( Originally Published 1936 )
PRENATAL CARE IMPORTANT TO SAFEGUARD MOTHER, BABE
THE most important safeguard for the mother's future health is that she be under careful medical supervision from the time she realizes she is to become a mother until the period of delivery. This supervision is known among physicians in this country as "prenatal care."
In these times of economic stress, many women believe that it is best to wait until the last minute to call a doctor: that it will be less expensive that way. This idea should be dispelled. Physicians today want and expect to take care of the mother during the entire period. They are prepared to make no greater charge for this than for the actual delivery. It is perfectly proper to consult a physician and make a financial arrangement with him which will cover the duration of the experience.
The advantage of prenatal examination and care cannot be over-estimated. The physician has an opportunity to make a complete physical examination and gauge the state of the mother's health. He can make measurements which will indicate to him whether extraordinary preparations will have to be made for the time of delivery. He can direct the diet, amount of exercise, clothing, and other things which will make for the best health possible for both mother and child.
Danger signals can be recognized and the dangers averted. A regular examination of the urine every month, and a record of the blood pressure, are among the most important elements in these examinations. The toxic states of pregnancy develop gradually and give definite signs, in most instances, long before they become fulminating. All competent physicians are trained to recognize these signs. They should not be left to chance.
For families whose financial conditions seem to preclude any possibility of such care, there are in every community organizations through which it can be provided. In larger cities, maternity centers and prenatal clinics in hospitals, or out-patient departments of medical schools; in smaller places, local hospitals, church organizations or members of the local medical profession will be glad to make proper arrangements. If no such facilities are provided in your community, steps should be taken at once to do so.
WHY PROSPECTIVE MOTHERS SHOULD BE WELL INFORMED
"The entire program of what we may designate as the new public health movement is focused about the child."
So wrote one of its foremost advocates a few years ago. Certainly it should be so. In spite of the fact that a great many people are worrying about the prolongation of life by annual health examinations and so-called prevention of heart disease, our duty is to the young and vigorous, those who are carrying on the work of the world.
The hopes of mankind for a future race, more virile, less susceptible to infection, better developed, and better balanced to meet both the pleasures and strains of life, depend in great measure upon the circumstances of the earliest formative years of childhood. But even to a greater degree, they depend upon the circumstances which surround the child before birth.
And much of this depends upon the intelligence and the education of the prospective mother during the period before the child is born. This is not to say that she must know so much that she can feel independent of the attending physician. But that instead of blindly following instructions, disregarding them because she does not under-stand their importance, she will co-operate with some knowledge of what it is all about. This should include the prospective father, as a matter of fact, so that all three—mother, father and physician—will try to help each other and work together in mutual confidence and understanding.
MUST KNOW PROPER DETAILS
The prospective mother will know about the details of diet, exercise, sleep, rest and strain as they apply to her. She will know what she should call to the physician's attention. She will be reassured by knowledge, not frightened. She will be delivered from the harassing, terrifying false beliefs and superstitions that are constantly thrust before her by ill-advised, thoughtless relations and friends of her own sex.
Most of the things that the prospective mother hears about the general situation are lies.
This, in spite of the fact that they may be told to her by otherwise kind-hearted and supposedly friendly old ladies who have a great air of authority. What prospective father has not come home from work to find his wife dissolved in tears after one of the recitals from Eve's comforters?
The movies are about as guilty as anybody. If the League for Decency has completed its work, there might be room for a league for preventing the showing on the screen of the prospective father being summoned post haste to the hospital to find his pale wife being carried through the halls on a cart to the operating room for an emergency. Why should that ALWAYS have to happen to harassed young married couples in the movies? Do the movies want to scare the wits out of the poor young things in the audience, for whom going to the movies is about the only diversion there is? Couldn't they ever show one of the ninety and nine cases where everything is perfectly normal, and as a mother of five said to me the other day, it's about as much effort as a strenuous game of tennis?
It is with that idea in mind that I write.
HOW NEW MEDICAL SCIENCE SAFEGUARDS THE MOTHERS
Medical science, since the middle of the sixteenth century, has never ceased to make definite progress. It has done so just as much in the field of childbirth as in such a field as that of surgery, which is popularly supposed to have made the most rapid advances.
We may, therefore, say with assurance that never, before our own day, has the prospective mother had as good a chance to bring a healthy child into the world with safety to herself, as today.
Consider the conditions which obtained in other times. The primitive Indian woman, to whom not a thought concerning her condition was given, until the actual moment when the baby arrived. She was expected to do hard labor, just as under ordinary conditions, ride horseback on long tribal marches, abandoned if she were too weak or sick to go on. When the time came for her delivery she was either left alone in a hut made of boughs, built near a stream, or given an attendant in the person of an elderly, dirty and ignorant squaw.
VICTORIANS NOT MUCH BETTER OFF
More recently, our grandmothers, even in the midst of Victorian civilization, were not much better oft. They were supposed, by the dictates of modesty, to conceal the condition until it was well advanced. They did not consult or engage a physician (or a midwife), except when necessity compelled them. Their general health was, therefore, a matter of guesswork during this period of rapid change. They were carefully guarded against a great many things that would do them good. They were surrounded by gloom, and no one seemed to think that the situation called for any rejoicing. When the time came for their delivery, confinement was really the word for it. They were confined in a room that was overheated, and had no ventilation, in the idea that this atmosphere would ease them, when all it did was to make them subject to respiratory disease. They were attended by a physician who knew little about asepsis, anesthesia, blood trans-fusion or bacteriology. So far as my own grandmother was concerned, her attendant knew NOTHING about any of these things—and that was not so long ago.
Today one of the prime lessons which the medical profession has tried to teach is that of prenatal care—that for her own safeguarding, the prospective mother should be under the physician's instructions from the earliest possible time.
Her physician has the resources of the laboratory, both the chemical and immunological laboratory, the x-ray, the blood pressure apparatus, a new knowledge of nutrition, besides the personal advantage of a broadened acquaintance with the new science of the subject.
No better illustration of such a state of affairs could be found than that which occurred this year—the unique phenomenon of the quintuplet birth, where, in an obscure village, under far from ideal conditions, there was present a practitioner who had at his fingertips all the accomplishments of modem science.
Some hold back from taking advantage of prenatal care because they think it will involve more expense. For them, let me say that in my experience physicians prefer to handle a case in this way, and. make no more charge than if they were called in just before the time of delivery.
RULES OF DIET, EXERCISE FOR PROSPECTIVE MOTHERS
Perhaps the most important thing for the prospective mother's health is for her not to worry about it too much. Nature will take care of things pretty well: she has done so many times before. If she has been assured by her physician that her general condition is normal, there are only a few simple rules she need follow.
Sleep is more important than even exercise or recreation, and every such patient should sleep at least eight hours a day. Nature usually attends to this also, and a tendency to be sleepy frequently is a natural accompaniment of the condition. It should be indulged.
Plenty of fresh air, especially in the sleeping room, is imperative, and is shown by the fact that many women feel a sense of oppression when they go to the theater or into close, crowded halls.
Bathing is even more important than under normal conditions. The skin is an organ of elimination and of heat regulation, and should be kept in the pink of condition now that the individual has two to eliminate for and to regulate temperature for.
The advisability of exercise is largely a matter of circumstances. For some, it is essential. For others, it is hazardous. If the patient feels well, and feels like exercising, it is always desirable to let her try. If the first attempts are refreshing and not tiring, they should be continued. The best form of exercise is walking, and it should be continued only to the point of pleasant and reasonable fatigue.
Under special circumstances, special exercises and postures, such as the kangaroo walk (walking on all fours with the knees stiff) and the knee-chest position, are beneficial, but only when medical advice has suggested them.
SPECIAL DIET UNNECESSARY
Diet needs no elaborate supervision. Sometimes a special diet is necessary, but not often. The important thing is to eat enough, and not try to stuff, on the theory that the mother is now eating for two. The second one isn't very big, for a long time, and doesn't require very much. A general wholesome diet is all that is necessary. Extra minerals, especially calcium, is advisable, but this can easily be supplied by extra milk. Raw fruits, especially oranges, are also helpful in supplying the accessory food factors.
The following diet, published in a recent sensible book of advice on this subject, is an indication of modern ideas:
"We suggest a diet as follows, with no intention that it includes everything permissible or that it is all necessary, but that it is sufficient. Selections may be made from it with safety.
"Fluids: Any kind, freely.
"Raw foods: Milk, cream, butter, oranges, bananas.
"Bread and cereal free from bran.
"Meats: Any kind: Steaks, chops, roast meats, fowl, bacon, eggs, cheese, etc.
"Fruits: Cooked fruit of any kind. As much of the peeling as possible should be removed. Add sugar if desired.
"Vegetables : Potatoes, tomatoes, peas, beans, corn. Cook all thoroughly. All of the coarser vegetables should have the peeling and the fiber removed as much as possible, and should be thoroughly cooked if they are used."
An abdominal binder or support and well fitting brassieres are advisable and comfortable.
In the rare cases where there is a great deal of headache, blurring of vision or vomiting at an abnormal time, the attending physician should be immediately notified.
SUPERSTITIONS THAT SCARE YOUNG PROSPECTIVE MOTHER
Superstition seems to be like one of the blind forces of Nature—as much a part of man's equipment as his skin. One thinks of it as an attribute of primitive man or of ignorant man, but, indeed, no sooner is the most modern triumph of civilization produced than it is found already encrusted with a heavy load of superstition.
I have striven for twenty years with the superstition that eating food cooked in aluminum cooking utensils is harmful. There is not a single shadow of a fact to substantiate it, yet people once hearing it from the lips of some ignorant corner store philosopher, cling to it against the advice of the best informed chemists and nutrition experts in the world. And thus they cheat themselves out of an inexpensive and convenient metal for cooking purposes. Such ideas act like a foreign body in the stream of consciousness; every thought impinges against them. The sort of evidence I get on the subject is that some-body's pet goat refused to drink milk out of an aluminum pan: so the goat's instinct is better than the exact knowledge of the professor of chemistry at Harvard.
Here is the airplane. That is modern enough so that you would think it would be free from any associations that belong to the cave man period. But I find there is a deeply rooted idea that if the mother of an unborn child goes up in an airplane, the baby will be born deaf and dumb. I am not advocating airplane rides for prospective mothers, mind you, but what nonsense.
SUPERSTITIONS NEVER DIE
And those things never die. There is always somebody to repeat them. Think of the misery that has been caused by the idea that children can be marked by something the mother does or something that happens to her. What utter rot. The only connection between the mother and the unborn child is the exchange of gases and nutritious material through a membrane. How could an injury to the mother's left arm possibly be communicated to the child's left arm?
Not only is it not theoretically possible, but there are billions of instances to prove that it is not true. The people now living in the United States spent, if the time is totalled up, a billion years inside their mothers. Now, suppose a person lived a billion years. That would go back to the time when the earth was largely gaseous. Don't you think plenty of things could happen to that person during that billion years? Don't you think plenty of things happened to all our mothers while they were carrying us? Yet there are very few "marks" to show for it.
And yet people will pay no attention to the possibility of really marking their children. Instance the marriage of the Infanta of Spain. She knows—the whole world knows—that she carries an hereditary taint likely to mark her sons with a horrible and crippling disease. She saw it in her own brothers. The disease wrecked the Russian empire and the Spanish monarchy. Yet she deliberately runs the risk of dumping a new load of hemophiliacs into the world. She is a woman trained to exercise self-control and denial. But even when her example is one that will be seen by everyone, she deliberately sets herself against laws far more inexorable than the laws of any church—the laws of Nature. No wonder men got rid of kings.