The Eugenic Marriage, Volume I. (of IV.)
W >> W. Grant Hague, M.D. >> The Eugenic Marriage, Volume I. (of IV.)INSOMNIA DURING PREGNANCY.--Insomnia or sleeplessness is sometimes a
vexatious complication during pregnancy. It seldom if ever becomes of
sufficient importance or seriousness to interfere with the pregnancy or the
health of the patient. Nevertheless, a period of sleeplessness lasting for
two or three weeks is not a pleasant experience to a pregnant woman. It is
most often met with during the latter half of pregnancy.
There can be no question that every case of insomnia has definite cause,
and can be relieved if we can find the cause. The only way to find it [87]
is to systematically take up the consideration of each case, and this is
best done by the physician. He must have patience and tact; you must answer
each question truthfully and fully. Your diet, personal conduct, exercise,
condition of bowels, mental environment, domestic atmosphere, everything,
in fact, which has any relation to you or your nerves, must be inspected
with a magnifying glass. Some little circumstance, easily overlooked, of
seemingly no importance, may be the cause of the trouble. You may need more
outdoor exercise, or you may need less outdoor exercise. You may need more
diversion, more variety, or you may need less. You may need a sincere,
honest, tactful, patient confidant and friend, or you may need to be saved
from your friends. You may be exhausting your vitality and fraying your
nerves by social exigencies,--those empty occupations which fill the lives
of so many fussy, loquacious females,--echoless, wasted, babbling moments,
of supreme important to the social bubbles who ceaselessly chase them but
of no more interest to humanity than the wasted evening zephyrs that play
tag with the sand eddies on the surface of the dead and silent desert. You
may have wandered from the narrow limitations of the diet allowable in
pregnancy, or you may be the victim of an objectionably sincere relation
who pesters you with solicitous inquiries of a needless character. Whatever
it is, rectify it. A good plan to follow on general principles is to take a
brisk evening walk with your husband just before bedtime, and at least two
hours after the evening meal. Follow this with a sitz bath as soon as you
return from the walk.
A sitz bath is a bath taken in the sitting position with the water reaching
to the waist line. It should last about fifteen minutes and the water
should be comfortably hot. It is sometimes found that this form of bath
creates too much activity on the part of the child and defeats the purpose
in view. This is apt to be the case in very thin women when the abdomen is
not covered by a sufficient layer of fatty tissue. These women will find it
advisable to take, in place of the sitz bath, a sponge bath in a warm room,
using the water rather cool than hot but in a warm room. Rub your skin [88]
briskly but waste no time in getting into bed. A glass of hot milk, before
going to bed, or when wakeful during the night, may serve as a preventive.
When these measures fail the physician should be called upon to advise and
prescribe.
PTYALISM, OR AN EXCESSIVE FLOW OF SALIVA.--This is a common condition in
pregnancy, but cannot be prevented. It is of no importance other than that
it is a temporary annoyance.
Itching of the abdomen can usually be allayed by a warm alcohol rub,
followed by gently kneading the surface of the abdomen with warm melted
cocoa butter, just before retiring.
A VAGINAL DISCHARGE.--Soon after pregnancy has taken place the woman may
notice a discharge. It may be very slight or it may be quite profuse. In
some cases it does not exist at all during the entire period. As a rule the
discharge is more frequent and more profuse toward the end of pregnancy.
If the discharge exists at any time,--and it is no cause for worry or alarm
if it does exist,--inform your physician. He will advise you what to do,
because it is not wise for you to begin taking vaginal douches or
injections without his knowledge, and at a time when they may do you
serious harm. Should itching occur as a result of any vaginal discharge the
following remedial measures may be employed:
A solution of one teaspoonful of baking soda to a douche bag of tepid water
may be allowed to flow over the parts, or cloths saturated with this
mixture may be laid on the itching part. A solution of carbolic acid in hot
water (one teaspoonful to one pint of hot water), is also useful, or a wash
followed by smearing carbolic vaseline over the itching parts. If your
physician should suggest a mild douche for itching of the vagina as the
result of a discharge, it may be promptly relieved by using Borolyptol in
the water. Buy a bottle and follow directions on the label.
TESTING URINE IN PREGNANCY--IMPORTANCE OF.--One of the most important
duties, if not the most important, of both the physician and the patient is
to have the urine of the pregnant woman examined every month during the[89]
first seven months and every two weeks during the last two months. The
urine examined during the first seven months should be the first urine
passed on the day it is sent for examination. During the last two months of
pregnancy the patient should pass all her water into a chamber for an
entire day, and take about three ounces of this mixed water for
examination. She should measure the total quantity passed during these days
and mark it with her name on the label of the bottle. The physician will
thus have an absolute record and guide of just how the kidneys are acting,
and as they are the most important organs to watch carefully during every
pregnancy, the greatest care should be taken to see that failure to note
the first symptom of trouble does not take place.
ATTENTION TO NIPPLES AND BREAST.--The physician should inspect the breasts
and nipples of every pregnant woman when she first visits his office.
Frequently the nipples are found to have been neglected, probably subjected
to pressure by badly fitting corsets or too tight clothing. Instructions
gently to pull depressed nipples out once daily, if begun early, will
result in marked improvement by the end of pregnancy. During the latter
part of pregnancy the breasts should be carefully and thoroughly bathed
daily in addition to the daily bath. This special bath should be with a
solution of boric acid (one teaspoonful to one pint of water). After the
bath apply a thin coating of white vaseline to the nipples. It may be
necessary to resort to the following mixture to harden the nipples and to
make them stand out so that the child can get them in its mouth: Alcohol
and water, equal parts into which put a pinch of powdered alum; this
mixture should be put in a saucer and the nipples gently massaged with it
twice daily. A depressed nipple may also be drawn out by means of a breast
pump. If the nipples are not pulled out the child will be unable to nurse.
It may then be necessary to put the child on the bottle and when the
nipples are ready he may not take them after being used to the rubber
nipple. The breasts may become caked and as a caked breast is a very
painful and serious ailment it is wise to attend to this matter in [90]
time.
THE VAGARIES OF PREGNANCY.--Certain foolish, old-fashioned ideas, have
crept into the minds of impressionable people regarding pregnancy, which
are aptly termed vagaries. It is believed by some that if the pregnant
woman is the victim of fright, or is badly scared, or witnesses a
terrifying or tragic sight, her child will be, in some way, affected by it.
If the incident is not of sufficient gravity to cause an abortion or a
miscarriage it will not, in any way mark, or affect the shape of the child
in the womb.
It is believed by some that a child can be marked by reason of some event
occurring to the mother while carrying it. This is not so; a child cannot
be marked by any experience or mental impression of the mother. Some
believe that the actual character of a child can be changed by influences
surrounding the mother while carrying it. The character of a child cannot
be changed one particle after conception takes place, no matter how the
mother spends her time in the interim.
It should be carefully understood that the character of the baby is
entirely different from the physical characteristics of the baby. Were this
not so it would be futile on the part of the mother to discipline or
sacrifice herself in the interest of her baby. The baby's character will
reflect the qualities of the combined union of mother and father. The
baby's physical characteristics will largely depend upon the treatment
accorded it by the mother during its intro-uterine life. Hence we lay down
rules of conduct, diet and exercise in order to produce a good, sturdy
animal, while the character or mind of the animal is a part of the
fundamental species already created. In other words, no matter how much
care you bestow upon a rose bush, its flower will still be a rose,--it may
be a better rose, a stronger, sturdier rose, a better smelling and a more
beautiful rose, but it is still a rose.
CONTACT WITH INFECTIOUS DISEASES.--The pregnant woman should be warned
against the danger of coming in contact with any person suffering from any
infectious or contagious diseases. To become the victim of one of these[91]
diseases near the time of labor would be a dangerous complication not only
to the mother, but to the child. A woman is more liable to catch one of
these diseases during the last month of pregnancy than at any other time.
The most dangerous diseases at this period are Scarlet Fever, Diphtheria,
Erysipelas, and all diseased conditions where pus is present.
AVOIDANCE OF DRUGS.--It is a safe rule during pregnancy to avoid absolutely
the taking of all medicines unless prescribed by a physician.
THE DANGER SIGNALS OF PREGNANCY.--The following conditions may be of very
great importance and may be the danger signals of serious coming trouble.
They must not therefore be neglected or lightly considered. When any of
them make their appearance send for the physician who has charge of your
case, at once, and follow his advice whatever it may be.
1. Any escape of blood from the vagina, whether in the form of a sudden
hemorrhage or a constant leaking, like a menstrual period.
2. Headache, constant and severe.
3. Severe pain in the stomach.
4. Vertigo or dizziness.
5. Severe sudden nausea and vomiting.
6. A fever, with or without a chill.
* * * * *
[93]
CHAPTER VIII
THE MANAGEMENT OF LABOR
WHEN TO SEND FOR THE PHYSICIAN IN CONFINEMENT CASES--THE PREPARATION OF
THE PATIENT--THE BEGINNING OF LABOR--THE FIRST PAINS--THE MEANING OF
THE TERM "LABOR"--LENGTH OF THE FIRST STAGE OF LABOR--WHAT THE FIRST
STAGE OF LABOR MEANS--WHAT THE SECOND STAGE OF LABOR MEANS--LENGTH OF
THE SECOND STAGE--DURATION OF THE FIRST CONFINEMENT--DURATION OF
SUBSEQUENT CONFINEMENTS--CONDUCT OF PATIENT DURING SECOND STAGE OF
LABOR--WHAT A LABOR PAIN MEANS--HOW A WILLFUL WOMAN CAN PROLONG
LABOR--MANAGEMENT OF ACTUAL BIRTH OF CHILD--POSITION OF WOMAN DURING
BIRTH OF CHILD--DUTY OF NURSE IMMEDIATELY FOLLOWING BIRTH OF
CHILD--EXPULSION OF AFTER-BIRTH--HOW TO EXPEL AFTER-BIRTH--CUTTING THE
CORD--WASHING THE BABY'S EYES IMMEDIATELY AFTER BIRTH--WHAT TO DO WITH
BABY IMMEDIATELY AFTER BIRTH--CONDUCT IMMEDIATELY AFTER LABOR--AFTER
PAINS--REST AND QUIET AFTER LABOR--POSITION OF PATIENT AFTER LABOR--THE
LOCHIA--THE EVENTS OF THE FOLLOWING DAY--THE FIRST BREAKFAST AFTER
CONFINEMENT--THE IMPORTANCE OF EMPTYING THE BLADDER AFTER LABOR--HOW TO
EFFECT A MOVEMENT OF THE BOWELS AFTER LABOR--INSTRUCTING THE NURSE IN
DETAILS--DOUCHING AFTER LABOR--HOW TO GIVE A DOUCHE--"COLOSTRUM," ITS
USES--ADVANTAGES OF PUTTING BABY TO BREAST EARLY AFTER LABOR--THE FIRST
LUNCH--THE FIRST DINNER--DIET AFTER THIRD DAY.
WHEN TO SEND FOR THE PHYSICIAN IN CONFINEMENT CASES.--The physician should
be notified just as soon as it is known that labor has begun. The adoption
of this course is necessary for a number of reasons. It is only just that
he should have an opportunity to arrange his work so that he may be at
liberty to give his whole time to your case when he is wanted. He may not
be at home at the moment, but can be notified, and can arrange to be on
hand when your case progresses far enough to need his personal attention.
It will relieve your mind to be assured that he will be with you in plenty
of time. [Page 94]
Don't worry unnecessarily if he does not come immediately when you notify
him, provided you notify him at the beginning of labor. There is plenty of
time. You have a lot of work to do before he can be of any help. Many women
entertain the idea that a physician can immediately perform some kind of
miracle to relieve them of all pains at any stage in labor. This is a
mistaken idea. No physician can hasten, or would if he could, a natural
confinement. He waits until nature accomplishes her work, and he simply
watches to see that nature is not being interfered with. If something goes
wrong, as it does now and again; or if the pains become too weak, or if the
proper progress is not being made, he may help nature or take the case out
of her hands and complete the confinement. If it is thought best to do
this, there will be plenty of time.
THE PREPARATION OF THE PATIENT AND THE CONDUCT OF ACTUAL LABOR.--It is
assumed that the patient has adhered to the instructions of the physician
given during the early days of her pregnancy. These instructions included
directions as to exercise, diet, bathing, etc.
Having calculated the probable date of the confinement, it is the better
wisdom to curtail all out-of-door visiting, shopping, social engagements,
etc.,--everything in fact out-of-doors except actual exercise, for two
weeks previous to the confinement date. The usual walk in the open air
should be continued up to the actual confinement day. The daily bath may be
taken, and it is desirable that it should be taken, up to and on the
confinement day.
THE MEANING OF THE TERM "LABOR."--By labor is meant, the task or work
involved in the progress by means of which a woman expels from her womb the
matured ovum or child. After the child has been carried in the womb for a
certain time (estimated to be 280 days) it is ripe, or fully matured, and
is ready to be born. The womb itself becomes irritable because it has
reached the limit of its growth and is becoming overstretched. Any slight
jar, or physical effort on the part of the patient, or the taking of a
cathartic, is apt to set up, or begin the contractions which nature has
devised as the process of "labor" by which the womb empties itself. [95]
THE BEGINNING OF LABOR.--When the first so-called pains of actual labor
begin they are not always recognized as such. The explanation of this
seeming paradox is that the "pains" are not always painful. A woman will
experience certain undefined sensations in her abdomen; to some, the
feeling is as if gas were rumbling around in their bowels; to others, the
feeling is as if they were having an attack of not very painful abdominal
colic; while others complain of actual pain. The fact that these sensations
continue, and that they grow a little worse; and that the day of the
confinement is due, or actually here, impresses them that something unusual
is taking place; then, and not till then, does the knowledge that labor is
really approaching dawn upon them.
In due time one of these new sensations, which constitute the first stage
of labor, will be more emphatic; there will be a little actual pain so that
she will feel like standing still, holding her breath and bearing down.
That is the first real labor pain and marks the beginning of the second
stage of labor, and may be the first absolute sign that will leave no doubt
in her mind that labor has begun.
The nurse will now inquire into the condition of the patient's bowels. If
they have not already moved freely that day, she will give the patient a
rectal injection of one pint of warm soap suds into which one teaspoonful
of turpentine is put. After the bowels have been thoroughly cleansed, the
patient will be made ready for the confinement. The clothing necessary
consists of dressing gown, night gown, stockings and slippers. These are
worn as long as the patient is out of bed, when all but the night gown will
be discarded. The entire body of the patient, from the waist line to the
knees, should be thoroughly cleansed, paying particular attention to the
private parts; first with warm water and castile soap, and then rendered
aseptic by washing with four quarts warm boiled water into which has been
put one teaspoonful of Pearson's Creolin. A soft napkin is then wrung out
of water that has been boiled and cooled to a suitable temperature, and
laid over the genital region, and held in place by a dry clean napkin, [96]
and allowed to remain there until the physician takes personal charge of
the case.
LENGTH OF THE FIRST STAGE OF LABOR.--There is no definite or even
approximate length of time for the first stage of labor,--that, you may
recall, was the more or less painless stage, or as it has been termed, the
"getting-ready" stage. Inasmuch as it is an unimportant and practically
painless stage, most patients do not mind it. They continue to be up and
around and work as usual.
The first stage of labor is utilized by nature in opening the mouth of the
womb.
The second stage of labor is utilized by nature in expelling the child into
the outer world.
LENGTH OF THE SECOND STAGE OF LABOR.--After the second stage has begun, the
length of time necessary to end the labor, assuming everything is normal,
depends upon the strength and frequency of the pains. The stronger and more
frequent the pains, the quicker it will be over. First confinements
necessarily take longer, because the parts take more time to open up, or
dilate, to a degree sufficient to allow the child to be born. In subsequent
confinements, these parts having once been dilated yield much easier, thus
shortening the time and the pains of this, the most painful, stage of
labor. The average duration of labor is eighteen hours in the case of the
first child, and about twelve hours with women who have already borne
children. The time, however, is subject to considerable variation, in
individual cases, as has been pointed out.
CONDUCT OF THE PATIENT DURING THE SECOND STAGE OF LABOR.--She should remain
up, out of bed, as long as she possibly can. The object of this is because
experience shows that the labor pains are stronger, and more frequent, when
in the upright position. Even though this procedure would seem to invite
more constant suffering, it must be remember that labor is a physiological,
natural process, that there is nothing to fear or dread; and if the patient
is in good health, it is to her advantage to have it over soon, rather than
to encourage a long drawn out, exhausting labor. When the pains come [97]
she should be told to hold on to something, to hold her breath as long as
possible, and to bear down. A good plan is to roll up a sheet lengthwise,
and throw it over the top of an open door and let her grasp both ends
tightly and bear down; or she can put her arms over the shoulders of the
nurse and bear down. Instruct her to hold her breath as long as she can,
bearing down all the time, and when she can't hold it any longer, tell her
to let up, and then take a quick deep breath and bear down again, repeating
this programme until the pain ceases. Tell her specifically to be sure to
keep bearing down till the end of the pain, because the most important
time, and the few seconds during which each pain does most of its work
during the second stage of labor, is at the very end of each pain. When a
woman understands that these instructions are for her good, and that they
are given with the one purpose of saving her pain, and shortening the
length of labor, she will try to obey. Each pain is intended by nature to
do a certain amount of work, and each pain will accomplish that work if the
woman does not prevent it; and if she does prevent it, she is only fooling
herself, because the next pain will have to do what she would not allow the
former to do, and so on according to how she acts.
THE CARRIERS OF HERITAGE
[Illustration: Here is the actual bridge from this generation to the next.
Into these two little bodies--the larger not over one-twenty-fifth of an
inch in diameter--is condensed the multitude of characteristics transmitted
from one generation to another.
The vital part of the _Ovum_ is the _Nucleus_, which contains the actual
bodies that carry heritage--the little grains that are the mother's
characteristics--_Chromosomes_. This nucleus is nourished by oils, salts
and other inclusions, known as _Cytoplasm_. Floating in the cytoplasm may
be found a tiny body known as the _Centrosome_, which acts as a magnet in
certain phases of cell development. Around this whole mass is a _Cell
Wall_, more or less resisting and protective.
The _Spermatozoan_ is structurally much different from the ovum, but it
also has its nucleus and chromosomes, which carry to the child the
transmittable characteristics of the father.
The ovum is usually comparatively large and stationary, and whatever motion
is therefore necessary to bring it into contact with the male cell devolves
upon the latter, which possesses what is known as a _locomotor tail_. In
addition there are usually many sperms to one ovum, so that the chances are
that at least one male cell will reach the egg and effect fertilization,
and the beginning of a new life.
The diagrams on the opposite page show the actual steps by which the
spermatozoan unites with the ovum. It is the very first stage of the
process of cell multiplication that results in the offspring.]
THE FORMATION OF A NEW LIFE
[Illustration: _Reproduced by permission from "Genetics," Walters, The
Macmillan Co._]
HOW A WILLFUL WOMAN CAN PROLONG LABOR.--For a certain time, during the
second stage of labor, a willful, unreasonable woman, can work against
nature and save herself a little pain by prolonging the issue; but there
will come a time when, the head having reached a certain position, the
expulsive pains will be so great that she won't be able to control them and
nature then seems to take her revenge. So if a woman holds back, and begins
to cry, and scream, when she feels a pain coming, she renders the pain to a
large degree negative, she prolongs her labor, adds to the total number of
pains, exhausts herself, and endangers the life of her child. It must,
however, be remembered in all justice that this is a time when it is much
easier to preach than to practice.
Every confinement is a new experience; no matter how many a physician may
have seen, there are no two alike. It is one of the interesting [98]
psychological problems in medicine to observe the conduct of women during
their first confinement.
Some are calm, exhibiting a degree of self-control that is admirable. They
are willing to be instructed, and they recognize that the advice is given
for their benefit. They conscientiously try to obey suggestions, and they
make praiseworthy efforts to keep themselves under control. They are
stoics.
Others collapse at once; they go to pieces under the slightest excuse, and
frequently without as much as an excuse. As soon as the pain begins, they
willfully ignore all the instructions given and desperately and foolishly
try to escape what they cannot escape. In this unreasonable selfishness
they resent advice, and at the same time they implore you to "do something"
for them. There is absolutely no excuse for this kind of conduct; and any
prospective mother who, because of a willful trait in her disposition,
refuses to profit by the kindly professional advice of her physician or
nurse, should at least have some consideration for her unborn babe. It may
seem unkind to criticise the conduct of any woman at such a time. It is not
prompted by a lack of patience or justice however. These women permit, in
spite of every assurance to the contrary, an unreasonable fear to overwhelm
them; and because of this fear they refuse to be guided into a path of
conduct that will save them suffering and shorten the pains which they
complain of. It is our conviction that if a woman would try to follow the
advice of the physician at this time, at least half of all the seeming
suffering would be avoided. We are glad to be able to truthfully state that
this type of woman is vastly in the minority.
When the second stage has advanced far enough, the patient will decide to
go to bed. It may be necessary to put her in bed earlier, if her pains are
very strong, as there is always a possibility of suddenly expelling the
child under the influence of a strong pain. She will, as previously stated,
discard all clothing, except her night gown, which can be folded up to her
waist line and let down as far as necessary after the confinement is over.
The obvious advantage of this arrangement is that the gown remains [99]
unsoiled, and saves what would be needless trouble if it proved necessary
to change the night gown at a time when the tired-out patient needs rest.
Much aid may be afforded the woman at this stage by twisting an ordinary
bed sheet and putting it around one of the posts or bars of the foot of the
bed. The patient may then pull on the ends during the pain; she may also
find much comfort and aid by bracing her feet on the foot of the bed while
pulling. It is desirable to instruct the nurse to press on the small of the
back during these pains. Some women appreciate a hot water bottle in this
region. If the pains are hard the patient may perspire freely; it is always
refreshing occasionally to wipe the face and brow off with a cloth wrung
out of cold water. Cramps of the limbs may be relieved by forcibly
stretching the leg and pulling the foot up toward the knee. From this time
until the child and after-birth are born the physician will take active
charge of the case.