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a community service



Federal Reserve Bank of St. Louis



Section 1

History— prologue to the present_______________
Attitudes toward mother and child__________ _____
Maternity homes get under way__________________
Changing philosophy of maternity-home care_____
And now the present____________________________


Section 2.

The value of case-work service_________________
Case work adapted to maternity homes____ .'.______
The decision to keep or to relinquish the child____
When the mother keeps her baby.__________
Placement of the relinquished child___________ ____
Ways of providing case-work service._______________
How psychiatry and psychology can help_________
Incomplete coordination of services._______________


New interests through group activities___________
Recreation and leisure-time activities.____________
Informal educational activities________ ____________
Religious activities______ ________________________


Health and medical services_______ _____________ _
Medical supervision .....______
Nursing service __________________________________
Prenatal care_______
Delivery service______ ......._____________________ ...__
Postpartum care ........._______________________
Care of infants____________________ ________.....____
Facilities for the medical and nursing care of
mothers ..........__ ________________ __________ _____........
Facilities for the medical and nursing care of
infants ___________________________


Section 3 .

Section 4.

Section 5..

The organization of a home______ _______________
The ground work_________________________________
The board of directors._____________
The staff ......___ ____ ...____ ______....................... ............
The buildings and grounds.___ _____ ______________ ....

illustrations by Constance Dillon
Federal Reserve Bank of St. Louis









a community service

Federal Reserve Bank of St. Louis

THE FIRST STEP in helping a baby born out of wedlock to get a start
life without the legal and social handicaps that society still imposes
for illegitimate birth is to make available to his mother during preg­
nancy, at delivery, and while she is planning her future and the future
of her baby whatever advice and assistance she needs. That is one of
the Childrens Bureaus interests in maternity homes for unmarried
mothers. Another o f its interests is that unmarried mothers receive the
same high quality o f maternity care— prenatal, delivery, and post­
partum— that all mothers should have and that the baby have good
medical and nursing care. It is possible for these two interests, the
life-long social welfare of mother and child and a high standard of
maternal and infant care for them, to find fulfillment in maternity-home
care. Both factors are discussed in this bulletin.
In M aternity H om es fo r Unm arried M others the homes are dis­
cussed as a community service. The bulletin is intended primarily, of
course, for the inner circle of boards of directors and the advisory com­
mittees they appoint, for example, medical advisory committees, and for
the staffs of homes and of the case-work agencies that work with them.
It will be of value also, we hope, to State and local departments of health
or welfare, which by law in many States have responsibility for licensing
and supervising, maternity homes, and to councils of social agencies in
helping the homes strengthen their programs.
Certain parts of the bulletin may be of use to social agencies other
than case-work agencies, for example, to youth-serving organizations;
to public-health agencies such as visiting-nurse associations; and to
some individuals who, because of their professions or occupations, are
likely to give the first advice to illegitimately pregnant young women,
that is, individuals who are physicians, nurses, lawyers, clergymen,
teachers, personnel directors, or emplovers.
The Children’s Bureau wishes to acknowledge with thanks the help
of all those who read the manuscript. They made many invaluable
Maud Morlock, Social Service Division, and Hilary Campbell, Di­
vision of Reports, wrote the bulletin except for the section, Health and
Medical Services. Miss M orlock is consultant in services to unmarried
mothers. Health and Medical Services was prepared by Barbara A.
Hewell, M.D., Division of Research in Child Development, in coopera­
tion with John L. Parks, M.D., the Bureau’s consultant in obstetrics,
and Marjorie M. Heseltine, consultant in nutrition, Division of Health

Chief, Children’s Bureau
Federal Reserve Bank of St. Louis


H istory— Prologue to the Present
Two hundred years of the social history o f the United States— as a
colony and as a republic— had woven their changing pattern into the
Nation’s life before protection was offered to unmarried mothers in
shelters definitely for them. During the two centuries in which this
new tolerance was slowly germinating, harsh punishment for the
mother and denial of legal rights to her child were the general rule.
The stigma placed on mother and child is an old, old story— much
older than two centuries. The stigma is as old as the institution of
marriage, which it is imposed to protect. Society hoped to prevent
illegitimate births by the severity of its punishment and of its legal
discriminations. It took no cognizance of causes or of the innocence
of the child. This solid wall of illogic had to be razed. Individuals
and groups who saw the role of society and the law as protective rather
than punitive have made a breach.

This bulletin deals with one part of the effort to break through this
wall of illogic surrounding illegitimate birth— maternity-home service
to an unmarried mother through her travail and her planning for the
future. First will be shown, briefly, public attitudes and their
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expressions in social care of mother or child— or the lack of it— during
the two hundred years before maternity homes came into being. Later
the bulletin presents for consideration the program of service of the
home of today, including case work, group activities, and health and
medical services, and outlines the organization of a home.

In colonial days
Attitudes in pre-Revolutionary New England toward illegitimate
birth stemmed from two sources. The religious code of the Puritan
settlers was predominant, but closely allied to this stern judgment was
the necessity for protecting from dependency the decidedly slender
resources of a community pioneering in a land of short summers and
stubborn soil. Legal punishment naturally followed the law of the
mother country, England. Naturally, too, the colonists tried to apply
the English laws on dependency to their own conditions but with a
determination to prevent what they thought of as the permanent
pauperism of the old country. They wanted everyone in the new set­
tlements to take a fair share in the conquest of the wilderness.
In English law, followed in the colonies, the mother of a child born
out of wedlock was known as a “ lewd” woman and her child as a
“ bastard.” In Puritan settlements the mother might be required to
confess her sin before the congregation. She might be publicly
whipped, placed in stocks', or imprisoned. Even after she had suffered
her legal punishment, her social punishment continued in ostracism.
T o help her or the child would, it was believed, increase the number
o f illegitimate births. The punishment prescribed for Hester Prynne
in Nathaniel Hawthorne’s The Scarlet Letter- —the lifelong wearing
of the letter “ A” for “ adulteress” — is fact, not fancy. This penalty will
be found among the laws of Plymouth Colony for 1658.
The cruel treatment of unmarried mothers and their children often
resulted in the concealment by the mother of her pregnancy and the
consequent lack of physical care, abortion, the death of the mother
in childbirth, the suicide o f the young woman, the abandonment of the
baby, or even the crime of infanticide. Concealment by the mother
of death of a child born out of wedlock was punishable by death unless
the mother could prove by the testimony of a witness that the child
was born dead. Effie Deans in Sir Walter Scott’s The Heart of
Midlothian, based on actual happenings in the Edinburgh of 1736, was
sentenced to death for the supposed death of her baby boy at birth.
He had actually been stolen and was found as a youth. Under Scottish
law the young woman could have been saved at her trial from the
death penalty by testimony that she had told her family of her preg­
nancy before the baby’s birth. The devoutly truthful sister, Jeanie,
who could not bring herself to swear falsely that Effie had told her,

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later walked from Edinburgh to London to win a pardon for the younger
Although an element in the legal harshness toward the child was the
desire to protect public funds, the father of the child actually faced
little inconvenience. His responsibility was difficult to prove and his
support seldom ordered. The burden of support was placed on the
mother. If she could not carry it, the child was exposed to whatever
methods the community had in caring for dependent children. The
baby of illegitimate birth whose mother could not support him was
frequently neglected by the community and always, as he grew, treated
as a social outcast.
Foundlings and children of all ages who became dependent on public
support were usually placed out in families by the process of indenture,
borrowed from England. Under this contract they were to be cared
for and taught an occupation and later were to repay the expense o f
their care and training by work.

Children in almshouses
Almshouses, the first public institutions in the American colonies,
came into existence as early as 1660. They sheltered dependent and
neglected children, many of whom were of illegitimate birth, as well
as poverty-stricken adults. This was true for over 200 years when
Massachusetts started placing children in family homes. W ith no dif­
ferentiation, the handicapped, the insane, the feeble-minded, the aged,
the vicious, the sick, and the homeless were all herded together in
crowded quarters. The overcrowding caused rapid spread of disease,
especially among children. The only care the children received, sick
o i well, was from the older inmates. Child mortality was very high.
Those who survived knew only life in a pauper institution. If they
were taught at all it was by ignorant employees.
Most of the foundlings placed in almshouses for shelter were of
illegitimate birth. The death rate of these babies was exceedingly
high during the whole history of these unclassified institutions. In the
early days o f a Massachusetts State almshouse, founded in 1854, between
80 and 90 percent of the foundlings sent there died within a year in
spite of the best care known at that time.

Private foster care for children
The nineteenth century opened with the public authorities apprentic­
ing dependent children, many of whom were born out of wedlock, to
families by indenture, or keeping them in almshouses with adults.
Meanwhile, however, private religious agencies not under church
auspices had been developing foster care of children concurrently with
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the growth of almshouses. Their wards "were dependent for the same
reasons as children in almshouses. Many of these institutions for
orphans were intended as temporary shelters until the children could
be placed in families to learn trades. They were better than alms­
houses only because they separated children from the insane, the
vicious, the sick and other adult inmates of almshouses. At least 26
institutions for destitute children are known to have been established
before 1825, and at least 80 more before 1850. Some of the early homes
were special institutions for children who were physically or mentally
handicapped. This segregation o f children from the mixed almshouse
was plainly one step forward toward a recognition of the fact that
dependent children need care different from the care given to adult
The beginning of the child-placing agency is of great significance to
the later establishment of maternity homes for unmarried mothers,
which are concerned with the future of the child as well as of the
mother. This start came about during the second half of the nine­
teenth century along with a great acceleration of the founding of institu­
tions under religious and secular auspices. Children’s aid societies
came into being as early as 1853, and had their greatest growth during
the 1880’s in eastern cities. The children’s homefinding movement
spread through the midwest and northwest. One of the services offered
was the sending of homeless children to farm families in the middle
western States. This method of placement in free homes or for adop­
tion recognized the fact that the usual experiences of life in an ordinary
family are better preparation for earning a living than institutional
training. In practice, the chief drawbacks of these placements were
that the agencies failed to safeguard the welfare of the children; took
children from their own homes, if parents requested it; kept inadequate
records; knew nothing of the homes the children went into; and failed
to follow up placements. These beginnings have grown into the net­
work of child-placing agencies of today whose services will be men­
tioned frequently in the section, The Value of Case-Work Service.

Substitutes for public almshouses
The middle of the nineteenth century also witnessed the develop­
ment of State and local institutions as substitutes for almshouse care
of children. By this time, the full horror of these mixed almshouses
as places for children was recognized by some groups of public-spirited
citizens, but shelter had to be planned for the children released from
almshouses. A number of States began to give subsidies to private
agencies to provide care for dependent children. A few States estab­
lished by law a State-wide system of county homes. Local institutions
were created in counties or in cities in a number of other States, but
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local care was more often provided by private institutions receiving
public funds.
During this period, Massachusetts made public-welfare history in two
ways. In 1863, it created the Board of State Charities to supervise its
whole system of public charities. This was the first State department
of public welfare. In its second report, the new board recommended
a reclassification of State almshouses and the separation of children
from contacts with adults. The second step came 4 years after the
board’s establishment when Massachusetts began to place its young de­
pendent wards in boarding homes. Other States followed the example
of Massachusetts during the latter part of the nineteenth century.

State responsibility
This trend toward recognition o f the responsibility of the State for
the well-being of individuals has developed consistently. State govern­
ments in recent years have shown active concern for a greater variety of
social problems. Structure and organization are being developed in
State governments that make possible social services and facilities for
all people in need of them.
Today, every State in the Union has a State department of public
welfare with a bureau or division charged with the welfare of children,
including those born out of wedlock. This division of the State depart­
ment of welfare helps counties or other local units to build up childwelfare services, which include, o f course, services to unmarried mothers
and their babies,

Federal assistance
The outstanding development of recent years in public services to
children is the assistance of the Federal Government in the extension
and strengthening of the service, made possible by the passage of the
Social Security Act in 1935. Provisions of the act make funds available
to States for establishing, extending, and strengthening public childwelfare services, especially in rural areas or in areas of special need.
Local, State, and Federal funds make possible the employment of
qualified child-welfare workers in communities that had never organ­
ized services for their children. As yet, many communities are without
these services because the funds available are insufficient for a pro­
gram reaching throughout the Nation. If services were provided in
every county, specialized help would be available to an unmarried
mother from the moment she asked advice from this source of counsel
through the various stages of her care and that of her baby.
The maternity homes should see their services in relation to the total

Federal Reserve Bank of St. Louis

child-welfare program. Application for maternity-home care, some­
times in homes located at a distance from the community where a
mother lives, can be made by or received by the child-welfare worker
who then can provide service before and after the period of care in
the maternity home. Also, children of unmarried mothers may receive
assistance under the provisions o f the Social Security Act for aid to
dependent children,

The first institutions that could be considered maternity homes for
unmarried mothers were founded in the middle of the nineteenth
century to shelter and to “ reform*’ unmarried mothers and to give
physical care to their babies. These institutions were usually under
religious auspices or motivation.

Obscurity o f early history
It is exceedingly difficult to trace the history of those early homes
or even to determine the dates of their origin. Some of them have
gone out of existence leaving no history behind; others that once served
unmarried mothers now provide other types of care and have no definite
record of their earlier work; and still others that now do this Work,
originally served a different purpose.
Today, the number of maternity homes for unmarried mothers in
the United States is estimated at 200. During a search for the historical
beginnings o f this movement, a list of maternity homes now in existence,
and for which the date of founding was obtainable, was checked
against various sources. Although the information so obtained gives
an incomplete picture, it does show that of 123 homes listed, 13 were
founded before 1870; 7 between 1870 and 1880; 12 between 1880 and
1890; 51 between 1890 and 1900; and 40 since 1900. That is, about
two-thirds started their work during the nineteenth century— the
majority of these during the last decade o f that century— and one-third
during the twentieth century,

Under Catholic auspices
Homes for the specific care of unmarried mothers did not develop
until the middle of the nineteenth century. A very early protective
service for young women afforded by the Roman Catholic Church
seems to have forecast the concern that later grew into Catholic homes
for unmarried mothers, Late in 1842 a band of Sisters of the Good

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Shepherd arrived in the United States from their motherhouse in
France, their destination being Louisville, Kentucky. In this work,
no matter how depraved a woman might have been, they did not give
up hope for her.1 The part of the Sisters’ work that touches the history
of maternity homes was o f a preventive nature— protection in the con­
vent of young women “ who had committed no offenses hut who were
exposed to temptations of wrong doing.” The Sisters’ program was
based on three elements, religion, work, and education. In a short
time their services became widely known and various bishops appealed
to the Louisville house for the establishment of similar work in their
dioceses. In response, the Sisters of the Good Shepherd established
convents in Philadelphia and St. Louis within seven years of their
arrival in this country.
The immediate predecessors o f Catholic homes for unmarried moth­
ers were shelters opened for abandoned or orphaned babies during a
serious cholera epidemic at the height of immigration from Ireland and
Germany about the middle of the century. Roman Catholic leaders
realized that the existing Catholic institutions for children were not
suitable for the care of babies; general hospitals provided the only
shelter for foundlings under Catholic auspices. One of these hospitals,
St. Mary’s in Buffalo, N. Y., started a small separate shelter for babies.
From this specialized care of foundlings grew the logical realization
that the care of their mothers was inseparably hound up with the fate
of the babies. Fewer babies would be abandoned if their mothers had
a place of refuge. Shortly after St. Mary’s started its separate homes for
babies, about 1852, the Sisters began to provide shelter and care for
unmarried mothers. The next institution for the care of foundlings
to be established, St. Ann’s in St. Louis, began with this idea, namely,
that one of the best means of saving a baby was by offering shelter to
the mother.
Two Roman Catholic infant and maternity homes were opened before
1855; 7 between 1855 and 1870; 6 between 1870 and 1890; 15 between
1890 and 1910; and 14 between 1910 and 1930.

Under Protestant auspices
Homes were undoubtedly being opened under Protestant or non­
sectarian auspices at about the same time that the Catholic homes were
being founded, but their history was seldom recorded. One of the
earliest o f these, still in existence, is the Talitha Cumi Maternity Home
and Hospital in Boston, organized in 1836.
About one group of homes, however, the Florence Crittenton, a
good deal has been written and their development can be readily fol1 Catholic Charities in the United States; history and problems, by John O’ Grady.
Conference o f Catholic Charities, Washington, D, C. 1930. 475 pp.


Federal Reserve Bank of St. Louis

lowed. As the history of this group undoubtedly parallels in many
respects that of other homes founded during the last two decades of
the nineteenth century, a glance at its history will give an idea of
the history of them all.2
F loren ce C rittenton h om es
Charles N. Crittenton, a successful business man, began this “ rescue
work” for women in memory of his daughter Florence, who died in
childhood. He opened the first Florence Night Mission in the heart
of the New York vice district in 1883. Here he held religious services
for “ outcast girls,” as part of his effort to redeem, through religious
conversion, prostitutes and other “ fallen” women. Being practical, he
soon realized, however, that a woman receiving the classical advice
“ go and sin no more” might have no place to go.
Charles Crittenton’s next move was a step toward prevention. He
established in New York a home in which working girls away from
their families might be safe from the dangers common to some of the
poorer boarding houses. This idea grew into the founding of rescue
homes for unmarried mothers.
Ten years after he started his work, Charles Crittenton met Kate
Waller Barrett. As the wife of a clergyman, Mrs. Barrett had seen
the harsh treatment inflicted upon many unmarried mothers and had
become active in their “ rescue.” She had already opened a home for
unmarried mothers in Atlanta, overcoming great resistence from some
groups in that city who thought unmarried mothers should not be
helped. v Working together, Mr. Crittenton and Mrs. Barrett planned
and started a Nation-wide Florence Crittenton organization which was
granted a national charter in 1898 by a special act of Congress.
Thirteen Florence Crittenton homes had been established by 1893,
IQ of which were in operation in 1933 when the history of the move­
ment was written. In 1945, 48 maternity homes were affiliated with
The National Florence Crittenton Mission.
The constitution of the new organization specified that homes granted
the use o f the Florence Crittenton name should conform to five prin­
ciples: (1) The government of the home shall be Christian and parental
in character; (2) the property purchased shall be used for all time for
the purpose for which it was acquired;, (3) no debts shall be incurred,
except for current expenses, without the consent of the national organ­
ization; (4) everything possible shall be done to keep mother and
child together; (5) the mother shall be required to stay in the home
at least 6 months after the birth o f the child.
In 1895, Charles Crittenton bought a private railroad car in which
2 Fifty Years’ Work with Girls 1883-1933, by Otto Wilson in collaboration with Robert South
Barrett. The National Florence Crittenton Mission, Alexandria, Va. 1933.

Federal Reserve Bank of St. Louis

he traveled over the country holding evangelistic services and urging
the establishment of rescue homes. As in the case of all pioneers, it
took courage on the part of Mr. Crittenton and Mrs. Barrett to attack
this social problem, taboo in the conventional circles of that day.
Kate Waller Barrett, a woman ahead of the thought of her time,
made an unusual contribution to services to unmarried mothers. Her
understanding of their difficulties was, of course, warmly sympathetic,
but also intellectual and thoroughly practical. She won her degree of
doctor of medicine in order to be of greater use to the cause in which
she worked so wholeheartedly. These two founders of the Florence
Crittenton homes undoubtedly helped to turn the trend of public opin­
ion away from placing a lifetime stigma on unmarried mothers and
their babies.
Salvation A r m y h om es and hospitals
The Salvation Army has long been concerned about the plight of
unmarried mothers and is one of the most active organizations in their
service. The Army is now operating 35 homes and hospitals for un­
married mothers in the United States.
The mission work founded in Great Britain in 1865 by the Rev.
William Booth and his wife, Catherine, was first called the Salvation
Army in 1878. Only 2 years later, the Army sent its first contingent
of officers to Philadelphia to start the work of the organization in the
United States. The pattern of work and of development has been
much the same in the old and new countries. The Army’s work, based
on religion and aimed at the redemption of the “ lost,” spread from
city to city as groups of citizens came to realize the unwholesome con­
ditions in their city’s “ slums” and asked the Army to try to clear
them up.
The maternity home for unmarried mothers is a natural outgrowth
of the Salvation Army’s early mission work for women. Women mem­
bers of the Army originated the work under the leadership of Mrs.
B ramwell Booth, the young daughter-in-law of the Army’s founder and
wife of the Chief of Staff. They went into the vice-ridden districts of
London seeking “ fallen” women— drunkards, narcotic addicts, and pros­
titutes— in the streets or brothels, begging them to begin a new life and
helping all who were willing to try. Soon women were coming to
the Army asking for shelter.
The early homes of the Salvation Army, tlie first opened in London
in 1884, were places of refuge for these homeless, destitute, “ debauched”
women. Some who came, however, were bewildered, young expectant
mothers, unmarried and cast out by all who knew them. They were
different in experience from the other women in the homes, needing

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protection and medical care. Within a year the Army realized that
a different place from the rescue homes was necessary for these un­
married mothers. Only the workhouse was open to them for the
delivery o f their babies and there they were thrown into exceedingly
undesirable company. This realization brought about the opening of
a small maternity home with space for six young women.
Three years after the work of the rescue homes began in England,
Mrs. Bramwell Booth sent one of her officers to the United States to
assist in the opening of the first rescue home here— in Brooklyn, N. Y.
That same year, 1887, homes were opened also in Grand Rapids,
Mich., and in Oakland, Calif. The young movement grew quickly.
In 7 years 15 homes had been opened in the United States.
The pattern of services and of development of what is now the
Women’s Social Service Department was much the same as in Britain
— first the “ rescue” of the prostitute and other outcast women and
later the segregation from them o f young unmarried mothers who
needed different care. The Salvation Army officers did hard, physical
drudgery as well as work for spiritual redemption. They had only
slender financial resources, begging food from commission houses in
the markets and other necessities from individuals of means. They
were inexperienced in the ways of the world and untrained for their
work. But they had faith in the improvability of individuals and love
and understanding to offer to the women society had cast out. Their
faith gave them courage to challenge the deep-rooted social intolerance
of their time and to lay the foundations for the service of today, the
extent of which in physical care at least they could not have imagined.
Although the Salvation Army is a religious organization, it does not
require those it serves to accept its religious point of view. Religion
is a therapy offered to those in trouble, to be accepted or rejected at
their will. Much of this therapy of religion reaches the residents of
the Army’s maternity homes through the way of life of the staff, as
the Army believes that a sermon is more effective lived than preached.

The foregoing summary has shown first the lfarsh intolerance of for­
mer times toward unmarried mothers and children b o m out of wedlock
and second the development of assistance for them, as groups of
people began to realize the injustice of the cruelties they suffered and
went to their help. Against this gradually shifting background the
changes that have taken place in the philosophy of maternity-home
care and the programs that grew out of these changes become clear.
Philosophy and program, like public attitudes toward the woman

Federal Reserve Bank of St. Louis

illegitimately pregnant, have changed as life for young people, espe­
cially young women, has reached new stages of independence.
These changes in social customs have come fast since the 1880’s when
the maternity-home movement got under way. Industrialization of
our economy took young people from the farms to cities. Youth now
establishes independence from the parental home at an earlier age.
Boys and girls go farther away from the home than they did. More
education is available to more young people, and a wider range of
employment is now open to them, particularly to women. The auto­
mobile has introduced new factors in behavior. Sex is more freely
discussed by all ages. More and more parents and schools are giving
young people sound sex education at the appropriate ages.

Repression as a cure
When maternity homes were starting their work, a woman who be­
came pregnant out of wedlock was considered a ‘‘fallen” woman and
a proper subject for reform. Maternity homes were places of refuge.
This idea is still suggested by the names of some of the homes today
— Door of Hope, House of Mercy, Sheltering Arms. Although the
groups that founded maternity homes championed the cause of un­
married mothers and worked for more humane treatment of them,
at the same time some homes limited the freedom of their residents—
even opened their mail, a procedure that plainly showed a lack of con­
fidence in them.
In the early years of maternity homes and other social agencies,
illegitimate pregnancy was viewed solely as a moral problem, without
the thought o f economic, social, or emotional factors. The whole life
experience of the individual was overshadowed by this one episode.
Repression was the formula for cure; the approach to the young
woman was moralistic, She was expected to keep her baby.

Deep-rooted causes
Today it is recognized that in practically every instance of illegitimate
birth the situation is much more complex than appears on the surface.
The first break with the earlier, stereotyped emphasis on sex behavior
was an attempt to explain the problem in terms of environmental causes,
that is, broken homes, low mentality, ignorance of parents, bad hous­
ing conditions, or lack o f sex information on the part of young women.
Although all of these adverse conditions may be factors, increasing
knowledge o f why people act as they do shows that illegitimate preg­
nancy involves not only the immediate situation but the whole life
pattern of the individual, which starts at birth. This knowledge shows
that young women who have had love and security in their own homes

Federal Reserve Bank of St. Louis

in childhood and adolescence through companionable relations with
their parents, who have had wholesome interests, suitable education
and recreation, and spiritual guidance are less likely to have a child
without marriage.
Most maternity homes have recognized this growing knowledge of
behavior as it affects the young women they serve. Deeper under­
standing o f the difficulties that bring girls to them has led maternity
home boards of directors and staffs to make their programs and pro­
cedures more flexible and more responsive to the differences in the
situations presented. They have developed programs that stimulate
new interests and develop individual skills in order to substitute for
confused, youthful groping, the tools to build a more satisfying way
o f life.
Some homes, however, have been slow to use pertinent new tech­
niques. These homes would want the latest medical knowledge used
if one of their residents was ill with typhoid fever, in order to insure
the recovery o f the patient and to protect the other residents. They
would go a step farther and cooperate with public-health authorities
to discover the source of infection, however remote from the home it
might be, for the safety o f the community or even of other communities.
They would accept the research work in all the sciences that have con­
tributed to the present knowledge o f typhoid fever, its transmission,
and the methods for its prevention. Unfortunately, however, it seems
to be hard for these same homes to accept new knowledge of why
individuals act as they do and new ways of helping young people to
find themselves#

Incompleteness o f service
Few communities, in planning for maternity-home service, have
taken into account the needs of women in racial minority groups. Only
a few homes for their protection exist, in spite of the fact that these
services should be for all unmarried mothers who need them. Further­
more, few communities afford mothers in minority groups adequate
case-work service and foster-home care for their babies. Frequently,
good medical care is not available to them. They may need financial
aid even more than young women of the majority population whose
relatives may be in better economic circumstances.
This lack o f service stands out conspicuously, for example, when the
welfare of Negro unmarried mothers and their babies is considered.
Historically, little service for them was provided in the years reviewed
An institution for dependent children of free Negro
families was organized as early as 1822. Both the Society of Friends
and the Roman Catholic Church were influential in the founding of

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some other institutions for Negro children. But relatively few had
service of any kind until foster-home care for children came into use.
A few homes for Negro unmarried mothers have been established as
a result o f the interest of Negro women themselves in the conditions
surrounding young women brought about by the mass migration of
Negroes from rural areas to big cities. Later a few established mater­
nity homes made arrangements for Negro unmarried mothers either
in the home itself or in foster family homes.

Giving assistance to unmarried mothers and their babies is only
one aspect of the broader community program of services to families
and children. That it is an important part is shown by the fact that
approximately 80,000 live births out of wedlock are reported each
year for the United States. The real figure is much larger because, it
is commonly known, many illegitimate births are registered as legiti­
mate, and 10 States, some of them with large populations, do not record
legitimacy on birth certificates.
Figures are valuable as a basis for planning, but more significant
than the figures are the human beings they represent. The question
can be asked, “ Who are these mothers, and what social conditions
have contributed to the birth of these infants?” We know that more
than half of the mothers come from rural areas which have little in the
way o f wholesome recreation or o f social-service facilities. We know
that illegitimacy is not confined to any one community group. For the
most part the mothers are young, about one-half of the* illegitimate
births occurring to mothers of less than 19 years. Many of them are im­
mature and still struggling with the problems of adolescence. Many
have not had the affection and security in their own homes, that are
essential in the development o f a child’s personality. Some may have
been employed, but in all probability they have not had much voca­
tional training. Their earnings from unskilled work are barely suf­
ficient for their own needs and there is often little margin for the
support of a child.
The problem of the unmarried mother is complicated by the attitude
of the girl and of her family toward bringing a child into the world
against the code established by society. Both the parents and the girl
may have feelings of guilt. They may also fear the attitude of friends
and neighbors and this fear1 may be sufficiently powerful to cause
them to make unwise plans, particularly in regard to the placement
of the baby,

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If the child born out o f wedlock is to have opportunity for normal
growth and development, his needs as well as those of his mother and
father must be met. He must be given a home where he will have
security. This may be either with his own mother or a foster home
that approximates as nearly as possible the home children normally
have with their own parents.
We do not have statistical information as to how many of these
infants are known to social agencies \>r how many o f their mothers
are being assisted in making plans for themselves and their habies.
In urban communities, social services of various kinds are usually
available to the unmarried mother and her child. Under the provi­
sions of the Social Security Act, many child-welfare workers are now
employed in rural counties, or in areas of special need. Increasingly,
more mothers are receiving early in pregnancy the help that they need.
It is imperative that such service be extended to every area in the United
States. Only then can we be assured that every unmarried mother and
her baby will receive individualized assistance.
A local child-welfare worker can help the community to understand
the needs o f young people and to provide the resources that make for
wholesome living. For those who get into difficulty, she can help to
provide the necessary assistance. One resource among many that she
will frequently use for the girl illegitimately pregnant is the maternity
home. Fortunately, the majority of such homes open their doors to
nonresidents o f the urban areas in which the homes are located.

Federal Reserve Bank of St. Louis


The Value o f Case-W ork Service
“ The art of helping people out of trouble.” Case work may be
defined as simply as that, in spite of its complexity. But however its
skills are described, no one who truly understands them can doubt
their value to a woman illegitimately pregnant who must decide
whether to face the world with a child born out of wedlock or to give
him to someone else. This experience calls for courage of a high order.
In this situation above all others, a girl suffers deep fears because she
knows the social cruelties that await her. Often she stands alone in
her bewilderment. Often she is torn between her wish to be free from
the social consequences of her own actions— to escape disgrace for
herself and her family— an 4 her responsibility toward the new life
she is bearing.
The usual avenues of advice and comfort seem to be or are closed
to an unmarried woman who is pregnant. Her circle— family, friends,
work associates— may contain individuals who will stand by her, but
in her panic how is she to know which ones will respond with help
rather than reproach? Her trouble is a test of their courage also, as
well as of their affection and intelligence. One unmarried mother may
eel hesitant about talking to anyone, even a staff member of a social
agency. Another may welcome the advice of someone she has not
previously known— particularly a professional person with an un676781 ° — 46— 2
Federal Reserve Bank of St. Louis

blaming attitude toward her and knowledge of how to help her meet
her difficulty.
An unmarried mother will accept the help of a case-work agency
with greater ease if she has learned through some channel to think of
the case worker as a person who “ listens thoughtfully and with dis­
cernment, without blaming, without judging . . . understands much
of human behavior, the forces moving within folks . • knows their
family patterns, their ‘folks ways,’ believes in the value of human
beings, their improvability, their courage to face life as it is.” She
“ cares for people’s happiness, their personal satisfactions, but her chief
concern is their general soeial usefulness.” 1
Helping in the situation of illegitimate pregnancy takes skill on the
part of the case worker. Nothing about it is simple, involving as it
does confused human emotions seldom disciplined by thought. Atti­
tudes toward the young woman who breaks the code of sexual moral­
ity have been undergoing a gradual change towards greater tolerance
since Victorian days. W^ar produces its own brand of accelerated tol­
erance that must be considered apart from the general trend. The
basic pattern of suffering for the woman, nevertheless, remains much
the same. She feels great loneliness— in sharp contrast to a young
wife happily married and expecting her first child. The wife is usually
surrounded by devoted family and friends who plan enthusiastically
for her welfare and for the health and future of the coming baby.
With the pregnant unmarried girl denial and concealment of preg­
nancy are common. Medical care is postponed. Living arrangements
and even food are often perilously different from what she should
have. Disgrace threatens her, or she believes it does. Guilt, anxiety,
and fear influence her actions.
Attitudes toward illegitimate pregnancy differ, of course, among the
young women, their families, and the communities in which they live.
Economic conditions, social position, religious background, and the
cultural pattern exert their influences. Under these circumstances the
girl from the established, well-to-do family may need assistance more
than the girl without resources whose unconventional behavior is ac­
cepted by her social group. The family of means may be influenced
by the fact that it has hard-earned prestige to lose. Its daughter may
suffer the severest panic and walk the hardest road.
“ The unmarried mother” and the father of her child are far from
being a type, a fact that makes the individual approach of case work
a valuable one. All kinds of human beings are represented and all
grades of intelligence. The unmarried father and mother may be school
children— or they may be middle aged. One or both parents may be
married— a complicating factor in planning for the baby. The friendx So You’re Going Into Social Work.

Federal Reserve Bank of St. Louis

Institute o f Family Service, Cleveland, Ohio.

ships or acquaintanceships that result in illegitimate pregnancy may
have been of long or short duration. The man is perhaps well known
to the young woman; he may have mentioned marriage. In contrast,
his first name may be the only clue to his identity.

What case work has to offer to the unmarried mother and to the
maternity home involves questions of immediate concern to both the
mother and the home in addition to questions involving long-time plan­
ning for the mother and her baby. The way in which these problems
are met will influence the mother’s ability to make the most of her
maternity-home experience and will influence the future welfare of
her baby.

The first contact
Case-work skills are useful from the very beginning of a girl’s rela­
tionship with the home. The worker can be helpful in handling admis­
sions. It is best for her to interview the young woman, if possible, to
help her decide whether care in a maternity home is the most suitable
plan for her. Pregnant girls often write in panic for admission. They
do not stop to consider their own resources— the possibility, perhaps,
of staying with relatives who live in other towns or cities. They do not
know o f social services other than the maternity home. Besides talk­
ing over alternative plans, the worker can tell the young woman in
detail the requirements of the home for admission and the regulations
for residents, giving her the reasons for them,
Applications fr o m a distance
If the-application is made by letter and the distance is too great for
a personal call, reaching a decision about admission is much more
difficult. Every maternity home will find it helpful to work out some
plan for cooperation with case-work agencies elsewhere. These should
be carefully chosen with due regard to the confidential nature of the
applications. Child-welfare divisions of State departments of welfare
and local child-welfare services can frequently be useful when an ap­
plicant lives in a rural area.
In a sense, this type of cooperation is an extension of the services
of a maternity home itself and can be explained to the unmarried
mother on that basis. In writing to ask her permission for a personal
interview its advantage to her can be pointed out. Perhaps she would

Federal Reserve Bank of St. Louis

prefer to make the arrangement herself directly with the State office
or local agency, it may be suggested. Perhaps she will reply by sug­
gesting an alternative, such as visiting the maternity home in advance
of admission.

Im m ediate and integrated attention
Regardless of whether the application is made by letter or by a
personal visit, the maternity home is responsible for seeing that the
girl receives immediate assistance, particularly medical care if she is
not getting it.
In a city that has a number of agencies giving service to unmarried
mothers it is wise to refer an applicant to another agency only after
making sure of the agency’s willingness to help her. Unless this is
done, unmarried mothers are likely to be passed from one agency to
another, an experience that may be very destructive. If, after agreeing
to accept the girl for service, the agency finds that it cannot do so or
fif the young woman fails to make a contact with the agency as she
agreed to do, the agency will report back in order that another plan
may be made. This is extremely important. Young women who are
emotionally disturbed about pregnancy are likely to become discour­
aged by obstacles to obtaining service, and, as a result, to make illadvised plans that do not sufficiently safeguard the welfare of their
The most opportune time for an expectant mother to discuss her
difficulties, to propose the solutions she sees, and to begin working on
a way out of her situation is when she is filled with anxiety for herself
and the coming baby. It is then that she approaches an agency for
help. She is more likely to accept its help instead of shying away
from what she considers rigid rules, if agency policies and procedures
are kept flexible and receptive.

Continuous service in the home
The time that an unmarried mother spends in a maternity home is
only a brief interlude in her total life span. It can, nevertheless, start
her on the way to a richer life which she may find through learning to
know herself better, being freed from some of her anxieties, and devel­
oping new satisfactions. The relationship with the case worker can
be one of the strongest factors in her growth experience, if the case
worker has been well chosen.
The case worker, it is clear, is responsible for continuous service to
the girl while she is living in the maternity home and for as long after­
ward as service is needed, As a result of several recent studies of un-

Federal Reserve Bank of St. Louis

married mothers known to social agencies, it is evident that services to
unmarried mothers are usually terminated too abruptly—while they
still need assistance.
The essence of case work is individualized treatment; that is, helping
each unmarried mother in whatever way she needs help. The worker
considers her as an individual different from all other individuals and
with certain inherent strengths and weaknesses. In cooperation with
the staff of the maternity home the case worker can do many things to
aid the girl’s adjustment to the home. After she comes to know her
through interviews, the worker can help other staff members to under­
stand the girl’s behavior and to plan an effective program for her.
Likewise, others working in the home can help the case worker to
understand the girl,
Arrangem ents fo r interviews
Interviews between the unmarried mother and the case worker
should continue as long as the girl remains in the home. Their fre­
quency will depend on the girl’s need for service. A girl who has many
difficulties and who is obviously disturbed by her pregnancy will un­
doubtedly require more assistance than the girl who is naturally well
adjusted and whose family accepted the fact of her situation in a
wholesome way. Many girls will need regular interviews of at least an
hour once a week or, perhaps, even oftener. These interviews may be
held in the office of the case worker employed by the home or, if the
services are provided by another agency, the interviews may take place
in the agency’s office.
This latter plan has certain advantages in that the girl can take
responsibility for her appointments and has an opportunity to be away
from the home. She may feel more at ease and be freer to discuss
her problems if the appointments are not at the maternity home.
Wherever the interviews are held, however, privacy is essential and
also surroundings that will make the unmarried mother feel comfort­
ably at ease.
T he interviews
Interviews with the unmarried mother will begin on the subjects
uppermost in her mind. The case worker, by an understanding, uncensorious, and objective attitude, will encourage the mother to discuss
her difficulties and the solutions that seem possible to her. Out of the
case worker’s wealth of experience in dealing with similar situations,
she will know when to interject a comment that will lead the girl into
further exploration of her problem. The worker will know the impli­
cations of what is said and of the way it is expressed and also the
significance of what is left unsaid, Through the interviews a young

Federal Reserve Bank of St. Louis

woman who has been deprived of emotional satisfactions and is in con­
flict with herself and others loses much of her hostility and is freed to
go ahead with constructive plans for the present and future.
Many unmarried mothers have met with deprivation throughout
their lives and have missed a warm affectional relationship with their
own parents. They want to talk about their past experiences, what
life has done to them, how they feel toward their parents and brothers
and sisters, and how pregnancy without marriage will change their lives.
O ne girl’ s p ro fit.— The conflict of Jean R. with herself and everyone
else illustrates these points. Soon after the attractive, 19-year-old girl
entered a maternity home she made herself disliked. She provoked
quarrels with other girls, objected to work, and demanded special
favors. Jean resisted vigorously when she learned that all residents
were expected to see the case worker. She went sullenly to the first
interview. To her surprise, however, she liked the worker. Later Jean
did learn to use the interviews to discuss her difficulties. Just before she
left the home she talked about her early resistance. “ I didn’t want to
confide in anyone,” she said, “ I just wouldn’t have anyone prying
around. You didn’t pry. You helped me to talk. No matter how
mean I was or what I told you, you never held anything against me.
Y ou trusted me— always.”
What had caused Jean’s conflicts came out in the interviews, gradu­
ally. She had known insecurity early. Her parents were divorced
when she was 4. The father, whom Jean loved deeply, won custody
of the children. But he put them separately in the homes of different
relatives, all of whom were reluctant to take them. The father and
mother moved from place to place, seldom seeing their children. At
the time the mother married her third husband, Jean was 16. Suddenly
her mother appeared to take her to the distant home of the new
husband. On the trip she forbade her daughter to call her “ mother.”
“ That was a big joke on me,” said Jean in telling about it, “ all I ever
wanted was a real home and a chance to talk to the kids in the block
about ‘mother and dad.’ ” Her mother kept her only 3 months.
Step by step in the talks Jean learned that the lack of stability
and affection in her childhood had made it hard for her to be friendly.
The case worker helped her to master an intense fear of death in
childbirth and to sort out her mixed feelings about her unborn baby.
Jean hoped for a daughter, saying, “ I’ll do better by my little girl
than my mother did by me.” But Jean didn’t have that chance, be­
cause her baby died at birth. Could she have done a good job as an
only parent? First she had to learn to live at peace with herself.
For that she had made a good beginning.
Relationships.— The case worker will probably have an opportunity to
meet some members of the girl’s family during her stay in the maternity

Federal Reserve Bank of St. Louis


home and to discuss with them future plans for the mother and baby*
This should not be done, however, without the young woman’s permission unless she is obviously unable to handle the situation. Even
then, it is to be hoped that she will eventually see the advantage of
sharing her experience with her own people— providing it is advan­
tageous. How important it is for the case worker to discuss the situa­
tion with members of the family depends upon their attitude toward
the mother and baby and her attitude toward them.
Sooner or later the unmarried mother will want to talk to the case
worker about her relationship with, and feeling toward, the father
of the baby. This attitude will influence in no small part her attitude
toward the baby and her adjustment to the maternity home. Fre­
quently the attitude the unmarried mother expresses at first toward
the father of her coming child is not her true feeling for him hut only
a cover up” for her pent-up emotion o f hurt pride or is what she
thinks is expected of her. The same is true of her expression of feeling
for the baby. It is helpful, therefore, to give her the opportunity to
discuss with the case worker this relationship with the father in order
to settle her own conflicts about it as well as to decide on the responsi­
bility she would like him to assume.
The unmarried mother may also want the case worker to talk to the
father o f the child in regard to his attitude toward her and the baby.
If he acknowledges his responsibility andJif real affection exists beween them, he will no doubt continue to see the girl at the maternity
home. If she has failed in her own efforts to reach a satisfactory agree­
ment with him, she may want the worker to interview him as often as
necessary. He, too, may be in need of case-work assistance. In some
instances it may be wise for the same case worker to talk with both the
young woman and the man but in others a different worker may be
advisable. It is important to remember that if the baby is to be placed
in adoption details about the father’s background are as significant as
details about the mother’s.
Many unmarried mothers, in contrast to those just mentioned, are
inclined to give a fictitious story about the man and to deny knowledge
of who or where he is. They do this for a variety of reasons, fre­
quently because the case worker has expected the mother to discuss
this matter too soon, before she has learned to know or trust the
worker. Perhaps the girl has not told the man o f the coming baby or
is dissatisfied with his attitude. In this latter instance, she may want
the case worker to interview him. Whatever her plan, the case worker’s
job is to assist her in thinking it through. Interviews with the man
may lead to a voluntary acknowledgment o f paternity and contribu­
tions to the maintenance o f the child or to a decision by the mother to
take court action. The case worker then has much responsibility in

Federal Reserve Bank of St. Louis

preparing the mother for interviews in connection with the court pro­
Many questions*—
—In addition to the emotional problems that confront
the unmarried mother other realistic issues arise on which the case
worker can give help. No one is in a better position to put at the
girl’s disposal the resources of the community— cultural, educational, 4
religious, or recreational— that will broaden her horizon. The stay
in the maternity home offers the case worker a chance to advise
the young woman who has not had employment about vocational op­
portunities and help her plan her training either while she is in the
home or after she leaves. When the girl is ready to leave, the case
worker can help her find a job suited to her ability and interests.
The unmarried mother may need assistance in finding a place to live
or she may need foster-home care for the child. She may need financial
assistance to tide her over until she has sufficient funds for her own
maintenance. Regardless of what she decides to do, a crucial adjust­
ment faces her when she leaves the maternity home. The social worker
can prepare her for this in many ways and during the early months,
of adjustment can stand by to respond to any need. The stay in the
maternity home should have given the girl a new perspective on life,
new interests, courage to face the future, and more ability to handle her
own life.

“ What shall I do with my baby?” is the question uppermost in the
of most women who are illegitimately pregnant. The question
cannot be answered at once, however, as the reply depends on many
complex factors that must be weighed. The factors are different for
each mother. They grow out of the kind of person she is, her relation­
ships, what her life has been so far, and what she is likely to make of
her future— particularly what kind o f mother she would be under the
most difficult circumstances for motherhood. These pages now present
some o f the factors a resident o f a maternity home should consider,
with good counsel at hand, before deciding this important question.
Perhaps the young woman and her family already have a plan
formulated when she arrives at the home, made by thoughtful consid­
eration or, may be, in panic. On arrival a girl may express indecision
and desperation or she may be too fearful of being considered a bad
mother” to put her feelings into words. She may be told that because
the birth is not imminent the matter will not he discussed until later.
She may be led to believe, not told in so many words, that a “ good

m in ds

Federal Reserve Bank of St. Louis

mother” keeps her child or she may be reminded that one condition
for admission is that babies be breast fed for 6 weeks or 3 months.
Perhaps she is told that other girls have shown similar concern but
learned to love their babies and have decided to keep them. Assur­
ance may be given that the case worker will help her make a plan and
that discussion can start immediately. In some instances adoption may
be mentioned.
Many maternity homes expect the girl who accepts their care to keep
her child. The original purpose of holding inflexibly to this principle
was commendable. It was a recognition by those responsible for ma­
ternity homes of the moral obligation o f a mother toward her child and
an expression of their desire to win more tolerance for unmarried
mothers so that they could bring up their children under favorable
circumstances. The homes believed that the mother had a right to
keep her child and that the child had a right to remain with his kin.
Many believed that the child would have a stabilizing effect on the
mother. Too little thought was given to such questions as whether the
mother was prepared to keep her child; what she had to offer him as
a parent; whether she could support him ; or whether she could face
the many difficulties that would confront her with a child b om out of
wedlock. She was given good physical care in the maternity home
but was allowed to go away with little preparation for the realities she
would meet when she stepped out o f the door with a fatherless baby in
her arms.

Freedom o f choice
Current philosophy among case workers and representatives of
maternity homes coincides on some of these points, certainly on the
need for greater tolerance and understanding. The girl who wants to
keep her child and who sees the way clear to do so should be helped
to make such a plan feasible. Return to her family is possible in some
instances, with support assured. Other mothers will require economic
assistance at least temporarily and may obtain it from either public
or private social agencies. Fortunately, aid to dependent children may
be given under the Social Security Act regardless of status of birth,
which means that many unmarried mothers are receiving this form of
assistance for their children. As aid to dependent children is a State
program, eligibility requirements and the amount of assistance differ
from State to State because they are based upon State law and the
policies, rules, and regulations of the administering agency. Unwise
discrimination against unmarried mothers persists in some communities
because of the fear that financial help would encourage illegitimacy.
Unfortunately, too, in many instances enough case-work service does not
accompany financial aid.
Federal Reserve Bank of St. Louis

Everyone tends to oversimplify the decision the mother has to make:
to keep or not to keep her child. The relationship of the mother and
child is far more complex than appears on the surface and the decisions
made at the beginning of the relationship influence profoundly not
only the mother’s life but the entire future of the child. Whoever
attempts to help the mother make her plans should possess the best
skills known to social work. Few studies have been made on this
mother-child relationship but the records of case-work agencies might
reveal many experiences, some happy, some tragic, that could be utilized
as a basis for more scientific, objective action.

Adjustments to be faced
Whatever the mother’s decision about her child’s future she is likely
to find herself in a very different position from that of the married
woman with a new baby. The universal first question, “ What is going
to happen to my baby?” shows that the idea of separation is present
from the beginning. During the stay in the maternity home, the nurse
usually has far more responsibility for the baby than the mother has.
If the mother returns to her parental home, she may have to share
the child with the grandparents to a far greater degree than the usual
child of legitimate birth is shared. This may be for any of several
reasons: The home is the grandparents’ and they may be helping
to support the mother and child; they may mistrust their daughter’s
ability to care for the child because o f her extreme youth or they may
question her judgment because she has had a child out of wedlock;
by assuming the responsibility for the baby they may wish to shield
their daughter’s reputation from prying new acquaintances or to give
her time to reestablish her social life; the grandmother usually takes
care of the baby while the mother works; and the grandfather feels that
he should play a father’s part in the life of his fatherless grandchild.
If the child is placed in foster care, the responsibility for its care rests
largely with the foster mother or with the staff of the institution. The
unmarried mother must adjust to a second place in which she does not
have the opportunity of doing many things that are normally con­
sidered the mother’s right.
This is only one of the many adjustments the unmarried mother must
make in relation to her child. Too frequently she must be prepared
to struggle for the child’s support— stretching the small earnings meant
for one to pay the living expenses of herself and her baby. Expressions
of sympathy for her are seldom heard, although almost everyone
laments, and justly so, the struggle that lies ahead for the young widow
with one child or for the “ war widow.” In most instances the widow’s
lot is far easier than the unmarried mother’s, because her plight may
bring help instead of hostility.

Federal Reserve Bank of St. Louis

Of her own volition or on the insistence of her family or public
official— if she applies for relief— the unmarried mother may initiate
proceedings to obtain support from the father of her child. In all prob­
ability she assumes that the amount will be sufficient for the baby s
maintenance. In reality, we know from such studies as have been
made that support from the father is at best pitiably small and that
the amount contributed is usually larger during the first few years of
the child’s life than later when expenses for the child are greater.
Other means must be found to supplement this support.
Many of the mothers who have been known to social agencies have
not had vocational training and are doing work that requires little
training, if any. If the mother is in a skilled occupation such as nurs­
ing, teaching, or social work she may find that she is unable to continue
in this occupation because of her illegitimate pregnancy and later
because of her child. She may have to seek employment in a new
field at a lower salary. Support for herself may be difficult and may
leave no margin for the care o f her child.
An unmarried mother may have to forego her former recreational
and leisure-time activities. She is expected by family, friends, and
community to tread the straight and narrow path and to demonstrate
that she has “ learned her lesson.” Sometimes she is expected to for­
sake the usual pleasures of youth and the companionship of men. In
many subtle ways she is even now expected to wear the scarlet letter.
he more she does for the child and denies herself just ordinary fun,
the greater the approval she receives from society.

The child’ s welfare
In view of the many adjustments that the unmarried mother will
have to make when she leaves the maternity home, she should have
the most skilled help available in the community in planning for her
child. His welfare is paramount. Protection for the child can best be
afforded through good case-work services to the mother. Considera­
tion of the plans for the child should start as soon as feasible prefer­
ably during early pregnancy before the mother enters the maternity
home. In any event, this vital subject should be a part of her inter­
views with the case worker as soon as the young woman is known to
the home. She may bring up the subject herself or the case worker
may have to introduce it. To discuss the subject early is a far sounder
policy than to tell a girl who is troubled about plans for the baby that
the subject cannot be discussed, or at least that no decision can be
made until after the birth of the baby. The matter is of such vital
concern to the mother that preventing her from talking about it may
impede her whole adjustment and block the opportunity for her to
work off some of her anxiety and hostility,

Federal Reserve Bank of St. Louis

Superintendents of maternity homes and case workers frequently
fear to allow girls to discuss plans early, in the belief that the girls
may make decisions that they will later regret because during preg­
nancy they may not be in emotional or physical condition to think
clearly. These superintendents and case workers may put off the/
decision in the hope that once the mother has seen her baby, maternal
affection will prevent separation. Furthermore, they know from
experience with other mothers and other babies that the child may be
found unsuitable for adoption; in that event, a plan for adoption formu­
lated early would have to be set aside.
Although the purpose of interviews on this subject is to help the
mother arrive at a workable plan for the child, the plan that she
makes early in pregnancy may not be the plan she ultimately carries
out. She will be in a better position, however, to make a final decision
if she has ample opportunity for discussion and thought.

Responses o f mothers to planning
Unmarried mothers respond to the necessity for decision in accord­
ance with the degree of their adjustment to life. Some, who are well
integrated persons, whatever their age, will face their difficult situation
squarely and will decide quite objectively whether to keep or to re­
linquish their babies. Others, neurotic individuals who have suffered
much deprivation in childhood and who are emotionally immature and
unstable, may appear to be just as sure of their decisions. Some may
be determined to keep their babies, saying, “ It’s my baby and no one
shall have it.” But to those who understand human behavior, it will
be evident that such an individual may not really be prepared to ac­
cept the responsibility nor really desire to do so.

Many unmarried mothers take it for granted from the beginning
that they will keep their babies, believing this course inevitable.
This decision should be arrived at as thoughtfully as the decision to
place the child in adoption. Unfortunately, this is not always done.
Too often the plan is made as the easiest way out of the situation for
the social agency. The mother, knowing of no alternatives, agrees.
If case workers are truly interested in preventing an unhappy life ex­
perience for the mother and child growing out of the fact of illegitimate^
birth, more careful study than is now being given should be concen­
trated on plans for the unmarried mother who leaves the maternity
home with her child.
Federal Reserve Bank of St. Louis

Is her plan a workable one? W ill support for the child be adequate?
W ill the home afford security and affection and a chance for growth
and normal development?

In her parent’ s home
These assurances are as important for the child returning to the
mother’s parental home as for the child o f a girl who lives in her own
apartment. We have been too free in assuming that relatives’ homes
are a satisfactory solution, and we forget that many young women who
are unmarried mothers have been in serious conflict with their parents.
Some unmarried mothers are themselves o f illegitimate birth. Yet the
baby returns with the mother to the environment in which the original
difficulty developed— perhaps later to follow in the mother’s footsteps.
Often social workers have no alternative but to let the mother go to
her home because of lack o f resources. If so, the plan can be carried
out with some awareness o f what is likely to happen. The mother can
be prepared for some o f the attitudes and some of the problems she
will encounter and she may be given sustaining help over a period of
years, if she wishes it. The child in the parental home, or elsewhere,
should be thought of not merely as an infant but as a growing child
who may have many difficulties to face because of hia illegitimate

In a foster home
Some mothers who keep their babies will not he able to return to
the parental home but will need foster care for their babies. Such
placement service needs to be available to every maternity home
through a qualified child-placing agency or child-welfare worker.
If the mother cannot pay for boarding care, another source of funds is
necessary. Foster homes for the babies of unmarried mothers have
to be selected even more carefully than the usual boarding home.
Their supervision by a social agency is essential.
In addition to giving adequate care to the baby, the foster parents,
if they are willing, can provide a “ home” for the mother when she has
free time to visit her child. They will be chosen because they are per­
sons who accept the mother, that is, have wholesome, friendly regard
for her and feel no need to punish her for her sex behavior. Ideally,
the foster parents are so secure in their relationships that they will not
need to supplant the mother as the real parent. They can learn to
distinguish between the kind of assistance they can best give the mother
and the service given by the case worker.
A type of plan that has been used effectively is the foster home in
which the mother and baby can live together, The foster mother as-

Federal Reserve Bank of St. Louis

sumes full responsibility for the child while the mother is at work.
Agreements about the details o f care need to be reached before the
placement is made, such as the amount of responsibility the mother
will assume when she is at home, and which o f the two will prepare
the child’s food on Sunday and do the baby’s laundry. Unless suchi'
matters are discussed in advance and unless the foster mother and the
child’s mother accept the plan whole-heartedly, friction is likely to
Many an, unmarried mother cannot make up her mind about keeping
her baby at first and may wish to have him placed for a while. The
mother may request placement in a home with the baby or foster care
for the child apart from her. This latter plan may afford her greater
opportunity to learn whether she is willing to make the many adjust­
ments that lie ahead for her if she keeps her baby. If she lives with
the baby, separation may become too difficult even though she does
not really want responsibility for his care.
Child-placing agencies and children’s institutions have had a great
deal o f experience with unmarried mothers who place their children
in foster care. Some mothers may take little responsibility for their
children’s support, or visit them irregularly, or give them little real
affection. Other mothers, particularly those whose children are placed
in family homes, may shower attention on them but in a way that makes
matters difficult for the foster mothers. Such behavior may be an in­
dication of an immature, self-centered individual who has no real in­
terest in her child.
The child is caught between conflicting disciplines and receives no
consistent affection or security from the mother. Owing to the difficul­
ties the mother causes in a foster home, the child is likely to be moved
from one home to another. This situation may continue year after
year with the mother refusing to make any other plan for her child.
Perhaps this condition drags on until the child is beyond the age for
placement in adoption.
Many such children spend their lives in institutions or in a series of
foster homes, making no real attachments to anyone. One such child
at 10 years of age is a disturbed, bewildered boy with many behavior
problems. He has lived in 20 foster homes. At the time of his birth
his mother was a docile, receptive girl who agreed with the philosophy
of the maternity home that she should keep her baby. Her parents
refused to allow her to live at home if she kept him. She went to work
in a store, paid the child’s board regularly, and visited him in the
foster home every 2 weeks. Gradually, however, her payments stopped.,)
Twice she attempted suicide. Either the original plan was an unsuitable
one for both her and the child, or the mother was not given enough
case-work assistance in carrying out the plan.
Federal Reserve Bank of St. Louis

Another mother now says that maybe it was a mistake for her to
have kept her child. She has been extremely possessive of him, yet
in many ways she has shown hostility toward him. At 6 years of age
he presents many problems. He has lived in 26 foster homes— some
found by the mother and some by social agencies.
Another mother is loud in her complaints against every agency that
has tried to help her. She makes unfounded complaints against the
foster mothers and refuses to contribute to the child’s maintenance.
This procedure has gone on for 8 years to the detriment of a child of
superior intelligence. Children who go through these experiences have
no opportunity to establish a love relationship with a parent or a parent
substitute. Gaining security from being in any one home long enough
to get the feeling of belonging there is denied them. They are “ pillar
to post” children.

Review o f the plan
Child-placement agencies have become much more conscious of these
unsatisfactory situations in recent years. Some agencies now tell the
mother that they will care for the baby until a certain date, at which
time the whole plan will be reviewed with her. In this way she knows
that she is expected to work on the solution of the problem—what is
best to do about her child— with the aid of the case worker.
The purpose of the review is to study further the mother’s relation­
ship with the child to determine whether she is interested in him and
to gage the sustaining quality of what interest she may have and her
ability to bring up the child in a satisfactory manner. One author has
suggested a list of points that may be used in evaluating an unmarried
mother’s interest in her child. They are as follow s:2

A time limit: W ill she agree to a temporary placement with an
appraisal o f the plan at the end of 6 months?


Scale of payment: What proportion of her earnings does she
volunteer for the child’s support?


Visits to her baby: Does she visit regularly? How long does
she stay? Is her time spent with the child or with others in the
foster fam ily? When did she first begin to absent herself from
the child?


Gifts to her child: Does she give her child clothing? Is it appro­
priate or inappropriate? Does she give harmful toys, or does
she refrain from ever giving him a gift?


Behavior toward her child:

How does she play with him?

2 C ase W o r k S e r v ic e f o r U n m a r r ie d M o th e r s, b y R u th F . B r e n n e r . T h e F a m ily , v o l. 22, N o v .D ee., 1941, p p . 211 -2 1 9 a n d 2 6 9 -2 7 6 . F a m ily W e lfa r e A s s o c ia tio n o f A m e r ic a , 130 E . 22 S t..
N e w Y o r k 10, N . Y .

Federal Reserve Bank of St. Louis

What does she do with him ?
in her handling of him?

Is she gentle and tender, or rough


Her expectations: What does she want from her child? How
much response? More of an adult response than would be normal
for a youngster of her child’s age? x


Her fantasies about her child: Does she see him as her pro­
tector in a few years or as a source of support for herself?


Excursions: What visiting does she do with her child? Whom
does she take him to see? Or does she never take him out? What
recreational trips does she take him on?


Discussions about her child: With whom does she talk about
her child? With others besides the case worker? With foster
mother, foster father, her own parents, her siblings, her baby’s
father, her friends, her em ployer? Or does she tell no one of
her child and confine her talk of him to the case worker?




Anxieties regarding her child: Does she worry about support­
ing him or about his name, particularly when entering school, or
how he will feel toward her when he discovers that his birth
was illegitimate? Does she question the adequacy of care given
by his foster parents?



Interrelationship of mother foster mother and child: Can
the mother share possession of her child with foster parents?
Does she quarrel with foster parents over the care of the child?
Does she attempt to precipitate quarrels between the foster

When the mother marries
Marriage of the parents in order to give the baby a name was the
solution formerly in vogue. It was not always accomplished, of course,
but the family of the young woman usually tried to bring it about if
they saw any possibility of doing so, often using every kind of pressure.
The custom still persists to a more limited degree, sometimes with the
planned intent to take advantage of increasingly liberalized divorce
laws after the birth has been legitimatized.
When the advice o f case workers is sought, marriage of the natural
parents is only one of the solutions considered and then only when a
real basis for marriage exists. If there is such a basis, of course it is
the logical solution. But case workers realize that without this foun­
dation marriage can bring little but unhappiness for mother, father,
and child. These marriages, in fact, need a particularly strong founda­
tion, as factors inherent in the original situation may easily wreck the
Federal Reserve Bank of St. Louis

No information is available on the number of unmarried mothers
who marry someone other than the father o f the child, nor do we have
sufficient information to know how such a plan succeeds, for the child.
The situation involves the usual adjustments of a stepparent relation­
ship added to those growing out of illegitimate birth. Is the stepfather
objective enough about the situation so that the child will have the
love and security he needs? Is he tolerant o f the child’s misbehavior
or is he oversevere with him because of the thought of the other man?
When children are b om of this marriage, is the child of illegitimate
birth treated with the same consideration and affection as the other
children? Does the sight o f the child put doubt in the stepfather’s
mind about the faithfulness of his wife to him and so create an atmos­
phere of conflict in the home?
Case workers and others have looked upon such marriages as a for­
tunate solution for the unmarried mother and her baby, and in many
instances they may be. Partly because the girl wants to forget the past
and partly because case workers are busy people, case-work services
are often terminated as soon as marriage seems imminent. In some
instances this may be the time that case work is needed most— to help
the couple make a success o f their marriage and to insure wholesome
development o f the child.
Some o f the difficulties that a case worker might assist in preventing
are shown in the marriage of Anna L., a girl who had immigrated to
he United States alone. Anna had not been here long when she be­
came pregnant. She had a few friends but because she had no relatives
to help her she chose to be cared for in a maternity home. As soon
as she could go to work again her infant son was placed in an institu­
tion. He remained there for 4 years and was then cared for in a series
of foster homes. Anna supported her child and visited him regularly.
When the boy was about 6 years o f age she married a man who had
been her friend for some time. He had known the child, had taken
him on trips, had given him gifts, and in every way had demonstrated
affection for him. The boy was devoted to both his mother and his
new father. The family, to the delight of their friends, built a small
home and moved to the country.
Gradually the difficulties began. Anna told her friends that she
wanted to work so that her husband would not need to contribute so
much for her child’s support. Later she said that she had lost her
feeling for the boy. She felt cold toward him ; she had no patience
with him. She explained that her husband was jealous of the child
and hurt her by his remarks about her early experience. She did not
want to give up her home, she said, but began to consider giving up
her son.
The child was a well adjusted, friendly, happy boy giving every
676781 ° — 46— 3

Federal Reserve Bank of St. Louis

promise of normal development. Children and adults were enthusiastic
about him. Then he began to steal— little things that he would use at
school as gifts to the other children. The stepfather insisted that the
mother search the child’s pockets before he left for school and kept
telling the lad that “ he would land in the reform school.” The only
solution Anna could see was to place her son in adoption.
W ould this solve Anna’s problem ? Probably not. It certainly would
not solve the boy’s, as by this time he had reached an age at which it is
difficult, though not impossible, to find an adoptive home. The scars
left from feeling unwanted and unloved and from being told, perhaps,
that he was a “ bastard child” can never be erased. The hurt will pene­
trate deeper when he realizes that he is forsaken by his mother who
plans to give him to someone else. He seems caught in a tragic net.
Skillful handling o f the first signs o f disunion— requiring greater
knowledge than the mother had— might have kept the home a good
place for the boy,

The waiting period
The girl who decides to give up her child has a right to know from
the case worker how placement will be made, that is, what procedure
will be followed to insure a good home for the baby. She may relin­
quish her parental rights to a child-placing agency in the community
as soon as she fully decides on this step. In some instances relinquish­
ment will occur soon after the child’s birth, especially when the case
worker has known the mother through much o f her pregnancy and
the two have talked over thoroughly the mother’s wish for the adop­
tion o f the child. The baby can then be placed in a boarding home
for further study, awaiting placement in an adoptive home. Support
for the child may be contributed by the mother or her family or it
may be wise for the agency to pay the full amount.
Some psychiatrists and case workers in child-placing agencies recom­
mend early placement o f infants for adoption. They base their recom­
mendations on evidence showing that infants thrive best when mothered
by one person. The fewer times the infant is placed, they believe, the
better for his physical and emotional development. When adoption is
clearly indicated as the best plan, these specialists recommend an ob­
servation period in a foster family home where hoard is paid until
adoption can be safely and wisely arranged, possibly at 4 months of
age. When a hahy is about 6 months old he usually establishes his
relationship to the person who cares for him. Greater caution is re­
quired, however, in early placements for adoption than in later ones,
Federal Reserve Bank of St. Louis

because a baby’s potential development is more difficult to appraise
than that of an older child.
During the observation period the mother may change her mind and
decide to keep the child if she sees her way clear to do so. She should
realize, however, that once she signs the final papers giving up her
parental rights in the child, she has no further responsibility for or
right to him or to be consulted on plans for him.
Maternity homes are not licensed usually as child-placing agencies.
When adoption is indicated, the best agency in the community respon­
sible for the placement o f children is the one to use.

Unsuitability for adoption
There are a variety of reasons why a child may be unsuitable for
adoption. Such children sometimes present problems that are very
complex and involve continuous study, long-time planning, and a con­
siderable expenditure of funds. To give these children protection, child­
placing agencies need to have flexible policies for unmarried mothers
and their children and to use this flexibility from the very beginning
of the service.
For example, a 16-year-old girl was sent by her family to an aunt
in another State when pregnancy was discovered. Social conditions
were so deplorable in the milltown where she grew up that her return
there seemed unwise. There young people had no wholesome recrea­
tion, no proper schooling, and no Social protection. Before the baby’s
birth the aunt consulted a children’s agency about having the child
placed in adoption soon after birth. She refused the agency’s assistance,
however, when she was told that her niece would be sent to a maternity
home and would be required to remain there with the baby for 6
months. The aunt, discouraged by this inflexible policy, turned to a
well known physician who agreed to give the girl prenatal care, to
deliver her in a private hospital, and to place the child in adoption.
He carried out the plan without knowing that mental tests had revealed
the girl was subnormal mentally or that nothing was known of the
father of the baby. Obviously a child-placing agency could have made
a far safer plan for the child and for the adoptive parents. Rigidity of
policy in the beginning defeated the protection that was the agency’ s

The storm center
Families sometimes make a decision about the future of the baby
that is in direct opposition to the wishes of the mother and that brings
about a disastrous plan or lack of plan for her child. The mother may
decide to keep her baby although her family insists upon adoption.
Federal Reserve Bank of St. Louis

The reasons for such differences of opinion are many. Parents perhaps
consider that the presence of a child will jeopardize the girl’s whole
future or that she is too young for such responsibility. The baby may
be used as a means of punishment, that is, the parents may wish to
deprive their daughter of her child to punish her or the daughter may
wish to keep her child to further offend her parents with whom she is in
For example, the daughter of parents in good circumstances, a 16year-old girl, became pregnant by a boy a year older, whom she wanted
to marry. Her parents refused to allow this marriage. She had been
“ running around” against the wishes of her parents who were greatly
disturbed by their loss of control over her. The mother sought the
help of a social agency but by refusing to permit more than one inter­
view with her daughter prevented anything constructive from being
done. The mother told her daughter— falsely— that the social agency
wanted to place her in a correctional school, which was in reality the
plan the mother desired. The daughter was so incensed by her mother’s
treatment of her that she refused to consider giving up her child and
was barred from her home because she kept him. When the baby was
6 months old the girl was found sitting at a table in a roadhouse with
the sick child in her lap. She said then that prostitution would be
the easiest way for her to earn her living.
An 18-year-old girl came from a well-to-do family. On the surface
she would appear to have everything that an adolescent girl could
desire— attentive parents, a good home, friends, fun, and fine educa­
tional opportunities. In reality she had a mother who dominated her
whole life, who treated her as a little girl, trying to prevent her from
having friends. When the mother discovered her daughter’s pregnancy
she would not let her see the father of her unborn child. It was the
mother who made all decisions for her daughter and for the future
of the coming baby. If the baby stayed in that home, he would be
in the steady cross-fire of conflict between mother and daughter. His
chance for a normal life would be greater with well-chosen adoptive
' .

Separation at birth
Separation at birth is contrary to the principles of many maternity
homes even if the mother, after careful consideration, wants to sur­
render custody of her child without seeing him. Those in charge of
the home hesitate to put such a plan into practice, fearing that the
mother may regret her decision later. They also question the effect
on the other residents of the home, believing that learning of the
possibility might increase the number who request this solution of their
Federal Reserve Bank of St. Louis

For the mother to give up her child without seeing him is a plan
that should be made only after careful consideration of all the factors
m the situation. If, however, the mother has had good case-work service
oyer a long enough period or if she insists upon placement in adoption
without seeing the child, the case worker may agree with the mother
that separation at birth is the most suitable plan for her and her baby.
The traumatic effect o f giving up her baby may he less severe for her
if she never sees him. In such instances maternity homes should plan
carefully to protect the mother from unnecessary strain and confusion.

Must the mother nurse her child ?


The question of early separation of mother and baby is closely
related to the policy of maternity homes in regard to the nursing of the
infant by the mother. Here also the individual approach is important.
Nevertheless, many homes state in their requirements for admission
that the mother must nurse the child for a minimum period, some of
them for as little as 3 weeks, if she is physically able to do so. The
basis of this requirement is the belief that for physical and perhaps
emotional reasons every mother should nurse her child and the estab­
lished fact that a child who is breast fed has a better start in life.
Exceptions to this rule are rarely made even though the situation of
the mother seems to warrant it. Another practice that does not allow
for individual choice is the practice in a few homes of drying up the
milk of all mothers immediately after delivery.
Actually, it would be well if exactly the same advice about nursing
her baby could be given to an unmarried mother as is given to one who
is married. Even with married mothers, health and social situations
may arise in which the physician recommends artificial feeding of the
infant. Three differences have to be considered, however, that make
immediate artificial feeding more often necessary for the unmarried
mother— the possibility of early separation of mother and child in
adoption; the frequent need of the unmarried girl to return to work
at once; and the danger that the mother required to nurse the child
against her wishes or her considered judgment may interpret it as
punishment and develop emotional difficulties that may harm her and
her child. Her objection, if she is about to relinquish him, mav be
Whatever is said about the advantages of breast feeding is best stated
scientifically and objectively as accepted medical fact, during the talks
given to the residents on health care for mother and child. The young
women will understand, then, that they are getting the same informa­
tion that is given to all mothers and are expected to nurse their babies,
if it is possible, for the same health reasons. Conversely, as a private
obstetrician makes exceptions, for certain patients, to his own customary

Federal Reserve Bank of St. Louis

advice about nursing, some exceptions can be made for mothers in a
maternity home. The mother who has thoughtfully decided on relin­
quishment and who fears to become too attached to her baby need not
be required to nurse him for a few weeks but can be assured that arti­
ficial feeding will be safe for her baby if done under the care of a

The discussion so far has attempted to show in some measure what
case work has to offer to unmarried mothers who go to maternity homes
for care. Some homes provide this service. Among those that do not,
many recognize its value and, ideally, want to add it to their program.
Practically, however, they ask how this can be done, in short, which
of several methods of providing case-work service is the most prac­
ticable for a particular maternity hom e? Because the answer depends
on many factors, each home will want to work out the plan that suits
it best. Among the factors to be considered are the type and size of
the home, the funds available for staff, the educational and vocational
background of the superintendent, the type and quality of the local
case-work agencies, and the current supply of qualified case workers.
The advantages and disadvantages of several ways of providing case­
work service will be considered at this point,

A case worker on the staff
Some maternity homes employ their own case workers. This is a
basically sound administrative procedure that is used by other types
of institutions. The experience of institutions for children that have
for many years tried both plans— having their own case worker or get­
ting this service through another agency— has demonstrated that, in
general, case work is more likely to be an integral part of the whole
program if the case worker is employed by the institution.
Some o f the other advantages are more specific. For example, the
case worker is more likely to be fully accepted by the board of directors
and staff members under this plan; the case worker who is on the staff
can help the nurse or the cook to understand individual girls when
questions arise; she is more readily within reach of the residents in the
home than an outside worker; the young women feel free to talk to
her and to consult her as often as is necessary. Such a worker, provided
she has sound professional education and qualifying experience,
becomes a specialist in this particular field. This results in excellent'
service to the individual mothers and leadership to the board of direc­
tors and other interested laymen. It may mean continuous service to

Federal Reserve Bank of St. Louis

the unmarried mother from the time she applies for entrance to the
maternity home until she no longer has need of assistance or until the
responsibility has passed to another agency. It is sometimes best,
however, to have the case-work agency that refers a girl to a home
continue to work with her while she is there as well as afterward.
The case worker employed by a maternity home is administratively
responsible to the superintendent. These two should work in close
cooperation for the welfare of the mothers and babies. The duties of
each one will, of course, be clearly defined. Matters pertaining to the
operation of the home and the total program are the logical responsi­
bility of the superintendent, but policies and procedures for carrying
them out may well be formulated in consultation with the case worker
because of their emotional and social implications and because of the
contribution that the case worker is equipped to make to the various
phases of the program. Although she should work in close cooperation
with the superintendent and the board o f directors who are responsible
to the community for the operation of the home, she should be free to
exercise her hest professional judgment on matters that are distinctly
in her field.
Having the case worker on the staff of the maternity home has, how­
ever, some disadvantages. Well-qualified case workers are scarce at
any time and they are particularly hard to find during a national crisis
such as economic depression or war. A family agency or a children’s
agency with a sizable staff is perhaps in a better position to compete
for workers than is a maternity home employing only one case worker.
The lone case worker in an institution, whatever the type, is more
likely to feel isolated. Close contacts with colleagues mean much to
her professional development, particularly if she is young. Shut off
from supervision and day-by-day association with other social workers,
she has to find other ways of keeping “ on her toes.” Possibly in these
situations supervision by a case-work agency might be arranged.
To the directors of many maternity homes the cost of employing
a case worker is undoubtedly an obstacle. Many maternity homes are
inadequately financed. The salary of a case worker seems high, per­
haps, in comparison with the amount the home has been paying the
superintendent. The home cares for relatively few unmarried mothers
in the course of a year and the board realizes that the addition of a case
worker will raise the per capita cost considerably. This question of
whether the increase is justifiable has only one answer— that case-work
service is an essential part of the program and should be financed
accordingly. Maternity homes that employ their own case workers
lould have the best qualified workers obtainable as to personality,
professional education, and case-work skill.
Because o f some o f the difficulties mentioned and because of the lack

Federal Reserve Bank of St. Louis

of clear-cut understanding on the qualifications of a case worker,
maternity homes, unfortunately, have sometimes employed individuals
who are not equipped by education and experience to give the high type
o f service called for.

Services from outside
Some maternity homes choose to obtain case-work service from
another agency rather than to employ their own case worker because
of the difficulties already discussed or because of conditions existing
in their own communities. This plan frequently works well, particularly
if the board of directors and staff of the home are convinced of the
value o f such an arrangement and if the cooperating family or children’s
agency accepts the plan wholeheartedly and is prepared to give ade­
quate service.
One of the advantages of outside service is that any case-work agency
providing service to families or to children can offer continuous service
for the whole period, before the young woman enters the home, during
her residence in the home, and after she leaves. Thus the young woman
will not need to make adjustments to several agencies. This is par­
ticularly important to the unmarried mother who is emotionally dis­
turbed or who hesitates to discuss her problems with more than one
individual. Another advantage based on continuous service without
referral is that agencies providing service to families are more likely
to have funds available for financial assistance if the mother needs i
and agencies providing service to children will probably be able to place
the baby in a foster home if that is indicated.
The joint plan between home and case-work agency presupposes a
willingness on the part of the agency to give service to unmarried
mothers who are not residents of the area to which the family or
children’s agency ordinarily limits its service. Unless such an agree­
ment can be made, another case-work agency must be found to help
nonresident mothers. Otherwise the maternity home will have to give
up the idea of a cooperative arrangement and employ its own case
worker in order to offer a complete service.
If case-work service is provided from outside the home a close work­
ing relationship between the maternity home and the agency is essen­
tial. Without complete confidence in each other, sharing of informa­
tion, and joint planning on behalf o f the mother and baby, the plan
is apt to be ineffective. One way to develop a good relationship is to
have the superintendent o f . the maternity home regularly attend staff
meetings o f the agency that provides the case-work service. Another is
for the agency to arrange for one staff member to give service to th|
home continuously and so come to know the work thoroughly rather
than to assign several workers to the home.

Federal Reserve Bank of St. Louis

A central service
In some large cities the case-work agencies that serve unmarried
mothers have agreed to have one o f the agencies serve as a center to
which any unmarried mother may be referred. This agency assumes
leadership in promoting services, in making known the needs of
mothers and their babies, and in keeping the public informed as to
how any individual— relative, friend, physician, nurse, teacher, clergy­
man, employer— may obtain skilled assistance for a pregnant unmar­
ried girl. Research on the subject o f illegitimate birth is another part
o f the central agency’s program.
The advantages of a centralized service are obvious. For the girl,
centralization eliminates the undesirable passing along from one agency
to another at the time o f application— one o f the greatest faults of
service to unmarried mothers. For a friend or relative who knows
vaguely that advice can be obtained for a pregnant girl and wants to
get it for her quickly, a central agency is a boon, eliminating the con­
fusing choice between agencies. Physicians do not need to know or to
attempt to remember which social agency gives which type of service
to girls who may come to them for medical care but who need other
kinds o f care as well. This convenience may easily increase the number
of unmarried mothers who go to case-work agencies for help.
Centralization does not mean that one agency alone provides service
to unmarried mothers. Other agencies may continue to give assistance
to girls who apply directly to them. Moreover, the central agency may
interview a girl only briefly before referring her, with her permission,
to one o f the other agencies. Likewise, it may suggest to a physician
inquiring about service for an unmarried mother that because this par­
ticular individual could be served best by another agency he arrange
for her care there.
A central agency for unmarried mothers, the Women’s Service Divi­
sion o f the United Charities, has been in operation in Chicago since
early in 1944. It was set up as the result o f a study made by the Coun­
cil of Social Agencies of services for unmarried mothers. This com­
prehensive, specialized program gives direct service to the mother, co­
ordinates all other services for her, gives information to individuals in
answer to specific questions and to the general public through widely
read media, and promotes standards and legislation on the subject of
illegitimate birth. A central office and four district offices cover the
whole city for referral and treatment.
As a private agency supported by the community as a whole, this
designated center does not, of course, assume responsibility for all un­
married mothers Who seek help from social agencies, Some unmarried
mothers may choose other agencies.

Federal Reserve Bank of St. Louis

A central organization is most successful if it has an active advisory
committee made up of representatives o f the leading agencies provid­
ing services to unmarried mothers and also some individuals who are
deeply interested in this specific problem but who are not necessarily
connected with a social agency«

A threefold service
In a few other cities somewhat different types o f central services
have been developed. For example, one agency, with a qualified case
worker as the executive, offers a threefold service: Maternity-home
care when desired and appropriate; care in a private family home when
that seems best; or case-work service outside the home for any unmar­
ried mother who decides she wants that help. The advantage of this
plan is that one organization can itself provide whatever service a girl
requires. Other agencies may continue to assist unmarried mothers
who apply to them or may refer them to the speieialized agency with
the threefold service. That agency may refer young women to other
agencies when advisable.

Two resources that the case worker may call upon or may help an
unmarried mother to utilize, if she needs either, are the services of a
psychiatrist or a psychologist. As has been shown, the causes under­
lying the behavior that results in illegitimate pregnancy may be deepseated within the individual. The behavior may be caused by an urge
to solve old conflicts or by other emotional tensions. A psychiatrist,
with his training in medicine and in the treatment of emotional dis­
orders, can be exceedingly helpful to a disturbed unmarried mother.
He can help her to understand her behavior and her attitudes and in
many instances can free her sufficiently from anxiety so that she can
go forward in planning more satisfactorily for herself and her baby.
Or, through conferences with the case worker rather than the young
woman, the psychiatrist may see diagnostic factors in the situation and
make valuable suggestions for treatment. Unfortunately, however,
psychiatric service is hard to obtain even when funds are available.
There are relatively few psychiatrists in the whole country and only
a small number of these have time or energy to expend on service to
social agencies.
The service of a psychologist is utilized by many homes as a guide
in helping an unmarried mother make her plans. Only a qualified
psychologist— one who has done graduate work in clinical psychology

Federal Reserve Bank of St. Louis

and has had clinical experience under supervision— should bei con­
sulted. This specialist, with the aid of standardized tests and of other
information supplied in advance o f the test, including the young
woman’s developmental history, her interests, and her experience, can
appraise her mental and emotional capacity and vocational aptitude.
The psychologist can also help in determining the mental capacity
o f the baby when adoption is being considered. Tests of babies are
not so accurate as tests o f older children and may have to be repeated
at different periods in their development. Considered with other in­
formation about the baby, however, they provide a valuable safeguard
in making decisions about placement.
After the tests have been given, the psychologist and case worker will
discuss the results in relation to other factors and will interpret them
in terms o f the plans the mother is considering for her future and the
future of the baby.

An attempt has been made in the previous pages to show the benefit
that an unmarried mother and her baby can receive from a coordina­
tion of the services o f a maternity home and o f case work. At their
best, these joint resources can be used by the mother to ease the diffi­
culties o f her readjustment and to give her baby a good start in life.
But, because o f different backgrounds, approaches, and skills, in the
actual working out o f local procedures, the two services do not always
dovetail as they should. If this bulletin is to be helpful in these situa­
tions, it should suggest some o f the causes o f the failure o f the services
to complement each other effectively,

Unawareness o f value
At present many homes fail to help the girl make the best use of
the case-work services. Some homes think only of case work in rela­
tion to the girl who is troublesome or not adjusting well to the home,
or if placement of the baby is desired. The resident who gives the
impression of being fairly well adjusted, who is conforming to the
routine of the home, and who seems to intend to keep her baby is
considered not to be in need of case work. Many mothers, therefore,
are deprived of the real help they seriously need— often because their
need for it is so deep-seated that it is not easily recognized.
One probable reason for this lack of case-work service is an unaware­
ness of its value on the part o f superintendents and boards of directors.
The superintendent who has had no training in social work and little

Federal Reserve Bank of St. Louis

contact with other social agencies may have had no chance to observe
the help that an individual can receive from a case worker. She is,
therefore, unable to interpret to the board and to the unmarried
mother the basic value of case work to the mothers the home serves.
Board members o f maternity homes who have not served on the board
o f directors o f other agencies may be unaware of how their own work
would be strengthened by this service. State departments of public
welfare and councils of social agencies that are mindful of this problem
might suggest to other local social agencies the value of inviting a few
progressive board members from each maternity home to serve on
hoards o f other agencies.

Undefined duties
Closely allied to this lack of understanding of case work is the fact
that in many communities no attempt has been made to define the
duties of the superintendent of a maternity home and those of a pro­
fessionally trained case worker. Each has an important place in service
to unmarried mothers. The superintendent, even though she is trained
in social work, has enough to do in giving leadership to the board, in
taking part in other community activities, and in looking after the
girls in the home without trying to do case work also. She should not
be asked to give this service, particularly if her training has not been
recent enough to include the newer concepts in case work, which is, of
course, not static. If she has not been professionally trained in case
work she should, obviously, no more attempt to fulfill the duties of a
case worker than to take the place of a nurse or an obstetrician. In
short, as an executive she should work with members of other pro­
fessions rather than supplant them.

Guarding relations
Some homes question whether they can use case-work service from
outside and still respect the confidences of an unmarried mother. They
consider that their own staffs must provide all service that is given to
her in order not to reveal information given to the home in confidence.
This attitude is commendable in many ways. Maternity homes can
feel assured, however, that they are not alone in their concern over pro­
tecting the information given by individuals who need assistance. It
is the concern of all case-work agencies that the confidential relation­
ship between case worker and client be guarded as carefully as that
between priest and parishioner or doctor and patient. Much has been
written in social-work literature on this subject.
The fact that social workers are a professional group should be recog­
nized by those responsible for the work of maternity homes. If in a
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certain community a home has reason to believe that this professional
attitude does not exist, or if evidence shows that confidential informa­
tion has been revealed, the board of directors of the home should bring
the matter to the attention o f the agency or agencies responsible. It
should be possible to work out procedures that will protect unmarried
mothers in these situations.

Disappointment in services
Many times superintendents of maternity homes have found service
from outside the home unsatisfactory. They have reported, with regret,
that when they have asked for the assistance of another social agency,
the service was disappointing. Some case workers have been content,
these superintendents have reported, to interview an unmarried mother
when she first enters the maternity home and then, because she is
receiving good care and the birth of the child is not imminent, have
not continued interviews with her for the purpose of planning. They
have left the whole responsibility to the home until notified that the
girl is ready to leave and that some plan must be made for her and
the baby. It is no wonder under these circumstances that the super­
intendent believes she understands the girl better than does the case
worker or that the board is not enthusiastic about case-work service.
Now and then a case worker shows a regrettable lack of reticence in
an interview that may prejudice the unmarried mother and, through
her, the home against case work in general. This case worker asks
without reason the intimate questions that a prosecuting attorney might
need to ask in preparing for court action. In doing so she forgets that
a sensitive girl may not want to talk about some phase of her experi­
ence and will do so only if she must in order to answer questions for
legal evidence.
The coin of disappointment has another side. Case workers have
sometimes met with great difficulty in establishing relationships with
residents of maternity homes. The case-work agency that refers a
young woman to a home may not be allowed to continue service to her.
Sometimes case workers are prevented from seeing mothers for 2 weeks
at the time of their confinement— a period when they may especially
need to see those close to them.
Some of the obstacles the workers encounter in homes are illustrated
by a lack of privacy for interviews or refusal to permit a resident to
leave the home for interviews. The reasons that superintendents fre­
quently give for failure to make satisfactory arrangements are that case
workers are not always thoughtful about timing their visits to the
homes and that making special concessions for one mother would dis­
rupt the routine of the home for the entire group.

Federal Reserve Bank of St. Louis

A full measure o f service
It is dangerous for any agency— maternity home or case-work
agency— to have too possessive an attitude toward the persons who
ask assistance and to be unwilling to share responsibility for treatment
with another agency or individual qualified to supplement its work.
It is dangerous, likewise, for individual staff members to become too
possessive of those they serve. Staff members are most valuable when
they have become aware of their own emotional needs; that is, when
they have learned to understand why they think and act as they do
day by day. Then, taking this knowledge into consideration in dealing
with others, they are more likely to give objective, fruitful service.
This is true regardless of whether they are staff members of an agency
serving families or children or o f a maternity home. Basically this is
what everyone must strive to learn in order to become a real person.
It is the key that case work tries to give— the ability to free one’s own
personality from its fetters.
This frank discussion o f the fetters that bind some maternity-home
and case-work agencies may help, it is hoped, to bring about uniform
strength. It may start other discussions that will finally free this rela­
tionship o f misunderstandings that now prevent a universally produc­
tive unity. Anything less robs unmarried mothers and their babies of
a full measure o f service.

Federal Reserve Bank of St. Louis

r ?


New Interests Through Group Activities
The time an unmarried mother spends in a maternity home, however
short, should be interesting and worthwhile. Making a recreational
and educational program for her is not just to keep her busy in order
to prevent boredom ; nor is it primarily to get the work of the home
accomplished. For some girls the mere act of living even for this
short time in an atmosphere o f serenity and orderliness has its values.
If in addition they acquire the beginnings of new skills and new in­
terests that they may develop in more detail when they leave the home,
that is all to the good. Too great accomplishments cannot be expected
from an educational program because o f the difficulties o f time and
the situation. The young women are pregnant and therefore limited
in their physical and social activities; some of the girls, emotionally
disturbed, are not in a receptive frame of mind for new experiences;
residents are entering and leaving the home constantly so that con­
tinuity of group activity is difficult, especially in small homes; the resi­
dents are different in age, interests, and background of home, school,
work, and other experiences. Because of the constant change and the
diversity, planning the daily activities o f the group requires technical
skill in program planning, imagination, ingenuity, and adaptability.
Through group activities a young woman may acquire an ability to
get along well with other people, a better knowledge of herself and of
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what she wants to make of her life, some practical skills that make
daily tasks more interesting, knowledge of where to go for information
and assistance when she needs it, or new interests that she may wish
to carry on in her precious leisure tiriie when she is a wage earner or
a busy housewife. No one girl will gain all of these tools for building
her future, o f course, and not all will need this type of service.
How the problems o f each unmarried mother are worked out with
her by the case worker has been discussed in the previous section, The
Value o f Case-Work Service. In addition to this individual counseling,
the home can plan activities for the whole group that give both fun and
knowledge. The case worker and the staff worker or volunteer respon­
sible for group activities will, of course, work closely together in plan­
ning this group program. The case worker can contribute her technical
knowledge of the basic difficulties that unmarried mothers face and
her understanding o f the individual residents of the home. The staff
member who is responsible for program activities can contribute her
skill in working with young people in a group.
Some suggestions for a program of activities are herewith offered
that may be adapted to particular homes. The suggestions may be ex­
panded or contracted to fit conditions in large or small homes, or
changed to suit a home organized very differently from most homes.
They do not pretend to be a complete program or a formula to follow
because a program must be shaped by the type and resources of the
home, the pattern of- daily life there, and the choice of activities made
by the girls living in the home at a given time.
What substance to give to the program and some ways to make it
work are the topics of this section. Three activities are suggested:
First, recreational and leisure-time activities; second, informal educa­
tional activities, including discussion groups, preparation for homemaking, and tutoring for incomplete studies; and, third, religious ac­

Recreation touches many deep phases of life. Among them are the
elemental desires for friendship, recognition, adventure, creative ex­
pression, and group acceptance. It offers values on which to draw for
creating happy experiences for the unmarried mothers in a maternity
home, individually and as a group. Recreation can start a young
woman off toward expressing her interests in play so that what she
gains will later help her to plan her lejsure time wisely. She will then
have wholesome outlets for her abilities and the energies that are char­
acteristic o f normal youth. The recreation planned for the residents
should include a wide selection o f activities—-appropriate to the age

Federal Reserve Bank of St. Louis

and social development o f all. It is a basic principle that each person
decides whether she wants to participate and then makes her own
choice o f what is offered.
It is important that the staff realizes fully the value o f recreation to
unmarried mothers. As staff members know, many young women come
to a maternity home partly as a result of unwise use of their leisure
time. Some actually do not know how to play, their chief recreation
having been found in “ movies,” dance halls, and unwholesome places
of commercial amusement. Many o f them are unaware of the resources
within themselves that, if developed, would contribute greatly to their
personal happiness. Knowing this should stimulate staff members to
help the residents select and organize their leisure-time activities and
recognize the possibilities of finding fun in simple ways.
Leadership from within the group should be encouraged— the kind
o f leadership that draws other girls into planning what the group wants
to do. Many young women are not aware o f their latent ability to
work with others and to plan and organize until given opportunity to
demonstrate what they can do. The timid, shy girl may have her whole
attitude toward herself and society changed to her advantage through
gaining the sincere approval o f the group she lives with for this brief
period o f her life. The domineering, aggressive girl may be helped to
find an acceptable place in the group and to gain the approval of her

Qualified leadership
It is desirable for the recreation program in the home to be planned
and developed by workers trained and experienced in the field of
group work and recreation.' Few homes have a group worker on the
staff or call afford to employ one for full time or even for part time.
Instead, these homes must call on other agencies in the community for
assistance in building up recreational activities. The council of social
agencies may be able to make the arrangements. Local private and
public agencies in the field can perhaps give their services, either in
an advisory capacity or by lending leaders from their staffs for short
periods o f time for special activities, or both. Some of these agencies
are the public schools, municipal recreation departments, the YWCA,
social settlements, community centers, and the Girl Scouts. All have
staff members qualified to act as consultants as well as workers who
might be sent to the home for special projects.
The home should assign the staff member or volunteer who has the
greatest aptitude for this kind o f work to act as the liaison between
the home and the advisory agency. This staff member or volunteer
should carry out the advice o f the consultant and arrange for the leader
lent by an agency to develop some definite part o f the program. The
676781 ° — 46— 4

Federal Reserve Bank of St. Louis

staff member should help the leader in advance of the visit to under­
stand the work of the home and the sensitivities of unmarried mothers.
She should also tell the residents about the leader in advance and then
help them get acquainted easily so that the leader and group can
immediately work closely together.

Indoor activities
In planning recreation it is well to include quiet and active types for
both indoor and outdoor programs. The advice of the medical staff
will, of course, govern the extent to which the girls take part in physical
activities. The daily program of the home should be arranged so that
free time is possible for each resident and time is allotted to planned
group activities. Space, equipment, and supplies are necessary for
recreational activities. Whenever possible a recreation room, separate
from the regular lounge or living room, should be arranged for in which
some girls can do handicraft, rehearse informal dramatics and music,
and plan activities, such as parties, without disturbing other girls. This
room should be made comfortable and attractive by use of bright
colored draperies, good pictures, rugs, lamps, tables and easy chairs,
a radio or phonograph, a piano, and cabinets for storing games and
equipment when not in use.
Table games.— There is no better way to develop friendly, under­
standing, and happy relationships between the girls than through
wholesome intragroup activity. "To make this possible, indoor activities
can be developed, for example, table tennis, ping pong, Chinese
checkers, backgammon, and card games.
Music.— Music offers many possibilities for individuals and groups.
Listening to music may be more than an enjoyment in itself; it may
stimulate a girl’s interest in developing latent musical talent or in con­
tinuing interrupted study. Radio broadcasts— the time and stations
carefully followed by one person in order to get the good programs—
and phonograph records offer opportunity to hear the greatest artists
and also to keep in touch with currently popular dance music. Informal
group singing can be fun if a good leader is available within the home
or from some community agency. Choral and part singing might even
grow, with good leadership, into an informal glee club that could work
toward songs for special days of celebration in the home.
Music can give intangible satisfactions. The superintendent of one
small home, for example, has found this to be true. She has a phono­
graph in her own centrally located room. Often when the residents
seem unusually restless or tense or a current of discord goes through
the house, the superintendent starts playing a record. The music flows
out through the halls and rooms of the home and after a while the

Federal Reserve Bank of St. Louis

restlessness or tension subsides. The three records she most frequently
plays in this way are The Lord’s Prayer, sung by John Charles Thomas,
and Panis Angelicus and Ave Maria, sung by Beniamino Gigli. Often
they are asked for just after the residents have gone to bed.
The screen.—-Sixteen-millimeter motion pictures that are of interest
to young people can be a welcome diversion during leisure time if they
are well selected. Should the home have no portable projection
machine and be unable to buy one, a board member might be able to
obtain one on loan for special occasions.
These home-shown pictures are of particular value if the maternity
home is far from the theaters in the community or when bad weather
keeps the residents inside. Visual slides and stereopticon views as well
as films on travel, vocations, and hundreds of other topics can be
obtained at small cost through most State departments of education
and other sources. The public-relations secretary of the local council
of social agencies may be consulted about obtaining films suitable for
young people. Current “ shorts” that are show regular theaters
can be arranged for through local motion-picture theaters or distribut­
ing offices at reasonable cost. If showings are planned well in advance
the residents will have a chance to assist in selecting the films and
arranging the programs.
Good motion-picture films made by amateurs on trips to other coun­
tries or to interesting parts o f this country can give a great deal of
pleasure. Local camera clubs will give suggestions about obtaining
these films for a showing. Board or staff members may have friends
who are camera enthusiasts and have taken motion pictures that might
be shown or who at least might suggest ways to obtain films. Some
amateur colored motion pictures of peoples of other lands not only
are beautiful to see but stimulate reading about these far-away
Arts and crafts.— Individuals and groups may enjoy different types of
arts and crafts and get from them an idea of their manual ability.
Young women may choose their own interests and hobbies after they
have had chances to experiment with different kinds- of handwork.
Some of these activities are block printing of different kinds, draw­
ing, sketching, water-color and finger painting, weaving, carving, clay
modeling, sewing, making collections. of certain items, and making
decorative posters.
An interest in a handcraft or in collecting that grows into a hobby
may become more than a pastime; it may be an absorbing pleasure for
years. Such a hobby may open new avenues of information and lead
to new, congenial acquaintanceships.

Federal Reserve Bank of St. Louis

Com m unity projects.— Taking part in community projects gives the
residents a chance to make a contribution to neighborhood and national
life. The council of social agencies may suggest community projects
functioning in the city that are suitable for residents of a home.
Reading.— An interest in reading can be one of the most absorbing
and rewarding habits a young person can acquire. For this reason most
homes try to make good, up-to-date reading matter easily accessible to
their residents. Books that are near at hand and can be picked up in
a moment of free time are more of a temptation than those neatly
tucked away on shelves in a special room.
An adequate and suitable supply of books, magazines, and daily
newspapers is essential. The books may range from attractively illus­
trated though inexpensive children’s books, so that the mothers may
learn what books are being published for children, to those on such
subjects as fast-moving current history. There should be good novels,
biographies of persons o f interest to young people, and books on cur­
rent events. Books on the care of babies, on homemaking, jobs and job
getting, good grooming and choice o f clothes, books on travel with
pictures— and on different hobbies and the materials used in hobbies
will be welcome. The library should have a standard encyclopedia
and an up-to-date unabridged dictionary.
Magazines should be chosen for their easy readability. For example,
the women’s magazines have a convenient combination of story and
practical suggestions about clothes, personal appearance, and other
things that interest girls. Magazines on gardening, sports, or good
health will be apt to have many readers in the home. A picture maga­
zine will be welcome for swift reviews of what is happening in the
world. At least one daily newspaper will of course be part of the
“ library” service, with enough copies for all to read.
If used books and magazines are offered to the home by board mem­
bers or by groups interested in the home, they should be accepted only
if they are appropriate for young people, of current interest, and in
good condition. It is best to keep the book supply growing by addi­
tions of new volumes bought from time to time by funds appropriated
by the board for this purpose. If gifts are depended on entirely, it is
well to have ready to give to prospective donors a list of books and
magazines that are especially wanted. That will give them an idea of
the type of reading matter the residents like.
The local public library will be of great help in building up a col­
lection of books for a home. Advice as to what books to buy, lists of
reading on specific subjects for individual readers, and the loan of a
collection of books suitable for the residents for a given time are some
of the services the home may obtain from a well-equipped public

Federal Reserve Bank of St. Louis

library. The superintendent will find it exceedingly profitable to know
the librarians and to have them know about the educational and recrea­
tional activities of the home. They may make excellent suggestions
about ways to help young people form good reading habits that will
always stand them in good Stead.
Besides the inside-the-home service, the public library can give as­
sistance at the library. Many o f the unmarried mothers knew their
home-town library before they came to the home and need only to be
told where the nearest library is to start “ getting books out” again. The
girls who never had the library habit might, with encouragement, go
there to see what this treasury o f books holds for them. They might
want to see the building itself, how the library operates, and how the
books are displayed to catch the eye o f a reader; to browse among the
magazines; to see an exhibit o f pictures, o f handicrafts, of ancient
pewter, perhaps; and to hear o f such services as readers’ advisers who
will answer questions, make out lists on special subjects, or help readers
find the information that they want. This introduction may lead to
use of libraries in later days in other places.
Dramatics.— Dramatics may be a particularly helpful activity for girls
in a maternity home. Through this outlet they may express themselves
without reticence because in “ play acting” they can afford to be fic­
ticious persons. A skilled dramatic leader would be helpful if she un­
derstood these particular young women.
The dramatization of special events and holidays is always of in­
terest to young people. With the help of staff members the residents
can present in an informal way short skits, plays, and simple pageants.
These can be given on Saturday nights or special occasions. This is
not only a means o f good fun, but is an excellent way to exercise
imagination and to develop confidence, self-expression, and ingenuity.
Some of the girls will be more interested in preparing the costumes
and settings than in acting.
Inform al in d o o r fu n .— Simple informal types of seasonal group rec­
reation that call for little expense, time, and energy are candy pulls,
popcorn parties, festival celebrations such as Halloween, and the like.
When certain materials are scarce, ingenuity is needed to plan such
gatherings. In one home, before bedtime each winter night the resi­
dents gather in the large, comfortable kitchen for a “ nightcap” of coffee
or chocolate, which they prepare. A visitor to the home on one occa­
sion was invited to join them. The girls decided that they would eat
as usual in the kitchen rather than make the occasion formal by using
the living room. They wished the visitor to feel that she was part of
the group. When the guest arrived she found that the residents had
whipped up a coffee cake as a surprise to her. Over their cake and

Federal Reserve Bank of St. Louis

beverage they sat around the table and chatted about various subjects
of interest to the girls. In this type of informal gathering, oppor­
tunity frequently arises to talk about matters that relate to the life of
the group as a whole that would be difficult to discuss under more
formal conditions.

Out-of-doors recreation
In the garden.— Because pregnant women need fresh air and plenty
of sunshine, out-of-doors recreation can be encouraged. The yard and
porch space o f the home should be equipped with plenty o f swings or
gliders, chairs and benches, to accommodate the residents. Tables are
convenient to use while doing handwork of any kind or playing table
games. Eating out-of-doors is pleasant in the right season. An out­
door oven for cooking picnic suppers makes an inexpensive and enjoy­
able way of changing the routine of the evening meal.
Some will enjoy growing flowers and tending small plots of vege­
tables, either as a familiar or a new experience. This gardening will
mean more to the gardener if it is not compulsory work and she can
choose her own planting and use the products as she wishes. The home
may have its own plot of ground that the residents can use or may
obtain a plot suitable for their use through a community gardening
One outdoor game that can be adapted to the physical conditions of
the girls is croquet. Other games, such as shuffle board and darts, may
be adapted also but should be planned for only in consultation with
the staff physician.
Recreation away fro m the h om e.— Some girls do not want to feel cut
off. from outside activities. They want to go out and get a feeling of
belonging to the community rather than avoiding contact with it.
They may want to go to concerts, museums, art galleries, department
stores, motion pictures, or to the theater. One girl may want to go
alone if the trip is one in which she only is interested hut most of the
girls will probably want to go with other residents or with relatives
or friends. Freedom to go without a staff member if they know how
to get around in town will be appreciated by the girls. In turn, they
will observe the ordinary courtesy o f any daughter to her parents—
to let the home know where she is going and when she expects to be
Young women who have never known the quiet pleasure that can be
found in group picnics and walks may find it during this stay in a
maternity home. Walks in botanical gardens, or the wooded parts
of city parks with someone who knows about trees, flowers, plants, and
birds may open new avenues of interest and lead to more ambitious

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walking later on. After learning that walking can be fun, two or
three girls may go out together to walk in woods or parks near the
home or conveniently reached by trolley or bus— wherever they will
not feel conspicuous as a group. Most cities have organized groups
for nature study and outings that can supply information on walks of
different lengths and o f different interests,

Just as the recreational activities are planned to make the residents’
brief stay in the home interesting, so the informal educational activi­
ties are planned with the same aim. If, in addition, a girl acquires
the beginnings o f new skills, more useful information, perhaps some
“ credits,” plus a desire to go deeper into these new interests, that is a
gain she may later value greatly. Some subjects that will be o f interest
are suggested here, along with some informal ways of presenting the
topics to the group. A skillful leader, in planning the activities o f the
residents, will encourage them to reveal their interests and will then
use these interests in planning an appealing program. How can educa­
tional material be offered in an informal and enjoyable way?

Discussion groups
In a series o f informal discussions under leadership, almost any of
the subjects o f interest and value to the residents may be presented—
if qualified leaders can be found. One leader may conduct a whole
series or several leaders may take up different parts o f a subject.
The choice of a discussion leader is most important, because this
work, seeming so simple, in reality takes great skill and much ex­
perience. Possibly some member of the staff has this skill and ex­
perience, for instance, the physician, the nurse, the case worker, or the
one who supervises the program of activities. A ll may be qualified as
far as subject matter is concerned but none may be a good discussion
leader. Leaders from outside can be found in adult-education groups,
in private and public agencies serving youth, public-health agencies,
child-study associations, child-guidance agencies, family and children’s
agencies, libraries, on faculties o f local high schools, colleges, or uni­
Before appointing a leader the superintendent should be sure that
the leader understands the difficulties o f the residents and is sympa­
thetic with them. Otherwise, the leader may unintentionally defeat
the purpose of the discussions by arousing resentment instead of an
interested desire to talk things over. The residents will be more in-

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terested in the series if they hear in advance about the background and
accomplishment of each leader.
To keep the atmosphere o f the meetings informal and as different
as possible from that o f a schoolroom is essential. Ways of conduct­
ing the meetings should vary from time to time. At some, discussionprovoking motion pictures or still pictures might be shown, at others,
exhibits o f collections made as a hobby or of handicrafts might be
on display to illustrate some point under discussion. Short stories,
articles, or hooks could be used as a basis for conversation. The leader
could start by reading aloud a story or a passage from a book, perhaps
dealing with family life, and follow the reading with a summary of
the book. The leader will weave in suggestions about sources o f fur­
ther information.
The group that chooses a series could meet as often as twice a week
at times when the mothers will not be too tired and when the period
is guarded from interruption. The number of times the group meets,
the content o f the discussion and the way the leader organizes her
material will be determined by the number of residents who will be
present for 6 weeks or 2 months. The informal talks may have a value
apart from their subject matter. They may increase the girls’ selfconfidence in expressing their opinions and in contributing points to
a general conversation in an effective way.
As an example of what is meant by a discussion series, a brief outline
is given below of practical talks about the care and guidance of children.
This subject will be of immediate interest to many of the unmarried
mothers— to those who plan to keep their babies, those who expect to
marry later, and those who may do domestic work. The mothers who
are giving up their hahies should not be included in this group unless
they specifically choose to join. The outline, divided into six topics,
might cover a period of 6 weeks, with two meetings on each topic.
Much of the time may be taken up in talking about actual happenings
brought up by members of the group to illustrate points discussed.

What all of us should know about children in order to be responsive
to their needs:



How to care for children physically.
How they grow, how to feed them, how to protect their health,
how the physical well-being of children depends upon the love
and affection that underlie their care.
How to give opportunities for the development of their minds.
What play means to children’s development; how their surround­
ings help or hinder the expansion of their interests and efforts; the

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importance of adults’ comradeship with children through read­
ing, conversation, and trips for exploring their environment.
III. How to understand the feelings of children and to help them
to control and direct their strong desires.
Appreciation of their desire to do things “ on their own,” of their
need for independence and for experimentation (examples:
dressing and eating), and of their desire to have others enjoy and
respond to them.
IV. How to guide the habits of children.
How children learn. (Laws of learning as applied to eating, sleep­
ing, eliminating, and so forth.)
How the habits o f adults affect children. (Example: an adult who
is consistent in his treatment of a child gives him a feeling of
security and safety; an adult who is well adjusted creates an atmos­
phere of harmony and order that contributes to a child’s acceptance
of guidance.)

How to understand the stages of growth of children and the
peculiar problems of each stage.
Infancy: The protection from fear, as well as from disease.
The toddler stage: Why children must learn through their senses.
The period o f resistance to authority: How to handle displays of
The period of questioning: Answers to questions children ask
about their bodies are as important as responses to other inquiries.
The period of imagination: W hy imagination is important; how
to deal with it.

VI. How to create a happy home.
The kind of house a child lives in, the kind of clothes he wears,
or the toys he has are of far less importance than his feeling of
being wanted and loved. (Example: a child can stand a terrifying
experience if he is with his mother and feels sure of her affection
for him.)
The quality of the relations between the adults with whom a child
lives forms the basis for his learning the values of family life.
If there are several children in a home, it is important that the
adults recognize each child as an individual with special needs.

Subjects for discussion
The content of an educational program for the unmarried mothers
in a home is essentially the same as for any group of girls of the same
age range. Because of pregnancy, some girls will have more than or­
dinary interest in certain subjects; others may show less interest in

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what appealed to them before. In general, young women are concerned
about how to earn a living, their relationship to others, freedom of
action, and assuming the responsibilities of adulthood. Questions
about these subjects will always be talked about, perhaps in very
simple terms, whenever girls get together in a group. A few topics
under these broad subjects are herewith given that might be discussed
in groups.1
Many of the unmarried mothers in a home will have been employed
in jobs with a future in which they were competent and happy. Others
who have been in dead-end jobs because, perhaps, they lacked skills
may have disliked their work. Still others have never worked for a
living. Some girls, particularly those from small towns and farms, may
have had no opportunity to learn of the many occupations open to
women and of the contributions that women have made to business
and industry. Well-planned discussions on these points will be of help
to all young women but particularly to those who would like a change
of employment or who are planning employment for the first time.
Another pertinent subject, but one that needs skillful handling,
centers around a girl’s relationship to other people. Each leader might
present the subject matter in a different way, according to her back­
ground and occupation. The case worker versed in leading discussions
might explore this topic with the unmarried mothers and in so doing
give them some insight into the reasons back of human behavior. An­
other leader might develop the subject from the standpoint of family
relationships— what makes a family and why some families get along
well together and others do not. Or the leader might think in terms
of the development of personality— what qualities persons like in others
and how individuals can learn to lead more satisfying lives.
Most girls are interested in personal attractiveness. It might be wise
to have talks centered on this topic as part of a series on health aimed
to give the mothers more understanding of physiology and of the im­
portance of rest, food, and physical activity. This leads naturally into
the subject of good grooming— Care of the body and clothing suitable
to a girl and her activities, planned on a knowledge of the quality o f
fabrics, of color, and of becoming lines.

Spontaneous discussions
That “ leaders” and “ series” have been suggested in the preceding
paragraphs does not mean that no significant discussions will take place
without planning or thought in advance. Many come about under any
circumstances in any group living under one roof or seeing one another
1 Subject matter for informal recreational and educational programs that can be adapted to
the use o f maternity homes has been developed by such organizations as the Young Women’s
Christian Association, 600 Lexington Ave., New York 22, N. Y „ and the Association fo r Family
Living, 209 So. State St., Chicago 4, 111.

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often. Spontaneous discussions may begin in a flash during a meal,
during a game of cards while one player is dealing, or while a number
of residents are walking home from the “ movies.” When a staff mem­
ber happens to be one of the group that starts such a discussion, she
may see a chance to throw in, by a casual remark, some information
that is needed or to focus more attention on a vital point that the talk
is skirting. Or she may just keep the discussion lively by being an
intent listener.
Some superintendents, who appreciate the value of this spontaneous
“ hashing over” of topics that concern young people, make opportunities
for them consciously but not obviously. The superintendents bring
about comfortable and easy times of sitting around a friendly open
fire in winter or in a cool corner of the garden on a summer afternoon.
Conversation develops naturally, perhaps out of something a girl has
done that day or from news in a letter from home or in a newspaper
item. Some shy girls may be brought into the conversation by a ques­
tion from an alert adult who is just one of the talkers, decidedly in the
background. As unobtrusively and naturally as possible the staff
member seeks to maintain the continuity of the conversation as long as
active interest is evident. The value of this type of spontaneous dis­
cussion is that the unmarried mothers, relaxed and unself conscious in
expressing themselves, may make points of depth and significance that
they would not bring up in more organized conversations.

Preparation for homemaking
The work that residents do in a home offers a good opportunity to
give them both skills and a sense of achievement. Persons supervising
their work should be understanding, practical, and able to teach effi­
cient practices in home management. They should also know that the
duties o f the mothers should be adjusted to their physical condition
on advice of the physician. Good supervisors will find ways to give
pride in a jo b well done. Homemaking can be a joy or a drudgery;
the girl’s attitude toward it and her command of efficient methods o f
work largely determine the outcome for her.
It is important that food served in the home be interesting and appe­
tizing as well as nutritious. (See p. 68 for the foods expectant mothers
need daily and menus including them.) Residents can be taught the
planning of nutritious meals, and the selecting, buying, preparing, and
serving o f food. Some homes have found one of the most popular
activities to be the combined cooking and nutrition classes taught by
carefully chosen home economists. One small home has arranged with
the local superintendent of schools for classes taught by a home-econom­
ics teacher in the homemaking classrooms of a nearby school. The
classes are held during the early evening when the building is not

Federal Reserve Bank of St. Louis

otherwise in use. In this way the residents are given professional instruction and the advantages of school equipment. At the same time,
the routine of the home’s kitchen is not slowed by teaching.
Knowing how to mend, launder, iron, remove spots, or press clothing
is a decided help to good grooming that will be useful wherever a young
woman may be. Young women who are handy with a needle or who
can he taught to be will find this skill an asset toward having a greater v
variety o f blouses, simple dresses, and clothes accessories. Learning to
use patterns and to remodel dresses are invaluable aids to being well
dressed, especially if the clothing budget is slim. Discussion of moneymanagement problems as related to these various aspects of home­
making can be most helpful when conducted by a skilled leader.
Taking pride in a job well done has a close connection with wage
earning as well as with homemaking. Good work habits are an inval­
uable asset in employment. The residents can be encouraged to take
full responsibility for assignments after they understand their instruc­
tions and to tie up all the loose ends o f a long jo b before they consider
it finished. This is decidedly a part o f group activity because recog­
nition on the part o f the staff or of other residents of a job well done
gives a girl a sense of achievement that can make work a satisfaction.

Tutoring for incomplete studies
Closely bound up with employment is the problem of uncompleted
education. The girl whose schooling has been interrupted by pregnancy
may decide after talks with the case worker that it is wise for her to
complete some part o f her education. In some cases, it may be wise
for the case worker to arrange for consultation with a vocational advisor
or a psychologist. A girl may want to study while in the home in order
to use this time to advantage. It may be wise for other girls who have
already dropped out of school to try to pick up the loose threads while
in the home as a test of whether further school work is practicable.
A qualified psychologist can be helpful to the case worker in all these
Many maternity homes have arranged with the local school author­
ities for the services o f a teacher. One home reports that for a period
of years its educational program has worked well to the great satisfac­
tion and enjoyment o f the residents. A teacher with wide experience
as a substitute in the public schools was assigned to the home by the
board o f education and was given the school authorities’ enthusiastic
support. The girls assist with the work o f the home from breakfast
until 11 a. m. They are then free for the activities they have chosen.
Those who are to do classroom work go to the room equipped for
school purposes. Classes are informal and as little like the disciplined,
ordinary classroom as possible, because some o f the girls have resisted

Federal Reserve Bank of St. Louis

school previously, considering it humdrum and boring. Classes last
30 minutes and are so arranged that girls who need rest can have
it. The classes are small and are organized so that the teacher can
divide her attention between groups that are busy studying while others
are carrying on class discussions. One o f the important features is that
the time is carefully guarded against interruption. Because the classes
are small, they can be planned to meet the requirements and interests
of each resident. The superintendent of schools, whose interest orig­
inally made the plan possible, has arranged that the girls get credit for
completed work, the certificates being issued from the nearest ele­
mentary or high school without the name o f the maternity home appear­
ing. Credits so earned are accepted anywhere in the State.
These classes have meant so much to some girls that they have kept
in touch with the instructor after leaving the home when their jobs
prevented them from taking courses at night schools. They have come
back to get assignments, submit written material, and discuss various
“ problems” with the teacher.

The social worker undoubtedly will discover in her work with un­
married mothers what part religion has played in each one’s life, its
present meaning to her, and how she can use it. The girls who come
to a maternity home have their inner conflicts and undefined longings
just as most young people have, but theirs are intensified by this crisis
in their lives. Some o f the young women who have already had satis­
fying religious experience can get comfort from their religion and
should be given every opportunity and encouragement in this. Others
have never had any religious influence or instruction. Still others feel
bitterness toward religion because of unhappy experiences they have
had in their own homes with “ religious” parents who showed a rigidly
moralistic attitude toward their children’s normal desire for fun. Still
others are indifferent to religion, thinking of it as merely formal church
services with a tedious sermon without any meaning for them.
Spiritual values have a place in everyone’s life. Some build and
express them in one way; others in another. Some do this best within
the frame o f formal religion through a lifetime of church devotion.
Others have broken their church connections by nonconformance to
the outward expression of the tenets o f their churches. They feel that
they can still maintain spiritual values without formal religious ob­
servance. These individuals often renew their connections with a
church when they are in serious trouble. They may find comfort and
strength through consultation with a pastor o f a church or through
attendance at religious services.

Federal Reserve Bank of St. Louis

Many maternity homes conduct their own religious services. The
home functioning under church auspices often has a regularly assigned
chaplain. He arranges for all the services that are appropriate. This
plan has great advantages in that the clergyman learns to know the
residents and their difficulties and can plan continuity of religious
instruction. Other homes rely for their religious services on pastors
of different churches or on lay religious groups. Each pastor or group
may come to the home on only one occasion or may take part in a
series of meetings.
The services that are held in the home should be carefully planned.
They should have dignity and beauty and, most surely, warmth and
meaning for these particular girls. These qualities are more likely to
be attained if whatever talks are given aim at a way of life that will
be rich in worth-while experience and satisfying to the one who lives
it and if nothing is said that might build up in any unmarried mother
feelings of guilt that might make her less capable of dealing with the
future. Everything said should help her to think hopefully of the
years ahead.
The qualifications of the clergymen who are invited to conduct serv­
ices should be considered with exceeding care. -.They should include
friendly understanding of young people and a knowledge of how to
talk to those who are out of step with accepted standards of conduct.
Visits from pastors or church groups that have not been carefully
planned in relation to the residents’ interests may alienate unmarried
mothers rather than help them. The principle to remember is to invite
only the most suitable persons—-those able to create a spiritual atmos­
phere and to adapt programs to a special group of young people.
In planning the religious services the staff member responsible may
want to enlist the help of the residents. Some of them may enjoy
arranging the setting, the flowers, chairs, books, and so forth, or even
taking more responsibility. They will certainly enjoy planning pro­
grams for special occasions such as Thanksgiving, Christmas, and Easter
when simple pageants or carol serviced may be given.
Even if the home has its own religious services, some residents may
wish to attend regular church services in the community. Those who
feel comfortable in doing so should be encouraged to go. Many girls
from small places may get inspiration from services unfamiliar to them,
for instance, the richness of services in some large city churches.
Furthermore, the girl who has not been a regular church attendant
may be more likely to continue attendance in church if she forms the
habit under stimulating circumstances while she is in the home. She
may find a congenial companion who wishes to go to church for the
same reasons as hers, and so begin in this natural way a whole new
religious experience.

Federal Reserve Bank of St. Louis


Health and Medical Services1
Preceding sections of the bulletin have discussed services that should
be available to an unmarried mother because of the complexities that
face her during pregnancy and the period of social adjustment after
the birth of her child. This section outlines the health and medical
care that she should receive. That this care should be of the same
high standard that a married mother should receive would seem to be
too obvious to mention. Unfortunately, however, most women who
are illegitimately pregnant receive unsatisfactory maternity care as
compared with pregnant married women. The chief reason for this
difference is the lateness in pregnancy when unmarried mothers usu­
ally come under medical supervision— often as late as the sixth month.
The social stigma attached to pregnancy without marriage is likely
to cause a girl to take the risk of concealing her condition as long as
possible. It is the responsibility of individuals or agencies who may
come into contact with pregnant unmarried girls to see that they get
under a physician’s care promptly. If an unmarried mother applies
to a maternity home early in pregnancy and plans to enter later, the
home will, of course, make sure that she has*good medical care in the
1 Prepared by Barbara A . Hewell, M. D., o f the Division o f Research in Child Development,
in cooperation with John L. Parks, M. D., the Children’s Bureau’ s consultant in obstetrics, and
Marjorie M. Heseltine, consultant in nutrition o f the Division of Health Services.

Federal Reserve Bank of St. Louis


Another reason for some of the unsatisfactory maternity care that
unmarried mothers receive, and one especially pertinent to this dis­
cussion, is that many maternity homes— small institutions, modestly
financed— cannot provide the quality of medical service that the facili­
ties and qualified personnel of large, well-equipped hospitals and
clinics can offer. Conditions do vary greatly as to the availability of
community or hospital prenatal clinics and services but when they
are available it is wise for small maternity homes to consider using
these clinics and services for prenatal, delivery, and postpartum care
rather than continuing or setting up a separate service.
Good maternity care requires expensive equipment, aseptic tech­
niques, safe anesthesia, provision for emergency treatment— such as
transfusions— and expert medical and nursing services. It is often im­
possible for small maternity homes to furnish them. Some of these
homes may be able to provide adequate prenatal supervision and
safe delivery care for patients without complications. The home
should, however, arrange with hospitals for the observation and delivery
of patients with complications or whose delivery may be difficult.
For large maternity homes in which many deliveries oecur, the expense
of the complete service may be justified.
The medical and nursing services offered by the maternity home
will vary according to whether the complete care is given in the home
by staff physicians and nurses or whether community clinics and
hospitals are used for prenatal, delivery, and postpartum care. In
the latter case, the staff physicians and nurses will give general super­
vision and will coordinate the home, clinic, and hospital services. The
emphasis in the health and medical program will be on the hygiene
of pregnancy, the prevention of complications, prompt referral to
clinic or hospital of all abnormalities, the care of infants, and late
po'stpar turn supervision. When the complete service is given in the
home-, prenatal examinations, delivery carer, and immediate postpartum
care o f mother and care of the infant will also be an important part
of the medical program.
The health of the mother during pregnancy affects the course of
labor and delivery, the condition of the infant, and later the health of
the mother. Adequate food during pregnancy is essential. T h e living
conditions- in the maternity home, the- social adjustments of the resi­
dents, the program, o f activities described in the section New Interests
Through Group Activities, have an important bearing on the physical
and mental health o f the unmarried mothers in the home.
In this section suggestions are given in outline form under the fol­
lowing eight headings: (1) Medical supervision, including advisory and
attending staff; (2) nursing service; (3) prenatal care, including medi­
cal services* supervision of diet, and hygiene of pregnancy; (4) delivery

Federal Reserve Bank of St. Louis

service; (5) postpartum care; (6) care of infants; (7) facilities for
medical and nursing care of mothers; and (8) facilities for medical
and nursing care of infants.
Only the essential points in the provision of health supervision and
medical services are included but references are given for more de­
tailed information. The extent of facilities and services needed will,
of course, vary with the type and size of the maternity home.

The m edical advisory com m ittee of the home should include
specialists in obstetrics, pediatrics, nursing, and social work. The
committee should have general responsibilities, such as organizing the
medical program; establishing policies, procedures, and standards of
care; arranging cooperative relationships with hospitals or other medical agencies; selecting staff physicians and determining their responsi­
bilities; approving nursing staff appointments; and providing clinical
consultation upon the request of the staff.
Consultation o f the superintendent of the home and the medical
advisory committee with the director of the maternal and child-health
division o f the State health department and the director o f the childwelfare "division o f the State welfare department will be helpful in
planning the health and medical policies, procedures, and program.
F or the States that license and supervise maternity homes, one or both
of these departments-—health and welfare— have the responsibility of
licensing and supervision and are therefore interested in standards of
The staff o f attending physicians should have direct responsibility
for the health supervision and medical care o f the women residents
in the home and their infants, according to the policies, procedures,
and standards established by the medical advisory committee. The
staff should include physicians who have had training and experience
in obstetrics, pediatrics, and general medicine.

Responsibilities o f the staff obstetrician
1. To supervise all health aspects of the program for care of
women in the home.
2. To provide prénatal, delivery, and postpartum care unless these
services are provided at clinics and hospitals.
3. To coordinate the program in the home with recommendations
of physicians in the prenatal clinic so that the women will be
able to follow out the instructions given in the clinic.
676781 ° — 46— 5

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4. To give any prenatal care that may be necessary in addition to
that given in the prenatal clinic and to arrange for care in ap­
propriate clinics or hospitals for remedial work, illnesses, oi
complications of pregnancy.
5. To be on call in case of obstetric emergency.
6. To be responsible for isolation o f any woman with an infec­
tious condition and for her transfer to a hospital when indicated.
7. To request consultation when indicated.
8. To keep a record o f the obstetric and medical history of every
woman admitted to the home.
9. To consult with the case worker regarding problems that call
for joint decision or action (for example, mental hygiene, work,
recreation, or medical follow-up after discharge).

Responsibilities o f the staff pediatrician
1. To supervise all health aspects of the care of infants in the
2. To give regular medical supervision to all infants in the home,
unless this has been arranged for in a child-health conference
or well-baby clinic. Such supervision will include initial and1'
periodic medical examination, direction of feeding, and daily
3. To give medical care to sick infants or those presenting any
abnormality or to provide for their care at appropriate clinics
or hospitals.
4. To be on call for pediatric emergency.
5. To be responsible for thé isolation of any infants having or
suspected of having infectious conditions.

6 . To request consultation when indicated.
7. To keep a record of the health history of each infant.

8 . To consult with the case worker regarding problems that call
for joint decision or action (discontinuance of breast feeding,
suitability of the baby for placement, or medical follow-up after

The staff physician who is responsible for general medical care
should be on call in case of illness not directly associated with
pregnancy, as, for example, for upper respiratory infections and

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communicable diseases. He should be responsible for consultation
service to the staff regarding diagnosis and treatment of medical

The administration o f the nursing service should be under the direc­
tion of a registered graduate nurse who has had postgraduate prepara­
tion and experience in obstetric nursing and in the care of infants.

Responsibilities o f the supervisor
1. In cooperation with the medical staff, to develop nursing pro­
cedures, techniques, routines, and standing orders to be used
in the care of maternity patients and their infants.
2. T o supervise and instruct the nursing staff in the policies and
procedures to be followed in the care of mothers and infants.
3. To maintain equipment and supplies essential to good nursing
care of mothers and infants.
4. To see that adequate nursing service is provided on a 24-hour
basis for all mothers and infants. This service should be suf­
ficient to provide assistance to physicians for necessary examina­
tions and treatment.
5. To direct the supervision o f all practical nurses, nurses’ aides,
and auxiliary workers.
6. To report promptly to the physician any evidence of abnormal­
ity in mother or infant.
7. To see that complete and accurate nursing records and reports
are kept for all mothers and infants.
8. To supervise the preparation of milk mixtures and other feed­
ings for infants.
9. To plan for instruction o f the mothers in prenatal and post­
partum care and the care of their infants.

10. To cooperate with the case worker in providing for follow-up
nursing care o f mothers and infants after their discharge.

Size o f nursing staff
The nursing staff should be sufficient in number to have one mem­
ber on duty at all times. This should be a graduate nurse. If there
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is only one graduate nurse, she should live in the home and be on
call by the attendant in case o f emergency. Additional nursing
service should be provided for emergency situations such as an
unusual number of deliveries or the serious illness of mothers or
Because the number of nurses needed will vary with the patient
load, it is impossible to give a ratio of nurses to patients that would
apply to the situation in different maternity homes. The follow­
ing ratios are desirable: for the delivery room, 2 nurses per patiefit
in labor; for postpartum care, 1 nurse to 5 patients by day and to
10 by night; for infants, 1 nurse to 8 full-term newborn infants and
1 nurse to 4 premature infants by day and night.

Prenatal care in the home or in a clinic should include:

Medical services
(See Children’s Bureau publication 153, Standards of Prenatal
Care; an outline for the use of physicians.)
1. A complete medical and obstetric history upon admission to the
2. A complete physical examination, including external abdominal
and internal pelvic examination and pelvic measurements.
This should be done by the staff or clinic physician when the
unmarried mother first comes under the medical supervision
of the home. This is usually done early in pregnancy but even
though a record is obtained from the woman’s physician, a com­
plete check should be made by the physician who will deliver
the patient.
Every possible effort should be made by the home to have the
unmarried mothers receive adequate early prenatal care before
entry to the home.
3. The admission examination should include blood pressure
determination, weight, urinalysis, a blood test for syphilis,
urethral and cervical smear and culture for gonorrheal infec­
tion, determination o f hemoglobin, red and white blood cell
counts, and any other special studies that may be indicated.
A short period of isolation of new admissions should be
observed until venereal infection has been ruled out. Although
negative reports o f Wassermann test and vaginal smear have
been received prior to admission, it will be safer to recheck.

Federal Reserve Bank of St. Louis

Patients with syphilis and gonorrhea can usually be rendered
noninfectious in a few weeks by modern methods of treatment.
If such treatment can be given, there is no reason why women
with these conditions cannot be cared for in the home.
4. Dental examination followed by treatment indicated.
5. Regular medical supervision. The physician should examine
the patient at least once a month in the first 6 months of preg­
nancy, twice a month in seventh and eighth months, weekly
during the ninth month, and more often if indicated. Blood
pressure, weight, height of fundus, fetal heart tones, fetal posi­
tion, and urine should be checked at each of these examinations.
At these regular visits the physician will discuss with the
mother such topics as diet, exercise, hygiene measures, or any
special problems and make specific suggestions to he followed
The weekly menus o f the home should be reviewed by the
physician. The maternity home should allow sufficient funds
in the budget to provide food that is adequate in quality and
6. Treatment o f abnormal conditions. Any complications of
pregnancy or other illness should be promptly recognized and
the appropriate treatment given.
Treatment for syphilis
should be begun early in pregnancy and continue through
pregnancy and after childbirth.
7. Adequate clinical records, both medical and nursing.
prenatal care is given at an outside clinic, significant findings
and instructions should be available from the clinic for the
maternity-home record form.

Supervision o f diet
One of the most important considerations in the health program
of the home is the provision of adequate food for the women dur­
ing pregnancy, as proper nutrition is essential for the health of
both mother and infant. Because unmarried mothers tend to come
under medical supervision late in pregnancy, many of them will
have had inadequate diets during the early months of pregnancy.
Their nutrition will need special consideration. The physician
w ill outline the essentials o f the diet for the home and will pre­
scribe modifications or special diets as indicated for individual ex­
pectant mothers.
The larger homes may be able to employ a full or part-time
dietitian to supervise this program. In the smaller homes the
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staff member responsible for planning the diet should be able to
obtain information and suggestions from home economists or nutri­
tionists from departments of health or welfare, or other qualified
agencies in the local community. In most States consultation ser­
vice may be obtained from the nutritionist on the staff of the
State health department.

The food needs of the pregnant woman and her baby will be
met if enough food is provided so that each expectant mother
receives every day:
M ilk: One quart.
Vegetables and fruits: Five or six servings (not neces­
sarily different vegetables).
A green leafy or deep yellow vegetable.
A raw vegetable or fruit.
A fruit or vegetable rich in vitamin C.
Another fruit or vegetable.
Bread or cereal: Two servings. Whole-grain bread and
cereals preferably, or if not these, enriched bread and
enriched or restored cereals.
Eggs: One egg.
Meat: One serving. Liver should be eaten at least once
a week. Fish, cheese, or dried beans may be eaten occa­
sionally as a substitute for meat.
A good source of vitamin D: Cod-liver oil or some other
source directed by the doctor.
Additional foods: As needed to meet the demands of the
individual woman.
Water; In liberal amounts.


One way of including each of these types of food is shown in
the following sample day’s menu for a healthy pregnant
woman of average weight.
Fruit: Grapefruit, orange, or other fruit rich in vitamin C.
Cereal: Whole-grain cereals preferred.
Bread: Whole-grain or enriched bread with butter, or with
fortified margarine.
M ilk: A glass of milk, or a cup of cocoa made with milk.
Coffee may be taken, if desired, but it should not replace
the milk.
Federal Reserve Bank of St. Louis

Meat: A liberal serving of lean meat.
A potato, white or sweet.
A cooked vegetable, usually a green leafy vegetable or
a deep yellow one.
A raw vegetable; this may be served as a salad.
Bread: Whole-grain or enriched bread with butter or
with fortified margarine.
Dessert: Desserts made with milk or fruit should be
served often.
Milk; A glass of milk.
Supper or . Luncheon
Main dish: A dish made with eggs, or with cheese, or with
milk, such as an omelet or rice and cheese.
Vegetable: A cooked vegetable or a salad, depending
upon the choice made at other meals.
Dessert: Raw or cooked fruit, with plain cake or cookies.
Milk: A glass of milk.
Cod-liver oil or some other source o f vitamin D should be
given during pregnancy. The physician will indicate his pref­
erence as to the kind and.quantity of vitamin D preparation
to be given. The daily amount should supply 400 to 800 inter­
national units of vitamin D.
The amount o f salt commonly used in cooking is sufficient
for the expectant mother without the addition of salt at the
table. Salty meats and salt fish should be avoided. Fried and
highly seasoned foods are apt to cause digestive upsets.
Varied and attractive food, a pleasant environment, a daily
program providing outdoor «exercise, rest periods and interest­
ing activities, a good social adjustment to the situation— are all
factors that improve appetite and utilization of food.


The quantity of food needed varies in different individuals.
An unusual gain in weight may he due to overeating. If so, a
reduction in the total amount of food is usually advisable. In
cutting down the total amount o f food, however, it is important
that there be no reduction in the amounts of the essential foods.
The foods that may be safely reduced are some fats, sweets,
pastries, and refined cereals and breads.
Frequently there are causes for rapid gain in weight other
than overeating. Any sudden marked gain may be a danger.
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signal and should be reported at once to the d octor; it may be
due to an accumulation of fluid in the body.
Limiting the amount o f food with the idea of having a small
infant is not only futile but is even dangerous.

Hygiene of pregnancy
(See Children’s Bureau publication 4, *Prenatal Care.)
1. Exercise and rest
The amount and kind of housework to be done by the women
in the home should not be sufficient to cause fatigue and should
be determined for each individual. Reaching, lifting, and push­
ing heavy things should be avoided. Daily exercise is impor­
tant for health and the- women should have 2 hours outside
daily, gardening or walking. No housework or exercise should
be -continued to the point of fatigue. If varicose veins, swelling
o f legs, pain in legs and back occur, some limitation of activity
may be indicated.
Every pregnant woman should have at least 8 hours sleep at
night and a nap or rest period of 1 hour during the day. Fresh
air and adequate ventilation in sitting and sleeping rooms pro­
mote rest and comfort.
2. Clothing
Dresses should be loose, comfortable, and attractive. Bras­
sieres and abdominal supports should be properly fitted, and
usually make the woman more comfortable. Round garters
and tight bands should be avoided. Shoes should be comfort­
ably large and have low or medium heels.
3. Care of bowels and kidneys
• Adequate diet, fluids, and exercise are aids in overcoming
constipation which is a common condition in pregnancy. Eat­
ing a variety of fruits, vegetables, and whole-grain products in
generous amounts promotes good elimination. The pregnant
woman should take a liberal amount of water and other fluids
daily. Enemas and laxatives should be given only on the phy­
sician’s recommendation.
4. Baths and care of skin
The daily bath may be a sponge, shower, or tub bath.
Tub baths should he avoided in the last month of pregnancy
and should never be taken after labor has begun.
5. Care of breasts
Hygienic care should include softening of crusts on nipples
Federal Reserve Bank of St. Louis

by use of cold cream. If possible, abnormality of nipples should
be corrected during pregnancy.
6. Care of teeth
A ll needed repairs and extractions should receive attention,
preferably during the second trimester of pregnancy. Cleaning
the teeth twice daily improves their appearance and the con­
dition o f gums and mouth.
7. Mental hygiene
Along with other phases of the program of the home which
provide a pleasant and helpful environment for the girls,
instruction should be given to prepare them for labor and
delivery, so that this experience will not be feared.
8. Complications o f pregnancy
Such symptoms as persistent vomiting, repeated headaches,
abdominal pains, dizziness, sudden gain in weight, puffiness of
face, hands and legs, bleeding or discharges from the vagina,
should be immediately reported to the physician and the proper
treatment given.

The delivery service in the home or hospital should provide for—
Proper care during labor, notification of the physician, arrange­
ment for transferral to hospital or delivery room at the appro­
priate stage.
There should be constant supervision by a graduate nurse
during the stages of labor. Sedation, preparation of the patient
for delivery, record of temperature, pulse, and respiration
should be carried out according to the physician’s directions.
The physician should see the patient at intervals during labor;
he should be aware at all times of the patient’s progress.
liq u id foods with definite nutritive value may be given dur­
ing the first stage of labor upon the physician’s recommenda­
2. The use of sedatives and administration of anesthetic should be
under the direction o f the physician.
3. The medical and nursing techniques should be in accord with
the best obstetric practice. Aseptic operating room technique
should be used.
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4. Emergency equipment should be available for the administra­
tion o f oxygen, intravenous fluids, blood transfusions, and for
5. Provision should be made for the proper care o f the newborn
6. A rècord o f labor and delivery should be kept.
7. When delivery service is given at the maternity home, a sepa­
rate unit, including the delivery room and rooms or wards for
mothers and infants should be provided.
8. The delivery room should be used for clean cases only. Patients
with infections or communicable conditions should not be
delivered in the small maternity home but should be transferred
to a hospital where isolation facilities for delivery are available.
These would include acute respiratory and contagious diseases
— such as pneumonia, influenza, measles— skin infections, open
venereal lesions, and intrapartum uterine infections resulting
from prolonged labor and rupture of the membranes.

Postpartum care in the home or hospital should provide for—
1. Recovery period following delivery. Every patient, regardless
o f type of delivery and anesthesia, should have constant nursing
attendance until fully conscious. It is well to observe patients
* * in the delivery room for an hour or more. Pulse, blood pres­
sure, height of fundus, amount of bleeding should be noted.
If there have occurred any postpartum complications, constant
nursing attention should be given. Every postpartum patient
should be watched closely for at least 6 hours after delivery
because o f danger o f delayed hemorrhage and shock.
2. Bed rest and bedside nursing care for the first 10 days after
delivery. There is special need for rest and sleep following
delivery. The patient should be allowed to move freely in bed
and perform parts o f her toilet. By the third or fourth day the
patient may sit up in bed with a back rest for short periods.
Most women may sit up in a chair for increasing periods of
time from the eighth to fourteenth day, may walk about the
room, and have bathroom privileges if bathroom is nearby.
After 2 weeks they usually walk about the house and by the
end of the third week are allowed to go up and down stairs. For
a period of 6 weeks the woman should refrain from full activity.
Federal Reserve Bank of St. Louis

These are suggestive periods of time for resumption of activity
and are to be determined by the physician for the individual
case. Mild exercises in bed to tone up the abdominal and
general musculature should be carried out as directed by the
3* Individualized nursing care with separate equipment for each
patient. Sterile perineal pads, sterile water for perineal cleans­
ing, and a clean bedpan used only for one patient is good pro­
cedure. (Bedpans should be sterilized before use by another
Thorough and frequent hand-washing by the nurse is essential
in giving safe postpartum care. The wearing of masks is con­
sidered optional; if worn, masks should be frequently changed,
and should not be handled or pulled up and down as is often
No nurse, attendant, or maid with an upper respiratory infec­
tion should give care or service to postpartum patients or work
in their rooms. This should apply also to physicians.
4. Temperatures to be taken twice daily, or every 4 hours if eleva­
tion of temperature occurs. Elevation o f temperature should
be reported immediately to the physician.
5. A separate room for isolation in case of infection or suspected
6. Immediate reporting of any complications or abnormal symp­
toms to the physician.
7. A complete medical examination, including a vaginal examina­
tion at 6 weeks by the physician.
8. Adequate diet. After full recovery from the anesthetic a
general diet may be given as tolerated.
If the infant is to be breast fed, the total food intake should
be increased and more milk added to the mother’s diet. The
addition of 1 pint o f milk (making a total of 1 ^ quarts of
m ilk ), extra servings of vegetables or fruit, a second serving of
meat, some increase in bread and cereal, and a little fat will
he sufficient. Cod-liver oil or some form of vitamin D should
be continued.
9. Breast feeding, if it has been decided advisable for the mother
to nurse the child. Instruction as to the care of the breasts, the
position of the mother, the technique of feeding the infant
should be given by the nurse.
10. Follow-up medical treatment as indicated.
Federal Reserve Bank of St. Louis

(See Children’s Bureau publications 292, Standards and Recom ­
mendations for Hospital Care of Newborn Infants, and 8, Infant Care. )
The program for the care o f infants in the hospital and in the home
should include:

Medical supervision
1. Observation of the infant at delivery in regard to respiratory
difficulties or abnormalities requiring emergency treatment.
Conservation of his body heat is of great importance— a heated
crib should be ready to receive him immediately. Prophylactic
treatment of the infant’s eyes, tying of the cord, and identifica­
tion should be attended to before the infant is taken from the
delivery room.
Weighing, measuring, bathing should be delayed until later.
In transferring the infant from the delivery room, care should
be taken to keep him warm.
The premature infant must have special consideration and
care; if the home cannot give the proper care, transfer to a
hospital is indicated.
2. A complete physical examination by the staff pediatrician or
physician within the first 24 hours, or sooner if indicated. A
repeat examination should be done within the jfirst 10 days.
3. Close observation by nurse and attendants of all newborn in­
fants, particularly during the first 48 hours.
4. Examinations and instructions regarding care by the staff pedia­
trician or physician at the following intervals : every week during the first month, twice during the second month, and once
a month during the remainder o f the first year. If progress is
not satisfactory, change o f feeding seems indicated, or abnor­
mality is present, additional examinations, consultation, and
appropriate treatment may be needed.


Nursing supervision
Care should be supervised by a registered nurse experienced
in the care o f infants.


P rotection fro m infection
1. Individual nursing care. Common bathing and dressing tables
should not be used. Strict hand-washing routines should b
observed by physician, nurses, and mothers. Hands should be
washed with soap and running water before and after handling,
diapering, or feeding each infant.

Federal Reserve Bank of St. Louis

2. Proper care o f the skin of newborn infants. This is important
in the prevention o f infections. It is recommended that no
water or oil bath be given for the first 10 days after birth. The
vem ix may be gently wiped away from the folds of the skin
with warm, sterile mineral oil. Linen, diapers, and gowns
should be thoroughly clean.
3. Isolation of any infant suspected o f having an infection or ex­
posed to infection.
4. Strict limitation of number of persons admitted to nursery.
Only those giving care to infants should be allowed in nursery.
No person with respiratory or other infection to be admitted.
5. Adequate nursery space so that infants are not crowded to­
gether. There should be at least 30 sq. ft..of floor space and 300
cu. ft. o f air space per infant. When mothers are cared for in
single rooms it is good policy to care for the infant in the same
room, moving him out when visitors are admitted.
6. No dry dusting or cleaning o f rooms.
should be used.

Wet cloths and mops

Approved feeding procedures
(See Children’s Bureau publication 8, Infant Care, for
1. Breast feeding, unless contra-indicated by medical or social fac­
tors. Such factors should be evaluated for each individual
mother and baby.
2. Aseptic technique in preparation of milk feeding and other
foods. All formulas and changes in feeding to be ordered by
the physician.
A separate room or space should be provided for prepara­
tion o f milk mixtures, other foods, and water. Provision for
sterilizing utensils, bottles, and nipples, and adequate refrig­
eration for storing o f milk and food must be made,
3 . Babies should he held by nurse, attendant, or mother while
being fed; bottles should not be propped up on pillows. Ade­
quate time for sucking should be allowed.
4. Cod-liver oil or some form o f vitamin D and orange juice (or
grapefruit or tomato juice) should be given in adequate
amounts to all infants, and early— by the end of the second
week— according to the physician’ s directions. Other foods
should be introduced at the appropriate ages.
Federal Reserve Bank of St. Louis


Affection and attention
In addition to good medical and physical care, every baby should
receive, from an early age, affection and attention according to his
age and needs. Impersonal, institutional type of care should never


Clinical records
Medical and nursing records should be kept adequately.
If infants are routinely supervised in child-health conferences,
only modified records need be kept in the home.

The number and arrangement of rooms and the equipment needed
will depend upon the size o f the maternity home and the type of ser­
vices given.

F or prenatal care

If prenatal supervision is given by a physician in the home, there
should be a room or office used for medical examinations.
Equipment should include examining table, desk, filing cabinet for
records, scales, sphygmomanometer for blood pressure readings, pelvi­
meter for measurements, and equipment for rectal and sterile vaginal
examinations, blood counts, Wassermann tests, and urinalyses. Hot and
cold running water should be available.

F or delivery

There should be a separate unit used only for maternity patients. It
should include one or more labor rooms, a delivery room, rooms for
postpartum patients, a nursery for newborn infants, and the accessory
rooms necessary. The unit should be located in a part of the building
away from the regular activities. It should not be used as a passage­
way or for other purposes when not in use.
1. Labor rooms
These should be single or 2-bed rooms near the delivery room
in which the nurse can conveniently observe and care for the,
patients. Each room should be furnished as a patient’s hos­
pital room with bedside table and individual thermometer,
bedpan, and toilet articles. The bed should be of the adjustable
type with a firm mattress covered with rubber sheeting.

Federal Reserve Bank of St. Louis

Equipment for carrying out the following procedures should
be available on a tray or cart— shaving the perineum, giving an
enema, making rectal and sterile vaginal examinations, giving
hypodermics, listening to the fetal heart, and taking blood
If more than one patient is cared for in the same room, screens
should be used to insure privacy.
Infected cases should be isolated in a separate room and isola­
tion technique should be observed.
2. Delivery room
Walls, ceiling, and floors should have a smooth and durable
finish to permit frequent washing. Windows should be frosted
because during delivery they must be closed. There should be
diffuse, adequate electric lighting and a portable spotlight. It
is desirable to have the delivery room air-conditioned because
other methods of ventilation increase danger of air-borne
There should be no flame or open filament in the delivery
room because of fire or explosion hazard when volatile anes­
thetic agents or oxygen are used.
Equipment should include:
a. A delivery table— adjustable, with stirrup attachments.
b. Table for sterile instruments— metal top, rolling type.
c. Facilities for anesthesia— what is needed will depend on
the established policies in regard to anesthesia. A small
table should be available for the anesthetist.
d. Suction apparatus— with catheter for use for the mother
and a suction bulb or ear syringe bulb for use for the
e. Sphygmomanometer and stethoscope
f. Provisions for care of infant:
Silver nitrate for eyes
Sterile packet for tying cord
Heated bassinet, warm blankets
Identification method
g. Sterile supplies for delivery— sheets, instruments, basins,
h. Supply cabinet or shelves for sterile packages, instruments,
suture material, syringes, needles, repair sets, intravenous
equipment, drugs, and other equipment that should he
immediately available in case of emergency. It is prefera77
Federal Reserve Bank of St. Louis

ble that this equipment be near but not in the delivery
3. Accessory rooms
a. Scrub room.— This should adjoin delivery room and be
equipped with sink, hot and cold running water, and
liquid soap dispenser, all controlled with knee or foot
levers, and alcohol basin. A view window between scrub
room and delivery room is desirable.
b. Sterilizing room.— Autoclaves and sterilizers should be
provided for sterilization of linens, dressings, instruments,
water, and other supplies. They should be checked regu­
larly for adequacy.
c. Supply room or closet.— For storage of clean linens, sterile
packages, instruments, and medications.
d. Utility room.— This should contain a sink with hot and
cold running water, work table, hampers for soiled linen,
covered metal waste can, and so on.
e. Dressing room for doctors.

f. A nurse’s station or desk from which activities are directed,
and where records are kept. Dressing room for nurses.

F or postpartum care
1. Rooms for postpartum care should be located in the maternity
unit, so that the nursing service can be centralized and sources
o f infection guarded against.
2. Running water in each room.
3. Equipment for individual care— bed, bedside table, wash basin,
bedpan, thermometer, toilet articles for each patient.
4. Supplies of linen, blankets, sterile perineal pads, masks and
gowns conveniently stored.
5. Utility room near patients’ rooms, with sink, hopper for
emptying and washing bedpans, bedpan sterilizer, hamper for
soiled linen.

What is needed by any home will depend upon the number of new­
born infants to be cared for, the policy of using a nursery or caring for
Federal Reserve Bank of St. Louis


them in their mothers’ rooms, and the length of time the infants are kept
in the home.

Nursery— for newborn infants up to 6 weeks of age
1. Size
Nursery should be large enough to allow a minimum of 30
sq. ft. of floor space and 300 cu. ft. of air space per infant.
Bassinets should be at least 6 inches apart and as much space as
possible is desirable.
2. Location, ventilation, lighting, construction
The nursery should be near the maternity rooms, out of the
line of traffic. A glass viewing window from the passageway or
nurse’s station makes possible observation of infants without
entering room.
There should be outside windows for lighting and ventilation.
Air-conditioning is, of course, desirable. The temperatures
should be kept constant at about 80°F, with a relative humidity
of 50 percent.
Walls, ceilings, and floors should be washable.
3. Furnishings and equipment
Individual care should be given each infant, which requires
for each one a bassinet on stand with bedside table or cabinet
where all Equipment used for the infant is kept.
An incubator, commercial or home-made, for the care of a
premature infant; lavatory with hot and cold water; covered
diaper cans; work table, chairs; and linen hampers are
Supplies for caring for infants— that is, sterile oil, cotton,
blankets, linens, diapers, shirts, gowns, and so forth— are neces­
Nurses’ gowns and masks, mops and materials for cleaning,
and laundry facilities— either at a commercial laundry or in a
laundry in the home— should be supplied.


Isolation nursery
For isolation of any infant who is ill or suspected of being ill.
If there is no equipped nursery for isolation, a room may be set
up for this purpose in the small home with the usual equipment
for isolation technique.


Care o f infants in m others’ room s
The same equipment will be needed for individual care as in
the nursery.
676781° — 46— 6

Federal Reserve Bank of St. Louis

Only one mother and her infant should be in a room. Individual
care and equipment for each infant should be provided as in the
nursery for the newborn.
When visitors are present, the newborn infant should be moved
out of the room.

Care o f older infants
There should be a separate nursery for infants over 6 weeks old
if they are cared for in the home after that age^ It is, however,
preferable that they be placed in foster family boarding homes
by child-placing agencies.
No infants should be kept in the home past the age of 6 months.
Individual equipment and technique should be continued for
infants over 6 weeks of age— with individual tubs for bathing.
Running water and a work table will be needed.
If the mother plans to keep her baby, it may be wise for her
to care for him in her room from birth until both are ready for


M ilk room
There should be a separate room or space for preparing milk
mixtures and other foods, used for no other purpose. This room
should be divided into two sections— one equipped for washing
bottles, nipples, and utensils that have been used and the other
for preparing milk mixtures with aseptic technique and for storing
Equipment should include: a refrigerator (temperature kept at
4 0 °-4 5 °F ), sink, lavatory, sterilizer, bottle warmer, cupboards, and
work table.


Other space and equipm ent
The larger homes will need an examining room, nurse’s work
space, and chart room.
The smaller homes will need to make more use of the space avail­
able. Convenient arrangement and good techniques can make pos­
sible safe and adequate care without the most expensive equipment.

Federal Reserve Bank of St. Louis


The Organization o f a H om e
The focus so far has been on the residents of a home, It is now
time to consider the organization that makes possible the services to
mothers and babies. This organization is accomplished by civic-minded
men and women who, out of interest in this particular community work,
join together to sponsor and finance a home and by workers who give
the actual service. The theme of this section is the way these two
groups, volunteer directors and salaried staff, complement each other
to create and foster the services of a maternity home.

All maternity homes should be incorporated under the laws o f the
State in which they are established. The law should provide that the
secretary of State shall not issue a charter or certificate of incorporation
until the authorized department of health or welfare or both shall have
1 See Social Agency Boards and How to Make Them Effective, by Clarence King,
Harper & Bros., New York 16, N. Y., 1938, 102 pp., and Institutions Serving' Children,
by Howard W. Hopkirk, Russell Sage Foundation, New York 10, N. Y., 1944, 244 pp.
Federal Reserve Bank of St. Louis

examined and given approval to the organization applying for incorpo­
ration and shall have filed a statement to that effect. The statement
should indicate that the department considers such an organization
necessary and that the plans for service and for financing are sound.
The advantage of such incorporation is that it enables the responsible
State departments to consult with the incorporators before the plan
is put into effect. It protects individuals and the community by pre­
venting the incorporation of organizations that are unsound or unnec­
essary. Furthermore, incorporation protects the individual hoard
members from personal liability for debts incurred by the home. It
denotes permanency and responsibility for funds and property. More­
over, Federal and State income taxes make provision for deduction of
gifts to charitable corporations. In some States, incorporation is neces­
sary to permit an organization to hold property and to receive bequests.

Constitution and bylaws
The maternity home, like any well-organized body, will have a con­
stitution and bylaws. They should be adapted to the needs of the par­
ticular organization but the items usually covered include, in general:
The name of the organization; purpose; membership of the corpora­
tion; size, selection, duties, and organization of the board of directors;
time and place of meetings, and number necessary for a quorum;
appointment and duties of committees and staff; and provisions for
changes in the constitution. The constitution and bylaws should he
studied from time to time for necessary revisions in order to keep
them up-to-date. The purpose of the organization should be stated in
sufficiently broad terms to permit changes in future years in the services
offered. Both constitution and bylaws should be so worded as to
facilitate the operation of the organization rather than to retard its

Source o f incom e
The incorporators of a new maternity home should have reasonable
assurance of an adequate, continuous flow of funds before beginning
to operate. A carefully worked out budget should be prepared yearly
by the board of directors and should be of concern to each board mem­
ber. In addition, accounts of all income and expenditures should be
kept and audited regularly by an accredited firm of accountants.
The source of income may be endowment, allotments from the com­
munity fund, direct private contributions, payment from public wel­
fare departments on a per capita basis for service rendered, or fees
from residents of the home. One State has established a home sup­
ported by State funds. More and more frequently maternity homes
Federal Reserve Bank of St. Louis

have been taking part in community-fund campaigns in recent years.
This is advantageous to the home and to the total community program
because it means that the homes take part in community planning.
Furthermore, it relieves the board of the home of the responsibility
o f raising the budget and it is a sounder method of financing than
solicitation by a staff member paid for the purpose.
It is important that unmarried mothers should contribute as much
as they can to the cost o f their care and the care of their babies. Some
mothers can pay the whole fee, although the maximum amount charged
by many homes does not nearly cover the cost o f the service. Other
mothers can pay part o f the fee. No mother or baby, however, should
be deprived o f care for lack o f money nor should a girl or her family
try to pay more than they can afford.
The unmarried mother should understand clearly in advance the
amount she is to pay. She and the case worker can decide this when
they talk before the young woman comes to the home. If the applica­
tion is made by letter, great care should be taken when answering the
letter that the details of the financial arrangement do not discourage
an unmarried mother without funds from getting the care that she

The effectiveness of a maternity home as a social organization depends
not upon its buildings but upon the caliber of the board of directors and
staff and the leadership they give. Their influence is reflected in the
atmosphere of the home and in the spirit of the residents.

The functions of the board o f directors depend somewhat on the
individual home and the way in which the community is organized to
meet its social-service needs. The board is the continuing body ulti­
mately responsible for the home. In general, the directors of a home
determine the program, make policies, and establish administrative
procedures. They see that the building is kept in good repair and
properly equipped. They are responsible for the raising of funds, or
for assisting in the community-fund drive, and for the wise expenditure
o f funds. They choose, advise, and may possibly remove the executive
but they delegate to her the details o f administration and the execution
o f plans. They keep closely informed on all m ajor activities in order
to be ready to back the executive effectively when necessary. The
oard should give leadership to the community’s program for unmar­
ried mothers. It serves as a nucleus to promote a program and to ex­
plain the work to the public in all possible ways.

Federal Reserve Bank of St. Louis

Michael M. Davis, while director of medical services of the Rosenwald Fund, prepared an excellent list o f duties for board members that
has been widely used by both public-health and social agencies. The
duties are, in part: To know why the organization exists and annually
to review why it should; to govern a board or a committee through
join t thinking, not by majority vote; to give money, or help get it, o£
both; to face budgets with courage, endowments with doubt, deficits
without dismay, and to recover quickly from a surplus; to deal with
members of the professional staff as partners; to keep far enough
ahead of the community to be progressive and close enough to be
practical; to interpret the work of the agency to the public in words
of two syllables; to be proud of a tradition but eager to improve it;
and to combine a sense of obligation with a sense of humor«

Basis of selection
Board members should be chosen carefully on the basis of the con­
tribution they can make to the effectiveness of the service. Some of
the qualifications that make for valuable board members are intelli­
gence, imagination, enthusiasm, tolerance, open-mindedness, and a
willingness to learn and to give time to the duties of membership.
Boards of directors of social organizations profit by having men as
well as women members. Although some maternity homes have only
women on their boards because of the nature of the service, they would
do well to realize that men with a social viewpoint do have a contribu­
tion to make in providing service to unmarried mothers and their
babies. Men may be chosen for membership who would be particularly
helpful on legal, medical, and administrative problems.
Board members should he selected for their ability to give leadership
in community activities. Although they should be thoroughly familiar
with and convinced of the usefulness of the particular organization they
represent, they are even more, valuable to it if they are interested in the
community welfare program as a whole and if they see clearly the
relationship of their own organization to the whole program. This
wider interest may be stimulated by having at least a few of the board
members of a maternity home serve on the boards of family, children’s,
or group-work agencies or public-health agencies such as visiting-nurse

Ways of keeping dynamic
A board so organized that new members replace retiring members
at regular intervals tends to strengthen the work of the organization
by preventing its program from becoming static and by educating a
larger number of interested supporters. This addition of new members
can be made possible by a provision in the bylaws for the retirement

Federal Reserve Bank of St. Louis

of a certain number of board members at regular intervals. This may
be done by authorizing appointments for a 3-year term with one-third
of the membership retiring each year. Provision may be made to re­
elect a member after a year of retirement. By such a procedure an
organization is more likely to keep abreast of developments in the fields
of social work and medical care.
The board and staff should be constantly on the alert for individuals
who have the qualifications necessary to promote the services of the
home and who will bring fresh points of view. Although receptivity
to new ideas is not measured by chronological age, every hoard of
directors will profit by having well-qualified young members.

Number of members
The size of the board is not so important as the qualifications of its
members. Some number of members between 10 and 20 will give a
board that can function most effectively. The exact number will depend
on the organization, type, and size o f the home. A representation large
enough to serve as a cross section of the different interests in the com­
munity and to carry on the necessary work of subcommittees is a good
basis for determining the size of the board. It should not be so large,
however, as to prevent free discussion and active participation by all
members. Individuals should be chosen for their own worth, but it
is all to the good if they have active connections with professional
groups, service clubs, labor unions, or civic organizations,

Officers and committees
Certain officers and committees are necessary in the administrative
organization of a board. There should be, of course, a president,
selected on the basis of leadership, ability to stimulate and hold the
interest of others, and broad interest in the total planning for social
services in the community.
The treasurer is responsible to the board for the finances of the
home. After the program has been planned for the coming year, a
budget should be developed to provide adequate funds. Full accounts
o f money received and disbursed will be audited by a public accountant
at regular intervals. In addition, it will be helpful in informing the
public how the money is spent if the receipts and expenditures can be
analyzed so as to form a clear picture of the cost of the various services.
The secretary is appointed to keep minutes o f board meetings and
to take care of the correspondence that has to do directly with the
activities of the board.
To make the board function effectively, certain committees will be
given specific responsibilities. The executive committee can act on
matters that need consideration by a small group before they are pre-

Federal Reserve Bank of St. Louis

sented to the whole board. This committee can also act in an emergency
when it is not possible to arrange for a meeting of the whole member­
ship. It will also carry out certain recommendations of the board.
Other committees will be needed, depending on the way the work of
the particular home is organized. Committees encourage participation
of individual board members and get certain tasks done that can be^
handled more expeditiously by a small group. A well-run board, how­
ever, does not have to undertake activities that should be handled by
the executive o f the home or other members of the staff.

It is best to hold meetings frequently and at regular intervals. A
plan of the points to be discussed or acted upon should be carefully
worked out in advance by the president with the help of the superin­
tendent of the home. The superintendent will, of course, attend all
board meetings for the full session to present facts about the work of
the home and to take part in the discussions. Other members of the
staff will be invited to attend when matters are to come up that touch
their work. The social worker responsible for case-work service should
be present to enter into the discussion when policies and procedures are
considered that affect the welfare of mothers and babies. These occa­
sions give the board members a chance to become acquainted with all
members o f the staff.
Many problems involving the operation o f the home will come to
the attention o f the board. Meetings, however, are more fruitful if
they are not devoted entirely to these items. Meetings are opportunities
for furthering the board members’ understanding of services to unmar­
ried mothers. This understanding may be brought about in a variety
o f ways. For example, specialists from related professional groups may
be invited to speak on certain topics. These talks are particularly
helpful if they are followed by discussion. A few suggested topics are:
Current trends in case-work philosophy; understanding the adolescent;
planning for babies b o m out o f wedlock; resources in the community
that can be used by a maternity home, including the specialized services
o f a psychiatrist or a psychologist; public-health developments; ways
in which State departments of health and welfare can assist maternity
homes; and new patterns in group-work and leisure-time activities.
Several members o f the board might report on current magazine
articles or newspaper feature stories that have a bearing on the work
o f the home. Or a member might report on a visit to a maternity home
in another city or on a pertinent lecture or conference he had attended.
In other words, if board members are to grow in knowledge and use­
fulness, they need the nurture given by constant alertness to all that is

Federal Reserve Bank of St. Louis

related to their responsibility and by sharing the results of this alert­
ness with their fellow members.

.Kind and number
The kind and number o f staff o f a home depend upon the number
o f mothers and habies cared for, the quality of the care given, and the
services obtained through other community resources. A home accom­
modating as few as from 15 to 30 mothers and babies has the advantage
of being able to create a homelike atmosphere. In a small home with­
out hospital facilities, a staff of three is necessary. One person— in
most homes known as the superintendent— is in charge. The assistant
superintendent is usually responsible when her superior is absent and
has direct responsibility for the smooth running o f the home in all the
aspects of household management.
Because of the nursing service involved in giving prenatal, delivery,
and postpartum care to the mothers and care to newborn babies, every
home should employ at least one registered graduate nurse. (See
Health, and Medical Services for details on medical and nursing staff.)
In some very small homes the position of superintendent and nurse is
combined, although this combination does not always make for effec­
tive service, centering as it does too much responsibility in one person.
Other workers are needed to do the heavy work of the home and
to give the additional service that is necessary at certain times. Their
number depends on the number o f residents the home can accommodate
and whether or not the mothers are delivered o f their babies in the
Staff members living in close association with unmarried mothers
24 hours a day can either make this experience for the young women
a constructive one that justifies the expense o f services in time and
money, or they can he so unequal to their jobs that they make the
residents’ stay in the home merely an endurance test. It is important,
therefore, for the board to analyze carefully the duties of each staff
member and the qualifications necessary for the satisfactory perform­
ance of these duties as the first step in filling the positions effectively.

The executive
The superintendent is the person who makes the wheels of admin­
istration and program turn. She has to be constantly on the alert for
lys to improve the home’s policies, procedures, and program. In
most homes she has the responsibility for selecting, training, and super­
vising the other staff members. She is responsible to the board of
directors for the satisfactory performance o f her staff in their jobs.
Federal Reserve Bank of St. Louis

Her leadership and enthusiasm carry over to the staff and minimize
the tensions that are bound to arise.
The superintendent is in close touch with the board of directors,
attending its meetings and submitting reports on various phases of the
work in order to keep the directors in touch with the major activities
of the home. She will think out ways of sustaining the interest of theboard in the whole field of care for unmarried mothers. For example,
she may report on meetings and conferences she attends, sharing with
the directors the new information and ideas she gains in this way. Or
she may stimulate individual board members to join actively in local
and State efforts to win more tolerance and more adequate services for
unmarried mothers and for children born out of wedlock. She and
the case worker together, because of their close relationship with the
mothers in the home, are responsible for making clear to the board the
needs of the residents for special services.
The superintendent is responsible also for the supervision of all
aspects of the housekeeping, including the planning of nutritious meals
under instructions of the physician for amounts and kinds of food
required by pregnant women. Many of the young women in the home
will not be in the best physical condition when they enter and will need
especially nutritious food to prepare them to go through pregnancy
and delivery and to have healthy babies. (See Health and Medical
The training and previous experience of the superintendent are im­
portant. She need not be a nurse, teacher, or social worker; she must
know when to call on specialists and how to utilize their services. It
would be helpful if all superintendents could have some professional
training in social work or at least some experience in a case-work agency
of high standards. If the superintendent is a nurse, it would be helpful
if she had professional training and experience as a public-health
nurse. Any shortage of case workers and nurses, however, will make
these requirements impracticable. More important than ever, there­
fore, is the ability of the superintendent, whatever her qualifications,
to distinguish between the work she is equipped to do and the assistance
she must obtain from professionally educated specialists.
In this division of labor, less confusion will probably arise in regard
to the physical care of the mothers than in the social planning for their
welfare and the welfare of the babies. This point has been discussed
earlier in The Value of Case-Work Service, but it can be reemphasized
here that the superintendent, engrossed in the responsibility of running
the home, is likely to have neither time nor energy, even if she h fd
qualifications, to give case-work service.
A superintendent is most useful to the home if she appreciates vari­
ous professional skills and knows when to accept professional opinion
Federal Reserve Bank of St. Louis

without question. Although no superintendent would question a
physician s judgment about the necessity for surgery, some superintend­
ents fail to recognize the value of other professional judgment on mat­
ters that will chart the course for the whole future of mother and child.
f They also fail to realize the interdependence of medical and social
Jfkills in giving a mother the best possible basis for her decisions. It is
a superintendent s responsibility to see that all phases of the young
woman s problems are considered professionally.
The superintendent s personal qualifications are of great consequence.
Broad cultural interests will help a superintendent to bring new inter­
ests to the residents of the home and to be effective in her relationships
with staff, members of the board, and others in the community.
One of the most significant— and least tangible— phases of the su­
perintendent s work is her relationship with the young women in the
home. Many of them are very young and many have had an unhappy
relationship with their own mothers. Some of this latter group will
look to the superintendent for the kind of refuge and strength they
would expect from their mothers. She will become to them a person
to admire and to pattern themselves after. Without realizing it, per­
haps, their trust in her grows out of her ability to accept them at their
current stage o f development and out of her complete freedom from
desire to punish them by word or deed for a point of view or behavior
different from her own standard of conduct.
The ideal executive of a home is the kind of person who can quickly
establish a friendly relationship with others. She is mature emotion­
ally but is not necessarily old in years. She is sensitive to the feelings
of others and realizes the meaning of an adolescent’s deviation from
normal behavior. Her understanding of the difficulties an unmarried
mother has faced and will face makes her tolerant of aggressive behavior
in the home. She knows how to help the residents individually and
how at the same time to promote the welfare of the group. She knows
when holding to regulations is essential to the smooth running of the
home, and when modifying them in the interest o f an individual mother
in a specific situation is wise. Her fundamental approach is one of

Personnel practices
The personal qualifications of the other staff members should be
similar to those of the superintendent in many ways, because they also
have close association with the residents of the home. The vocational
^ills of the others will vary, however, because of the different tasks
that they are employed to do. (For the responsibilities of the medical
and nursing staff see the section, Health and Medical Services. )
If a home is to have a well-qualified staff, the conditions of employ-

Federal Reserve Bank of St. Louis

ment must be such as to make the work a satisfying experience. Such
procedures as arrangements for vacations, sick leave, and accident insur­
ance coverage that are in keeping with the policies of other social
agencies in the community should be explained at the time a staff mem­
ber is employed. The board of directors should follow consistently the
practice of handling all matters directly with the superintendent/,
instead of taking them up directly with other staff members. Likewise,
the superintendent should be responsible to the entire board rather
than to any one member or one committee. Unless basic considerations
like these are adhered to, the staff can easily be at the beck and call of
a number of different directors— perhaps making conflicting requests.
Staff members who live at the home should have comfortable quarters
and as much privacy as possible. Working hours should be reasonable.
It would be well if arrangements could be made for staff members to
spend at least one regular day a week and one week-end a month away
from the home. If this particular-arrangement is not convenient, some
reasonable amount of free time should be allotted regularly so that staff
members may return to the home refreshed. Additional persons should
be planned for to take the places of the workers who are away.

The plant and equipment of a maternity home are of consequence to
its program. They influence the ease with which work can be done
and, in general, create the atmosphere of the home. The type of build­
ings and equipment, however, is not so important as the way in which
the two are used. Some homes are giving excellent service in plants
that are old and unsuited to their present use. Others have modern,
well-equipped buildings but outmoded programs for the residents that
are out of keeping with the excellence of their physical plants. The
spirit of the home is its value.

Kinds of buildings
Many homes are at present housed in buildings that are not designed
for this purpose; they were formerly private residences. Some of these
houses may be well adapted to their current use, but others may lack
facilities to give proper care to pregnant women and to babies. This is
particularly true if the home attempts to provide delivery service rather
than to send the mothers to a hospital. In addition, the living quarters
may be inadequate and inconvenient. There may be too few bath­
rooms, stairs may be too steep, and living and sleeping quarters may
overcrowded. The advantage of using a former residence is that the
number of young women accepted is usually small and the place can
have the atmosphere of a family home rather than of an institution.

Federal Reserve Bank of St. Louis

All laws and regulations having to do with fire hazards and health
should be observed with particular care in these remodeled buildings,
These protections should, of course, be assured in all homes but are
easier to accomplish in a building designed as a maternity home.
Another type of building used for the care of unmarried mothers is
obviously institutional. Such a “ home” may be a unit in itself, set apart
m a suburban section or in the midst of a crowded city district, or it
may be one unit of an institution that also has a maternity hospital and
a home for infants. Although this latter arrangement may be very
satisfactory because the building can be made homelike, it is more apt
to have grave disadvantages that require wise planning to overcome.
These institutions are usually located on downtown streets that were
formerly residential or in neighborhoods that have deteriorated since
the institution was founded and are no longer suitable for the program.
Furthermore, housing the unmarried mothers in part of the institution
offers a temptation to have them do the household work of the other
units. This plan may be advantageous to the institution but defeats the
true social purpose of a maternity home. An even less desirable place
for group care of unmarried mothers is one wing or a separate floor of a
Maternity homes are located in all kinds of neighborhoods, it has
just been pointed out, some obviously unsuited as places o f residence
for young unmarried mothers. The home should be in a location in
which the mothers can feel comfortable on the streets and can be free
to go and come unaccompanied by a member of the staff.
The grounds of the home, although they need not be large, should
be large enough to permit the entire group of mothers to spend much
of their leisure time out o f doors and to give the babies their quota of
fresh air. It is an advantage if the grounds are large enough for recrea­
tional equipment. Trees, shrubs, and flowers will make the garden space
attractive. This attractiveness can he accomplished without too great
an expenditure of money if space and soil permit and especially if some
member of the board has the imagination and enthusiasm to promote
the project.

Interior of a home
The rooms of the building should he decorated and furnished in good
taste in a way to be as inviting and homelike as possible. Anyone who
has visited a good number of homes will have flashes of memory of some
cheerful spot in some particular home that have nothing to do with
a modern building or expensive furnishings but everything to do with
homemaking ability. Memory may recall a sunshine-flooded dining
room furnished with small tables for four. The bright windows are

Federal Reserve Bank of St. Louis

curtained in excellent taste and the walls and furniture are painted a
soft, pleasant color. A room young women would like— and do. Or
memory may show again the wonders done in a huge dormitory that
used to house the mothers en masse. The big room has high ceilings
and good ventilation and its wide open spaces have been transformed
into small bedrooms by the use of temporary walls. These airy, cheer­
ful bedrooms have become “ home” to many a young woman who never
before knew the privacy of a room of her own or had even a place to
put her possessions.
Although these pictures are of physical backgrounds, they reflect the
thoughtfulness of those who direct a home towards its residents in try­
ing to make a livable, pleasing atmosphere in spite of adverse housing
conditions. Even in old buildings ingenuity, a knowledge of color
values for choosing curtain materials and paint for woodwork, and a
sense of simplicity in decoration that makes the total effect of color
and design in the home a unity can make the difference between a drab,
repelling interior and a welcoming one.

The rooms of a home
Certain rooms are required to carry on the activities of a home. Space
and equipment for the health and medical program are listed in detail
in another section, Health and Medical Services. This discussion is of
the other quarters.
The superintendent will need an office in which privacy is assured
for interviews with residents and staff members. She will need a desk,
of course, and lockable files for records and other confidential papers.
If the home employs its own case worker, she, too, should have an office
in which the mothers would feel free to talk to her about confidential
Some homes will have their own chapels, around which the religious
activities of the residents center. Other homes will use the living room
for religious services and other gatherings. For this reason, the living
room should be large enough to accommodate easily the whole number
of residents. It might well have comfortable davenports and chairs and
the other furnishings that a family home has when the homemaker
gives thought and time to her family’s convenience and pleasure. This
room should have a piano, radio, phonograph, and plenty o f records
of music that young women would like. Readable books and magazines
suited to different grades of intelligence and types of interest should be
readily accessible.
One smaller room, and preferably more than one, should be set asid^j
for young women to read and write letters, listen to music away from
the group or entertain their friends. The larger homes, especially those
built for their present purpose, should have a recreation room with

Federal Reserve Bank of St. Louis

suitable equipment. Smaller homes may have to combine the living
and recreation rooms.
A pleasant dining room is a necessity. Tables for four are desirable,
shared by staff members and residents. Mealtime should be cheerful__
not a time to settle the problems of the day.
Many who are interested in maternity-home care believe that each
resident should have her own bedroom. This not only insures privacy
and the rest that is required in pregnancy, but gives a young woman a
sense of pride in caring for her room that she can carry over into her
own home later. Many of the unmarried mothers have lived in such
crowded homes that they have never known what it means to have one
spot they can call theirs. A resident should feel free to spend time in
her own room and to have her own things there. Each resident will
need, as a minimum in the way of furniture, her own bed, chest of
drawers, mirror, and chair. If she does not bring toilet articles with
her, inexpensive but attractive ones should be given to her to keep.
One argument advanced against single rooms is that unmarried
mothers may become morose and lonely in rooms of their own. The
answer is that if a mother is in a depressed state, she needs assistance
from a case worker or a psychiatrist rather than the company of a room
mate. The home that has an adequate program of activities and a
happy, friendly atmosphere will have few young women who fear to
be alone. (See New Interests Through Group Activities.) If single
rooms are impossible in a home, not more than two or three residents
should have to share a room. Some of the older, institutional type of
homes, built when dormitories were in vogue, may be able to divide the
space into single rooms by partitions. Even screens or curtains are
preferable to one large open space, but care is required to insure satis­
factory ventilation.
Fully adequate hath and toilet facilities should be located con­
veniently near the bedrooms. Both tubs and showers are desirable,
one or the other to be used in accordance with the physician’s recom­
mendation. Even the detail of having enough towel racks is of con­
Suitable living quarters will, it has been said, be provided for the
staff to insure as much privacy and quiet as possibly. In some homes
a common living room for the staff seems best, but in others, the staff
may prefer to have day beds so that they may use their rooms as sitting
rooms. A chance to relax and rest in comfort for even short periods of
time means a great deal to workers who live where they work.
Efficient food service calls for not only a well-arranged kitchen but
a separate room for storing staple and canned goods, adequate refrigera­
tion facilities, and provision for prompt disposal of garbage and other
waste. Good lighting and proper ventilation make it possible to work

Federal Reserve Bank of St. Louis

with a minimum of fatigue. Plumbing and facilities for storing and
handling food should conform to local sanitary regulations, copies of
which are available from the department of health.
If residents are to participate in food preparation and serving, extra
care should be given to removal of accident hazards. Even in homes
that are not equipped with modern facilities and that have little money
to spend on improvements, good planning will eliminate or greatly
reduce the number o f accidents caused by swinging doors, slippery
floors, and unprotected equipment.
Other rooms may be necessary in addition to those mentioned,
depending on the program of the home. Some homes for instance,
will equip schoolrooms if young girls are accepted for care and if t e
home finds it possible to get a satisfactory teacher.




Have maternity homes kept pace during the last 6 decades with the
advances in social and medical sciences to which they are allied,
especially in the understanding of human behavior as it has developed
in these fields? That question is not meant to be answered, of course,
because in none o f the factors can the advance be measured accurately
enough to warrant comparison. But the thought behind the question
may be seen constantly between the lines of this bulletin. The pages
suggest some specific goals for strengthening the services given to unmar­
ried mothers in maternity homes. The goals are quite obtainable with
good planning. They are, in brief, to utilize for the residents sound
advances in social service, obstetric and pediatric medicine, and the
results of psychiatric research through the practical applications
3.V il l l

1^ e

Maternity homes, beginning as places of refuge that shut themselves
away from the life of the cities surrounding their walls, are now becom­
ing an articulate force in influencing social justice. What group knows
better than their directors and staffs how unfair the world can be to
unmarried mothers and to boys and girls who start out in life with
the heavy, society-placed burden o f illegitimate birth?

■fr U. S. Government Printing Office : 1946— 676781

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