked too far. The more strenuous forms of 
athletic exercise, such as tennis, golf, horseback 
riding, or swimming, can be indulged in only with 
the greatest care, and under certain circumstances 
(see "Miscarriage," chapter VI) must be given up 
entirely. Many patients will obtain a considerable 
amount of exercise around their own house in the 
many details of housekeeping. But even here, the 
patient must remember that she must not overdo; 
she must not lift heavy pieces of furniture, and she 
must not do a hard day's washing. In many cases, 
of course, this can not be avoided, but when neces- 
sary work must be done, the patient must try to plan 
the work so that as little as possible is done during 
the time that would be a menstrual period were she 
not pregnant. This phrase, "the menstrual period 
were she not pregnant," must be remembered 
throughout the entire pregnancy, and the reason for 
it is that the uterus is more irritable, has a greater 
tendency to contract, with a possible miscarriage 
following, at this time than at any other. 
Whether we shall allow pregnant patients to work 
during their pregnancy has to a slight extent been 
settled for us. In some of the States, pregnant 
women are allowed to work in the mills up to with- 
in four weeks of their expected confinement. This 
varies in different parts of the country; but our 
legislative bodies have recognized the fact that the 
pregnant woman should not work up to the date of 
confinement. That, however, is a very uncertain 
date, and the result is that many women work up 
to the very day they are confined. Until our laws 
are better framed, this condition will continue to 
exist. It surely is not right and should not be al- 
lowed, but the economic situation in many families is such that the woman of the family feels that she 
must work to help eke out the man's meager in- 
come. There is no doubt that tremendous strides 
can be made in this respect in the care of the preg- 
nant woman, but it can not be done unless the pub- 
lic appreciates the danger that comes to the preg- 
nant woman and her unborn child from working 
at this time, and will safeguard her in every possi- 
ble way. 
HYGIENE OF PREGNANCY 
11 
Fresh Air and Recreation 
Fresh air and recreation are important. If the 
patient finds that she is unable to get out a part of 
each day and have the walk that is necessary, she 
should do the work that she does around the house 
with her windows open as wide as possible. It is a 
makeshift at best, but it is better than nothing. As 
far as recreation is concerned, any of the simpler 
forms of recreation are not only allowable but es- 
sential for the patient's well-being. Many women 
lead a humdrum existence with practically no form 
of recreation. With the wide use of the automo- 
bile, however, much pleasure can be derived from 
carefully planned rides. No long rides over rough 
roads should be allowed. Long touring not infre- 
quently causes abortions, and if the patient has 
shown the slightest suggestion of miscarrying, the 
automobile should be forbidden. Riding in the front 
seat causes very much less jarring than in the back 
seat. Driving herself does no harm provided she 
drives carefully and slowly over good roads at a 
moderate speed-not over twenty miles an hour. 
The time may come in the pregnancy, however, 
when automobile riding becomes very fatiguing, 
causing backache and other discomforts. When 
this does occur, it is very much better for the pa- 
tient to stay out of the automobile entirely. The 12 
THE EXPECTANT MOTHER 
automobile, carefully used, is without doubt a splen- 
did means of recreation, but carried to extremes 
it is an abuse that causes many miscarriages. Every 
individual patient must be told by her own physi- 
cian what she can do. No- two patients are alike. 
Long trips in railroad trains undoubtedly do cause 
a certain number of miscarriages. If it is absolutely 
necessary that a long* trip be taken, it should be 
broken by a day or two of rest, and the trip should 
not be taken during the time that would be a men- 
strual period if the patient were not pregnant. The 
same may be said of long sea trips. The funda- 
mental thing to be remembered is that when a patient 
is pregnant she should stay where she can be prop- 
erly looked after, and not go traveling about the 
country. 
The question of fresh air in the sleeping room 
is also very important. Every patient should sleep 
with her windows open. Many women feel the 
need for fresh air especially marked as they go on 
in their pregnancy. For this reason many patients 
feel a sense of oppression when they go to the thea- 
ter or into close and crowded halls. 
Any mild form of exercise which gives to the 
patient a sense of well-being and recreation is good 
for her, and should be encouraged in every possi- 
ble way, but if the simplest sort of exercise causes 
fatigue, her routine must be carefully studied and 
rearranged by her physician. 
Rest 
Every patient should so map out the schedule of 
her day that she will lie down at least one hour with 
her clothes off, especially with her corsets off if 
she is wearing them, in order to have a complete 
rest. Those who can do this-and many more can 
do it than think they can, if they plan their work HYGIENE OF PREGNANCY 
13 
carefully-go through pregnancy in much better 
condition than if they had no rest. We appreciate 
that it is a difficult thing for many patients to ac- 
complish this rest. If they can not do it for an hour 
at a time, they can do it for half an hour morning 
and afternoon to great advantage. Especially 
should a working woman who is pregnant be given 
a period for rest in the morning and again in the 
afternoon. 
Sleep 
Important as are exercise and recreation, sleep 
is more important, and every patient should sleep 
at least eight hours every night. Undoubtedly many 
patients sleep less than this, and for a while go along 
apparently satisfactorily, only to notice in the course 
of a few months that they begin to feel very tired 
and not equal to doing the things that they usually 
do. When one questions their mode of living, one 
finds many times that sleep is the one necessary 
thing that is not being obtained. Many patients 
have an overwhelming sleepiness in the first two or 
three months of pregnancy, which annoys them very 
much. They often think something serious is hap- 
pening. If by careful physical examination it is 
found that all the organs are doing their work sat- 
isfactorily, it need give no cause for worry, and as- 
surance can be given that it will soon pass off. 
Baths 
During pregnancy the skin must be kept in good 
active condition. This can not be done unless daily 
baths are taken. Warm tub baths are essential, but 
hot soaks must be avoided, especially at the time 
that would be the menstrual period. If the patient 
has been accustomed to cold baths, there is no rea- 
son why she should not continue to have them, 14 
provided she reacts perfectly well following each 
one. But if on the contrary she is thoroughly chilled 
without the sense of well-being that comes from cold 
baths, she must not continue them. Sea-bathing 
does no harm provided the water is not too cold 
and there is no high surf. Neither does careful 
swimming do any harm; but strenuous swimming 
and diving must be avoided. It must also be 
added that patients who do not react well from sea- 
bathing must not continue it. 
THE EXPECTANT MOTHER 
The care of the bowels is one of the most im- 
portant points. The patient must have at least one 
good satisfactory movement a day. If the fact is 
recalled to her that the baby is growing rapidly 
inside the uterus with all its products of growth 
thrown off into her own system, she will at once ap- 
preciate the need of getting this material out of her 
system regularly and completely. This can be done 
only if she has satisfactory movements each day, 
combined with a satisfactory urinary output and 
action of the skin. 
The majority of women while they are pregnant 
need to have some mild cathartic which the physician 
in charge should advise. A simple cathartic which 
will give one satisfactory movement a day is the 
best. Many patients are fearful of getting the habit 
of taking a cathartic at this time, for they are afraid 
they will not be able to overcome it when the preg- 
nancy is finished. The habit will not be acquired, 
if satisfactory care is taken as soon as the baby is 
born. Even if a habit is acquired, the risk because 
of insufficient bowel movements is much greater 
than the discomfort that may arise from the forma- 
tion of the habit. She may be able to get along 
satisfactorily without a cathartic the first few months 
Bowels HYGIENE OF PREGNANCY 
15 
of the pregnancy, but in the latter half it is always 
advisable to take some mild cathartic at least twice 
a week until the pregnancy is finished. Supposito- 
ries and enemas are not at all satisfactory, as they 
empty the lower bowel only and must not be de- 
pended upon. 
The patient should pass at least three pints of 
urine in the twenty-four hours. Once a month, per- 
haps, it is important that the amount be known 
accurately. The twenty-four-hour amount of urine 
is measured by passing the urine at a given hour 
in the morning, and then collecting and measur- 
ing all of the urine that is passed from that hour 
to and including the same hour the next day. Un- 
less the physician asks especially for the twenty- 
four-houi- amount, it is sufficient to measure the 
urine up to the time that three pints is passed, 
noting the time of day. Then, of course, the re- 
mainder that is passed shows that the patient is 
passing well over the necessary amount. At no time 
should the urine be of high color. It should always 
be a very light, straw color. If the patient notices 
that the urine is of high color, she must at once 
drink large amounts of water in order to keep the 
secretion of urine up to the minimal amount. Ex- 
amination of the urine should be done by the physi- 
cian at least once a month for the first five months, 
then once in three weeks for the next two months, 
and the last two months once a week. If at any 
time abnormal conditions are found, the physician 
may call for daily specimens of urine. 
Kidneys 
Skin 
The bowels and the kidneys are the two principal 
means by which the patient rids herself of the prod- 16 
ucts of the baby's growth and of her own metabolism. 
The skin is the third means. The invisible per- 
spiration that is going on constantly over the en- 
tire body is an important part in the well-being of 
the patient. The skin of the body must be kept 
clean and the pores open by daily bathing. It is 
for that reason that the warm bath already spoken 
of is so essential throughout pregnancy. 
The discolorations that come in various parts of 
the body during pregnancy need only be remarked 
upon and explained. The dark line running from 
around the navel downwards and upwards is some- 
times very marked, especially in brunettes. The 
increased dark areas around the nipples are some- 
times very marked. As the patient increases in 
size and puts on weight, little red lines appear on 
the abdomen and on the hips, sometimes on the 
breasts, especially on the under sides of the breasts. 
These lines are due to the stretching of one of the 
layers of the skin. They often give a sensation 
of burning or tingling, but much more frequently 
they disturb the patient because of the appearance 
rather than because of any discomfort that they 
cause. There is nothing that can be done to stop 
them. Sometimes the tingling can be relieved by 
gently rubbing in olive oil, but nothing can be done 
to remove these lines. When the pregnancy is over 
the redness of these lines fades and they become 
white. They remain always, but require no treat- 
ment. Many patients show dark blotches on the 
face, especially over the cheeks. Similar blotches 
may appear on other parts of the body. They are 
due to an increased amount of pigment which is 
deposited in the skin. To some patients these blotches 
are most disturbing. Little can be done to lessen 
them, but assurance can be given that when the 
THE EXPECTANT MOTHER pregnancy is over the spots will fade and the patient 
will regain her original complexion. 
HYGIENE OF PREGNANCY 
17 
The breasts begin to enlarge very early in preg- 
nancy, especially in the first pregnancy. They be- 
come much more firm and many times are very 
tender. The tenderness and the tingling, of which 
many patients often speak, come at the time that 
the patient would menstruate were she not pregnant. 
The breasts are a very sensitive part of the organism, 
and patients must be careful to protect them from 
blows. Just outside the nipples in a ring are a 
few little glands which enlarge quite a bit during 
pregnancy-the so-called "glands of Montgomery." 
Usually it is just noted that they are enlarged, and 
rarely do they cause any trouble. Occasionally they 
become infected and may break down. The nipples 
themselves must be kept clean, but the secretion 
which sometimes exudes from them and dries in 
crusts should never be picked off with the finger 
nails. Whenever any crusts are seen to form, a 
simple ointment, such as cold cream or lanoline, may 
be put on them at bed time, and when the morning 
bath is taken the crusts are softened and come off 
with the bath. If the nipples have not the normal 
formation, the physician in charge will say specifi- 
cally what directions he wants carried out. Do 
not begin to manipulate the nipples, to wash them or 
handle them, unless specific orders have been given. 
Breasts 
Clothing 
The fundamentals to be remembered regarding 
clothing are that the clothes must be warm; they 
must not be tight around the abdomen, and all that 
can must hang from the shoulders. At the present 
day, even with a very small expenditure of money, THE EXPECTANT MOTHER 
18 
attractive maternity gowns may be had. There is 
no need for pregnant patients to appear unsightly 
with ill-fitting garments. The underclothing in 
cold climates should be warm in winter, of the 
union-suit type. The present-day fashion of wear- 
ing very light undergarments is dangerous for the 
pregnant woman because of the danger of chilling 
the body and consequent colds. The corsets for the 
first three or four months may be of the type to 
which the patient is accustomed, with the under- 
standing that as she increases in weight and size 
they are to be let out so that at no time do they 
mark the abdomen. They should never give a sense 
of pressure. The corsets may be pulled in for sup- 
port snugly around the hips, but at all times must 
be loose over the enlarging abdomen. At the fourth 
or fifth month of the pregnancy the larger or stouter 
patients especially may want to put on maternity 
corsets. There is no special maternity corset that 
is better than others. One patient may like one 
type of corset and another may always wear a totally 
different one, both perfectly adequate and giving 
proper support. The essential thing to remember 
is that the corset must be comfortable, must give 
good support in front for the enlarging abdomen. 
Because a patient is pregnant is no reason that she 
should put on corsets if she has never worn them 
before. They are entirely unnecessary and many 
of the present-day athletic women do perfectly 
well without wearing any at all, and are comfort- 
able throughout their entire pregnancies. 
The shoes should be comfortable, well-fitting, 
and with low heels. High heels put an extra strain 
on the patient's back muscles, to say nothing of 
the danger that they cause the patient from trip- 
ping. They ought not to be allowed, and in every possible way patients should be urged to wear the 
sensible, well-shaped, low-heeled shoe. Round gar- 
ters are forbidden, for they cause added pressure 
on the veins of the legs which are pressed upon 
greatly by the enlarging uterus. 
HYGIENE OF PREGNANCY 
19 
Teeth 
For generations past it has apparently been im- 
pressed upon women that as soon as pregnancy be- 
gins they should have no dentistry done, and it is for 
this reason that the old saying arose, "For every 
child a tooth." Nothing can be further from the 
truth. As soon as a woman knows that she is preg- 
nant, she should have her teeth examined by a com- 
petent dentist, and the necessary work done. If 
the dentist says that a tooth should be extracted, 
there is absolutely no reason why it should not be 
done. No difficult, painful work that can be avoided 
need be done, but for the dentist to keep the patient's 
teeth in good condition is exactly as important as it 
is for the physician to carry her through in good 
condition. The two are closely related, and some 
of the ills of pregnancy can be referred directly 
to bad teeth. 
Not infrequently when patients are examined after 
a pregnancy, it is found that many teeth have little 
cavities and that much attention is necessary. Many 
of these can be avoided if the patient will brush her 
teeth regularly after each meal, and, if she has 
nausea with the belching up of acid-tasting secre- 
tions, rinse her mouth with milk of magnesia to 
counteract the action of the acid on the enamel of 
the teeth. If she makes a special effort to adopt a 
satisfactory diet with a good supply of the leafy 
vegetables, she will help herself greatly to prevent 
the decaying of her teeth. 20 
THE EXPECTANT MOTHER 
Many patients complain that a great deal of 
their hair drops out during pregnancy, but more 
especially after the pregnancy is completed. We 
know of no way to stop this absolutely. Help may 
be given by keeping the scalp in good condition 
through shampooing and massage, but it will not 
stop the falling out of the hair in all cases. In 
most cases the hair soon grows in again. 
Hair 
Undoubtedly the majority of patients have inter- 
course during their pregnancy. How frequently in- 
tercourse is the cause of miscarriages in the early 
weeks of pregnancy is unknown, but it is certain 
that it is a potent cause. Many patients are averse 
to all intercourse during pregnancy. In a small 
number the desire for intercourse apparently is 
greater. Every patient should know that there un- 
doubtedly is a risk of miscarriage from intercourse, 
and it should be strongly advised against at what 
would be a menstrual period were the patient not 
pregnant. Intercourse in the middle three months 
of the pregnancy is of less risk than at other times. 
It should be forbidden absolutely the last two months, 
because of danger of infection. 
Intercourse 
Maternal Impressions 
Of the superstitions that surround pregnancy, 
none cause quite so much worry and discomfort 
as the stories that are told in regard to maternal 
impressions. In a word, the superstition is this: 
If the patient hears of or sees some very unpleasant 
sight, she will receive such a shock that her baby 
will be marked. Gossip-mongers who like to re- 
peat such stories, especially to the woman who is 
having her first baby, always have some such tale HYGIENE OF PREGNANCY 
21 
to relate when a baby exhibits some abnormality. 
From a physiological point of view and as a matter 
of fact, there is absolutely no possibility that any- 
thing of this type can in any way mark or cause 
a malformation in a baby. There is absolutely no 
physical connection between the mother's blood and 
the blood of the unborn child, nor is there any ner- 
vous connection between the mother and the baby. 
The pregnant woman must not be allowed to think 
that anything that she may do or say or think can 
in any way cause her baby to be marked or mal- 
formed. The causes of these malformations and the 
markings, which are really a very rare occurrence, 
are not known, but we do know that the beginning 
of such malformations takes place very early in the 
pregnancy, not infrequently before the patient her- 
self realizes that she is pregnant. 
Visits to the Physician 
Patients, on the whole, do not see their chosen 
physician as frequently as is advisable. It has al- 
ready been noted how seldom women present them- 
selves for supervision as soon as they think a 
pregnancy has begun. The importance of early 
supervision can .not be insisted upon too strongly. 
Satisfactory care of the pregnant patient will not be 
given until this is the rule and not the exception. 
During the first five or six months the patient must 
see her physician regularly once a month; for the 
next two months once in three weeks, and for the 
last two months once in two weeks. This is the 
minimum that can be regarded as satisfactory. In 
order to keep in still closer touch with the physician, 
specimens of the urine are sent to him between 
the visits. By this plan contact with the physician 
is kept every two weeks during the first part of the 
pregnancy, every ten days in the middle, and every 22 
THE EXPECTANT MOTHER 
week during the last two months. By this arrange- 
ment any changes from the normal are quickly dis- 
covered and proper steps may at once be taken 
to combat the complications. 
If the patient is registered at a clinic for the 
care of pregnant women, the same plan is carried 
out-the visits to the clinic are made at the times 
requested and the nurses make the visits to the 
patient's home between these clinic visits or the 
patient comes to the mothers' classes. At each visit 
the urine is examined, the patient's general health 
is investigated, and the various medical procedures 
are carried out. What these are varies in each 
physician's routine or at each clinic. A blood test, 
the so-called Wassermann, is the usual procedure in 
clinic work. It, however, is not done in private work 
as often as it should be. 
Whether the pelvis is measured the first time the 
patient presents herself to her physician depends 
upon his routine. Whether it is done at the first 
visit or at some subsequent visit is immaterial so 
long as it is done before the seventh month. In 
clinics patients are usually measured the first time 
they appear. Measurements show the physician the 
type of pelvis that the patient has. They will in but 
a few cases definitely tell the physician whether or 
not a normal delivery may be anticipated. It is for 
this reason that as pregnancy advances careful esti- 
mation of the size of the baby and its relation to 
the pelvis must be made from time to time. It is 
only by this careful oversight that emergency oper- 
ations can in a great measure be avoided. 
In any study of the disasters that come in preg- 
nancy and labor, it is found that the large majority 
occur in those patients who have had inadequate 
medical supervision. A careful physician knows 
before labor begins which cases are likely to prove HYGIENE OF PREGNANCY 
23 
abnormal, and he plans beforehand the best method 
of delivery. He is not forced to do hurried, ill- 
advised operative work on patients who have not 
been properly studied. It is, therefore, a dual re- 
sponsibility that is present. The patient must pre- 
sent herself to the physician early for adequate medi- 
cal supervision, and the physician must give to 
his patients conscientious care according to the best 
medical teaching of our time. When such coopera- 
tion is present, the untoward disasters that to-day 
are all too frequent will be greatly diminished. 
Pregnancy is a normal physiological function, but 
it is a condition which may, without proper super- 
vision, become very abnormal, calling for the ex- 
ercise of quick decision and skilled medical atten- 
tion. CHAPTER V 
DISCOMFORTS AND ILLS OF PREGNANCY 
THE FIRST of the discomforts to appear fol- 
lowing the beginning of pregnancy is the nau- 
sea and vomiting. Some patients have nausea the 
entire time of their pregnancy, with occasional 
vomiting. Other patients have no nausea to speak 
of at all. In another group the nausea appears only 
in the morning, especially on rising; and a small 
percentage of patients have the nausea in the late 
afternoon and early evening. At times there is 
nausea without vomiting, but more commonly the 
nausea, which may come in waves, is accompanied 
by vomiting. The majority of patients, having 
heard that nausea and vomiting are very common 
in pregnancy, make no effort to help it and all 
too seldom consult their physician. There is much 
that can be done if the patient will consult her 
physician early and keep herself in the best phys- 
ical condition. The patient who has a slight de- 
gree of nausea and vomiting can be helped much 
by eating some simple food before she gets out of 
bed, even before she raises her head from the pil- 
low, and then lying still in bed for half to three- 
quarters of an hour. She may then slowly dress 
and have her breakfast. A short rest after break- 
fast will help much, and then she can usually begin 
the day's routine. During the day she should never 
go longer than three hours without food, and care 
must be taken not to become over fatigued, for nau- 
Nausea and Vomiting 
24 DISCOMFORTS OF PREGNANCY 
25 
sea is brought on constantly by overfatigue and 
worry. If the nausea and vomiting persist and grow 
steadily worse, a physician must be seen and careful 
medical and nursing care instituted at once, so that 
the patient will not go from bad to worse and be- 
come a seriously sick woman. 
Salivation 
A few patients are very seriously bothered with 
a large increase in the amount of saliva that may 
be secreted during pregnancy. The amount secreted 
varies very much, but occasionally the patient pours 
out large amounts constantly. Unfortunately, drugs 
have but slight effect on this condition. If it is at 
all marked, the patient should consult her doctor 
in regard to it. Under no circumstances should she 
constantly swallow this saliva. 
Heartburn, Gas, Flatulence 
Heartburn in its milder forms is a very common 
accompaniment of pregnancy and is relieved by the 
simplest remedies, soda-mint tablets or bicarbonate 
of soda, a saltspoonful in a half glass of water 
sipped slowly, or a somewhat better way is to take 
a saltspoonful dry on the tongue and swallow it 
quickly with a drink of cold water. Heartburn may 
be caused by indiscretions in diet, and any article 
of diet that is known to upset the patient when she 
is not pregnant should not be eaten during her preg-- 
nancy. A few patients are relieved by taking a 
few ounces of cream a half to three-quarters of an 
hour 'before the heartburn usually appears. To 
many, however, this gives no relief. The alkaline 
waters, taken in large amounts, will help greatly 
for the time being, but in some cases the heartburn 
is a manifestation of poisoning that is going on as a 
result of the pregnancy and will not be cleared 26 
THE EXPECTANT MOTHER 
up or improved until this poisoning, the "toxemia 
of pregnancy," is overcome. In a few patients 
nothing seems to overcome the distress, and the dis- 
comfort is present until the end of pregnancy, but 
in most cases temporary relief can be obtained by 
taking large amounts of alkalies. The flatulence 
which often appears in pregnancy is helped ma- 
terially by regulation of the diet and the use of 
some intestinal antiseptic or tonic. In many cases, 
however, the end of pregnancy alone relieves the 
distress. 
Increase in Weight 
During the first weeks of pregnancy many pa- 
tients, because of nausea and vomiting accompanied 
by lack of food, lose weight, but after the third 
month they begin to gain. Unless an accurate rec- 
ord of the patient's weight is kept, she often will 
put on too much weight. The discomfort that arises 
from this rapid increase in weight is sometimes 
very great. The patient also runs a greater risk 
of developing a toxemia of pregnancy. The average 
woman gains in her pregnancy from ten to thirty 
pounds. The short stocky woman is very apt to 
gain more than the tall thin one. Occasionally a 
patient will gain fifty or even sixty pounds of 
weight, but when it is found that the weight is in- 
creasing as much as this she should be put on a 
careful non-fattening diet. When a patient in- 
creases in weight rapidly, shortness of breath is 
very apt to appear, due not only to the increase of 
her own weight, but to the increase of the pressure 
of the growing uterus in the abdomen. With this 
increase in weight she may complain of more or 
less constant pain in her legs and in her feet. Care- 
ful examination will reveal the fact that the arches DISCOMFORTS OF PREGNANCY 
27 
of her feet have given way because of this rapid in- 
crease of weight. 
Varicose Veins 
The enlarging uterus, as the weeks go by, presses 
more and more on the pelvic veins and in many in- 
stances varicose veins of the leg appear. At the 
beginning only little dilated blood-vessels are seen 
on the legs, but gradually as the pressure increases 
these veins stretch until frequently large varicose 
veins make their appearance. At first the patient 
simply complains of their appearance, then she may 
complain of slight burning or tingling sensations 
in the legs. If the symptoms are slight, no treat- 
ment is necessary. Much relief is obtained if the 
patient lies down for an hour morning and night. 
In more marked cases great relief can be obtained 
by having the patient raise her legs to right angles 
to the body, in order to help the blood flow out of 
the distended veins. A three-inch flannel bandage 
cut on the bias may be applied to the legs, starting 
from the toes, and will give great relief. Adhesive 
plaster, put three-quarters of the way around the 
leg, supporting the veins, will also give much re- 
lief ; but none of these simple aids should be used 
without the physician's consent and knowledge. In 
a very marked case of varicosity, an elastic stocking 
may be necessary. 
Hemorrhoids 
Hemorrhoids (piles) is the name given to varicose 
veins of the rectum. They are a very annoying 
and distressing complication of pregnancy. If they 
appear at all, if any discomfort is present in the 
rectum or in the anus, the patient's physician must 
be told of it at once and appropriate measures car- 
ried out. 28 
THE EXPECTANT MOTHER 
Cramps in the Legs 
Annoying cramps in the legs, appearing usually 
after the patient has gone to bed, may appear in any 
part of the pregnancy, but they usually come in the 
latter half. Much help can be given to this condition 
by a gentle massage of the legs before the patient 
goes to sleep each night. It is not always possible 
to stop them, but massage will do more good than any 
other one thing. 
As pregnancy advances, the three joints in the 
pelvis, the two behind and one in front, relax. 
Very commonly the relaxation of one or the other 
of the posterior joints gives pain, running down the 
leg on the side which relaxes. Much help can be 
given by a proper supporting girdle or corset, but 
when it is at all marked manipulation may be neces- 
sary to put the joint back into its proper relations. 
Relaxation of the Pelvic Joints 
The discomfort caused by a marked leucorrhea, 
which is the name given to the whitish discharge 
which comes from the vagina, is frequently very 
annoying and distressing. Under no circumstances 
should douches be taken to overcome this condition 
unless it is on the specific advice of a physician. 
If the leucorrhea is accompanied by an inflammation 
of the vagina or of the urethra, a careful examina- 
tion must be made to determine the cause. If it is 
caused by a gonorrheal infection it must be treated 
efficiently through the pregnancy, in order that it 
may not cause serious complications at the birth 
of the child. For the simple leucorrhea that prac- 
tically all women complain of, especially toward the 
end of pregnancy, no treatment, except cleanliness, 
Leucorrhea DISCOMFORTS OF PREGNANCY 
29 
should be begun unless it is on the specific orders 
of the physician. 
Pendulous or Relaxed Abdomen 
In some patients, after they have had one or more 
pregnancies, the abdomen hangs down in each suc- 
ceeding pregnancy and becomes what is called a 
pendulous abdomen. This condition is due to the 
fact that the abdominal muscles are greatly stretched 
during the pregnancy and do not regain the proper 
tone. This is one of the reasons that patients are 
kept in bed after the birth of the child, and that 
exercises are given them while they are in bed. 
If the condition is present, the patient will obtain 
much relief if she wears a well-fitting corset with 
support from below, or a well-fitting binder. If the 
condition is at all marked, the physician will specify 
the exact means of support which will give the 
patient the greatest relief. CHAPTER VI 
IT IS obvious that all of the complications of 
pregnancy can not be discussed here, and it is 
my wish to speak only of miscarriages, the toxemias 
of pregnancy, bleeding in pregnancy, and sepsis, 
commonly called blood-poisoning. 
COMPLICATIONS OF PREGNANCY 
Miscarriage 
In the ordinary use of the word among the laity, 
a miscarriage means the emptying of the uterus be- 
fore the time that it is possible for the baby to live. 
From a medical point of view, the division is made 
more clear. An abortion takes place when the 
ovum is expelled from the uterus in the first three 
months; a miscarriage, when it is expelled in the 
next three months; and a premature birth from the 
ssixth month on until maturity arrives. A still 
further distinction is made when a patient takes 
some artificial means to interrupt her pregnancy. 
This is called a criminal abortion. Any means 
whatsoever that is taken to interrupt pregnancy from 
the moment that impregnation takes place is a crim- 
inal procedure. Many people think that a pregnancy 
can be interrupted without criticism up to the period 
when the woman feels life. That is an idea that 
should be strongly combated, for the moment that 
conception takes place a new life is started and 
any interruption by any method is a criminal pro- 
cedure. In certain States, when from any cause 
a pregnancy threatens the patient's life, a "ther- 
apeutic abortion" may be performed after consulta- 
30 COMPLICATIONS OF PREGNANCY 
31 
tion has been held with one or more physicians. 
In many States, however, this procedure is not rec- 
ognized as a lawful one. It is done, however; but 
any therapeutic abortion is done openly, following 
a consultation, and is recognized as allowable. 
The occurrence of miscarriages is very common. 
How frequently early miscarriages take place is a 
great question, and there can be no accurate statistics 
on this subject. Many patients fail completely to 
recognize the fact that they have been pregnant, 
and the miscarriage takes place so early that it is 
not much more than an unusual period. It may, 
however, be the beginning of a long period of in- 
validism. Most miscarriages occur between the sec- 
ond and third months. The causes of miscarriages 
are many, and when one realizes the method of 
growth of the ovum and its attachment to the uterus, 
the wonder is that more do not occur. It is be- 
yond the province of this little pamphlet to go 
into the causes of these miscarriages. Any abnormal 
condition of the uterus, any abnormal condition of 
the ovum, may bring about a miscarriage. It is 
doubtful if sudden shock is a cause. The under- 
lying cause is present, and the shock to the patient 
may be the obvious but not the real cause. The 
role that drugs play in the causation of miscarriage 
is questionable, for if there were any one drug that 
would surely bring about a miscarriage it is quite 
certain that there would be few illegitimate chil- 
dren. Repeated miscarriages may come with any 
patient, and in order to obviate them it may be 
necessary for her to stay the greater part of the 
time in bed. This, however, should be done only 
on the advice and with the oversight of a physician. 
To avoid these early miscarriages the patient should 
see a physician as soon as she suspects that preg- 
nancy has begun, in order to have a careful talk 32 
on the hygiene of pregnancy and to receive the 
necessary medical care. 
The early symptoms of miscarriage are pain re- 
sembling, more or less, the pain that many women 
have with their menstrual period, and a slight 
amount of bloody show. A woman who supposes 
that she is pregnant who has a slight show of 
blood must always regard it as a serious sign until 
it is proved not to be. Many women think that 
a slight show of blood is a common thing in preg- 
nancy. As a matter of fact, any sign of blood from 
the vagina is an abnormal condition and it must 
be determined by the physician in charge of the 
case whether a serious interpretation shall be put 
on it. The principle on which the patient should 
act is that it is serious until proved to be other- 
wise, and she must let her physician know that 
she has had the show of blood as soon as it ap- 
pears, and not wait for days or even hours. 
THE EXPECTANT MOTHER 
Any woman who is pregnant may develop a 
toxemia of pregnancy. That is the name given to 
the poisoning that takes place as the result of 
pregnancy. The exact cause of this poisoning is 
unknown at the present time. It is characterized 
by certain signs and symptoms, chief of which are 
headache, lassitude, spots before the eyes, some- 
times pain in the pit of the stomach, diminished 
amount of urine which when analyzed contains 
varying amounts of albumin, and a rising blood- 
pressure. If this poisoning goes on without treat- 
ment, convulsions appear, and the condition is then 
called eclampsia. A toxemia may develop at any 
time; eclampsia develops only very rarely when there 
is efficient medical supervision. 
Toxemia of Pregnancy COMPLICATIONS OF PREGNANCY 
33 
Relatively few cases of eclampsia come out of 
a clear sky. Practically all are of some days, some- 
times of weeks, duration, and the eclampsia ap- 
pears as the result of the accumulated poisons. It 
is because a toxemia may appear at any time that 
physicians ask patients to send in specimens of 
urine regularly and ask to see the patients regularly. 
In the past years this insistence throughout the coun- 
try that patients be seen regularly has brought down 
the number of eclamptic cases very greatly. This 
is especially true in the large clinics. Many clinics 
can show thousands of cases in which perhaps 
only one or two cases of eclampsia have developed. 
Unfortunately this is not as true of cases looked 
after by private physicians. The reason for this 
condition is two-fold: first, patients do not seek 
medical care sufficiently early; and second, it is all 
too frequently the case that medical care consists 
only in the patient going to the doctor, telling him 
that she is pregnant, making an approximate date 
for the delivery, and then not seeing him again 
until she starts in labor. An analysis of many of 
the disasters that appear in pregnancy shows that 
the patient has often not been seen until she comes 
into labor, or at most perhaps a day or so before 
delivery takes place. That of course should be an 
impossible situation. No patient should go through 
her pregnancy without intelligent medical super- 
vision, and intelligent supervision can not be given 
unless the patient will cooperate with the doctor 
and unless the doctor insists that the patient come 
to see him, as has been discussed under "Hygiene of 
Pregnancy," chapter IV. 
There is no more terrifying condition in preg- 
nancy than an eclampsia, and it has been well dem- 
onstrated that eclampsia can be almost completely 34 
THE EXPECTANT MOTHER 
wiped out if the patient and the doctor cooperate. 
If either one fails to do what progressive physicians 
know is the proper procedure, disaster may overtake 
any pregnant woman. I do not write this in order to 
make the pregnant patient apprehensive, but it is 
well to let her know that this condition, toxemia 
of pregnancy, may arise at any time; that, if prop- 
erly supervised, in the majority of cases no serious 
outcome will appear. In a very few cases even 
under careful supervision the toxemia of pregnancy 
will go on and develop into eclampsia, but those cases 
are very few and far between. At the present day 
it is almost fair to say that if an eclampsia de- 
velops, some one has failed-either the patient her- 
self has neglected to go to her physician, or the 
physician has sadly failed in carrying out the funda- 
mental rules of the hygiene of pregnancy. 
In the earlier section we spoke of the bleeding 
that sometimes occurs in the early part of pregnancy, 
due to a miscarriage. As pregnancy goes on, if 
bleeding occurs, the patient must always regard it 
as a more serious sign. No matter how slight a 
bleeding appears, she should go to bed and at once 
notify her physician. He will determine whether 
the bleeding is serious, but under no circumstances 
should the patient continue up about the house with 
her daily routine while she has a slight show of 
blood from the vagina. She must not believe the 
story that bleeding in pregnancy is a normal con- 
dition that often occurs, for it does not ever occur 
in a normal case. In the latter three months of 
pregnancy the bleeding may be a very serious sign, 
and if it is not carefully and intelligently managed 
the patient may suffer very serious results. 
Bleeding in Pregnancy COMPLICATIONS OF PREGNANCY 
35 
In April, 1843, Dr. Oliver Wendell Holmes pub- 
lished an article on "The Contagiousness of Puer- 
peral Fever," in which his final paragraph is as 
follows: "Whatever indulgence may be granted 
to those who have heretofore been the ignorant 
causes of so much misery, the time has come when 
the existence of a private pestilence in the sphere of 
a single physician should be looked upon not as a 
misfortune but a crime; and in the knowledge of such 
occurrences, the duties of the practitioner to his 
profession should give way to his paramount obli- 
gations to society." That statement made eighty- 
odd years ago is as true to-day as it was then. Sep- 
sis must be regarded as a pestilence, and it must 
be eradicated. Any active practitioner of medicine 
may have an occasional case of sepsis (puerperal 
fever, childbed fever), but if he continues having 
such cases now and again, he should, as Professor 
Holmes has stated, think of his paramount obli- 
gations to society. He is a danger to the community 
in which he practises. Many thousands of phys- 
icians go through their professional careers with 
only a very rare case of sepsis occurring in their 
obstetrical work. If these thousands of physicians 
can do that, then all physicians can do it, but not 
unless they have developed a conscience, and not 
unless they do good, clean work on all occasions. 
Septicemia following childbirth, in the very large 
majority of cases, is brought to the patient by un- 
clean methods of delivery or of operative work. 
Until the laity takes the stand that puerperal sepsis 
must be eradicated, no marked improvement will 
take place. It is a blot on our country's death-rate 
that we lose so many mothers each year from 
puerperal sepsis. I know of no way of overcoming 
the terrible mortality from this complication ex- 
Sepsis, Puerperal Fever, Childbed Fever 36 
THE EXPECTANT MOTHER 
cept by reiterating again and again that deaths from 
sepsis are unnecessary in all but a small percentage 
of cases. In a few cases sepsis will appear no 
matter how careful the physician may be. 
The point that I want to make is that when a 
physician every little while has a case of sepsis in his 
practise, that man is a dangerous practitioner of 
medicine, and if we are going to improve our mor- 
tality records he must be eliminated from doing 
obstetrical work. CHAPTER VII 
PREPARATIONS FOR DELIVERY 
Home or Hospital 
THE PATIENT must decide, with the help of 
her physician, whether she will have her baby 
at home or at a hospital. More and more patients 
are being delivered in hospitals, and the reason for 
this is that the hospitals are much better equipped 
for obstetrical work than they were a few years 
ago. If a patient is to have her baby in a hospital, 
she must find out through her physician whether the 
hospital is well equipped for obstetrical work. 
There are too many so-called hospitals taking ob- 
stetrical work which are only hospitals in name. 
They are not equipped in any way to look after a 
delivery satisfactorily. Rather than have a patient 
go into such hospitals as these, it is far better to 
have her at home with the necessary supplies there. 
On the other hand, in a hospital, well equipped 
according to modern surgical standards, where there 
is no overcrowding and where good clean work is 
constantly carried on, the patient undoubtedly is 
safeguarded in every possible emergency. A physi- 
cian sending a patient to a hospital vouches for the 
technique that is employed at that hospital, and it 
behooves him to know that the technique is sat- 
isfactory and up to date. 
If, after careful prenatal examination and care, 
the patient is found to have some abnormality, she 
is unquestionably better off in a well-equipped ma- 
ternity hospital. If there is no such hospital in the 
community where she lives, and an abnormality is 
discovered, she should go to the nearest good hos- 
37 38 
THE EXPECTANT MOTHER 
pital and should not consider being delivered at 
home. In cases where prenatal care indicates that 
the pregnancy is advancing normally and there is no 
reason to anticipate any complications, there is no 
reason why she should not be looked after at home. 
The comparative cost of being cared for at home 
with a trained nurse or in a well-equipped maternity 
hospital is about the same. Of course, the cost is 
much less if the patient is looked after at home 
with a visiting nurse coming in for the daily nurs- 
ing and being present at the delivery. When the 
nursing is done by a semi-trained attendant, again 
the cost is lower at home than in a hospital. By 
far the majority of patients are delivered in their 
own homes, and emergency work alone is sent to 
the hospital. In the large cities, however, in these 
days of apartment life, there can be no adequate 
provision for a delivery at home. Under these 
circumstances a hospital is much the better place for 
the average patient. In rural communities where 
the distances are great and the physicians few, 
unquestionably patients must plan carefully for their 
deliveries, and in many instances will have to go 
to a city or large town to secure adequate care. 
If the patient makes up her mind, with the help 
of her doctor, that it is reasonably safe to be de- 
livered at home, there are certain preparations that 
must be made. A sunny quiet room should be 
chosen. Often there is no choice whatever of the 
room; one is available and that is taken. If pos- 
sible, it should be in close proximity to a bath- 
room; but many times a bathroom is a luxury and 
not a necessity, for many thousands of cases are 
satisfactorily delivered each year in homes where 
there is no bathroom. The room should be clean, 
and not recently used by infectious or contagious 
diseases. It need not be stripped of its furniture PREPARATIONS FOR DELIVERY 
39 
or hangings, but unnecessary furniture should be 
removed. A single bed, with the top of the mat- 
tress thirty to thirty-five inches from the floor, is 
ideal. It is not within the means of many fami- 
lies, however, to provide a single bed, and a low 
double bed must be used which is unsatisfactory 
from every point of view. Even the low beds can be 
made satisfactory by placing the four posts on blocks 
of wood of the height necessary to bring the bed 
to the desired distance from the floor. 
SuPPLIES FOR THE MOTHER 
The following is a list of supplies which is en- 
tirely adequate for a delivery in the home. Many 
thousands of women are delivered each year with- 
out such supplies, and the work in the out-patient 
clinics in the poor quarters of the cities is done 
with no such list. It is not essential that all these 
things be provided, but if the mother can afford to 
have them they will help materially in her com- 
fort and care. 
2 nail brushes (5c ones) 
2 glass drinking-tubes 
2 lb. absorbent cotton 
1 orange-wood stick 
2 enamel basins, 10 in. in 
diameter 
1 large basin, 12 to 18 in. 
in diameter 
2 pails with covers 
1 quart alcohol 
(medicated) 
4 oz. boric-acid crystals 
2 half-pound cans of ether 
1 tube lanoline 
8 oz. tincture green soap 
White vaseline 
Delivery pads 
Bedpan 
Cheese-cloth 
Fountain syringe 
(2 quarts) 
Hot-water bottle 
6 yards unbleached cotton 
to make binders 
Rubber sheeting to cover 
the bed 
Rubber sheeting, one yard 
square 
2 doz. safety pins, size o 
4 doz. safety pins, size 4 
Old blanket, clean and soft 
Plenty of old linen and 
cotton 
Newspapers 
1 pair white stockings 40 
THE EXPECTANT MOTHER 
The essential items in this list are: absorbent cot- 
ton, basins, bedpan, rubber sheeting, and bed-pads to 
cover the bed. The delivery pads can be made 
from eight to ten thicknesses of newspaper with 
muslin or cheese-cloth tacked over the newspapers. 
As one is soiled it is replaced by a new one. Three 
or four are sufficient. The pads that are used after 
the delivery are made from absorbent cotton covered 
with cheese-cloth and either done up in packages of 
three or four or put into a pillow case, and then 
baked. This, of course, does not give absolutely 
sterile pads for use after the delivery. In many 
parts of the country the Visiting Nurse Associations 
have the pads sterilized at their central offices 
and sell them to the prospective mothers for a 
nominal sum. If the patients are unable to ob- 
tain these sterilized pads, the nurses will show them 
how to make the pads and do them up, so that 
they can be relatively sterile. 
If this list is not essential, why do we ask for 
it? It is perfectly true that many deliveries can be 
successfully accomplished without any such list, but 
the articles in this list do add much to the comfort 
of the patient. There are two things to be con- 
sidered in every delivery; first, the safety of the 
patient, and second, her comfort. The safety of 
the patient depends upon the careful supervision of 
the patient throughout her pregnancy, as outlined 
in the "Hygiene of Pregnancy," and upon the de- 
livery being accomplished in an aseptic, clean man- 
ner so that the patient does not become infected. 
It has been shown by many series of statistics that 
thousands of women die each year, as a result of 
childbirth, from sepsis, which is the medical term 
for blood-poisoning. It has further been shown that 
practically all of these cases die from infection car- 
ried from outside to the patient, either by unclean PREPARATIONS FOR DELIVERY 
41 
surroundings, or by unclean, careless vaginal ex- 
aminations and unclean operating. If we can safe- 
guard these thousands of women by insisting that 
they have adequate care at the time of delivery, we 
can do much to lower our maternal death-rate. 
To overcome the lack of sterile supplies, there 
has been developed a system for the putting up of 
sterile packages containing the necessary pads, bed- 
pads, sheets, and towels. The expense of these out- 
fits is considerable. If it is known that they are 
sterilized by a reputable concern and put up in a 
proper manner, they are most satisfactory. Too 
much reliance must not be put on the absolute ster- 
ility of these supplies when they are obtained from 
department stores. How long they have been in 
stock, no one knows. If such outfits are to be 
bought, they should be obtained from well-known 
and reliable surgical-supply houses and not from 
department stores. CHAPTER VIII 
LABOR 
WHY PATIENTS start up in labor has long 
been a debated question. No one has yet dis- 
covered the fundamental cause. Many reasons have 
been assigned for it. Exactly whether it is due to the 
distension of the uterus, to some changes in the 
placenta, or what may be the cause, no one really 
knows. We simply know at the present time that, 
as a rule, labor begins after the pregnancy has 
existed over the usual time of ten lunar periods, 
or 280 days. The majority of patients start up labor 
in relation to their tenth period. Some, as has al- 
ready been stated in "Duration of Pregnancy," may 
go overtime. 
Cause of Labor 
Preparation of the Patient 
As soon as it is determined that the patient is in 
labor, there are certain things which must be done. 
First the pubic and the vulval hair should be shaved. 
It is much safer to shave the pubic hairs than to clip 
them, for if they are shaved there is no danger of 
the short clipped hairs being carried into the vagina 
during labor. If patients realize that this shaving 
is done for their own comfort and safety they will 
never object. It should be a routine procedure to 
shave all patients before the delivery. The patient 
then takes a sponge bath, or is given one if the 
nurse is present. Under no circumstances should 
she take a tub bath. This is especially to be in- 
42 LABOR 
43 
sisted upon if the patient is having her second baby, 
because of the relaxation of the vagina that is so 
commonly present. There is no objection, however, 
to her getting into the tub and kneeling down, but 
she should not sit in the tub. The hair is then 
braided in two braids to obviate matting and tangling 
while the patient is in active labor. The food that 
should be taken during labor is a debatable point. 
Many physicians give a relatively small amount of 
food, because they feel that when a patient is in 
active labor food digests poorly and many times is 
vomited, to the great discomfort of the patient. On 
the other hand, if the patient is having a slow, long- 
drawn-out labor, she must have a sufficient amount 
of food to satisfy her. If she is in active labor, 
however, the probability is that she will need but 
little food until after the labor is over. 
Labor is divided into three parts. The first part 
is occupied in the dilatation of the mouth of the 
uterus. The second is the expulsive stage, in which 
the baby is expelled from the mother, and the third 
is the expulsion of the placenta, or afterbirth. The 
beginning of labor is most variable. Its onset is 
shown by the occurrence of intermittent pains at 
varying times. These pains are caused by the 
uterine contractions. Uterine contractions may be 
noted throughout the patient's pregnancy, but they 
are not painful until the patient starts in labor. It 
is these painful contractions, the so-called labor 
pains, that are characteristic of labor. The first 
pains sometimes are felt in the lower abdomen and 
sometimes in the lower back. They may first simu- 
late a stomachache or a backache. How any one 
woman will start in labor is not known, and if she 
has started in labor once in one way she will not 
Course of Labor 44 
THE EXPECTANT MOTHER 
necessarily start in the same way in succeeding 
labors. Coincident with the pains, if the patient puts 
her hand on the abdomen she will feel the uterine 
muscle contract and become very hard while the 
pain is present. The pains may begin at first only 
once an hour or once in twenty minutes, or they 
may start at once, coming either ten or five minutes 
apart. At the beginning, or shortly after the pains 
have begun, the patient may notice a slight increase 
in leucorrhea coming from the vagina, oftentimes 
tinged with blood, and as labor goes on and becomes 
definitely established this leucorrheal discharge 
changes to a thick, mucous, tenacious discharge, 
more or less tinged with blood. This appearance 
of blood is the so-called "show" that many patients 
have, and it is much more apt to be present in a 
woman having her first baby than in a woman hav- 
ing repeated pregnancies. It is due to the stretching 
of the mouth of the uterus, which causes the small 
blood-vessels to break. Some nurses and doctors are 
in the habit of following the progress of a patient by 
the amount of show that she has. This is an entirely 
unreliable sign, for many patients, especially after 
they have had the first child, will complete the 
first part of labor without any show whatsoever. 
The principal characteristic of normal true labor is 
that the pains recur at decreasing intervals and be- 
come steadily harder and more severe. The first 
stage of labor is much more difficult for many 
patients to bear than the second stage, for it is in 
this first part of labor that patients feel they are 
not accomplishing anything, and lose courage and 
want help. A first-class nurse is of much assistance 
at this time, for with the help of the doctor she will 
carry many patients through a trying first stage. 
Gradually, as the pains come with increasing fre- 
quency, the mouth of the uterus becomes what is called "fully dilated." That is, the uterus is ready 
to expel the baby. It is in this stage that the bag 
of waters which surrounds the baby is supposed to 
break. If this bag of waters, the amniotic sac, does 
not break when the mouth of the uterus is fully 
opened, the physician breaks it in order to let the 
expulsion of the baby take place. If the amniotic 
sac breaks before labor pains begin, the patient will 
have what is designated as a "dry labor." To the 
laity a "dry labor" means a long, hard, difficult 
labor. That is sometimes true, but it often happens 
that labor will start promptly, and will go through 
to a perfectly successful conclusion even if the labor 
is dry. It is hardly fair to say, because the patient 
ruptures her membranes early before labor begins, 
that she is sure to have a difficult time, for such is 
not necessarily the case. Sometimes, however, a 
dry labor is long and hard, and the risk to the baby 
is increased because the pressure of the contracting 
uterus is greater on the baby when the uterus has 
become emptied of fluid. 
As the first stage is completed, which is deter- 
mined by the doctor, the second or expulsive stage 
begins. It is then that the patient begins to have 
a desire to bear down and to hold her breath in 
order to push the baby out. The patient should not 
bear down and try to expel the baby until she is told 
by her doctor that it is time for her to do so. Bear- 
ing down before the mouth of the uterus . is open 
tires her out, may cause unnecessary tearing, and 
will lead more frequently to operative interference 
than any other one procedure. If the doctor does 
not arrive, a good rule for the patient to follow is 
not to bear down until the pains are such that she 
can not hold back any longer. Gradually the baby 
is pushed down until the head is seen, then the head 
is born, followed by the shoulders and the body. 
LABOR 
45 46 
THE EXPECTANT MOTHER 
After the delivery of the child the third stage 
begins. This stage is the delivery of the placenta. 
Between the birth of the baby and the delivery of 
the placenta, many doctors look at the birth canal to 
see whether any tears have taken place. If it is 
not done then, it is done immediately after the 
placenta is delivered. Every patient who is torn 
at all should be sewed up at once. Except for the 
very simple breaks in the mucous membrane, all 
tears should be repaired. There is absolutely no 
reason for criticism of the doctor if a tear occurs, 
for in many cases it can not be helped. In by far 
the majority of cases there is some slight tear of 
the patient at the delivery. When the patient con- 
siders the reason for the tear, she surely can not 
blame the physician for it. The birth canal is 
stretched from a small passage up to a canal that 
will admit the passage of the baby's head. The 
wonder is that more severe tears do not occur. The 
criticism should come when the physician does not 
repair the tears. A tear may occur in the practise 
of any physician, but there are all too few stitches 
put in after the tears have been produced. The more 
careful the physician, the more carefully does he 
investigate the birth canal to see whether a tear 
has occurred, the more certain is he to put in the 
necessary stitches to bring the broken tissue into 
good approximation. I know of one case of a 
physician who said that he could not afford to put 
in any stitches in the town where he practised, be- 
cause none of the other doctors ever sewed up a 
tear, and if he were known to do so he would not 
get any work. Such a situation should not be al- 
lowed to exist. The man who puts irf stitches must 
be regarded as a careful man, and one who is trying 
to safeguard the patient's future well-being. LABOR 
47 
Most patients are given no anesthetic during their 
labor. Probably the reason for this is the fact of 
the added cost, and because in the majority of cases 
there is nobody present to give the anesthetic. Ether 
is the safest anesthetic for use, but chloroform in 
labor has been given for years without fatalities, 
and when carefully administered can be used with 
quick effect and apparently without danger. In re- 
cent years the combination of nitrous oxid and 
oxygen has been used with great success. This, 
however, necessitates a special machine for its ad- 
ministration, it is expensive, and it will probably 
never come into general use. To be given satisfac- 
torily and well it needs an assistant or a well-trained 
nurse to administer it. The so-called "twilight 
sleep," which is the use of some derivative of 
morphia and the drug scopolamin, caused a great 
furor a few years ago, but is not being used to any 
great extent at the present time. It must be used 
only by physicians well qualified to give it and to 
follow its action carefully. Carelessly given, it may 
cause serious trouble. Carefully given in certain 
selected cases, it does work beautifully. It takes 
about three hours for the drug to work satisfac- 
torily; hence, in rapid labors it is impossible to 
administer it successfully. At the present time many 
doctors are administering it in a modified form, not 
attempting to cause complete forgetfulness, but with 
the object of easing the labor. Labor should be made 
in all cases as easy as possible, and never in a normal 
case is there a contra-indication for the use of an 
anesthetic. 
Anesthetics in Labor CHAPTER IX 
THE BABY 
THE CARE of the baby is ably covered in 
another book1 of this series and therefore it is 
unnecessary to go into the various details that are 
essential for the baby's well-being. There are, how- 
ever, a few points that should be taken up here. 
The greatest number of deaths among babies occur 
in the first week of life, and during this first week 
the majority die in the first twenty-four hours, 
showing how frail a hold on life a new-born baby 
has. Many babies are seriously chilled at birth, and 
to avoid this the room where the baby is born should 
be warm and without drafts. For a full-term baby 
a temperature of 75 degrees Fahrenheit is satisfac- 
tory; but if the baby comes before the full time, the 
room in which the delivery takes place should be up 
to 80 degrees so that there can be no chilling. As 
soon as the birth has occurred the baby must be 
covered up at once and the body-heat carefully pre- 
served. Heaters, carefully placed, unless the baby 
is born in hot summer weather, should be around 
the baby. 
The umbilical cord, which is tied and cut by the 
physician in charge of the delivery, must be care- 
fully covered with a sterile dressing so that no in- 
fection (poisoning) will take place at this point. 
Bleeding occasionally occurs from this cord after it 
is tied, and, therefore, the cord must be inspected 
every few minutes to see that no bleeding is taking 
1 See "The Baby's Health," by R. A. Bolt, M.D., in the 
National Health Series. 
48 THE BABY 
49 
place. The cord gradually dries up, and from the 
third to the tenth day drops off, leaving a well- 
healed umbilicus (navel). If the cord becomes 
moist or does not promptly separate, the physician 
does what is necessary to make it right. 
The baby's first bath is given usually after the 
mother is made comfortable. There never is any 
hurry about this first bath, and unless the room in 
which it is to be given can be made warm, it is 
much better that the bath be postponed until the 
room is sufficiently warm. Here again serious chill- 
ing of the baby often takes place and must be 
guarded against. If the baby has been subjected to 
a hard operative delivery it is better to delay the 
bath until the baby's condition is entirely satisfac- 
tory. 
The physician should invariably put into each eye 
of a baby soon after birth a drop of a silver-salt 
solution to prevent the swelling and discharge that 
babies sometimes have following birth. In many 
cases this discharge is caused by a gonorrheal infec- 
tion, but it should never be regarded as such unless 
the patient is known to have had this disease or a 
proper examination of the discharge discloses its 
character. The birth canal in every woman has 
many bacteria in it, and this simple precaution safe- 
guards the baby's eyesight. In many States the law 
requires that every baby shall have this treatment 
carried out by the physician. In some States when 
a birth occurs in a hospital this treatment is com- 
pulsory. Since this routine has been carried out 
the number of babies with sore eyes (called ophthal- 
mia neonatorum) has been greatly reduced. To 
safeguard the baby's eyesight still further, the 
mother or person in attendance must report to the 
physician at once if the baby shows any redness or 
swelling or stickiness of the lids at any time. If 50 
THE EXPECTANT MOTHER 
such a condition occurs, efficient medical treatment 
must be begun at once or the baby may lose its 
eyesight. Delay of a few hours may mean total 
blindness. 
Occasionally the breasts of a new-born baby swell 
and become hard and red. Usually if they are left 
absolutely alone they soon soften and become normal. 
In rare cases an abscess forms and must be opened 
and drained. It must be insisted upon that if the 
breasts do become red and hard they are not to be 
rubbed by the mother or the untrained attendant. 
The management of nursing and other points in 
the baby's early life are taken up fully and com- 
pletely in another volume. CHAPTER X 
CONVALESCENCE 
Rest and Visitors 
REST and quiet are the first two requisites for 
. a woman who has just been delivered of a baby. 
No matter how short the labor has been or how well 
she may feel, under no circumstances should she be 
deprived of rest and quiet. Labor at best is work, 
and many times hard work. When it is successfully 
accomplished the patient deserves a good period of 
undisturbed freedom from the cares and worries of 
her household. The rest and sleep immediately after 
the labor is over is most essential and does much 
to start the patient on a good convalescence. In the 
morning there is not always time for a nap, but in 
the afternoon after lunch one must always be taken. 
At least eight hours sleep is necessary, but this can 
not always be obtained consecutively on account of 
the baby's nursing. 
Friends and relatives, more curious always to see 
the baby than to see the mother, may be received 
when, in the physician's judgment, the patient will 
gain by a short sprightly visit. The majority of 
women are not in any way to be regarded as sick 
patients. Callers of the right and sensible kind are 
always cheering, but when those of the reverse type 
wish to see the patient it is always best to become 
very strict and keep them away. Callers of the 
latter type are much too apt to stir up and annoy a 
woman who has just been delivered. We do not 
consider it at all necessary, however, to keep friends 
away for any great time. On the other hand, should 
51 52 
THE EXPECTANT MOTHER 
the patient be sick, a different problem arises and 
the physician must settle whether visitors are to be 
permitted. 
Diet 
Years ago, and even now by some physicians, 
women just delivered are kept on liquids and semi- 
solid foods for the first three days. We believe that 
this is entirely unnecessary, and advise letting the 
patient have a good nourishing diet of marked varia- 
tion. They may have practically anything they wish, 
provided they know that what they eat will not cause 
indigestion. Naturally they should not choose any- 
thing which if they were up and about would com- 
monly upset them. They should not overeat, but 
they must have a well-balanced diet. Do not begin 
to eliminate one article of diet after another because 
the baby has an attack of colic. Wait until the baby 
is normal again and then again eat the suspected 
article. If the baby is again distressed it is reason- 
able to eliminate this one article from the diet. The 
practise of forcing patients to drink one or more 
cups of various rich drinks between meals in order 
to increase the milk is of doubtful value, for before 
many days the majority of patients will have an 
upset stomach and the desired result is not secured. 
On the other hand, if patients feel the need of some 
light food or drink between meals, there is every 
reason for their having it. 
Most patients are more comfortable if they have 
a daily movement of the bowels. Some physicians 
order a mild laxative to be taken each night, while 
others order an enema or a suppository. Diet alone 
in the first days of the convalescence will not usually 
produce a movement. 
Bowels CONVALESCENCE 
Urine 
53 
Because of the stretching of the birth canal and 
the pressure on the urethra, women just delivered 
frequently find it difficult to pass their urine. This 
is with some patients complicated by the fact that 
they never before have had to make use of the 
bedpan. A further reason is that the bladder fills 
up very readily because of the relaxed abdominal 
walls, and patients do not realize what is taking 
place. For this reason it is essential to know that 
the bladder is always emptied at each voiding. 
Involution of the Uterus 
After the birth of the baby and afterbirth, the 
uterus is felt as a hard round mass almost up to the 
umbilicus (navel). In order to come down to its 
normal size after the birth, certain changes take 
place and these changes are expressed by what phys- 
icians call the involution of the uterus. After the 
birth the uterus weighs about two pounds, and as a 
result of this involution, carried out properly and 
completely, it comes to weigh roughly about two 
ounces. It is a marvelous phenomenon, and to ac- 
complish it time and rest are necessary. From day 
to day the physician or nurse carefully notes the 
progress of the uterus decreasing in size, until by 
the end of a week it is scarcely felt in the abdomen, 
having grown so small that it goes down into the 
pelvis. The physical sign of this process is shown 
by the discharge which is always present after a 
delivery. This discharge-called the lochia-is at 
first bright red and profuse, but gradually lessens in 
amount and becomes less colored. Gradually it be- 
comes whitish, and in the course of two to three 
weeks the patient finds that she has no more vaginal 
discharge than was present before she was pregnant. 54 
THE EXPECTANT MOTHER 
Nursing 
Nursing is begun after the patient has her first 
good rest, usually within the first twelve hours. The 
first attempts of the baby to nurse may be futile, 
but most babies take hold of the nipples without any 
delay. Babies go to the breast perhaps twice in the 
first twenty-four hours, four times the second. 
Whether they are put on a regular three-hour 
schedule depends upon how much milk is present 
on the third day. Normal new-born babies should 
not nurse oftener than every three hours from six 
a. m. to ten p. m. Many babies do better on four- 
hour intervals. Some babies do remarkably well 
without the early two a. m. feeding, and others 
apparently need this extra feeding. If the two 
a. m. feeding is started, it must be stopped as soon 
as it is possible to do so, for unbroken sleep means 
much to the well-being of the mother. Practically 
all women can nurse, at least for a few weeks, if 
they wish. The woman who refuses to try to nurse 
her baby is not worthy to have one. Fortunately at 
the present day this situation rarely "occurs. 
I shall not go into the technique of nursing. 
Suffice it to say that the nipples must be kept clean 
and protected. Individual doctors vary much in 
their methods. If, however, the nipples become sore, 
cracked, or bleeding, the physician must be notified 
at once, not after a few hours. Much can be done 
the moment a crack appears, but after it has become 
marked it is increasingly difficult to heal. 
If, while the patient is nursing, she feels any ten- 
der spot in the breast or a lump develops, the physi- 
cian must be consulted at once, for if tender spots 
and lumps are not properly and immediately treated, 
breast abscesses may develop. CONVALESCENCE 
Exercises 
55 
In the first week after the baby is born many 
physicians ask their patients to begin simple foot- 
and-leg exercises. Gradually they are increased in 
duration and more strenuous ones are added. If 
exercises are done carefully and intelligently, the 
majority of patients get up out of bed and expe- 
rience no sensations of pins and needles in the feet 
and legs. The exercises strengthen the abdominal 
muscles, and the patient recovers her normal figure 
much more quickly than when she does not make 
use of them. 
The abdominal binder is put on the patient imme- 
diately after delivery in probably the majority of 
cases. It gives the patient a sense of support and 
makes her much more comfortable. The binder 
may, however, be taken off as soon as her exercises 
are begun. Patients desire the abdominal binder, 
for by it they think that they will regain their figure 
rapidly. This, however, is not the case, and many 
physicians forbid the binder entirely, fearing it will 
cause displacement of the uterus. The putting on 
of corsets after delivery is usually a question of 
great moment. Women desire them for the same 
reason they wish the binder, and because they are 
accustomed to them. Exercises will do much more 
good than the corsets, but few women will give up 
the time necessary to have exercises help their 
muscles. They prefer to take the short-cut for sup- 
port and use the corset. The physician will tell the 
patient when the corset may be put on. It must 
be remembered that the support must be from below 
upwards. 
Getting Up 
A patient should stay in bed at least ten days 
following childbirth. The birth canal does not ap- 56 
THE EXPECTANT MOTHER 
proach normal in less time than this, and for the 
welfare of the patient fourteen days should be in- 
sisted upon. For obvious economic reasons the 
majority of women are up and about doing their 
work in two weeks. The result is that in later years 
they have to undergo serious reparative work or lead 
lives of semi-invalidism. Rest in bed until the uterus 
becomes small and of normal size is a woman's right 
following childbirth, but one that the majority 
scarcely ever exercise. 
Return of Menstruation 
The majority of women who nurse their children 
do not menstruate while nursing. There are, how- 
ever, many exceptions. In fact, the exceptions are 
so common that it is my custom to tell patients that 
they may menstruate at any time. The first men- 
struation is apt to be profuse, and the patient should 
rest as much as possible during it. Women must 
remember that whether menstruation is established 
or not, pregnancy may follow if intercourse takes 
place. The old theory that as long as a woman is 
nursing her baby and is not menstruating she can not 
again become pregnant has been many times dis- 
proved. 
Every patient should, six weeks after the birth of 
her baby, have a final examination in order to be 
certain that the pelvic organs are in normal condi- 
tion. If the uterus is found to be displaced, treat- 
ment can be carried out at this time which, if 
neglected, may cause much unnecessary discomfort. 
Final Examination CHAPTER XI 
CONCLUSION 
THE FOREGOING outline of the care of the 
pregnant woman is in its essentials one that has 
worked most satisfactorily for a number of years 
in my own practise. The fundamental point to be 
insisted upon is cooperation between the physician 
and the patient. The former, to do good obstetric 
work, must have within him a true sense of responsi- 
bility to the community in which he practises and a 
well-developed conscience. The majority of physi- 
cians to-day are well trained and know how to 
manage obstetric cases successfully. The latter must 
be taught that without careful supervision disasters 
will inevitably arise. Physicians are many times 
blamed for these untoward results when in reality 
the blame lies with the patient. She either has gone 
through her pregnancy without supervision or she 
has failed to report her symptoms as requested. 
Pregnancy is a normal physiological function, but 
there is no condition in medicine which may cause 
such disaster so quickly as a badly managed preg- 
nancy. Disasters, on the whole, are really of rare 
occurrence, and if the routine as here outlined were 
carried out in all cases they would be still further 
reduced. Lack of intelligent oversight by the phys- 
ician is the cause of most of the bad results. If 
the physician is at fault, he is to be condemned; if 
the patient is to blame, then the other women in 
her community must be taught wherein she erred 
so that they may do differently. Successful results 
follow cooperation between physician and patient. 
57 BEFORE AND AFTER BABY COMES 
Dr. Louis Fischer, one of the most eminent child 
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By LOUIS FISCHER, M.D. 
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