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TtM copy ftlmvd h«r« has b—n r«produe«d thanks
tt» th« gancTMity of:

D.B. WtMon Library
Univtrtity of Wttttrn OnUrio

L'aMamplaira fllm4 fut raproduit grlca i la
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D.B. WtMon Library
Univanity of Wattarn Ontario

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Rochester, New vork 14609 USA

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(716) 288 - 5989 - Fo«

THE HYGIENE OF CHILDBEARING

By William Ritten house, M. D., Chicago

Profeaor of Obitetrics Loyola Univertity; Late Pro-
fessor of Obstetrics Illinois Medical College.
Jenner Medical College, and Reliance
Medical College; Late Obstetrician
Illinois Hospital.

INTBODUCTORV

This article is not intended to take the place of the
family physician, but merely to supplement his advice
and instruction. It is a well-known fact that some of
the accidente and dangers of childbearing are serious to
the patient mainly because she did not recognize them in
time to seek early help from her physician. Had the
doctor been informed of the symptoms he might have
taken measures to prevent the danger. But it often hap-
pens that the patient regards certain symptoms as harm-
less or unavoidable, and perhaps her friends even assure
her that she must expect to bear those things without
murmuring, and so she fails to consult her doctor until it
is too late. Many a woman has lost her life from con-
vulsions, or other calamities of childbirth simply because
she did not see any danger in their early symptoms. If
I can give my readers an intelligent idea of some of the
chief dangers of childbearing and enable them better to

THE HYGIENE OF CHILDBEARINO

recognize the warning signs df those dangers my object
will be accomplished.

ABOITION

Danger. — Abortion or miscarriage is always accom-
panied by danger whether it occurs from accidental
causes or from criminal interference. Of course criminal
abortion is much the more dangerous both because of the
danger of infection and because serious injuries to
the organs are often inflicted by persons ignorant of

anatomy.

Early Abortion, — An idea prevails extensively among
the public that there is little danger in an early abortion.
Doctors often hear pleas for help from women who say
they have missed only one menstrual period and there-
fore they say there can be no danger in "doing some-
thing.'* Nothing can be farther from the truth. In an
experience of thirty years I have seen a good many
women lose their lives from abortion. A very large nui-
jority of these (over 90 per cent,) were less than txoo
months pregnant.

Reason of Danger, — The reason for this is not hard to
understand. The two chief dangers in abortion are
blood-poisoning and hemorrhage. Very few die from
hemorrhage; most of the deaths are due to blood-poison-
ing; and in early abortion the danger of blood-poisoning
is greatly increased by the difficulty of emptying the
uterus, and the frequency with which it is wounded.

Symptoms, — ^The principal symptoms of threatened
abortion are pain and bleeding. If a pregnant woman

THE HYGIENK OF t lULUHKAUINO

has pains in the lower part of her body, which last from
half-a-minute to a minute an<l return at re^ilar intervaU
nf five to fifteen niiiiutcM, she whouid at uncc send for
medical aid, and in the meantime Khould lie down and
keep quiet. In case the doctor cutuiot l>e reached
promptly it would lie perfectly pn)i)er to take a tea-
spoonful of paregoric (otice) which mi;{ht cheek the
paim and prevent an abortion. The pains are really
contractions of the womb an<l if not checked they will
soon loosen Jie fetus from its attachment and tlien the
abortion is unavoidable.

Importance of Bleeding. — Bleeding from the womb in
a pregnant woman whether much or little should always
receive the attention of the family ()hysician as soon as
possible, and until his arrival the patient should follow
the advice given above for pains. In the first half of
pregnancy bleeding from the womb means that abortion
is either actually occurring or is gravely threatening. In
the latter half of pregnane}' bleeding is more serious still,
as it may mean Placenta Previa, which is one of the most
dangerous conditions the childbearing woman is ever
called upon to meet.

FIXING THE DATE OF I^VBOR

^Desirability. — It is very desirable both from the stand-
point of the doctor and from that of the patient that we
should be able to foretell as nearly as possible the date on
which labor may be expected. Unfortunately, however,
there are so many elements of uncertainty in the problem

THE IIVGIENE OF CHILDBKARING

Uutt no greftt degree of tocuracy U potable. The arer-
age length of pregnancy ia S80 dayi, or 40 wccki; but
many pregnanciei are longer than this, and toine are
shorter. Add to this the fact that the exact date of con-
ception it leldoni known, and it ii clear that it mutt be
impossible to foretell the time of dcUvery very closely.

Method. — The usual metho<l is to take the last day of
the last menstruation, count back three months, and add
five days. For exa* nie, supiK>sc the last menstmal pe-
riod ended July 28nl. Counting back three months
(which is more convenient than counting ahead nine
months) brings us to April 28rd. Adding five days
makes April 28th the probable date. We have one check
on this calculation, and this is the fact that the mother
feels life ("quickening") about the middle of pregnancy,
or four months *nd a half after conception. This, too, is
subject to variation. Life may be felt as early as four
months, or it may be delayed until five. But this sign
has sufficient value that every prospective mother should
note carefully both the date of the close of the last men-
struatior. . and the date when life is first felt.

A Supentition, — In regard to this matter of feeling
life or quickening (as it was formerly called) there pre-
vails extensively in the public mind an error or supersti-
tion ^hat has come down from the ignorance of the past.
This is the belief that the child actually comes to life at
this time when the mother first feels its movements. Of
course, this is not true. The fetus is alive and makes
movements from the beginning, but it is so small and its
movements are so feeble that they are not felt by the

THE HYGIEXK OF CHILDBKAKINC;

mother until about the middle of pregnancy. Thii ttiper-
itition wmild have little importance if it were not that
•ome people draw very lerioui conclusions from it.
Womf n who wish to avoid motherhood often reason that
if, ai they believe, the child is not alive before quickening,
then to produce an abortion early can l>e no great wrong.
But abortion is murder, and the law regards it as such,
whether performed early or late.

CONVUIJUONH, OR Et'LAMPRIA

A Grave Condition. — Most chiid-tiearing women
know that convulsions in a woman at alniut the time of
childbirth are very dangerous, but comparatively few
know that they can usually be foreseen, and, by proper
treatment, prevented. This condition is known to the
profession as Puerperal Eclampsia, and may occur either
shortly before, during, or shortly after confinement.
The woman is suddenly seized with a violent convulsion,
becoming unconscious at the same time. The convul-
sion lasts from three to five minutes, and following it the
patient lies in a heavy, snoring sleep. After a time she
may recover consciousness, or she may pass into another
convulsion ; and this may be repeated until death ocairs.

Treatment. — Of course a doctor should be obtained
as quickly as possible. While awaiting his arrival, the
treatment should \ye limited to preventing the patient
from injuring herself. The tongue may l)e severely bit-
ten, and even the fingers may get between the teeth
and be injured. To protect the tongue the handle of a

s^. .-

THE HYGIENE OF CHILDBEARING

table fork covered with a towel may be inserted between
the teeth. If tlie doctor's arrival be long delayed, the
patient may be given a sweat by means oi' blankets and
hot water bottles, care being taken not to bum her.
This accident may easily happen in the excitement.
She may also be given a large injection of warm salt-
water (an even Leaspoonful to a pint). This should be
passed slowly into the rectum with a fountain syringe
lo be absorbed into the system.

For the principal treatment, however, the physician
must be <lepended upon.

Prevention. — With convulsions as with manv other
troubles, prevention is better than cure. The up-to-date
physician using modern methods can nearly always pre-
vent convulsions if he has the opportunity to treat the
patient beforehand. For this reason a patient should
always engage her physician at least three months be-
fore her confinement, and place herself in his crre from
that time on.

Convulsions are due to a disorder of the kidneys. It
is the function of these organs to separate the lu-ine from
the blood, thus carrying off certain poisonous body-
wastes which would cause death if retained in the sys-
tem. For some reason not yet clearly understood, preg-
nancy is liable in some cases to so derange the action of
the kidneys that the system is poisoned and the patient
placed in great danger. This condition is often called
Albuminuria of Pregnancy, because one of the symp-
toms is usually the presence of albumen in the urine. It
cannot be seen in the urine without making a test.

THE HYGIENE OF CHILDBEARING

Urine may be clear as water and yet contain much albu-
men. A cloudy sediment in urine when passed or form-
ing on cooling is not albumen. A simple test that cnn
be made by any one is as follows:

Boil a little urine over a lamp in a small glass vial or
even in a spoon. If the urine remains clear there is no
albumen. If it becomes cloudy add a few drops of vine-
gar. If this makes it clear again there is no albumen.
If the cloudiness remains the e is albumen. Of course
this test should not take the place of the more complete
and thorough test by the physician, but may be useful
when he is not near at hand.

Swollen Feet as a Symptom. — In albuminuria the
feet and ankles often become greatly swollen, and in
some cases even the hands and face become puffy. Such
swelling should always be reported to the physician, and
a sample of urine sent to him for examination. Some-
times this swelling is quite harmless, being due to the
womb pressing on the large bloodvessels, but only the
doctor can tell whether it is important or not, so he
should always be informed. Some doctors make it a
rule to examine the urine once a week during the last
three months of pregnancy in all cases. I regard this
as an unnecessary extreme of carefulness. By a little
instruction the patient can be taught to recognize danger
signals so that she will be perfectly safe.

Headache. — When albuminuria has become intense
so that the danger of convulsions is very great, the pa-
tient often experiences severe headache, and sometimes
nausea and vomiting. The occurrence of these symp-

THE HYGIENE OF CHILDBEARING

toms, therefore, in a case where there has been more or
less albumen present, should be regarded as a sign of
the utmost importance, and no time should be lost in se-
curing medical aid.

The Real Danger, — It is well to bear in mind that it
is not the loss of albumen which is the serious feature of
these cases. Even some physicians fail to grasp this
idea. To cut albuminous foods out of the patient's diet
in the hope of reducing the amount of albumen in the
urine, fails to touch the real cause of the trouble. It is
not what she is losing that we have to fear; the danger
comes from what she is not losing. In other words the
albumen lost is comparatively unimportant; but the
poisonous wastes which she retains in her system are
capable of destroying her life.

SIGNS OF LABOR

Sinking. — Prospective mothers as well as doctors
would be glad if some way could be found of foretelling
the exact date when delivery may be expected. But no
such way has ever been found and probably never wiU
be. In most cases it is not possible to tell the exact time
of labor until it actually sets in. In some cases the sign
known as "sinking" gives a vague warning two or three
days in advance. Where this sign is well-marked the
pregnant uterus sinks decidedly lower, and the patient
experiences a sense of relief, because the stomach is no
longer crowded up against the heart and lungs. At the
same time the shape of the abdomen is changed so that

THE HYGIENE OF CHILDBEARING

its most prominent part is now somewhat lower than be-
fore. Sometimes more pressure upon the bladder is felt,
causing more frequent desire to urinate.

The value of this sign is greatly lessened by the fact
that it is often absent, and occasionally it occurs three
or four weeks before labor.

The Safe Side. — The young mother near the end of
her first pregnancy is often puzzled to know whether she
is in labor or not. On the one hand false pains may
cause her to send for her doctor before she is really in
labor; on the other hand tnie pains are sometimes so mild
that she may wait too long before sending and the in-
fant may be born before the doctor's arrival. It is best
to be on the safe side. Sending too early can do no
great harm but sending too late may be dangerous to
both mother and child. In self-delivery the mother is
liable to be torn much more seriously than if she had
proper assistance, and the child may fail to breathe be-
cause there is no one present to give it proper care.

False Pains. — Many women in the last months of
pregnancy are troubled with false pains. They are so
much like true pains that the patient caimot tell the dif-
ference, and even the doctor, after making an examina-
tion, may still be puzzled. They usually come on in the
evening when the patient is tired, and disappear during
the night as she becomes rested. True pains are usually
accompanied by a discharge from the vagina of mucus,
sometimes streaked with blood. This, whether streaked
with blood or not, is called the "Show," and may be quite
profuse, or it may be little more than the natural mois-

THE HYGIENE OF CHILDBEARING

ture. When it is plentiful, and especially when colored,
it is a positive sign of labor. But it ^ < sometimes slight,
and even absent altogether in true labor, so it cannot
always be depended upon as a diagnostic sign.

A full dose of some opiate such as a teaspoonful of
paregoric, will stop false pains inside of '*orty minutes,
while it will not aiffect true labor pains. This is a re-
liable means of diagnosis but should only be used under
the physician's advice.

TEUE LABOB

In tnie labor the contractions of the womb which are
conii. ''^ .ly called "pains," grow more frequent and more
powerful as time goes on. They may come only every
half hour at first, but when labor has fully set in five
minutes is a fair average, although there is great varia-
tion in diiFerent cases. The object of these contractions
is, first, to open the womb and, second, to expel the child.
We divide labor into three stages. The first is called the
stage of dilatation, and ends when the mouth of the
womb is fully open so that the head of the infant can
pass. This stage may last thirty-six hours or it may be
over in an hour. Ten hours is a fair average.

The seco" *-age is called the stage of expulsion, and
ends when tn*:, child is completely bom. It Hi^y last five
minutes, or five hours. A fair average is two hours. If
it Idsts longer than two hours, assistance should be given
in most cases.

The third stage is the expulsion of the afterbirth

THE HYGIENE OF CHILDBEARING

(placenta) and membranes. It should not take over
lialf-an-hour.

At the beginning of labor the child lies in a thin,
closed, membranous sac usually called "the membranes."
In this sac surrounding the child is the amniotic Huid, or
"birth-water." The amount of this varies from a pint
to several quarts. When the uterus contracts during a
pain the pressure on this water forces a little pouch of
membranes through the mouth of the womb, thus acting
as a dilator to open it. This pouch is called the "bag of
waters." At the end of the first stage when the womb is
fully open the bag of wafers usually gives way, and the
water comes away with a gush. Sometimes the water
breaks earlier, even at the beginning of labor. This
condition was formerly called "a dry labor," and was
regarded as a misfortune. It was thought that the labor
would be hard and long. But better observation has
taught us that the so-called "dry" labors average up just
as well as the others. The cause of hard labors lies in
other conditions.

When the membranes fail to rupture at the proper
time the child may be born enclosed in the sac. This is
being born with a "caul" or a "veil." The infant must
be instantly released or it will die. Among the ignorant
this "veil" is dried and carefully preserved. There is a
superstitious belief that the possessor of it cannot die
frCiO drowning.

During the first stage of labor the patient may be up
and about. The pains are usually more active when she
is up than when lying down. There is a certain amount

THE HYGIENE OF CHILDBEARING

of work to be done, and the oftener the pains come the
sooner she will be through. Some women, however, feel
so ill and weak that they prefer to lie down. In this caae
it should be permitted.

During the first stage the patient should not bear
down, or strain. She would only be wasting her
strength. Ignorant bystanders often urge her to do so,
but she should remember that the womb is not yet open,
and that she cannot expel the child no matter how hard
she tries. She should save her strength for the second
stage, when the womb is open and when straining and
forcing? may do good. In fact nature follows this plan.
In the first stage the patient feels no inclination to bear
down; but in the second stage the inchnation to bear
down is so strong that she cannot help it.

SELF DELIVERY

It sometimes happens that the infant is born before
the arrival of the doctor. Wiien this seems to be in
danger of happening the patient should do everjihin^?
possible to delay the delivery. She should lie down,
avoid all straining, or bearing down, should not pull on
anything wi.h her hands, and when a pain occurs should
not hold her breath, but should breathe in a quick pant-
ing manner. The moment she holds her breath she hiU
bear down, and this is to be avoided at all costs. By
following these suggestions she may succeed in delay-
ing the delivery so much that she will not be torn; for
in self-delivery extensive tears are very apt to occur.

THE HYGIENE OF CHILDBEARING

Cwe of Infant— It in spite of all, the infant is born
before the doctor's arrival, see that it does not smother.
If it breathes lay it on its back between the mother's
thighs, wipe the mucus from its mouth using the little
finger covered with a soft cloth, cover it and the mother
warmly, and wait for skilled help. If it does not
breathe, wipe out its mouth, take it by the heels and
hold its head lower than its l)ody fi>r few minutes; in
other words, stand it on its head. Keep it warm and it
will soon breathe. Keeping the body warm and stand-
ing on the head will revive 09 per cent, of all infants
that are not actually dead. The other means of resusci-
tation should not be attempted by an unskilled person,
for fear of doing more harm than good.

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