The Four Epochs of Woman's Life - Chapters X-XI



PART III. -- MATERNITY.

CHAPTER X.
PREGNANCY.
Nature of Conception; Pregnancy Defined; Duration of Pregnancy; the Signs 
of Pregnancy; Quickening; the Determination of Sex at Will; the Influence 
of the Male Sexual Element on the Female Organism; Heredity; Hygiene of 
Pregnancy; Causes of Miscarriage.

"Happy he 
 With such a mother, faith in womankind 
 Beats with his bood, and trust in all things high 
 Comes easy to him, and though he trip and fall, 
 He shall not bind his soul with clay." 
 -- TENNYSON. 

Nature of Conception.-- Conception, or impregnation, is the union of the 
germ and the sperm cell, the result of which is a new being. On coition, 
the semen being received into the female organs, which are at that time in 
a state of turgescence, the spermatozoa, by means of their own vibratile 
activity, find their way into the Fallopian tubes, and here come in 
contact with the ovule. 

The ovule is a minute cell with a transparent membrane, within which is 
the yolk containing the germinal vesicle. The spermatozoon penetrates into 
the ovule and becomes fused with it. The processes of development begin at 
once to occur. There is congestion of the uterine mucous membrane out of 
proportion to the rest of the uterus; the ovum finds lodging here, and 
becomes surrounded by a membrane which incloses it in a separate sac. 

Pregnancy Defined.-- Pregnancy begins with conception and ends with 
parturition; it provides for the nutrition and the expulsion of the embryo 
and for its nutrition for a short time after birth. 

The average duration of pregnancy is ten lunar months, or two hundred and 
eighty days. The date of the confinement is calculated by reckoning from 
the date of the last menstrual flow; count backward three months from the 
date of the first appearance of the last menses; to this add twelve months 
and seven days, five days being for the average menstrual duration and two 
days for the possibility of fecundation. 

Duration of Pregnancy.-- Many difficulties are experienced in determining 
the date of the expected confinement. As most pregnancies occur in married 
women, we cannot base any calculations on a single act of coitus. And even 
if there was but one, all physiologists agree that there is a variable 
period in different women, and in the same woman at different times, 
between insemination and the fertilization of the ovum. It is the moment 
of fecundation, or the union of the germ and sperm cells, which marks the 
beginning of pregnancy. The uncertainty becomes still greater owing to our 
inadequate knowledge as to the length of time during which the sexual 
elements, the ova and the spermatozoa, retain their vitality after 
liberation from their respective sources. While it is not certainly known, 
it is probable that the ovum is capable of impregnation any time during 
its sojourn within the oviduct and before reaching the uterus, or probably 
for a period of about one week from the time of its escape from the 
Graafian follicle. The remarkable vitality of the spermatozoa even under 
less favorable circumstances-- direct observation shows that these 
elements retain their movements for over nine days outside of the body-- 
renders it almost certain that their powers of fertilization are 
maintained for a long time after they are deposited within the healthy 
female genital tract; it is believed that the spermatozoa are capable of 
fertilization after a sojourn of three or more weeks within the oviduct. 

Consideration of these facts renders apparent the impossibility of fixing 
with certainty the date of the beginning of pregnancy, since conception 
may result from the union of the ovum liberated at the beginning of the 
period with the spermatozoon introduced at the end of that time; or it may 
result from the meeting of the male elements already within the oviduct 
with an ovum discharged a day or two before the occurrence of the 
menstrual period. 

The Signs of Pregnancy.-- The cessation of the menstrual period is the 
sign of the greatest value in women who have been regular; but it must 
always be remembered that there may be an irregularity of menstruation for 
the first few months after marriage. The appetite is capricious; morning 
sickness or nausea in the morning on first getting up is a very common 
symptom in the early months of pregnancy; enlargement of the abdomen; in 
the first two months of pregnancy the abdomen is flattened and the 
umbilicus is depressed; after this the abdomen begins to enlarge. There is 
also an increase in the size of the breasts, with a deepened color of 
their areolae and later a watery secretion. The external genitals become 
swollen and of a bluish color. Feeling of the fetal movements-- that is, 
the movements of the small parts of the child in the womb-- by the mother 
is not always reliable, since gas in the intestines has sometimes been 
mistaken for this. These signs are more valuable when several exist 
together. 

The nausea and vomiting of pregnancy, the so-called morning sickness, 
consists of nausea accompanied often by vomiting or retching of a glairy 
fiuid, showing itself most frequently on rising in the morning, but 
sometimes appearing after breakfast. It is aggravated by the assumption of 
the erect position. It may begin within a few days, but as a rule it does 
not show itself until the fourth week of pregnancy; and it generally 
ceases about the fourth month, rarely persisting throughout the entire 
time. In the majority of cases it does not sensibly impair the health. It 
is a sympathetic disorder reflected from the uterus; it is aggravated by 
indigestible food, by sexual excitement, and by emotional disturbances; it 
is most marked in first pregnancies and in women of highly emotional 
natures. It is not infrequently due to some inflammation of the uterus or 
erosion about the external orifice, and disappears on the removal of the 
cause. 

Mammary Changes.-- During pregnancy the mammary glands are in immediate 
sympathy with the growing reproductive organs of the pelvis; consequently 
a genuine physiologic enlargement commences in these organs from the 
beginning of gestation. Their glandular structure becomes larger, fuller, 
and firmer; a sensation of weight or pricking is felt by the patient; the 
veins become more prominent. The nipples also become enlarged, more 
elongated, and somewhat erect. Surrounding the nipple is the areola; this 
becomes darker in color. 

In most women a drop of watery fiuid, the so-called colostrum, may be 
squeezed out from the nipple at the end of the third month of pregnancy. 

The signs of pregnancy are divided into the presumptive, the probable, and 
the positive. The presumptive signs are: menstrual suppression, morning 
sickness, irritable bladder, mental and emotional phenomena. The probable 
signs are: mammary changes, abdominal enlargement, changes in the neck of 
the womb, and certain changes which are felt on bimanual examination. The 
positive signs are: feeling the various parts of the fetus, active 
movements of the fetus, and hearing the fetal heart sounds. 

Functional disturbances of the bladder are quite often noticeable in the 
early part of the pregnancy. In the first part of the pregnancy the 
bladder is dragged upon, and later it is pressed upon by the enlarged 
uterus so that the bladder capacity is lessened and frequency of urination 
is the result. In the fourth month, when the uterus ascends into the 
abdominal cavity, these bladder symptoms subside, until the very close of 
the pregnancy, when by the descent of the now greatly enlarged uterus 
there may be even incontinence of urine. 

Changes in the Abdomen.-- During the first two months of the pregnancy 
there is a flattening of the abdominal surface, due to the descent of the 
uterus into the pelvic cavity, thus slightly dragging the bladder downward 
and drawing the umbilicus inward. In the latter part of the fourth month 
there is noticeable a slight abdominal enlargement, and the umbilicus is 
no longer sunken. By the end of the fourth month the base of the uterus 
has risen two inches above the symphysis, and at the end of the thirty-
eighth week it touches the lower extremity of the breast-bone; the 
umbilicus has been for many weeks protruding; during the last two weeks of 
pregnancy the uterus again descends and the woman feels more comfortable. 

On the inspection of the abdomen of a pregnant woman there will be noticed 
a brown line which extends from the umbilicus to the pubes, and all over 
the surface the presence of striae, or long purple grooves, due to the 
distention of the abdomen; on the sides of the abdomen and down the 
thighs, red, blue, or white markings, like cicatrices, may be seen. 

Quickening.-- Quickening is the sensation experienced by the mother as the 
result of the active fetal movements of the child in the womb. These 
movements are first felt between the eighteenth and the twentieth week; 
the common rule is that quickening occurs at the middle of pregnancy; that 
is, at four and a half months. As pregnancy advances these active motions 
increase in frequency and become more marked. When felt or seen by the 
physician, as can be done in the sixth month, fetal movements constitute a 
positive sign of pregnancy. 

The Determination of Sex at Will.-- Although this has always been a 
question of great interest, and the subject of much experimentation, no 
rule can as yet be given by which the parents can know in advance of the 
birth of the child what the sex will be. Dr. Schenck's theory is that the 
ruling factor in determining the sex is the food partaken of by the 
mother. 

Furst believes that the differentiation may occur before, during, and a 
little while after the impregnation; that the chances of the development 
of one or another sex in one and the same woman may vary before final 
differentiation occurs. It is impossible to determine the sex of the 
embryo before the tenth week of fetal life. The cause of the 
differentiation, he believes, lies largely in the good or bad state of the 
health of the parents; in the first instance there being an excess of 
females, and in the latter an excess of males, relatively speaking. He 
believes that there is an excess of male children when conception takes 
place during the post-menstrual anemia. He has investigated one hundred 
and ninety-three cases carefully in regard to the probable date of 
conception after menstruation, and there is a notable increase of male 
births over female in the cases where conception occurred in the first 
five days after menstruation; that is to say, where the woman is not so 
well nourished as later. 

Dr. J. Griffith Davis gives as the result of her experiments in this 
direction, that when conception takes place three days before the 
menstrual period or within forty-eight hours afterward, the child will be 
a girl; when conception takes place ten days after the period, the child 
will be a boy. 

Although there are a greater number of the female than the male sex in all 
parts of the world where reliable statistics have been taken, in all 
civilized countries the proportion of male births is greater than that of 
females. There is a greater tendency of the male offspring to die earlier, 
and this is seen even before birth, in the proportion of three to two. For 
this reason the stronger sex as applied to men has been regarded by some 
authors as a misnomer. They are physically weaker in early life and 
succumb more readily to noxious influences. 

The relative age of the parents is said to be another factor in 
determining the sex of the children. Seniority on the father's side gives 
an excess of male children; equality in the age of the parents gives a 
slight preponderance of females; seniority on the mother's side gives an 
excess of females. Men, and especially scholars, who pass a sedentary life 
and who exhaust their nervous force to a great extent, beget more girls 
than boys; so, also, a very advanced age on the part of the man diminishes 
the number of male offspring. 

The Influence of the Male Sexual Element on the Female Organism. -- Dr. 
Alexander Harvey, of Aberdeen, has adopted the theory of fetal 
inoculation. He believes that the effect is first due to the influence of 
the male element upon the ovum, which, in consequence of the subsequent 
close attachment and freely inter-communicating blood-vessels between the 
modified embryo and the mother, inoculates the condition of the mother 
with the qualities of the male; and so, on the subsequent impregnation by 
another male, the offspring resembles the first male and not its real 
parent. He even goes further, and says that it is conceivable, by 
successive impregnations effected by him, that the influence may be 
increased, and if so the younger children begotten by him, rather than the 
elder, might be expected, ceteris paribus, to bear their father's image. 
And as regards the mother, he suggests the question, whether there is not 
something in the popular notion that in the course of years the wife comes 
to resemble the husband; and that not merely in respect of temper, 
disposition, or habits of thought, but in bodily appearance, which may be 
referable to this influence exerted by the husband on her constitution, 
through the medium of the fetuses in utero.

"Yet it shall be; thou shalt lower to his level day by day, 
 What is fine within thee growing coarse to sympathize with clay. 
 As the husband is the wife is; thou art mated with a clown, 
 And the grossness of his nature will have weight to drag thee down. 
 He will hold thee, when his passion shall have spent its novel force, 
 Something better than his dog, a little dearer than his horse." 

Darwin, on the other hand, considers it a most improbable hypothesis that 
the mere blood of one individual should affect the reproductive organs of 
another individual in such a manner as to affect the subsequent offspring. 
The analogy, he says, from the direct action of the foreign pollen on the 
ovaries and seed coats of the mother plant strongly supports the belief 
that the male element acts directly on the reproductive organs of the 
female, and not through the intervention of the crossed embryo. 

Dr. John Brown, in reviewing the subject, says it must be conceded that 
the male element has an influence on the female, over and above its 
fertilizing influence upon the ovum. The limit of this influence is at 
present unknown. 

Heredity.-- Girls are more apt to resemble their fathers in mental traits, 
disposition, and constitution; while boys take after their mothers. Boys 
procreated by intelligent mothers will be intelligent; while it does not 
always follow that the sons of intelligent fathers are intelligent. The 
poets Burns, Ben Johnson, Goethe, Walter Scott, Byron, and Lamartine were 
all born of women remarkable for vivacity and brilliance of language. 

Hygiene of Pregnancy.-- The health and perfection of the child depend 
largely upon the health and perfection of the parents at the time of its 
conception, as well as upon the condition of the mother during the 
pregnancy. Even when both parents possess a strong constitution, but one 
or both of them is suffering from a temporary exhaustion or malaise, the 
child will be born below the standard of health it ought to possess. 
Children born during the first year of married life seldom equal in health 
the children born of the same parents later; they are not only apt to be 
sickly, but the liability to premature death is greatly increased. For 
this reason it is better that the first year of married life should be 
allowed to pass without conception taking place. A child begotten in an 
intoxicated or depraved condition of a parent may be depraved itself in 
the same way, and is apt to be feeble-minded or idiotic. 

It must be borne in mind that prenatal culture of some sort begins at the 
time of conception; and that on the mental as well as on the physical 
state of the mother, the health as well as the disposition of the child 
will depend to no slight extent. The prospective mother who constantly 
gives way to her feelings does a wrong to her unborn child. The mother is 
at this time more impressionable, more nervous, and more irritable than is 
natural to her; and while her family should make a certain allowance for 
her condition, she, on her part, should not allow herself to give way to 
her morbid feelings. The prospective mother should not lead a life of self-
indulgence, on the one hand, or, on the other, should not be weighed down 
with cares; she should interest herself in her usual duties, and be 
relieved of all anxiety possible. 

Dress.-- The clothing must be loose, and all compression about the waist 
and abdomen must be especially avoided. If the woman wears corsets, she 
must take them off at once, and substitute a Ferris or some similar 
hygienic waist. The corset prevents the proper development of the 
abdominal muscles, which play so important a role in the expulsion of the 
child from the womb, as well as in the proper growth and development of 
the fetus itself. If the woman has already borne children, and toward the 
end of the pregnancy the abdomen becomes pendulous, she will very 
materially add to her comfort by swearing a muslin abdominal bandage. 

A woolen undersuit, or undervest and drawers, with high neck and long 
sleeves, must be worn winter and summer; the grade of the wool to be 
adapted to the season of the year. The especial necessity for wearing wool 
next the skin during the pregnancy is because of the intimate relation 
between the skin and the kidneys. Any chilling of the body at this time is 
apt to lead to the congestion of the kidneys. If there is already any 
congestion of the kidneys present, or any abdominal pain, in addition to 
the undersuit an abdominal bandage should be worn. These bandages come 
woven in ribbed woolen, and fit the body snugly. This bandage is to be 
constantly worn, and, of course, changed at night. During the cold weather 
the stockings should also be of wool. Under no circumstances are garters 
allowed to be worn, as they form a constriction around the leg and 
interfere with the return of the venous blood to the heart, and so 
increase the tendency to the formation of the varicose veins. It is better 
not to use any means to hold the stockings up; they will be kept 
sufficiently well in place by the under-drawers. Low shoes should never be 
worn except in the hottest weather. It is of the greatest importance that 
the woman should be impressed with the necessity of the avoidance of 
taking cold, since any lung or kidney trouble is a serious complication of 
pregnancy. 

Diet.-- The diet is the same as that at any other time, only it is more 
necessary to guard against anything which is likely to cause indigestion. 
In other words, the diet should be plain, simple, and easy of digestion; 
nutritious and partaken of at regular intervals. In the latter part of 
pregnancy owing to the pressure of the enlarged uterus on the stomach, the 
food may have to be partaken of in smaller quantities and at shorter 
intervals. At this time also the appetite is abnormally large. Where it 
does not disagree with the patient, milk is the best adjuvant possible to 
the diet. 

Constipation.-- Constipation is the rule of pregnancy. This is due to the 
great pressure that the enlarged uterus makes on the bowel; and as 
important as it is at all times to keep the bowels regular, it is at this 
time more necessary than ever that the woman should have the bowels well 
evacuated every day. A retention of fecal matter in the body causes the 
reabsorption into the blood of the toxic matters, with the resulting 
headaches, dizziness, loss of appetite, and intense nervousness. To 
obviate this tendency to constipation, plenty of fruit and vegetables 
should be eaten, as well as cereals if the woman is taking a good deal of 
outdoor exercise, otherwise the latter had better be omitted. The woman 
should drink plenty of water-- at least three pints a day; this acts as a 
laxative as well as to flush out the kidneys. If, in spite of all these 
measures, constipation still persists, as it probably will, a seidlitz 
powder can be taken the first thing on rising in the morning; or from one 
teaspoonful to one tablespoonful of the effervescing granules of the 
phosphate of soda in a glass of water, also to be taken on rising in the 
morning; or one-half grain of the solid extract of cascara sagrada night 
and morning. The object of these is to keep the bowels open, but purgation 
must always be avoided. 

Bladder Symptoms.-- If there is any irritability of the bladder, any 
scalding on urination, or a very great frequency of emptying the bladder 
in the early months of pregnancy, a physician should be consulted at once; 
in the last months of pregnancy there is a desire to evacuate the bladder 
frequently, and sometimes at the last there is an incontinence of urine, 
which is due to the descent of the uterus and the great pressure on the 
bladder; this condition disappears with the confinement. 

Leucorrhea.-- If this is present to any marked degree, the vaginal douche 
should be continued throughout the pregnancy; the temperature of the 
douche should be from 110 degrees to 112 degrees F.; it must never be 
taken very hot or very cold. The fountain syringe should be used, and the 
bag should not be hung more than three feet above the bed, so that there 
shall not be too much force to the stream of water. 

Baths.-- Warm tub-baths may be taken throughout the pregnancy, but never 
oftener than twice a week, and the woman should never stay in the tub 
longer than is absolutely necessary for the bath, as otherwise the bath is 
too enervating. A daily sponge-bath of cool or cold salt water at a 
temperature of from 80 degrees to 70 degrees F., and in the proportion of 
a pint of rock or sea salt to a gallon of water is most invigorating, and 
counteracts many of the nervous symptoms and promotes sleep and good 
digestion. The temperature of the room in which this bath is taken should 
be 72 degrees F. Shower-baths cause too great a shock to the nervous 
system, and they as well as foot-baths must be prohibited. Sitz-baths at a 
temperature from 110 degrees to 90 degrees F. may be taken just before 
retiring throughout the pregnancy. The frequency and duration of the bath 
as well as the temperature should be regulated by the attending physician. 
In cases of intense nervousness and insomnia these baths have an excellent 
sedative effect. A pregnant woman must never under any circumstances take 
ocean baths, since there is always great danger that the shock of the 
waves will cause an abortion. Sea-voyages should be avoided because of the 
severe nausea and vomiting, as well as the danger that the lurching of the 
vessel may cause miscarriage. 

The sewing-machine is a tabooed thing for the pregnant woman, because of 
the jarring of the pelvis which it produces. Sweeping of heavy carpets is 
also injurious. There must be no lifting of heavy pieces of furniture, and 
especially no lifting from the floor, as it interferes with the 
circulation in the uterus and is apt to produce miscarriage. 

Driving in an easy carriage over smooth roads is permissible; dogcarts, or 
any conveyance which produces much jolting, must be avoided; and while 
driving is good, the woman should not do her own driving, on account of 
the danger of the jars that would be caused by the sudden pulling of the 
horse upon the lines. Horseback-riding and bicycling are, of course, 
forbidden, as are also golf, tennis, and dancing. 

Exercise.-- Exercise in the open air should be taken every day, when the 
weather is suitable, and walking is the best form of exercise. The amount 
will be regulated to some extent by what the woman has been accustomed to 
taking, and it should always stop short of fatigue. The woman should live 
as much as possible in the open air, and she should attend to her ordinary 
duties about the house. Long railway journeys are always objectionable. 

Hemorrhoids or piles are very often troublesome toward the close of the 
pregnancy. To overcome this, the patient should lie down immediately after 
the bowel movement, and remain in the recumbent position for ten or 
fifteen minutes. In addition, care should be taken to secure a loose 
movement of the bowels. Should the piles come down, applications of cloths 
wrung out of hot water, and held well pressed against the bowel, should be 
made; the piles should then be pressed back until the finger feels that 
the mass has been pushed above the second constriction of the bowel, which 
is felt to exist at about two inches above the sphincter ani muscle. 
Should these means not suffice, the physician must be consulted at once. 

Swelling and pain of the external genitals and of the lower limbs are best 
relieved by the recumbent position. Should the veins of the legs be much 
enlarged or the feet swollen, the patient should have compression made by 
the wearing of elastic stockings. Or in some cases a bandage is 
sufficient; in this case the bandage may be made of muslin; it should be 
three inches wide, and, beginning at the toes, should extend up as high as 
the enlargement of the veins continues. This bandage should be freshly 
applied every morning before rising. 

Pain caused by the stretching of the skin may be relieved by the inunction 
of the skin with cottonseed or cocoanut oil. For severe pain in the small 
of the back, rubbing with soap liniment or alcohol will be found useful. 

Mental Occupation.-- Important as this always is, it is doubly so now. The 
mind should be constantly and pleasantly occupied, but no severe study 
should be indulged in. The emotional susceptibility is generally somewhat 
increased. The pregnant woman, quite excitable and irritable, readily 
responds to influences by which in the non-gravid condition she could not 
be affected. Sometimes she feels unusually well, is intellectually 
brightened and more active, and says she is positively happier. At other 
times she is despondent and morose. 

Physiologists admit and observation proves that maternal emotions do 
affect the development and the exterior of the fetus; likewise the mental 
organization of the fetus may be affected. All unpleasant news, frights, 
and physical shocks, also scenes of suffering and distress, must be 
avoided, as the mind is particularly impressionable at this time. Around 
the patient should be thrown a gentle and protective care, and she should 
be treated with the considerate kindness which her condition demands. 
Theatres and all places where there will be a large assemblage of people 
should be avoided, as the close air and general bad ventilation are apt to 
produce vertigo and sometimes attacks of fainting. 

Sleep.-- During pregnancy a large amount of sleep is required; there 
should be eight hours spent in sleep at night, and one hour every 
afternoon. Pregnant women should never do any night watching. There is 
unusual necessity for good ventilation during sleep at this time. 

The Marital Relation.-- Coitus is, as a rule, distasteful to pregnant 
women. It is for the best interest of the wife as well as for that of the 
child that all marital relation should be suspended at this time. Even 
uncivilized nations have condemned the privilege of sexual intercourse 
during pregnancy, and have visited punishment on the offender. If these 
relations are not wholly suspended, they must at least be at those periods 
which correspond to the time at which the woman would have been unwell had 
she not been pregnant. To the continuance of these relations throughout 
the pregnancy is due much of the suffering of the wife, not only then, but 
at the time of the labor as well; and the nourishment of the child is 
interfered with. 

Causes of Miscarriage.-- Hemorrhoids; straining at stool; excessive 
intercourse in the newly married; nursing; ocean-bathing; overexertion; 
overexcitement; a fall; any violent emotion; anger; sudden or excessive 
joy; a fright; running; dancing; horseback-riding; riding in a heavily 
built carriage over rough roads; great fatigue; lifting heavy weights; the 
abuse of purgative medicines; disease or displacements of the womb; and a 
general condition of ill health. 

The danger of miscarriage is greatest during the first three months of 
pregnancy. Miscarriage is a fruitful source of disease and often of danger 
to wives; it is said that thirty-seven out of every hundred pregnant women 
miscarry. Miscarriage is most apt to occur during the first pregnancy; and 
great care should be taken to prevent this, as the habit is easily 
established, and after one miscarriage has occurred, another is likely to 
follow, so that it is sometimes with the greatest difficulty that the 
woman can be made to carry the fetus to full term. Artificially produced 
abortions are not an infrequent cause of sterility; the young wife becomes 
pregnant, and has an abortion produced because she is not yet ready to 
give up all her pleasures; and eventually when she does become very 
anxious to have a child such an extent of uterine disease has been 
produced by the abortions that she cannot conceive. 

To Prevent Miscarriage.-- The life must be free from all excitement, and 
must be as quiet as possible without becoming monotonous; especial care 
must be exercised at the return of the dates for the menstrual periods. 

The symptoms of miscarriage are a show of blood, more or less profuse, 
with intense abdominal pain; on the slightest show of blood the patient 
should go to bed at once and the physician should be sent for. 



CHAPTER XI.
THE CONFINEMENT.
Preparation for the Confinement; Signs of Approaching Labor; Symptoms of 
Actual Labor; the Confinement-bed; the Process of Labor.

"To my conception one generation of educated mothers would do more for the 
regeneration of the race than all other human agencies combined; and it is 
an instruction of the head they need, and not of the heart. The doctrine 
of responsibility has been ground into Christian mothers above what they 
are able to bear." 
-- ISABELLE BEECHER HOOKER. 

Preparations for the Confinement.-- The right time to engage the physician 
who is to take charge of the woman at her confinement is just so soon as 
the woman knows that she is pregnant. It used to be argued that, since 
giving birth to children was a physiologic process, there was no necessity 
for the woman to consult the physician until he was sent for when the 
labor pains began. Take the case of the woman who is for the first time 
pregnant; she is absolutely at sea; she has not the least idea how she 
ought to feel, what she ought to do or to leave undone; the result is that 
she often has a miscarriage which is the source of the greatest 
disappointment to her husband and herself, or she suffers very 
unnecessarily throughout the entire pregnancy, has a difficult labor, and 
perhaps gives birth to a sickly child. 

The educated physician will explain to her what symptoms are normal and 
what are pathologic, and often he will be able to entirely cure the 
latter. It is now a well-established fact that the most serious 
complications of the pregnancy, and of the labor itself are caused by 
severe congestion or disease of the kidneys. The condition of the kidneys 
can only be determined by frequent examinations of the urine; during the 
early months of pregnancy these examinations are made once a month, and 
during the last month they are made every week. The amount of urine passed 
in the normal condition is three pints a day. 

Nowhere, perhaps, is the constant vigilance of the physician so well 
rewarded as in the careful oversight of the pregnant woman. She goes 
through her entire pregnancy feeling well, and often the greatest 
discomfort that she suffers is due to her size; her labor and her lying-in 
are normal, and she gives birth to a healthy child. 

Engagement of the Nurse.-- This is generally left to the physician in 
charge of the case, since he is responsible for the safe delivery of the 
woman; but if the patient has any decided choice in the matter, it is 
acceded to unless there should be some very valid objections, and the 
physician always sends the nurse in view for that case to see the patient 
in order to ascertain if she is personally agreeable to the patient. 

Choice of Room for the Confinement and Lying-in.-- The room should be 
light, sunny, and well ventilated; it should not be too near a water-
closet. In the city as quiet a room as possible should be selected, and 
one that is well removed from the rest of the house, so that if necessary 
perfect quiet can be maintained. The room should be as cheery as possible. 

The dress of the mother during the lying-in consists of a merino 
undervest, with high neck and long sleeves, and a nightgown, which shall 
be open all the way down the front. The gowns should be made of light 
muslin or of cambric; and there should be a sufficient number so that they 
may be changed every day. 

Six abdominal bandages should be provided. These are made of light muslin, 
and they should be eighteen inches wide and long enough to go once and a 
third around the patient's hips at the sixth month of pregnancy, or about 
one yard and a quarter long; they may be made straight or to fit the 
patient at the sixth month. This bandage is fastened down the front; it is 
applied directly after the labor, and adds greatly to the patient's 
comfort during the lying-in. 

The vulvar pads used during the lying-in are the antiseptic absorbent pads 
which can be obtained at any place where surgical dressings are sold; they 
are made of absorbent cotton, covered with cheesecloth, and sterilized. 

There must be a sufficiently generous supply of sheets so that they can be 
changed every day, and the drawsheet as often as may be required. Nothing 
is so important to a good lying-in as to have a clean, well-ventilated 
room, and plenty of fresh bed-linen. Cleanliness is the first requisite to 
antisepsis, and this is the secret of avoiding puerperal fever. 

Articles to be provided for the confinement are: 

An oblong douche-pan of agate-ware. 
An agate bed-pan. 
A bath thermometer. 
Two pieces of rubber sheeting; one, one yard square, and the other two 
yards square. 
Two sterilized bed-pads, 30 inches square by 3 to 4 inches thick. 
Three dozen antiseptic absorbent pads. 
One pound of sterilized absorbent cotton; twelve yards of cheese-cloth. 
Six abdominal bandages, eighteen inches wide, preferably made to fit the 
figure at the sixth month of gestation. 
Two hand-scrubs. 
Four ounces of the tincture of green soap. 
Bottle of corrosive sublimate tablets. 
Four ounces of powdered boric acid. 
Half a pint of good whisky. 
Two ounces of aromatic spirits of ammonia. 
Two ounces of aqua ammonia. 
One pint of alcohol. 
Two tubes sterilized white vaselin. 
Plenty of large and small safety-pins. 
Hot-water bag. 
New fountain syringe, to hold four quarts; with glass nozle. 
One small basin for vomited matter. 
Two very large agate basins or wash-bowls for washing doctor's hands and 
for antiseptic solutions. 
Vessel for after-birth. 
Three large pitchers; one for boiling water, one for cold boiled water, 
and one for antiseptic solution. 
Tumbler for boric acid solution for washing baby's eyes, with fine old 
linen sterilized. 
One dozen freshly laundered sheets, and two dozen towels. 
Stocking-drawers, muslin. 
Change of night-clothing warmed for the mother. 
A warm blanket to receive the baby. 
An infant bath-tub. 
A large piece of oil-cloth to protect the floor.(*)

(* Van Horn & Co., Park Avenue and 41st Street, New York, keep an 
obstetric outfit, containing many of the above articles, cleansed, 
sterilized, and packed in a box ready for use, so that they remain intact 
until needed. The price of this outfit is $16.50.)

Baby's Outfit.-- Four flannel bandages, to be made of fine, soft flannel, 
four inches wide, to go once and a third around the body. The edges may be 
pinked or whipped, but should never be hemmed; a tape is sewed on double, 
the ends passing around the body, and so the bandage is fastened without 
pinning. 

Six merino shirts, with high neck and long sleeves, made to button down 
the front. 

Cotton diaper napkins, not too large; old soft ones are preferable. 

Long merino stockings which can be pinned to the napkin. 

Flannel petticoats, not too long; these may be made on muslin bands, which 
are held up on the shoulders by means of straps. The essential in all the 
clothing is that it should be sufficiently loose. 

Dress-slips should not be so elaborate that they cannot be washed and 
changed with sufficient frequency; and not so long that the baby's feet 
will be hampered in their movements by them. All of baby's clothes but the 
dress should be fastened by safety-pins. 

Baby's basket should contain: 

One outfit of clothes. 
One tube of sterilized tape. 
A pair of blunt-pointed scissors. 
Large and small safety-pins. 
Pieces of fine old linen; old handkerchiefs are the best. 
A soft hair-brush. 
A powder box and puff, with talcum powder. 
Two tubes of sterilized white vaselin. 
Two soft towels. 
Castile soap. 
Single-bulb syringe; so-called "eye and ear syringe." 
A woolen shawl or wrap. 

If there is no nurse available before the labor sets in, and it is 
necessary for the patient to see to the sterilizing of the above articles, 
she should first scrub off all pitchers, basins, and other utensils, as 
well as the douche-pan, fountain syringe, and rubber sheeting, with a 
brush and hot soap-suds; the hand-scrubs are to be well washed; then each 
article should be pinned separately in coarse towels, and put to boil for 
half an hour in an ordinary wash-boiler. The articles so boiled are then 
dried without removing the towels, put away, and not opened till the time 
of the labor. 

The abdominal bandages must be laundried and pinned up in separate towels 
until they are needed. The cheese-cloth must be laundried and then 
sterilized. 

The vulvar pads should be pinned in an old napkin, in packages of half a 
dozen each; and one package is sterilized at a time by placing it in the 
oven until the outer covering is scorched. The linen for the baby's eyes 
and the cheese-cloth are treated in the same way; they are to be cut up 
into small pieces and sterilized as needed. 

Signs of Approaching Labor.-- About two weeks before labor there is a 
sinking of the womb. At the beginning of the ninth lunar month this was at 
the end of the breast-bone; it now descends to a point midway between this 
and the navel; the abdomen becomes smaller, the pressure on the lungs is 
relieved, and the woman breathes more freely. But at the same time that 
the woman is relieved of the pressure on the chest, she experiences 
increase of the troubles in the lower extremities. There is an increase of 
the bladder symptoms, with a desire for frequent unrination. Constipation 
becomes more troublesome, and there may be hemorrhoids; the veins of the 
lower extremities may become greatly enlarged. 

There is an increased fullness of the external genitals and a greatly 
augmented amount of mucous discharge. There is a feeling of anxiety and 
nervousness, with depression of spirits. 

During the last two weeks of pregnancy patients are apt to have cramp-like 
pains in the lower part of the abdomen. These are often mistaken for labor 
pains. True labor pains are characterized by starting in the back, 
extending around the abdomen and toward the pubes and down the thighs; 
they come at more or less regular intervals of half to three-quarters of 
an hour, and increase in intensity with a decrease in the intervals. A 
strong pain is apt to be followed by two weaker ones. The so-called false 
pains are irregular in their occurrence. 

Symptoms of Actual Labor.-- First is generally the show; this is a 
discharge of mucous tinged with blood; at the same time the true labor 
pains set in. When the patient or nurse is in any doubt as to the 
character of the pains, or when the show appears, the physician should be 
summoned at once. Other symptoms are frequent desire to empty the bladder 
and bowels, and a sensation of shivering. 

The Confinement-Bed.-- A single bed is much more convenient, but it is 
rarely found in a private house. The double bed is arranged as follows: 
The hair mattress is covered with a large rubber sheet, which is pinned 
with safety-pins at the corners and tucked well under the mattress; the 
rubber sheet must not be drawn too tightly for fear of tearing. Over this 
comes the sheet, and over the upper half of the bed, the draw-sheet; this 
is a sheet folded four double, which goes across the bed so as to come 
under the hips of the patient, and is tucked under the mattress at both 
sides. The object of this is so that it may be frequently and easily 
changed without disturbing the patient. The sheet, blanket, and spread 
which are to serve as a covering after delivery are folded back and placed 
on the left side of the bed. 

The lower right-hand corner of the bed-- the right side of the bed is that 
side which is toward the right hand as one stands facing the foot-board-- 
is arranged for the confinement; on this is fastened the smaller rubber 
sheet, and over this the sheet is folded, and both are fastened down with 
safety-pins. The pillow for the patient should be placed at the upper and 
inner corner of the square. After the delivery the patient is lifted to 
the upper part of the bed and the temporary dressing is removed. A sheet 
and blanket are used for a covering during the confinement. 

Before the labor begins it is well to fasten up the vest and gown, so that 
they will not be soiled, as it is important that the patient shall be 
moved as little as possible after the labor, as all movements tend to 
increase the bleeding. 

The floor oilcloth must be spread at the side of the bed which is made up 
for the confinement, and should extend slightly under the bed. 

A bureau in the room should contain the mother's and baby's clothing, bed-
linen, towels, and any other articles which will be needed, all properly 
arranged. 

The clothing for the mother and baby will be placed where it will keep 
warm, and the infant bathtub will be in readiness in case of sudden need 
for it. 

All water used about the confinement must have been carefully sterilized 
in advance. The best way to sterilize the water is by boiling it in a 
large wash-boiler; whatever vessel is used must be scrupulously clean, and 
ought to be new. The vessel is covered over, and the water is allowed to 
boil for half an hour; it is then, still covered, set aside to cool. There 
should be three gallons each of sterilized hot and cold water; since in 
case of an emergency there must be plenty of water ready for use. 

The various articles ordered in the confinement outfit will be at hand 
ready for use. It is the duty of the nurse to have everything ready for 
the doctor before his arrival. The patient should have a full warm tub-
bath, fresh night-clothes put on, and an enema should be at once given to 
unload the bowels, and this even though there may have been a bowel 
movement only a few hours previously. The patient should remain in bed 
until the arrival of the doctor. After an examination has assured the 
latter that all is right, she may be allowed to go around the room, with a 
wrapper thrown on over the night-gown. 

Conveniently near the bed should be a small table, covered with one or two 
freshly laundried towels. This table should have on it a wash-basin, a 
hand-brush, soap and hot water, an antiseptic solution, scissors, a 
ligature for the navel, and a suitable aseptic lubricant for the hands. 

The Process of Labor.-- The process of labor is divided into three stages. 
The first stage is that of dilatation; by which is meant the stretching of 
the mouth of the womb so that the child may pass through. At the first 
confinement this stage lasts about fifteen hours; at subsequent labors the 
length of this stage is much shorter, the average time being eight hours. 
The pains during this stage are sharp and cutting, and they are 
accompanied by a slight show of blood. The patient is fretful and nervous 

The second stage of labor is called that of expulsion, because in this 
stage the uterus contracts down together with the abdominal muscles to 
expel the child from the womb and the vagina into the world. The duration 
of this stage in the first confinement is about an hour and a half. 

The third stage of labor includes the time from the expulsion of the child 
till the coming away of the after-birth; the average length of this stage 
is from twenty minutes to half an hour. 

The average length of time for the first labor is seventeen hours; and for 
subsequent labors from eight to eleven hours. 

The bag of waters is the sac of membranes in which the child is inclosed. 
It contains a liquid in which the child floats; the object of the water is 
to protect the child from sudden shocks or any kind of injury during 
pregnancy. During labor this membrane with its contained water serves as a 
dilating wedge to assist in the opening of the womb, and it also protects 
the child from the direct contraction of the uterus upon it. When the 
waters break prematurely, the labor is much longer and more tedious; 
normally this should not occur before the mouth of the womb is fully 
dilated. 

The pains of the second stage of labor are of a bearing down character, 
and constantly increase in force and frequency; the climax being reached 
as the head passes through the vulvar orifice. 

A child usually lies in the womb with the head downward; the reason of 
this is that there is more room in the upper part of the uterus, and as 
the small parts of the child as it is folded upon itself take up the most 
space, they occupy this position, while the head lies just above the 
pubes. The normal position of the child is: the head is flexed on the 
chest, the legs on the thighs and the thighs on the abdomen, and the hands 
are folded across the chest. And so the child is usually born head first. 

During the stage of expulsion the head of the child is forced down 
slightly during each pain, to recede a little during the intervals between 
the pains; in this way the vagina and its external orifice are gradually 
stretched so that the head of the child may pass through without tearing 
the parts. If the head is allowed to pass through suddenly, or where the 
labors are rapid, as in the case of women who have given birth to several 
children, much mischief may be done by tearing the soft parts. 

After the birth of the head there is a short interval of rest, when the 
shoulders are born; the rest of the body easily slips out; and with the 
expulsion of the after-birth the labor is over. 

At the very beginning of labor the patient should be given a full warm tub-
bath, and make an entire change of linen. She will usually prefer to be 
dressed in her night-clothing, over which during the first stage she may 
wear a loose wrapper; a sterilized napkin should be worn over the vulva 
during this stage. During the first stage, as a rule, the patient should 
not be confined to bed until the dilatation is well advanced; she is 
generally more comfortable if she is allowed to move around the room, and 
the pains are thereby advanced. 

The only way in which the physician can determine whether labor has begun 
is by making an internal examination; and this will enable him to decide 
as to whether it is necessary to remain or not. 

The nurse should always wear a wash dress in the confinement and lying-in 
room. 

If the labor is long, nourishment in the form of beef-tea, broths, and 
milk may be given. No stimulants should be given without the direction of 
the physician. The frequent taking of cold water is permissible. 

At the beginning of the labor the family and friends must be excluded from 
the room, and it must be kept as quiet and as cheerful as possible. 

Toilet of the Patient.-- The newly born child is received in a small 
blanket, is well wrapped, and laid in a warm place. The nurse then turns 
her attention to the mother; the external genitals and soiled parts of the 
body are cleansed with sterilized cheese-cloth wrung out of an antiseptic 
solution; if the body-linen has become soiled, it is also changed, and all 
blood-stained articles are removed from the bed. The patient is then 
carefully lifted up on the permanent bed, and the vulvar pad and the 
abdominal bandage are applied; after which the patient is allowed to rest.