CHAPTER III.
HYGIENE OF PREGNANCY.
The study of Hygiene is an old study ; it dates back to ancient times. It was the practice of the ancient Greeks and Romans; not as practiced today, but for specific reasons. "Hygiene,'' the goddess of health, and as the word signifies 'To make beautiful;'" the science of health and its preservation, and as taught today is quite a modern science, broadening and wid- ening our duty as nurses. It is easier to keep people well than to cure them after they are sick. This is particularly true of the obstetrical patient. The health of the patient is a matter of great importance during the pregnant state. Health as we are taught is that perfect condition of an individual in which all parts of the wonderful body act in perfect harmony, freedom and uniformity, and in which there is a per- fect balance between waste and repair, between the outpour of energy in work, and the intake of energv in food. Between the quantity and quality of solids and fluids taken in and thrown off by the body each day. Health is a body state of perfect harmony ; the perfect circulation of pure blood in a sound organism. The most essential rules to be observed during the pregnant state is to keep all the organs in a good health}- condition that they may accomplish the ex- tra work required of them. This is accomplished by living in a healthy natural manner ; having regu- lar hours for meals and sleep : daily exercise in the
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open air ; comfortable clothing ; avoidance of exhaus- tion and great muscular exertion ; frequent bathing ; freedom from worries. The patient should not fret, but keep herself occupied by light and pleasant work. During the pregnant state the increased elimination of waste material which must be thrown off by the mother, both for herself and the developing child, throws extra work on the various organs of the body. The greatest strain falls on the eliminative organs. Those organs that dispose of waste materials found in the blood are the lungs, the skin, the liver, the bow- els and the kidneys. As these organs dispose of waste products they should receive special attention.
The Lungs. — During pregnancy the increased elimi- nation of carbon dioxide by the lungs is necessarily associated with an increased consumption of oxygen. This respiratory activity makes an abundance of fresh, pure air at all times a matter of great importance. Small, close, over-heated or crowded rooms are to be avoided, also, confinement indoors. The patient should have all the fresh, pure air possible.
Sleep. — Regular and abundant sleep is required by the pregnant woman — at least eight hours — and a nap should be taken in the afternoon, or if the patient is unable to sleep the time should be spent quietly resting on the bed. Avoid entertainments, theatrical parties and all social engagements which necessitate late hours, irregular meals or excitement.
Diet. — Xo absolute rule or list can be given as the same foods do not agree with or appeal to all patients. But generally little if any change is necessary in the diet. It should, however, embrace all nutritious and easily digested articles of food. A normal supply of
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nutritious food improves the blood supply ; increases functual activity, and aids in the healthy develop- ment of the fetus. The food should be plain and nour- ishing- and easily digested and of sufficient quantity. The mother must take nourishment for the develop- ing child as well as for herself. Milk, soft-boiled eggs, fresh ripe fruit in season, fruits cooked with very lit- tle sugar, with plenty of well cooked vegetables and red meat but once a day. These articles should form the basis of the diet. Fruits are valuable because of their laxative properties, and their stimulating action upon digestion. Fried dishes, pastries, unusually highly seasoned or very rich dishes, and sweet meats of all kinds are to be avoided. There is, during preg- nancy a natural tendency to digestive disturbance, which is apt to be increased by rich food. Any actual craving- for certain things should be submitted to the physician before it is yielded to. The appetite is natur- ally somewhat increased during this period, but should be kept within bounds. Over eating should be avoided.
Drink. — The patient should drink an abundance of pure cool water, at least from live to seven glasses daily. It washes the stomach, flushes the kidneys and assists these organs to get rid of waste products. Best taken before meals, an hour before eating and at bed time. If taken during- meals it dilutes the diges- tive juices and reduces the temperature of the stomach and thus retards digestion. The water may be cool but not ice cold. Ice cold drinks are very injurious and should be avoided. Soda, orangeade, and lemon- ade are permissible. But beer, wine and all alco- holic stimulants are forbidden except by order of the attending physician.
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Clothing. — The clothing should be loose and suit- able for the season of the year. The underwear should be of wool even in summer. The drawers should be long reaching to the ankles. Wool is recommended in place of cotton, linen or silk because it absorbs the presperation as rapidly as it is formed and keeps the skin free from moisture and thus prevents chill- ing of the body. It keeps the vital organs warm and protects them. The clothing should be supported from the shoulders, which is the best method, and not from the waist, as too much pressure and weight is brought to bear on the chest and abdomen. Corsets should be discarded early in pregnane}-, as they in- terfere seriously with the development of the child, they also hinder the action of the mother's heart and lungs, resulting in the improper oxygenation of blood for the requirements of both mother and child. This is especially true if worn tight. To lace to hide and conceal her true condition is foolish and wrong and may result in seri- ous injury to both mother and child. Where the weight is very great and the patient feels the necessity of support, an abdominal bandage may be worn with the permission of the attending physician. Gar- ters which encircle the legs j* should also be discarded, as X^ y.<";-;
they interfere with the circu- W
lation of the lower extreme- ties. The stockings should be
i-i ~ . Fig. 9 — Corset pushing the child
pinned With Satetv pillS, Or and organs down in the pelvis.
side suspenders or supporters worn.
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T
".;v
Exercise. — Regular daily exercise in the open air should be taken each day, and never omitted except when the weather is very bad. The best form of ex- ercise is walking. The length of the walk will de- pend on the strength and condition of the patient. A walk in the sun-light will often promote sleep. If un- able to walk, a pleasant drive over a smooth street may be taken. Care must be taken not to over do it, and the patient become fatigued. Women miscarry most often at the third and seventh months. Women prone to miscarriage should observe care at the time that would correspond to the occurrence of the men- strual periods. Fatiguing exercise and great mus- cular efforts may prove disastrous. Violent excite- ment of any kind should be avoided.
Bathing. — The skin should be kept in a healthy condition by frequent bathing. A daily bath should be taken during the summer months, and twice a week during the winter months. The water should be warm, not hot or cold. Shower baths and sprays are never permitted during pregnancy. Baths are best taken upon retiring-, as there is less danger in tak- ing cold, they are restful and promote sleep. Thus by frequent bathing the skin is kept in a healthy condition, and by its elimitive action relieves the kidneys of some of the work they have to do. Dur- ing the last two months of pregnancy, a daily appli- cation of olive oil to the skin, especially to the abdo- men, vulva and perineum aids greatly in the pre- vention of tear from the distention of labor. It les- sens the amount of scar tissues to be seen on the ab- domen after pregnancy.
The Urine. — The urine should be examined from time to time in order to detect the first approach of
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that very dangerous condition termed "albumenuria of pregnancy," which often causes the death of the mother and child, by convulsions.
The Bowels. — Normal evacuation of the bowels once daily should be the rule. If constipation presist the patient should consult her physician who will re- lieve her and adjust matters by some simple laxa- tive. The use of active purgative pills cannot be too strongly condemned.
The Kidneys. — The kidneys during these months should receive special attention. The first decided evidence of disease or faulty metabolism is often found in the urine. Hence it is of the utmost importance that an examination of the urine should be made at the regular intervals in order that any such disturb- ance may be discovered in time and corrected. Once every month ascertain the quantity of urine passed during the twenty-four hours. Should it fall below forty-live ounces, it should be increased by drinking more water. Should this fail to increase the quanti- ty the physician's attention should be called to it. Of course, the time of the year and the execretion of the skin are to be considered. A specimen of the mixed twenty-four hours urine should be sent to the physician in charge of the case once a month during the first six months, and twice a month during the last three months of pregnancy. Accompanying the specimen should be an accurate statement of the amount passed during the twenty-four hours. The examination of the urine is very important and should not be neglected. Neglect in some cases might cause serious trouble, and progress to such an extent as to produce a fatal termination, via, nephritis, uremic
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poisoning and eclampsia. Toxameia in pregnancy is caused by the eleminative organs not doing their work properly. While these cases are comparatively few. no one can tell in which case this dangerous condition will arise. The only safe way is to treat each case with careful supervision, then the depart- ure from health can be treated on rirst appearance and serious trouble aA'erted. "Vigilance is the price of safety." The bottle should be surgically clean which is to receive the specimen for the doctor's ex- amination. That is the bottle should be washed clean and then the bottle and cork boiled live minutes be- fore using. It should hold at least three ounces ; be tightly corked, and bear the date, name and address of the patient. Care should be taken to have the ves- sel surgically clean in which the urine is passed, and the external parts should be well cleansed. Washing well with soap and water before passing the urine. The kidneys are the weakest spot of the patient during pregnancy and deserve special atten- tion.
The Teeth. — The teeth require special care during the pregnate state, as the salvia is more acid and the teeth decay more rapidly, and are often very sensi- tive, causing much suffering. There is an old saving "For every child a tooth." They should be cleansed in the morning", after each meal and upon retiring at night. Brushing them and rinsing the mouth well and thoroughlv with a weak antiseptic, after which a little milk of magnesia taken into the mouth and allowed to cover and float around and over the teeth.. This forms a film or coating which will protect them from the acid action of the salvia, thus preventing ir- ritation and helps to preserve them. Should the teeth
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become sensitive or the gums sore, the physician should be consulted. A tablespoon of lime water taken several times a week has been recommended. All small cavities should be filled. Large ones cleaned and temporarily filled, but no long tedious gold fillings or bridge work should be attempted during pregnane}'.
Care of the Nipples. — During the last four weeks of pregnancy, the nipples should be washed with a bor- ic acid solution, a tablespoonful to a pint of water. At night apply an ointment of cocoa butter or white vaseline. In the morning it should be removed with warm water, soap and a soft brush. This process helps to toughen them and prepare them for nursing. If they are small or sunken, they should be kneaded and manipulated and gently drawn out with the thumb and index finger so as to lengthen them, and the phy- sician's attention called to it. It is
. . , F i g-. 10 — Massage
very important that the breast re- Qf the nipple. Be-
ceive the necessary care to enable fore child birth. them to perform their important function.
Swelling. — Should there be any swelling of the face, hands or feet ; any headache or vomiting or disturbance of the sight, the physician should be informed immedi- ately.
Vaginal Cleanliness. — During the first weeks and the last two or three weeks of pregnancy, there is an in- creased vaginal discharge, and it is very important that the external genitals should be kept daily cleansed to prevent irritation. Vaginal douches should not be tak- en except by orders of the physician in attendance. If used at all the}' should be warm ; not hot or cold.
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Contagious Diseases. — Avoid coming in contact with contagious diseases, diphtheria, scarlet fever, small pox, etc. Avoid, also, unsightly objects, fright or lift- ing heavy articles, running a sewing machine, overhead reaching, such as hanging up clothes, reaching to get an object from a shelf, and a pregnant woman should be careful and not lift young children. There is as much danger in lifting a heavy child as in lifting any other heavy article. Any discharge of blood, no matter how slight, occurmg any time during pregnancy, is a warn- ing to go immediately to bed, keep quiet, and send for the physician at once.
Occupation. — The patient should keep herself en- gaged in some pleasant, light and useful work which will give exercise to the muscles and occupy the mind. such as light house work, sewing and fancy work. The work must not be pushed to fatigue. She should be very careful not to expose herself in any way so as to take cold. Avoid wet feet. Neglect may be serious.
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