HEALTH AND THE EXPECTANT MOTHER
THE IMMINENT ARRIVAL of a baby in a home (especially the first) presages many changes in the home and in family life. But the first and most important consideration is the health of the mother-to-be and the unborn child.
If the expectant mother has a physician, the task of choosing a doctor is relatively easy. Thus the family physician himself may well care for the mother during pregnancy and childbirth, and later for the baby. In the event of complications, obstetrical consultation may be necessary, but for the most part, childbirth is usually an uncomplicated procedure.
If the expectant mother has a physician, the task of choosing a doctor is relatively easy. Thus the family physician himself may well care for the mother during pregnancy and childbirth, and later for the baby. In the event of complications, obstetrical consultation may be necessary, but for the most part, childbirth is usually an uncomplicated procedure.
Prenatal Care
It is vital that we provide the best facilities and protection available for the important group of our society.
This should begin with proper instruction in our schools, especially for the girls. It should be impossible for a girl to graduate from high school without having learned the fundamental facts about her own body and its functions, and about how to care for a newborn child.
It is further important to realize that the child is father to the man and that boy in his teens will soon be heading his own home, responsible for the health and welfare of three or more people. The more he knows about the reproduction of his species, the better off he and his marital partner and their offspring will be.
Many state require couples to have a medical examination within 15 days before marriage to determine the absence of venereal infection. The couple should have a complete physical examination including examination of heart and lungs, and or the general tract to see if any abnormalities or deformities of these organs are present. The blood pressure ( BP) should be taken to determine if it is higher or normal than normal. The urine must be tested for albumin or other evidence of kidney damage, and for sugar. After such an examination a physician can usually give reassurance that there are no abnormalities.
These precautions will help to prevent needless apprehension, pain, and embarrassment after marriage.
When is Pregnancy Most Likely
Assuming that the women has a normal menstrual cycle of 28 days and that this is reasonably regular, the date of ovulation (when the ovum is discharged from the ovary) can be calculated within fair accuracy. When the cycle is irregular, this becomes more difficult, and the greater the irregularity, the less likely it is that the period of greatest fertility can be estimated.
Since fertilization depends on the meeting of the ovum with a living sperm, the most likely time for fertilization to occur is at the time of ovulation. The life-span of an unfertilized human ovum is unknown, but is perhaps less that 24 hours. Fertilized ova require four to five days to progress from the end of the fallopian tube to the uterus. The sperm likewise lives for about 36 to 48 hours after being discharged into the vagina. The most fertile time therefore comes midway between the first days of two successive menstrual periods in a regular cycle. The least fertile periods are normally those times most remote from the central point in time when the ovum is discharged. Pregnancies, however, have been known to occur at all stages of the menstrual cycle, so there is no time when a pregnancy may be regarded as out of the question.
Since fertilization depends on the meeting of the ovum with a living sperm, the most likely time for fertilization to occur is at the time of ovulation. The life-span of an unfertilized human ovum is unknown, but is perhaps less that 24 hours. Fertilized ova require four to five days to progress from the end of the fallopian tube to the uterus. The sperm likewise lives for about 36 to 48 hours after being discharged into the vagina. The most fertile time therefore comes midway between the first days of two successive menstrual periods in a regular cycle. The least fertile periods are normally those times most remote from the central point in time when the ovum is discharged. Pregnancies, however, have been known to occur at all stages of the menstrual cycle, so there is no time when a pregnancy may be regarded as out of the question.
Signs and Symptoms for Pregnancy
The signs and symptoms of pregnancy vary greatly in different women and at different stages of pregnancy. During the early weeks they are vague, but become more clear in time.
The missing of a menstrual period is probably evidence that pregnancy exists if periods have been previously been regular. However, some women menstruate more regularly than others because of their physiological and psychological constitutions. A period may be delayed a week or more than as result of such simple causes as nervous shock, bad news, change of climate, or acute infections.
The missing of a menstrual period is probably evidence that pregnancy exists if periods have been previously been regular. However, some women menstruate more regularly than others because of their physiological and psychological constitutions. A period may be delayed a week or more than as result of such simple causes as nervous shock, bad news, change of climate, or acute infections.
In early pregnancy, the breasts become larger and there is more tingling and soreness of the nipples. The pressure of the enlarging uterus upon the bladder may result in greater frequency in urination. Nervous instability and an abnormal desire for unaccustomed foods such as sour pickles is normal.
After the second missed period, a special test (Friedman) can be made using an immature female rabbit and injecting into her vein 10 cc. of the patient’s filtered urine. After 48 hours the rabbit is killed, the abdomen opened, and the ovaries exposed. If there are certain changes in the rabbit’s ovaries which are characteristic of pregnancy, it can be correctly assumed in 85% of cases that the woman is pregnant.
More recent simple test for pregnancy are based on the immune reaction of the woman’s body to the hormones secreted by the placenta (afterbirth). These are detected by skin tests which require only a few hours, and are very simple to perform.
After the second missed period, a special test (Friedman) can be made using an immature female rabbit and injecting into her vein 10 cc. of the patient’s filtered urine. After 48 hours the rabbit is killed, the abdomen opened, and the ovaries exposed. If there are certain changes in the rabbit’s ovaries which are characteristic of pregnancy, it can be correctly assumed in 85% of cases that the woman is pregnant.
More recent simple test for pregnancy are based on the immune reaction of the woman’s body to the hormones secreted by the placenta (afterbirth). These are detected by skin tests which require only a few hours, and are very simple to perform.
The Months of Pregnancy
If the expectant mother sees her doctor regularly at eh intervals which he suggests, she gives him an opportunity to observe her pregnancy progress, control her weight, and take prompt measures to correct any abnormalities which may appear. Though observations, examinations, urinalyses, and blood pressure reading, he is able to detect threatened toxemias due to liver or kidney failure and to watch the growth of the baby and its position in the uterus.
Obstetrical History
When taking the patient’s health history the doctor will inquire about illness which the patient has experienced involving heart, lungs, and abdomen, especially rheumatic heart disease, diabetes, German measles, surgical operations, and their dates and circumstances. He will wish to know about diseases in the patient’s family and that of her husband.
The menstrual history as regards amount, duration, regularity, and type of blood, and whether she has leukorrheal (whites) discharge will be discussed, together with any known pelvic abnormalities or disease. Previous pregnancies, if any, their dates, and outcome will be recorded.Physical Examination
When pregnancy seems likely, a through examination is in order. Many young women look upon this with considerable apprehension. This is one of the difficult mental hazards to be overcome. In reality, it is very simple and very necessary procedure. The doctor must know certain anatomical and physiological facts which he can obtain only by making a complete examination. This will determine if there are any physical defects which must be considered in connection with the management of the pregnancy. The heart, lungs, teeth, nervous system, kidneys, blood, and blood pressure are investigated.
A careful pelvic examination is made to disclose if bony deformities or tumors are present which might obstruct the passage of a baby. The examination findings are carefully recorded on a chart, for later comparison.
Laboratory examinations which are important in pregnancy are;
- Urine analysis which determine the ability of the kidneys to do their work properly.
- Blood count and hemoglobin estimation: this is very important that many women are anemic before becoming pregnant or become anemic during pregnancy, and all are faced with the possibility of blood loss during labor and after delivery. Since this cannot be anticipated in most cases, it seems logical to estimate the amount of blood a patient has and how much she is apt to lose.
- Blood tests are also important to determine the Rh factor to prevent a possible severe transfusion reaction or even injury to the unborn baby. The Wassermann or kahn test is also done routinely. If positive, it usually means that the patient has syphilis, and if treatment can be started before the 16th week of the pregnancy, the baby will not be infected and the mother will get the benefit of immediate medical treatment.
- X-ray examinations may be necessary in exceptional circumstances to determine the presence of the developing baby, and its presentation and position. When recommended such examinations are entirely safe for mother and baby. Deformity in the pelvic bones, tumor masses which might prevent normal delivery, and the presence of twins or triplets can also be determined by x-ray.
- Blood pressure is taken to detect any significant rise above normal that might indicate a possible toxic condition in the mother which could be dangerous.
Growth of the Fetus
The baby begins to move within the uterus with sufficient vigor to be felt by the mother at about the 20th week, if it is her first pregnancy, and at about the 18th if she has previously had a baby. At first the movement is a weak flutter, but later vigorous kicks are felt. Along about the time the fourth period has been missed or a few weeks earlier, the size of the abdomen becomes markedly greater and continues to increase as time goes on. The stretching of the skin of the abdomen gives rise to streaks of a silvery or pink color. These never completely disappear after pregnancy.
The length of the fetus in centimeters equals the square of the month of pregnancy ; one month equals 1 cm, two months equals 4 cm, three months 9 cm. After the 5th month of gestation the fetus grows 5 cm in length every month until the 10th lunar month. During this period the nervous system, lungs, liver, kidneys, heart, and other vital organs develop and becomes functional so that a baby born after the 28th week can usually survive if properly cared for. However, every week that the baby spends in the uterus until the full 280 days have passed is so much clear gain as far as its strength, maturity, and ability to survive is concerned. For this reason it is advisable to try to prevent the onset of premature labor whenever possible.Diet
Except for limitation of the daily calorie intake, the diet of the expectant mother does not differ from that of any adult who prays proper attention to the intake of all essential foodstuffs. A good general diet includes protein, meat, egg and fish. Red meats are particularly important during pregnancy because they furnish hemoglobin which will be stored in the liver, spleen and bone marrow, and used to make new blood cells and thus protect from the dangers of anemia due to hemorrhage if this occurs. Necessary minerals such as Calcium, Phosphorus and Manganese ate also supplied through foods and transferred from the blood through the placenta to the baby. Fruits, Vegetables, dairy products, cereals, and some meats contain vitamins necessary for the health of both mother and baby.
Weight control is of the greatest importance to the pregnant women, both during her pregnancy and afterward. Excess weight puts an extra burden on the liver and kidneys, which already carried on overload. It adds to her discomfort, especially in the later months when the abdomen becomes enlarged. It increases the likelihood of pregnant marking on her skin. It also impairs her figure after the baby born.Digestive Disturbances
Most women have some nausea with or without vomiting in the early weeks of pregnancy- due probably to the adjustment that has to be made in the function of the thyroid and other glands of internal secretion. Certain changes in their functions are important in the initiation and maintenance of pregnancy. Constipation bothers many pregnant women, but it can usually be controlled by the eating of sufficient fruits and vegetables and by the avoidance of a diet that seems to produce constipation.
Diarrhea is usually due to some indiscretion in diet and should be checked promptly if severe because it may stimulate uterine contractions and even bring on miscarriage, especially in the early months. A bland diet of custard, milk, and cheese is helpful. “Heartburn” or sour stomach is frequently present in the early months. Ordinarily this occurs about one hour after meals and can usually be controlled by taking one-half teaspoonful of baking soda in a glass of water or a few soda mint tablets.
Diarrhea is usually due to some indiscretion in diet and should be checked promptly if severe because it may stimulate uterine contractions and even bring on miscarriage, especially in the early months. A bland diet of custard, milk, and cheese is helpful. “Heartburn” or sour stomach is frequently present in the early months. Ordinarily this occurs about one hour after meals and can usually be controlled by taking one-half teaspoonful of baking soda in a glass of water or a few soda mint tablets.
Exercise and Rest
Every pregnant women in normal health should take some form of exercise. Walking, swimming, rowing, and other comparable activities are advised in moderation. Diving, horseback riding, and other sports in which the hazards of blows or falls are great are best avoided. If she feels refreshed after a rest, the exercise has been beneficial.
A rest period of 20 minutes or so before noon will help the pregnant woman get through the day more comfortably. Fatigue is the enemy of the pregnant woman. She should try to get eight hours of sleep at night if possible, and more if necessary.
Back pains may be caused in later pregnancy by loosening of the sacroiliac joints. This condition can be helped by the use of a properly fitted maternity corset which supports the joints. Dry or moist heat applied to the lower back on retiring is very soothing.Dental Hygiene
Dental hygiene during pregnancy is particularly important. Pregnancy puts a drain on the body’s calcium supply, and this may cause tooth decay. It was formerly believed that a woman had to lose “ a tooth for every child “. Dental work can be done during pregnancy, but is best done at a date removed from that at which menstruation would have been expected in the absence of pregnancy.
Dress
The most important item in a pregnant woman’s dress is her shoes, both for comfort and safety. These should be well fitted, with low heels. “ wearing out “ old and dilapidated shoes during pregnancy is not only uncomfortable but dangerous, since they may cause falling.
In early pregnancy, up to fourth the month, one may wear ordinary clothing except for stockings. These should support the superficial veins of the legs because they tend to dilate during pregnancy.
About the fifth month the distension of the abdomen by the pregnant uterus requires some form of girdle support. A well-fitted maternity corset with sacroiliac belt attachment can be obtained at any store handling women’s apparel. This will help to prevent or relieve low backache when under physical strain and will furnish additional protection against cold weather.
It is particularly important for the pregnant woman to avoid chilling and to be well protected against colds, sore throat, influenza, and other infections. Heavy underwear and stockings and overshoes to avoid cold and wet feet are recommended.
About the fifth month the distension of the abdomen by the pregnant uterus requires some form of girdle support. A well-fitted maternity corset with sacroiliac belt attachment can be obtained at any store handling women’s apparel. This will help to prevent or relieve low backache when under physical strain and will furnish additional protection against cold weather.
It is particularly important for the pregnant woman to avoid chilling and to be well protected against colds, sore throat, influenza, and other infections. Heavy underwear and stockings and overshoes to avoid cold and wet feet are recommended.
The Breasts
There is, in most cases, no other food which is quite as good. The primary reason for this is that immune substance transmitted to the baby from the mother protect it from the diseases which she has had and recovered from.
An additional reason for nursing the baby is that many authorities believe it helps establish a sense of security in the baby and develops an emotional closeness which may help to prevent behavior problems as the baby grows up.
During pregnancy nipples should be kept clean made longer and softer by massage and gentle pulling using a cold cream or cocoa butter in the last three months to prevent inversion. Small breasts may undergo considerable development during pregnancy ; if they become tender, a well-fitting brassiere gives considerable comfort. Occasionally they leak fluid near the time of delivery, and it may be necessary to wear a protective pad.
An additional reason for nursing the baby is that many authorities believe it helps establish a sense of security in the baby and develops an emotional closeness which may help to prevent behavior problems as the baby grows up.
During pregnancy nipples should be kept clean made longer and softer by massage and gentle pulling using a cold cream or cocoa butter in the last three months to prevent inversion. Small breasts may undergo considerable development during pregnancy ; if they become tender, a well-fitting brassiere gives considerable comfort. Occasionally they leak fluid near the time of delivery, and it may be necessary to wear a protective pad.
