As soon as a woman discovers that she is pregnant, she should sit down and quietly think out the plan for the nine months of expectancy.

The cessation of the menses may come as a surprise to her, and for a while she is more or less confused; she must go over the whole situation and adjust future plans to fit in with this new and all important fact. From a large experience with maternity cases, I have reached the conclusion that the larger percentage of pregnancies do come as a surprise, and in many instances a complete change of program must be painstakingly thought out. This is especially true of the business woman, the professional woman, the busy club woman, or the active society woman.

EARLY PLANNING

Let me say to the woman who is pregnant for the first time, the experiences of the pregnant state should cause you no fear, worry, or anxiety. Giving birth to a baby is a perfectly natural, normal procedure, and if you are in reasonable health—if your physician tells you you are a fairly normal woman—then you can dismiss further thought of danger and go on your way rejoicing. For thousands of years maternity has been women's exclusive profession and no doubt will continue to be many ages hence.

By far the most important and the first thing to do is carefully to select the best physician your means will allow, and place yourself under his or her care. Your doctor will help you to plan wisely and intelligently during the waiting time, for physicians have learned from experience that the better care the pregnant woman receives, the easier will be her labor, and the more speedy and uneventful the recovery.

And now, we proceed to take up one by one the particular phases of the hygiene of pregnancy which touch the comfort, convenience, and health of both the mother and her unborn child.

THE CLOTHING

At all times and under all circumstances the pregnant woman's clothing should be comfortable, suitable for the occasion, artistic, and practical. And to be thus beautifully clothed is to be as inconspicuous as is possible. Of all times, occasions, and conditions, that of pregnancy demands modesty in color, simplicity in style, together with long straight lines (Fig. 2). For the "going out" dress, select soft shades of brown, blue, wine, or dark green. Let the house dresses be simple, easy to launder, without constricting waist bands, of the one-piece type, in every way suitable for the work at hand. Under this outer dress, a princess petticoat should cover a specially designed maternity corset (if any corset at all be worn), to which is attached side hose-supporters. A support for the breasts may be worn if desired, it should be loose enough to allow perfect freedom in breathing.

The union suit may be of linen, silk, or cotton, with the weight suitable for the season. Stockings and shoes should be of a comfortable type, straight last, low or medium heel and at least as wide as the foot. There are two or three shoes on the market that are particularly good, whose arches are flexible, heels comfortable, straight last, and whose soles look very much like the lines of the foot unclothed. This style is particularly good during the maternity days. Painful feet are a great strain upon the general nervous system. Who of us has not seen women with strained, tense faces hobbling about in high-heeled, narrow-toed shoes? And if we followed them we would not only see tenseness and strain in the features of the face, but could hear outbursts of temper on the least provocation. Aching feet produce general irritability. If ease of body and calmness of spirit is desired, wear shoes that are comfortable, and the surprising part of it is that many of them are very good looking.

Toward the end of pregnancy ofttimes the feet swell, in which instance larger shoes should be worn in connection with the bandaging of the ankles and legs.

During the latter days of expectancy an abdominal supporter may be worn advantageously. Much of the backache and heaviness in the pelvis is entirely relieved by the supporting of the pendulous abdomen with a well-fitted binder. An ordinary piece of linen crash may be fitted properly by the taking in of darts at the lower front edge; or elastic linen, or silk binder may be secured; in fact, any binder that properly supports the abdomen will answer the purpose.

It should be within the means of every pregnant woman to have a neat, artistic out-door costume, for social, club and church occasions (Fig. 2). For no reason but illness should an expectant mother shut herself up in doors.

True men and true women hold the very highest esteem for the maternal state, and the opinion of all others matters not; so joyfully go forth to the club, social event, concert, or church; and to do this, you must have a well-designed, artistic dress. The material does not matter much, but the shade and style are important.

DIET

There are certain laws which govern the diet at all times; for instance, the man who digs ditches requires more of a certain element of food and more food in general, than does the man who digs thoughts out of his brain. The growing child requires somewhat different elements of food than does an adult. In other words, "The diet should suit the times, occasions, occupations, etc."

In the case of the expectant mother it should be remembered that the child gains nine-tenths of its weight after the fifth month of pregnancy, and it is, therefore, not necessary that a woman shall begin "eating for two" until after the fifth month. And since it is also true that the baby doubles its weight during the last eight weeks of pregnancy, it follows that then is the time when special attention must be given to the quantity as well as the quality of "mothers' food."

During the first five months, if the urine and blood-pressure are normal, the "lady in waiting" should follow her usual dietetic tastes and fancies so long as they do not distress or cause indigestion. Because of the additional work of the elimination of the fetal wastes, much water, seven or eight glasses a day, should be taken; while one of the meals—should there be three—may well consist largely of fruit. All of the vegetables may be enjoyed; salads with simple dressings and fruits may be eaten liberally. Of the breads, bran, whole wheat, or graham are far better for the bowels than the finer grain breads, or the hot breads.

Something fresh—raw—should be taken every day, such as lettuce, radishes, cabbage salad, and fresh fruits.

If the prospective mother is accustomed to the liberal use of meat, providing the blood-pressure and urine are normal, she may be able to indulge in meat once a day. Many physicians believe that the maternal woman should eat meat rather sparingly—from once a day to once or twice or three times a week.

Of the desserts, gelatine, junket, ice cream, sponge cake, and fruit are far better than the rich pastries, which never fail even in health to encourage indigestion and heart burn. The fruitades are all good. Candies and other sweets may be eaten in moderation. Alcohol should be avoided. Tea and coffee should be restricted, and in many cases abandoned. For many, two meals and a lunch of fruit or broth are better than three full meals. There is a continual and increased accumulation of waste matter which must be thrown off by the lungs, kidneys bowels, and skin; so that clogging of one channel of elimination makes more work for one or more of the other eliminative organs.

Sometimes the craving for food is excessive, and the desire to nibble between meals is quite troublesome. These unusual feelings should be controlled or ignored. A glass of orangeade will sometimes satisfy this unnatural craving. Save your appetite for meal time—for a good appetite means good digestion —all things equal. The woman who habitually eats between meals is the sluggish, constipated individual who needs to acquire self-control and learn self-mastery.

WATER DRINKING

Water is the circulating medium of the body, from which the digestive secretions are formed, and by which the food is assimilated and distributed to individual cells. And, finally, water is the agent for dissolving and removing waste products from the body through the various eliminating organs. We literally live, think, and have our being, as it were, under water. The tiny cell creatures of our bodies, from the humble bile workers of the liver to the exalted thinking cells of the brain, all carry on their work submerged. Accordingly, the amount of water we drink each day, determines whether the liquids circulating through our tissues shall be pure, fresh, and life-giving, or stagnant, stale, and death-dealing.

Thirst is the expression of the nervous system, constituting a call for water, the same as hunger represents a call for food. Pure water, free from all foreign substances, is the best liquid with which to quench this thirst.

It is just as important to supply abundance of water for the proper bathing and cleansing of the internal parts of the body, as it is to wash and bathe the external skin frequently. The living tissues are just as literally soiled and dirtied by their life action and their poisonous excretions, as is the skin soiled by its excretions of sweat and poisonous solids. Thus the regular drinking of water is absolutely necessary to enable the body to enjoy its internal bath, and this internal cleansing is just as grateful and refreshing to the cells and tissues, as is the external bath to the nerves which exist in the skin.

The total amount of water necessary varies according to the nature of one's work, the amount of sweating from the skin, the moisture of the atmosphere, the amount of water in the food, etc. We believe the average person requires about eight glasses of liquid a day; that is, about two quarts. By the word "glass" we refer to the ordinary glass or goblet, two of which equal one pint. This amount of water should be increased, if anything, throughout pregnancy; while, during the later months, the amount of water taken each day should be at least doubled.

In the condemnation of so-called artificial beverages, an exception should be made of the fruit juices. The fresh, unfermented juices of various fruits come very near being pure, distilled water, as they consist of only a little fruit sugar and acid, together with small amounts of flavoring and coloring substances, dissolved in pure water. None of these substances contained in pure fruit juice needs to be digested.

Lemonade not too sweet, and taken in moderate quantities, is certainly a beverage free from objection when used by the average pregnant woman. Unripe or overripe fruits frequently cause bowel disturbances; as also do the millions of germs which lurk upon the outside of fruits, and which find their way into the stomach and bowels when these fruits are eaten raw without washing or paring. Otherwise, the juices of fruits and melons are wholesome food beverages when consumed in moderation.

EXERCISE

It should be the regular practice of every expectant mother to spend a portion of each day in agreeable, suitable exercise or physical work of some description. This exercise will be far more beneficial if it can be taken in the open air. The weather and the strength of the patient must be taken into consideration and the necessary modifications of the daily exercise should be made.

An expectant mother living in the city and enjoying the average health and strength, should engage in such agreeable exercise as the raising of flowers, the training of vines, with brisk walks in the fresh air. As much time as possible should be spent in the parks.

The rural "mother in waiting," may do light gardening, raising of chickens, or pigeons, training of vines, or other outdoor work she may enjoy.

No matter what kind of weather prevails, a daily brisk walk should be taken, out of doors, on the porch or in a room with open windows. A daily sweat, as well as the daily prayer, is good for the well-being of the expectant mother. All forms of light housework are commendable. Keep out of crowds. Spend more time in the parks than in the department stores. An occasional evening at the concert or theater is diversion and harmless provided the ventilation is good. Such exercises as horseback riding, bicycling, dancing, driving over rough roads, lifting and straining of any kind, and all other forms of fatiguing exercise should be avoided.

REST

Rest and relaxation are quite necessary for men and women even in the best of health. A kind providence has arranged that we spend a large portion of our time resting, and sleeping. In addition to unbroken rest at night it is well for the prospective mother quietly to withdraw from the family circle, when the first signs of fatigue begin to appear, and indulge in a little rest, before she gets into a state of nervousness—where nerves twitch and she becomes irritable.

I have told many women whose household duties press hard: "Your husband would rather see a cold lunch on the table, or 'go out' for dinner, while his wife rested, smiling and happy, than to have a most sumptuous meal spread before him and the wife tired, and fretful." Every woman should make it the rule of her life to stop just this side of the outburst of words, and lie down long enough, breathing deeply, to calm the spirit.

FRESH AIR

"With all persons plenty of fresh air, night and day, is indispensable to health, and to none more than the pregnant woman. She should sleep with the windows open, or out of doors, at all seasons of the year; of course, making due allowance for the severity of the winters in the North. It is not only necessary to provide for the adequate ventilation of sleeping-rooms, but also for that of the living-rooms of the house.

Many persons, who are quite particular to open wide the windows of the bedrooms, forget that the other rooms need it quite as much. All the rooms of the house which are occupied should be thoroughly ventilated by throwing doors and windows open every morning; at night when the family is assembled the air must be changed now and then or it will become unfit for human lungs."

Men and women are outdoor animals. They were made to live in a garden, not a house. Remember that each person requires one cubic foot of fresh air every second. Don't allow the temperature of living-rooms, during the winter season, to go above sixty-eight degrees. If your home has no system of ventilation, open wide the windows and doors several times a day and enjoy the blessings of a thorough-going flushing with fresh air.

Oxygen is the vital fire of life. Our food, however well digested and assimilated, is just as useless to the body without oxygen, as coal is to the furnace without air. It is equally important to keep up the proper degree of moisture in the air of the living-rooms.

BATHING

Bathing is made necessary by the clothes we wear and by our indoor life. If the skin were daily exposed to sunshine and fresh air, it would seldom be necessary to bathe. The neglect of regular bathing results in overworking the liver and kidneys, and debilitates the skin. Regular bathing—ofttimes sweating baths—is very essential to the hygiene of pregnancy.

The neutral bath (97 F.) is excellent to quiet the nerves and induce sleep. Morning bathing is an exceedingly valuable practice. If properly taken before breakfast or midway between breakfast and lunch, it is found to be refreshing and tonic in nature. The feet should be in warm water, the application of cold should be short and vigorous. A rough mit dipped in cold water, rubbed over the body until the skin is pink, is a splendid tonic.

Warm cleansing baths should be taken twice a week at night. There is no good reason for the use of the vaginal douche during pregnancy.

THE TEETH

Because the mother's system is drained of the lime salts which aid in building up the bones of the child, along with other metabolic changes which cause the retention of certain acids which ofttimes affect the teeth, they should be frequently examined and carefully guarded. Severe dental work should be avoided, but all cavities should receive temporary fillings while the teeth are kept free from deposits.

As a preventive to this tendency of the teeth to decay, a simple mouth wash of one of the following may be used after meals:

1. One teaspoon of milk magnesia.
2. One tablespoon of lime water.
3. One-half teaspoon common baking soda.

Any one to be dissolved in a glass of water.

DIRECTIONS FOR SAVING URINE SPECIMENS

Beginning with the second voiding of urine after rising on the morning of the day you are to save the specimen, save all that is passed during the following twenty-four hours, including the first voiding on the second morning. Measure carefully the total quantity passed in the twenty-four hours. Shake thoroughly so that all the sediment will be mixed, and immediately after shaking take out eight ounces or thereabouts for delivery to the physician the same forenoon. The following items should be noted, and this memoranda should accompany the specimen:

1. Patient's name.

2. Address.

3. This specimen was taken from a twenty-four hour voiding of urine, which began at .... a. m. ...., and ended at .... a. m. ....

4. The total quantity voided during this twenty-four hours was .... pints.

This specimen should reach the laboratory by ten o'clock the same morning.

It is of utmost importance the specimen should be taken to your physician every two weeks, and oftener if conditions indicate it. Take it yourself at the appointed time.

THE BOWELS

Owing to the increasing pressure exerted upon the intestines, most expectant mothers experience a tendency to sluggish bowels and constipation. This unpleasant symptom is usually increased during the later months.

In the first place, a definite time must be selected for bowel action. It may ofttimes be necessary, and it is far less harmful, to insert a glycerine suppository into the rectum, than to get into the enema habit. The injection of a large quantity of water into the lower bowel will mechanically empty it; but the effects are atonic and depressing as regards future action.

Before we take up the advisability of taking laxatives let us consider what foods will aid in combating constipation. The following list of foods are laxative in their action and will be found helpful in overcoming the constipation so often associated with pregnancy:

1. All forms of sugar, especially fruit sugar, honey, syrup, and malt. All the concentrated fruit juices. Sweet fruits, such as figs, raisins, prunes, fruit jellies, etc.

2. All sour fruits, and fruit acids: Apples, grapes, gooseberries, grape fruit, currants, plums, and tomatoes.

3. Fruit juices, especially from sour fruits: Grape juice, lemonade, fruit soup, etc.

4. All foods high in fat: Butter, cream, eggs, eggnog, ripe olives, olive oil, nuts—especially pecans, brazil nuts, and pine nuts.

5. Buttermilk and koumiss.

6. All foods rich in cellulose: Wheat flakes, asparagus, cauliflower, spinach, sweet potatoes, green corn and popcorn, graham flour, oatmeal foods, whole-wheat preparations, bran bread, apples, blackberries, cherries, cranberries, melons, oranges, peaches, pineapples, plums, whortleberries, raw cabbage, celery, greens, lettuce, onions, parsnips, turnips, lima beans, and peanuts.

White bread should be tabooed, and in its place a well-made bran bread should be used. Two recipes for bran bread follow, one sweetened and containing fruit, the other unsweetened:

BRAN BREAD RECIPES

1. Two eggs, beaten separately; three-fourths cup of molasses, plus one round teaspoon of soda; one cup of sour cream; one cup of sultana seedless raisins; one cup of wheat flour, plus one heaping teaspoon baking powder; two cups of bran; stir well and bake one hour.

2. One cup of cooking molasses; one teaspoon of soda; one small teaspoon of salt, one pint of sour milk or buttermilk, one quart of bran, one pint of flour. Stir well, and bake for one hour in a very slow oven. It may be baked in loaf, or in gem pans, as preferred. The bread should be moist and tender, and may be eaten freely, day after day, and is quite sure to have a salutary effect if used persistently.

The drinking of one-half glass of cold water on rising in the morning often aids in keeping the bowels active. Of the laxative drugs which may be used at such a time, cascara sagrada and senna are among the least harmful. Two recipes of senna preparation follow, and may be tried in obstinate cases:

1. Senna Prunes. Place an ounce of senna leaves in a jar and pour over them a quart of boiling water. After allowing them to stand for two hours strain, and to the clear liquid add a pound of well-washed prunes. Let them soak over night. In the morning cook until tender in the same water, sweetening with two tablespoons of brown sugar. Both the fruit and the sirup are laxative. Begin by eating a half-dozen of the prunes with sirup at night, and increase or decrease the amount as may be needed.

2. Senna with prunes and figs. This recipe does not call for cooking. Take a pound of dried figs and a pound of dried prunes, wash well. Remove the stones from the prunes and if very dry soak for an hour. Then put both fruits through the meat chopper, adding two ounces of finely powdered senna leaves. Stir into this mixture two tablespoons of molasses to bind it together, the result being a thick paste. Begin by eating at bedtime an amount equal to the size of an egg, and increase or decrease as may be necessary. Keep the paste tightly covered in a glass jar in a cool place. If the senna is distasteful a smaller quantity may be used at first.

CARE OF THE BREASTS

The breasts are usually neglected during the months of pregnancy, and as a result complications occur after the baby comes which cause no end of discomfort to the mother. If, during the pregnancy, the breasts are washed daily with liquid soap and cold water, and rubbed increasingly until all sensitiveness has disappeared, they may be toughened to the extent that no pain whatsoever is experienced by the mother when the babe begins to nurse. During the last month of pregnancy a solution of tannin upon a piece of cotton may be applied after the usual vigorous bathing. If the nipples are retracted they should be massaged until visible results are attained.

THE MENTAL STATE

Keep the mind occupied with normal, useful, and healthy thoughts. Listen to no tales of woe. Stay away from the neighborhood auntie dolefuls. Keep yourself happy and free from all worry, care, and anxiety.

"Put no faith in fables of cravings, markings, signs, or superstitions. They are all unfounded vagaries of ignorant old women and will not bear investigation."

Don't take drugs for worry and sleeplessness. Take a bath.

The secret of deliverance from worrying is self-control. Minimize your difficulties. Cultivate faith and trust.

The conditions which favor sound sleep are: Quiet, mental peace, pure blood, good digestion, fresh air (the colder the better), physical weariness (but not fatigue), mental weariness (but not worry).

When tempted to borrow trouble, when harassed by fictitious worries, remember the old man who had passed through many troubles, most of which never happened. Train the mind to think positive thoughts. Replace worry-thought with an opposite thought which will occupy the mind and enthuse the soul. Drive out fear-thought by exercising faith-thought. Cultivate the art of living with yourself as you are, and with the world as it is. Learn the art of living easily. Associate with children and learn how to forget the vexing trifles of everyday life.

There is something decidedly wrong with one's nerves when everybody is constantly "getting on them." They are either highly diseased or abnormally sensitive. Every woman is a slave to every other that annoys her.

Fear is capable of so disarranging the circulation as to contribute to the elevation of blood-pressure—which will be more fully considered in a later chapter.