PRECAUTIONS AND SUGGESTIONS TO PREGNANT WOMEN.

There is a hygiene of pregnancy which the enceinte female should observe, for by so doing, she will not only make the period of her gestation less onerous to herself, but she will be able to materially contribute toward the accomplishment of a natural childbirth. Although pregnancy is a physiological process, the conditions in the female economy, under which this is carried on, are at variance with those which are to be found in the unimpregnated state, and as a consequence it rationally follows that the pregnant female should endeavor to conform to the demands which the altered relations require.

If the pregnant woman is properly clothed to begin with, she will greatly mitigate some of the symptoms which very often mar her well-being. The clothing should neither be too heavy in summer, nor too light in winter, she must dress so as to conform to the season and feel comfortable; but by all means the chest and abdomen should be kept free from pressure, the skirts must be supported from the shoulders, and the corset also, should be dispensed with, and a waist worn instead, one that partly answers the purpose of a corset, and to which the skirts can be fastened or buttoned at the same time. I have no respect nor patience for those women who desire to conceal by tight lacing, the appearance of their pregnancy. Motherhood, whether active or prospective, is a divine function, and as creatures are the instruments of the Creator, there is nothing to be ashamed of by those who have complied with the usages of civilized peoples, and wherever an exhibition of pregnancy becomes indelicate, a person who hopes or expects to be a mother should not be. If a woman has the true characteristics to make a good mother, she cannot, nor will she trifle with her own health or that of her child; in truth, mothers cannot begin too soon to consider the welfare of their offspring.

To guard against taking cold is one of the maxims, that the pregnant woman should heed, especially during the last half of gestation when the prominence of the abdomen shortens the skirts in front and removes them off from the limbs. Flannel drawers properly adapted to the limbs and worn underneath the muslin ones affords the best protection that can be adopted, and it replaces cumbersome skirts. Sudden extreme variations of temperature should also be avoided, like going from an overheated apartment into the cold outside air, or into another cold chilly room. In making these changes, one should gradually cool off, and then by putting on additional clothing, wraps or shawls, the danger of taking cold may be removed. Hot coffee or tea or hot alcoholic beverages are equally as dangerous as overheated apartments, for anything which stimulates the circulation of the blood in an inordinate degree is liable to produce a congestion of the placenta, and thus incite an abortion; hence fevers of all kinds are known to have brought about an expulsion of the fetus. On the whole, either very hot or very cold temperatures are to be avoided, for instance, prolonged staying in cold weather or lengthened exposure to the rays of the sun should be prudently guarded against by the pregnant female. Of course this is not to be construed as meaning, that she should not partake of exercise in the open fresh air—far from it, but the exercise shall not be forced or driven, it shall at all times be voluntary and passive, so that when a tired feeling comes on, she can rest and refresh herself. The best time for these little walks is in the morning and evening in the summer season and in the middle of the day in cold weather. A rough, uneven walk should be avoided because she may stumble; jolting in either street cars or wagon is equally pernicious. A great deal of stair climbing is injurious, and when it becomes necessary it must be done slowly; running the sewing machine has caused many miscarriages. Avoid running, jumping, riding on horseback, and lifting heavy weights, hanging laundried clothes on lines, in fact everything that can strain the muscles, bear down, increase the intra-abdominal pressure and excite the nervous system.

The prospective mother must resign her amusements at evening entertainments in crowded halls or theaters, in which the air becomes foul and overheated from large congregations of persons. Here she is also threatened to be jostled and jammed, and perhaps injured in other ways. Her sleeping apartments should be thoroughly ventilated through the day, and coition, if not entirely suspended, at least restrained and only passively exercised, for any excess of this nature is not only injurious to the child, but may cause a miscarriage. It is not expected that the pregnant woman should sit in the arm chair during the period of gestation, far from it, but it is even greatly desired that she continue her usual vocation. Exercise of a passive nature is always wholesome, and for this reason it will be conducive to good health if enough work is done over every day to keep the system in gentle activity; the domestic duties of a household will or should always furnish that. All good women take a pride in their household affairs, if they do not they are not good; and those who boast that they never put their hands to anything in the house, have mistaken their vocation as women, and are either indolent or worthless, and often both. No one should boast of idleness, rather be ashamed of it. Employment makes character; it gives buoyancy to the spirit and tranquillity of mind. The influence that an equable temperament exercises over the nervous development of the unborn child may eventually be demonstrated by its resistance to the shock of diseases which superinduce convulsions and death. It is not advisable to sleep during the day, it is better to retire early after a light supper, so as to rest a few hours before midnight. This makes one fresh and spry in the morning, being on hand early in the morning, it gives ample time to dispose of domestic duties, and thus avoid confusion and rushing during the day.

Cleanliness is one of the cardinal virtues of the pregnant woman—as pregnancy will be followed with childbirth, and as cleanliness is but another name for antiseptic, and that will guard against childbed fever, the importance of cleanliness springs at once into unusual prominence. No person can be filthy and slovenly during the entire period of gestation, and then at the moment of confinement become clean, even if in the last moment the person becomes bathed and brushed, everything else around and about her is soiled and dirty, unless she be taken to a lying-in home. Cleanliness must be cultivated, and finally it becomes second nature. The daily ablution of the external genitals should not be neglected, and general bathing in water not altogether too warm, say 90 to 94 degrees F., twice a week will prove beneficial in many ways. The linen that is worn, and that which is in the bed should be kept sweet and clean, and cleaner than ever on the day of confinement.

The mammÆ of the pregnant woman are sometimes very painful; as pregnancy advances they enlarge, the lacteal glands become congested and swollen. To relieve this I recommend the application of a liniment of equal parts camphorated oil, laudanum, and tincture of belladonna gently applied several times a day. The breasts should always be extra well covered with flannel so as not to take cold in them, otherwise an abscess may form in them long before the child is born. If the nipples are sensitive it is advisable to begin to harden them during the last few months of gestation. Tannate of glycerine is perhaps the best thing to apply for this purpose; it is best done by means of a small camel’s hair brush. If the nipples are sunken into the breast, and too short for subsequent use for the baby, it is well to draw them out by means of a breast pump, the bowl of a new clay pipe, or by employing a bottle from which the air has been replaced by filling it with hot water and then pouring it out; the mouth of the hot bottle is applied over the depressed nipple, and as it cools off, the vacuum thus formed draws the nipple out.

Nausea and vomiting in pregnancy is often so annoying and weakening that the strength of the patient becomes seriously threatened, and hence some measures must be employed to counteract it. A great variety of agents have been suggested for this purpose. Tincture of nux vomica in two or three drop doses every three or four hours is a useful remedy; the oxalate of cerium is another valuable agent for this purpose, in five to ten grain doses three times a day, but a more valuable remedy than any other that I know, is the Femina vaginal capsule, to be used every night at bedtime, and in severe cases, also in the morning.

Salivation is not constantly an attendant upon pregnancy, but when it does occur it is weakening and debilitating. There are many remedies for this disorder, but one of the most effectual ones is an occasional dose of Epsom salts, say a teaspoonful in a half tumbler of water every other morning, so as to produce free discharges from the bowels; when salts are found objectionable, the Femina laxative syrup taken in doses that have a similar effect will be a most excellent substitute.

Constipation is one of the most common derangements of the pregnant woman; it is the rule in which the exceptions are few and far between. I do not include those cases of costiveness which are habitual, and which are to be attributed to carelessness in not responding to nature’s call when there is an inclination, but to those in which constipation is contemporaneous with pregnancy. We have already seen the sympathy between the stomach and other organs in pregnancy, and that a similar derangement should exist between the uterus and rectum is not at all unreasonable, and, indeed, it can be explained in that way. In the early months of pregnancy, the torpor of the bowels may be due to the general derangement which follows digestive disturbances; in the latter months, the enlarged uterus presses against the large intestines, so as to obstruct more or less the descent of the feces into the rectum. This torpor of the bowels should not be allowed to be unrelieved, for if permitted to continue it may not only induce a miscarriage, but it is apt to cause fever, headache and loss of appetite. Harsh cathartics must not be employed; and if a simple enema of warm water early every morning does not give the desired relief, I would recommend a daily dose of Femina laxative syrup. If it is found that in attempting to administer an enema, the fluid is immediately returned, then it will probably be owing to lumps of fecal matter which clog up the rectum; this will likely give rise to more or less straining or bearing down in the back passage, and to pains in the pelvis and lower limbs, all of which is not without danger of exciting premature labor pains; the fecal lumps must be removed even if it becomes necessary to use the finger.

Diarrhea is the opposite condition of things, namely a looseness of the bowels. This may be occasioned by improper food, cold or any other cause capable of producing diarrhea when pregnancy does not exist. Habitual costiveness is often followed by diarrhea from the irritation which the hardened feces excite. A dose of castor oil is sometimes an efficient remedy for this variety of diarrhea, but when the disease becomes obstinate and painful, the following remedy can always be depended upon for relief:—

Mix and take a tablespoonful every four hours until relieved.

Bladder trouble is not infrequent in the early and last stages of pregnancy; the causes of this were pointed out when the symptoms of pregnancy were inquired into. Recipe No. V is sometimes very useful to relieve this irritability, or a Femina vaginal capsule introduced into the vagina every night at bedtime, is sure to give the desired relief.

The kidneys of pregnant women should not be neglected. On this question Dumas, an eminent French authority, says: “Physiological pregnancy, by modifying the quality and quantity of the blood is a predisposing general cause of albuminuria or Bright’s disease. But to produce the last a cause must be added, and this may be due to a true pathological state of the blood, a morbid condition of the kidney, an accidental cause or mechanical pressure exerted by the uterus, where it has acquired a sufficient size.” If the pregnant woman notices that her urine becomes thick and foamy, that her head aches and her limbs swell, she should pay particular attention to keep her bowels free, and besides drink a cupful of buchu tea every night at bedtime.

Palpitation of the heart is a source of great annoyance to some women in the earlier months of pregnancy. Women of a nervous temperament and those who are of a full plethoric habit are most likely to suffer from distressing palpitation. Nervous women should take ten grains of bromide of sodium in half tumbler of water at bedtime, and only a very light supper, while those who are full blooded should keep their bowels freely opened and remove all pressure from the chest and abdomen by wearing the clothing loose.

Pain in the abdomen walls from the sixth to the ninth month is particularly apt to occur in the first pregnancy. The abdominal walls offer a firm resistance to the growth of the uterus, and being thus put on the stretch by the combined development of the child and the womb, the muscles and skin become excessively tender and painful. I have recommended for this complaint:—

Mix and apply by means of gentle friction every night at bedtime or night and morning.

Itching of the external organs will sometimes make the life of the pregnant woman miserable. I have seen it in so aggravated a form that the constant scratching to which the patient had recourse in the hope of being relieved, lacerated the parts so that they became ulcerated. The causes of this condition are numerous, the patient from motives of delicacy conceals her suffering until she can endure it no longer. It also happens that pregnancy has nothing at all to do with the itching for it may be due to diabetes, inattention to personal cleanliness, the presence of small parasitic insects, acrid discharges from the vagina, or from pinworms in the rectum.

If owing to parasites, mercurial ointment will cure the disease, if from vaginal discharges warm vaginal douches in which the Femina antiseptic tablets are dissolved will be the efficient remedy, and after a thorough ablution, the application by means of a camel’s hair brush of a solution of cocaine will relieve the itching.

Hemorrhoids, or piles, frequently torment the pregnant female beyond reasonable endurance. Piles may be either external or internal, in either case they are exceedingly apt to be very painful. When they occur in pregnancy they are due, in the first place, to an obstruction to the free return of blood to the heart by the enlarged uterus pressing on the large venous trunks and secondly, to constipation, which as we have learned is so frequently an attendant upon pregnancy. If the piles bleed it may give temporary relief, but if the bleeding occurs too frequently, the patient becomes pale and weak from the loss of blood. I know of no painful and troublesome malady in which the application of a little common sense has greater brilliant results than in piles, yet of all maladies, with perhaps the exception of catarrh of the nose, it is the most abused by senseless and meddlesome doctoring. The first step to engage the attention of the patient is to regulate the bowels and overcome the constipation; the passages must be kept soft and soluble, unless this is accomplished all the other efforts fail. The constipation must be partly relieved by proper dieting, and partly by suitable remedies. A simple bland diet, for a short time at least, is very useful; bread and milk, thin milk gruel, fruits and vegetables are to be preferred; abstain from solids, from meat and eggs and everything of the nature of beer and wine or alcohol, even coffee is irritating; while the disease is at its height eat sparingly of everything, but drink plenty of water, warm or cold, but not iced cold. The bowels should be regulated by taking a mild, efficient laxative, none being better than the Femina laxative syrup. Another precaution, very essential to success, is that after each stool the parts are gently bathed and washed with tepid or cool water by means of a soft sponge; gentle pressure can be exerted at the same time so as to assist the piles to return into the rectum. If they cannot be returned in this manner, the patient must learn to use her index finger and with it oiled with a little sweet oil or vaseline the piles are gradually shoved back into the rectum which alone relieves the suffering, because it relieves the strangulation and swelling which the sphincter muscle of the rectum causes. The pushing back after each stool and even between times is one of the essential features of a successful home treatment for piles, and it must be kept up for years, if necessary, to insure comfort and to guard against a relapse. Better than plain oil or vaseline is the nutgall ointment to be had at any drug store, but if the pain and distress continue use the following recipe:—

Mix and make into an ointment; apply to the piles at bedtime or whenever they come down and have to be returned; a few days in bed will materially aid in the recovery.

The diet of the pregnant female should be made a special study for upon the regimen of food not only depends her immediate comfort, but its ultimate effect on the process of parturition is equally marked. I do not agree with the opinion, laid down by some of the highest authorities, that “as far as eating and drinking is concerned, the pregnant woman may continue her accustomed diet.” I believe that there is a diet peculiarly adapted to the pregnant woman and very beneficial to her if she lives up to it. Stimulants of every kind are not good; wine, beer, whisky and even strong coffee and tea, as well as highly seasoned food, salty or sour salads should not be eaten.

How very often does it happen that a very strong, muscular, robust, healthy young woman, who, during her entire period of gestation, was in the best of health and spirits, and from whom, from all appearances one may predict that she will have an “easy time” in her confinement, quite the opposite occurs. And why as a matter of fact and experience is this not so, is indeed an interesting inquiry. I believe that the answer to this question can be made so plain and reasonable, that a mere statement of a few simple facts will make it apparent.

The process of delivery, presupposes the contraction of the uterus and the descent of the child down into the pelvic canal and its further passage through the floor of the pelvis.

The pelvic floor (see page 228) forms the bottom of the pelvic canal through which the child must be forced. The vagina is the opening through this floor, and this is composed of the muscles and membranes of the vagina, the skin, two layers of fascea, the triangular ligaments of the bladder and a group of interlacing muscles. In the birth of the child all these tissues are forced to relax to such an extent, that the vaginal canal (or the vagina) will be sufficiently widened or dilated to allow the child to pass through into the world. A moment’s reflection will at once make clear, that in a strong muscular person, the resistance to the necessary dilatation will become correspondingly great, because the muscles are so strong and tense. I have attended some women where the muscles under the excitement of labor pains felt as tense and hard, as though they were made of strong india rubber. It is apparent that the muscular resistance that is offered by these strong, tense muscles, clearly obstructs and delays the passage or birth of the child and it makes the strongest labor pains of no avail. And experience teaches, that the progress of labor is slow and the delivery generally prolonged until the pains and physical suffering of many hours, exhaust and relax the muscular resistance so that the child is allowed to pass. If the above truths were generally understood and generally recognized they might be guarded against by a proper dietetic regulation, and thus an infinite amount of suffering could be avoided.

Painless childbirth is only relative, and in the absolute meaning of the term it is not true, and for this reason, that severe contractions of the womb are always painful, and extreme tension of tissues and muscles such as the passage of the child will occasion in its passage through the soft parts is also more or less painful and there is no natural childbirth possible without both these factors being present. Painless childbirth in its absolute sense, as a scientific fact, is not true, but to assure a comparatively painless childbirth in accordance with scientific facts which are capable of demonstration is not only reasonable but absolutely true.

The term “food” is understood to be all those substances, solid and liquid, which are used for the process of nutrition. For our present purpose foods may be divided into three classes: carbo-hydrates, albuminoids, and phosphates.

The carbo-hydrates furnish fat and warmth, as an example we have starch, sugar, and fats. Persons who are fed principally upon this class become warm and fat, but will lack muscle and nerve.

The albuminoids are also termed nitrogenous substances, and constitute the muscle making material. They are derived both from animal and vegetable sources, and in their most concentrated form we find them in eggs, milk or cheese, and in meats also in certain meals; wheat, for instance, contains fourteen per cent of nitrate or muscle-making material.

Phosphates are generally taken into the system as phosphate of lime contained in certain foods we eat, as fish, lobster, beef, Southern corn, peas and beans, barley, sweet potatoes and oats.

It is obvious from what was said of painful and prolonged childbirth, that the pregnant woman should avoid as much as possible nitrogenous or muscle-making food; she must starve her muscular system as much as it is possible for her to do, and the result will be that her muscles will become soft and relaxable and that means a comparatively easy or painless childbirth. In Europe, the peasantry who eat meat sparingly or very seldom, have comparatively little pain, because vegetables enter largely into their daily diet; the same is true in Asiatic countries where the staple is rice, the throes of labor are very light. The squaws of our Indian tribes are remarkable for the little pain they suffer in childbirth and for the shortness of its duration, and the recuperation is also a speedy one, for an Indian woman will travel or be about in a few days after her confinement with her pappoose on her back.

I would recommend to the pregnant woman to live as much as it is possible for her to do on a fruit and vegetable diet. Her meals must be taken at regular intervals, otherwise derangement of the stomach is sure to follow. Excess in eating even the plainest kind of food must be studiously avoided, and all food must be eaten slowly and thoroughly masticated. Wheaten bread or rice and milk diluted with water should form the main diet. Thoroughly cooked garden vegetables and fresh, ripe fruit like apples, grapes, peaches, plums, etc., should be used in summer, and some of the same fruits canned in winter, or dried fruits slowly simmered until they are soft; it is always better to soak dried fruit for several hours or overnight before it is put over to boil.