The Mother And Her Child Part 7

Headache as an indicator of toxemia is of special significance when coupled with the other two cardinal symptoms of eclampsia--urinary casts and increasing high blood-pressure. Therefore, the necessity for frequent urinary tests and blood-pressure examinations during the last weeks of pregnancy--especially, if the patient has suffered from headaches and has been running alb.u.min in the urine.

[Ill.u.s.tration: Fig. 4. Taking the Blood Pressure]

HIGH BLOOD-PRESSURE

Blood-pressure is a term used to indicate the actual pressure of the blood stream against the walls of the blood vessels. The blood-pressure machine tells us the same story about our circulatory mechanism, that a steam gauge does about a high-pressure boiler (See Fig. 4). The normal blood-pressure varies according to the age of the patient. For instance, the normal pressure of a young person, say up to twenty years of age, runs from 100 to 120 millimeters of mercury; and then, as the age advances, the blood-pressure increases in direct ratio; for every two years additional age the blood-pressure increases about one point--one millimeter.

The average pregnant woman starts in her pregnancy with a blood-pressure of say, 125 millimeters, but as pressure symptoms increase, and as constipation manifests itself, and as the circulating fluids are further burdened with the toxins which are eliminated from the child, the blood-pressure normally increases to about 140 mm., and later, possibly to 150 mm. If the pressure goes no higher, we are not alarmed, for we have come to recognize a blood-pressure of 140 as about the normal pressure of the pregnant woman.

There are a number of factors which enter into the raising of the blood-pressure. For instance, at any time during the pregnancy, if the eliminative organs of the mother are doing inefficient work, if she falls a victim to a torpid liver, diseased kidneys, decreased skin elimination, or sluggish bowels, then, with the added and extra excretions from the child, there is superimposed upon the mother far more than the normal amount of eliminative work--and then, because of improper and incomplete elimination, the blood-pressure is increasingly raised.

ECLAMPSIA PREVENTED

This whole subject can best be ill.u.s.trated by relating a story, the actual experience of Mrs. A. This patient came to the office with a history of Bright's disease (alb.u.min and casts in the urine), and chronic appendicitis. While treating her for the kidney condition, preparatory to an operation for the removal of the troublesome appendix--in the very midst of this treatment--she became pregnant, and great indeed was our dismay. We entertained little hope of getting both the mother and child safely through. Frequent examination of urine was inst.i.tuted, the alb.u.min did not increase and the blood-pressure remained at normal--about 124 mm. She paid weekly or bi-weekly visits to the office and carefully followed the regime outlined. She drank abundantly of water and strictly followed the dietary prescribed. Weeks and months pa.s.sed uneventful, until we approached the last six weeks of pregnancy, and then we found to our surprise one day that the blood-pressure had made a sudden jump up to 175 mm., while the urine revealed the presence of numerous casts and alb.u.min--in the meantime the alb.u.min had entirely disappeared. There were also other urinary findings which showed that the liver was not doing its share in the work of burning up certain poisons.

In her home we began the following program: Every day we had her placed in a bathtub of hot water, keeping cold cloths upon her brow, face and neck, and then, by increasing the temperature of the bath, we produced a very profuse perspiration. She was taken out of this bath and wrapped in blankets, thus continuing the sweat. All meat, baked beans, and such foods as macaroni and other articles containing a high per cent of protein were largely eliminated from her diet. At times she did not even eat bread. Her chief diet was fruit, vegetables, and simple salads, and yet the alb.u.min and casts continued to increase in the urine and the blood-pressure climbed up to 190 mm.

As we approached the last two weeks of pregnancy, this little woman was taken to the hospital and systematic daily treatment with sweating procedures was begun. Among other things, she had a daily electric light bath. After each of these baths she was wrapped in blankets and the sweating continued for some time. Careful estimations of alb.u.min were made daily and the blood-pressure findings noted three times a day. During the last week of pregnancy she lived on oranges and grapes. Day by day she was watched until the eventful hour arrived.

She went into the delivery room and gave birth to a perfectly normal child. The alb.u.min and casts quickly cleared up, the blood-pressure lowered, and today the little woman is a fond mother of a beautiful baby boy.

It is hard to estimate what might have taken place had not her elimination been stimulated. The blood-pressure was our guide. Had the alb.u.min (without casts) appeared in the latter weeks of pregnancy with a blood-pressure of 140 or 150 mm., we would not have become excited, for the reason that in every normal pregnancy there is often present a trace of alb.u.min in the latter weeks; but when the blood-pressure jumped to 170 or 190, then we knew that toxemia--eclampsia--convulsions--were imminent. So we have in recent years, come to look upon the blood-pressure as an exceedingly important factor--as an infallible indicator of approaching trouble--as a red signal light at the precipice or the point of danger; and it not only warns us of the danger, but it tells us about how near the boilers are to the bursting point. The gla.s.sy eye, the headache, the full bounding pulse and the blurring of vision, are all symptoms accompanying this high blood-pressure, so that in these enlightened days no pract.i.tioner can count himself worthy the name, or in any way fit to carry a pregnant woman through the months of waiting, unless he sees, appreciates, and understands the value of blood-pressure findings in pregnancy.

CHAPTER VII

PREPARATIONS FOR THE NATAL DAY

Two months before baby is to arrive, the expectant mother should pay particular attention to the conservation of her strength. The woman who is compelled to leave her home for the factory, the laundry, the office, or other place of employment, should stop work during these last two or three months. The active club woman should pa.s.s the burdens on to others, and the woman of leisure should withdraw from active social life with its varied obligations. During the final weeks of pregnancy, the prospective mother needs the same hygienic care regarding fresh air, exercise, diet, and water drinking, as outlined in a former chapter.

THE FINAL WEEKS

As the gravid uterus rises higher in the abdomen, increased pressure is exerted on the stomach, the lungs, and upon the nerve centers of the back; and it is because of this situation, that the duties and obligations of the prospective mother should be reduced to a minimum, that she may feel at liberty to lie down several times during the day on the porch or in a well-ventilated room, in the midst of the best possible surroundings. s.e.xual intercourse should be largely discontinued during the last months of pregnancy.

I sometimes wish the prospective mothers in our dispensary districts might have some of the care and the kind treatment which is bestowed upon an ordinary prospective mother horse, which at least enjoys a vacation from heavy labor, and whose food is eaten with calm nerves and in the quietness of a clean stall. While the state of the mother's mind does not materially influence the child; nevertheless, the state of the mother's body, the weary over-worked muscles and nerves of hot, tired women, bending over cook stoves, laundry tubs, or scrubbing floors, does materially derange the mother's health and digestion, which in turn, reflexly interferes with the growth and physical development of her child. Extra strength is required for the day of labor, and since the baby doubles its weight during the last two months, the mother is living for two, and should, therefore, avoid extreme fatigue, over tiring, and irksome labor during these final weeks of watchful waiting.

SELECTION OF THE HOME

It may or may not be within the province of prospective parents to rearrange, rebuild, or otherwise change the home. Usually the size of the pocketbook, the bank account, or the weekly pay envelope decide such things for us. The home may be in the country or suburbs, with its wide expanse of lawns, its hedges of shrubbery, and with its s.p.a.cious rooms and porches; or it may be a beautifully equipped, modern apartment on the boulevard of a city, with its sun parlors, large back porches, conveniently located near some well-kept city park, or it may be one of those smaller but "snug as a bug in a rug"

apartments, in another part of the city, where usually there is a sunny back porch; or again some of my readers may themselves be, or their friends may be, in a darkened bas.e.m.e.nt with broken windows, illy ventilated rooms, with no porches, no yards, no bright rays to be seen coming in through windows--and yet into all of these varied homes there come little babies--sweet, charming little babies, to be cared for, dressed, fed, and reared. And we must now proceed to the subject of making the most of what we have--to create out of what we have, as best we can, that which ought to be.

SANITARY PREMISES

In both the country and city place, yards and alleys should be cleaned up. Garbage--the great breeding place of flies--should be removed or burned. The manure pile of the stable or alley should also be properly covered and cared for. In this way breeding places for flies are minimized and millions and billions of unhatched eggs are destroyed.

In the large cities, provision is made for the prompt disposal of garbage, and laws are beginning to be enforced regarding the covering and the weekly removal of manure, and thus in many of our large cities flies are diminis.h.i.+ng in numbers each year. Fly campaigns and garbage campaigns are teaching us all to realize the dangers of infection, contagion, and disease as a result of filth; while through the schools, the children of even our foreign tongued neighbors take home the spirit of "cleaning up week." Even in the rural districts we hope for the dawning of the day when filth, stagnant pools, open manure piles, and open privies, will be as much feared as scorpions or smallpox.

ENGAGING THE DOCTOR

As suggested elsewhere, as soon as the expectant mother is aware that she is pregnant, she should engage her physician. And since these are days of specialists, he may or may not be the regular family doctor.

The husband and friends may be consulted, but the final choice should be made by the prospective mother herself. "The faith which casts out fear, the indefinable sense of security which she feels in her chosen physician, supports her through the hours of confinement." Twenty-four hour specimens of urine should be saved and taken to the physician twice each month and oftener during later months of pregnancy. The chosen physician's instructions and suggestions should be carried out and counsel should be sought of him as to the place of confinement.

THE PLACE OF CONFINEMENT

There are a number of factors that enter into the selection of the place of confinement. In the first place, if the home be roomy, bathroom convenient, if the required preparation of all necessities for the day of labor can be effected, and it is further possible to prepare a suitable delivery-room at home with ample facilities for emergencies and complications, and you can persuade your physician to do it--then the best place in the world for the mother to be confined is within the walls of her own home. But such is the case in but one home out of hundreds, and I regret that time and s.p.a.ce will not allow me to describe and portray the many untimely deaths that might have been avoided if this or that supply had only been ready at the moment of the unexpected complication of delivery. Why should we needlessly risk the lives of prospective mothers, when, in every up-to-date hospital delivery-room, all these life-saving facilities are freely provided? Here in the modern hospital, the mothers from small homes and apartments, the mothers who live in stuffy bas.e.m.e.nts, as well as those from the average home in the average neighborhood, can come with the a.s.surance of receiving the best possible care and attention. Every woman who can arrange or afford it, should plan to avail herself of the benefits, comforts, quietness, and calm of a well-equipped hospital and the surgical cleanliness and safety of its aseptic delivery-room.

Fortunately, the mother of the bas.e.m.e.nt home may have the same clean, sterile dressings used upon her as does the mother of the boulevard mansion. The maternity ward bed at $8.00 to $10.00 a week can be just as clean as the bed of the $40.00 a week room. The methods and procedures of the delivery-room can be just as good in the case of the very poor woman as in the case of the magnate's wife. In no way and for no reason fear the hospital. It is the cleanest, safest, and by far the cheapest way. The weekly amount paid includes the board of the patient, the routine care, and all appliances and supplies of every sort that will be used. Under no circ.u.mstances should a midwife be engaged. Any reputable physician or any intellectual minister will advise that. Let your choice be either the hospital or the home; but always engage a physician, _never_ a midwife.

THE NURSE

After selecting the place of confinement, the question of the nurse may next be considered. If it is to be the hospital, you need give little further thought to the nurse, for your physician will arrange for the nurse at the time you enter the hospital. She will be a part of the complete service you may enjoy. You will find her on duty as you, quietly resting in your room, awaken in the sweet satisfaction that at last it is all over--at last your baby is here.

A competent nurse is a necessity, if the confinement takes place in the home. She may be a visiting nurse, who, for a small fee, will not only come on the day of labor, but will make what is known as "post-partum calls" each day for ten or twelve days. These are short calls, but are long enough to clean up the mother and wash and dress the babe. She is not supposed to prepare any meals or care for the home. Then there is the practical nurse--women who have prepared themselves along these lines of nursing, whose fees range from $12.00 to $18.00 a week. If your physician recommends one to you, you may know she is clean and dependable. The trained nurse, who has graduated from a three years' course of training, is prepared for every emergency, and will intelligently work with the physician for the patient's welfare and comfort. Her fees range from $25.00 to $35.00 a week.

Both the practical and the trained nurses are human beings, and require rest and sleep the same as all other women do. One nurse, after having faithfully remained at her post of duty some sixty hours reminded the husband and sister of the patient that she must now have five hours of unbroken rest and they replied in a most surprised manner, "Why we are paying you $30.00 a week, and besides, we understood you were a _trained_ nurse."

The physician usually makes arrangement with the family for competent relief for the nurse. She should have at least one to two hours of each day for an airing, and six hours out of the twenty-four for sleep.

PREPARATIONS FOR A HOME DELIVERY

The supplies should all be in the home and ready, as the seventh month of pregnancy draws near. In the first place, select the drawer or closet shelf where the supplies are to remain, untouched, until your physician orders them brought out. The supplies requiring special preparation and sterilization are:

Three pounds of absorbent cotton.

One large package of sterile gauze (25 yards).

Four rolls of cotton batting.

Two yards of stout muslin for abdominal binders.

Two old sheets.

Twelve old towels or diapers.

One yard of strong narrow tape for tying the cord.

Three short obstetrical gowns for the patient.

Two pairs of extra long white stockings.

Four T-binders.

Other articles needed by physician, nurse, and patient are:

Fifty b.i.+.c.hloride of mercury tablets (plainly marked "_poison_").

Four ounces of lysol.

Two ounces of powdered boric acid.

One half ounce of 20% argyrol.