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 165J Eos! Mam StrMt 
 
 Rochester, New vork 14609 USA 
 
 (716) 482 - 0300 - Phone 
 
 (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 
 
 4 
 
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. 
 
 6 
 
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- 
 
 7 
 
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 
 
 8 
 
THE HYGIENE OF CHILDBEARING 
 
 I 
 
 
 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- 
 
 9 
 
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 
 
 10 
 
THE HYGIENE OF CHILDBEARING 
 
 S 
 
 4 
 
 (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 
 
 11 
 
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. 
 
 12 
 
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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