CHAPTER III

Pregnancy

Advice as to Food and Clothing-Sleep and Air-The Mental State -Care in Childbirth-The Young Mother-The Baby's Needs.

HYGIENE OF PREGNANCY.-The symptoms and signs of pregnancy are discussed in another section (p. 365). The duration of pregnancy usually extends for 280 days from the end of the last menstruation. It is well to acquaint the family doctor with the fact of pregnancy as soon as it is probable, as frequent examinations of the urine are necessary, and also an examination of the parturient or maternal canal in a mother pregnant for the first time, to ascertain whether the child may be born without hindrance, and to determine the position of the child.

Exercise is essential to strengthen the muscles on which an easy labor largely depends, but stretching, lifting, jarring, jumping, the use of sewing machine, bicycling, riding, and dancing are to be avoided. Daily walks and light household work are very desirable.

A large amount of food is requisite, but the separate meals should not be large, especially as pregnancy advances. To avoid this there should be light lunches taken between the regular meals and at bedtime. One

of the dangers of pregnancy consists in the large amount of waste matter resulting from the activity of the vital processes going on in the body, and this is best combated by the use of daily baths in tepid water, and the drinking of six or eight glasses of cool (not iced) water during the day, preferably half an hour before and between meals, and at bedtime. Milk or other fluids, as cocoa, etc., may be substituted to some extent for the water. Alcohol in any form is usually harmful, and there should be great moderation in tea and coffee drinking. Fried food, pastries, and sweets must be avoided, and meat should be eaten but once a day.

Since the clothing should be loose, corsets are usually inadvisable, and a linen waist, sold for this condition, may be worn, to which the lower garments and garters are fastened. Circular garters do harm by causing enlarged veins. The teeth are prone to decay during pregnancy and require in consequence especial care. They should be brushed carefully after each meal, and be examined at frequent intervals by the dentist. It is important to avoid constipation, and if food of the proper character will not prevent it medicines may be employed (see Constipation, p. 505). Pregnant women require eight hours sleep daily and an abundance of fresh air. As much as three pints of urine should be passed daily, and if this does not occur, when the quantity of liquid advised is taken, a physician should be consulted. Sexual intercourse is not allow

able during pregnancy. A discharge is quite frequent from the vagina during pregnancy, and this may set up irritation and itching of the external parts. An injection consisting of a pint of tepid water containing a tablespoonful of boric acid may be taken daily with a fountain syringe for this trouble, and the external parts washed frequently with the same. To relieve itching a solution of baking soda in water may be applied, or cloths saturated with it may be laid on the itching parts. A solution of carbolic acid in hot water (one teaspoonful of the strong acid to the pint of hot water) is also useful as a wash, followed by the application of carbolized vaseline.

Vomiting and nausea are not uncommon during the first months of pregnancy. The "morning sickness " is best avoided by lying in bed till after a cup of hot milk or cocoa has been taken, and an extra half hour has passed, then rising to eat a moderate breakfast. Neuralgias occur occasionally, particularly about the face, and also pain in the upper part of the back of the thigh, resembling rheumatism or sciatica, more troublesome when walking. The pain in the face may proceed from a decayed tooth; otherwise it may be relieved by a hot-water bag or external use of the menthol pencil.

The pain in the thigh is due usually to pressure of the child's head on the nerves in the back of the cavity within which the head of the child rests. If the patient assume a position upon a bed or couch face downward,

and resting only on the knees and chest for ten minutes, or until beginning fatigue, twice or thrice daily, the position of the child may change and the pressure on the nerves of the mother be removed. This should more properly be done with the consent of the family physician. Varicose or enlarged veins upon the legs and thighs are natural consequences of pregnancy. Relief from the discomfort caused by them may be obtained by the use of the elastic stocking fitted by the makers; or by the application of a flannel bandage, before arising in the morning, which should be started at the toes and wound from thence up the leg to the top of the thigh. After retiring at night the bandage is removed and rolled. The bandage is made at home by sewing together strips of cheap flannel cut on the bias, four inches wide, and is more efficient than the elastic stocking.

Excessive secretion of saliva is common in pregnancy, but cannot readily be prevented. Frequent passing of urine is also troublesome, occurring more often during the first three or four months from pressure of the child, and during the last two months from alteration in the shape of the bladder. This cannot be prevented, but if the urine becomes thick and cloudy the condition should be referred to a doctor. Cramps at night attacking the legs, are annoying accompaniments. They may be prevented oftentimes by rubbing the limbs from below upward before retiring. Sleeplessness, more usually during the latter months, is occasionally

a vexatious complication. The use of a glass of warm milk, or a glass of beer, before going to bed, or when wakeful during the night, may serve as a preventive. This means failing, sodium bromide (ten grains) dissolved in a quarter of a glass of water and taken at 6, 8, and 9 P.M., may relieve the symptom. More powerful remedies should not be resorted to without medical advice.

During the last four weeks of pregnancy the breasts should be bathed daily, especially the nipples, with boric-acid solution (two tablespoonfuls to the pint of water), and vaseline applied to the nipples. If the nipple is depressed and shrunken it may be pulled outward, but much manipulation of the breast is inadvisable as it stimulates the womb. If at any time during pregnancy there appears any escape of blood from the vagina, or if headache becomes severe, or pain in the stomach or dizziness develop, or nausea and vomiting return during the later months, the physician should be immediately acquainted with the facts, since these are, or may be, danger signals not to be neglected.

The mental state of the pregnant woman is often subject to change, as one of the symptoms of her condition. Her character may become much altered, and she may become irritable, suspicious, and difficult to live with. All things tending toward cheerfulness should surround her, and the cares incident to business, social, or educational matters, she must forego. The unnatural mental state more often appears in the middle