UC-NRLF II I {11 nil |hMII l|! Ill III. li iir I B 3 flMb U2S i«(axi minmiumHumamiK TTING READY BE A MOTHER .YN C. VANBLARCOM mmm. GIFT OF Pacif:'.c- Coast "'■'iJ:-r-ja]. of I'iursii:].^ r rp GETTING READY TO BE A MOTHER f^)^ THE MACMILLAN COMPANY NEW YORK • BOSTON' • CHICAGO • DALLAS ATLANTA • SAN FRANCISCO MACMILLAN & CO., Limited LONDON • BOMBAY • CALCUTTA MELBOURNE THE MACMILLAN CO. OF CANADA, Lm TORONTO From, the painting by Gari Melchera. THE CAI{J':SS THE BKrrTNNTNO "Where did I come from, wlicrc did you ])iok nie up?" the baby asked its mother. She answered, hnlf crvinu, hiilf lautihiui;, and clasping the baby to her breast : "You Averc hidden in my heart as its desire, my darlinu". "You were in tlio dolls of my cliildliood's uaiuos: and when with clay I made the imaue of uiy iiod every moiiiing, I made and unmade you then. "You were enshrined with our household ileity. in his worship I worshiped you. "In all my hopes and my loves, in my life, in the life of my mother you have lived. "In the lap of the deathless spirit, wlio rules our home, you have been nursed for ages. "When, in girlhood, my heart was ojiening its petals, you hovered as a fragrance about it. "Your tender softness bloomed in my youthful limbs like a glow in the sky before sunrise. "Heaven's first darling, twin-born with the morning light, you have floated down the stream of the world's life, and at last you have stranded on my heart. "As I gaze on your face mystery overwhelms me; you who belong to all who have become mine. "For fear of losing you I hold you tight to my breast. What magic has snared the world's treasure iu these slender arms of mine?" From "The Crescent Moon" (child poem.s), l)y Kabunlrauath Tagore. GETTING READY TO BE A MOTHER A Little Booh- of Information ond Adincc for ihc Young Woman Who is Looking Forward to Motherhood BY CAROLYN CONANT VAN BLARCOM, R.N. AUTHOR OF "obstetrical NURSING," "tHE MIDWIFE IN ENGLAND" Fortnerhj Assistant Suprrinteiidcnt and Instructor in Obstetrical Nursing and the Care of Infants and Children at the Johns Hopkins Hospital Training School for Nurses. Hnnnrnni Member of the Midwives' Institute, Enijland. WITH AN INTRODUCTION BY J. CLIFTON EDGAR, M.D. Emeritus Professor of Obstetrics and Cluiieal Miduifery in the Cornell University Medical College ; Consulting Obstetriciwi to Bellevue Hospital : Surgeon to the Manhattaii Materniti/ and Dispensary : Consulting Obste- trician to the Neir York Maternity, Jewish Maternity and Greenwich General Hospitals. AND FREDERICK W. RICE, M.D. Associate Professor of Obstelries, New York University and Bellevue Hospital Medical College; Attending Obstetrician to Bellevue Hospital; Assistant Surgeon to the Manhattan Maternity and Dispensary: Assistant Surgeon to St. Bartholomew's Clinic and Hospital. WITH SEVENTY ILLUSTRATIONS THE MACMILLAN COMPANY 1922 All Rights Reserved PRINTED IN THE UNITED STATES OF AMERICA Bioiosr Ubkar/ GIFT PAOIFiO OOAST JOURNAL OF NURSING TO HYG£Ji>J£ DEPT Copyright, 1922, By the MACMILLAN t'OMPANV. Set up and elt'ctrotyped. Published December, 1922. V BIOLOGY LIBRARY TO THE BABY, UPON WHOSE WPXLBEING DEP?:XDS THE FUTURE OF THE RACE 743698 PREFACE The young woman wlio is lookinf? forward to motherhood is very often torn by sliai'i)ly conHictinji' amotions. Her eagerness to have a baby and her happy anticipations may be dimmed by fears and misgivings, by superstitious and er- roneous beliefs born of an ignorance that is little less than pathetic. A little information about physiological func- tions and an explanation of some of the facts of mother- hood prove to be very reassuring to the mystified, unin- formed young woman. There is, too, the immeasurably important question of the expectant mother's personal hygiene — the general scheme of her living in such a way as to promote her own and her baby's welfare — concerning which the average young woman is almost wholly ignorant. But the busy doctor, who gives of himself, impartially, to a large number of patients, often finds it difficult to dis- cuss with each one, in a leisurely, reassuring way, the facts that he would like to have her grasp, the misinformation he would like to dispel and the small but influential de- tails of her daily life that he wishes her to consider. It is just such simple information and such details of per- sonal hygiene that T have attempted to set forth in this little book, with the hope that it may help the expectant mother intelligently and confidently to do her part in mak- ing ready for the baby ; and to spend the period of her ex- pectancy in a happy frame of mind, free from haunting anxieties. And I have given some space to a description of the course of the baby's development in order that his xii PREFACE mother might have an abiding; sense of his reality and his need of her protecting care from the very moment of his origin. In no sense does this book replace the doctor's care, for it is merely a composite of the advice about simple, every- day little things which the majority of obstetricians give to the average, normal woman. I have stressed the fact that the first need of both mother and baby, from the be- ginning of pregnancy, is supervision by a physician and that such advice as these pages offer is of value only as it forms a part of his personal care. I have drawn information from "The Practice of Ob- stetrics," by J. Clifton Edgar, IM. D. ; "Obstetrics," by J. Whitridge Williams, M. D. ; " The Prospective Mother, ' ' by J. Morris Slemons, M. D. ; " The Diseases of Infants and Children," by J. P. Crozer Griffith, M. D. and "The Newer Knowledge of Nutrition," by E. V. McCollum, Ph. D., Sc. D. I am deeply indebted to Dr. J. Clifton Edgar, Dr. Frederick W. Rice and Dr. John W. Harris for helpful advice and criticisms and to ^liss Louise A. Scho- field for editorial assistance. Practical suggestions have been generously contributed by other doctors, and by nurses, in this country and Canada, whose effective work is inspired by their belief that the future welfare of our race depends upon the care given to-day to maternity patients and their babies. Carolyn Conant Van Blarcom. 149 East 40th Street New York City IXTRODICTION Tlio child-bearinp: function is a \sondvrh\\\\ complex physiological phenomenon. It affects and is influenced by almost every organ and tissue in the human body. The body of the female child from the earliest weeks of its life in its mother's womb, while receiving nourishment from her body, through infancy and the years of child- hood to maturity is being gradually molded and developed for the special carrying out oi this one function — the crowning and most vital act of woman. Although the child-bearing function is the origin and source of the human race, existing throughout the ages, the processes connected with it have only in recent years been clearly understood. Our present-day knowledge of the processes connected with childbirth makes it easy to understand how, in the early ages of the human race, the function was a normal function, with little or no danger to mother or child. But with the gradual growth of the race, with the begin- ning of the struggle for existence and the appearance and spreading of disease, all interfering with the natural groAvth and development of the body, the function of child bearing ceased to be a normal function, as designed by its ]\Iaker. and became one fraught witli dangers to both mother and child. Xevertheless, tlii'ougli ignorance of these changes brought on by civilization, tlie idea that the func- tion is a normal process, the risk slight and fatalities in- frequent and wlien occurring, inevitable, is the almost uni- versal belief to-day. The dangers to the life of the mother and child in the carrying out of this function are well known to the medi- xiv INTRODUCTION cal profession, as well as the fact that for the most part they are preventable. Yet in spite of this knowledge, each year brings forth, unchanging, its toll in fatalities and countless numbers of invalid mothers, with the inevitable destroying factor of the happiness of the home. Statistics are available to show that less than half of all pregnancies are normal and that the illness and loss of human life, from causes associated with childbirth, are dis- tressingly and needlessly high. Failure to get these facts to the public ; failure to teach lay Avomen the dangers to be avoided and the methods of protection, is one very important reason why there has been no decrease in the high mortality rates. During the past ten years, maternity hospitals and pri- vate and public health bodies, in various parts of the country, have obtained wonderful results, locally, in reduc- ing infant and maternal mortality, by giving to large groups of prospective mothers information concerning the common dangers associated with childbirth and how they might best be prevented. If every expectant mother, no matter what her status or location, followed the simple, practical advice which this book offers, the rate of illness and death among our mothers and babies would be materially lessened. This book, therefore, so complete in its information on every subject pertaining to the mother during pregnancy and confinement and of the care of the newborn infant, should be far reaching in its beneficial results. It is a book containing knowledge which every physician must admit that expectant mothers should have, and which a large number of expectant mothers are now earnestly seeking for their own protection and that of their newborn. J. Clifton Edgar, M. D. Frederick W. Rice, M. D. New York City November, 1922 CONTENTS PAGE Preface xi Introduction, by J. Clifton Edgar, M.D., and Fred- erick W. Rice, M.D xiii CHAPTER I Getting Ready to Be a Mother 1 II Signs that a Baby is Coming 11 III Where the Baby's Life Begins 20 IV How the Baby Develops Before He is Born ... 34 V Taking Care of the Baby Before He Comes ... 46 VI Making Ready for the Baby 82 VII The Baby's Arrival 98 VIII The Baby 's Mother 114 IX The Mother 's Care of Herself — for the Baby 's Sake 138 X The Mother's Care of Her Baby 148 XI The Nutrition of Mother and Baby 226 ^«u^w^';S LIST OF ILLUSTRATIONS •'The Caress" by Gari Mclcliois Frontispiece Chapter III. no. PAGE 1. Diagram of pelvis 21 2. Side view of female generative organs 23 3. Front view of female generative organs 25 4. Diagram of human ovum 26 5. Front view of breast 32 Chapter IF. 6. Diagram showing process of cell division 36 7. Diagram of baby, cord, membranes and placenta within the uterus 38 8. Appearance of the baby at different stages of development 40 9. Position of baby in the uterus just before birth ... 42 Chapter V. 10. Front and side views of maternity corsets 59 11. Front, side and back views of homemade abdominal binder and breast bandage, applied 60 12. Abdominal binder used in Fig. 11 61 13. Front and back views of homemade stocking supporters . 62 14. Eight-angled position for relief of swollen feet and legs . 71 15. Lying with hips elevated to relieve swelling of vulva . . 73 Chapter VI. 16. Leggings for use at the baby's birth 88 17. Pad made of newspapers, to protect bed 90 18. Pattern for baby's petticoat 92 19. Pattern for baby's dress 93 20. Outfit of satisfactory baby-clothes 94 21. Baby 's toilet tray 96 xvii xviii LIST OF ILLUSTRATIONS Chapter FII. FIO. PAGE 22. Diagram showing cervix in process of being dilated . . 101 23. Drawing showing descent of baby during birth .... 104 24. Helping the baby to breathe HI Chapter VIII. 25. Supporting heavy breasts with straight binder .... 118 26. Supporting heavy breasts by means of three folded towels 119 27. Indian binder for heavy breasts 120 28. Protecting nipples with sterile gauze 121 29. Position of mother and baby while nursing in bed . . . 123 30. Using shield to protect sore nipples, while nursing baby . 124 31. Nipple shield used in Fig. 30 125 32 to 38, inclusive. Bed exercises 128 to 131 39. Knee chest position 132 40. Walking on all fours 133 Chapter X. 41. Baby's weight chart 151 42. Diagram of first teeth 153 43. Appearance of fresh cord immediately after birth . . . 154 44. Appearance of cord four days after birth 155 45. Appearance of navel after cord has dropped off . ' . . . 155 46. Appearance of normal, well healed navel 156 47. Preparing the baby's milk 169 48. Position in which to hold baby and bottle for feeding . 172 49. Holding baby upright after feeding to prevent colic . . 173 50. Putting the baby into his bath 185 51. Supporting the baby's head above water while giving bath 186 52. Dry, sterile cord dressing 189 53. Flannel band over cord dressing 190 54. Putting on the straight diaper 191 55. The diaper in Fig. 54 applied 192 56. The Sutton poncho 198 57. Method of carrying baby to support back and head . . 200 58. Training the baby to use a chamber 202 59. Elbow cuffs to prevent thumb-sucking 203 60. Immersing baby for bran or mustard bath 209 LIST OF ILLUSTRATIONS xix FIO. PAGB 61. Putting the baby into a wet pack 210 62. The baby in a wet pack 211 63. Diagrams showing successive steps in giving pack . . . 213 64. Giving the baby an enema 217 65. Quilted robe for the premature l)abv 220 66. Bed for premature baliy improvised from a clothes basket 221 67. The baby in a basket, ready to travel 224 GETTINCx READY TO BE A MOTHER CHAPTER I GETTING READY TO B^ A MOTHER How does it seem to you — the coining of a b.aby? , . Does it seem the most amazing ci miiacles, so stirring in its beauty and mystery that you are eager to make ready and prepare for it fitly? Or have you, perhaps, come to share the general feeling that motherhood is a natural state which one accepts when it comes, but need not prepare for? This attitude seems to go back to a very old and deeply rooted conviction that, as women always have had babies and have had them through the working of one of Nature's laws that has been operating over and over throughout the ages, they doubtless will continue to have them in the same old way, and the entire matter may well be left to take care of itself. As to the baby, when he comes, one may expect that the ability to care for him will come too. Because of this reasoning, or lack of it, it has been a fairly general custom for the woman who expected a baby to seek her doctor's aid only when she went into labor, or shortly beforehand, and to give no thought to the care of her baby until he was bom. All too often the mother has died, because of this tardy care, been injured or become an invalid, while equally sad things have happened to the baby — and needlessly so. But now, happily, a great change is taking place in the realm of mothers and babies. We still realize, of course, that childbearing is a natural function, but we know that conditions must be made favorable for the smooth working 1 2 GETTING READY TO BE A MOTHER of this natural law if all is to be well ; that for the sake of both mother and baby it is of urgent importance to give thought and care to the baby during the nine months before he is born. There is little doubt that the most critical period in one 's life :s the first ten months — the nine months before birth and the firsc month afterward — and that the care which is gixsii during these months influences one's physical state, for good or ill, throughout all the rest of life. In the light of this knowledge, women arc more and more generally seeking and being given "prenatal care," which is care before the baby is born, together with advice and instruc- tions which fit them to assume motherhood safely and suc- cessfully. Ideal prenatal care would really begin during the ex- pectant mother's own infancy, for the chances of a normal pregnancy, labor and lying-in period are greatly increased by good care during the early j^ears of life. But for the time being we shall have to content ourselves with an ef- fort to extend, as Avidely as possible, the care that is now known to be beneficial for expectant mothers from the be- ginning of pregnancy. This prenatal care is undertaken in much the same spirit in which one makes a garden, for example. AVe know, of course, that plants which are neglected sometimes grow and blossom satisfactorily, though one would not think of depending upon them to do so. But we have learned that plants that are given the care and protection that they need are almost certain to flourish and bloom after the manner of their kind. Experience teaches, however, that this care must be regular and sustained and always given for the twofold purpose of preserving the plants from injury as well as nourishing them. Accordingly we put them in good soil, GETTING READY TO BE A MOTHER 3 to begin -with, and then give water, sunshine or shade, ac- cording to their respective needs, and we take care to pro- tect them from tlie destructive effects of harmful insects, blights, weeds or anything which may be unfavorable to their healthy progress. AVe do not close our eyes to the fact that these harmful conditions are possible. Instead, we are anxious to find out all about them — what causes them and how to recognize tiicm — in order that we may prevent or remove them before they do serious damage. Many women, nowadays, arc taking just that kind of attitude toward motherhood. They begin ])y consult- ing a doctor as soon as they know that they are pregnant, because they appreciate the importance of doing so. They study eagerly the questions relating to motherhood; the structure and workings of those parts of their own bodies which are concerned with the baby's creation; how he evolves within them; what he needs during those nine months of development; what practices, what conditions are bad for the baby and themselves ; what they can do to avoid or correct these and how they can help to make things go smoothly. The women who face the facts of motherhood in this way generally go through the entire adventure normally and successfully, as Nature intended they should. More than this, those women who place themselves under a doc- tor's care from the beginning of, or early in, pregnancy, are greatly reassured to find out how much can be done to safeguard them, and they do not have that fear of the approaching birth which is suffered by so many women who do not know nor understand what is going on. The results of the painstaking work and study which have been carried on to increase the comfort and safety of mothers and babies have made it possible for the doc- tors to plan something of a routine which they find ad- 4 GETTING READY TO BE A MOTHER visable for their patients to adopt. To begin with, it is quite plain that the first need of every expectant mother is examination and measurement, early in pregnancy, by a good physician. The information thus obtained helps the doctor to foretell the kind of labor that his patient is likely to have, and by planning for it ahead of time he is often able to save her much harm and suffering. An early ex- amination also enables the doctor to discover and correct any slight trouble which may exist at that time and which might grow worse if not treated, and to advise his patient about the general care which he wishes her to take of her- self throughout pregnancy. In regard to this care, doc- tors are generally agreed that the average woman needs to do little more than observe the ordinary rules of personal hygiene, which as a matter of fact, should be followed by all of us ; that is, she should live a simple, regular life as to diet, fresh air, exercise, rest, sleep, diversions, etc. This all sounds simple enough and as a matter of course, but it is usually overlooked in spite of being of the most ur- gent importance to both mother and baby. This advice varies in little things, here and there, among different doctors, but in the main it is about the same the world over, where thought is being given to the care of expectant mothers. For no matter where they are or what their status, their needs in general are the same. They need a doctor's supervision and they need to practice the principles of personal hygiene. Accordingly, in addition to making an early examina- tion and giving instructions about the regulation of her daily life, the doctor usually wants to see his patient and make certain observations every little while during preg- nancy, just to make sure that everything is going as it should and to be in a position to discover the earliest and slightest symptoms of complications. GETTING HEADY TO BE A MOTIIKK 5 In the old clays there were certain complications asso- ciated with childbirth which the doctors did not know how to prevent and sometimes could not cure — complications which were bad for both mother and baby. But now they know a great deal about both preventing and curing even the most serious of these complications. They have discov- ered, for one thing, that many conditions which give seri- ous trouble during labor, or soon afterwards, actually have their beginnings during pregnancy, and sometimes very early. Quite evidently, then, it means a great deal to the ex- pectant mother to have the doctor discover and treat these complications before they have had time to become serious. But he can give early treatment only if he knows about the symptoms of the trouble when they first a-ppear. Some of these symptoms may be detected by the Expectant "mother herself after they have been explained to her, but some of them can be discovered only by a doctor or a nurse. That is why it is important for the doctor to see his patient at frequent intervals during pregnancy; about once a month during the first half and every two weeks after- wards. He sees her for much the same reasons that the house- wife looks over the contents of her darning basket — not once and for all time, but regularly, once a week, over and over and over. She searches each time not for holes alone, but for thin places, too ; an occasional broken thread or the beginning of a " run, ' ' knowing how much trouble she will save herself, later on, by promptly repairing the smallest break or evidence of wear. She knows quite well that there are no more holes because she looks for them, than there are if she does not, and that failure to look for them will not keep the holes from being there nor from growing larger. No more does the expectant mother develop a complica- 6 GETTING READY TO BE A MOTHER tion because she is examined, nor does an existing condi- tion cease to exist because she is not examined ; and yet some women still take just that illogical attitude toward ex- aminations and supervision during pregnancy. One factor which keeps some expectant mothers from seeking medical care is the well meaning but dangerous counsel so freely offered by older women who claim fitness to advise by virtue of having had several children of their own. Their lack of success, as evidenced by miscarriages, stillbirths, cliildren dying in early infancy, as well as in- juries and disabilities of their own, is usually overlooked as they press their superstitions and remedies upon the in- experienced and bewildered younger woman. When dis- aster follows, as it so often does, it is very likely to be as- cribed to the will of God, and the mother's needless sacri- fice does not even serve as a warning to others who are in line for the same kind of advice. Another obstacle to adequate prenatal care is sometimes found in the husband who considers it entirely reasonable to secure expert advice upon the subject of cattle-raising, let us say, or the care and running of his automobile or about his investments, but who has a conviction that it is normal and natural for women to have children without making what he considers a fuss about it. He may cher- ish, too, a suspicion that it is not altogether good for his wife to be thinking too much about her condition. His mother never began bothering until the baby came. On the other hand, many husbands show the tenderest solicitude for their wives throughout pregnancy and would be only too eager to have them enjoy all the benefits of prenatal care, if they only knew and understood about it. The expectant mother will be wise, therefore, if she under- takes to convince her husband, if need be, that her occupa- tion of bearing and rearing children merits quite the same C}p]TTTNCJ KKADV TO UK A MOTIIKR 7 thoughtful attention as his work, to which he devotes his best powers. How easy and wortli while this may he was demonstrated a couple of years ago at a count}' fair whicli was attended by a very intelligent fanner and liis wife. The farmer was interested in hog-raising and both he and his wife ac- cepted without question tlie fact that success in this enter- prise could be achieved only tlirough serious study and the most painstaking care. ]5ut as to childbearing, if they thought of it at all, they looked upon it as simply one of those natural functions whicli always had and doubtless always would take care of itself. "When this couple reached the fair the farmer entered one of his fine animals in a prize-winning contest and as there was a baby contest, too, the wife entered their little son. In due time the judges inspected the various con- testants and it was found that point by point the farmer's hog measured up to all of the standards of perfection for his kind and easily won the first prize. Not so with the baby; point by point he fell below even a moderate aver- age of what a baby should be and was outranked by many of his more robust infant competitors. As various admirers discussed hog-raising with the farmer, it became quite evident that he had carefully studied the question and had applied to his occupa- tion the most approved methods of which he could learn. But when the doctors and nurses at the baby contest talked with the crestfallen mother about her baby, who had seemed right enough to her, they found that she knew little or noth- ing of the business of being a mother; that it had never occurred to her nor to her husband that she might profit by care and instruction about herself and her baby both be- fore and after he was born. As might be expected, she had been unable to nurse him and on the Avhole he proved 8 GETTING READY TO BE A MOTHER to be a pretty poor specimen of a baby, with a dismal out- look as to health. Since the mother was then in an early stage of another pregnancy, the doctor talked it all over with her and her husband. He convinced them that such thoughtful and painstaking care as they had devoted successfully to hog- raising were equally effective when applied to baby-raising. As a result, the expectant mother, with her husband's whole-hearted approval, placed herself under the care and supervision which she found were available through a pre- natal clinic in her vicinity. The happy sequel to that story is that when another fair was held, a year later, the farmer entered another one of his hogs and the wife her new baby, and that this baby held his own with the hog by taking a prize, too. So sincerely do doctors now believe in the urgency of having all maternity patients under supervision and care during the nine months before the baby comes and the first several weeks afterwards, that they not only care for those women who come to their offices, but also give of their knowledge and skill to organizations engaged in prenatal and maternity work. These organizations may be visiting nurse associations, prenatal clinics, health centers or dis- pensaries. As the doctors are assisted by nursing staffs they are able to offer protection, through these channels, to a very large number of mothers and babies. Among the women who are cared for by such organiza- tions, or by doctors in their private practice, there is an enormous reduction in the occurrence of convulsions, for ex- ample, abortions, miscarriages, stillbirths, infections (child- bed fever) , and prolonged and difficult labors. Or, to put it the other way round, good care started during early pregnancy and continued throughout labor and the lying-in period gives both mother and baby enormously increased GP]TTINa KEA13V TO JiE A MOTHER 9 chances to live and enjoy ffood liealtli. One reason Avhy the baby is so mucli better off is that good care practically always enables his mother to nurse him, for, except in ex- tremely rare cases wlion there is a definite physical dis- ability, as tuberculosis for example, every mother can nurse her baby if she really wants to and if she, the doctor and nurse bend all their onorgies to accomplish this happy end. A baby who is not breast-fed is defrauded of a pro- tection which is rightfully his, and usually because some- one has failed to do all in his or her power. Organizations which include doctors and nurses who can give skilled care to maternity patients are increasing in scope and number throughout cities, towns and rural dis- tricts in all parts of the country. This makes us hope that before long good care during pregnancy, childbirth and young motherhood will be available to every woman in the land. But quite as earnestly do we also hope that every woman in the land who is looking forward to mother- hood will seek this care. Certain it is that the expectant mother who does seek care, whether from a doctor in his office or through a prenatal clinic, is approaching her motherhood in the only way that is safe for herself and her baby. She should realize, however, that although the doctors can accomplish a great deal through examinations and advice, they can give the full benefits of their skill only to those women who do their part by following in- structions faithfully, week after week, throughout nine months. The doctor cannot live his patient's life for her; he can plan and advise her ever so wisely, but this counts for very little unless she lives as he directs. The young woman who sees her motherhood as a coveted privilege, crowded with happy possibilities, who is will- ing to bear its inconveniences and take the necessary pre- cautions to insure a satisfactory outcome, is very likely to 10 GETTING READY TO BE A MOTHER go through her experience in good health and buoyant spirits. And in the end she will have not only the ecstasy of possessing a beautiful, well baby who has every prospect of continuing so, but as the years pass she will have the satisfaction of knowing that she is a better, more helpful, more companionable mother because of being in good health herself. That is the point of good maternity care — future well- being as well as immediate safety for both mother and baby — and it rests with each woman to decide for herself if she is to have such care. CHAPTER II SIGNS THAT A BABY IS COMING The ■woman who wants a bal)y and is in a position to have ( ne is usually eager to know hoAV she can tell when a baby is coming. She wants to know because the babj^'s coming means so much to her and also in order that she may know when to consult a doctor. I am sorry to have to admit, at the outset, that making this important discovery is far from being a simple mat- ter. One would suppose, after all these ages, during which countless babies have been born and countless pregnancies have been observed by doctors and others, that there would be some known way of finding out definitely, at an early date, whether or not a baby was coming. But strangely enough, there is no positive evidence of the baby 's existence within his mother's body until eighteen or twenty weeks after his life there has begun. On the other hand, so many symptoms of pregnancy are known to women, the world over, that very often an ex- pectant mother is correct when she suspects at an early date that she is pregnant, particularly- if she has already had a child. But as the well-known sj-mptoms are much like those of various conditions other than pregnancy, even ex- perienced mothers sometimes believe themselves pregnant when they are not. The reverse is true also, for we occa- sionally hear of a woman who fails to recognize the meaning of the changes wliicli she notices in herself, and is unaware of being pregnant up to the very time of going into labor. 11 12 GETTING READY TO BE A MOTHER And so we find that there are some signs of pre^ancy wliich are only possible, since they may be caused by some other conditions ; others which may be accepted as provable, and a few signs which are positive because they are never due to any cause but pregnancy. The possible signs can all be detected by the expectant mother, herself, and may be described as follows: 1. Stopping of Menstruation. This is usually the first symptom noticed. Although it is possible for the periods to be stopped by any one of several other causes, the miss- ing of two successive periods, after intercourse, is a strong indication of pregnancy in a healthy woman of the child- bearing age, whose menses have been regular. 2. Changes in the Breasts. These, also, occur early. The breasts usually increase in size and firmness, and many women complain of throbbing, tingling or pricking sensa- tions and a feeling of tightness and fullness. The breasts may be so tender that even slight pressure is painful. The nipples become larger and more prominent; they and the colored circle of skin around them grow darker, while the veins and the glands that feel like little lumps under the skin become more noticeable. If, in addition to these symp- toms, it is possible for a woman who has not had children to squeeze from her nipples a pale yellowish fluid, called colostrum, she may feel almost certain that she is preg- nant. But it must be remembered that these symptoms, also, may be due to causes other than pregnancy; that even milk in the breasts may be present in a woman who has borne children, for months, or possibly years, after the birth of her last baby. 3. "Morning sickness," as the name suggests, is nausea, sometimes accompanied by vomiting, from which many ex- pectant mothers suffer the first thing in the morning. This varies from a little nausea, when first raising her head, SIGNS THAT A BABY IS COMING 13 to repeated attacks of vomiting: during' the day and even dnrinpr tlie nitrlit. As a rule, however, the discomfort is experienced during the early part of the day oidy. Morn- ing sickness may set in immediately after conception, but begins al)ont the sixth week, as a rule, and lasts until the third or fourth month. It occurs in about half of all preg- nancies and is particularly common among women who are pregnant for the first time. On the other hand, one must not forget that many non-pregnant women suffer from nau- sea in the morning; many women go through pregnancy without any such disturbance, while others are entirely comfortable in the morning but nauseated during the lat- ter part of the day. 4. Frequent Urination. There is usually a desire to pass urine frequently during the first three or four months of pregnancy, after which the tendency disappears, but re- turns during the later months. The desire may be due in part to nervousness, but is largely caused bj^ pressure made upon the bladder by the growing baby, and not by kidney trouble, as is sometimes believed. For pressure on the outside of the bladder gives much the same sensation as is experienced when the bladder is full of urine. After the baby grows to such a size that he pushes up into the abdomen (we shall describe this later), he does not press upon the bladder and therefore ceases to create a desire to urinate until the last month or six weeks before he is born when he sinks back into the pelvis. 5. Increased discoloration of the colored parts of the skin is another early symptom of pregnancy. In addition to the deepened tint of the nipples and the circles around them, a dark streak appears upon the lower part of the abdomen, extending upward toward the umbilicus, or navel. There are also the yelloM'ish, irregularly shaped blotches which sometimes appear upon the face and neck; dark cir- 14 GETTING READY TO BE A MOTHER cles under the eyes and pinkish or bluish streaks on the abdomen. 6. "Quickening" is the name which is commonly given to the mother's first feeling of the baby's movements. It occurs about tlie eighteenth or twentieth week, and is re- garded by some doctors as a positive sign of pregnancy and by others as merely a possible sign. The sensation is com- pared to a very slight (luivering, or tapping, or to the flut- tering of the wings of a bird as it is held in one's hand. Beginning very gently, lliesc movements grow more vigor- ous, as time goes on, until tlicy become very troublesome to- ward the latter part of pregnancy, amounting then to sharp kicks and blows. Women who liave had children can usu- ally distinguish between quickening and the somewhat simi- lar sensation caused by the movement of gas in the intes- tines ; but a woman pregnant for the first time may be deceived. There are many other possible symptoms of pregnancy, but their value is very uncertain and as we have seen, even the ones described above are not entirely dependable. But if you have missed two periods ; if your breasts have grown larger and firmer; if your nipples are stiffer and more prominent and you can squeeze colostrum from them, you may be reasonably certain that a baby is coming. The probable signs of pregnancy are more apparent to the doctor than to the expectant mother, but there are two which you may easily detect : 1. Enlargement of the abdomen, which is a very impor- tant sign, may be noticed about the third month. At this stage a rounded mass may be felt in the abdomen which steadily increases in size as the weeks and months slip by. Rapid enlargement of the abdomen in a woman of child- bearing age may be taken as fair, but not positive, evi- dence that she is carrying a bal)y. However, complete re- SKJXS THAT A \',A\',\ IS CO.MINi; i:, liance cannot bo placed in this siirn, since it is possil)l(' for tiie abdomen to be cidai'fifd l>y a tnnior, by dropsy, or by fat. 2. Painless contractions of the uterus (or womb, within which the hal)y lies i hcjiiii diiriiiii' the early weeks of preg- nancy and occur at intervals of five or ten minutes throughout the entire period. The expectant mother may not be conscious (»f these contractions during the early months, but later she can detect them by placing her hand upon her abdomen and feeling the uterus, l)eneath it, grow first hard and then soft, as it contracts and relaxes. But the probable signs of pregnancy, like the possible symp- toms, may occur in Avomen who are not pregnant, and ac- cordingly the appearan(^e of any one of them alone, is not of great significance. The positive signs of pregnancy, of which there are three, are not apparent until the eighteenth or twentieth week. They relate to the baby, I)ut with one exception they can- not be detected by the expectant mother. However, they are of such moment that you will be interested to know what they are. 1. Hearing and counting the baby's heart beat is un- mistakable evidence of the baby's existence. The doctor sometimes hears this by resting his ear upon the mother's abdomen and souu'times by listening through a stethoscope. 2. Ability to feel the outline of the baby's body is also a positive sign of pregnancy, if the head, l)Uttocks, back and extremities are unmistakably made out through the mother's abdominal Avail. 3. Feeling the movements of the baby is accepted as a third positive sign of pi-egnancy. There is some difference of opinion concerning the value of "quickening," alone, as a positive sign, but if the baby's movements are felt by the doctor, also, through tlie mother's abdominal wall, or 16 GETTING READY TO BE A MOTHER by vaginal examination, there can be no donbt that a baby is there. Feeling these movements some time after the eighteenth or twentieth week, by placing a hand upon the abdomen, is the one positive sign which the expectant mother may detect for herself. Some Other Changes in the Mother's Body While the Baby Grows. In addition to the signs and symptoms which we have just described, there are a good many other changes which will take place in your own body, in the course of the baby's development, and you will want to learn about some of them in order that you may know what to expect. The abdomen. Of course, the steady enlargement of the abdomen and the alteration in its shape, as pregnancy ad- vances, is the change that you will be most conscious of. As the abdomen grows larger, the skin which covers it is stretched more and more tightly with the result that the tissues just under the surface sometimes give way, or split and form pale pink or bluish streaks. These streaks, which are called strm, grow white and glistening after the baby is born, so that the abdomen of an expectant mother who has had children, will show silvery streaks from earlier pregnancies and also the bluish ones recently formed. These streaks are of no consequence and I mention them simply because you are almost certain to notice them and may wonder what they are. They may appear upon the hips, thighs and breasts as well as upon the abdomen, if the skin over these parts is greatly stretched. The umbilicus (navel) is deeply indented during about the first three months of pregnancy, but afterwards the pit steadily grows shallower and by the seventh month, it is level with the surface of the abdomen. After this time the navel may protrude, in which state it is described as a "pouting umbilicus." SIGNS THAT A J'.AT.Y IS COMING 17 An increase in the vaginal discharge is another change Avhieh you may notice during tiie latter months of preg- nancy. The changes in the skin consist chiefly of the increased discoloration over various parts of the body, which was mentioned among the possible signs of pregnancy. The degree of this discoloration varies with the complexion of the individual, as blonds may be tinted but slightly more than usual, while the discolored areas on a brunette may become almost black. As the skin glands become more ac- tive, there is also an increase in perspiration and sometimes the hair becomes much more luxuriant during pregnancy. Changes in the digestive tract are the morning sickness alread}' described, and constipation. The latter is suffered by at least one half of all pregnant women and is due chiefly to pressure made upon the intestines by the en- larged uterus, though weakening of the stretched abdom- inal muscles may be one cause. Constipation is most troublesome during the latter part of pregnancy. There may be, also, heartburn, acid stomach and intestinal indi- gestion giving rise to gas, diarrhea and cramps. The so- called "cravings" of pregnancy are not so common in real life as they are in rumor, but the expectant mother may show unexpected likes and dislikes for certain dishes, pos- sibly because of her tendency to be nauseated. Her ap- petite may be very capricious during the early weeks and become almost ravenous later on. The bones and teeth may grow softer during pregnancy, if the expectant mother does not eat proper food, and as a result we hear of the old beliefs that each baby costs the mother a tooth and that broken bones heal slowly during pregnancy. Both of these occurrences are entirely un- necessary, and may be prevented by eating suitable food, as will be explained in the chapter on nutrition. 18 GETTING KEADY TO BE A MOTHER The carriage, or mode of walking, is someAA'hat affected by pregnancy l)CL'anse of the inereasetl size and weight of the abdomen. In an effort to liold herself erect, the expect- ant mother throws back her head and shoulders and finally assumes a gait that may be described as a waddle, being particularlj^ noticeable in short women. You hear a good deal about the thyroid gland these days, so you may as well know that it is very often enlarged during pregnancy and thus may form a swelling on the front part of the neck. If you notice it you might tell your doctor but it need not worry you for it Avill almost certainly return to its normal size after the baby comes. When to Expect the Baby. Now that you are familiar with the most apparent changes w^hich will take place in your body during pregnancy, you are probably on tiptoe to find out as nearly as possible the date upon which to ex- pect the baby. Unfortunately we cannot foretell the exact date, for the very simple reason that we have no way of knowing just when pregnancy begins. Quite evidently, then, not knowing when it begins w-e cannot figure out the exact date upon which pregnancy will end in the baby's birth. But we do know that labor usually begins about ten lunar months, or forty weeks, or from 273 to 280 days, after the beginning of the last menstrual period. Thus the approximate date of the baby's arrival may be esti- mated by counting forward 280 days or backward 85 days from the first day of the last period. Or, wiiat is perhaps simpler and amounts to the same thing, one ma}" add seven days to the first day of the last period and count back three months. For example, if the last period began on June 3, the addition of seven days brings us to June 10, while counting back three months from this, indicates March 10 as the approximate date upon which the baby maj' be expected. SIGNS TllxVT A BABY IS COMING 19 This is probal)ly as satisfactory as any method of estima- tion, but at best it is only approximate, being accurate in about one case in twenty. However, it comes within a week of being correct in half the cases; and is witliin two weeks of the actual tlatc in ('i-nol ou^L^ Fig. 3. — Diagram showing the structure and relation of the female generative organs, as seen from the front. lion, waving and sweeping along in much the same way that a field of wheat waves and sweeps in the wind. Re- member about this, too, for it has something to do with the very beginning of the baby. The Ovaries. Very near and a little below the tiaring, open ends of the tubes are the ovaries, the sex glands of the 26 GETTING READY TO BE A MOTHER female. There is one on each side, held in place by liga- ments and they are about the size and shape of almonds. In the ovaries are embedded the ova, or eggs, the female germ cells which are concerned Avith producing the baby and also with the function of menstruation. Just a word about what is meant by "a cell. " It is sim- ply a tiny mass of jelly-like substance, called protoplasm, nucleolus or* ge-»">n spot nucleus Fig. 4. — Diagram of human ovum. contained in a thin membrane or skin and is so small that it can be seen only through a microscope. In its unmatured state the ovum is a single cell, about 1/125 of an inch in diameter. In the protoplasm there is a spot called the nucleus and within this a smaller one called the nucleolus, or the germinal spot. These are long names and you need not remember them unless you want to, but glance at Fig. 4 which shows an ovum and you will see that in its general structure it is much like a hen's egg, for the latter has a WHERE TllK ^.A^.^■■S IJFH III'XJINS 27 yolk within the wliite and on the yolk a tiny speek or germinal spot. The formation of eaeh woman's full quota of ova, fifty thousand or more, is probably complete at the time of her birth. The vagina is a nniscular tul)i'. or passag-e way, leading from the outside of the body to tlic cervix, which you will remember is the lower ])art of tlic uterus. The vagina slopes upward from its opening and instead of meeting the cervix evenly it meets it almost at right angles and en- eases it like a sheath for about half an incli. Fig. 2 shows how these organs would appear if we were looking at them from the side. The Bladder. Jf you will glance again at P'ig. 2, you will see that just in front of the vagina there is a tiny ])assage leading up to a sac which also is in front of the vagina, and since in this picture it is practically empty, it lies below the uterus. This sac is the bladder and you can readily understand that as the uterus enlarges during pregnancy, it presses upon the bladdei- and this pressure on the outside gives the same sensation as is produced by pressure from the inside when the bladder is filled with urine. That is why the expectant mother has such a constant desire to urinate during the early weeks of pregnancy, before the uterus pushes up into the abdomen, and also during the later weeks, as well as during labor, when the bladder is being pressed upon by the baby's head. The Rectum. In the same picture you will see the rec- tum which lies just behind the uterus and vagina and which terminates in the anus. Between the rectum and the vagina is a thick triangulai- mass of muscle, called tlie perineum, which practically forms a fioor to the pelvis, the bony basin without a bottom. The external genitalia, sometimes called the vulva, really have nothing to do with the creation of the baby, but 28 GETTING READY TO BE A MOTHER you will better understand some of the care that is given you if you know a little about them, too. Between the thighs, where they join the body, are two thick folds of flesh, called the labia and between these lie the perineum, just mentioned, and the openings from the rectum, vagina and bladder as shown in Fig. 2. Now that w^e have something of an idea of the structure of the organs concerned with tlie creation of the baby, we shall want to learn about the usual activities of these in- teresting little parts, before the baby begins his life within them. Puberty or Adolescence. You know, of course, that girls are incapable of becoming mothers until after what is termed puberty, or adolescence, and by these terms we mean the period during which childhood develops into sexual maturity, and the individual becomes capable of re- production. The age at which puberty occurs varies with climate, race and occupation and with different individ- uals of the same status. But the average for girls, in tem- perate climates, is from the twelfth to the sixteenth year and for boys from the fourteenth to the seventeenth year. Girls in southern climates sometimes mature as early as the eighth or ninth year while in colder regions puberty may be delayed until they are eighteen or twenty years old. The occurrence of puberty marks the establishment of ovulation and menstruation, tAvo functions which are usu- ally performed once a month during the ehildbearing period. Ovulation, which probably- occurs abovit midway between the menstrual periods, is simply the name which has been given to the principal function of the ovary and may be defined as the development of the ovum, or egg, and its ex- pulsion, when mature, from the ovary. As the entire hu- WHERE THE BABY'S LIFE BEGINS 29 man body has its origin in this tiny ovum, its career and course of development are of momentous importance to us, and at the same time furnish a tah- of ahsorl)ing: in- terest. The ovaries ai'c i)acke(l full of these tiny egg-like cells, which probably lie dormanl, as stated before, until the girl reaches ])ubei'ty. Then tiiey begin to develop and grow and push their way fi'om the inside of the ovary to the surface where they look more or less like blisters. When an ovum reaches the sui'face of the ovary, a thin membrane which contains it, bursts, and it is suddenly expelled into the abdominal cavity. You will remember that the ovary is very near the funnel-like end of the tube, so. when the little cell is shot out of the ovary, it finds itself floating around quite close to this wide opening. Some of the ova that are projected into the abdominal cavity are doubtless lost, but others find their way into the near-by mouth of the tube, and if not fertilized by uniting with a male cell, wiiich w^e shall explain presently, they i)ass down the tube into the uterus and are finally carried out in the menstrual flow. It is probable that as a rule only one ovum ripens and es- capes from the ovary each month from puberty until the menopause or change of life. The interesting thing al)out all of this is that each time an ovum does mature and is discharged from the ovary, the lining of the uterus becomes thicker and softer in order to facilitate the attachment of the ovum, if it is fertilized, this attachment being necessary if a baby is to develop. This preparation of the utei-ine lining is often, and very appropriately, referred to as "nest-building." Menstruation, which is the evidence of sexual maturity, is a monthly hemorrhage from the uterus, escaping through the vagina, and it normally i-ecurs regularly throughout the child-bearing period, except during pregnancy and while the young mother nurses her baby. The length of this child- THF PAPFCIP r»r»/IOT indnatii 30 GETTING READY TO BE A MOTHER bearing period is about thirty years and continues from puberty until the menopause. The frequency of the men- strual periods varies from twenty-one to thirty days but the normal interval between periods is tw^enty-eight days, which is the length of what is called the ' ' menstrual cycle. ' ' Thus it is usually a lunar month from the beginning of one period to the next one, making thirteen menstrual periods during each calendar year. The complete course of a men- strual cycle consists of four stages, which, it is believed, occur somewhat as follows : The first, or constructive stage, lasts about seven days. It is during this stage that the preparations are made to receive the ovum traveling down the tube. The entire uterus becomes congested with blood and is somewhat en- larged and softened as a result, while its lining grows red, thick and velvety. If the ovum remains unfertilized, which is usually the case, it does not attach itself to this elabo- rately prepared lining, but passes out with the uterine dis- charges and all of this preparation not only goes for naught but must be undone. The second stage, therefore, which lasts about five days, is the destructive stage and is the period we speak of as menstruation. During this period the extra tissue which has been formed in the uterus is broken down ; it mixes with the blood that oozes from the congested lining and together they pour from the vagina as the menstrual flow. The third or reparative stage, which follows, occupies about three days during which time the uterus and its lin- ing return to their normal state. The fourth, or quiescent stage, now follows and lasts twelve or fourteen days. This is the time remaining before Nature, with unwearying patience, begins all over again to prepare for the reception and attachment of the next ma- WHERE THE BABYS IJFE BEGINS M tiircd ovum, in case of its possiblo fertilization. And so it goes, month after month and year after year. It is very important for a woman who is suffering from painful menstruation to consult a doctor about correcting the cause, in the interests of her future child-bearing, if for no other reason, for this is one step toward preparing a good soil in which to plant the seed from which a baby may grow\ For example, a misplacement of the uterus i a frequent cause of painful menstruation and if it re- mains uncorrected may make conception impossible; or if conception perchance does take place, the malposition of the uterus may, later, be the cause of an abortion or mis- carriage. Inflammation of the lining of the uterus is an- other cause of menstrual difficulty and if allowed to persist, may interfere later on with the normal development and nourishment of the baby. The menopause, also termed the climacteric, or the change of life, marks the permanent stopping of menstrua- tion and ability to bear children. This ordinarily occurs betW'Cen the ages of forty and fifty, the majority of women ceasing to menstruate during their forty-sixth year. The most favorable age for motherhood to begin is a sub- ject of considerable interest to most women. When it is considered from all standpoints, social, ethical, spiritual as well as physical, the most favorable age for motherhood to begin seems to be sometime in the early twenties. Chil- dren have been born to little girls nine years old and to women over sixty, but the extremes of the reproductive years are not favorable periods for child-bearing. Now a word about the breasts. Tliej' appear to be merelj^ large, soft masses of fat, one on each side of the chest, having no connection with the pelvic organs. But in reality they are very complicated glands and strangely enough, though no one knows why, their activities are con- 32 GETTING READY TO BE A MOTHER trolled by the activities of the generative organs down in the pelvis. Certain it is that their function is very im- portant to the baby, for the breasts are the factories in which nourishment is produced to nourish him during the first few months after he is born. If we could look inside of the breasts we should see that in structure they are much like several clusters of grapes Fig. 5. — Front view of breast, showing areola ; openings from milk ducts and the glands beneath the skin. in which the stems and grapes are hollow. The milk is formed in the tiny sacs corresponding to the grapes, and pours into the little tubes conforming to the stems; these empty into a central tube, opening upon the surface of the nipple from which the baby will extract his nourishment. If you will look at Fig. 5 you will see in that picture of the front of a breast, that a part of it apparently has been magnified to show these openings of the milk ducts. There WHERE THE BABY'S LIFE BEGINS 33 are about fifteen or twenty of them in each nipple. The picture shows also the little frlaiuls which appear as small lumps under the skin ai-onnd the nipple, both in the dark circle called the (inula and in the white skin surround- ing it. Summing up this chapter briefly, we find that the pelvis is an irregular, bony canal or l)asin, drawn in about the middle, thus forminjr the ui)i)er, or false pelvis and lower or true pelvis, neither of which has a bottom. The open- ing between these two basins is called the inlet, while the low^er margin of the true pelvis is called the outlet, but it is the inlet that is of particular importance during child-birth. In the center of tlic lower pelvis and swung upon ligaments attached to its sides is the uterus, whose lower part, called the cervix, extends downward into the vagina ; while reaching out from the upper corners of the uterus are tlie tubes, and near their open ends, one on each side, are the ovaries filled with germ cells called ova. The bladder lies in front of the uterus and vagina and the rec- tum behind, while below is the perineum, forming a flqor to the pelvic cavity. Every four weeks during the child- bearing years an ovum is expelled from one of the ovaries into the abdominal cavity and the uterus regularly pre- pares to receive it in case of its fertilization, but if it is not fertilized the ovum is lost and menstruation occurs. We see, too, that although the breasts are situated re- motely from the pelvic organs thej' are really very im- portant accessories, since they provide milk to nourish the baby after his life within the uterus is terminated by his birth. CHAPTER IV HOW THE BABY DEVELOPS BEFORE HE IS BORN Now that we know something of the place where the baby's life begins and how the way is prepared for his growth, we are ready to follow the interesting course of events that occur from the time the seed, a tiny egg-like cell, bursts from an ovary until the beautiful, fully de- veloped baby comes into the world. You will remember that Avhen the ovum is expelled from an ovary it may float about in the abdominal cavity and be lost or it may enter the near-by mouth of a tube. Also that if it enters a tube it is carried downward tow^ard the uterine cavity by the sweeping motion of the hair-like projections on the lining of the tube. This journey of the ovum through the tube is of enormous consequence, for dur- ing its course occur the events which decide whether the ovum shall, like most of its fellows, be simply swept along to no end and lost, or whether by chance it is to receive the mysterious impulse which begins the development of a new human being. The amazing power which enables this cell to reproduce itself, and to develop with unbelievable complexity is acquired somewhere in the tube, usually in the upper end, by meeting and fusing with a sperma- tozoon, the germinal cell of the male. The spermatozoa are attracted to the ovum much as bits of metal are drawn to a magnet, but although the ovum that is destined to be fertilized is surrounded by several spermatozoa, only one actually enters and fuses with it. 34 HOW BAIiY DP]VKL()1»S l>,P]FORE BIRTH :r) This fusion is termed fertilization, or, in lay i)arlanee, conception, and the instant at which it occurs marks the beginning' of pregnancy. The establishment of this fact is of considerable importance, since it does away with any possible controversy concerning tlie time at which a new life begins. The origin of the baby is exactly coinci- dent with the fusion of the male and female cells. Fur- thermore, the sex of the cliild and any inherited traits and characteristics are also established at this decisive moment. No amount of dieting, exercise or mental effort on the part of the expectant mother can alter or influence them in the smallest degree, for the father has made his complete contri- bution toward the creation of the new being and the mother, also, has made hers, except for nourishment which she provides throughout pregnancy. All told, probably more than five hundred theories have been advanced to explain -what it is that decides of which sex the forthcoming child is going to be. But as the results of applying these theories have scarcely borne out the claims of their advocates, they are given but scant attention to-day. The present belief regarding the causation of sex is that although there is but one kind of ovum, there are two kinds of spermatozoa, one capable of producing a male and the other a female child, but the sex-determining form of the male cell that fertilizes any one ovum is a matter of the merest chance. Statistics shoAv that more male than female babies are born, the usual proportion being about 105 boys to 100 girls among those who are carried to "term" or the end of pregnancy. Among abortions and prematurely born babies there is also a larger number of boys than girls, but as more boj's than girls die in infancy, the two sexes about even up in the number of those living to adult life. 36 GETTING READY TO BE A MOTHER Concerning the time of the month when conception is most likely to occur, there is a wide difference of opinion. Some doctors think that the most favorable period is just before or just after menstruation, while others believe that conception is most likely to take place about midway be- tween the menstrual periods. Returning to the ovum which meets a spermatozoon in the course of its journey down the tube, Wc find that as Latev staceS of ceU division. Fig. 6. — Diagram indicating process of cell division. soon as a spermatozoon enters an ovum it disappears and is completely absorbed, and, as the ovum in turn is instantly possessed of new powers, through the presence of the male cell, the result of this union is an entirely new cell. But instead of continuing its existence as a single cell, the fertil- ized ovum divides into two cells ; these two into four ; the four into eight and so on until a clustering mass of cells is formed which looks something like a mulberry. If you will look at Fig. 6 you will see what happens as this cell division progresses and also that in time the cells rearrange them- selves in such a way as to leave a space in the center of the now I'.Ai'.v I)i:\'i:l()I's p.kkoi;!-; iiiiri'ii wi mass so that it becojiics a little sac with a cliistcr ol' cells at one point, which liaii<,'s toward the center, called tiie internal cell mass. This will interest yon becanse it is from cells at one point in this little cluster that the baby begins to de- velop, together with the cord, bag of waters and after- birth, to be described later. While these changes are taking place, the entire mass is being carried slowly down the tnbe toward the nterus by the sweeping motion of tiic soft little hairs on the lining of the tube. It is steadily growing, and by the time it reaches the uterus the mass is about the size of the head of a pin. As you will remember, the lining of the uterus prepares each month to receive the fertilized ovum, becom- ing soft and thick. The cell mass floats around for a little while after it reaches the uterine cavity and then resting at some point, sinks down into the soft lining and is completely buried. From now on the cells which compose the mass rapidly increase in number and very shortly cease to be all of one kind. These different kinds of cells rearrange themselves and grow in such a manner that some of them begin to form the different parts of the baby's body and others develop into two thin membranes that finally enclose the baby in a double sac. lie is attached to the inner surface of the sac ; the space which he does not occupy is filled with fluid and the sac itself is attached to the uterine lining at the point where the cell mass happened to stop and bury itself. This sac is what you have heard called the "bag of waters," but the doctors refer to it as the membranes. As it enlarges and pushes out into the uterine cavity it still consists of two thin membranes except where it is attached to the uterus, at which point it grows into a thick, spongy mass of blood-vessels. These blood-vessels divide and 38 GETTING READY TO BE A MOTHER branch out in a tree-like fashion and burrow into the uterine wall. As you will see later, it is through this mass of branching blood-vessels that the. baby virtually eats and breathes and gives off waste materials during the nine months of his life within the uterus. The doctors refer to Tut^^^ c^-viTv Fig. 7. — Diagram showing the developing baby, at an early stage, with cord, membranes and placenta, within the uterine cavity. the mass as the placenta but you have heard it called the "afterbirth," because it is expelled after the baby is born. As the baby's development advances the part by which he is connected with the placenta lengthens out into what is called the umbilical cord. There are blood-vessels in this cord through which blood constantly flows back and forth, carrving nourishment to the baby from his mother now i5Anv DKVKivors i'.ki-'oiji-: luirni ;{!) and waste matter from his little body to the plaeenta where it is taken up by her blood. I>iit this exehaiifre of materials takes place tiiroufjh tiiiii )iiembraiies and eonsequently the blood of the mother and baby never mingle. Fig. 7 will give yon an idea of how the sae of membranes, with the baby hanging inside, grows out into the uterine cavity; how at the point where the membi-aiu's are attached to the uterus the blood-vessels lia\e develoi)ed into the thick, spongy placenta and liow the baby is connected with it by means of the cord, in Fig. S yon nuiy see how the baby changes in ajipearaiu-e as the weeks of ])regnancy go by. At the end of the fourth month he I'cally looks (|uite like the baby that we are so eagerly preparing for. If we follow his development within the uterus month by month, we fiiul that by the end of the first lunar month, or fourth week, the bal)y's body is about i/. inch long and looks about as is suggested in the third little outline in Fig. 8. At the end of the second month, or eighth week, his head is fairly well shaped; bones are beginning to develop, webbed hands and feet are formed and the little body is about 1 inch long. At the end of the third month, or twelfth week, his entire body shows mai-ked development and is about 31/2 inches long. His fingers and toes are separated and bear soft nails ; the teeth are fonning, the eyes have lids and the umbilical cord has taken definite form. At the end of the fourth month, or sixteenth week, in addition to the development of all parts a fine, soft hair appears over the body; there is a black, tarry substance, called meconium, in the I)ab\'s intestines and he measures about 6 inches in length and weighs perhaps 1/4 pound. By the end of the fifth month, or twentieth week, the baby lias grown and developed mai'kedly. lie is now cov- 40 GETTING READY TO BE A MOTHER w- '-' w So 5H P. HOW HAIiV DKVKLOI'S I'.KKOliK lilKTII 41 ered with skin on which are occasional patches ol' a greasy, cheesy substance called vernix caseusa, and though there is some fat beneath the skin his face looks old and wrinkled. A certain amount of hair has appeared upon the head and the eyelids are opening. It is usually during the fifth month that the expectant mother first feels her baby move, this sensation being commonly referred to as "quickening." He is now about 10 inches long and weighs about H nnnces. By the end of the sixth month or twenty-fourth week, the baby is about VI inches long and weighs possibly II/2 pounds. He is thin and wrinkled in appearance and if born at this time will attempt to breathe and move his limbs but will perish in a short time. By the end of the seventh month, or twenty-eighth week, he still looks thin and scrawny; his skin is reddisli and is well covered with the cheesy vernix caseosa. If born at this stage, the baby will move quite vigorously and cry feebly, but he is not likely to live for any length of time. He is now about l-t inches long and weighs about 2% pounds. By the end of the eighth month, or thirty-second week, the baby has grown to about 17 inciies in length and -4 pounds in weight, but continues to look thin and old and wrinkled. His nails do not extend beyond the ends of his fingers but are firmer in texture ; the soft, downy hair begins to disappear from his face but the hair on his head is more abundant. If born at this stage, the ])aby will have a fair chance to live, provided he is given painstaking care. This is true in spite of the old belief, still widely current, that a seven months' baby is more likely to live than one born at eight months (meaning calendar months). The fact is that after the twenty-eighth week the i)rol)ability of the baby's living increases greatly with each added week of life within the uterus. His growth during the latter part of pregnancy 42 GETTING READV TO BE A MOTHER is rapid, for he gains nine tenths of his weight after the fifth month and one half of liis weight during the last eight weeks of uterine life. At the end. of the ninth month, or thirty-sixth week, the increased amount of fat under the baby's skin has given a plumper, rounder contour to the entire body; the aged Uterine ^^^':>'<^^^ Pi a cent CoydL VJtertn External Fig. 9. — The usual position of the baby just before he is born. look has passed and his chances for life have greatly in- creased. He weighs about 5I/2 pounds at this stage and is perhaps 18 inches long. The end of the tenth month, or fortieth week, usually marks the end of pregnancy. Fig. 9 will show ,you liow the baby lies in the uterus just before birth, curled up into the smallest possible space. now liAin' i)i:\KL()i»s ijkkoi^k I'.iirrii 4;{ The average iionnally devdojx'd Itahy lias grown to a length of about 20 inches and weighs about 7V4 l)'>uiids, bo^'S usually being about three ounces lieavier than gii'ls, but there may be a variation of weight among entirely normal, healthy babies from a minimum of 5 pounds to as high as 11 pounds or more. Newborn l)abies very seldom weigh more tiian 12 pounds, in spite ol' h'gends and rumors to the contrary. The size of the baby is affected by the race of his parents ; colored babies/for example, averaging a smaller weight than white babies. And, as might be expected, the size of the parents is likely to be reflected in their infants, large par- ents tending to have large children and vice versa. The number of children which the mother has previously borne is also a factor, since the first child is usually the smallest, the size of those followdng showing an increase with the mother's age up to her twenty-eighth year, if her preg- nancies do not occur at too frequent intervals. Twins. Sometimes a woman gives birth to more than one baby at the same time. When there are two they are called twins ; triplets when there are three ; quadruplets, quintuplets and sextuplets respectively, when there are four, five and six babies within the uterus at once. Six is the largest accredited number on record. It is estimated that twins occur once in ninety preg- nancies and triplets once in about seven thousand cases. The tendency seems to be inherited, as is evidenced by the number of twins and triplets to be found among relatives. Twins are often prematurely born and each is likely to be smaller than a baby resulting from a single pregnancy, but their combined weight is greater than the weight of one normal baby. Extra-Uterine Pregnancy. Another departure from the normal pregnancy is when the baby develops outside of the 44 GETTING READV TO BE A MOTHER uterus. Although in the normal course of events the fer- tilized ovum travels down the tube and becomes attached to the uterine lining, it is possible for it to stop, and more or less completely develop at any point along the way. This is called an extra-uterine pregnancy, since it occurs outside of the uterus. If the baby develops in one of the ovaries, it is termed an ovarian pregnancy, and a tubal pregnancy if it develops in a tube, this being the most frequent variety of extra-nterine pregnancies. Only about one out of a hundred such pregnancies continue throughout the allotted period, and accordingly, a live baby, capable of living for any length of time, seldom results. To sum up a normal pregnancy, we find that in the course of ten lunar months following the fertilization of an ovum, the uterus grows from a small, flattened pelvic organ, 3 inches in length, to a large muscular sac, about 15 inches long occupying the abdominal cavity. It increases its weight sixteen times, that is, from 2 ounces to 2 pounds, while the capacity of the uterine cavity is multiplied five hundred times. Within the uterus is a baby weighing about 7I/4 pounds; a placenta weighing perhaps ly^ pounds and ap- proximately- a quart of fluid. The baby is attached to the placenta by means of a jelly-like cord about as thick as one's first finger and 20 inches long; baby, placenta, cord and fluid all being contained in a thin, but strong sac fre- quently called the bag of waters, but by the doctors termed the membranes. The total weight of the uterus and its contents at the end of pregnancy is usually about 15 pounds. Throughout the baby's life within the uterus, the placenta virtually acts as his digestive organs, lungs, kidne.ys and bowels. Bear this in mind, and you will realize why, in taking care of yourself you are taking care of your baby while his body is being built and getting itself into running HOW BABY DEVELOI'S I'.KFORH P.IRTII 45 order to take up lit'c as a separate l)ein'0()(1 for you is <;oo(l for your baby will make you eager to give yourself the eare that is out- lined in the next chapter. CHAPTER V TAKING CARE OF THE BABY BEFORE HE COMES We shall see that taking- care of your baby before he is born means taking- surh care of yourself throughout pregnancy, that you not only keep your own body in its usual good running order, but in addition, so effectively promote the activities of your various organs that you also keep the baby's body going, his body that is grow- ing all the time. Quite reasonably this requires extra work on the part of some of your organs, particularly those concerned with digestion and the process of throwing off impurities. The latter is of the greatest possible importance for in addition to excreting the usual amount of impurities from your own body you must excrete also those thrown off' by your baby. The amount of waste from him is not large but it seems to be of such a character that it harms the mother if it is not steadily excreted. Good digestion and satisfactory excretion are dependent upon a number of factors and fortunately most of them are wdthin your own control. Your frame of mind is one of the most important factors of all. I know that to suggest the cultivation of a cheerful, hopeful mental attitude is easier said than done. But after all it really is largely a matter of habit which you can acquire if you set yourself to it, particularly if you realize that your physical condition will be benefited by your going through pregnancy happily. And remember that Avhatever is good for you is good for your baby. 40 CARE OF Tiir: I'.Ai;^' i;h:K()i,"i'; iik co.Miis 47 Contiiiiic with the work, amusements iiiid exereise that you are used to and enjoy, except of course such itetivities as the doctor may forbid. In jjjcncial, try to forget that you are pregnant, so far as you can (h) this and still re- member to take ])ropcr cai'i* of yoni-sclf. Above all, don't Mony. Worry will iiilerfere with your sleep and it will also upsci your digestion quite as seri- ously as will wi'ong food. Tvy not to Ix' too self-centered or too watchful of your syinptoins, hui at tiie same time avoid the dangerous habit of thinking that any unusual con- dition which develops is due to your being pregnant, for a sick pregnancy is not normal. It will relieve you of a great deal of anxiety if you report to your doctor everything you do not understand, for the consciousness that he will know just what to do, if anything is necessary, will help to keep you from worrying. It is important, too, for you to get rid of the depressing beliefs in connection with pregnancy that have come down to us through the ages. For instance, do not believe for a moment that anything you do, think or see can "mark" or deform your baby, for remember that after conception you give him nothing but nourishment. The only communication between you and the baby is through your and his blood, and l)lood does not carry mental impressions. Accordingly, no etfects of fear, horror or unpleasant memories which you may have can possibly reaeli him. It is true that once in a while a woman does see something shocking and later gives l)irth to a marked or deformed baby. But there is little doubt, now, that such an occurrence is merely a coincidence. If you will stop and think for a moment you will realize that most expectant mothers see or lieai- or think something unpleasant at some time during pregnancy, and yet most babies are born witliout mark or blemish. Anger, fright 48 GETTING KEADY TO BE A MOTHER or sudden shock may upset your digestion, but it does not directly affect your baby. As for that common belief that in "reaching up" the mother maj" slip the cord around the baby's neck — if yon will picture for a moment liow the baby lies Avithin the uterus you will realize how impossible this is, for the mother's arms have no connection with hiin or the cord. So dismiss tlieso doubts and fears from your mind and dwell instead upon the loveliness of wliat is in store for you, for, I repeat, your pliysical condition will be bene- fited if you go through pregnancy happily. And remember again that whatever is good for you is good for your baby. So your first step toward caring for the little life already within your charge is to follow the example of Mrs. Wiggs, who constantly wiped the dust from her rose-colored spec- tacles. Now for the more specific details of your care. Of these the question of your diet is of enormous importance. Let us consider first what your food accomplishes if it is suitable and conditions are favorable for its use by you and the baby. It should provide nourishment for your various tissues, as under ordinary conditions; it should promote the activities of your skin and kidneys, as well as bowels, since it is tlirough them tliat the waste from your own and your baby 's body must be excreted, and your food should be adequate also, to build and nourish the baby's body without his having to draw materials from your tissues. Strange as it may seem, the baby's physical needs are supplied before yours are met, and if there are not enough food materials for you both, your bones, teeth and muscles will be deprived. Eurthermore, taking proper food during pregnancy is an important step toward preparing yourself to nurse your baby, after he is born, which is quite as urgent as nourishing him before birth. CARE OP TIII^] BABY IJIOFOKK 11 H COMES 49 To accomplish these ends you not only must eat suitable food, but you must difrest and absorb it as well. Tliis re- quires that you constantly gruard a^rainst overeating, con- stipation and indigestion ot" any kind. Indigestion may be avoided during pregnancy exactly as it is at other times, by eating proper food. I)\' cultivating a happy frame of mind; by having sut^icicnl c.xcrcise. fresh air, rest and sleep. If you are accusioiucd lo a fairly sinii)lc, well balanced, mixed diet, you probjibly will need to nuike little or no change, except to iuive the evening meal light if it has been a hearty one. It may surprise you to learn that you need not "eat for two,'' in ((uautity. as is so commonly believed necessary, for during pregnancy you make so nuich better use of food materials than usual that an amount and kind of food that keep you in good condition will be adequate to meet your baby's needs, too. until the latter part of preg- nancy. On the other hand, it is very unwise for an expect- ant mother to cut down her diet, with the idea of keeping the baby snudl and thus make labor easy, except under the direction of her doctor. In general it is the size of the baby's head that makes labor easy or difficult, and not the amount of fat distributed over his body. And if the mother cuts down the miiu'rals in her diet to make the baby bones soft, the only result is that her own bones and teeth are softened, because the baby extracts from them enough lime to supply what the food lacks. Three meals a day will usually be enough during at least the first half of pregnancy and they should be taken with clock-like regularity, eaten slowly and masticated thor- oughly. The possible need for slight additional food during the later weeks may be supplied more satisfactorily by lunches of milk, cocoa or broth and crackers or toast, be- tween meals ;iiid upon retiring, than by taking larger meals. 50 GETTING READY TO BE A MOTHER An expectant mother who has a tendency to nansea early in pregnancy often feels better for taking a small Innch regularly five or six times daily instead of the usual three full meals. It is of the greatest importance that every pregnant wom- an drink an abundance of fluid to act as a solvent for her food and waste material and promote the activity of her kidneys, skin and bowels. She needs about three quarts daily, most of which should be water, the remainder consist- ing of milk, cocoa, soup and other liquids. Alcohol should not be taken except upon the doctor's orders and only moderate amounts of coffee and tea, unless he gives per- mission for more. The expectant mother will be wise to avoid fried food, pastry, rich desserts, rich salad dressings and any other food which would ordinarily disagree with her. Since the enjoyment of one's meals promotes digestion at all times, the expectant mother should try to eat the things that she enjoys most and that agree with her. The average pregnant woman who has no symptoms of com- plications will usually be able to supply her own and her baby's needs and at the same time keep within the bounds of safety if she selects her diet from the foods included in the following groups : Animal Foods. INIilk and eggs are the most satisfactory, but for the sake of variety and to tempt her appetite the expectant mother will usually be allowed to take rather sparingly, and preferably only once a day, of fish, the various kinds of shell fish, beef, lamb, chicken or game. Pork, veal and goose should be avoided as a rule, and par- ticularly by women with whom they ordinarily disagree. Soups. Thin soups and broths have little food value but because of their appetizing flavor and aroma are an aid to digestion, and frequently by stimulating a flagging appe- CARK OF TTTK r.AliV liKFOKP] HE COMES 51 tite ^vill hell) the expectant mother to eat and assimilate more than she would without them. But eream soups and purees have a hi^h food value and, like thin soui)s and broths, also supply a definite amount of fluid which she must have. Vegetables. The group of vegetables generally desig- nated as "leafy" are of even greater importance to the expectant mother than they are to the average person. Of these she may safely eat onions, asparagus, celery, string beans, spinach, and she should make a point of taking a green salad, such as lettuce, cress or romaine, at least once daily. Sweet potatoes, white potatoes, rice, peas, Lima beans, tomatoes, beets and carrots, also, may be eaten with safety, as a rule, but cabbage, cauliflower, corn, egg-plant, Brussels sprouts, parsnips, cucumbers and radishes should be taken with gi*eat caution and avoided altogether if they cause gas or any kind of distress. Fresh Fruits. A necessary part of the diet is fresh fruit, and among those fruits which are both beneficial and usu- ally harmless are ap])les, peaches, apricots, }iears, oranges, figs, cherries, pineapple, grapes, plums, strawberries, rasp- berries, blackberries and grapefruit. These are more likely to be laxative if eaten alone, as before breakfast and at bed- time. Cooked fruits are also valuable articles of diet, but are probably less laxative than raw fruit. Some of the citrous fruits, oranges, grapefruit or lemons, should be taken daily because they i)0ssess a certain indispensable food value Avhich is peculiar to them. Cereals. For their nourishing and laxative qualities, cereals are important and their food value is increased by the milk and cream which are usually taken Avitli them. Cooked cereals should invariably be cooked longer than the usual directions suggest. Bran, eaten alone as a cereal or in combination with other grains, is an excellent laxative. 52 GETTING KEADY TO BE A MOTHER Breads. Graham, eoriimeal, whole wheat and bran bread are all good, in general the expectant mother will be on the safe side if she eats sparingh', if at all, of very fresh or hot breads and hot cakes. Desserts. Desserts are very important for they add to the attractiveness of most people's meals, and if wisely chosen and properly made, may snppl}^ a good deal of easily digested nonrishment. They may include, in addition to fresh and cooked fruits and preserves, ice-cream, a wide variety of custards, creams and puddings made largely of milk, eggs and some ingredient to give substance and firm- ness, such as gelatin, cornstarch, rice, tapioca, farina, ar- row-root and similar materials. In general the expectant mother should eat an abimdance of fruit and vegetables, taking at least some uncooked fruit and a green salad, daily, and make sure that her food con- tains a good deal of residue, such as is provided by fruit and coarse vegetables. This residue increases the bulk of the material in the intestines, and this helps to overcome the tendency toward constipation. As fat is less easily digested than starchy foods, and more likely to cause nausea during pregnancy, it is better to eat no more fat than usual but to supply the additional material which is needed after about the sixth month, by taking a little more starchy food. How- ever, a slight increase only is necessary, and this chiefly during the last three or four weeks. The Kidneys. It is scarcely possible to say enough about the importance of keeping your kidneys in normal working order during pregnancy, for through them is excreted much of the waste matter from your baby's body as well as your own. Sometimes when these impurities are not thrown off as they should be the expectant mother has con- vulsions. You will be glad to know how much you yourself can do toward preventing convulsions l»y drinking plenty CARE OF TIIF. BAliY V.KFOliK UK COMES 53 of water and by faillifully measuring ^-oiir ui-ine and taking a specimen to tlie doctor when he asks you to. As I said before, you should drink at least three quarts of tiuid every (lay. .Most of this should be water, the remainder being milk, cocoa, soup, tea, coffee, and so on. The doctor will probably want you to measure your urine and take a specimen to liim once a month during the first half of pregnancy and every two weeks afterward, or even every week toward the end. lie can tell by examining the urine whether your kidneys are acting as they should and if they are not he may save you serious trouble by put- ting you to bed for a few days with no nourishment but milk and water. In preparing a specimen you will need a covered corked vessel large enough to hold all the urine passed in twenty- four hours, and it must be thoroughly washed and scalded. The next step is to pass urine, suppose we say at eight o'clock in the morning, and throw it away. All of the urine which you pass after this time until eight o'clock the next morning must be saved in the vessel and kept in a cool place to prevent its decomposing. If you will put a tea- spoonful of chloroform or boraeic acid powder into the ves- sel it will tend to preserve the urine and will not injure the specimen. At the end of twenty-four hours the urine should be shaken to mix it thoroughly and about half a pint }K)ured into a bottle that has l)een washed and scalded. Carefully cork and label this with the date, your name and address and the total amount of urine passed in the twenty-four hours. The vessel for collecting the urine and whatever you use as a measure should be reserved for these purposes only. If 3'ou have no tin or glass measure, a regular-size quart tomato can will prove entirely satisfac- tory. If you find, when measuring your urine, that you pass 54 GETTING KIOADV TO liE A MOTHER less than a quart and a half in twenty-four hours, you may know without being told tliat this is not enough and that you should drink more water. The Skin. People are likely to think of the skin as being simply a covering for the body, whereas, in reality, it is a very complicated and active organ which helps to regulate the body temperature and constantly throws off impurities, just as the kidneys do. This latter function is performed by the sweat glands which open upon the surface of the skin as the "pores," and we are told that in all there are some twenty-eight miles of these tiny tube-like structures in the skin. These glands should be, and usually are, con- stantly active ; they pour upon tlie surface of the body an oily substance which keeps the skin soft; the}" also excrete something more than a pint of water daily, which contains impurities that are harmful if retained in the body. We are not aware of this constant excretion of fluids, which is termed "insensible perspiration," but it continues even in cold weather and must not be stopped if health is to be preserved. If the oil, dust, particles of dead skin and the waste material left by dried perspiration are allowed to remain upon the surface of the body they will clog the pores, or gland openings, and thus interfere with their ac- tion. The removal of this material, then, is necessary to maintain health, and is done automatically in part for the fluid evaporates and much of the solid matter is rubbed off on the clothing. The most important aids to the skin's activity are the drinking of plenty of water, deep breathing, exercise and warm baths. Regular and thorough bathing serves the double purpose of removing waste matter already on the surface, and of stimulating the glands to increased activity in giving oft' still more. Many doctors advise a warm, not hot, shower or tub bath CARE OF THE IJAP.V BEFORE HE COMES 55 every day, with soap used freely over tlie entire body, fol- lowed by a brisk rub. The best time for this warm, cleans- ing batii, as a rule, is just before rctii-ina:, as it is soothing and restful, and tends to induce sleep. Very hot baths are fatiguing, particularly during jiregnancy. and should never be taken except with the doctor's i)erniission ; but cold baths usually may be contiinied througliout pregnancy if one is accustomed to them and reacts well afterwards. Un- der these conditions the morning cold plunge, shower or sponge is beneficial, as it stimulates the circulation and thus promotes the activity of the skin. Some doctors for- bid tub bathing of any kind after the seventh month, on the ground that as the expectant mother sits in the tub her va- gina is filled Avith unsterile water and should labor occur shortly afterward an infection, or fever, might result. And as she is heavy and somewhat uncertain on her feet, there is also the danger of her slipping and falling while getting in or out of the tub. Other doctors permit tub baths throughout pregnancy, up until the onset of labor ; while as to hot foot baths, since there seems to be no reason for or against them at any time during the nine months, they may be taken or not at will. Bathing in a quiet stream or lake is apparently harmless but sea bathing, if the surf is rough, is inadvisable because of the beating of the waves upon the abdomen and the gen- eral violence of the exercise. The importance of keeping the body evenly warm throughout pregnancy cannot be overemphasized, for a sud- den chilling or wetting may so check action of the skin as to impose more of a burden upon the kidneys than they can meet, in their effort to throw off the skin 's share of the body waste. Accordingly, a single chilling will sometimes be enough to cause convulsions. This may be one reason why convulsions occur more frequently during cold weather 56 GETTING READY TO BE A MOTHER or after a sudden drop in the temperature after warm or mild days. The Bowels. The bowels, also, throw off a certain amount of impurities and if they do not move thoroughly at least once a day these impurities may be taken into the system and again the kidneys be given extra work. Unhappily a great many pregnant women are consti- pated, particularly during the later weeks, while women who have always had a tendency of this kind may have trouble with their bowels from the very beginning of preg- nancy. Your bowels should move regularly every day, and to this end you should attempt to empty them at the same hour each day, immediately after breakfast being the best time. The importance of regularity in making the attempt cannot be overemphasized, even though the bowels do not always move. The measures which tend to prevent constipation, as al- ready pointed out, are drinking plenty of fluids, and eating fresh fruit, coarse vegetables and bulky cereals such as bran ; also taking a glass of hot or cold water just before going to bed and the first thing in the morning. You should not take enemas or cathartics without j'our doctor's order, but you may safely increase the amount of fluids which you drink and the bulk of your food, in order to regulate your bowels. Senna and prunes cooked together prove to be helpful in keeping the bowels regular and the}" are entirely harm- less. A simple way of preparing them for this purpose is to pour a quart of boiling water over an ounce of senna leaves and allow them to stand for about two hours. A pound of well washed prunes should soak overnight in this liquor, after it has been strained, and then cooked in it until tender. They may be sweetened with two tablespoonfuls of brown sugar, and the flavor improved by adding a stick CARK OF TIJK HAI'.V 1;KK(>KI<: 1 1 10 COMKS 57 of cinnamon or slice of lemon while they are cooking?. Half a dozen of these prunes, witii some of tlie syrup, may be taken at the evening meal to start with, and increased or decreased in number as necessary. Clothes. The chief i)urp()se of clothes under all condi- tions is to aid in keepinji' the body warm, thus helping to preserve an even circulation of the blood and the activity of the sweat glands. As has been jwinted out, this is of espe- cial importance during pregnancy. Tlu' expectant mother's clothes should be not only sutificiently wai-m, but they should be equally warm over her entire body. They should be light and porous, and fairly loose, so as iiot to interfere with the circulation or other bodily functions. There must be no pressure on chest or abdomen ; no tight garters, belts, collars or shoes. The clothes of the mother-to-be, like every other detail of her care, must be adapted to her surrouiulings and mode of living. If her house is well and evenly heated during tiie cold months, she may EFORE HE COMES 77 to know th^ difference between theui. Doctors are not likely to use the word miscarriage, but will describe as an abor- tion a termination of pregnancy which occurs before the end of the seventh month and as premature labors those occurring from that time until the expected date of confine- ment. In the minds of lay people, however, the term abortion is often associated with criminal practice, mis- carriage being a term loosely applied to all births occurring before the seventh mouth, while the premature baby is the one born after the seventh month of pregnancy but before the expected date of continement. Of all of these accidents, abortions are the most frequent, though in the nature of things it is imposible to say how often they occur. They sometimes happen so early in preg- nancy that the expectant mother is unaware of the acci- dent ; or if she does know of it she may make the mistake of taking no notice of it or regard it of so little consequence that she does not consult a doctor. Bvit such information as is available suggests that at least one out of every five pregnancies ends in abortion, the traged}^ of this being that it is very largely a preventable disaster. Since the ovum is insecurely attached to the uterine lining until the sixteenth or eighteenth week, an abortion is more likely to occur during this time than later, while of this period, the second and third months seem to be the most perilous. Abortions are less likely to happen during first pregnancies than succeeding ones and their frequency seems to increase with the number of pregnancies. They occur more often among women over thirty-five years than in younger ones, and in all cases are most likely to take place at the time when menstruation would fall due were the woman not pregnant. The prevention of abortions is of such obvious importance and there is so much that you can do to this end, that we 78 GETTING READY TO BE A MOTHER shall take up the question somewhat at len^h. Preventive treatment really begins very early. In the discussion about menstruation we referred to .the importance of finding out the cause of painful periods, in the interest of good obstet- rics, since inflammation of the uterine lining or a mis- placed uterus might be responsible for the pain and if neg- lected might cause an abortion later on. The correction of such troubles, no matter when they are discovered, is an early step toward preventing abortions. But after pregnancy has actually begun, there are certain preventive measures which have proved to be very effective. A woman who is pregnant for the first time, and who, there- fore, does not knoAV whether she is likely to have an abor- tion or not, should avoid such risks as fatigue, sweeping, lifting or moving heavy objects, running a sewing machine by foot, running, jumping, dancing, traveling or any action which might jar or jolt her during the first sixteen or eighteen weeks. An expectant mother who has had an abortion will have to take even greater precautions, as she is in more danger than is a woman who has not had this experience. It is of prime importance, to begin with, that she have the cause of her previous abortion discovered, and if possible corrected. And since the accident is most likely to be repeated at about the same time, or a little earlier, in each succeeding preg- nancy it is a wise precaution for the expectant mother to remain quietly in bed for at least a week before and after the time when an abortion may be feared. Complete rest and relaxation are such effective preventive measures that patients with a tendency to have abortions •who have been willing to stay in bed during most of their pregnancy have sometimes been rewarded by going through the entire period and in the end giving birth to a normal, fully developed baby. As out-of-door exercise is clearly CARE OF THE BABY BEFORE HE COMES 79 impossible in such cases, it is iini)<)rlaiit tlial tlic patient keep her room very well ventilated all oi" the time, and possibly, under the doetor's direction, have massage or bed exercises. The marital relation is usually considered inadvisable in all cases after the eighth month of pregnancy, and among women who have had aboi-tions or miscarriages it is best omitted throughout the entire period. This is particularly true of women over thirty-five who are pregnant for the first time. To sum it up in a word, your part in preventing an abor- tion or miscarriage after pregnancy has begun, consists largely of avoiding fatigue ; resting when tired ; avoiding physical shocks such as blows upon the abdomen, jolts or falls particularl}' during the first sixteen or eighteen weeks and at the time when menstruation would ordinarily occur if you were not pregnant, and avoiding overwork during the later weeks of pregnancy. The common symptoms of abortions or miscarriages are bleeding, often accompanied by recurring pain, beginning in the small of the back and finally felt as cramps in the lower part of the abdomen. Since menstruation is sus- pended during pregnancy you should always regard bleed- ing or a bloody discharge as a symptom of a possible mis- carriage, whether you have pain or not. Fpon its appear- ance you should send for the doctor, go to bed at once and keep absolutely cjuiet. Should you be so unfortunate as to have a miscarriage, in spite of all your precautions, bear in mind that "you will need to stay in bed quite as long afterwards and have the same care as though you had given birth to a fully devel- oped baby. It is because so many women fail to appreciate this that abortions and i)rcmature births are often followed by ill health and invalidism. Under jirojier care, an abor- 80 GETTING READY TO BE A MOTHER tion or premature labor is not, of itself, any more serious for a woman than a normal delivery. Bleeding from the vagina, or a sudden increase in the size of the abdomen with perspiration and a sudden feeling" of faintness, may be the beginning of severe bleeding, or hemorrhage, from any one of a number of causes, and in such a case the expectant mother should notify her doctor, go to bed at once and keep quiet until he arrives. Summing up the whole question of preventing complica- tions, we find that the following symptoms may be forerun- ners of serious trouble and therefore should be watched for and reported to the doctor as soon as they are noticed : 1. Persistent or severe vomiting. 2. Persistent or severe headache. 3. Dizziness. 4. Blurred vision or the appearance of black spots before the eyes. 5. Puffiness under the eyes, or elsewhere about the face. G. Swelling of the feet, ankles or hands. 7. Sharp pains, particularly in the stomach. 8. Prolonged failure to feel the baby's movements after they have once been felt. 9. Bleeding, or a bloody discharge. 10. Pain in the small of the back followed by cramp-like pains in the abdomen, before the expected date of confine- ment. 11. Unwarranted mental depression, anxiety or apprehension. These are generally accepted as the danger signs of pregnancy, any one of which, alone or in combination with one or more of the others, is of importance. In addition to these it really is important that you talk to your doctor or your nurse freely if you are feeling worried or depressed about anything at all. Sometimes one feels blue without knowing why, and if you should feel so during your preg- CARE OF THE BABY BEFORE HE COMES 81 nancy you should not keop it to yourself but talk it over witli your doctor or your nurse. When all is said and done, what we want for each expect- ant niotiier is little more than that she shall live a nor- mal, regular, wholesome life; that she shall be able, and w'hat is of equal importance, be willing to weave into her everyday life the principles of personal care which every one should adopt ; that she shall watch and be watched for symptoms of complications throughout the entire period of pregnancy, in order that they may be detected early, speedily treattnl and serious troubles thereby prevented. The adoption of such simple precautions will pave the highroad to health and happiness for yourself and your baby. .«nf»sr* CHAPTER VI MAKING READY FOR THE BABY In making ready for the actual arrival of the baby there are several factors to consider, chief among them being the doctor; the nurse; the place where the baby is to be born; the room he is to occupy and an equipment which will facilitate the care of yourself and the baby, at the time of his birth and afterwards. Of course you have long since placed yourself under a doctor's care, so that is settled. If you are in the care of a privately engaged physician, he will, in all probability tell you his wishes in regard to your engaging a nurse. She should be satisfactory to both you and the doctor from the standpoint of training and professional fitness as well as her personality. The selection of the nurse, therefore, should be made in cooperation with your doctor. It is wise to engage her during the early part of your pregnancy both to insure your securing the one that you and the doctor want especially, and to have that much of the preparation off your mind. It is usually a good plan to engage the nurse to hold herself in readiness to respond to your call at any time after two weeks before the expected date of your confinement. Quite reasonably, if she is obliged to give up or refuse an engagement in order to hold herself available for you, from a given date, she will do so at your expense. Try to arrange to have the nurse stay with you for six weeks after the baby is born, even though this in- volves considerable financial sacrifice on your part. Of 82 MAKING READY FOR THE HABY 8.} course if 3'oii can afford to keep lier still longer, so niut'h the better. All of this is in case you are in the care of a privately engaged phj-sician and are to have a special nurse. If you are being cared for during pregnancy by doctors and nurses connected with a dispensary, health center or pre- natal clinic, they will advise with you about your nursing care at the time of confinement and afterwards. The next question to consider is whether the baby is to be born at j^our home or in a liospital. The doctor who is advising you will have his wishes on this subject, too, and as they are entirely in your interest, you will, of course, do as he advises. You will be likely to find that for the birth of the first baby he will want you to go to a hospital, if there is a good one available ; also if you have had any symptoms of complications during this pregnancy or diiifi- culty with previous labors. If you are going to a hospital you or your doctor will make the necessary arrangements about j^our room, well in advance of the date upon which you expect to go, in order to feel sure that a room will be ready for you. It sometimes happens, that for a varietj^ of reasons it is nearly or quite impossible for the expectant mother to go to a hospital, or that her doctor is entirely Avilling that she shall be confined at home. If it is decided that you are to remain at home, it will be possible, with a little planning and effort on your part, to imitate very nearly in your own home the advantages which are offered by a hospital. You will remember that in the last chapter I mentioned childbed fever as being one of the serious complications, associated Avith childbirth, that could be prevented by care- ful work. In the old days, when the importance of cleanli- ness was not appreciated, this fever was very common in maternity hospitals, but nowadays it seldom occurs in 84 GETTING READY TO BE A MOTHER well conducted institutions because the doctors and nurses know how to do clean work and also because they have clean things to work with. So if you are to be attended at home by a good doctor and a good nurse you may make the conditions of your confinement practically ideal by provid- ing a clean room and such an outfit of sterile sheets, towels, dressings and certain other articles as would be available for their use in a hospital. Suppose we settle tlie question of the rooms first. It is a very imi)ortant one but need not be the bugbear that some people think it is. In all probability you will have no choice as to a room for yourself and will have to use the one you ordinarily occupy. Should you have a choice, however, it will be well to select one that is cool and shady, if the baby is coming during the summer, but one that is bright and sunny for occupancy during most of the year. It should be conveniently near a bathroom, if possible ;> have an adjoining room for the nurse and one near by for the baby. The ideal to work toward is: A room with a washable floor with small, light rugs ; freshly laundered curtains at the windows but no heavy draperies; a single brass or iron bedstead, about thirty inches high, with a firm mat- tress, and so placed as to be accessible from both sides and with the foot in a good light, either by day or night ; a bed- side table and two others (folding card tables are a great convenience); a bureau; a washstand, unless there is a bathroom on the same floor; one or two comfortable chairs, two or three straight chairs and a couch or chaise longue, all of which should be of wood or wicker or covered with freshly laundered chintzes. Between such a room as this and the one that must be used there may be a wide difference, but it will be worth while to approach this standard as nearly as possible. It is MAKING READY FOR THE BABY 85 not necessary to make the room bare ; in fact, it should be as cheerful and pretty as is compatible with clfanliness. There is no objection to pictures on the walls, but the room should be free from useless, small articles which are likely to be dust (•at<-lM'rs, jrive the nurse unnecessary' work and occupy space needed for other tilings. The room should be given a thorough house-cleaning about two weeks before the baby is expected. If there is a carpet on the floor that cannot be taken up conveniently, it might be well to have in readiness a large canvas or rubber or an abundance of newspapers to protect the floor near tlie bed. If the bed is low. the attentions of the doctor and nurse will be made much easier if you have ready four solid blocks of wood, of the same size, upon which to elevate the bed, after the casters have been removed. The blocks should be of such a size as to bring the height of the bed up to thirty inches. And it is important, too, to have a large board, or table leaves, at hand, to slip under the mattress to make it firm, particularly if the bed is soft or sinks in the middle. The chief requisites for the baby's room are that it may be well ventilated and easily cleaned. The floor should be of hard wood, or covered with linoleum, in order that it may be wiped up with a damp cloth every day. and the walls should be freshly papered, or, better still, painted. As bright light and glare are bad for the baby the walls would better be of a soft shade, such as gra.vish green or blue, than white, and there should be dark shades at the Avindows, in order that the room may be darkened at will. The furnishings may consist of a brass or enameled crib, with a hair mattress ; a chest of drawers ; a low straight chair and low rocker, both without arms, and a low table for the baby's toilet articles. An ordinary kitchen table, enameled and with the legs sawed off, serves admirablv. All 86 GETTING EEADY TO BE A MOTHER of the furniture should have smooth, washable surfaces, such as hard wood or enamel, and the walls should be free from pictures, for the baby's room will have to be kept scrupulously clean and free from dust. So much for the rooms. When it comes to tlie question of providing the outfit to be used in your personal care, the matter of nightgowns and the like will be determined by your tastes and your means, rather than by specific needs. But six or eight nightgowns, a warm bed jacket if the weather is cool, a dressing-gown and a pair of slippers, will prol)ably be enough to keep you fresli and comfortable, so far as these things are concerned, whether you are in a hospital or at home. But the preparation of necessary dressings and other arti- cles for a home confinement is a different matter and you should learn the wishes of your doctor concerning them. If his instructions are not specific, you may find that the following lists will be helpful guides in assembling an equip- ment which will prove adequate to meet the ordinary re- quirements of a home confinement. ]\Iost of the articles listed, or satisfactory substitutes, are to be found in the average household, but they should be gotten together in one place so as to be ready at a moment's notice. For the Confinement and Your Own Care: Plenty of sheets, pillow cases and towels. 4 sanitary belts. 1 piece rubber sheeting- or oil cloth, 1 x ly? yards. 1 piece rubber sheeting- or oilcloth, 2x11/2 yards. Two or three dozen safety pins. Hot water bag with flannel cover. 1 two-quart fountain syringe. 1 douche pan. 1 bed pan. MAKING READY FOR THE BAliV 87 2 covered slop jars or coviMod i)ails. 3 basins, about Ki, 14 and 12 inches in diameter. 2 stiff nail brushes, nail scissois and tile or oraiiue stick. 3 agate or enamel pitchers, holdiui;- at least 1 (juart each. Medicine glass. Medicine dropper. 2 bent glass diiiiking tul)es. 100 bichlorid tablets. •i ounces chloroform. 4 ounces boric acid powdci". 4 ounces green soaj). 1 pint grain alcohol. Small jar of vaselin to be sterilized. Lard, olive oil, vnselin or albolene to nil llic baby. Roll of adhesive jilaster, 1 inch wide. One package of absorbent cotton. One clinical thermometer. In addition to these, a certain snpply of sterile dressings will be needed. Complete ontfits of such dressings, ster- ilized and ready for nse, may be obtained from any one of a number of firms, of which your doctor will know; or they may be prepared by the nurse, or you yourself may prepare and sterilize the following : One dozen towels. Three sheets. Five or six dozen sanitary pads, about 10 inches long and 4 inches wide, made of gauze and cotton batting with a top layer of absorbent cotton. Two to four bed pads, about 30 inches square and 4 inches thick, made of gauze and cotton waste or cotton batting with a top layer of absorbent cotton; or of news)iapers covered Avith muslin. One pair of leggings made of canton- or outing-fiainiel, either loose fitting hose reaching to the thighs or a yard square folded diagonally and stitched on one side. See Fig. 16. 88 GETTING READY TO BE A MOTHER Five or six dozen gauze sponges, made by folding pieces of gauze 18 inches square into small pads with all raw edges inside. Two or three dozen gauze squares, 4 inches square. Four or five dozen cotton pledgets, or wads of absorbent cotton about the size of an egg with the edges dra\vn together between thumb and finger and twisted into a spiral. Six pieces of bobbin or narrow tape, 9 inches long, to tie the baby's cord. Fig. 16. — Two types of easily made lejjgings, suitable for use at the baby's birth. To make these supplies you will need about four pounds of absorbent cotton, 6 or 8 packages of cotton batting, and possibly 40 yards of gauze in addition to cotton-flannel for the hose. In preparing the dressings for sterilization, you may divide them into packages as follows: The sheets in one package; 6 towels in a package; 6 sanitary pads in a pack- MAKING READY FOR TUE liAliV 89 age ; 2 delivery pads in a package ; the gauze squares in two packages; the leggings in one package; tlie bobbin in one package. The sponges and pledgets should be j)nt up in bags or small pillow eases, 2 or 3 dozen in a bag. Wrap each package in heavy muslin, either new or old, using pieces large enough to well protect the contents from contamina- tion by dust or handling, tie them securely with string and sterilize as follows: Fill a wash boiler about a (piarter full of water and fashion a hammock by securely tying a towel or strip of muslin to the handles at each end and allowing it to hang so that the bottom of the hammock is about halfway down in the boiler. As the weight of the dressings makes the hammock sag low in the middle it is a wise pre- caution to place a rack or support of some kind in the bot- tom of the boiler, to hold the dressings well above the bubbling water, at the point where they hang lowest. Pile the dressings into the hammock, cover the boiler tightly and keep the water boiling vigorously for an hour ; dry the packages in the sun, or by placing them in the oven for a few moments, taking care that they are not loosened or opened, and at the end of twenty-four hours repeat the steaming and drying process, w^ap the packages in a clean sheet and put them in a drawer or covered box where they maj' remain undisturbed until needed. The nail brushes, douche pan and fountain syringe may be wrapped in muslin and sterilized in the same way, or the nurse may boil them when the time comes to use them. Bed pads made of newspapers offer excellent protection and are, of course, less expensive than those made of cotton. They consist of six or eight thicknesses of newspaper opened out to the full size of the page and covered with a piece of freshly laundered muslin which is folded over the edges and basted in place or held with safety-pins, as shown in Fig. 17, These pads may be made virtually sterile by 90 GETTING READY TO BE A MOTHER ironing them on the muslin side with a very hot iron, folding the ironed surface inside without touching it, ironing the outside after it is folded and wrapping the pads in a clean sheet or muslin, also recently ironed, and putting them away with the other dressings, in a place protected from dust. Fig. 17. — Eeverse side of pad made of newspapers and old muslin to protect bed during a home confinement. Tf muslin is held in place with safety pins it may be removed easily, washed and used for an- other pad. (By courtesy of the Maternity Centre Association.) Baby Clothes. In planning the baby clothes, there are a few general principles to bear in mind that are of con- siderable importance to the baby's welfare. His health actually may be injured by having his clothes too warm or not warm enough, and also if they are tight enough to bind or constrict any part of his body or so ample as to form bunches and wrinkles which will make him uncom- fortable and restless. MAKTXCi KKADV FOR THE I'.AIIV f)l To bo entirely satisfactory his clothes should he sim|)le in design and so made as to slip on easily, fit loosely and at the same time smoothly ; the materials should be soft, light and porous. Complete outfits of baby clothes may be bought outright, but few expectant mothers are willing to forego the sheer ecstasy of fashioning the little garments them- selves, while they dream dreams of the ba])y who is to wear them. The following list of garments will meet the baby's needs, and those which you may make are really very simjile: Two to four dozen (liajiers, about IS inches square. Three flannel bands (i inches wide and 27 inches long, iin- hemme A i { ?\ ] ^, 1 \ \ < ^\ ^' ■~i ^ \, V A ?^ \ V i. N, Vtl -S y ,\ v^ tS \, \: ^, -S V J«l <- is .'; \ V N *-, ^ N. \ ■^ N \ „ J _ _ _ ^ 151 152 GETTING READY TO BE A MOTHER The weight is perhaps the most valuable single index to the baby's condition that we have, but at the same time it must be rememhered that^ baby whose food contains an excess of sugar or starch may be of normal weight, or over, but be incompletely nourished and very susceptible to infection, while other babies Avho are small and gain slowly are sometimes very well and vigorous. Moreover, cjuite commonly there are periods in the lives of entirely normal babies during which there is little or no gain in weight. This may occur during the period from the seventh to the tenth month, for example, or in very warm weather. But the doctor is likely to want to Avatch the baby's weight, for when studied in conjunction with other conditions it gives a certain amount of information about the baby's gen- eral state and progress. Height. The height of the average baby at birth is about 20 inches, though boys may measure a little more and girls a little less ; at six months it is about 25 inches and 28 or 29 inches at the end of a year. Head and Chest. The circumferences of the head and chest are about the same at birth, the chest being possibly a little the smaller of the two. Both measure about 13^2 inches, gradually increasing to about I6I/2 inches in six months and to 18 inches by the end of the first year. Fontanelles. The posterior fontanelle, the one at the crown of the head, usually closes in six or eight weeks but the larger, anterior fontanelle is not entirely closed until the baby is about eighteen or twenty months old. Teeth. Although it occasionally happens that a baby has one or two teeth at birth, the average infant has none until the sixth or seventh month, when the two lower, cen- tral incisors appear. After a pause of a few Aveeks the two upper, central incisors come through, followed by the two lateral incisors in the upper jaw. At the end of the THE MOTHER'S CARE OK II KK V.W.Y 15:5 first year, therororc tlic Jivcraj^n' I);ii)y hns six tooth, or eight if the lower lateral incisors have appeared ])y the first birthday, as they sometimes do. This is the visual course of dentition, during the first year, as shown in Fig. 42, lint til ere are wide variations among entirely well and normal babies, the first tooth sometimes not appearing be- fore the tenth, eleventh or even twelfth month. As a rule, 50tkMoyvth I6th Month 22ndMonth IZih Month. StkJlcntk^^ nth Month ZZndMonth ibthMonth ^Oih Month ZAthMovith Hth Month 19 tk Month I 19th Month Hth Men Ih. 24 th Month Fig. 42. — Diaoraiu sluiwinu first, or "milk," teeth and the ages at which I hoy usually appear. however, an entire lack of teeth by the time the baby is a year old is regarded as an evidence of faulty nutrition. The baby w'ho is properly fed and cared for, cuts his teeth with little or no trouble, in spite of the widely current but seriously mistaken belief that a teething baby is a sick baby. AVe have no way of estimating the number of babies who die, needlessly, as a result of this dangerous convic- tion, for if the baby is sick while teething, the trouble is all too often accepted as a normal occurrence and is not given the attention it needs until too late. Frail, delicate babies may have convulsions each time that a tooth is cut and if a baby is having digestive trouble, this is likely to grow worse while he is teetliing. l>ut cutting teeth is a normal 154 GETTING READY TO BE A MOTHER process and the healthy, properly fed baby suffers little or no inconvenience while it is in progress. Stools and Urine. During the first two or three days the stools are of dark green, tarry material called meconium. In the course of two or three days they begin to grow lighter and shortly the normal stools appear, these being bright yellow in color, of a smooth, pasty consistency and having a characteristic odor. During the first month or Fig. 43. — Appearance of cord immediately after birth. six weeks the baby's bowels may move three or four times daily, but after this they usually move but once or twice in the course of twenty-four hours. As the nourishment is increased, the stools grow somewhat darker and firmer and finally become formed. The newborn baby's bladder usually contains urine and this may be passed immediately after birth or not until several hours later. After the first urination the bladder may be emptied five or six times a day or oftener. The Cord. Within a few days after birth the stump of the umbilical cord that is attached to the baby's navel. THE MOTHER'S CARE OF HER BABY 155 begins to shrivel and turn black and a red line a[)|)ears where the cord joins the abdomen. By the eighth or tenth Fig. 44. — Appearance of cord four days after birth. day, as a rule, the cord has shrunken to a dry. black string, when it drops off and leaves an ulcer or small red area Fig. 45. — Appearance of navel immediately after cord has dropped off. which heals entirely in the course of a few days. Figs. 43, 44, 45 and 46 show these progressive changes. 156 GETTING READY TO BE A MOTHER Skin. The soft, downy hair that may be remaining on the surface of the body usually disappears by the end of the first week and there is often a sealing of the skin which lasts for two or three weeks, while a delicate pink tint replaces the deeper color of the skin in the course of ten days or two weeks. The baby does not perspire until after the first month, ordinarily, when a very slight perspira- tion begins, gradually increasing until by the time the baby is a few months old he is perspiring freely. Fig. 46. — Appearance of a normal, Avell healed naveL Tears. There are no tears at birth and opinions differ as to whether tbej^ appear in the course of two or three weeks or three or four months. The absence of tears is one reason for bathing the baby's eyes so carefully during the early days and weeks, for if dust or other foreign material gets into the eyes it is not washed out by tears as it is after their flow is established. General Behavior. During the first few weeks the average baby sleeps most of the time ; that is, from 19 to 21 hours daily. He gradually sleeps less, as the special senses THE MOTHER'S CARE OF HER BABY 157 develop and will sometimes lie quietly for an hour or more with his eyes open, sleeping only 16 or 18 hours, daily, at six months and 14 to 16 hours at the end of a year. The baby begins to make noises and "coo" at about two months and to utter various vowel sounds when about six montlis old. By the end of a year these indefinite noises and sounds become distinct words. At about the fourth month he grasps at objects and smiles, and very soon even laughs. He holds up his head at about the third or fourth month ; sits up and also begins to creep at six or seven months, while sometime between the ninth and twelfth months he will stand while holding on to something secure and begin to walk with assistance. These degrees of development at different ages are not to be taken as the only measure of normal progress, for some well babies mature more rapidly and many others more slowly than at the rate which is found to be average. In addition to these fairly specific evidences of the baby's condition and progress, such as weight, height, strength and muscular development, there are other and less definite indications of his well-being which should be taken into account. The baby who is well and is being properly fed in all respects, will have good color ; his flesh will be firm ; he will take his nourishment with a certain amount of eagerness and seem satisfied afterwards. He will sleep for two or three hours after each feeding; will sleep quietly at night and while awake, unless he is wet or uncomfortable for some other good reason, he will seem contented, good-natured and happy. You have seen how the average, well baby grows and de- velops, provided he is given proper care. I want you now to have just a glimpse of the other side of the question, so that you may realize what happens to the unfortunate little 158 GETTING READY TO BE A MOTHER citizens who are not given such care. This glimpse will make you realize more than ever, how worth while are all of the precautions that you take for your baby. It is estimated that out of every 1000 babies born alive, in this country, 40 die during the first month of life, and that more than as many again, or about 85 all told, perish before reaching the first birthday. So hazardous is this period of early infancy, in the United States, that our annual loss of baby life is between seven and eight times as great as was the yearly loss of our young men in the war, for upwards of 200,000 babies less than a year old die each year. That the first month is more dan- gerous than any which follow is shown by the fact that about 100,000 of these baby deaths occur during the first four weeks of life. The tragedy of these figures is made darker by the fact that at least half of the babies who are lost die from preventable causes. In other words, they die from lack of proper care. That is the point of this for you. These babies die, not by an act of Providence, but from lack of care — not the difficult, complicated care needed by sick babies but just the everyday care which any mother may give — the care that keeps wein)abies well. That is what you are going to do — keep your well baby well. And you are going to be surprised to find how easy it is, after all, to say nothing of the pleasure of it, for the thing very nearly sums itself up into feeding your baby as the doctor orders and keeping him clean in every par- ticular. Bear these two factors in mind for errors in feed- ing and lack of cleanliness are the underl^nng causes of the vast majority of baby ills. You will often feel a little like Alice in Wonderland, who found, one time, that she had to keep running very fast to stay where she was, for you will not be able to THE MOTHER'S CARE OF HER BABY I.IO relax in a single detail of youi- baby's care if yoii inc 1o keep him well. With him, as witii you, or anyone else, the satisfactory use of even ideal food is largely dejiendent upon the general condition and mode of living, and we find accordingly, that the (|uestion of keeping the baby well finally resolves itself into the following common sense re- quirements : 1. Proper food. 2. Fresh air. 3. Regularity in the daily routine care. 4. Cleanliness of food, clothing and surroundings. 5. Preservation of an even body temperature. G. Adequate rest and sleep. 7. Periodic consultations with your doctor. Carve these principles into the tablets of your brain and you cannot fail to give your baby the kind of care that is literally life-saving. I am going to describe the tiny, intimate details of this care, for I think this will help you, in the beginning at least, but if you will keep these fundamentals in mind and use good common sense you really need not read another word about baby care, for they give it all in a nutshell. Let me warn you emphatically against making the very serious mistake of acting upon the advice of friends or relatives, no matter how many children they have had. These counselors are just as dangerous for babies as they are for expectant mothers, so beware of them ! "Is it not preposterous," says Herbei't 8pencer, "that the fate of a new generation should be left to the chance of unreasoning custom, impulse, fancy, joined with the suggestions of ignorant nurses and the prejudiced counsel of grandmothers? To tens of thousands that are killed, add hundreds of thousands that sur- vive with feeble constitutions, and millions that grow up with constitutions not so strong as they should be, and you have some 160 GETTING READY TO BE A MOTHER idea of the curse inflicted on their offspring by parents ignorant of the laws of life." It is a very wise precaution to have your doctor see the baby every week or ten days during the first three months and once a month during the remainder of the year. Not because he is fragile or ill. Not at all. You consult your doctor in order to be sure that you are keeping your hahy well. Did you ever hear of the Chinese custom of paying the doctor as long as one is well, but not paying for attention during illness? It isn't so very heathenish — that idea of paying for the skillful care that will prevent illness. In addition to taking the general precaution of seeing your doctor periodically, about the baby, be sure to consult him about anything that you do not understand or about any new condition that arises. You will find any number of persons who are ready and eager to advise you, but your doctor is the only one whose advice it is safe for you to follow. The Daily Schedule. The importance of regularity in the daily routine of the baby's care cannot be stressed too often nor too insistently. No matter how well he is nursed in other respects, nor how skillfully the doctor directs his care, the baby cannot be expected to progress satisfactorily if his life is not absolutely regular. Begin by arranging a daily program for the feedings, fresh air, bath, sleep and exercise and then allow nothing to interfere with your carrying it out. The hours for the nursings, which vary with different doctors, will constitute the greater part of this daily sched- ule. For a baby on four hour feedings, for example, some such program as the following may be arranged, while for a baby on a three hour schedule a slightly different pro- gram may be arranged. THE MOTHER'S CARE OF HER BABY 161 6 a.m. J"'eeding:. 8 a.m. Orange juice (when ordered). 9 a.m. Bath. 10 a.m. Feediufj'. 10:30 to 2 p.m. Out of doors. 2 p.m. Feediuij-. 2:30 to 4 p.m. Out of doois. 4 p.m. Orange juice (when ordered). 4 to 5:30 1 p.m. Indoor airing and exercises (when ordered) 5:3C • p.iu. Preparation for the night. 6 p.m. Feeding. 10 l).m. Feeding. 2 a.m. P"'eeding (when ordered). YOUR BABY'S FOOD Proper feeding is probably the most decisive single fac- tor in the routine care of the baby. In order that the food shall be satisfactory, it must be not only suitable in composition for the individual baby, but it must be clean, fresh and at the right temperature ; given in suitable amounts and at suitable intervals ; it must be given properly — not too fast nor too slowly and it must be given under favorable conditions. Moreover, as has been stated, the babj^ himself, must be kept in a general con- dition which will promote the digestion and assimilation of the food that is given to him. Fresh air, suitable clothing, an even body temperature, gentle handling, proper bath- ing, regular sleep, freedom from excitement, fatigue and irritation all promote the bady's ability to use his food to advantage. Reverse conditions all work against it. Ac- cordingly, the actual value of the baby's food to him will be largely dependent upon the care that you give him. There are three methods of nourishing the baby : by breast feeding, by artificial feeding and by a combination of the two, termed mixed or supplementary feeding. 162 GETTING READY TO BE A MOTHER Breast Feeding. From all standpoints, maternal nurs- ing, under normal conditions, is the most satisfactory meth- od of nourishing a baby. H the breast milk is suitable it meets all of the baby's requirements and the proportion and character of its constituents are exactly suited to his digestive powers. In order for maternal nursing to be entirely satisfactory, the condition of both mother and baby must be favorable. The preparation and care of the mother have been described : her general condition and state of nutrition; the care and condition of her nipples, flat or retracted nipples being brought out if possible, and if not, the nursing facilitated by the use of a shield. As to the baby, if his diaper is wet or soiled, it should be changed before he is put to the breast, partly to make him comfortable and partly to avoid disturbing him for this after his feeding; and his mouth is gently swabbed with boric-soaked cotton, if your doctor so orders.^ Although nursing is an instinct, the baby may have to learn how to nurse or to acquire the habit, this being one reason fur putting him to the breast during those first two or three days when he obtains little or no actual food, as was explained in Chapter IX. As he expresses the milk by squeezing and suction made possible only when the nipple is well back in his mouth, he must take into his mouth practically the entire colored area which surrounds the nip- ple. To do this he lies in 'the curve of his mother's arm as she turns slightly to one side, and holds her breast away from his nostrils in order that he may breathe freely. Sometimes, even when other conditions are favorable, the baby is unable to nurse because of some physical dis- ability. He may be too feeble, may have a cleft palate or find suckling painful because of an injury to the mucous ^ Boracic acid solution is made by adding one teaspoonf ul of the crystals to one cup (half -pint) of Vjoiling water. THE MOTHER S CARE OF HER BABY 163 membrane Avhich occurred when his mouth was wiped out just after birth. The manner in which the baby nurses, therefore, may be significant and should be described to the doctor if there is any difficulty. When the baby has finished nursing he should be taken up very gently, held upright against the shoulder for a moment or two, to help him bring up gas if he has any, and then placed in his crib and left to sleep. If he is nursing satisfactorily, he will be sleepy and contented afterwards and Avill sleep for two or three hours; he will seem generally good-humored and comfortable while awake; he will have good color; gain weight steadily and have two or three normal bowel movements daily. The normal stool in breast-fed babies is bright yellow, smooth and has no evidences of undigested food. If the baby is not being adequately nourished, he will present exactly the opposite picture, in some or all of these respects. He will be unwilling to stop nursing after the normal length of time and will give evidence of being not satisfied when taken from the breast. He may be list- less and fretful and sleep badly. He wall not gain weight as he should and he may vomit or have colic after nursing. To ascertain whether or not such a baby is getting enough milk it is customary to weigh him, without undressing him, before and after each nursing. Each fiuid ounce of milk will increase his weight one ounce. If the baby is not ob- taining a normal amount of milk at each nursing, he is often given enough modified milk after each meal to supply the shortage, but at the same time an effort is made to in- crease the supply of breast milk by improving the mother's personal hygiene, as described in Chapter IX. The amount which the baby needs at each feeding varies, not only according to his weight and age, but also accord- ing to his vigor and activitv and therefore must be esti- 164 GETTING READY TO BE A MOTHER mated for each baby. A very general estimate of the amount taken by the average, well baby at each feeding, is about as follows : First week 11/2 to 21/2 ounces Second and third week 2 to 4 ounces Fourth to ninth week 3 to 4^ ounces Tenth week to fifth month 3V2 to 5 ounces Fifth to seventh month 4V2 to 6V2 ounces Seventh to twelfth month 6V2 to 9 ounces Artificial Feeding. There is no entirely adequate substi- tute for satisfactory maternal nursing, and any other food that is given to the young baby is at best a makeshift. Considering the baby's delicacy, therefore, and his urgent needs, no pains should be spared to make any artificial food that is given to him, as satisfactory as possible. And no matter what it costs, he should have only the freshest, cleanest and purest milk that can be bought. In preparing and giving artificial food it must be borne in mind that normal breast milk has the following charac- teristics : 1. It is exactly right in (juantity, quality and proportion. 2. It is fresh, clean and sweet. 3. It is free from bacteria. 4. It tends to protect the baby fi'om infection. 5. It definitely protects him from certain nutritional diseases. Cows' milk, suitably modified, is apparently the best available substitute for mother's milk, but it must first meet certain requirements and then be handled with scrup- ulous cleanliness and care, if it is to be satisfactory. The requirements are that the milk shall be : 1. Whole milk. It must not be altered by the removal of cream nor the addition of such preservatives as salicylic acid, formaldehyde or boracic acid. THE MOTHER'S ("AUH OK IIEK liAllV Ki.") 2. Its composition imist not vary greatly I'roni day tn l surer of keejiing 170 GETTING READY TO BE A MOTHER the mouths of the bottles clean if you cover them with squares of gauze or muslin before they are sterilized, hold- ing the caps in place with tapes or rubber bands. Pasteurization as applied to infant feeding consists of heating the milk to 140-165° F. and keeping it at that tem- perature for 20 to 30 minutes. There are many excellent pasteurizers for home use on the market, but entirely satisfactory results may be obtained by improvising one from the wire bottle rack seen in Fig. 47, and the large kettle already provided. One method is to place the rack, containing the bottles, in the kettle which is filled with cold water to a level a little above the top of the milk in the bottles, and allow the water to come to the boiling point. The kettle is removed from the fire, covered tightly and the bottles allowed to stand in the hot water for twenty minutes. Cold water is then run into the kettle to cool the milk gradually and avoid breaking the bottles, after which they are placed in the refrigerator, well or spring-house and kept at a temperature of 50° F. until they are taken out, one at a time, for feedings. If a wire rack is not available the bottles may be stood on a saucer or a thick pad of folded newspapers in the bottom of the kettle. Pasteurization does not destroy all germs that may be in the milk, but it kills the more important ones and appar- ently impairs the nutritive and protective properties of the milk less than boiling. However, pasteurized milk must be kept cold and must be used within twenty-four hours, for the aging of milk is quite as undesirable as souring. Scalding is another method of destroying germs in milk. The milk is placed in an open vessel and the temperature raised to about 180° F., or until bubbles appear around the edge and the milk steams in the center, after which it is cooled and kept at a temperature of 50° F. THE MOTHER'S CARE OF HER BABY 171 Many doctors prefer to have the baby's milk boiled, since boiling insures absolute sterilization and also renders the curd more digestible. Other changes are produced by boil- ing, however, which make it important to add orange juice and cod-liver oil to the baby's diet at an early date, as will be explained in the next chapter. Milk may be boiled directlj^ over the tiame for a time varying from three to forty-five minutes, or it may be placed in a double boiler, the water in the lower receptacle being cold, and allowed to remain until the water has boiled from six to forty-five minutes. When milk is boiled or scalded, the other ingredients are added beforehand, as a rule, after which it is measured and poured into the bottles. Or the milk mixture may be poured into the bottles as for pasteurization and the bottles kept in the actively boiling water for any desired length of time. All of these points, however, are definitelj^ specified by the doctor. Giving the Baby His Bottle. At feeding time, the bottle should be taken from the refrigerator^ the stopper removed and a sterile nipple taken up by the margin and put on the bottle without touching the mouthpiece. The milk is brought to a temperature of about 100° F. by standing the bottle in a deep cup or kettle of warm water and placing it on the fire. The temperature of the milk may be tested by dropping a few drops on the inner side of the wrist or forearm where it should feel warm but not hot. This dropping will also indicate if the hole in the nipple is of the proper size to allow the milk to drop rapidly in clean drops but not to pour. If the hole is too small, the drops will be small and infrequent and the baby will be obliged to work too hard to obtain it ; Avhile if the hole is too large the baby W'ill feed too rapidly and may have colic as a 172 GETTING READY TO BE A MOTHER result. If the hole is too large the nipple will have to be discarded; if too small or if there is no hole, one of the proper size may be made by piercing the nipple with a heated darning needle or small steel knitting needle. Fig. 48.— Proper position in which to hold baby and botth^ during feeding. THE MOTHER'S CARE OF HER BABY 173 The baby's diaper should be changed if it is soiled or wet before he is given the bottle and he should be held com- fortnblv on vonr arm, in a reclining position, while you Fig. 49. — Holding the baby upright immediately after feeding, and gently patting his back to help him bring up air in order to prevent colic. hold the bottle Avith your free hand as shown by the nurse in Fig. 48. The bottle should be inclined sufficiently to keep the neck full of milk ; otherwise the baby may draw in air as he nurses. He should be kept awake while feeding 174 GETTING READY TO BE A MOTHER but he should be allowed to pause every three or four min- utes in order not to take his milk too rapidly. Not less than ten nor more than twenty minutes is devoted to a feeding, as a rule, and if the baby refuses a part of his milk, it should be thrown away; never warmed over for another time. After being fed, the baby should be held ujiright against your shoulder for a moment or two, as in Fig. 49, and ever so gently patted on the back to help bring up any air which he may have swallowed. He should on no account be rocked nor played with after taking the bottle, but should be placed gently in his crib, warm and dry and left alone to sleep. Turning him or moving him about even to the extent of changing his diaper at this time may cause vomit- ing. The evidences of satisfactory and unsatisfactory feeding in the bottle-fed baby are about the same as in the baby who is fed at the breast, except that the gain in weight on artificial food may be a little slower and less steady than on maternal nursing ; the stools have a characteristic sour odor; are a little lighter in color and may contain white lumps of undigested fat ; are usually dryer than in breast- feeding and may be formed, in even a very young baby. IMany doctors feel that all babies, whether breast-fed or on the bottle, require a certain amount of cool boiled water to drink between feedings. A small amount is given at first and gradually increased according to the doctor's instructions, and it may be given from a bottle, a medicine dropper or poured slowly from the tip of a teaspoon. I feel sure that you have realized, long before this, that the entire question of planning the baby's food is such an important and complicated matter that it cannot with safety to the baby be undertaken by any one but your doc- tor. Unexpected situations do arise, however, when the THE MOTHER'S CARE OF HER BAliV 175 doctor is not within immediate reach and the mother has to phm the l)aby'.s food, temporarily, to the best of her ability. Should you find yourself in such an emergency, you will find help in the milk formulas contained in a pamphlet issued by the American Medical Association, remembering that they are intended for the average, normal baby and are not necessarily suitable for all babies. A large, vigorous baby may need more food and a small, frail baby have to take less than the amounts specified in the following direc- tions •} "The simplest plan is to use whole milk (from a shaken bottle) which is to be diluted according to the child's age and digestion. "Beginning on the thii'd day, the average baby should be given 3 ounces of milk daily, diluted with seven ounces of water. To this should be added one tablespoonful of lime water and 2 level teaspoonfuls of sugar. This should be given in 7 feedings. "At one week, the average child requires 5 ounces of milk daily, which should be diluted with 10 ounces of water. To this should be added IV2 even tablespoonfuls of sugar and one ounce of lime water. This should be given in 7 feedings. "The milk should be increased by V2 ounce about eveiy 4 days. "The water should be increased by Y^ ounce about every 8 days. "At 3 months the average child requires 16 ounces of milk daily, which should be diluted with 10 ounces of water. To this should be added 3 tablespoonfuls of .sugar and 2 ounces of lime water. This should be given in 6 feedings. "The milk should be increased by V-i ounce about every 6 days. "The water should be reduced by V2 ounce about everj' 2 weeks. ^ From ' ' Save The Babies ' ' by Dr. L. Emmet Holt and Dt. H. K. L. Shaw. Copied by courtesy of The American Medical Association. 176 GETTING READY TO BE A MOTHER "At 6 months the average child requires 24 ounces of milk daily, which should be diluted with 12 ounces of water. To this should be added 2 ounces of lime water and 3 even tablespoonfuls of sugar. This should be given in 5 feedings. "The amount of milk should be increased by 1/2 ounce every week. "The milk should be increased only if the child is hungry and digesting his food well. It should not be increased unless he is hungry, nor if he is suffering from indigestion even though he seems hungry. "At 9 months, the average child requires 30 ounces of milk daily, which should be diluted with 10 ounces of water. To this should be added 2 even tablespoonfuls of sugar and 2 ounces of lime water. This should be given in 5 feedings. "The sugar added may be milk sugar or, if this cannot be obtained, cane (granulated) sugar or maltose (malt sugar). "At first plain water should be used to dilute the milk. "At 3 months, sometimes earlier, weak barley water may be used in the place of plain water; it is made with 1/2 level tablespoonful of barley flour to 16 ounces of water and cooked 20 minutes. "At 6 months the barley flour may be increased to IV^ even tablespoonfuls, cooked in the 12 ounces of water. "At 9 months, the barley flour may be increased to 3 level tablespoonfuls, cooked in the 10 ounces of water. "A very large baby may require a little more milk than that allowed in these formulas. A small delicate baby will require less than the milk allowed in the formulas." These formulas may be tabulated as shown on p. 177. Mixed Feeding. Under some conditions the breast-fed baby is given also a certain amount of modified milk, and this combination of natural and artificial feeding is termed mixed or supplementary feeding. A deficiency in the breast milk, ascertained by weighing the baby before and after each nursing, may be supplied THE MOTHER'S CARE OF HER BAliV 177 by following eat-h nursing with a bottle feeding; or for some reason, one or two breast-feedings, in the course of the day are sometimes replaced by entire bottle feedings. In any case the milk mixture to be used as supplementary feeding is prepared with exactly the same painstaking care as is the milk for entire artificial feeding. If supplementary food is given because of an inadequate supply of breast milk, it is of great importance that the baby be put to the breast regularly, no matter how little food he obtains, for his suckling is the best iiossiblo means of stimulating the breasts to secrete more milk, and of equal Age Milk Water Barley- Waier Lime- Water Sugar No. of feed' ings Hours Day I Night 3-7 days 3 ozs. 7 ozs. J^ozs. 2 teaspoons 7 6-9-12-3-6 10-2 2d week 5 " 10 " 1 " 11/2 tablespoons 7 6-9-12-3-6 10-2 3d " 6 " 10>^ " 1 " 1}^ 7 6-9-12-3-6 10-2 1 month 7 " 11 " 1 " 2 7 6-9-12-3-6 10-2 2 " 11 " 13 " i'A " 2H 7 6-9-12-3-6 10-2 3 " 16 " 16 ozs. 2 " 3 7 6-9-12-3-6 10-2 i " 19 " 15 " 2 " 3 6 6-9-12-3-6 10 5 211.2 " 14 •' 2 •' 3 6 6-9-12-3-6 10 6 '• 24 " 12 " 2 3 5 6-10-2-6 10 7 26 •' 12 " 2 " 3 6-10-2-6 10 8 " 28 " 11 " 2 " m o 6-10-2-6 10 9 " 30 " 10 •• 2 " 2 6-10-2-6 10 importance is the fact that they will tend to dry up if the baby nurses less than about five times in twenty-four hours. Moreover, even a little breast milk is valuable to him and he should have the benefit of all there is to be had. An entire bottle feeding is sometimes given to a baby who is nursing satisfactorily at the breast, in order to give his mother an opportunity to take longer outings than are possible between the regular nursings. And sometimes it is to the mother's advantage, and therefore to the baby's, to give him a bottle during the night and thus allow her to sleep undisturbed. 178 GETTING READY TO BE A MOTHER COMMERCIAL BABY FOODS Since the baby's nourishment is prescribed by the doe- tor, you have no reason to concern yourself with the vari- ous proprietary baby foods and canned and powdered milks that are so persuasively advertised to young mothers. And I earnestly hope that by the time you finish this little book, no one will be able to make you believe that any of these foods is likely to be satisfactory if used as a sole article of diet throughout the bottle-feeding period. Uncjuestionably there are many times and circumstances when the temporary or supplementary use of a prepared infant food or canned or powdered milk is advantageous. In some cases of intestinal disturbance a proprietary food may be a great boon, or while the mother is traveling and is unable to have freshly prepared milk formulas supplied to her along the way. These foods may be valuable, also, during the summer, while one stays at a hotel or boarding house where the freshness, cleanliness or purity of the milk are uncertain, or during a sudden shortage of fresh milk, as may occur during a strike or severe storm when trans- portation is interrupted. But you should not use a pre- pared infant food for any length of time without your doctor's order. If you are confronted with the necessity of choosing a prepared food, for temporary use, you may be guided by considering the general objects and principles of baby feeding and the character of the various foods at your disposal. The proprietary foods may be divided into two general groups : one kind contains milk powder and is usually added to water, while the other consists largely of sugar and starch and is added to fresh milk before being given to the babv. THE MOTHER'S CARE OF II HR BABY 179 Canned milk is of two kinds; evaporated, which is un- sweetened, and condensed, Avhich is sweetened. Evaporated milk is whole milk from which part of the water has been removed, the milk then being canned and sterilized. The addition of water to evaporated milk restores it to the com- position of whole milk in many respects, but it is still milk that has been heated. Condensed milk is evaporated milk to which cane sugar has been added to aid in its jn-eserva- tion. Since bacteria do not grow well in highly sweetened foods, it is not necessary to bring sweetened condensed milk to as high a temperature as the unsweetened product, to prevent subsequent bacterial decomposition. The high per- centage of sugar in condensed milk quite obviously renders it unsuitable for continuous use as the sole article in a baby's dietary. Milk powders or dried milks are prepared by rapidly evaporating the water from whole milk, skimmed milk or partly skimmed milk, leaving the solid constituents in the form of a light, white powder. ]\lilk powder readily dis- solves in water, forming a "reconstructed milk" which closely resembles the fresh milk from which it was pre- pared. But it must not be forgotten that reconstructed milk has been heated. Many doctors consider whole milk powder the most satisfactory form of preserved milk which is available for baby food. Should it be used, however, the importance of keeping it tightly covered and in a cold place must be recognized, for the presence of fat renders it likely to become rancid if not kept cold. ARTICLES OF FOOD WHICH ARE SOMETIMES INCLUDED IN THE BABY'S DIETARY Barley water, sometimes used to dilute whole milk, is made bj* mixing the barley flour to a smooth paste in cold water, adding boiling water and boiling for twenty minutes 180 GETTING READY TO BE A MOTHER or cooking in a double boiler for an hour straining and adding enough water to replace the amount lost in cook- ing. The proportions for different ages are as follows : Three months, V2 level tablespoonfnl barley flour to 16 oz. water. Six months, IV2 level tablespoonf uls barley flour to 12 oz. water. Nine months, 3 level tablespoonf uls barley flour to 10 oz. water. Potato Water. One tablesi)oonful of thoroughly boiled potato is mashed into one pint of the water in which the potato was boiled and carefully strained. Spinach. Spinach is carefully washed, steamed for half an hour and mashed through a line sieve. It is sometimes started at the sixth month ; one teaspoonf ul daily, gradually increased to one or two tablespoonfuls daily. Orange Juice. The orange should be dipped in boiling water and wiped on a clean towel before being cut and squeezed, to avoid possible infection of juice. It is usually given to babies, sometimes as young as one month old, who take heated milk. It is carefully strained and started grad- ually by giving one teaspoonful in water once or twice daily between feedings and increasing to I/2 or 1 ounce by the sixth month and l^/o to 2 ounces by the end of the first year. Infusion of Orange Peel. This is sometimes used instead of orange juice, and is made by boiling one ounce of finely grated orange peel in two ounces of water, adding a little sugar to counteract the bitter taste and adding enough sterile water to bring it up to two ounces. Tomato Juice. Canned tomato strained through a fine sieve, is sometimes given to a baby a fcAv weeks old, starting with one teaspoonful and gradually increasing to four to six ounces daily. Whey. One quart of whole milk heated to 98° F. or 100° F. and one half ounce of liquid rennet or one junket THE MOTHER'S CARE OF HER BABY 181 tablet stirred into it and allowed to stand half an honi- or until firm and solid, is poured into a cheesecloth bag and allowed to drain for about an hour without being squeezed. Protein Milk. The curd from one quart of milk, which remains after the whey is drained, as directed above, is mashed through cheesecloth in a fine wire sieve, with a potato-masher or bowl of a spoon and the curd washed through with one pint of water. A pint of buttermilk is added and the mixture boiled while being stirred con- stantly. This is sometimes given in diarrhea. Beef Juice. One pound of thick round steak, slightly broiled, is cut into small pieces and the juice expressed with a meat press or a lemon s(iueezer, the amount varying from 2 to 3 ounces. It nuiy be diluted with an equal amount of warm water, or slightly warmed by being placed in a cup standing in hot water, and salted to taste. Broths. One pound of lean meat, all fat and gristle re- moved, is allowed to one pint of water. The meat is cut finely and put on in cold water, heated slowly and allowed to simmer for three or four hours, when water is added to replace Avhat was lost in cooking. It is strained, the fat removed and slightly salted. Oatmeal Water. Two level tablespoonfuls of oatmeal in a pint of boiling water is cooked in a d()ul)le-boiler for two hours, strained and enough boiling water to replace the amount lost in cooking. BATHING AND DRESSING YOUR BABY By the time you assume your baby's care he will prob- ably be having his daily bath in a tub. It may be given under a spray, however, or the doctor may prefer to have him sponged. The sponge bath may be given in your 182 GETTING READY TO BE A MOTHER lap or on a table covered with a pad, either method being satisfactory if the baby is kept warm and comfortable. But one inclines to the idea of having the baby bathed in the lap for he seems happier there ; more comfortable and less frightened and we cannot be sure that these factors are unimportant to even a tiny baby. The best time for the daily bath, during the first three or four months, is about an hour before the second feeding in the morning. After this age the full bath is sometimes given before the six o'clock feeding, in the evening, for a bath at this hour is soothing and restful and often helps toward giving the baby a good night. Preparation for the bath should be made with its possible effects, both good and bad, in mind, for the baby may be helped or harmed according to the skill with which he is bathed. He must not be chilled during his bath, and fatigue and irritation must be avoided by giving it quickly and with the least possible handling and turning. These ends may be served by conveniently arranging all of the articles which will be needed, on a low table at the right hand side of your chair, before the baby is undressed. There should be a pitcher of hot and one of cold water ; a bath thermometer ; two soft washcloths ; soft towels ; bath blankets ; Castile, or some other mild soap ; boracic acid solution ; sterile cotton pledgets ; large and small safety- pins, or large ones and a needle and thread if the band is to be sewed on ; unscented talcum powder ; sterile albolene or olive oil ; soft hair brush and a complete outfit of cloth- ing. The little garments should be arranged in the order in which they will be put on, the petticoat slipped inside the dress, and in cold weather, all hung before the fire or heater, to warm. The temperature of the room should be about 72° F. and if it is possible to bathe the baby before an open fire THE MOTHER'S CARE OF IlKK P.AIiV 18:j or a heater, so much the better. In any case he must be protected from drafts and a sheet hung over the backs of two straight chairs will serve very well as a screen if no other is available. The tub or basin should be about three-quarters full of water at 100° F. for the new baby; about 95° F. after the third month and gradually lowered to 85° F. or 90° F. for the baby a year old. The temperature of the Avater should not be guessed at, but tested with a thermometer, though in an emergency you may safely use water that feels com- fortably warm to your elbow. Lay a folded towel in the bottom of the tub, before be- ginning, as babies are often frightened by coming in con- tact with the hard surface. It is a good plan to wear a waterproof apron, covered with one of flannel over which is laid a soft towel, until the bath is finished. The towel is then slipped out, leaving the dry, flannel apron to wrap about the baby. Wash your hands thoroughly with hot water and soap, before begin- ning; sit squarely, Avith your knees together, on a chair without arms ; take the baby in your lap and undress him under a blanket. In order that the bath may be given deftly and quickly it is well to bathe the different parts in the same order every day, for practice makes perfect. It is usually a routine to weigh the baby every morning, during the first two or three weeks and once or twice a week afterwards, though premature babies and those who are frail are sometimes weighed at longer intervals because of the inadvisability of disturbing them so often. The baby is undressed for his bath, wrapped in a blanket, and laid in the scoop or basket of a beam scale and a note made of the entire weight, for if he is placed in the scales without protection he is likely to be chilled and frightened. The 154 GETTIN'G READY TO BE A MOTHER -^i-.zht of the blanket is aseertained separately and deducted ir :ii the total thus giTing: the baby's exact weight. T: f -~^ should be bathed firsts with pledgets of sterile .:: p»ed in warm boraeie acid solution, each pledget - - ':.'. onee. To prevent the solution from running 7 ~:k the other, the baby's head is turned . r " - le^ and the lower eye wiped gently from -ard. The lids may then be separated by piiaemg ' below the brow and lifting it slightly, and the r -d with a gentle stream by squeezing a fre^y soaked pledget just above it. The head is turned to the other dde and the eye on that side bathed in like manner. The month is swabbed out very gently with boricnsoaked eotton wrapped about the tip of the little finger, care being taken not to injure the delicate mucous lining. The nos- trils are cleaned with little spirals of eotton dipped in mineral oil or olire oiL The £aee is then washed with warm water, no soap, and patted dry. The scalp, neck and ears are wa^ed with soap and water and thoroughly dried by patting and by wiping gentty in the creases. The body should then be soaped with your hand, only one part being uneovered at a time in order to avoid chilling. To place the baby in the tub, slip your left hand under his head in such a way that it will rest upon your wrist as your fingers spread out to support his shoulders. Tour thumb naturalhr curves over and holds the upper part of the baby'^s arm without pulling or straining it. Grasp his ankles with the right hand and lower the little body into the water, feet first, as shown in Fig. 50. This gradual lowering of the baby into the water is worth while, for he is like^ to be frightened if he is plunged in suddenly. 11 the baby's arm and shoulder are firmly held and sup- 186 GETTING READY TO BE A MOTHER Fig. 51. — Method of comfortably supporting the baby's head above the water wliile giving his bath. ported by your left hand, it is an easy matter to steady his entire body and keep his head out of the water Avhile giving the bath with your right hand, as in Fig. 51. The new baby is not usually kept in the tub for more than two or three minutes, but when he is three or four months THE MOTHER'S CAIJE OF HER BABY 187 old he may stay in for five minules and still longer as he grows oldei-. Hot water should never he poured into the tuh after the baby has been plaeed in his hath hut cold water is often added, for a three or four months old baby, or the warm hath followed by a quiek sponge with eold water. The little body is ((uickly patted dry, afterwards, and rubbed briskly with tiie ])alm of the hand; the legs and arms stroked toward the body ; the baek from the neek down- ward and the ehest and abdomen with a eireular motion. Babies who react well to eold baths are benefited by them, but those who do not, may be harmed. Such "toughening" methods, to be benefieial, therefore, must be adjusted very carefully to the individual baby and should be employed only in aeeordanee with the doctor's directions. The genitals should be bathed and dried with care ; in- spected daily and any unusual appearance reported to the doctor. It is not uncommon for girl babies to have a slight bloody discharge from the vagina. Although this is unimportant and soon disappears, your doctor should be told of any discharge, however slight. The doctor often washes to have the foreskin of boy babies retracted every morning at the time of the bath, by gently rubbing it back with gauze or cotton, taking pains that it is pulled forward to the original position after the part underneath has been thoroughly bathed with boracic acid solution. If retraction is impossible after several daily attempts, the baby is not infrequently circumcised. The care of the baby's teeth is a part of the bath and should begin when the first tooth appears. It should be wiped front and back with a piece of gauze or cotton dipped in boracic acid or soda solution or some other weak alka- line wash, to neutralize the acid secretions of the mouth as these favor decay. After the baby has five or six teeth, 188 GETTING READY TO BE A MOTHER the use of a very soft brush with tooth paste is often advised, the teeth being brushed with a circular motion or from the gums toward their edges. The teeth should be wiped, or brushed, morning and evening and after feed- ings. The reason for such close care of the temporary teeth is that they serve as a mold or brace to hold the jaws in proper shape for the permanent teeth which appear later. If the "milk" or first teeth decay or crumble away before the jaws are developed to the point when the permanent teeth appear, these second teeth are likely to be crowded, crooked and uneven. After all of these details have been attended to and the entire body, including creases and folds, has been patted quite dry, it may be dusted with an unscented tal- cum powder, but this powdering must not be resorted to as an aid in drying the skin. In order to prevent chafing, the buttocks and thighs should be wiped clean with oil, or bathed with warm water, no soap, patted dry and powdered or oiled each time that the diaper is changed. The cord has dropped off, in all probability, by the time you begin to bathe your baby, and the navel so well healed that you need do nothing to it, but you may be interested to know what painstaking care the nurse has given to this important detail of the baby 's toilet. The form and method of cord dressings vary somewhat with different doctors but in practically all cases the dressings are sterile, to prevent infection, and porous in order that air may gain access to the cord and promote the drying process. The dressing itself may consist of dr.y, sterile gauze or gauze wet with alcohol wrapped about the cord, as shown in Fig. 52 ; or it may consist of squares of sterile gauze or muslin with holes in the centers to fit around the cord, and dusted with some such powder as boric acid, bismuth or salicylic acid and starch. The dressed curd is laid flat on the abdo- THE MOTHER'S CARE OF HER BABY 189 men and directed upward to prevent its being wet with urine; a gauze sponge is placed over the dressing and the Fig. 52. — Cord dressed with dry sterile gauze. (From photograph taken at Johns Hopkins Hospital.) flannel binder applied, being sewed on or held in place with safety-pins, as shown in Fig. 53. The band is put on firmly and with even pressure, but not tightly. , It is a mistake to think that a tight band 190 GETTING READY TO BE A MOTHER strengthens the baby's abdominal muscles, for it has quite the opposite tendency and in addition may give pain and Tig. 53. — Straight flannel binder applied over cord dressing. even cause vomiting. The band is removed every morning at the time of the bath, or whenever it is soiled, but the THE MOTHER'S CARE OB^ HER BABY 191 cord dressing is not usually taken ofV unless it is soiled. When the eord finally didps oft", the straijzht flannel binder is replaced by a knitted band with shoulder sti-aps. This is usually worn for three oi- i'oui- months, particularly in cold weather, to provide a little extra warmth over the abdomen. Thin, delicate babies sometimes need this band for a vear or more. Fig. 54. — Putting on the diaper which has been fohled straight throiish the middle. After the band has been applied, the warmed shirt is put on and then the diaper. There are two methods of putting on the diaper. One is to fold the square diagonally and bring the diag- onal fold around the baby's waist. One of the lower cor- ners is drawn up between the thighs, the two corners from the sides brought over this, straight across the waistline and not carried down between the thighs. The fourth corner is brought up over these and all are pinned se- curely with a safety-pin, while two other safety-pins hold the margins of the diaper together above the knees. The other method is to fold the diaper straight through the 192 GETTING READY TO BE A MOTHER center, forming a rectangle twice as long as it is wide ; to lay the baby on it lengthwise, draw the lower half up between his thighs as shown in Fig, 54, and pin it on each side at the waistline and above the knees. (See Fig. 55.) In either case the diaper must be put on smoothly and care taken to avoid forming a thick pad between the thighs as this will tend to curve the bones of legs, which, as you know, are still soft. Squares of soft, absorbent material, Fig. 55. — How the diaper in Fig. 54 looks after it has been put on. which may be burned, when soiled, placed inside the dia- pers will greatly facilitate the laundry work. The baby's diaper should be changed whenever it is wet or soiled, for in addition to making him restless and fret- ful for the time being, the skin about the thighs and but- tocks will grow red and chafed if he is allowed to wear wet diapers. AVet diapers should not be dried and used again but washed with mild soap, boiled and whenever possible, dried in tlie open air and sunshine. All of this makes it apparent that the regular use of waterproof protectors is to be condemned since a baby so protected may wear a wet diaper for some time before it is discov- ered. Under special circumstances such as a drive, a THE MOTHER S CARE OF HER BABY 193 short journey or visit the diaper may he covered l)y water- proof drawers hut their hal)itual use will make the haby unhappy and uncomfortable and may even result in a serious condition of the skin. Cominp: baek to dressing the baby, after his bath, we find that after the band, shirt and diai)er have been ad- justed the petticoat and dress are put on with the fewest possible motions and the baby's hair brushed upward from his neck and back from the forehead. He should be wrapped in a small blanket, fed and laid (juietly in his crib to sleep. If his hands and feet are cold a hot-water bottle at 125° P. with a tlannel cover, may be placed beside him. When the baby is made ready for the nigfht he may have a sponge bath or simply have his face and hands sponged with warm water, according to the wishes of the doctor. The clothing which the baby has worn during the day should be entirely replaced. The day and night clothing may be worn more than once, if clean and if aired between times, but it is better not to have the baby wear the same set of clothes for twenty-four hours at a stretch. In cold weather a tape is often run through the hem of the stock- inette or flannel nightgown in order that it may be drawn up, bag fashion, to keep the baby's feet warm. During very warm weather the baby sleeps in a thin cotton slip. YOUR BABY'S CLOTHES Your baby's clothes w'ere made long since, of course, but a word about their use is worth while as they may be very influential in promoting the baby's well-being. In order that his body may be kept at an even temperature the warmth of his clothing must always be adjusted to the needs of the moment. The general tendency is to dress the 194 GETTING READY TO BE A MOTHER bab}' too warmly and the usual result is that he perspires ; is listless, pale, and fretful; sleeps badly; is susceptible to colds and other infections and has poor recuperative powers. His digestion is likely to be deranged and he may have prickly heat. On the other hand, if the baby is not dressed warmly enough his hands and feet will be cold and his lips blue ; he will cry from discomfort and the general result may be lowered vitality and disturbed diges- tion. If the baby's clothes are not comfortable, if they pull and drag or have tight bands, he will be fretful and restless, with disturbed sleep and upset digestion in con- sequence. The little wardrobe will be entirely adequate, under ordinary conditions, if it consists of shirts, bands, diapers, flannel petticoats, dresses, nightgowns, flannel wrappers and sacques. As the petticoats and dresses are cut twenty- seven inches long, many doctors feel that they offer enough protection for the feet of the average baby to make stock- ings unnecessary until he is from four to six months old. The skirts are then shortened to ankle length and stockings added to the baby's attire. Other doctors think it wiser to put knitted socks or part wool stockings on the new baby, particularly if he is born during cold weather. When the baby begins to creep, he should wear soft soled shoes, part wool stockings in cold weather and thin cotton or silk ones during the summer, and firm but flexible soled shoes as soon as he tries to stand alone or to walk. During the first month or two the baby scarcely needs special clothing for outdoor wear as he may be wrapped in one of the flannel squaries with a casing run in one cor- ner to form a hood, or he may be placed on a square diag- onally and the upper corner folded about his head and held under the chin with a safety-pin. The corners on the sides are folded about his shoulders, the lower one brought THE MOTHER'S CARE OF HER BABY 195 up over his feet and limbs and the additional blankets tucked in over all. But as the baby grows older and moves about in his carriage, he will need a cap and cloak or wrap with hood attached. In cold w^eather the cap should be knitted or wool lined and the cloak of soft woolen material or wool lin(>d. In moderate weathei- tlie cap may be of one thickness of cotton or silk, or very light flainiel, wliile on very warm days lie will need no head covering at all. To sum u]): The baby's clothes should be simple in de- sign, hang from the shoulders, fit smoothly but loosely and have no constricting bands; they should be of soft, light, porous material; their warmth always adjusted to the im- mediate temperature so that the baby will be protected from being either chilled or overheated. And his clothing must always be clean and dry. AIRING YOUR BABY An abundance of fresh air is one of the baby's greatest needs as it increases his resistance to disease and his recu- perative powers, improves his appetite and aids digestion. In general, the more the baby is in the open air and the more fresh air he has while in the house, the better. The two factors which must be considered in supplying the baby with fresh air are the condition and vigor of the baby himself and the immediate temperature and state of the weather. His age and the season of the year can be only partial guides because of the difference between in- dividual babies of the same age and the variations in tem- perature, winds and moisture during any one season. The air of the room which the baby occupies should be changing constantly in order that it may always be fresh, ^ but the temperature should be equable and the baby pro- tected from drafts. As the tendency here, as with the 196 GETTING READY TO BE A MOTHER baby's clothes, is toward overheating, you will do well to remember that the young baby who lies covered up in his crib, may usually be kept an a colder room than is advis- able for an older one who is creeping or walking about. During cold weather the baby's bed should not be di- rectly in front of an open window and he should be pro- tected from direct currents of cold air by a sheet hung over the head and side of his crib. Two or three times daily, while the baby is out of the room, the windows should be opened wide to air the room thoroughly, one of these airings being just before the baby is put to bed for the night. The doctor's usual instructions concerning the tempera- ture of the nursery are to keep it from 68° F. to 70° F. during the day and about 65° F. at night, during the first three months and lower it gradually to 64° F. during the day and about 55° F. at night as the baby grows older. It is customary to begin to open the nursery window at night when the baby is three or four months old, if he is well and the temperature is above freezing. In planning to take the baby out of doors it is wiser, as a rule, to begin with the indoor airing when he is about a month old, except, of course, during the moderate or mild months of the 3'ear, when he is taken out at once. If the weather is cold, the baby may be protected with extra wraps and carried in the arms, into a room in which the windows are open and kept there for fifteen or twenty minutes. This indoor airing is increased by being gradually length- ened to two or three hours and by having the windows opened wider and wider. By the time he is two or three months old he is taken out of doors on clear, bright days, the best time being between ten and three o'clock, when the sun is high. If he is carried in the nurse's arms at first the warmth of her body serves as a protection and helps to THE MOTHER-R CARE OF HER R.AIJY 197 accustom him to the out-of-door life, when he spends a good deal of his time out of doors in his carriafrc On windy, stormy days or when thci-c is melting snow on the ground, the baby may be given his airing on a pro- tected porch or in a room with the windows oi)en. lie is not usually taken out if the temix'rature is below freezing until the third or fourth inoiitli. After this time the average baby is taken out when the temperature is not lower than 20° F. When the baby is dressed in his extra wraps he must be taken out of doors or the windows o])e)ied immediately, for otherwise he will become overheated and be in danger of chilling when taken into the colder air. Warm hands and feet, a good color and the baby's tend- ency to sleep most of the time while out of doors are evi- dences of his being adequately clothed for his airing, while the reverse is true if he is not warm enough. A robust baby who has been gradually accustomed to being out of doors during the day will usually be much benefited by sleeping out at night. But he must be pro- tected from winds and his clothing so arranged that he can- not be chilled. Knitted or flannel sleeping garments or sleeping bags (See Fig. 20) are valuable and in addition, the blankets which cover the baby should be securely pinned to the mattress with safety-pins and tucked well under it at the sides and foot. The baby should wear a warm cap and the bed should be warmed before he is put into it. Or better still, he may be dressed for the night, put to bed in a warm room and the crib then moved out on the sleeping- porch. An excellent device for protecting the l)aby's arms and chest, and keeping him generally well covered, is the ]ioneho (Fig. 56) devised by Dr. Lucy Porter Sutton of Bellevue Hospital. The poncho is a rectangle made of flannel, out- 198 GETTING READY TO BE A MOTHER ing flannel or an old blanket and cut large enough to tuck well under the head and sides of the mattress and extend below the baby's feet. The baby's head slips through an opening, which is almost a right-angled slit, equally distant from the sides of the poncho and about 20 inches from Fig. 56. — The "Sutton Poncho" which keeps even a restless baby well covered. The insert shows how to make the slit for his head to pass through. The regular bedding is turned back in this picture. (From a photograph taken at Bellevue Hospital.) the top. The slit is firmly bound and provided with tapes to tie it together after the baby is put in. The poncho should be put on loosely enough to permit the baby to move about at will beneath it. After it is adjusted the bed is made up as usual with additional blankets. Under all conditions the baby 's airings must be increased THE MOTHER'S CARE OF HER BABY 199 gradually, both as regards lowerino: the temperature and lengthening the time, and always adjusted to the vigor and reaction of the individual baby. He must be warm, but not too warm ; he must be protected from wind and dust, and his eyes shielded from glare and from flickering light, such as may be caused by a tree in a light breeze. EXERCISING YOUR BABY Although the baby should not be handled unnecessarily nor tossed about and played with by friends and relatives, it is important that his muscular development be promoted by regular and carefully planned exercise. It is usually considered best for the baby to lie quiet and undisturbed in his crib most of the time during the first three or four weeks. Dr. Griffith begins the baby's exercise about that time by having the nurse or mother take him in her arms on a pillow and carry him about for a few moments several times daily. After a week or two of this form of exercise the baby is carried in the arms without a pillow but with his head and back carefulh^ supported as the nurse is doing in Fig. 57. The position of the baby's body is changed by his being carried about in this way and the movement of the nurse or mother as she walks, causes a certain amount of motion of the baby's muscles which constitutes a gen- tle exercise. The baby should be carried first on one arm and then on the other in order that both sides of his body may be equally exercised. This semi-passive form of exercise by means of being carried about is regarded by many doctors as almost indis- pensable to the baby's welfare. There is a possibility that lack of this form of "mothering" is one reason why babies in institutions sometimes fail to progress as they should. Certainly, it is inadvisable for the baby to be al- lowed to lie for very long in one position. 200 GETTING READY TO BE A MOTHER By the third or fourth month the baby sits up in his mother's arms, as she carries him about, and he may be placed on the outside of -his crib coverings for a little Fig. 57. — Method of carrying baby to suj^port his head and back. while every day, to kick and struggle at will. His skirts should be rolled up under his arms, or removed entirely, to leave his legs quite free, care being taken that the room is warm and that he has on stockings. THE MOTHER'S CARE OF UVAl I'.AUV 201 By about the sixth iiioiilli lie will usually l)c floor before the baby is put down to creep. When the sheet is taken up, be sure that it is folded with the upper surface inside in order that when it is again init down the baby will play on that side and not on the side that has been next the floor. A creeping pen or cariole or some such provision is often more satisfactory than the floor, consisting as it does of a railed-in platform raised about six or eight inches from the floor. The suggestions for exercise, like those for the baby's airing, must be very general since it should always be ad- justed to the powers of the individual baby and directed by the doctor. TRAINING YOUR BABY Bowels. It is possible to train even a very young baby to have regular, daily bowel movements ; and this training should be started when the baby is about a month old. At the same hour each day he may be laid on a padded table, or taken in your lap, a small basin being placed against or under the buttocks and a soap stick introduced an inch or two into the rectum and moved gently in and out. This slight irritation will usually result in the baby's emptying his bowels almost immediately. Another method is to 202 GETTING READY TO BE A MOTHER hold the baby in a comfortable, reclining position, on a small chamber in your lap, as in Fig. 58 or with his back supported against your chest, and the desire to empty his bowels stimulated by using the soap stick as described. (A soap stick is simply a piece of soap about three inches long whittled down to about the size and shape of a lead pencil with a blunt point.) Fig. 58. — A comfortable position for the baby who is being trained to use a chamber. It is of considerable importance that the position and method which are adopted, be employed at exactly the same time each day in order to establish a habit. If this is done and the baby is being properly fed, it will usually be found that before he is many months old, his bowels will move freely and regularly without the stimulation of the soap stick and only when he is resting on the small chamber or basin that he is accustomed to using. This establish- ment of a regular bowel movement not only simplifies the THE MOTHER'S CARE OF HER BABY 20:] laundry work and the care of the baby but is of great moment to his health. Thumb Sucking. It is si-areely necessary nowadays to tell a mother that her baby must not be alloAved to suck on an empty bottle or a pacifier nor be permitted to suck his llmmb. These habits are very dirty and help to spread Fig. 59.- — Stiff cuffs on the baby's elbows keep him from sucking his thumbs. disease. The baby may swallow air while practicing them, with colic as a result, and he may so deform the shape of his upper jaw that later in life, the upper and lower teeth will not meet as they should for satisfactory mastication; his front teeth may protrude in a disfiguring manner ; and by narrowing and elongating the roof of his mouth, the structure of the air passages may be altered, with respira- 204 GETTING KEADY TO BE A MOTHER tory troubles and adenoids as a probable consequence. Thumb sucking- may be prevented by the simple pro- cedure of putting stiif cuff-s on the baby's elbows, such as are shown in Fig. 59, and which make it impossible for him to reach his mouth with his thumb. These cuff's are easily made by covering pieces of cardboard with muslin and attaching tapes with which to tie them on the baby's arms. Another method is to put the baby's hands into celluloid or aluminum mitts made for this purpose, or little bags made of stiff', heavy material, which in turn are tied to his wrists ; or his sleeves may be drawn down over his hands and sewed or pinned with safety-pins. It should be borne in mind that a baby sometimes sucks his thumb because he is hungry or thirsty and will give up the practice when his food is increased or when he is regularly given water to drink. Ear pulling is not uncommon among young babies and, if allowed to continue, a long, misshapen ear may result. This may be prevented by using a thin close fitting cap which ties under the chin, or by using the same kind of elbow splints as for thumb sucking. Crying. It is very easy to allow the baby to develop the crying habit but very difficult to break it up. The first step toward prevention is general good care, for a baby who is properly fed and exercised, kept dry and warm, but not too warm, and whose clothes are comfortable, will usually cry very little if wisely handled in other respects. But a baby may cry because he is hungry, thirsty, wet, cold, overheated, sick or in pain or simply because he wants to be taken up and entertained and has learned that the way to realize his wish is to cry. By examining the baby's condition and observing his habits, it is usually possible to discover the cause of his crying. Very often a drink of fairly warm water will quiet him, particularly at night. THE MOTHER'S CAKE OF HER BABY 205 Bui unless he sccuis to luivo colic ;nul sl()|)s crying becaus(! of llu" i-('li('f due lo the upriglil position in your arms, you sliouUl lu'sitatc lo tak<' tin- ci-yiug baby up and carry liiiii about and linld him when it is discox-crcd that this atten- tion sto])s his cryinji". Persistent eryinji; sbouhl be reported lo your doctor as it may bo of some signilieance. KEEPING YOUR BABY WELL IN SUMMER Notice that 1 say kccpiiuj him. well. There was a time when Ave looked upon the scoui'ge, variously known as "summer eomplaint," "summer diarrhea'' and "cholera infantum" as a seasonal visitation that was to be accepted with resignation. But happily those dark days are past, for though the condition itself is a complicated one, the one big factor in its causation was dirty milk — milk that was infected or spoiled or both — given to a baby whose forces were lowered by the heat. It is perfectly clear, then, isn't it, that a baby is no more likely to be ill during the summer than at any other time, if he is given proper care, the kind of care that we have been going over in detail? Each of these details is important but .just bear in mind that during warm weather it is particularly urgent to: 1. Feed the baby proi)erly. 2. Keep him clenii. 3. Keep bini cool. 4. Keep him <|uiet. The end and aim of these precautions is to prevent dis- turbance of the baby's digestion. As babies suffer from the heat more than adults do and are often excessively ir- ritated and exj)austed on warm days, these results of the 206 GETTING READY TO BE A MOTHER heat are sometimes enough to upset his digestion unless he is safeguarded with greatest care. It is much the same as with grown people, who often find that their digestions are upset solely by their being tired or excited. The baby should have maternal nursing if possible, dur- ing the summer, for breast-fed babies fall victim to summer complaint much less frequently than de bottle babies. Quite evidently, then, you should regulate your own life with even more care than usual — for the baby's sake. He should be fed with absolute regularity, and as a rule, no matter what the nature of his food, it should be reduced one quarter to one third in amount when the days are very hot, and he should have an increased amount of cool, boiled water to drink. His weight may increase only slightly, or even stand still for a short time, as a result of his de- creased food, but you need not worry about this if he keeps well, for the important thing i-s to avoid digestive disturb- ances. It is just the same as with grown people who are advised to eat less and lighter food than usual, while the weather is very warm, in order to keep well. Cleanliness, as at other times, applies to the baby's food, clothing and surroundings. Many doctors think it safer to have all milk boiled during the summer, and of course expect scrupulous cleanliness in its preparation and administration. The baby's soiled napkins should be placed immediately in a covered receptacle containing water, or a disinfecting solution and not left for even a moment where they may be reached by flies. They should be washed, boiled and dried in the open air and sunshine as promptly as possible. The baby should be protected from Hies and mosquitoes by screens in the windows and netting over his crib and carriage, botli because these insects make him restless and THE MOTHER •« CAKE Ol' 11 1 IK r.Ai;V JOT irritabU' and because Hies, ])ai'1iculiii'ly, are carriers of (ilth and disease — the kind of disease that kills so many babies during the summer. Aceordinfrly, you should re- gard tiies witii (h'adly fear. The baby should be kept away from dusty places and from cats and dogs. And since he will put his fingers into his mouth, in s])ite of you, it is a wise precaution to wash his hands several tiiiies a day. The baby should he in the country, in the mountains or at the seashore, if possible during the warmest part of the summer at least, but if he is in town there is much that you can do to keep him cool and comfortable. His cloth- ing at this season must be adjusted to his condition and the temperature of the moment just as it is in cold weather. A thin shirt, band, diaper and cotton slip will usually be enough for out-of-door wear, while in the house he may often dispense with the slip, and sometimes with everything but his diaper. It is usually best to take the baby out of doors early in the morning and late in the afternoon, but to keep him indoors during the warmest part of the day, when it is likely to be cooler inside than out, particularly if the blinds are closed. During excessively hot days, the baby will usually be more comfortable if he has two or three cool sponge baths, in addition to the soap and water bath, one of the sponges being given just before he is put to bed for the night. He should sleep on a firm mattress, preferably curled hair but never feathers, and in the coolest, best ventilated room available. He must not be played with, held on hot laps nor sub- jected to the entertainment and attention which well-mean- ing but misguided mothers and friends are so eager to lavish on a hot, fretful baby. 208 GETTING READY TO BE A MOTHER Prickly Heat. Very often during warm weather a fine rash, known as "prickly heat" or heat rash, appears on the back of the baby's neck and spreads over his head, neck, chest and shoulders. As this rash is due to too warm clothing or to the hot weather or to both, less clothing and frequent baths will often give relief. If the baby is very uncomfortable he may be greatly soothed by being im- mersed, for two to four minutes in baths, at the tempera- ture he is accustomed to, containing soda, bran or starch in the following proportions: Soda Bath. Two tablespoonfnls of baking soda to one gallon of water. Bran Bath. A cheesecloth bag about six inches square, partly filled with bran, is soaked and squeezed in the bath until the water is milky. Starch Bath. About a cupful of cooked laundi'y starch to one gallon of water. The baby should be placed in the tub as for his daily bath and his entire body submerged, as shown in Fig. 60, •care being taken that his ears are above the surface of the water. No soap should be used while the baby has prickly heat and after the bath he should be patted thoroughly dry and powdered with some such soothing powder as the follow- ing: Powdered starch one ounce Oxid of zinc one ounce Boraeie acid jiowdei- 00 grains Diarrhea. If your baby has an increase in the number of his movements, or if the.y become watery in character, something is wrong. It may be only a mild disturbance or it may be the beginning of an attack of summer diarrhea, THE MOTHER'S CARE OF HER BABY 209 and as at first you cannot possibly tell which it is, you must not take it lip;htly. Xotit'y your doctor at once, but if you are remotely situated or he is delayed in communica- ting with you, there are certain helpful things that you cau Fig. 60. — Method of holding the I)aby in tiie tnb to keep all but his head covered, in giving a bran, starch, ,so(hi or mustard bath. do for the baby while waitinpr for the doctor. The first is to give an enema of half a pint of water, at 110° F., containing Y^ teaspoonful of salt. (See Fig. 64, page 217, for method of giving enema.) If the I)aby seems to have 210 GETTING READY TO BE A MOTHER only a slight diarrhea it may be enough to reduce his food one half, whether he is breast-fed or bottle-fed, and to give him an abundance of cool -boiled water to drink. If he is bottle-fed it is a wise precaution to make up his formula with skimmed milk and leave out the sugar. If the baby has frequent loose movements; seems fever- ish : vomits and cries as though he had pain, stop all food Tig. 61. — Putting the baby into a wet pack. and give nothing by mouth but water, until the doctor comes. If you care for your baby, yourself, through an attack of summer complaint you will tind that the doctor's in- structions are directed tOAvard keeping the baby cool, clean and quiet, while he, himself, gives very careful attention to the question of feeding. It is clear, then, that the baby should be lightly clad and kept quiet and undisturbed, in a cool shady place, out THE MOTHER'S CARE OP HER BABY 211 of doors as imich as possible. During the wannest part of the day, however, he will often he better off in the house, in a room with the shutters closed. But Avhile keeping the baby eool, you must beai- in mind the harm that may be done by chilling him or exjiosing him to a cold draft or wind. The doctor may want him to have several baths daily, possibly tub baths, at a temperature of 100° F,, or cool sponge baths. Packs, also, are given, for they not only cool the baby but quiet him as well, if he is restless. Fig. 62. — The baby in a wet pack with a hot-water bag at his feet and cold compress on his head. These packs may be eool (80° F.) ; tepid (100° F.) or hot (105° to 108° F.) according to the baby's needs. It is a simple matter to give a pack and you will enjoy doing it for you Avill actually see that your baby will grow rpiieter and more comfortable as you give it. Cover the bed with a rubber and sheet and bring to the bedside a basin containing a sheet wrung from water of the specified temperature ; a l)asin containing ice and compresses for the baby's head and a flannel covered hot-water bottle at 125° F., for his feet. The baby is laid on the upper half of the folded wet sheet, and an upper corner wrapped about each arm, as in Fig. 61, and the sides folded around his legs. The lower half is brought up between his feet and used to 212 GETTING READY TO BE A MOTHER cover his entire body, being tncked around his shoulders. The hot-water bottle is placed at his feet and an ice com- press on his head, as in Fig. 62. If the sheets are wrung from warm or hot-water, the bal)y is covered with a blanket after he is put into the pack. Loujer half o( sVieel token up betaieen Legs (feel not covered) to cover body cornpletely and is tucUed under shoulders Corners o{ sheet, u/rapped .oround arms ■' Sides of sheet uraoped around leas Fig. 63. — Diagrams showing the successive steps in putting the baby in a pack. Should your baby have summer complaint, remember that even a mild attack predisposes to another and you will have to be even more watchful and painstaking than ever, in your care of him. He will have to return to his customary diet very slowly, or he may not be able to take his usual amount of nourishment at all until the weather turns cool. Even though he gains no weight it is important to avoid taxing his digestion since it is already being threatened by the heat. TllK MO'IMIKKS {\\\{K OK IIKK \',\\'>\ J):: KEEPING YOUR BABY WELL IN WINTER There arc certain evils llial Ix'sct tlic l)al)y's way during the winter just as tlicre are seasonal pitfalls in summer, but the truth is that if yon care for yourself and him ae- cordino: to the suggestions that have been set down in the foregoing pages, you are doing practically everything nec- essary to make his way safe and comfortable. A baby who has proper food, plenty of fresh air, is kept clean and whose daily life is regular, is not likely to be ill during the winter or any other time. The chief baby ills that come with the blustery weather are colds and the troubles that are likely to follow in their wake, such as bronchitis and pneumonia. Colds are infec- tious, you know, so keep the baby away from sneezy peo- ple and out of crowds and dust}- places. If he should take cold in spite of you, send for the doctor at once. It may amount to nothing and clear up in a day or two, but if you let it run on, the dreaded bronchitis or pneumonia may result. RELIEVING COLIC, CONSTIPATION AND CONVULSIONS I have tried to impress upon you, at every step, that it is very unwise for you to delay in sending for the doctor when your baby seems ill, or to attempt to treat him ac- cording to your own ideas or those of your neighbors. But if the baby should begin to scream with colic or have a spasm, you would want to know what to do at the moment, and in case of constipation there are a few simple nursing l)rocedures that you may employ to the baby's advantage. Colic is always due to indigestion, whether the baby is breast-fed or bottle-fed, because of the food itself being wrong in some respect or because it is not properly given. 214 GETTING READY TO BE A MOTHER The milk may contain too much of the material that forms the curd, or so much starch and sugar that fermentation takes place, the pain itself usually being due to undigested food or gas in the intestines. This condition may also result from the baby's being fed too rapidly or too fre- quently, or from his swallowing air while sucking on a pacifier or an empty bottle. Colic may be caused, too, by chilling the baby as this is likely to disturb his diges- tion. Most babies have colic at some time during the first year, usually before the fifth month. The attacks may occur several times a day, after feeding, or they may not come on until the late afternoon or evening when the baby is tired. Colic is so common that most people are familiar with the symptoms: violent crying and a flushed drawn face ; cold hands and feet ; tightly clenched fists and a hard, swollen abdomen. As the pain is cramp-like, the baby stops crying every little while, and then suddenly begins again, drawing up his legs, doubling up his body and then straightening out with a jerk. For immediate relief, j'ou may give the baby a table- spoonful of hot water in which half a soda mint tablet has been dissolved, and an enema of half a pint of water, at 110° F., containing one half teaspoonful of salt, given through a small rubber tube introduced about six inches. This empties the lower bowel and enables the baby to expel a good deal of the gas that is troubling him so. Rub his ab- domen with a little oil and apply a compress of several thicknesses of flannel, wrung from hot water, covering this with a larger piece of dry flannel, and change it every three or four minutes for a while. Place a flannel covered hot- water bottle (at 125° F.) at his feet, cover him warmly, darken the room and he will almost certainly go to sleep. It is often a good plan to substitute barley water for one THE MOTHER'S TAHE OF HER BABY 215 or two feedings, after an attack of colic, in order to give the disturbed digestive tract a rest. Quite natui-ally, you must tell your doctor if your baby has colic for the cause iiui\' lie in llic duiracter of his food. But it may lie in some erior on your i)art. Go over all the details of your share of Ihe l)aby"s care and see if you can discover anything to correct. "With breast-fed l)abies, iirevention is often accomplished by the mother's nursing her baby more slowly, lengthening the intervals between nursings and by improving her own hygiene, particularly^ by relieving constipation and increas- ing her recreation and out-of-door exercise. Nursing mothers who lead sedentary lives and eat rich food very often have colicky babies as do those who are nervous, irritable and inclined to worry. If the baby is bottle-fed he may be taking his food too fast because of an over-large hole in the nipple ; he may not pause often enough during his meal or he may take in air as he nurses because the bottle is not properly held, as shown in Fig. 48. In any event do not stop until you get at the cause of the trouble for though the colic itself may not necessarily be serious, a continuation of the cause may result in a run down condition or even in malnutrition. Don't forget the importance of holding the baby upright over your shoulder after each feeding, to help him bring up gas, and of placing him immediately in his crib to be left quiet and undisturbed. And ask your doctor about drink- ing water. Very often the tendency toAvard colic is les- sened by increasing the amount of cool boiled water given between meals. Constipation is very common among babies and may be manifest by the stools being too small, too dry or too infre- quent. It is more difticult to cope with than colic, though it, 216 GETTING READY TO BE A MOTHER too, may have its origin solely in unsuitable food. In some cases, however, the constipation is due to absence of habit in emptying the bowels regularly ; to weakness of the in- testinal muscles; to long-continued undernourishment or to some such disease as rickets. It becomes apparent that the prevention of this trouble- some condition is accomplished largely by giving suitable food; constant fresh air; regularity in the daily routine and training the baby to empty his bowels at the same time every day. When constipation is due to insufficient fat in the food, cod-liver oil is sometimes given, 15 to 30 drops three or four times a day ; or a teaspoonful of olive oil two or three times a day. Maltose, malt soup, malted milk, milk of magnesia, mineral oil, oatmeal water and orange juice are all found among the remedies for constipation; while soap sticks, suppositories and enemas of oil or soapsuds some- times have to be resorted to. In giving an enema to relieve constipation, the baby should be protected from chilling, laid on a pillow and the bedpan so placed that he will be comfortable and not in- clined to move, and from half a cup to a cup of soapsuds, at 105° F., given with a small hard-rubber nozzle, as in Fig. 64. When warm olive oil is given at night (2 to 4 tablespoonfuls slowly through a small rubber tube intro- duced about six inches), it is very often retained until morning when the baby empties his bowels freely with little or no assistance. Abdominal massage will often relieve constipation by strengthening the intestinal muscles, this in turn tending to make the bowels move. The abdomen should be rubbed with a firm but not hard, circular stroke, beginning in the right groin and working up to the margin of the ribs, across to the left side and down to the groin. This massage is THE MOTHER'S CAKE OK IIEK 15A15V LM7 often fifivcii for aboul ton minutes every day, preferably at night, but never just after feeding. Constii)ation is sometimes cntii-ely cured by nothing more than a suitable dietary ; an abundance of drinking Fig. 64. — Giving- the baby an enema. He is well protected, to prevent chillino-, and lies comfortably on a pillow which reaches to the bed-pan, the latter l)eing- covered with a diaper where he rests upon it. water ; an out-of-door life ; massage, and above all, the unceasing effort to establish a regular habit. These are all things whieh you, yourself, may do for the baby. The longer constipation persists, the harder it is to cure, so do 218 GETTING READY TO BE A MOTHER all in your power to prevent it and if it develops, try to end it at once. Convulsions are a symptom of several disorders of in- fancy and they may occur unexpectedly. Although at the moment, they are more distressing than serious, you should notify your doctor at once. If he cannot come promptly you may end the seizure by employing measures that will quiet and relax the struggling baby. The room should be darkened, kept absolutely quiet and the baby handled with the utmost gentleness. As a rule the most satisfactory course is to immerse the baby in water at 100° F. and keep him there for five or ten minutes, supporting his head above the level of the water as shown in Fig. 60. (See p. 209.) Have some member of the household place cloths, wrung from cold or iced water, on the baby's head and change them frequently. When removed from the bath, the baby should be wrapped in a blanket, kept very quiet and the cold applications to his head continued. If the baby often has convulsions the doctor may instruct you to give him either a mustard bath or pack whenever he has an attack. For a bath, one ounce, or six level tablespoonfuls of dry mustard is added to one gallon of water at 105° F. and the baby kept in it for about ten minutes, or until the skin is well reddened. He is then wrapped in a warm blanket and surrounded by hot-Avater bottles, with cold compresses applied to his head. The mustard pack is given in the manner shown in Figs. 61 and 62, with a sheet wrung from mustard water which is possibly a little warmer and stronger than that for the bath, care being taken that the sheet is not cooled before it is wrapped about the baby. He is usually left in the pack for about ten minutes or until his skin is reddened, and then wrapped in warm blankets, with cold compresses to his head. THE MOTIIKKS CAKE (»K I IKK BABY 219 THE PREMATURE BABY All of the precautions and gentlciK'ss wliicli are necessary in the care of the normal l)al)\', Ixti-ii at term, must be greatly increased in caring for the l)al)y wlio is born pre- maturely. The premature baby is not only small, but in general is imperfectly developed, having slenderer powers than the full term baby, and at the same time much greater needs. His resi)iratory and digestive organs are less ready to act than those of the normal baby ; his muscles and nerves are feeble ; his heat-producing machinery is unstable and yet he loses an excessive amount of body heat. Accordingly, the baby who has been deprived of those valuable last weeks of growth and development within the uterus, is small and limp ; lies quietly most of the time ; moves very feeblj^ if at all, and needs special care. To help him in maintaining a normal body temperature it is usually necessary for him to be oiled with warm olive oil and* entirely wrapped in cotton batting or flannel or enveloped in a quilted garment, with hood attached, made of cheese- cloth or flannel and cotton batting, such as is shown in Fig. 65. Diapers are often omitted in caring for very feeble babies, a pad of cotton, instead, being slipped under the buttocks, as this may be changed with less disturbance to the baby than a diaper. A satisfactory bed may be devised from a basket or box with the bottom well padded with several inches of cotton, a small jiillow or a soft blanket folded to the proper size, covered with rubber or oiled muslin and a cotton sheet. The sides of the basket may be lined with heavy quilted material, to shut out drafts and help to preserve an even temperature of the air immediately "around the baby, or such a basket as is shown in Fig. 66 may be used. A flannel covered hot-water bag at 110° F. may be placed 220 GETTING READY TO BE A MOTHER beside the baby, or two, three or four glass bottles, each holding about a pint, containing water at 100° F. and securely stoppered, may be. hung in the corners of the basket. A thermometer, also, should hang in the basket Fig. 65.- — Quilted robe, with hood, for the premature baby. It may be made of flannel or cheesecloth with cotton batting for the padding. and the temperature kept between 80° F. and 90° F. The temperature varies less if the bottles are filled in rotation than if all are reheated at the same time. The amount of heat needed around the baby is decided by taking his temperature (by rectum) at regular intervals; supplying more heat if the temperature is low and less if it is at or above normal. Some doctors have the tempera- ture taken every four hours; others twice daily. As the Fig. 66. — An improvised bed for the preiiuitiire baby, consisting of a closely woven clothes basket with padded bottom and four flannel-covered bottles of hot water, attached to the sides. The necessary thermometer and special feeder are shown in the basket. (By courtesy of Dr. Alan Brown, Hospital for Sick Children, Toronto.) 221 222 GETTING READY TO BE A MOTHER baby grows able to maintain a temperature of 98° F. to 100° F., unassisted, the surrounding heat is gradually reduced and finally removed, and flannel clothing replaces the quilted robe. The basket in which the baby lies should be placed in a darkened, well ventilated room and should be carefully screened from drafts. As the baby needs moist air there should be a large, open vessel of water in the room. Since the premature baby's lungs are not fully expanded, respirations are likely to be shallow and irregular, thus fail- ing to supply the amount of oxygen which he needs. And as crying always causes deep breathing, it is a common practice to make the baby cry at regular intervals during the day. In feeding the premature baby, breast milk is the most desirable food. In fact, many doctors feel that his life virtually depends upon it. If the baby is too feeble to nurse, the milk may be expressed from the mother 's breast, being immediately covered and placed in the refrigerator unless used at once. Breast milk is sometimes used whole and sometimes diluted with sterile water and is often given from a medicine dropper or through a special feeder. Such a feeder consists of a glass tube with a small nipple on one end and a rubber bulb on the other, by means of which the milk may be gently expressed into the baby's mouth. (See Fig. 66.) The premature baby's bath is of considerable importance. It almost always consists of sponging him with warm olive oil as he lies in his bed and with the least possible exposure and turning. It is given every day or every second or third day, according to his condition. Tlie eyes are wiped with boric pledgets and the nostrils with spirals of cotton dipped in oil. The buttocks are wiped with an oil sponge each time the diaper is changed. THE MOTHER'S CARE OF HER BABY 22:j It nnist he hoi-m^ in mind constantly that tlic pi'crnalurt' baby is i)aitii'ularly snsc'e|)tibl(' to infection. lie should be safeguarded by having everything tliat comes in contact with bim scrupulously clean ; being protected from drafts, chilling and dust, and allowing no one with a trace of a cold to come near him. The person who cares for him should wear a freshly laundered gown and protect her nose and mouth with a gauze masiv while attending him, TRAVELING WITH YOUR BABY Babies should not travel; that is obvious. But if a journey- is unavoidable, the attendant diflficulties and dis- advantages may be greatly lessened by making certain preparations. If the baby is bottle-fed, the preparations will depend upon the length of the journey and whether or not it will be possible to have freshly prepared feedings, for each twenty-four hours, put on the train from laboratories along the way. If this is not possible and the journey is not to take more than twenty-four hours, the entire quantity of food, ice cold, may be carried in a thermos bottle. The requisite number of sterile nursing bottles may be taken or one bottle which is boiled before each feeding. Or the milk may be prepared as usual and the bottles packed in a port- able refrigerator. Such a refrigerator may be bought or one may be improvised. The bottles are placed in a covered pail and packed solidly in crushed ice ; this is placed in a second pail or a box with a diameter which is at least two inches larger than the inner pail and the space between the two packed firmly with sawdust. Several thicknesses of newspapers should be pressed down over the top and a tight cover fitted to the outer receptacle. The sterile nipples may be taken in a sterile jar and a deep cup or kettle will be needed in which to warm the 224 GETTING liEADV TO \Mi A MOTHEli bottle before each feeding;. It is usually possible to obtain water on the train which is hot enough for this, or cans of solid alcohol, a stand and a metal tray may be added to the traveling outfit. If fresh formula; cannot be delivered to the train, daily, and the journey is to last more than twenty-four hours, one of the proprietary foods or a pow- FiG. 67. — If traveling is unavoidable the baby will be comfort- able and undisturbed in a basket converted into a bed. (By courtesy of the Maternity Centre Association.) dered milk will often prove to be a satisfactory solution to the problem of feeding the baby while traveling. The course to be followed, however, should be selected by your doctor. The baby will usually travel more comfortably and sleep better if he is carried in a basket. A large market basket with a handle or a small clothes basket will serve. It may be lined with a sheet or a blanket ; have a small hair pillow or folded blanket in the bottom and be made up like a crib. (Fig. 67.) If this basket stands on the car seat during the THE MOTH Kirs ("A UK OK HKK KAISV 225 day, and on the fool of youi- hcrtli a1 iiijrlit, the baby will be cleaner, (inieter and less ex|)()sc(l lo drafts tlian if carried in the arms. As we look back over these pages of somewhat detailed description of the baby's care it is borne in npon us that the nursing of this unfailingly delightful and engaging little person has special adjustments and adaptations for different seasons and circumstances. But that on the whole the care of all babies, the year round, resolves itself into the observation of a few general principles, namely: proper feeding; fresh air, rest and (piiet: i-cgularity in the daily routine ; cleanliness of food, clothing and surroundings ; preservation of an even body temj^erature ; consultation with the doctor at regular intervals and also whenever the baby seems ever so little ill. If you are guided constantly by these general principles and apply them conscientiously, you may revel in the satis- fying consciousness that you are keeping yonr pledge to your baby by giving him the best possible start on his life's journey. CHAPTER XI THE NUTRITION OF MOTHER AND BABY Perhaps you are wondering, just a little, why I devote even a short chapter to the subject of nutrition when I have already given you suggestions about dietaries for yourself and your baby. I am doing so because this ques- tion of nutrition is one of such enormous importance in relation to the baby 's future well-being that I want to give it special emphasis. It is probably safe to say that the two most influential factors in creating and maintaining a satisfactory state of health are suitable nutrition and the prevention of infec- tion. Although we shall concern ourselves solely with nutrition, in this chapter, it may be stated in passing that a state of good nutrition goes far toward protecting one from infection. It will help to make the entire matter clearer to explain in the beginning that a state of good nutrition is not neces- sarily evidenced by one's being tall nor by being fat. But it is evidenced by normal size and development ; sound teeth and bones ; hair and skin of normal color and texture ; blood of the normal composition ; stable nerves ; vigor both mental arid physical; normally' functioning organs; resistance to disease, and above all that indescribable condition which is summed up as a state of general well-being. That this degree of nutritional stability is not as preva- lent in this country as might be desired is disclosed by reports upon findings of the examining boards for army 226 THE NUTRITION OF MOTHER AND BABY 227 service, over a period of three years, and pliysical examina- tions of various groups of school children throughout the country, it was found in tiic first case, that about sixteen per cent, of the apparently normal young men who were inspected for military service, wore undernourished in some degree, and according to Dr. Thomas W. Wood, Professor of Physical Education, Columbia University, "Five mil- lion children in the United States are suffering from mal- nutrition." This army of undernoiirislied children, which represents about one third of the children of the country, is on the broad highway to ill health, invalidism of various kinds and degrees, instability and inef^ciency. They are certainly not developing into the clear-eyed, alert, buoyant individuals that go to make up good citizenry. The tragic asi)ect of this state of undernourishment is that though a great deal can be done to nourish and build up the malnourislied child or adult, a certain amount of damage that results from inadequate nourishment during the early, formative weeks and months cannot be entirely repaired later on in life. As the baby grows and develops, certain substances are needed at the various stages of his progress, and if these are not supplied at these stages, there will always be some degree of inadequacy in the adult make up. It is much like the futility, when building a house, of using bricks without straw for the foundation instead of firm, durable rock, and then trying to make the structure substantial and secure later on by using good materials when building the upper stories. The solid foundation and substantial beams and girders for men and women are put in during infancy and early childhood in the shape of good material that forms good nerves, muscles, bones, teeth and general physical stability. It is practically impossible to make up to the older child or 228 GETTING READY TO BE A MOTHER adult for damage caused by failure to supply sufficient nourishment to the gr<)\vin^ ,0**'^^