In writing this book on obstetrical nursing I have been influenced by certain steadily deepening impressions which have been received in the course of my contact with maternity work in this country, Canada and England during the past twenty years. It has been borne in upon me, in the first place, that very often there is something akin to bewilderment among those nurses who have been trained to care for patients according to the teachings of one group of obstetricians and who later find themselves nursing the patients of other doctors who hold different, or even opposite views. And not infrequently I have found in the nurses a degree of loyalty to their training which made them sceptical, or even intolerant, of nursing methods which differed from those which they had been taught.

I have become convinced, therefore, that a book on obstetrical nursing which would be helpful to and widen the outlook of all nurses, no matter where nor by whom trained, must of necessity describe the underlying principles of obstetrical nursing and offer a survey of the nursing methods which are employed in maternity wards and hospitals of recognized excellence and in the practice of acknowledged authorities upon obstetrics.

This is, I am aware, a unique attitude, for the present text books on obstetrics for nurses reflect, in each instance, the wishes of one doctor, almost entirely, or advocate the methods employed in one hospital. My experience in teaching obstetrical nursing makes me feel that a parallel description of dissimilar nursing procedures serves to broaden the nurse’s attitude toward her work and her grasp of the entire subject, both because she becomes aware of the fact that methods, other than those with which she is familiar, are employed in hospitals of high standing and because she appreciates the fact that these unfamiliar methods may be as efficacious as those in which she has become expert.

Accordingly I have devoted the better part of the past year and a half to a study of the scope and methods of the present training in maternity nursing in several hospitals, in this country and Canada, in which the obstetrical work is of a conspicuously high character, and have presented a composite of this teaching in the succeeding pages.

But that there might not be apparent inconsistencies in the different methods of maternity care described, I have given an explanation of the purposes and general principles of the care, including nursing, which the nurse is likely to find is given to all obstetrical patients, the country over.

For the sake of simplicity and clarity I have divided the book into seven parts, following an introduction which describes the requisites and opportunities of obstetrical nursing and the importance of the nurse’s own attitude toward her work and her patient. The first two parts, dealing with the normal anatomy and physiology of the female generative tract and the development of the fetus, are designed to supply the nurse with enough technical information to make her ministrations intelligent and effective. In this respect, I have doubtless given less than some nurses will wish and possibly more than others will think necessary, but I have given about the average amount of instruction that is found satisfactory in the training schools of high standing. Four of the succeeding parts are devoted respectively to a description of the nurse’s duties during pregnancy, labor, the puerperium and early infancy. In each of these I have explained, first, the normal physiological processes which take place; then, the nurse’s duties under average conditions and finally, her responsibilities in the event of complications or abnormalities. A separate part is devoted to a description of the organized care and instruction of the maternity patient, by public health nurses, both before and after delivery, which have proved to be satisfactory.

While describing various hospital procedures, I have deemed it of practical importance to explain, in each instance, how similar results might be obtained, with improvised appliances, in a patient’s home whether in a city or a rural community. In short, I have endeavored to make clear the essentials of obstetrical nursing without regard to the status or location of the patient.

Since the patient’s state of nutrition and her frame of mind are of vital importance throughout pregnancy, labor and the puerperium, I have not only dwelt upon them in all descriptions of the nurse’s duties during these periods but have devoted an entire chapter to a simple explanation of the principles of each of these two important subjects.

My varied contact with obstetrical nurses has convinced me that those nurses who appreciate the never ending wonder and beauty of this miracle of the beginning of a new life, derive peculiar satisfaction from the care of the maternity patient. At the same time, in many hospitals, even where the patients are given the most conscientious care, the nurses are often so nearly overwhelmed by the long, irregular hours and the insistent demands of routine duties, that they do not grasp the significance of the event in which they are participants. Accordingly, I have made a sustained effort throughout the following pages to give the young nurse something of a feeling of reverence for this great mystery of birth.

In the course of my survey of the present training in obstetrical nursing, I have met the warmest generosity on the part of the obstetrical and nursing staffs in all of the hospitals which I have visited. Accordingly, I find it very difficult to find adequate expression for my sense of gratitude to the doctors and nurses of the Montreal Maternity Hospital; the Burnside Obstetrical Department of the Toronto General Hospital; The Hospital of the University of Pennsylvania; Bellevue Hospital; The Long Island College Hospital; The Brooklyn Hospital; The Cleveland Maternity Hospital and to Dr. J. Whitridge Williams and Miss Elsie Lawler for making available the entire resources of the wards, clinics, laboratories and class and lecture rooms at Johns Hopkins Hospital.

I wish to offer an expression of deepest possible appreciation to Dr. John W. Harris for the generosity with which he has given of his time, thought and wide experience in an effort to provide accurate and practical information, and to set a high standard of work and ideals for those nurses who would be influenced by this book. Having taught and lectured to nurses, as well as medical students, for years, Dr. Harris is in a position to give counsel and criticism of peculiar value to a book on obstetrical nursing and he has given these throughout the entire preparation of this book.

Because of their concern with any effort to better the state of mothers and babies, I have been given suggestions, assistance and inspiration with the most selfless generosity by The Reverend Father John J. Burke; Dr. J. Clifton Edgar; Dr. Frederic W. Rice; Dr. J. P. Crozer Griffith; Dr. Caroline F. J. Rickards; Dr. Esther Loring Richards; Dr. E. V. McCollum; Miss Nina Simmonds and Dr. John R. Fraser. Among the many nurses with whom I have conferred, I have met a characteristic spirit of helpfulness which has expressed itself in their eager readiness to pass on to other nurses the benefits of their own training and experience. Those to whom I am especially indebted, for aid and suggestions, are Miss Calvin MacDonald; Mrs. Bessie Amerman Haasis; Miss Robina Stewart; Miss Caroline V. Barrett; Miss Katherine de Long; Miss Jean Gunn; Miss Mary E. Robinson; Miss Sara Cooper; Miss Laura F. Keesey; Miss Chelly Wasserberg; Miss Kate Madden; Mrs. Minnie S. Brown; Miss Anne Stevens; Miss Madge Allison and Miss Katherine Tucker.

To Mrs. Elizabeth Porter Wyckoff I am under heavy obligation for most discriminating editorial assistance and for her farsighted criticisms toward increasing the clarity of the text. And I feel sure that the tender little poem on the miracle of motherhood, which Mrs. Elizabeth Newport Hepburn wrote expressly for this book, will be as warmly appreciated by my readers as it is by me.

I wish to express my deep gratitude to Mr. Max Brodel for his invaluable counsel and guidance in planning and assembling the illustrations to elucidate the text. And I am very grateful to Mr. Gari Melchers for the spirit which I believe is infused into this book through the reproduction of two of his lovely paintings of a mother and baby, and to Mr. Russell Drake for his valuable drawings. I wish further to thank Mr. J. Norris Myers, of The Macmillan Company, for unfailing courtesy and helpfulness in facilitating all matters relating to the publication of this book.

For statistical information I am indebted to Dr. Louis I. Dublin and for authority in offering the scientific background of the teaching I have drawn from “The Practice of Obstetrics” by J. Clifton Edgar; “Obstetrics” by J. Whitridge Williams; “The Diseases of Infants and Children” by J. P. Crozer Griffith and “The Prospective Mother” by J. Morris Slemons.