PART II MOTHERHOOD (Part 1)

PART II MOTHERHOOD THE PHYSIOLOGY AND HYGIENE OF PREGNANCY Indications of Pregnancy — Quickening — Dress— Need of Fresh Air- Exercise —Food— Bathing— Sleep and Rest — Heredity THE ordinary woman understands too little of the physiology of the organs which come to their full development during pregnancy. In discussing the intelligent question of motherhood we can hardly expect to take 0f our an intelligent point of view unless we know not only necessary the structure and use of these organs, but also their relation to other organs and parts of the body. The lower part of the abdomen, protected by its bony girdle, gets its name from the Greek word mean- ing basin. The womb, or uterus, is suspended in this cavity, and is kept in its position by ligaments. This ^pe°f" suspension and control make the organ freely movable the uterus and also explain the reason for displacements and falling of the womb, which often follows childbirth when due care is not taken. A full bladder tips the uterus backward, a full rectum throws it forward, and when the ligaments why a become weakened from any cause it is more difficult rest is for it to resume and hold its correct position. This aft^chiki- is the case directly after childbirth, and is one of the birth reasons why a long rest in bed is such a necessity, and why so many women who have not taken the proper care are broken down and old before their time. The uterus itself is somewhat pear-shaped. The Shape of larger end points upward and the lower end, which (185) 186 MOTHERHOOD is called the neck, extends down into the vagina, which is the external opening. From the upper angle of the uterus, on either side, Function is found a canal called the Fallopian tube, through Fallopian which the tiny eggs — the ova — pass on their way to ovarieSand the uterus. These germ cells live in the ovaries, which are small bodies lying below the Fallopian tubes, also on either side of the uterus. The connec- tion between the two is through the fringe-like ends of the tubes, which grasp the ovaries at the time the ova are discharged. These then are classed together as the generative organs, and their function or use is the development of the germ cell, or egg, into life, by its union with the corresponding germ cell, or semen, from the male parent. At puberty the ovaries begin their work of dis- Changes at charging ova, once each month, into the cavity of the pu er y uterus. These ova, unimpregnated, pass away in the menstrual flow. The monthly sickness involves no adjustment of The ner- the pelvic organs, and no change of their position, as tem at pregnancy does, yet we can realize how closely con- Sckness nected different parts of our bodies are by the wonder- ful mechanism of the nervous system. ' Nearly every one is conscious of mental depression or some nervous disturbance during the menstrual period, and many persons have definite physical accompaniments, like headache or enlargement of the glands in the breasts. The same thing is true in more marked degree at At the the time of the "change of life," when these organs menopause are losing their function. The menstruation becomes more and more irregular and finally ceases. Some- times the flowing is so profuse as to be alarming, at such times, and sometimes decreases in quantity. THE HYGIENE OF PREGNANCY 187 The constitutional disturbances are, however, the most trying, and as a rule the more vigorous and The con- normal a woman has been, the less trying will this disturb- period be. The flashes of heat that sweep over the ances whole body from time to time are very characteristic, and the increase in the size of the abdomen is to be expected. If there is any chronic disease it is very liable to be exaggerated at this time, and there may be pain in the head and back, loss of appetite, or im- paired digestion. Depression of spirits is very com- monly felt at this time, and an unreasoning apprehen- sion about the outcome of this trying period. Rest, quiet, nourishing food, and considerate care are the chief helps, and before long- the system adjusts Helpful 1 111 1 t r 1 1 • 1 treatment itself to the altered demands. If the disorders are and care serious ones the advice of a physician should be asked. Most of the symptoms manifested in both these cases being quite apart from any affection of the Evidences pelvic organs must lead us to see how unified our 0f our systems are, and from that to understand the reason systems for many of the minor ailments of pregnancy. It is, however, the hygiene rather than the ills of pregnancy that we are considering. We can not, of course, expect perfect physical conditions during this state, unless we have a perfect Perfect i • i" 1 i i • i • 1 physical physical development, which is rare among the women deveiop- of this generation, and in this land of little leisure, where equal demands are made on the nervous and the bodily strength. Mr. Dooley says: "Th' difFrence between Chris- tvan Scientists an' doctors is that Christyan Scientists think they'se no such thing as disease, an' doctors that they ain't anny thing else." We may run some risk in adopting the Christian rnent rare 188 MOTHERHOOD Child- bearing is a normal process If a wom- an leads a normal life no radical change necessary - The physi- ological changes do not interfere with or- dinary duties and exercises Whole- some and joyous liv- ing adds to the * child's inheritance Science point of view in matters of general health, but in this question of pregnancy it is certainly the saner attitude. This is a matter which we can not emphasize too strongly. Child-bearing is a normal process. The organs of generation are fulfilling their natural use, and the nearer women approach the highest ideal of health, the more absolutely normal will childbirth become. Nature has wonderfully accommodated these or- gans and the entire mechanism of the body to this function, and only asks to be given fair play. If a woman's life is normal, healthful, and wholesome, which ought to be one and the same thing, the fact that she is to bear a child need bring about no radical change. It should not be necessary for her to give up her daily occupations or to alter her mode of living. The housekeeping cares, even the actual work, and the ordinary exercise in the open air, the pleasures and duties that commonly form a part of the day, should keep their place. Other duties and pleasures will come in, to be sure, and the bodily changes during the nine months will bring the necessity of adapting her life in a measure to the new conditions, but most of these bodily or physiological changes are normal, and do not indicate disease. The more wholesomely and joyously a woman can live during this period, the more naturally will the changes and the adjustment to them come, and, fur- thermore, we must believe, the better inheritance will she give her children. INDICATIONS OF PREGNANCY The first indication of pregnancy is the cessation of the monthly flow. The blood which would have come away as menstrual discharge is used to supply THE HYGIENE OF PREGNANCY 189 the ovum in it's development. This is not what is Cessation called a positive sign, because with some women of the first exceedingly nervous temperament an emotional ex- indlcatl0n citement, or unusual physical weariness, or slight ill- ness temporarily interferes with the regularity of the monthly sickness. Interruption may also be caused by more serious disease. In rare cases the flow con- tinues more or less regularly throughout the entire course of pregnancy. But ordinarily its cessation may be regarded as an indication that impregnation has taken place. The glands which are to secrete the milk become enlarged, and this growth is accompanied by sensa- Changes tions of weight and tingling or pricking in the breasts, milk The areola or circle about the nipple gradually be- fhe" breast comes darker in color, and later a secondary disk appears surrounding the first. Milk can sometimes be pressed from the breasts some weeks before de- livery, and in the case of a woman who has never borne a child this is considered a valuable sign. Nausea is a very usual trouble at this time, though it is not universal. It occurs generallv on rising or The mom- infif sick* immediately after the first meal, and may or may not ness be accompanied by vomiting. It usually begins about the fourth week, and may last two months or longer. Occasionally it is so persistent that medical advice and treatment are necessary. The uterus sinks a little in the pelvic cavity dur- ing the early weeks, and draws with it the bladder, Changes in which in turn pulls the umbilicus inward. This causes abdomen the navel, and in fact the abdomen generally, to ap- pear unusually flat. By the third month the uterus has risen enough to Gradual be felt if the hand is placed on the lower part of the ment^i abdomen just above the pubic bone. From this time the uterus 190 MOTHERHOOD on the enlargement increases at the rate of one and one-half to two inches every four weeks, until during the last month the uterus almost reaches the cartilage at the end of the breast-bone. At about the middle of pregnancy a physician can Beatings determine by the help of the stethoscope the beating fetal of the child's heart. This establishes beyond a doubt heart the existence of pregnancy, though failure to hear the sounds does not negative the diagnosis. The heart of the child in the uterus is quite independent of the mother's, so the two can never be confused unless the frequency of the mother's is increased by disease. The fetal heart beats from 130 to 150 times a minute. As a rule the larger the child the slower the heart action. Boys are usually larger than girls, and so False the conclusion has been drawn that the sex can be regarding determined by the rapidity of the heart beat. This !ngofeat" reasoning is not at all reliable, however, and the same heartetal may ^e sa*^ °^ most °f tne attempts which are made from time to time to determine sex before birth. It is quite as well to disregard entirely such methods, for they succeed only often enough to convince the credulous that they are infallible. QUICKENING This is the term used to express the activity of the The quick- child in the uterus. It was formerly supposed that the child until those movements were felt by the mother there was no life, but of course conception itself, the union of the two germ cells, depends upon the living princi- ple within them. Quickening is first felt about- the middle of preg- its effect nancy. It is often recognized by the mother before mPo°therhe tne examiner can detect it, and it may at first give her very unpleasant sensations, such as nausea or faint- THE HYGIENE OF PREGNANCY 191 ness. Later in the course of pregnancy the activity is often so marked that the examining physician can eas- ily see as well as feel them, and the mother sometimes suffers pain from the violence of the movements. Absence of this sensation does not prove that pregnancy does not exist. The child may be dead, or it may be quiet during the entire term. If there Signifi- 11 • • • • r 1 cance of has #een activity and it ceases, especially if the absence of mother has had an attack of illness, a physician sus- quic emng pects the death of the fetus. Toward the end of pregnancy, however, the growth of the child may, and usually does, prevent freedom of movement, so that a woman need feel no alarm if she is conscious of little or no quickening during the last two months — unless there has been sickness of severity enough to warrant the death of the child in the uterus. There are diseases which present symptoms so nearly like those of pregnancy that even physicians are sometimes misled. In intenselv nervous or hys- False , J . J signs of terical women many of the signs are so closely simu- pregnancy lated that they deceive every one. The cessation of the menses, the sympathetic stomach disturbance, and even the abdominal enlargement are present. If suspicion arises in the mind of the physician, he will probably administer ether, and make an ex- amination while the patient is under its influence. Examina- tion by The muscles are then relaxed, and the true condition physician can be ascertained. There may be a distention of the uterus or of the abdominal cavity, from gas or fluid, in which case most of the reliable attendant signs are lacking. After long experiences, such as a woman gains Shape of by repeated pregnancies, the shape of the abdo- me/char- men is a very significant sign, and its characteris- actenstic 192 MOTHERHOOD . tics are such that there is generally little difficulty in diagnosis. The outlines of the pregnant uterus are very smooth, and its shape is even. There is a peculiar elongation in the enlargement of the abdomen, and on pressure it seems very stiff and elastic. Generally the uterus can be felt to contract, especially if a cold hand is laid over it. It is hardly too much to say that in doubtful cases even a very clever physician can rarely make an un- Positive qualified statement about the existence of pregnancy aSTsTn's before the middle of the period. Then rarely is there not mani- hesitation, because the probability of pregnancy as fest the , , r i . • r ,1,1 first the result of the marriage union of a normal, healthy man and woman is so great, but mistakes in diagnosis are so severely criticised that it seems only fair to call attention to the fact that the positive, unmistakable signs are not manifest during the first weeks. DRESS For the first two months in a normal pregnancy, few changes need be made. After this, the clothing will begin to feel tight, and it must be loosened. Cor- sets should be discarded, in order to remove pressure, both from the breasts and the uterus, which is steadily must*!* mounting in the abdominal cavity. The corset waist anTskirts may ^e substituted to give the accustomed warmth, hung and to serve as a support for the skirts, which should shoulders be fastened to it, or suspended from the shoulders. Princess gowns, or those made with jackets, having full vests, are very practicable, as they emphasize the size of the figure less, besides being more comfortable than the ordinary costume. Now, more than ever, one should be protected from the cold, and yet the clothing should be light in weight. THE HYGIENE OF PREGNANCY 193 High shoes should be worn, to give extra support to the ankles, and the stockings should be held up by Warm, straps at the side, never by round elastics, which, if i00se effective, constrict the legs, and interfere with the clothing circulation, often causing varicose veins. NEED OF FRESH AIR The essential fact to bear in mind is that the body is doinsr work for two instead of one. As the blood The mofn- ° ... ers body flows through the arteries, carrying nourishment to doing the various parts, it loses its life-giving properties, and breathing it must take its way back through the veins to the for two lungs, to be re-vitalized by the pure air. This work of the circulation in taking oxygen to the tissues is as important a part of respiration as the familiar act whereby the lungs alternately inhale air and expel it. For the little new life, which has its being through the parent, this internal respiration constitutes the imperative . . < . • , , "eed of entire process, for it has no communication with the fresh air outside world. This means that the rooms should be well ventilated, so that with each breath the lungs may be filled with fresh air. Inside chambers, having no windows opening out- of-doors, are never suitable for sleeping rooms, and ft^yof now when every atom of vital power needs to be vital saved and used they are especially to be condemned, needs to Remember that a fire, gas or a lamp will use up oxy- e save gen, so that more ventilation is needed when they are burning. EXERCISE The exercise in the open is equally important if it serves only to fill the lungs a few times with fresh air. Walking is a safe exercise, and may be followed up during the entire term. Driving, unless it must be 9 Vol. 3 194 MOTHERHOOD over very rough roads, is equally beneficial. It must Howmus- be remembered that absolute rest is not a wise general erc^ehls prescription for the pregnant woman. She needs oc- vaiue cupation to keep her healthy minded and happy, and labor is usually less painful when the muscles have been kept in good working order. Sometimes trifling discomfort, particularly in a young woman, makes h'er fail to realize this, and she ■is inclined to lie down when physically she is quite able to take moderate exercise. The open air, with The open its change of scene and diversion of the mind, is her air a ° • safeguard safeguard, for if she makes an invalid of herself, and keeps her mind full of unpleasant possibilities, the in- validism will tend to become a fact, and the nervous apprehension will result in hysteria. FOOD