Full text of Prenatal Care, Bureau Publication No. 4

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UNITED STATES DEPARTMENT OF LABOR
JAMES J. DAVIS, Secretary

U ^ S .CHILDREN’ S BUREAU
I t f

GRACE ABBO TT, Chief

PRENATAL CARE

i

U N ITE D STATES
GOVERN M EN T PR IN T IN G OFFICE
W ASHINGTON : 1930

For sale b y the Superintendent of Documents, Washington, D . C,


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SEE THAT THE BIRTH OF YOUR BABY IS REGISTERED
It is of the utmost importance to have the birth o f your baby promptly and
properly registered. This should be done within 36 hours after the baby’s
birth.
In most States the physician,, midwife, nurse, or other attendant is required
by law to report the birth to the local registrar, who will see that the date
of birth and the child’s name, together with other related facts, are made mat­
ters o f public record. . Birth registration is necessary in order to prove, among
other things, the child’s age and citizenship, his right to go to school, his right
to go to work, to inherit property, to marry, to hold office, to obtain passports
for foreign travel, and to prove his mother’s right to a pension, if she is a widow.
Parents should make sure that this protection o f fundamental rights is assured
to every child born to them. I f there is any doubt about whether the birth
o f a child has been registered, an inquiry may be sent to the State board of
health at the State capital, where the records are filed. I f the birth has not
been reported the board will furnish a blank to be filled out and returned.
It is suggested that a memorandum be made below of certain facts recorded
in the birth certificate.
Baby’s nam e_______________________________________________________________
Father’s nam e_______________________________________ ____________ — _ _
Mother’s maiden nam e_____________________________________ _____________
Sex of b ab y ________________________ ________________________________________
If twin or triplet, give number in order of birth---------

-----------------------

Date of baby’s birth________________________ _____________________________
(Month)

(Day)

(Year)

Birthplace:
City, town, or village________________________________________________
C ounty______________________ ____________ _ ;

--------------------------- -------

State______J___________________________________________________________
Attending physician:
N am e________________________________ _________________________________
Address__________ _______________________________________________ _____
Baby’s registered n u m b e r._______________________________________________

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CONTENTS
Page

Letter o f transmittal______________________________________________
Signs o f pregnancy_____________________________________ ___________
Duration o f pregnancy_________________________ I ____ __________ _
Engaging the doctor and the nurse______________________________
Importance of physical examination________________________
Importance of medical supervision throughout pregnancy.
Selection of a nurse_______________ ___________________________
The hygiene of pregnancy________________________________ _»___ pi..
D iet_______________________________________________________ —
Exercise and rest___________________________________________ _
Clothing_________ _______i______ ________________________________
Care of the bowels___________________________________________
Care o f the kidneys__________________________________________
Baths and care of the skin__________________________________
Care o f the teeth________ ___________________________________
,
Care of the breasts______ ______________________ _____ i ________
Intercourse during pregnancy____ __________ ________________
Mental hygiene____________________ ________ ____ - ___ _________
Home or hospital for the delivery___________ ____ - ________ 4___
Supplies and equipment_______________________________ ,JL
§1—
The delivery room and its equipment____________ - ____ ____
Supplies for the mother------------------------------- jl-------- :---------Supplies for the baby___ ____________________ _______ ________
Common disorders of pregnancy_____________________________p l l
Nausea and vomiting_________ *______________________ ■&_'___,a.
Heartburn______________________________________ _______ — ___

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Varicose veins and piles_____________ __________ - - - - r---------- Cramps in the legs_______________ 4 - - - ___________ ___________
Relaxation of the pelvic joints------------------------- -------------Leucbrrhea______________________________ 4 - _______________ §___
Complications of pregnancy________________ _____._________________
Toxemia ____________________________ _________ ^ ___- ------------------ M iscarriage________________________ - ______________________
Bleeding in pregnancy--------------------- __________________________
Birth of the baby__________________ ^______________________1---------- ,
Precautions that must be taken_______________________ .____
Labor________________ — --------------.----------------------- 44 j ---------- Emergencies________________________ .__________ Js---------- — —
------First care o f the newborn_______________________________________
Nitrate of silver for the baby’s eyes------------------------------------Bathing the baby________ •=-------- _ _ -------------------------- ----------- 1—
The baby’s stools---------------------------- -------- -— ------------------ -—
Lying-in period____________________________________________________


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IV

CON TEN TS

Nursing the baby_______________
Advantages of breast feeding over artificial feeding___________________
C olostrum _____________._____________________________________________________
Position for nursing____________________________
Feeding schedule___________________________________
Care o f the breasts______ • ____________________ ___________________________
The baby’s progress________________________________________________________
Hygiene of the nursing mother_____________________________________ .__________
A day’s food plan for the nursing mother_______________________________
Healthful living especially important for nursing mothers_____________
Temporary decrease in milk supply no reason for weaning____________
Premature delivery and the care o f the premature baby______ ___ __________
Keeping the baby at normal temperature________________ ______________
Protecting the baby from infections_____________________________________
Feeding the baby____________________ ______________________________ _____
Sun baths______________________________________ _________________ ______ .J.___
The baby’s later development_______________________________
Selected books of interest to mothers_________________ _______ ^___________ _____
G lossary___________________________________________________________________._____
Index_______________________________________________________


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LETTER OF TRANSMITTAL
U. S. D epar tm ent

of

L abor,

C h ildr en ’ s B u reau ,

,

W ashington, Septem ber 26 1930.

: There is transmitted herewith a complete revision o f the bul­
letin Prenatal Care, originally published in 1913 as the first o f the
Children’s Bureau series on the care o f children.
This revision is the work o f Dr. Robert L. De Normandie, chair­
man o f the bureau’s advisory committee o f obstetricians, in coopera­
tion with the members o f the committee and with Dr. Blanche M.
Haines, director o f the maternity and infant hygiene division o f the
bureau. The members o f the committee are: Dr. Robert L. De Nor­
mandie, instructor in obstetrics, Harvard Medical School, chairman;
Dr. Fred L. Adair, professor o f obstetrics and gynecology, Univer­
sity o f Chicago; Dr. Rudolph W. Holmes, professor o f obstetrics,
Northwestern University Medical School, Chicago; Dr. Ralph W.
Lobenstine, chairman medical advisory board, Maternity Center
Association, New Y ork; Dr. Frank W . Lynch, professor o f obstetrics
and gynecology, University o f California Medical School; Dr. James
R. McCord, professor o f obstetrics and gynecology, Emory Univer­
sity School o f Medicine, Atlanta; Dr. C. Jeff Miller, professor o f
gynecology, Tulane University o f Louisiana School o f Medicine, New
Orleans; Dr. Otto H. Schwarz, professor o f obstetrics and gyne­
cology, Washington University School of Medicine, St. Louis; Dr.
Alice N. Pickett, assistant professor o f obstetrics, University o f Louis­
ville School o f Medicine, Louisville. Assistance vas also received
from Dr. E. V. McCollum, professor o f biochemistry, School o f
Hygiene and-Public Health, Johns Hopkins University, who read
the manuscript and made valuable suggestions on the'diet section.
Respectfully submitted.
G race A bbott, Chief,
S ir

H on. Jam es J. D

a v is ,

Seereta/rp o f Labor,


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PRENATAL CARE
Prenatal care is that part of maternal care which has as its object
the complete supervision of the pregnant woman in order to preserve
the happiness, health, and life o f the mother and child. What this
prenatal care should be is the subject matter of this book.
More important than anything else in planning the best possible
care for mother and child is that the mother should go to a doctor for
examination and advice just as soon as she thinks she is pregnant and
should remain under his constant care until the baby is born. This
book is not meant to take the place of this medical care. It is
written in the hope that it will be helpful to those expectant mothers
for whom medical aid is not at hand, and to those doctors who may
wish their patients to have it as a supplement to their instructions.
SIGNS OF PREGNANCY
Early signs that a pregnancy is probably present are these:
1.
2.
3.
4.

Missing a monthly period.
Changes in the breasts.
Nausea or vomiting—“ morning sickness.”
Desire to pass urine more often than usual.

The first is the most significant. The missing o f the monthly, or
menstrual, period is especially suggestive o f pregnancy in the case
o f a woman who has always had regular, normal monthly periods,
and has had a recent opportunity o f becoming pregnant. The miss­
ing o f two monthly periods, one after the other, makes pregnancy
more probable.
At the time o f the first skipped period the breasts often get a little
larger. They may also be tender to the touch and may have a sting­
ing or prickling feeling. I f the breasts have never felt like this
before during the monthly period, the feeling is probably another
sign that pregnancy exists.
A feeling o f nausea, or sickness o f the stomach, sometimes with
vomiting, is a very common early sign o f pregnancy. Most women
who are troubled with this nausea feel it in the morning, and it is
commonly called “ morning sickness.” Some women feel it in the
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P R E N A T A L CARE

late afternoon or early evening. And some women do not feel it
at all.
The desire to pass urine more often than usual is very common early
in pregnancy. Women when pregnant sometimes have to get .up
during the night to pass urine who before had been able to sleep
right through the night.
When all four o f these signs appear, the woman is probably preg­
nant. A doctor can give a more definite opinion, however, after he
has made an examination by the vagina, which is the lower part o f
the birth canal. This examination should always be made early in
pregnancy, as it enables the doctor to make sure that the pelvic
organs— those parts o f the body directly connected with child­
bearing—are in good condition and position.
A t about four and a half months the mother can usually “ feel
life ”—that is, feel the baby move in the uterus, or womb, the organ
in which it develops. This movement, which is also called “ the
quickening,” is a fairly certain sign o f pregnancy. The movement
o f gas in the intestines, however, may cause a feeling so similar that
a woman may mistake it for the quickening. The positive signs that
a woman is pregnant are feeling the baby move and hearing the
baby’s heart beat. These can be determined by>a doctor’s examination
about the fifth month or sometimes earlier.
DURATION OF PREGNANCY
The probable length o f pregnancy is about 40 weeks, or 280 days.
I f you count 30 days to the month, the 280 days come to just a little
more than the 9 months commonly spoken o f as the period o f preg­
nancy. You may determine the probable date o f delivery by counting
back from the beginning o f the last monthly period 3 calendar months
and adding 7 days. For example, if the last monthly period began
on October 30, counting back 3 months to July 30 and adding 7 days
gives August 6 as the estimated date o f confinement. Many babies
are born a few days earlier or a few days later than the expected
date, some as much as 2 or 3 weeks later. In these cases the usual
explanation is that the pregnancy began in relation to the period
that was missed and not from the last period that appeared. There­
fore, if the delivery does not come when it is expected, there is no
reason, in by far the majority o f cases, to think that anything is
abnormal; it usually means that the patient did not become pregnant
as early as it was thought.


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ENGAGING THE DOCTOR AND THE NURSE
As soon as a woman thinks she may be pregnant she should choose
her doctor and go to him at once for a complete physical examination
and for advice as to the hygiene o f pregnancy. A t this first visit the
doctor will ask her many questions about her medical history— what
diseases and operations she has had, i f any, with special detail for
any involving the abdomen or the pelvis; whether her monthly
periods have always been regular and normal ; whether she has been
pregnant before, and, if so, when her pregnancy and labor occurred

and what they were like. He will also ask her the date and character
o f her last monthly period, for from this he will estimate the date of
delivery.
IM P O R T A N C E O F P H Y S IC A L E X A M IN A T IO N

A complete physical examination will include— besides an external
abdominal and an internal pelvic examination and measurements of
the pelvis, or bony framework—an examination o f the teeth, tonsils,
throat, thyroid, heart, lungs, kidneys, and digestive organs, taking
o f blood pressure and weight, and testing; o f the blood. This
examination is most important for the mother’s well-being, for it
enables the doctor to find out whether her organs are in good condi4063°— 3 0 ----- 2
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P R E N A T A L CARE

tion and to start treatment at once if anything is wrong. Moreover,
i f the physician knows his patient’s condition early in pregnancy,
he will be able to discover slight changes at later examinations if
they appear and interpret them intelligently. Pregnancy and labor
are normal functions o f the body and do not normally interfere with
health; in fact, many women are in better health after pregnancy
than before. However, pregnancy must be carefully and constantly
watched, for it may become abnormal very quickly and will then
require special treatment to insure a happy outcome for mother and
child.

The doctor taking the mother’s blood pressure
[Many doctors take the blood pressure with the patient lying down.]

IM P O R T A N C E O F M E D IC A L S U P E R V IS IO N T H R O U G H O U T
PREGNANCY

It is at this first visit that the doctor will go over with the expect­
ant mother the hygiene of pregnancy, or prenatal care. He will
explain to her why she should go at once to a good dentist. The
doctor will tell her when he himself wishes to see her—at least once
a month during the first six months, every two weeks or oftener in the
next two months, and every week in the last month. He will explain
to her what he will do at each visit— look into her general condition,
take her blood pressure, analyze her urine, and carefully weigh her.
The plan that will be followed should be carefully talked over by
the doctor and the expectant mother, and she should feel free to ask
about its cost. I f she can not afford to go to a private physician,
she should go at once to a prenatal center or clinic. She should
report to the clinic as required and should follow absolutely the
directions given to her at the clinic just as she would the instructions
o f a private physician.


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5

I f a woman finds it impossible to see a doctor as often as has been
advised, it is highly important that she should be in close touch with
a district or public-health nurse who will observe her and report any
suspicious symptoms to the doctor in charge.
S E L E C T IO N O F A N U R S E

I f she has decided to have the baby at home, she will want a nurse;
and the doctor can probably suggest one, for most doctors have on
file the names o f good nurses that have worked with them. A pri­
vate nurse should be engaged some time before the expected date of
delivery; and as this date is uncertain it is well to have a definite
understanding when her pay is to begin. The nurse should visit the
home a few weeks before the baby is expected and make herself
familiar with the rooms and the arrangements for the birth. She
will be needed for a longer or a shorter period in different cases;
but as it is important that the mother should rest and be relieved o f
strain for the first weeks after childbirth, it is worth stretching a
point financially to keep the nurse as long as she is needed—two weeks
at least and three or four weeks in some cases. In many places, par­
ticularly in large cities, a nurse from the visiting-nurse association
will come as needed and is paid only a small fee for each visit. I f
the confinement is a normal one and there is some one to do the
housework, the needs o f mother and baby may be provided for in
this way very well and much more cheaply than when a trained
nurse is employed for the entire time. Other forms o f nursing serv­
ice may be had in different communities; some are good and some
are not so good. But the best nursing that she can have is what
the expectant mother should plan for.


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THE HYGIENE OF PREGNANCY
Simple rules for keeping well during pregnancy are given by the
doctor at the first visit o f the expectant mother. The details that
he would tell her about if he had all the time that he would like
are set down here for her to read and refer to. She must remember
that she is like an athlete in training for a race or a swimming con­
test, who lives according to rules worked out with the test that he will
have to meet in mind. Her test is her confinement, and the goal is
health for the baby and herself.
D IE T

During the pregnancy nature is building a new person. The
mother supplies the building materials in the form o f nourishment
which passes through the placenta (afterbirth) to the growing baby.
Therefore her diet must have in it the foods which contain the proper
kinds o f building materials. A woman may live in fair health on a
diet upon which she can not nourish an unborn baby and keep her
health. I f the baby can not get what he needs from the mother’s
food, he will take it from her body. This means that the mother
will be undernourished and, perhaps, her teeth will suffer. Neither
o f these things needs to happen if she eats properly and was in good
health at the time o f conception.
E S S E N T IA L

ELEM ENTS

IN T H E

D IE T

The diet at all times should contain sufficient amounts o f tissue­
building substances (proteins), starches (carbohydrates), fats, min­
eral matter, and the essential food elements known as vitamins.
During pregnancy the diet should contain an extra amount o f min­
erals and vitamins. The foods that are needed for building bones
and other body tissues are milk, whole-grain cereals, eggs, fruit, and
green vegetables like spinach and lettuce. These essential growth
foods, which safeguard the bones and teeth, brain, and muscles o f
the baby, can be increased in the diet without necessarily increasing
the total amount o f food taken daily. Many persons in this country
live mainly on a faulty diet o f bread, meat, potatoes, and sugar.
Milk, green vegetables, and fruit are needed to supply the defects
o f such a diet, which is especially poor in vitamins and minerals,
the food elements in which the diet o f the expectant mother should
be especially rich.
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THE VALUE OP MILK

I f plenty o f green leafy vegetables are eaten daily, a quart of
milk a day (including what is used in cooking and on cereal) will
give the mother enough calcium (lime) to insure her own bones and
teeth against injury in supplying the baby’s needs. It seems prac­
tically impossible for the pregnant woman to get enough calcium in
her diet unless she takes daily at least a pint o f milk or its equiva­
lent. Milk is superior to any other single food in its combination
o f protein value, abundance o f calcium and variety o f other min­
erals, and richness in vitamins. The use o f milk in cooking cereals,
soups, white sauce, custards, puddings, and cocoa helps to put the
needed quart in the daily food. Skimmed milk, buttermilk, or cot­
tage cheese made with rennet may be used instead o f whole milk if
butter or cream is used. When good fresh milk is not available,
milk powder or evaporated milk may be taken. Some women who
dislike milk may find mixing milk powder with other foods the
easiest way in which to obtain the required amount.
Butter (not butter substitute) or cream served on food adds greatly
to the vitamin as well as the fuel value o f the diet.
WHOLE GRAINS

Whole grains have a high mineral and vitamin content. For this
reason, and also because they help to regulate the bowels, it is well
for the pregnant woman to have at least part o f her breads and
cereals made o f whole grains.
GREEN LEAFY VEGETABLES

The green leafy vegetables, such as spinach, chard, lettuce, endive,
cress, cabbage, kale, collards, cauliflower, Brussels sprouts, string
beans, dandelion greens, turnip tops, and beet tops, have a greater
\alue in the diet than tubers (such as potatoes), or root vegetables
(such as carrots), or legumes (such as peas and beans).
SAMPLE MENUS

I f all expectant mothers are divided into three groups according
to their weight at the beginning of pregnancy, they may be called
underweight, average, and overweight. Their diets should vary in
fuel value, which is measured by a unit called calories, from 4,000
calories a day for the underweight woman to 2,000 calories for the
overweight woman. What may be called the first 1,000 calories
should be the same for all, however, as they constitute the daily die­
tary essentials for growth: One quart o f milk, one raw-vegetable


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P R E N A T A L CARE

salad, one egg, one-half grapefruit or an orange or tomato, one
cooked green leafy vegetable, and one serving o f cereal or bread.
I f meat or fish, potato, sugar, fruit dessert, and bread and butter
are added to these essential foods, the diet will be sufficient in cal­
ories and adequate in the growth essentials for the average expectant
mother. A sample day’s menu for the expectant mother o f average

weight who is not doing especially hard work may be given as
follow s:
A S A M P L E D A Y 'S M E N U F O R T H E A V E R A G E P R E G N A N T W O M A N
[T h e “ d ie ta r y e s s e n t ia ls ” a n d 2,009 ca lo rie s m o re]

Breakfast
Raw fr u it: One-half grapefruit or whole orange.
C ereal: Oatmeal, or any whole-grain cereal, with
whole milk and sugar.
Bread and butter: One slice o f toast with one pat
of butter.
M ilk : One cup of cocoa made with whole milk.
10 a. m. luncheon
M ilk : One glass o f whole milk, with or without egg.


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Dinner
Meat, fish, or e g g : Two beef balls, or scrambled eggs*
P otato: Baked potato with one pat of butter.
Green vegetable: Creamed spinach.
Bread and b u tter: One slice o f bread with one pat o f
butter.
D essert: Baked custard made with whole milk.
Supper or luncheon
Soup or other hot dish (made with whole m ilk) :
Creamed pea sOup, or macaroni, or rice and cheese.
Salad: Raw-vegetable and nut salad on lettuce with
mayonnaise dressing.
Bread and butter: Two date bran muffins with one
and one-half pats o f butter.
Cooked fr u it: Baked apple with whole milk.

The pregnant woman of average weight who is doing hard work
and the underweight pregnant woman will require more food— a
total o f 4,000 calories. The following may be suggested as a sample
day’s menu for either o f these women:
A S A M P L E D A Y ’ S M E N U F O R T H E U N D E R W E IG H T P R E G N A N T W O M A N
[T h e “ d ie ta r y e s s e n t ia ls ” a n d 3,000 c a lo r ie s m o r e ]

Breakfast
Raw fr u it : One-half grapefruit or whole orange.
Cereal: Oatmeal, or any whole-grain cereal, with
whole milk and sugar.
Bread and butter: Two slices o f toast with two pats
o f butter.
M ilk : One cup of cocoa made with whole milk.
10 a. m. luncheon
M ilk : One glass of whole milk, with or without egg.
Dinner
Meat, fish, or e g g : Two beef balls, or mutton stew.
Potatoes: Two baked potatoes with two pats of
butter.
Green vegetable: Creamed spinach.
Bread and butter: Two slices of bread with one pat
o f butter.
D essert: Baked custard made with whole milk.
One cup of tea or coffee with cream and sugar.
Afternoon luncheon
Fruit or m ilk: One raw apple or other fresh fruit,
or glass o f milk.


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P R E N A T A L CARE

Supper or luncheon
Soup or other hot dish (made with whole m i lk ) :
Creamed pea soup, or rice and cheese.
Salad: Raw-vegetable and nut salad on lettuce with
mayonnaise dressing.
Bread and butter: Tw o date bran muffins with two
pats of butter.
Cooked fr u it: Baked apple with top milk or cream.

The overweight woman must get her “ dietary essentials,” but
she will need less o f additional foods, so that her total must not
exceed 2,000 calories. She must reduce her use of sugar, potato,
bread, and cereal. The following sample day’s menu shows how she
can take the dietary essentials and some additional foods without
necessarily having a fattening diet:
A S A M P L E D A Y 'S M E N U F O R T H E O V E R W E IG H T P R E G N A N T W O M A N
[T h e “ d ie ta r y e s s e n tia ls ” a n d 1,000 c a lo r ie s m o re]

Breakfast
Raw fr u it: One-half grapefruit or whole orange.
Bread and bu tter: One slice of toast with one pat of
butter.
M ilk : One cup o f cocoa made with whole milk.
10 a. m. luncheon
M ilk : One glass o f whole milk.
Dinner
Meat, fish, or eg g: One beef ball, or small serving of
fish.
Green vegetable: Creamed spinach.
Bread and bu tter: One slice of bread with one pat of
butter.
Dessert : Baked custard made with whole milk.
Supper or luncheon
S a la d : Raw-vegetable and nut salad on lettuce.
Bread and butter: Two date bran muffins with onehalf pat o f butter.
Cooked fr u it: Baked apple with whole milk.
M ilk : One glass of whole milk.
A LAXATIVE DIET

The mother’s body not only must supply food for the baby’s devel­
opment but must carry off the baby’s waste products as well as her
own. The accumulation o f waste products in the system is the
cause o f various minor ailments in pregnancy and o f some serious
ones. Since liquids help the bowels, kidneys, and skin to throw off
these waste products, and thus do away with some o f the sources


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11

o f danger at this time, it is most important that liquids form a
large part o f the diet o f every pregnant woman. The proper
amount to be taken varies, but it should usually be about 3
quarts. Much o f this should be water, o f which the average ex­
pectant mother should drink 8 glasses a day. I f she does this,
the milk, cocoa, soup, and other liquids included in the diet will
supply the remaining quantity. I f one is accustomed to the daily
use o f tea and coffee, it is unnecessary to stop their use altogether,
but they should be used in moderation.
A laxative diet will include fresh fruits. One kind or anothercan be had at all times of the year in most parts o f the country.
Cooked fruits, such as prunes, figs, apples, peaches, and apricots,
may be freely eaten, but it is well to have fresh fruit, uncooked, at
least once a day. Vegetables, especially the green ones, and wholegrain breads and cereals also have a laxative effect.
In addition to drinking liquids and eating laxative foods it is
well to limit the amount taken of the foods that give the kidneys much
waste to dispose of—meat and fish. Meat should be taken only once
a day, and during the last two months o f pregnancy less often.
Eggs or cottage cheese may be substituted for meat several times a
week.
IODINE

A small amount of iodine is necessary for normal growth and
health. I f this is not provided, the thyroid may enlarge and form a
goiter. In certain regions, especially around the Great Lakes, in
the Northwest, and in some o f the eastern mountainous regions the
water and soil have lost their iodine, so that foods grown in these
localities may not provide the necessary amount. A t least in these
regions, throughout pregnancy, iodine should be given to prevent
goiter in the baby as well as in the mother. Iodized table salt may
fill this need. Its use or the taking o f the iodine itself should be
directed by a physician or the local health authorities.,
COD-LIVER O IL1

Cod-liver oil is excellent in many instances for the mother to take,
not only* during pregnancy but during the nursing period. It is
o f special value in climates without much sunshine and in the last
six months o f pregnancy when the baby’s teeth are being formed.
The amounts taken, however, should be regulated by the doctor.
1 Viosterol is sometimes ordered by the doctor instead of cod-liver o il; it should never
be taken except under a doctor’s direction.

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AVOIDANCE OF TOO MUCH SALT

The amount o f salt commonly used in cooking is sufficient for the
expectant mother. She should not add salt at the table.
SUITING THE DIET TO THE DIGESTION

No matter how generally suitable the diet, the mother and the
baby are not getting its full benefit unless the food is properly
digested. A healthful, happy life, with plenty o f outdoor sunshine,
enables the mother to use her food to the best advantage. She may
find four or five small meals better than three large ones, especially
in early pregnancy if she is troubled with nausea. Eating too much,
eating in a hurry, or eating at irregular hours is harmful.
Every woman must realize that any food or drink which she does
not digest should be avoided, though she should not omit from her
diet any o f the foods called the “ dietary essentials ” unless the
doctor so advises. She may find certain meats and vegetables easier
to digest than others, however, and it would be wise to leave out any
that constantly trouble her. Early in pregnancy, if she is feeling
nauseated, she may find that fats increase her discomfort; in this case
she should cut down their amount at least for the time being. Fried
foods or highly seasoned dishes may upset her stomach, and it is well
during this period at least to prepare the foods in other ways.
AVOIDANCE OF CHOCOLATES AND RICH DESSERTS

Chocolates and rich desserts should be excluded from the diet to
a great extent, especially if the expectant mother is gaining weight
rapidly.
DANGER OF OVEREATING

The pregnant woman may eat freely but should at no time overeat.
Overeating during this period is dangerous. The woman of average
weight should not gain more than 20 pounds during pregnancy.
The overweight w o m p will be better for gaining less, or not at all.
Excessive increase in weight can always be stopped by the doctor
through careful attention to details o f the diet. A sudden marked
gain in weight may be a danger signal and should be reported at once
to the doctor.
CRAVINGS FOR INDIVIDUAL FOODS

Now and then an expectant mother wants to eat nothing except one
or two articles o f food. Such a craving should not be indulged,
because the diet would be very unbalanced and inadequate. But


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there is no reason why a craving for a particular food should not be
satisfied in moderation if a balanced diet is being followed and the
food desired is not harmful.
TOBACCO AND ALCOHOLIC DRINKS

The use o f tobacco in any form should be greatly restricted, and
alcoholic drinks should be avoided entirely.
E X E R C IS E A N D R E S T

Daily exercise is important for health. The expectant mother
should spend at least two hours each day (more if possible) in the
open air and sunshine, and she should be getting some exercise during
at least part o f this time out o f doors unless necessary household or
other tasks have already tired her.
Violent exercise and excessive hard work should be avoided during
pregnancy. Avoid reaching and lifting or pushing heavy things
around. Most husbands will be glad to take over the heavier tasks
during this time if they understand that this kind o f work may
injure the mother and the baby.
Less exercise should be taken at the time the monthly period ordi­
narily would be due, as there is more danger o f miscarriage at this
time. Marking these dates on a calendar will help the mother to
plan a quiet life during these times.
WALKING AND OTHER OUTDOOR EXERCISE

A woman who has been used to an active outdoor life will probably
be able to continue active exercise, but she should avoid very tiring
and dangerous sports. I f the mother has been used to a quiet indoor
life, she should plan to take regular exercise and to take it out o f
doors, but she will find it wise to begin it very moderately. In pleas­
ant weather walking is a valuable exercise. The length o f the walk
will depend on how soon the mother tires. It may be 2 miles or more
i f she is accustomed to walking; but i f she finds that she is tired
after half a mile, she should not try to go so far the next time.
Easy gardening work is a good and a pleasant form o f exercise; but
it should be not a task that must be finished, but a diversion that may
be stopped at will. I f the day is too cold or tod stormy for the
mother to go out, she should take a walk on the porch or at least
in a room with the windows wide open.
There is nothing that takes the place o f outdoor life. Sunshine,
besides being good for the general health, has a special value for the
pregnant woman, because it enables the baby to make use o f the


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calcium (or lime) in the food for building bones and teeth. Pleasant
open-air occupations strengthen the muscles, stimulate the sweat
glands and other organs that get rid o f the body’s wastes, benefit the
circulation, and help digestion and assimilation o f food. The sights
and sounds o f the open, too, often take the pressure off overworked
nerves.
AVOIDANCE OF STRENUOUS SPORTS

There is some tendency to-day, with increased interest in sports
for women, to forget that a pregnant woman, though needing exer­
cise, must build up her strength, not tear it down. Some sports that
she may have been used to are too strenuous for her when pregnant
and may cause miscarriage. G olf may be indulged in moderately
during the first half o f pregnancy. Bathing and swimming also
are permissible during the first half i f the water is not too cold and
i f there is no chilling or other unfavorable effect; diving and stunt
swimming should not be permitted. Horseback riding and tennis are
to be forbidden. Motoring over rough roads or for long distances
should be avoided if possible. Driving an automobile involves an
additional risk and should be done moderately and cautiously. A
long railroad trip or a long sea trip may cause a miscarriage or a
premature delivery; journeys should be avoided unless absolutely
necessary.
■"
■
. *
Exercise should be taken in some form throughout pregnancy
under the direction o f the physician. It should never be carried to
the point o f fatigue.
IMPORTANCE OF FRESH AIR

Fresh air, day and night, is required by all persons if they are to
be healthy. None needs it more than the expectant mother, who
breathes in from the air the oxygen for herself and the baby. She
should sleep with the windows open or out o f doors at all seasons
o f the year. In the living rooms, too, the air should be kept fresh,
even in cold weather.
ADEQUATE SLEEP AND REST

Every pregnant woman should have at least eight hours’ sleep at
night and an hour’s nap or rest lying down during the day. Many
women may think that they have no time for this rest period; but
it is essential to health during pregnancy, and they will find that
it enables them to do their work to better advantage.


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C L O T H IN G

The clothing worn by the expectant mother should be loose
enough not to interfere with the breathing, the circulation, or the
increase in size o f the baby. It should hang from the shoulders,

not from a waistband, and should be as light in weight as it can be
and still be warm enough in winter. She should wear sufficient
clothing in cold weather to keep her comfortably warm, for it is

Two styles of suitable shoes with low, broad heels

important that she avoid getting chilled. The amount needed to
make her comfortable will vary with the individual and will also
depend upon the climate, the season, and the extent to which the


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house is heated in cold weather. In an evenly warm house or apart­
ment much lighter clothing may be worn with comfort and safety.
DRESSES

Dresses for the pregnant woman can and
should be attractive as well as practical. The
present-day dresses hanging from the shoulders
can be readily adapted by means o f tucks,
pleats, or buttons and loops to allow for growth
about the waist and hips. The dress should be
worn with a slip and a one-piece undergarment
that will vary in weight with the season.
BRASSIERES

A brassiere or breast binder may be worn
that will support the breasts but not flatten
them. It should be loose
over the nipples. A good
model is shown on page 15.
CORSETS OR ABDOMINAL
SUPPORTS

A maternity corset or
an abdominal support re­
lieves back strain and usu­
ally makes the mother more
comfortable. A n abdominal support may be
made o f two thicknesses o f muslin, with darts
as needed to make it fit the abdomen. (See illus­
tration on page 15.)
GARTERS

Round garters or any tight bands should
not be worn, for they interfere with the circu­
lation. Side garters may be attached to a
waist hung from the shoulders, or to a belt
that rests on the hip bones, or to the abdominal
support.
SHOES

Shoes should be comfortably large and have
low, broad heels. High heels should not be
Maternity street dress
worn. They are dangerous not only because
they may cause tripping and falling but because they throw
the body out of the natural position and put undue strain on the
muscles o f the back.


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CARE OF TH E BO W ELS

The body casts off waste material through the bowels and the
kidneys, the lungs, and the skin. These are called the excretory
organs. They have extra work to do during pregnancy and should
be kept in the best possible condition to do it.
Many women suffer more or less from constipation during preg­
nancy. There is a tendency to constipation from the pressure o f
the enlarging uterus on the intestines; but this tendency can usually
be overcome by proper health habits, drinking plenty o f liquids,
eating laxative foods, and taking regular exercise.- Throughout
pregnancy it is most important that the bowels should move freely
at least once a day. Try to form the habit o f emptying them, or
trying to empty them, at the same hour each day. This should be
done without fail, whether the attempt is always successful or not.
Drinking plenty o f water is important; a glassful just after getting
up and just before going to bed may help. A laxative diet (see
p. 10) will include considerable fruit, raw or cooked; plenty o f fresh
vegetables, especially the green ones, eaten with olive oil; and the
dark-colored breads and cereals. The roughage in these “ wholegrain ” breads and cereals increases the activity o f the intestines.
Too much o f it may cause colicky pain in the abdomen; and if this
occurs, the amount o f these foods should be reduced.
I f, in spite o f all these health measures, the expectant mother
is still troubled with constipation, she should see her doctor. No
medicines or enemas should be taken except upon his advice.
C A R E O F T H E K ID N E Y S

In order to know whether the kidneys are performing their func­
tions normally, the expectant mother should measure the quantity
o f urine passed in 24 hours and should take a specimen o f it to the
doctor for examination. I f there is less than 3 pints, she is not
drinking enough fluid; if the color is dark amber, she is probably
not drinking enough water. Certain more serious conditions o f the
kidneys can be found only by chemical tests. That is why it is
important for the doctor to make these tests regularly.
The method o f collecting a 24-hour specimen o f urine is as follow s:
Use a perfectly clean and scalded vessel or jar with a cover. Put
in a teaspoonful o f boric-acid crystals to keep the urine from de­
composing. Beginning at some convenient hour in the morning, say
8 o’clock, empty the bladder and throw the urine away. Thereafter
empty the bladder into the jar each time until the next morning at


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the same hour. Keep the jar tightly covered and in a cool place.
Measure the amount o f urine passed and, after shaking it well, fill
a perfectly clean 6-ounce bottle, cork tightly, label with the name,
date, and quantity passed in 24 hours, and take it at once to the
doctor.
B A T H S A N D C A R E O F T H E S K IN

The skin should be kept in good condition at all times and espe­
cially during pregnancy, when the work o f the excretory organs, of
which the skin is an important one, is increased. In order to
keep the skin in health, the entire body should be washed every day.
A brisk rubbing o f the body with a rough towel after the bath
stimulates the circulation. The bath may be a sponge, shower, or
tub bath, except that the tub bath is not safe near the end of
pregnancy. A morning bath in cool water is a more effective stimu­
lant, but the warm bath is necessary for the thorough cleansing
o f the skin. Warm baths, with soap, should therefore be taken two
or three times a week, even if the cool bath is taken regularly in
the morning.
A pregnant woman should never take a very hot bath. I f she has
been used to the daily cold bath, there is no reason why she should
give it up at this time, provided she feels a healthy glow afterward;
but she may find it advisable to have the water cool, rather than cold.
Taking a tub bath when labor begins is dangerous and should never
be done. Germs in the water may enter the birth canal and cause
blood poisoning. There is some slight danger o f such infection even
before labor begins.
CARE OF THE TEETH

A mother’s responsibility for the teeth o f her baby begins long
before he is born. The baby’s teeth begin to form as early as the
third month o f pregnancy. A ll o f the first set o f 20 teeth are in the
jaw at birth, and the quality of these teeth as well as the formation
o f the jaw, therefore, is determined largely in the prenatal period.
Later, if the baby is fortunate enough to be nursed at the breast,
he will be preparing the way for well-spaced regular teeth. Nursing
tends to strengthen the muscles of the jaw and to widen the dental
arch. The substances needed to build teeth are mineral salts (lime
and phosphorus) and certain vitamins. The baby will take them
from his mother’s body if he does not get them through her food;
but the milk, eggs, fresh vegetables, fruits, and whole grains that
the expectant mother is taking are the very foods that supply these
materials for the teeth. Outdoor sunshine and cod-liver oil helpi to
utilize these food materials for the baby’s growing teeth and bones.


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The old saying, “ For every child a tooth,” shows only that in the
past expectant mothers did not have the proper food. F or it is true
that in case o f food shortage or a poor selection of food the mother
suffers first. But if she is on an adequate diet and is under the care
o f a good dentist, the old saying need no longer be true.
It is true, however, that during pregnancy the mother’s teeth will
be especially affected by any deficiency in diet and are thus peculiarly
susceptible to decay during and just after this period. For these
reasons it is essential for every woman, as soon as she knows that she
is pregnant, to go to a good dentist and have such repairs made to

her teeth as are needed and to receive instruction in mouth hygiene.
In addition to this, the teeth should be brushed after each meal and
the mouth well rinsed. This brushing should be from the gums
toward the biting edge and not crosswise. Excellent washes for the
mouth are made with a teaspoonful o f milk o f magnesia or a table­
spoonful o f limewater, or half a teaspoonful of baking soda mixed
with a glassful o f water.
CARE OF TH E BREASTS

It should be the hope, as it is the first duty, of every mother to
nurse her baby. Breast milk is the natural food for the baby. It is
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easily assimilated, cheap, clean, and convenient. Breast feeding gives
a baby a much better chance for life and for steady, normal growth.
In preparation for this function, all the healthful measures already
set forth will play an important part. The mother can help further
in this preparation by seeing to it that the breasts themselves are in
the best possible condition. By wearing loose clothing she allows
them plenty o f room to develop; a tight brassiere may do harm by
preventing free circulation. The breasts and nipples may require
special attention. The doctor will examine them to see if special
treatment is necessary. I f a little dried scale appears on the nipples,
do not pick it off. Rub a little cold-cream ointment over them care­
fully at night to soften the crust, which will probably be washed
away by the bath. I f the cold cream does not soften the scale, ask
the doctor what to do.
IN T E R C O U R S E D U R IN G P R E G N A N C Y

Intercourse during the early months of pregnancy is a frequent
cause o f miscarriage. The danger is increased if the intercourse
takes place at what would be a monthly period were the woman not
pregnant. During the last three months intercourse should be for­
bidden, because it may bring on labor ahead o f time. I f intercourse
takes place shortly before labor begins, blood poisoning (septicemia)*
may follow with very serious results. It is, therefore, advisable to
limit the frequency o f intercourse during the first six months of
pregnancy and to stop it entirely during the last three. Intercourse
should also be avoided for the first six weeks after delivery,
M E N T A L H Y G IE N E

How the expectant mother can keep her body in proper condition
to produce a healthy baby has been pointed out in the foregoing
sections. She needs also to keep her mind healthy. Confidence, con­
tentment, a happy anticipation o f the new life that will be hers to
guide, and a cheerful acceptance o f this responsibility—these are the
signs o f mental poise.
The mother will keep this poise much more easily i f she and
her husband are working together to make their home world a happy
place for the baby to be born into. The prospective father can help
by showing that he wants to help. Then he can speak gently and
not claim the privilege o f being cross because he has come in tired
from his day’s work. Pregnancy is not a disease, but it is “ nature
under a strain ” ; and the strain may show itself in overwrought
nerves i f there is jangling instead o f peace in the family. There
will be many things for the father and mother to talk over in the


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evenings and decide: That their baby will be breast fed because that
will give him a better chance for life and health than the
artificially-fed baby has; that their baby will be trained in the right
habits from birth; that they will work together, as they must, to give
him the right habits and a happy and harmonious 'home.
How can the mother spend her day so that she will be ready for
such a quiet, happy evening? Her two hours or more in the open
air and sunshine will help her mentally as well as physically. They
will help her all the more if she can arrange to get them without
hurrying her household or other tasks and getting nervous over fin­
ishing them in time. Perhaps the need of these hours of freedom
will make her think out some way to do her work that will take fewer
steps and less time, and thus will allow for her hour’s nap or rest
lying down as well as her time out o f doors. Recreation, so long as
it does not tire her, is necessary for her well-being.
The greatest enemies o f mental health (and you can not have
physical health unless you have mental health) are worry, nervous­
ness, fears. The mother should not worry if she has pain she can
not account f o r ; she should tell the doctor, and he will explain how
to relieve it or remove the cause. She should not think o f herself
as an invalid just because she is pregnant, nor should her friends.
She is to be envied, not sympathized with. Above all, she should not
be afraid for herself or for the baby.
Some women are afraid that their babies will have “ birthmarks ”
or “ maternal impressions.” B y a “ maternal impression ” is meant
an injury to the child through the influence o f some harmful state
o f mind in the mother. In other words, there is a widespread feeling
that i f a mother is injured or sees some one injured or sees something
especially repulsive to her, her baby will be “ marked.” But there
is no connection between the nervous system o f the mother and o f
the unborn baby, and such “ maternal impressions,” as these alleged
injuries to the baby are called, are absolutely impossible.
A mother may harm the baby, however, by failing to plan her
own life, physical and mental, in the way that will result in the
highest degree o f health and happiness for herself and, therefore,
for the child. Nervousness and fears may affect her ability to nurse
her baby. Steady nerves and mental poise and the earnest desire to
give her baby this advantage will help her to do so. It can not be
emphasized too much that pregnancy is not a disease but is fre­
quently a pathway to better health.


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HOME OR HOSPITAL FOR THE DELIVERY
It is becoming more and more common for women to go to hos­
pitals to be delivered. I f a hospital is chosen, it should be one that
is well equipped to handle obstetrical work and that provides for
the separation o f maternity cases from all other patients in the
hospital. Otherwise it has no advantage over a woman’s own
home. A well-equipped and well-conducted hospital has many ad­
vantages over a private home. It may be cheaper, it is far more con­
venient, and, if any emergency arises, it is much safer for both
mother and baby. In many parts o f the country no hospitals o f any
sort are near enough to be used, and the majority o f women must
necessarily be delivered at home. By careful examination the doctor
can usually tell by the eighth month whether or not a normal
delivery is to be expected. I f he expects an abnormal delivery or if
by this time he is still in doubt, he will probably arrange to send
the woman to the nearest and best hospital available. The delivery
may turn out to be easier than he had expected, but it is much
better to go unnecessarily to a hospital than to be delivered at home
with unfortunate results.
Hospital charges in the various parts o f the country vary greatly.
The private physician’s fees are in addition to the hospital charges,
and not infrequently the baby’s laundry must be provided for
outside. In most cases the routine care given by the floor nurses will
be sufficient; i f a spe.cial nurse is employed, the cost is much
increased, for her salary is never included in the hospital rate. It
would be well to have a definite understanding beforehand as to the
cost o f the physician, the hospital, and the nurse.
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SUPPLIES AND EQUIPMENT
Hospitals vary in their rules about baby clothes; some prefer to
furnish the clothes while the baby is in the hospital, but others re­
quire the mother to furnish them. When the mother furnishes the
clothes, the washing o f the clothes is usually done outside the hos­
pital. Diapers are usually furnished by the hospital. Because hos­
pitals differ in their requirements, the expectant mother should
always find out what the hospital she is going to expects her to
bring for the baby.

Bed prepared for delivery

Hospitals furnish nightgowns for the mother if desired; if she
prefers to use her own, arrangements must be made to have them
laundered outside the hospital. Public hospitals usually furnish
kimonos and slippers, but private hospitals do not. The mother
must provide her own brush, comb, toothbrush, and other toilet
articles.
T H E D E L IV E R Y R O O M A N D IT S E Q U IP M E N T

The room for the home delivery, i f there is a choice, should be the
quietest in the house. I f sun enters, so much the better. Nearness to
the bathroom is to be desired. A single bed so placed that both sides
can readily be approached is best. I f the bed is low, it should be
raised up on blocks so that the mattress is 30 inches from the floor.
This is a great help to the doctor during the actual delivery, and


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afterwards it makes the nursing care much easier. Placing a board
across the bed under the springs prevents the bed from sagging and
is o f much help at the time o f delivery. The bed should be in a
good light by day and well lighted at night. Two small tables are
useful; but if they can not be had, chairs may be used in their place.
It is not necessary to take draperies dow n; but it is well to take out
unnecessary furniture and to protect the floor and the floor covering.
S U P P L IE S F O R T H E M O T H E R

The supplies considered necessary for a delivery at home vary
greatly according to the mother’s finances. The following list con­
tains the supplies that it is advisable to have, but even this list can be
cut if necessary:
I 14 yards of rubber sheeting at least 36 inches wide, or 1 y2 yards o f white
table oilcloth to protect the mattress.
4 clean sheets and 4 pillowcases.
Receiving blanket for the baby ( a piece of old clean blanket about a yard square
or a soft bath tow el).
4 delivery pads. To make one, take 12 opened-out sheets of newspaper and
cover them with white cheesecloth with edges turned in and basted. They
are better if they are padded with a 2-inch layer of absorbent cotton on
t o p ; but the cotton need not be used if this makes them too expensive.
Iron the pads with a hot iron until they are scorched slightly, fold them top »
side in, and put them away in a clean pillowcase.
Supply of newspapers.
2 pounds o f absorbent cotton.
2 enamel basins 10 inches in diameter.
2 pails with covers. (These can bfe used after the delivery for diapers.)
Bed pan.
1 stewpan with handle (2-quart size).
1 pair o f scissors.
1 skein o f bobbin (narrow cotton tape) or strong cotton string to tie the
cord.
4 yards o f unbleached muslin for abdominal binders.
4 ounces o f tincture of green soap.
4 ounces of boric-acid crystals.
Castile soap.
Tube o f plain white petroleum jelly.
2-quart fountain syringe or enema can (with rectal tip ).
Hot-water bottle.
2 glass drinking tubes.
2 dozen safety pins, size 0.
2 dozen safety pins, size 4.
2 nail brushes, stiff and cheap.
2 wash cloths.
1 dozen hand towels.
3 nightgowns (either low enough in the neck to allow for nursing or opening
down the fron t).
1 pair white stockings.
10 yards of gauze for making sanitary pads, “ sponges,” and dressings.


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The towels and the following articles are to be sterilized and put
away until the time o f delivery:
2 dozen sanitary pads. These may be bought ready made or may be made at
home of absorbent cotton wrapped in gauze or in old soft cloths that have
been washed and boiled. Cut the cotton into pads 10 inches long, 4 inches
wide, and 1 inch thick. Cut the gauze into pieces o f the right size to
fold around the cotton, and allow it, when folded, to extend 2 or 3 inches
beyond the cotton at each end.
1 dozen gauze “ sponges.” Take a piece of gauze 16 by 16 inches; fold edges
to center; fold a ga in ; bring raw ends to center; fold again, making a
finished sponge about 4 inches square.
5 dozen cotton pledgets. Take a piece of absorbent cotton the size of an egg;
make it into a b a ll; twist the loose end. Put them into five muslin bags.
1 dozen gauze squares (4-inch size) for cord dressings. Make like the
“ sponges,” then cut a hole the size of a quarter in the center of six of them.
1 yard of bobbin (very narrow tape) or strong white cotton string. Cut this
into four pieces, each 9 inches long, to use in tying the cord. Put these
and four of the gauze squares, two with and two without holes, into a
muslin bag.

In many parts o f the country the visiting-nurse associations have
sterilized delivery pads at their central offices, which they sell to
the mother at cost. Surgical-supply houses in the large cities also
put up these sterile supplies. Some o f the State departments o f
health sterilize obstetrical packages that are sent to them for this
purpose. The mother should buy these supplies only from sources
that she knows to be reliable, preferably on the recommendation of
her doctor, for it is o f the utmost importance that these supplies
should be thoroughly and recently sterilized and well packed.
HOW TO STERILIZE THESE ARTICLES

W rap the sanitary pads, towels, and
the sponges in packages of six each, and
the remainder of the gauze squares in
muslin and fasten with common pins.
Put these packages and the muslin bags
(five containing the cotton pledgets, the
other the four cord ties and four
gauze squares) into a pillowcase. Use
a large wash boiler with a cover. Put
water into it to a depth of 6 inches.
Suspend the pillowcase containing the
dressings in a hammock made from a
towel or a piece of muslin (the hammock
must not touch the w ater). Attach the ends of the hammock to the handles
of the boiler. W rap a cloth around the cover so that the cover will fit tightly.
Steam an hour. Dry in the oven or in the sun by pinning the bag to a clothes­
line. Repeat the process the following day. Dry thoroughly. Put the pillow­
case away, unopened, until the articles are needed. I f these articles have


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been sterilized more than a month, they must be sterilized again. The mother’s
nurse or the public-health nurse will explain to her the details of preparing
and sterilizing these supplies.
S U P P L IE S FO R T H E B A B Y

The following list contains the articles it is well to have for the
baby. A few o f these could be omitted if all can not be had:
1 bassinette, basket, or box for bed. A clothes basket makes a good bed. A
basket or box that can be moved about readily is a great convenience.
1 blanket, felt pad, or pillow for mattress. Table or bed padding,. folded a few
times, makes a very soft, smooth mattress and has the advantage over the
ordinary mattress that it may be washed and boiled and dried in the
sun.
2 small warm blankets.
3 small sheets or pillowcases.

2 soft towels.
2 soft wash cloths.
1 piece Castile soap.

6 ounces o f olive oil or liquid petrolatum.
3 binders (canton flannel) 6 by 27 inches, with edges pinked, not hemmed;
used to keep the cord dressing in place. After the cord comes off and the
navel is healed, a band with shoulder straps is the only garment worn
under the shirt. Binders are usually supplied by the hospital if the baby
is born there.
3 knitted bands, size 2. These are made with a bodice top (a straight top
with shoulder straps) and slip on over the feet. The bottom edge- is
reinforced all the way around, so that the diaper may be pinned in any
position. I f size 2 is too big at first, a tuck can be taken in the top
of each shoulder strap.
48 diapers 24 by 24 inches.
3 shirts, size 2— for summer, made of light-weight cotton ; for winter, o f cotton
and wool or silk and wool.


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3

petticoats, or gertrudes, 20 inches long finished, made of muslin (not needed
except for the sake of appearance with thin dresses). These may open
on the shoulders so that they can be slipped off if soiled without removing
the dress, or they may open down the back, like the dress.
3 dresses, 31 inches long finished. These may be made from a nainsook or
a fine quality of crinkle crêpe which does not need to be ironed. They
should open all the way down the back so that they can be pulled off from
under the baby.

3 flannel or knitted squares 36 by 36 inches, which can be used instead o f coat
and bonnet for the very young baby.
(See illustration p. 26.)
1 coat and bonnet, simple and washable.
3 nightgowns, 27 inches long finished, made o f muslin or flannel according to
the season. These open down the back. Tape should be run through the
bottom hem to draw it together.

Baby’s toilet tray

The baby’s toilet tray varies with the mother’s individual wishes
even more than the list just given. It should contain three covered
jars (jelly glasses or mayonnaise jars will do), one for boiled water,
one for rubber nipples, and one for cotton swabs; two flat dishes,
one for the soap and one for the oil; a pincushion; and a nursing
bottle for drinking water.
4063°— 30----- 5


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A D D IT IO N A L

C O N V E N IE N C E S

Below is a list o f additional articles that will be found convenient
in the care o f the baby, though not so essential as those previously
listed:
Bathtub— tin, enameled ware, or rubber.
Drying frames for shirts and stockings.
Bath apron of Turkish toweling or outing flannel.
A low chair without arms.
. i
Baby scales.
.
A low screen to protect the baby while he is being bathed.
A low table on which to bathe and dress the baby.


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COMMON DISORDERS OF PREGNANCY
N A U S E A A N D V O M IT IN G

Nausea with or without vomiting is one of the common ailments
o f early pregnancy (from about the fourth to the twelfth week).
It is very apt to come in the morning, and for that reason is often
called “ morning sickness,” although not infrequently it comes only
in the late afternoon or early evening. Many women do not have
it at all. I f there is more than slight occasional vomiting, the doctor
should be consulted. Eating six small meals a day instead o f three
larger ones helps to relieve this nausea. Taking something to eat
before getting up, such as toast or crackers, will often help. No one
method o f treatment works satisfactorily with all women. There­
fore the physician must decide what is best for each individual.
HEARTBURN

Not infrequently during pregnancy the expectant mother com­
plains o f burning in the throat caused by bitter eructations (belching) from the stomach. This condition is commonly called “ heart­
burn.” I f it continues, the doctor should be notified. Frequently
heartburn is evidence that the diet contains too much sugar and
starches; the doctor will get further evidence on this point if he
finds sugar present when he analyzes the urine.
V A R IC O S E V E IN S A N D P IL E S

As the weeks go by, the enlarging uterus presses more and more
on the blood vessels in the lower abdomen, and in many instances
the veins o f the leg appear as bluish lines. These are called u vari­
cose veins.’ Later as they enlarge they may cause slight burning
or tingling sensations in the legs. I f the symptoms remain slight,
no treatment is necessary. I f they become more marked, lying
down for an hour morning and night with the legs elevated or at
right angles to the body may give relief. The doctor’s attention
should be called to these varicose veins, and he will direct any
necessary treatment.
When the varicose veins appear in the rectum, they are called
hemorrhoids,” or “ piles.” These again are due to pressure; and
i f any discomfort is felt at the anus the doctor must be told at once
so that he may direct appropriate treatment.


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C R A M P S I N T H E LE G S

Cramps in the legs, usually after the mother has gone to bed, may
occur in any part o f the pregnancy, but they are more apt to come
in the latter half. Relief may be given by gentle massage o f the
legs or by bending the foot up on the ankle.
R E L A X A T IO N O F T H E P E L V IC J O IN T S

As pregnancy advances, the three joints which go to make up the
pelvic girdle, two behind and one in front, oftentimes relax to such
an extent that severe pains are felt in the legs. An abdominal sup­
port, such as has been recommended (see p. 15), will do much to
relieve this condition.
LEUCORRHEA

Leucorrhea (whites) is a whitish discharge from the vagina.
This discharge comes from the glands in the neck o f the uterus and
the entrance to the birth canal, which are more active than usual
because o f pressure o f the enlarging uterus on the blood vessels.
Leucorrhea is often annoying but not usually serious. The physi­
cian should be told o f it, and he will prescribe the necessary treat­
ment. Douches o f any sort should not be taken except under his
advice.


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COMPLICATIONS OF PREGNANCY
T O X E M IA

As the baby grows in the uterus there is being sent back into the
mother’s blood an increasing amount o f waste matter. I f the
mother’s elimination is imperfect, so that she has difficulty in getting
rid o f her own as well as the baby’s waste products, a toxic, or
poisoned, condition may result which will be more or less serious for
both the mother and the child. Some o f the common symptoms are:
(1)
(2)
13)
(4)
(5)
(6)

Serious or persistent vomiting.
Repeated headaches.
Dizziness.
Puffiness about the face, hands, and legs.
Blurring o f the vision, or spots before the eyes.
Neuralgic pains, especially about the pit o f the
stomach.

Having one or even more o f these symptoms does not necessarily
mean that toxemia is present, for in many cases the cause o f the
trouble may be removed very easily without serious results. But
when such symptoms appear, they should always be brought at once
to the attention o f the doctor, and it will be well also to send a
specimen o f the urine to him immediately. Prevention o f serious
results from toxemia by observing and reporting to the doctor the
symptoms which precede it is o f great importance to all pregnant
women.
There is an unfortunate tendency among women to regard some
o f these disturbances as a necessary part o f pregnancy. No pain or
distress that can be prevented by proper means should be endured
during pregnancy or at any other time. There is no truth in the old
saying that a “ sick pregnancy is a safe one.” I f a pregnant woman
will follow certain simple rules for health, she will not have cause
to fear toxemia and will be in better condition to meet the strains o f
pregnancy and childbirth. She should—
(1) Place herself under the care of a competent physician.
(2) Consult him regularly, at least once a month during the first
six months, then every two weeks or oftener, preferably
every week in the last four weeks of the pregnancy.
(3) Have her blood pressure taken regularly.
(4) Have her urine examined at the visits to the doctor.
(5) Guard carefully against constipation.


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(6) Avoid a large amount of meat and any other form o f over­
eating and all extra salt.
(7) Drink eight glasses o f water a day.
(8) Exercise daily out o f doors but not to the point o f fatigue,
(9) Keep all the rooms o f the house well ventilated day and night.
(10) Bathe every day.
(11) Wear lightweight but warm and comfortable clothing.
(12) Sleep at least 8 hours out o f the 24, rest during the day, and
not get overtired.
(13) Report to the doctor all acute illnesses, especially colds, sore
throat, or persistent cough.
(14) Go to the dentist early in pregnancy.
(15) Report any unfavorable symptom, remembering that she must
at all times be well.
M IS C A R R IA G E

“ Miscarriage ” is commonly used to mean the birth o f the child
before it is sufficiently developed to be able to live outside its mother’s
body—that is, before the end o f the sixth month of pregnancy.
There are many possible causes o f this mishap. Among them are
heavy work (such as washing, sweeping, lifting, or moving heavy
furniture), running a sewing machine or other form of taxing labor,
strenuous indulgence in amusements that jar the body (such as danc­
ing, skating, tennis, golf, horseback riding, or climbing), or jolting
over rough roads in an automobile, or long journeys by train or
boat. Some constitutional disease o f the mother, a fault in the posi­
tion o f the uterus or some abnormality o f its lining, or intercourse
during pregnancy (see p. 20) may cause miscarriage. Microscopic
examination o f tissues thrown off from early miscarriages has shown
that many are due to faulty development o f the fetus (unborn
b a b y ); such miscarriages are nature’s way o f getting rid o f a preg­
nancy that could not go on to final success. In many cases the cause
is impossible to discover, and a woman may have repeated miscar­
riages. The prevention o f many miscarriages lies in guarding
against overexertion in the early weeks o f pregnancy. I f a woman
has had a miscarriage before, a long stay in bed may carry her past
the danger when nothing else will do it.
Syphilis is often the cause o f miscarriages, but as yet it has not
been proved that it causes miscarriage in the first two months of
pregnancy.
A ny woman who has had repeated miscarriages or premature la­
bors with dead babies should have a blood test (Wassermann) to find
out whether she has syphilis. This test should be part o f the doctor’s
complete examination o f every expectant mother; it is o f special
importance for the mother who has had a previous miscarriage o f


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which she does not know the cause. The blood for this test is
easily withdrawn from the arm. I f it ¿hows that the mother has
syphilis, treatment should be started at once and kept up systemati­
cally throughout pregnancy. I f she receives proper treatment, a
syphilitic mother will give birth to a healthy baby.
At the first appearance o f bleeding or abdominal pain the mother
should go to bed at once. It is always advisable to send for the
doctor; it is urgent to do so if the pregnancy has advanced beyond
the sixth week. I f the mother can not get the doctor, she must
remain perfectly quiet in bed for at least 48 hours after bleeding
or pain has stopped. A miscarriage occurring before the sixth
week may appear as nothing more than an unusually severe
menstrual period.
What happens is that the placenta and membranes which surround
the fetus have become loosened from the uterus. I f the loosening is
slight, complete rest in bed may prevent it from going further. I f
a large part o f these membranes, however, has become separated
from the uterus, the separation will become complete and the fetus
will be expelled. It is not until the twelfth to the fourteenth week
o f pregnancy that the union between these membranes and the
uterus becomes firm ; consequently it is during these early weeks that
miscarriage is most likely to occur.
When a miscarriage has occurred, there is danger that portions
o f the membrane may stick to the uterus and not be expelled. In
order to find out whether this is the case, it is important that a
doctor should be in attendance and that whatever has been expelled
be saved for him to see.
A neglected miscarriage may mean the total loss o f health; a
spontaneous miscarriage properly attended is not likely to have
bad results. On the other hand, a self-induced miscarriage may
result in blood poisoning and death. It is unreasonable to regard
a miscarriage as something to be concealed, and dangerous to de­
prive oneself on this account o f proper care and treatment. This
unhappy way o f regarding a miscarriage is perhaps partly due to
the association in many persons’ minds of a miscarriage with a
criminal abortion, the results o f which are often serious and many
times fatal. Such an attitude o f mincf is unjustified, for there are
many causes o f miscarriage, and often, humanly speaking, it is
unavoidable. It should be treated like any other illness, and such
measures should be taken as will best conserve the future health
o f the disappointed mother.


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P R EN ATA L, CARE

B L E E D IN G I N P R E G N A N C Y

Bleeding, or the show of blood from the vagina in a pregnant
woman, demands investigation, for it never occurs in normal cases.
It may be a very serious sign, especially i f it occurs in the latter
part o f pregnancy. It always must be regarded as serious until the
doctor by careful examination determines that it is not. At the
first sign o f blood from the vagina a pregnant woman should go to
bed and should notify the doctor at once. Under no circumstances
should a woman who has had vaginal bleeding be up and about her
house attending to her household. It can not be overemphasized
that bleeding from the vagina in pregnancy is abnormal and may be
a very serious complication. The responsibility for good results
when bleeding has occurred is tw ofold : (1) Upon the patient—she
must report it to her physician at once; (2) upon the doctor—he
must respond without delay, determine the cause o f the bleeding,
and give the proper treatment.


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BIRTH OF THE BABY
A t the end o f the nine months’ development in the uterus the
baby is born, and the act o f birth is called “ labor.” This act is a
natural one and, though it is painful and tiring, it should end
normally with a healthy mother and a healthy baby. It probably
will have this happy ending if the mother has had proper care
during her pregnancy, and is in the hands of a competent attendant
who understands the need for perfect cleanliness and uses every
means to secure it.
P R E C A U T IO N S T H A T M U S T B E T A K E N

The prevention o f the infection that causes puerperal septicemia, or
“ childbed fever,” lies in the scrupulous care taken by everyone
who is concerned in any way with the attendance upon a woman
in childbirth to allow nothing not absolutely clean to touch her.
Puerperal septicemia is a largely preventable disease, since its cause
and the measures necessary to prevent it ate well known, and all
women in childbirth and theiy families have a right to insist upon
this protection. No physician who values his professional reputa­
tion will be satisfied to neglect any o f the precautions against this
most dreadful disease. The patient can help by having ready clean
bedding, towels, and sterile supplies. The woman, the family,
and the nurse must be ready in every way to aid the physician in
this effort.
The well-trained doctor in sists that the external parts be shaved
when the patient goes into labor. This shaving is for the patient’s
protection and does much toward the prevention o f blood poisoning.
The doctor can obtain much information as to how soon the baby will
be born by rectal examinations, and the patient should never refuse
to permit them. Vaginal examinations during labor, no matter how
carefully done, always carry a certain amount o f risk. When the
physician exposes the patient during the actual delivery o f the baby,
the patient must realize that he is working in her interest and for her
protection.
LABOR

The progress o f labor is divided into three stages. The first is
occupied with the dilatation, or enlargement, o f the mouth o f the
uterus, the second with the actual birth o f the child, and the
third with the separation and throwing out o f the afterbirth and
membranes.


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P R E N A T A L CARE

The first stage is the longest and most trying part to the expectant
mother. During this time the mouth o f the uterus, which is less than
one-quarter o f an inch in diameter at first, must increase to 3y2 to 4
inches before it is large enough to permit the child’s body to pass out.
This stage usually takes a number o f hours and is very tedious to
the woman, because she is unable to feel for herself that she is making
progress. Labor pains may begin in the abdomen or in the back.
They may come at first half an hour or an hour apart, or perhaps only
a few minutes. They will come at shorter and shorter intervals and
with greater and greater strength as the mouth o f the uterus gets
larger. Sometimes the bag o f waters (amniotic sac) that surrounds
the baby breaks before labor begins. At the time labor begins or
shortly after there may be a slight blood-tinged discharge. This is
commonly called the “ show ” and is more likely to appear in first
labors than in later ones. The progress of labor can not be judged
by the show alone. The regularity, the frequency, and the strength
o f the pains are the chief guides.
To pass the time between the pains, the woman may occupy herself
in any way she likes ; she may sit down, lie down, walk about, or even
sleep, if she can. She should notify the nurse and the doctor as soon
as she becomes convinced o f the regularity o f labor pains, or in case
water in any quantity comes away before the pains begin, or in case
of any bloody discharge. Since the doctor can not hasten the progress
o f this stage, it is not usually necessary for him to remain with her
all the time. But he should keep close watch o f the case and be
always within easy call. No enema should be taken on the onset of
labor except on thé advice o f the physician. I f the woman is hungry,
she may have some light food. As soon as the doctor comes, he will
give advice on all necessary details.
The bed should be made ready, the mattress being protected by
a rubber sheet or oilcloth or several layers o f newspapers. An extra
sheet, folded in the middle, is pinned across the bed under the
mother’s hips; this sheet may be drawn out after the labor, leaving
the bed clean and dry.
I f the confinement is to take place at a hospital, the woman should
be ready to go when regular pains have started. The ride to the
hospital will help to pass the time and may also serve to hasten the
delivery to some extent. She will take with her a bag that should
have been packed some time before, containing nightgowns, toilet
articles, slippers, kimono, and the like, with the baby’s first outfit.
The second stage o f labor, in which the actual birth occurs, is
much shorter than the first, usually from two to two and one-half
hours. It is frequently less trying to the patient than the first
stage, because as each pain occurs the muscles are pushing the baby


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37

along the birth canal, and she feels that she can help by straining, or
“ bearing down/’ The amniotic sac is usually ruptured as the
pains of this stage begin, and after this occurs it will usually not be
long before the child is born. In case the bag of waters has broken
earlier, as sometimes happens, the birth is said to be “ dry ” and
may proceed somewhat more slowly. Whether the pain of the actual
birth should be lessened or deadened by the use of an anesthetic
will be decided by the physician.
After the baby is born the third stage of labor takes place—
namely, the separation and throwing out of the afterbirth (placenta)
and the other tissues that connected the baby’s body with the mother
during pregnancy. This occupies about half an hour. “Afterpains ”
are the pains that immediately follow the emptying of the uterus
and are due to the natural contractions of its muscle fibers. These
pains are less likely to be felt in a first confinement than in later ones.

if V


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EMERGENCIES
It sometimes happens that the baby is born before the arrival
o f the doctor or nurse, when labor comes on earlier than was expected,
or the doctor is at some distance. In an emergency like this it is
necessary for the expectant mother and her family to know what
to do.
The delivery room must be set in order and the bed freshly made.
The mattress should first be protected with the rubber sheet or oil­
cloth, or newspapers, and the extra folded sheet as described on
page 36. The mother’s external parts should be well washed and
shaved. The sterilized dressings, still in their packages, should be
put close at hand. A large kettle o f water should be boiled and
cooled without being uncovered. A t this same time the scissors for
cutting the cord should be boiled for 10 minutes and left untouched.
Meanwhile, i f matters have gone so far that the pains are return­
ing every 5 minutes, or i f the “ waters ” have broken, the woman
should go to bed; she will lie on her back, with her knees drawn
up and spread apart. ( I f the doctor is in charge, he may prefer
another position.) When the pain comes, the patient will bear down
but will not attempt to strain except when she feels she must. W ho­
ever is at hand to help will then put one o f the delivery pads under­
neath the mother’s hips and should thoroughly disinfect the hands
by scrubbing them for 10 minutes in warm water, using a brush and
plenty o f soap. The attendant will sit by the mother until the baby
is born, but should not touch her. After the head is born, i f the face
o f the baby turns blue, the mother should be told to strain vigorously,
and at the same time she may press with both hands upon her abdo­
men, while the attendant grasps the baby’s head and pulls it steadily
but gently downward. This will shortly bring out the baby.
As soon as the child is born he should take a breath and cry. I f
he does not do this, the attendant should slap him smartly upon the
buttocks, meanwhile holding him up by the feet for a moment. When
he cries, he should be laid down close enough to the mother so that
the navel cord will not be stretched, care being taken not to smother
him nor allow any o f the discharges to touch his face. Then the
attendant will tie the cord twice, once 2 inches from the child’s
navel, once 2 inches nearer the mother, using pieces o f sterilized
bobbin or other string that has been boiled. The cord is then cut
with the scissors between the two ties (ligatures) . There will be a
38


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single spurt o f blood, but bleeding will cease immediately if the cord
is tied tight. I f bleeding from the baby’s navel should not stop
altogether, the cord should be tied again nearer the baby without
disturbing the first tie. The cord dressing should be put in place
at once. The baby should then be covered with a light, warm, and
soft blanket, removed to a place o f safety while the mother is being
taken care of, and kept warm.
The separation o f the afterbirth usually takes place within 10 to
30 minutes. Sometimes it takes as much as two hours, but the proc­
ess must not be hurried, unless under the doctor’s directions. Some­
times the mother can help by straining as she did to bring the child;
but unless the doctor or nurse has arrived it is better to be patient
and wait for the contents o f the uterus to be expelled naturally. A ll
the soiled pads and dressings and everything that has been expelled
should be saved for the doctor’s inspection.
A fter the soiled pads have been removed, the region around the
vagina is carefully washed with sterile warm water, pieces o f sterile
gauze or cotton pledgets being used for this purpose. An abdomi­
nal binder and one o f the sanitary pads are then put on. A ll the
soiled dressings are removed and the pad beneath the mother re­
newed. If, after all is over, the mother suffers from a nervous chill,
as often happens, she need not be alarmed. A hot-water bag at her
feet, a glass o f hot milk, and a blanket will soon warm her, and she
will usually be ready to fall asleep to rest after the fatigue o f the
labor.
There is always a considerable discharge o f blood just after the
birth. The attendant can help to stop this bleeding. Sitting on the
bed, facing the foot o f the bed with the hands on the mother’s
abdomen, she will feel for the uterus, which will be a rather large,
soft mass just under the navel, and will massage it gently, passing
the thumb over the front o f the organ, while the fingers surround it.
This will cause the muscles o f the uterus to contract and will help to
stop the bleeding. The massage should be begun gently, as soon as
the child is born. Then the uterus will stay very tightly contracted
and firmer to the touch, and in the long run a great amount o f blood
will be saved. While the attendant is caring for the baby, either
the mother herself can be rubbing the lower abdomen or someone
else in the family can help temporarily. Cracked ice, wrapped in
gauze, may be laid over the uterus to help in the contractions, and
sometimes putting the baby to breast will serve the same purpose.
These measures are especially necessary if the amount o f bleeding
seems excessive and the doctor has not arrived.
When the doctor comes, he will repair any lacerations (tears) that
may have occurred during the baby’s birth.


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FIRST CARE OF THE NEWBORN
Immediately after the baby is born his eyes should be carefully
wiped free from mucus or blood with the pledgets o f sterile clean
absorbent cotton which were prepared beforehand. (See mother’s
supplies, p. 24.) A separate piece o f cotton should be used for each
eye and should be discarded as soon as it has been used once. Wipe
from the nose outward without opening the lid. A t this time also
the lips and nose should be wiped clean and the nurse’s or doctor’s
little finger, wrapped with a piece o f moist cotton, should be passed
into the child’s mouth and any accumulated mucus removed by an
outward sweep o f the finger.
N IT R A T E O F S IL V E R FO R T H E B A B Y ’S E Y E S

As soon after birth as possible the eyelids should again be wiped
clean o f mucus, and two drops o f a silver preparation which the
doctor or nurse will provide should be put into each o f the baby’s
eyes, the lids being gently opened so that the medicine will get
inside the eye. (Nitrate o f silver in 1 per cent solution is put up in
ampules for this purpose.) This care is necessary in all cases be­
cause a baby’s eyes may become infected during the passage through
the birth canal, and this infection sometimes leads to an eye disease
o f the newborn, called ophthalmia neonatorum, which may cause
blindness. The treatment is simple and perfectly harmless and is
certain to prevent the infection from developing. If, however, the
treatment is not given and symptoms of the disease appear (namely,
redness, swelling o f the lids, and a discharge from beneath them),
the mother should not lose an hour in placing the baby in the hands
o f the best doctor she can find. The eyes may be saved by a few
hours’ care, but treatment to be efficient must be begun at once; neg­
lect may doom the baby to lifelong blindness or at best to imperfect
vision. It is the law in all the States except one that this condition
must be reported to the health authorities.
In bathing the eyes always use a different piece of cotton or gauze
for each eye, and in case o f any infection use the greatest care not to
infect one eye from the other. The germs may be carried by the
fingers, the towels, the cotton, or any other article that has touched
the infected eye.
40


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P R EN ATA L. CARE

41

BATHING THE BABY

The newborn baby’s skin is covered -with a cheeselike substance,
which is the more easily removed if it is first oiled with olive oil,
liquid petrolatum, or petroleum jelly. The baby may then be
wrapped warmly and put in a safe place until the mother has been
attended to, after which the baby may be bathed. The water should
be o f a temperature that feels comfortable to the bare elbow o f the
nurse. After the skin is thoroughly but very gently washed with
Castile soap (care should be taken not to get soap into the eyes) it
should be patted dry with warm and very soft old towels. A square
of; sterile gauze, with a hole for the cord, is placed over the navel.
This square is folded back to cover the cut end of the cord, or a
second pad is placed over the cut end. The dressing is held in place
with the flannel binder already prepared. Unless this dressing
becomes wet or soiled it is not necessary to change it for a few days.
The stump o f the cord will usually shrivel and fall off within a
week. After this happens the navel will be dressed in the same
manner until it is entirely healed.
i

THE BABY’S STOOLS

The first discharges from a newborn baby’s bowels are known as
meconium. They are very dark green, thick and sticky, with little
or no odor. These soon change to the normal yellow stools of the
healthy baby after he begins to be fed. I f any blood is seen in the
stool of a newborn baby, the fact should be reported to the doctor
immediately..


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LYING-IN PERIOD
The time just after childbirth, when maternal nursing begins and
the organs connected with childbirth return to the condition they
were in before pregnancy, is called the lying-in period. The change
in the uterus, called the involution, is the most important. The uterus
dwindles in weight from about 2 pounds to about 2 ounces and
sinks down to its original position in the pelvic Cavity. The length
o f time required for these changes to take place is shorter with
nursing than with nonnursing mothers, but complete involution com­
monly takes five or six weeks. I f lacerations (tears) or other acci­
dents have occurred during childbirth, involution may take longer.
It is plain, then, that the mother, no matter how well she may feel,
needs a certain time o f rest before she is fully able to take up her
ordinary occupations and pleasures, which, if she goes back to them
too early, may slow up or stop the natural restorative processes.
Most women are allowed to sit up in a chair for an hour on the tenth
day. Usually they may walk about the room after two weeks, and
by the end of the month they will be allowed to go up and down
stairs; but in all cases it is well for the mother to refrain from full
activity for six weeks. After six weeks the doctor should make a
final internal (vaginal) examination to be sure that all is as it should
be and will direct the proper treatment in case anything is wrong.
For some time after the baby’s birth there is a discharge from the
vagina. This discharge, which is called the lochia, at first is pure
blood, but later becomes quite brown in color. It is likely to increase
somewhat as the mother gets about, and this is an additional reason
for lengthening the period o f rest and quiet after childbirth.
In a small percentage of cases the monthly periods may return at
once, but in the vast majority o f cases menstruation is not established
until a month or two after nursing has stopped. Nursing the baby
does not prevent conception, even though menstruation has not begun
again.


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NURSING THE BABY
It is the first duty o f every mother to nurse her baby. Every
doctor, nurse, or other attendant should insist that the mother nurse
her baby and should do everything possible to start the secretion o f
milk, to promote it, or even to bring it back i f for any reason it has
stopped. It isTrue that not all mothers are able to nurse their babies,
even when they would gladly do so, but the cases in which maternal
nursing is impossible, at least for a few weeks, are very uncommon.
There are only a few good reasons for not nursing an infant under
6 months old. Chief among them are tuberculosis in the mother
and the beginning o f another pregnancy.
ADVANTAGES

O F B R E A S T F E E D IN G O V E R A R T IF IC IA L

F E E D IN G

Mother’s milk gives the baby the greatest help in the complicated
and difficult task o f growing, and it also makes the baby more
resistant to the various sicknesses to which he may be exposed. Sat­
isfactory nursing greatly increases his chances for growing up.
Besides, it is easier to nurse the baby than to feed him otherwise.
T o make bottle feeding safe requires scrupulous and constant care.
T o secure a supply o f pure milk, to keep it at the proper temperature,
to have it properly prepared for the baby’s use, to change the compo­
sition o f the milk in accordance with the baby’s changing needs, to
keep all the utensils used in the care and preparation o f the baby’s
feedings absolutely clean, to have the bottles and nipples scrubbed
and sterilized, call for constant care and attention even when the baby
is thriving. But when, as is often the ease, the baby does not thrive,
the difficulties o f artificial feeding are greatly multiplied. Too often
artificially-fed babies pass their first 6 or 12 months in a series of
unfortunate feeding experiments, with the result that the growth o f
the organs, the functions, and the general development are retarded.
COLOSTRUM

A t the birth of the baby there is, in by far the majority o f cases,
no milk in the mother’s breasts. The secretion that is in the breasts
at that time is called colostrum. The mother’s milk does not usually
come for two or three days, sometimes longer, after the baby is born.
The colostrum has a laxative effect on the baby and for that reason
is valuable during the first days of his life. After the mother has


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P R E N A T A L CARE

had a good rest for 6 to 12 hours after the delivery, the baby should
be put to the breast for 2 or 3 minutes. By this early nursing the
breasts are stimulated to secrete milk, and the baby is trained early
to nurse. I f before the first nursing the baby becomes restless and
cries a great deal, he may be given a few teaspoonfuls o f warm boiled
water from a bottle. It is not necessary that the water be sweetened
or contain any medicine, although many physicians use a 5 per cent
solution o f milk sugar until the milk comes in.
P O S IT IO N FO R N U R S IN G

The position that the mother assumes for nursing her baby varies
more or less with the advice of the physician and nurse. A satis­
factory position is for the mother to turn well onto the side on
which she is to nurse, with the arm on that side raised up above
her head. The baby, lying on the bed" at her side, is able to get
hold of the nipple satisfactorily and the mother is not in a cramped
position.
F E E D IN G S C H E D U L E

The time for nursing varies considerably in different parts of the
country, but the majority o f physicians now have the mothers nurse
not oftener than once in three hours, and many put the baby at once
on 4-hour feedings. The routine in the establishment o f nursing
varies considerably, depending many times upon how much milk
there is in the breasts. As has already been said, the first nursing
takes place after the mother has had a good rest. Some doctors
increase the daily number o f feedings gradually, so that the regular
routine is established by the third or the fourth day o f life. Others
put the baby on the 4-hour or the 3-hour schedule immediately
after the first nursing. It is important that the nursings be by the
clock as soon as the regular routine can be established in order to
start the baby with good habits.
CARE OF TH E BREASTS

Before the baby nurses the first time the breasts should be thor­
oughly but gently washed. I f the nipples have been carefully at­
tended to in the last two months of the pregnancy, there will be no
dried secretion on them. I f by chance the nipples have not been
properly attended to and there is dried secretion on them, care must
be taken in removing it. The nipples first should be covered with a
simple cold-cream ointment in order to soften this secretion. Under
no circumstances should it be picked off, for, if it is, damage may
be done to the nipples, and this may allow infection o f the breasts
to occur.


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A fter the milk comes in, there may be an excessive supply for a
few days. In the majority o f cases there is no need o f doing any­
thing to the breasts with the first engorgement (fullness). Occa­
sionally the physician in charge may suggest the use o f a breast
pump or o f massage or the use o f warm oil to relieve the tension in
the breasts, but none o f these should be used unless the physician
advises it. I f the engorgement is very painful, the comfort o f the
patient may be increased materially if ice bags are put to the breasts.
A supporting bandage may greatly help large pendulous breasts,
but it must be put on properly and must in no way constrict them.
Massage must not be used on the breasts unless it is specifically
ordered by the physician in charge. Manipulation o f the breasts at
the first engorgement does more harm than the good that may come
in a few cases. A breast pump must not be used unless it is ordered
by a physician; and i f it is used, it must first be boiled and then
cooled.
In the early weeks o f nursing the breasts are extremely liable to
injury, and the nipples especially are very apt to become cracked.
I f this occurs, infection may follow. The three requirements for the
protection of the breasts are (1) absolute cleanliness, including
washing with boiled water before and after each nursing; (2) avoid­
ance o f the slightest injury; and (3) protection o f the nipples and,
in the beginning, o f the breasts themselves with clean linen between
nursings. I f the nipples crack, the baby may have to be taken off
the breast entirely for a few nursings, or a nipple shield may have
to be used. I f the nipple shield is used, it should be boiled before
each nursing. Advice on the use of the shield should be sought
from the doctor.
T H E B A B Y ’S P R O G R E SS

Whether the baby is doing satisfactorily may be found by weigh­
ing him every two or three days. A nursing baby should gain at
least 4 or 5 ounces a week. An ounce a day is a very satisfactory
gain, and many babies gain much more. A fter the nursing is well
established there should be a steady gain in the baby’s weight.
I f the baby cries before the feeding is due or immediately after
the feeding, it may be because he is not getting enough milk, and
that can readily be determined by weighing him with all his clothes
on before and after nursing and noting the gain. It is not sufficient
to do this once in the day. In order to find out whether there is
a sufficient amount of milk, he should be weighed before and after
every feeding in one 24-hour period and the amount o f milk ob­
tained noted. Even if the baby is getting only 1 ounce at a feed­
ing— obviously not enough—this is not usually a sufficient reason for


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P R E N A T A L CARE

weaning him. The breast milk must be supplemented with modified
cow’s milk. The thing to do is to obtain the advice o f some good
doctor who understands infant feeding. Four or five ounces o f
mother’s milk is distinctly worth while for the baby, especially if
this can be kept up for the first three months o f his life. The at­
tempt to nurse the baby will stimulate the flow o f milk, and then,
i f the breasts are completely emptied at each nursing1, the milk
oftentimes will increase, especially if the mother’s diet and her rest
periods and general health are carefully looked after.

Another bulletin o f the Children’s Bureau, Infant Care, gives
directions for the care of the baby to the end o f the first year.

1I f the baby does not empty the breasts, the milk should be expressed by hand or by
means of a breast pump. See footnote 1, p. 55.


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HYGIENE OF THE NURSING MOTHER
The diet for a nursing mother under ordinary circumstances will
be the same as that prescribed during pregnancy—that is, it must
be nutritious, laxative, and appetizing. The old idea that acid
fruits and vegetables give the baby colic is not true, since these acids
are changed in the process o f the mother’s digestion. However, if
they or any other food or drink disturbs the mother’s digestion, this
may have an unfavorable effect upon the milk. I f a woman eats
slowly, chews her food thoroughly, and, above all, has sufficient rest
and refrains from worry, there will be no reason to suppose that the
maternal milk will not agree with the baby. Constipation should
be guarded against as carefully during the period o f lactation as
during pregnancy.
A DAY’S FOOD PLAN FOR THE NURSING MOTHER

A quart o f milk, a leafy vegetable, a citrous fruit (orange or half
grapefruit), and an egg are essential in the nursing mother’s daily
diet. The following plan for the whole day’s food may be helpful:
jBreakfast

F r u it: H alf grapefruit, whole orange, or whole banana.
Cereal (well cooked) : Oatmeal, farina, or corn meal
with whole milk and sugar.
Bread and butter: Two slices of bread, with two pats
of butter.
M ilk : One cup, or one cup of cocoa made with whole
milk.
An egg, or bacon and egg, may be added to this meal.
(The egg should be
boiled, coddled, or poached.) One cup of coffee may be taken if desired.
10 a. m. luncheon
M ilk : One glass of whole milk (if this does not inter­
fere with the appetite for dinner).
D inner
Meat, fish, or egg.
S a la d : Lettuce, romaine, endive, cress, raw cabbage,
tomato, celery and nut, fruit, with mayonnaise or
French dressing.
Vegetables: Baked potato with butter, tomatoes, car­
rots, peas, or string beans; properly cooked cab­
bage, spinach, or other greens, creamed.


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PR EN ATAL, CARE

Bread and butter: Two slices of bread with one pat
of butter.
D essert: Custard, gelatin, canned or raw fruit, milk
pudding.
M ilk : One glass of whole milk.
Supper
Soup or "other hot dish (made with whole m i lk ):
Creamed pea, tomato, or other vegetable soup,
or a scalloped vegetable, or macaroni and toma­
toes, or rice and cheese.
Bread and butter: Bran or graham muffins or toasted
raisin bread with two pats o f butter.
D essert: Stewed fruit and cake or baked apple with
top milk or cream.
M ilk : One glass of whole milk.
One cup of tea may be taken in addition to the milk.
A glass of milk may be taken at 10 p. m.

Every effort should be made to get fresh vegetables, as no other
food can adequately replace them in the diet o f the nursing mother.
Canned tomatoes may be used frequently, and canned spinach occa­
sionally. When fresh fruit is too expensive or out of season, dried
or canned fruit may be used. I f it is impossible to obtain fresh
cow’s milk, dried or evaporated milk should be used.
Cod-liver oil is excellent to take under the doctor’s direction dur­
ing the period o f lactation, as it is during pregnancy. (See p. 11.)
HEALTHFUL LIVING ESPECIALLY IMPORTANT FOR NURSING
MOTHERS

It is necessary to emphasize the importance of a quiet state of mind
for all nursing mothers. There is no one thing which more cer­
tainly and completely interferes with the secretion o f the milk than
an overwrought, nervous condition. Moreover, an overworked
mother can not be expected to supply breast milk satisfactory in
either quality or quantity. The mother should have pleasant exer­
cise, out-of-door life, pleasure, cheerful society, and should be sur­
rounded as far as possible with things that interest her. She should
have at least eight hours o f sleep at night and an hour’s rest during
the day. The busy mother may add to her rest period by lying
down while she nurses the baby. Plenty o f fresh air and sunshine
are always desirable. The amount and kind o f exercise the mother
should take depend upon her habits. Many mothers find a walk
beneficial. A good rule is to exercise only to the point of a sense o f
pleasant stimulation. The busy housewife may get sufficient exercise
in her daily activities. She should take some time out o f doors, how­
ever, in the sun, preferably in the middle o f the day in winter and
before 12 and after 3 o’clock in hot weather.


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P R E N A T A L CARE

TEM PORARY

DECREASE

IN M IL K S U P P L Y
W E A N IN G

NO

REASON

FO R

There is usually a period after the nurse has gone and the mother
is left to herself when the weariness resulting from the fact that her
strength has not fully returned, broken sleep, and the worry conse­
quent upon taking care of the baby alone causes the milk to diminish
in quantity. This usually means that the mother is overdoing; she
has not gained the strength to take care of her household and at the
same time produce milk for the baby. It is at this time that many a
mother concludes that the baby is starving and is very apt to become
discouraged and give up nursing as hopeless. This is a great mistake.
It is usually true that the strain o f this period is relieved, day by
day, as mother and baby gradually become adjusted; her strength
returns; slowly but certainly things will grow more comfortable,
and with this will come more milk. So that i f the mother will only
strive to carry herself and the baby past this time she will in all
likelihood be able to nurse the baby quite successfully. At least
every possible means to this end should be tried before weaning is
resorted to.
The return o f the menstrual periods is not a sufficient reason for
weaning; but a pregnancy demands it, as the mother’s strength will
hardly be sufficient for this additional strain.


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PREMATURE DELIVERY AND THE CARE OF THE
PREMATURE BABY
The last two months o f prenatal life are very important in the
growth o f the baby, and every effort should be made to prevent pre­
mature birth. Delivery before the proper time may be the result
o f some o f the factors that lead to miscarriage. (See p. 32.) I f the
physician thinks that labor is about to take place before the proper
time, he will probably send the mother to a hospital.
In spite o f every effort and for some causes that are unavoidable, a
certain number o f deliveries occur prematurely. A premature baby
is not so well developed at birth as a baby bom at full term. The
earlier the baby is born, the more difficult it is to keep him alive. A
baby born only two or three weeks before the expected date may be
quite strong and little different from a full-term baby. A baby born
seven or eight or more weeks early may be very small and difficult
to save, and occasionally a baby born at full term is exceptionally
small and feeble. A ll babies weighing less than 5 pounds at birth
should be treated as if premature. Instructions for care o f the pre­
mature baby are included here in case the mother has not yet obtained
a book on infant care. (These instructions are quoted from the
Children’s Bureau publication, Infant Care, which may be obtained
free on application to the bureau at Washington, D. C.)
Many babies weighing only 2 or 3 pounds at birth can oe saved if
the proper care is given them. Premature babies born at home are
often best cared for in their home surroundings unless a hospital
suitably equipped for the care o f these small infants is available.
Such a hospital will have special rooms for these babies and will
have doctors and nurses on the staff who are trained to care for
them and who will be able to feed them properly. Great care
should be taken to keep the baby warm while he is being carried to
the hospital, as chilling at this time decreases the chances of saving
his life. He should be wrapped immediately after birth in wool
flannel or cotton batting and in several soft wool blankets, and if
the hospital is more than a short distance away warm-water bottles
should be used to keep him warm during the trip.

Most premature babies are born unexpectedly, and it is wise for
every expectant mother to have her equipment for the birth ready two
months before the baby is due.
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P R E N A T A L GARE

I f, as is the case in many communities, a properly equipped hos­
pital is not available, the premature baby must be cared for at home.
The advice o f a physician specially trained in the care o f babies
should be obtained at once and followed closely. I f a nurse who has
been trained in the care of premature babies can be engaged her
experience will be a great help to the mother.
In caring for a premature baby there are three main problems
which must be kept in mind constantly:
1. How can his body be kept at normal temperature ?
2. How can he be protected from infections?
3. How can he best be fed?
K E E P IN G T H E B A B Y A T N O R M A L T E M P E R A T U R E

The premature baby’s heat-regulating power is very slight. His
body temperature must be maintained for him by having the room in
which he is to be born kept warm (80° F .), by preventing exposure,
by using proper clothing to prevent loss of heat, and by applying
external heat. A ll this is most important in the first hours and
days o f life.
CARE

IM M E D IA T E L Y A F T E R

B IR T H

A premature baby may die from exposure unless proper care is
given him at once after birth. As soon as he is born he should be
wrapped in wool flannel or cotton batting, covering his entire body
except his face. This is necessary in order to keep him from losing
any o f his body heat. (The cord must be protected with a sterile
dressing.) He should be put at once into a warm bed which has
been prepared for him (see p. 53 for homemade heated bed) in a
warm room. His temperature should be taken by rectum soon after
birth, and his skin should not be oiled until his temperature is nor­
mal (98.6°-99.6° F .), and then only if his general condition is good
and the room temperature is not lower than 80° F. He may then
be cleaned with warm oil, one part o f his body at a time being
uncovered. It is much more important to keep him warm than to
give him a bath. The complete oil bath need not be given for
several hours or even a day or two after birth.
GENERAL

CARE

A premature baby should be exposed and handled as little as
possible— only when it is necessary to oil him, feed him, give him
drinking water, or change his diaper. He may be turned over as
often as every hour or two, but should not be picked up and handled
unnecessarily.


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P R E N A T A L CARE

The room in which the premature baby is kept should be venti­
lated by means o f a narrow cloth screen (2 inches or more, accord­
ing to the climate) at the top of one window, and a temperature
o f 75° to 80° F. should be maintained steadily, day and night.
When the temperature in a room is as high as this, it is apt to be
very dry. I f a window is kept open, even a small amount of out­
door air coming in will bring with it some moisture. More moisture
can be obtained by hanging wet sheets in the room or by keeping
a kettle o f water boiling on a small stove at a safe distance from
the baby. The temperature inside the crib should be between 80°
and 90° F. A thermometer should be kept in the crib with the baby
so that the temperature in the bed can be known at any time. The
baby’s body temperature should be taken by rectum every four
hours and recorded on a chart. It should be kept between 98.6°
and 99.6° F.
C L O T H IN G

The first clothing that a premature baby wears is usually the wool
flannel or cotton batting in which he is wrapped at birth and soft
wool blankets. The clothes that have been prepared for him are
as a rule much too large, and the mother or nurse must prepare
substitutes at once which can be put on and taken off with the least
possible handling o f the baby. The clothes must fit the baby snugly
to provide the necessary warmth but must not be tight. For a week
or two after the baby’s birth it may be best to continue the use of
the cotton batting or wool flannel wrapped closely about the baby’s
body and to use small squares o f cotton batting as diapers. Soon
after that, however, small shirts and bands o f wool flannel or
knitted wool material and small diapers may be used. A few o f
the regular-sized diapers can be cut down to fit the tiny baby. I f
the diapers can not be changed without considerable handling of
the baby, it is better to continue to use the cotton-batting squares,
which can be removed easily.
A sleeveless padded jacket may be used as a wrap. The jacket
may be made o f two squares o f cheesecloth or o f some very thin
cotton material (18 inches square), with a thick layer o f cotton bat­
ting stitched between, having a piece o f the padded material
arranged as a hood, and should be long enough to cover the feet well
and wide enough to lap over and be pinned in front. It may be
opened at the bottom for changing the baby’s diaper. When soiled,
such a jacket may be burned and a new one substituted. A small
square o f wool flannel or soft old blanketing may be used as a wrap
instead o f the cotton-padded jacket; but, though it is warmer, it is
less convenient for changing the diaper without disturbing the baby.


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P R E N A T A L CARE

53

A small-sized sleeping bag made o f a double thickness of flannel or
very light-weight soft wool material may be used.
None of the baby’s wraps should be so tight that his movements
are hampered.
HOM EM ADE

HEATED

BED

It sometimes is necessary to prepare an emergency heated bed
during delivery o f a premature baby. Such a bed may be a small
clothes basket or wooden box, prepared as follow s: Place a pillow or
several layers o f folded blanket in the bottom and cover this with
a piece o f thin rubber sheeting. Spread a cotton sheet or an old

blanket over the rubber sheeting and provide small, soft wool
blankets with which to wrap and cover the baby. Three warm-water
bottles should be filled with water at 115° F., placed in the bed
before the baby is born, and kept in the bed to warm it and the
blankets. (Warm bricks may be used instead.) The bed should not
be allowed to get cold before the baby is put into it. After the
baby is wrapped in warm blankets and put into the bed, the tem­
perature inside the bed must be kept at 80° to 90° F., but no higher.
The warm-water bottles should be refilled (at different times) with
water at 110° to 115° F. and kept in the bed, but outside the baby’s
wraps. I f warm bricks are used, they must be wrapped up and
placed outside the baby’s wraps. Care must be taken not to have
them too hot. Such a bed will serve at first until a better one can
be arranged.


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P EEN-A T A L CAKE

A better bed can be arranged by using a small clothes basket or,
still better, a box well padded inside and outside by quilting, into
which is fitted a removable platform about 4 inches above the padded
floor o f the basket. A thin, flat hair pillow or several layers o f wool
blanketing should be used as a mattress to cover the platform.
Beneath the platform, on the floor o f the basket, three warm-water
bottles are placed, which must be refilled whenever necessary to keep
the temperature in the bed between 80° and 90° F. It is best to
refill one bottle at a time, so as not to cool the bed too much. An
opening should be cut in the side of the basket below the platform
so that the warm-water bottles can be removed for refilling without
disturbing the baby. (See illustration, p. 58.) The bottles beneath
the platform should be at 115° to 125° F. I f warm-water bottles
are placed beside the baby in the bed, they should never be warmer
than 115° F.
I f the baby’s bed is. too hot, his temperature will rise above normal.
B A T H IN G

W ith very small and weak babies it is frequently advisable not to
give a bath for two or three days. It may, however, be necessary
for the doctor or nurse to use the warm bath to stimulate the baby
when he does not breathe well. I f the complete daily bath can not
be undertaken without danger o f chilling the baby, it should be
dispensed with or a partial bath may be given daily— washing the
face, buttocks, and genitals only— without removing the baby from
the heated bed and without exposing the rest o f the body.
The baths should consist o f a rapid sponging with oil or with
water at 105° F. in a room 75° to 80° F., one part o f the body only
being exposed at a time to prevent chilling.
P R O T E C T IN G T H E B A B Y FR O M IN F E C T IO N S

Premature babies have very little resistance to disease. They are
particularly subject to infections, especially colds. A cold is serious
in a premature baby because it is very likely to develop into pneu­
monia, which may prove fatal. Every person who cares for a pre­
mature baby or comes in contact with him in any way must be
careful to wash the hands before touching the baby lest some infec­
tion be carried to him. No one who has even a slight cold or other
infectious illness should be allowed to care for a premature baby.
No visitor should ever be permitted in the room where a premature
baby is kept. These rules can not be kept too strictly. Colds, pneu­
monia, and ear infections are common causes o f death in premature
babies.


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P R E N A T A L CARE

55

F E E D IN G T H E B A B Y
HUM AN

M IL K

The feeding o f a premature baby is a most serious problem.
Mother’s milk is the best food for him. Until the mother’s milk
is established, every effort should be made to get at least a few
ounces o f milk daily from some other mother nursing her own
child or from a breast-milk agency, or to obtain a regular wet nurse.
Any milk except that of the premature baby’s own mother should
be boiled for one minute.
The premature baby may be too weak to nurse or to draw milk from
a bottle, and in that case the mother’s milk should be expressed by
hand or by a breast pump 1 and fed to the baby slowly by means o f a
medicine dropper or stomach tube. Feeding with a stomach tube
(so-called “ catheter feeding ” ) should be undertaken only by a
trained person. I f a medicine dropper is used, it is well to slip a
short piece o f soft-rubber tubing over the end to prevent injury to
the baby’s .mouth. Occasionally a strong premature baby may be
able to nurse or to take breast milk from a bottle.
As it may be some weeks before the baby is able to draw even
small amounts o f milk from the breast, it will be necessary for the
mother to empty her breasts at regular intervals, not only *to obtain
milk for the baby during the early weeks o f life, but to keep up the
milk flow until the baby is strong enough to nurse.
I f breast milk can not be obtained, artificial feeding will become
necessary. The doctor will order the formula.
Oare should be taken that the baby is not overtired during feeding.
NUM BER AND AM OUNT

O F F E E D IN G S

^ It is best to withhold food for 12 hours the first day o f the baby’s
life. During the second 12 hours the baby may receive three feedings.
Expression o f milk from the mother’s breasts should be begun at the
1 The breasts may be emptied by hand, by an' electric breast pump, or by a hydraulic
breast pump. Breast pumps may be rented or purchased through the physician. The
ordinary suction breast pump is of little value. Emptying the breast by hand should
be done as follows : Scrub hands and nails with soap and warm water for one full
minute, using a brush. Dry the hands on a; clean towel. Wash the nipple with cotton
dipped in boiled water. Have a sterilized glass and bottle ready to receive the milk. If
the glass you are using has no lip, you should also have a sterilized funnel ready.
Place the balls of the thumb and forefinger on opposite sides of the breast 1 % inches
from the nipple. This is usually at the edge of the pigmented area. Press deeply guS
firmly into the breast until the resistance of the ribs isl felt. Then bring the thumb
and fingers tightly together well behind the base of the nipple When the fingers and
thumb are pressed deeply into the breast, keep them there and repeat the “ together”
motion 60 to 100 times per minuta Speed is important and is attained after some prac­
tice. The fingers should not slip forward on the breast lest the skin be irritated. It is
not necessary to touch the nipple. I f the stripping of thé breasts is done in this way it
Will cause no discomfort. I f the milk expressed is not to be used at once, it should
be kept on ice in a sterilized stoppered bottle.


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56

P R E N A T A L CARE

end o f 12 hours, and the colostrum— and the milk when it comes—
should be given to the baby. From then on he should be fed regularly
day and night. Small babies fed with a medicine dropper should
receive their food at 2-hour intervals during the day and 3-hour inter­
vals during the night (10 feedings in 24 hours). Larger babies,
whether fed with a dropper or from a bottle, may be fed from the
start at 3-hour or even 4-hour intervals.
The baby needs daily a total amount of fluid (milk and water)
equal to about one-fifth to one-sixth o f his body weight in pounds.
For instance, if the baby weighs 3 pounds, he will need daily one-fifth
o f 3 pounds, or three-fifths of a pound o f fluid. As 1 pound is equal
to 16 ounces, three-fifths o f a pound will be equal to about 9y2
ounces. The 3-pound baby’s full requirement o f fluid therefore
during 24 hours will be 9y2 ounces.
Such quantities, although needed, can not be given to the premature
baby during the first days o f life. The amount given daily will at
first be small and the increases gradual. In fact, it is fortunate if the
baby can take one-eighth of his body weight in total fluid (2 ounces
for each pound o f body weight) by the fourth day.
The quantity o f milk given in 24 hours at first will be half an
ounce to an ounce o f milk for each pound o f body Weight. This will
be divided into 10 feedings; each feeding will therefore be very
small— 1 to 3 teaspoonfuls of breast milk. The total amount o f milk
given in 24 hours may be increased daily by one-eighth to one-fourth
ounce for each pound o f body weight, until usually by the tenth day
the total amount o f milk taken in 24 hours will be 2 to 3 ounces per
pound o f body weight. The rapidity with which the amounts can be
increased will vary with the size and development of the individual
baby.
D R IN K IN G

W ATER

During the period when the baby is receiving very small feedings
o f breast milk, special care must be taken to give him small quanti­
ties (2 to 4 teaspoonfuls) o f boiled water between feedings. He will
need this to bring his total intake o f fluid up to even the lowest
requirement— 2 ounces for each pound o f body weight. As he takes
more milk he will require less water, but it is well to offer water to
him between feedings even when he is strong enough to take an
adequate amount o f fluid at his feedings.
THE

B A B Y ’ S W E IG H T

Although occasionally premature babies will hold their birth
weight, most of them will lose weight and should not be expected to
regain their birth weight until the second or, what is more likely,


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P R E N A T A L GARE

57

the end o f the third week. In very small premature babies an aver­
age daily gain o f one-third to one-half ounce, with a doubling o f
birth weight in 75 to 100 days, may be considered satisfactory.
A D D IT IO N A L

FO OD S

Premature babies are likely to develop rickets, and therefore it is
important that treatment in the form o f pure cod-liver oil, tested
for the antirachitic vitamin D, should be begun at the end o f the
first week o f life. Begin .with one-fourth teaspoonful o f cod-liver
oil twice a day and after two or three weeks increase this amount to
one-half teaspoonful twice a day. A t the end o f six weeks this
amount may be again increased to 1 teaspoonful twice a day, and in
the third month to 1y2 teaspoonfuls twice a day.
Orange juice— one-half teaspoonful in water once a day—should
be begun when the baby is 2 weeks old and the amount increased
gradually so that at 2 months the baby receives one-half table­
spoonful twice a day and at 3 months 1 tablespoonful.
Other foods should be added to the baby’s diet as he grows older,
as they are to the diet of the normal baby.
SU N BATHS

Sun baths can not be given to small premature babies until they
are strong enough to have part o f their clothing removed and lie
in the sun without chilling. In summer, when the sun is very warm,
premature babies may be given sun baths at an earlier age than in
winter. Because sun baths can not be given to premature babies
when they are very young, special effort must be made to see that the
full amount o f cod-liver oil, tested for vitamin D, is given with great
regularity. In hospitals artificial sun baths o f ultra-violet light may
be advised by the doctor.
T H E B A B Y ’S L A T E R D E V E L O P M E N T

As he grows older a premature baby should become more and more
like a small edition of a healthy full-term baby. Though small, he
should have good color in his cheeks, his muscles should be firm, and
he should gradually become more and more active and alert. He
may be slower in learning to do some things, like holding up his head
or sitting up; but if he gets the right kind o f food and plenty o f
sunlight, he will usually catch up to the full-term baby o f the same
age by the time he is 2 or 3 years old.


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SELECTED BOOKS OF INTEREST TO MOTHERS
B a b y ’s D a ily T im e Cards.

U . S. C hildren’s B u reau C h art N o. 14.

F ebru ary, 1930.)
T he B ab y in the H ou se o f H ealth .
Y ork , 1926.

48 pp.

(R evise d

A m erican C hild H ea lth A ssociation, N ew

1 0 cents.

B reast Feeding. U . S. C hildren’s B u reau F old er No. 8.
C h ild M anagem ent, by D . A . T h om , M . D . U . S. Children’s B u reau Publication
No. 143.

W a sh in g ton , 1928.

47 pp. (N e w edition in prep aration.)

A D octor’s L etters to E xpectant Parents, by F ra n k H ow ard R ichardson, M . D .
Children, the P aren ts’ . M agazine, and W . W . N orton & Co., N ew Y ork , 1929.
118 pp. $1.75.
T h e E xp ectan t M o th e r ; care o f her health, by R obert L . D e N orm andie, M . D .
(E d ite d by the N ation al H ea lth C ouncil.)

F u n k & W a g n a lls Co., N ew Y o rk ,

1924. 57 pp. 30 cents.
T h e E xp ectan t M other in the H ou se o f H ea lth .

A m erican C hild H ea lth A ssocia­

tion, N ew Y o rk , 1926. 23 pp. 10 cents.
E v ery d a y P roblem s o f the E v eryd ay Child, b y D . A . Thom , M . D .
& Co., N ew Y o rk , 1927. 349 pp. $2.50.
F eedin g th e F a m ily , by M a ry S w artz R ose.

D . A ppleton

M acm illan Co., N ew Y o rk , 1929.

459 pp. $2.40.
G ettin g R ea d y to B e a M other, by C arolyn C onant V a n B larcom , R . N .
m illan Co., N ew Y o rk , 1922. 237 pp. $1.50.
In fa n t Care. U . S. Children’s B u reau P ublication No. &

M a c­

W a sh in g ton , 1929.

127 pp.
T h e In fa n t and Y o u n g C h ild ; its care and feeding from birth until school age,
by John L ovett M orse,. A . M ., M . D ., E . T . W y m a n , M . D ., and L . W . H ill,
M. D.

(R e v ise d .)

W . B. Saunders Co., Philadelphia, 1929.

K eep in g the W e ll B ab y W e ll.

1930.)
A P ractical Psychology o f Babyhood, by Jessie Chase Fenton.
flin Co., Boston, 1925. 348 pp. $3.50.
T h e P rospective M other, by J. M orris Slemons.

(R ev ise d .)

Sun ligh t fo r Babies.
W h a t B u ild s Babies.
W h y D rin k M ilk ?
W h y Sleep?

263 pp.

$2.

(R evised

H oughton M if­

D . Appleton & Co.,

N e w Y o rk , 1921. 343 pp. $2.
S im p lifyin g M otherhood, by F ran k H ow ard R ichardson, M . D .
Sons, N ew Y o rk , 1925.

299 pp.

U. S. C h ildren ’s B u reau F o ld e r N o. 9,

G. P. P u tn am ’s

$1.75.

U . S. Children’s B u reau Folder No. 5.
U . S. Children’s B u reau F older N o. 4.

TJ. S. Children’s B u reau F older No. 3.

U. S. C hildren’s B u reau F older N o. 11.

Y o u r C h ild ’s Teeth.

U. S. Children’s B u reau F older No. 12.

1 Single copies of Children’s Bureau publications may be obtained free by writing to
the bureau at Washington, D. C.
58


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GLOSSARY

Abdomen.'— T h e b e lly ; the p a rt o f the body between the chest and the pelvis,
containing the stom ach, bow els, etc.
A bnorm al.— Ir r e g u la r ; not according to the usual standard or condition.
Abortion.— A m iscarriage.
A fte rb irth .— T h e m a ss o f tissu e (p lacen ta and m em branes) expelled fro m the
uterus a fte r the baby’s birth.
A n tirach itic.— P reven ting rickets fro m developing, or curing the disease i f it
is present.
A n u s.— T h e ou tlet o f the bow els.
A ssim ilation .— T h e process by which the body absorbs or m akes use o f nourish­
ment.
B irth canal.— T h e p assage through which the child is born.
B lood pressure.— T h e pressure o f the blood on the w a lls o f the blood vessels.
It is o f special im portance th at the doctor tak e a t each v isit the blood pres­
sure o f the expectant m other because a risin g blood pressure is one o f the
sym ptom s

o f toxem ia

o f pregnancy.

C alcium .— L im e ; a m ineral required by the body, particu larly fo r th e teeth and
bones.
Childbed fever.— F ever o f the m other resulting from blood poisoning at or near
the tim e o f ch ild b irth ; puerperal septicemia.
Circulation.— M ovem ent in a regular course, as the circulation o f th e blood
in th e vessels o f the body.
C olostrum .— T h e first fluid fro m the b reasts o f the m other a fter delivery o f the
child but before the m ilk comes.
Conception.— T h e fertilization by the fa th er o f the egg in the m other w hich
starts the grow th o f the fetu s in the m oth er’s body.
Confinement.— T h e tim e th at it is necessary fo r a m other to rem ain in bed
during and a fter the birth o f her baby.
C onstipation.— T h e passing

o f v ery

hard m aterial

from

the bowels,

or the

p assin g o f a very sm all amount, or fa ilu re to em pty the bow els daily.
C onstitu tion al disease.— A disease in which the w hole body or a large part o f
it is affected.
C rim in al abortion.— A n

abortion

or m iscarriage

that

is

artificially

brought

about and is not necessary to save the life or protect the health o f the
m other.
D eliv ery.— T h e. birth o f the baby.
D en tal arch.— T h e arch o f the ja w th a t contains the teeth and is covered by
the gum s.
D ig estive organs.— T h e principal digestive organs a re the m outh, stom ach, and
bowels.
D ouche.— A stream o f w ater directed upon or into a part o f the body.
E n em a.— T h e insertion o f a medicine or liquid in to the rectum.


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59

60

GLOSSARY

Fetus»-— T h e unborn ch ild in the uterus.
G oiter.— E n largem en t o f the th yroid gland, causing a sw elling in th e fro n t
part o f the neck.
H ygien e.— A system o f health rules or principles th at w ill prevent disease and
keep the body in good condition.
Infection .— T h e entrance in to the body o f germ s th at cause disease.
Intestin es.— T h e long tube extending fr o m the stom ach to the a n u s ; the bow els.
Involu tion .— T h e return o f the uterus to its n atu ral size a fte r the b a b y is born.
K id n eys.— T h e tw o organs in the abdom inal cavity that secrete the urine.
L actation .— T h e form ation o f m ilk in the m other’s breasts a fter the b irth o f
the b a b y ; th e nursing period.
L a x a tiv e .— A

food th at keeps the bow els o p e n ; a m edicine that causes th e

bow els to move.
M assage.— T rea tin g th e body by system atic stroking, rubbing, or kneading.
M en stru al period (m e n stru a tio n ).— T h e m on th ly flow in women.
M iscarriage.— E xp u lsion o f th e fe tu s before it can liv e outside the m other’s
body— th a t is, before the seventh m onth o f p reg n an cy ; abortion.
induced m is c a r ria g e ; C rim in al abortion.

See Self-

N ausea.— Sickness a t the stom ach.
N avel.— T h e place in the abdom en w h ere a t birth the cord w as attached that
connected the b aby w ith the mother.
O bstetrical.— H a v in g

to

do w ith

the care

and

treatm ent

of

women

during

pregnancy and childbirth.
Pelvis.— T h e bony cavity fo rm e d chiefly by the hip bones and containing the
uterus, vagina, bladder, and rectum.
P lacenta.— T h e organ w ith in th e”u terus o f the pregnant w om an through w hich
nourishm ent passes fro m her to the fetu s.

I t is attached on one side to th e

uterus o f the m o th e r ; a cord on the other side connects it w ith the fe tu s.
P rem atu re.— H appening before the u su al tim e, w hich in reference to th e length
o f pregnancy is nine m o n th s ; as, prem ature birth, prem ature labor.
P ren atal.— B efo re b ir t h ; refers to the period o f pregnancy.
P ren atal center or clinic.— A

place to w hich expectant m others can go fo r

advice fre e or fo r a sm all s u m ; u su ally connected w ith health departm ents
or hospitals.
P u erp eral septicem ia.— A

disease caused by blood poisoning a t or near the

tim e o f c h ild b irth ; som etim es called childbed fever.
R ectu m .— E n d o f the low er intestine lead in g to th e opening or anus.
R ick ets.— A disease o f children in which th e bones becom e so ft because o f lack
o f calcium .

I t can be prevented and cured b y sunlight and cod -liver oil.

Roughage.— A n y p art o f food th a t passes through the bow els w ith ou t being
d ig e s te d ; it thus helps to m ak e the bow els m ove and to prevent constipation.
Self-induced m iscarriage.— A

m iscarriage

or abortion

th at is brought about

m iscarriage or abortion

that occurs n atu rally,

by the m other.
Spontaneous m iscarriage.— A

w ith ou t artificial interference.
Sterilize.— T o m ake fr e e fro m all germs.
Stool.— T h e discharge fro m the bowels.
Syphilis.— A certain con stitu tion al disease th at is com m unicable through con­
tact— by sex u al intercourse or oth erw ise— w ith a person w ho has the disease
or w ith h is tow els, drin kin g g lass, or other personal belongings.

T h e baby

in th e uterus w ill becom e in fected w ith the disease from a m other w ho has
it i f th e m other does not receive adequate treatm en t during pregnancy.

F or

this reason a blood test (W a s s e rm a n n ) is necessary fo r all pregnant women.


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GLOSSARY

61

T h yroid .— A large gland in the neck th at is o f great im portance to th e proper
w orking o f the body m achinery.

See Goiter.

T issu e.— A collection o f cells form in g parts o f the body, a s bone tissue, brain
tissue, m uscle tissue.
T onsils.— S m all, so ft m asses lyin g on each side o f the throat.
U ltra -v iole t ligh t.— R a y s o f the sun or o f certain kin ds o f artificial light th at
do not give h eat and can not be seen but have a pow erful effect on liv in g
m a t t e r ; they prevent and cure rickets.
U terus.— T h e organ in which the unborn baby l i e s ; womb.
V a gin a .— T h e p assage through which the baby leaves his m other’s body a t
b ir t h ; the low er part o f the birth canal.
V itam in s.— Certain food elem ents th at are necessary fo r proper nourishm ent
and grow th.

L a ck o f v itam in s in the diet produces certain d iseases such

a s rickets.
V io stero l .— A m edicine m ade by treatin g a substance called ergosterol w ith
u ltra-violet ligh t.
W a sserm an n test.— A test o f the blood, to find out i f syphilis is present.
W o m b .— U terus.


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INDEX
Abdom en:
Binders or supports for, 15, 16, 24,
30, 39.
Blood vessels of, 29.
Definition, 59.
Examination of, 3.
Labor pains in, 36.
Pain in, during pregnancy, 17, 33.
Pressure on, during delivery, 38.
Abnormal delivery, 22.
Abortion, 59. See also Miscarriage
and Criminal abortion.
Acid fruits and vegetables, 47.
See
also Fruits and Vegetables.
Afterbirth, 35, 37, 39, 59.
See also
Placenta.
“ Afterpains,” 37.
Alcoholic drinks, 13.
Amniotic sac, 36, 37.
Anesthetic, 37.
Anus, 29, 59, 60.
Appetite, 12, 47. See also Food.
Artificial feeding:
O f baby, 21, 43.
Of premature baby, 55.
Attendant a t birth, 35, 38, 39, 43.
Automobile rides, 14, 32.
B ab y :
Birth of, 3 5 -3 7 , 3 8 -3 9 .
Care of newborn, 39, 4 0 -4 1 .
Care of premature, 5 0 -5 7 .
Clothing for, 23, 2 6 -2 7 , 36.
Feeding of, 4 3 -4 9 .
Supplies for, 2 6 -2 8 .
“ B aby’s sore eyes.”
See Ophthalmia
neonatorum.
Back:
Labor pains in, 36.
Strain on, caused by high heels, 16.
Bag of waters, 36, 37, 38.
Baking soda, 19.
B ath:
D aily, for expectant mother, 18,
20, 32.
First, for baby, 41.
For premature baby, 51, 54.


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Bands, baby’s knitted, 26.
See also
Binders.
Basket bed, baby’s, 26.
Bassinette, 26.
Bathing and swimming, 14.
“ Bearing down,” 37, 38.
Belching, 29.
Bicarbonate of soda. See Baking soda.
Binders, abdominal:
For use during pregnancy, 15, 16,
30.
For use after delivery, 24, 39.
Binders, baby’s flannel, 26, 41.
See
also Bands.
Binders, breast. See Brassières.
Birth canal, 2, 18, 37, 40, 59.
Birth o f baby. See Delivery.
Birth, probable date of, 2, 3.
Birth-registration information, n .
“ Birthmarks,” 21.
Bladder. See Urine.
Bleeding :
After delivery, 39.
From baby’s navel, 39.
In pregnancy, 33, 34.
Blindness in baby, prevention of, 40.
Blocks to raise delivery bed, 23.
Blood :
From navel cord, 39.
In baby’s stools, 41.
Loss of, after delivery, 39.
See also Bleeding.
Blood poisoning (puerperal septicemia),
18, 20, 33, 35.
Blood pressure, 3, 4, 31, 59.
Blood tests, 3, 32, 60, 61.
Blood vessels, 29, 30.
Bloody discharge during labor, 36.
See also Bleeding.
Bobbin, for tying navel cord, 24, 25.
Bones :
B aby’s, 6, 14, 18, 59, 60.
M other’s pelvic, 3.
Books for mothers, 58.
Boric acid, 17, 24.
Bottle feeding of baby. See Artificial
feeding of baby.
63

64

INDEX

Bottles, liursing, sterilization of, 43.
Bowels:
B aby’s, 41. .
Expectant mother’s, 7, 1 0 -1 1 , 17,
59, 60. See also Elimina­
tion of body wastes and
Digestive organs.
Bran muffins, 9, 10, 48.
Brassières, 15, 16, 20, 45.
Breads, 6 -1 1 , 17, 4 7 -4 8 .
Breast feeding, 18, 4 3 -4 9 , 60.
Beginning of, 39, 42.
Of premature baby, 5 5 -5 6 .
Preparation for, during pregnancy,
1 9 -2 0 , 21.
Breast milk, 1 9 -2 0 . £ee also Breast
feeding.
Breast-milk agency, 55.
Breast pump, 45, 46, 55.
Breasts:
Binders for. See Brassières.
Care of, during nursing period,
44r-45.
Care of, during pregnancy, 19 -2 0.
Engorgement of, 45.
Enlarging of, 1.
Expression of milk from, 55.
Stripping of, 55.
Tenderness, stinging, or prickling
in, 1.
See also Breast feeding and Nipples.
Butter, 7 -1 0 , 4 7 -4 8 ,,
Buttermilk, 7.
Calcium :
Definition, 59.
In diet, 7, 14, 18.
See also Rickets.
Calories needed by expectant mother,
7 -1 0 .
Candy. See Chocolates.
Canned fruit, 48.
Canned milk. See Dried milk and
Evaporated milk.
Canned vegetables, 48.
Carbohydrates in diet, 6, 29.
Cereals, 6 -1 0 , 17, 47. See also W holegrain breads and cereals.
Cheese, 7, 0 -1 1 , 48.
Chewing food thoroughly, 47.
Child, See Baby.
“ Childbed fever,” 59. See Puerperal
septicemia.


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Childbirth. See Delivery.
Chilling:
After delivery, 39.
In pregnancy, 14, 15.
Of premature baby, 50, 54, 57.
Chocolates, 12.
Circulation, 14, 15, 16, 18, 20, 59.
Citrous fruit, 47. See also Fruit.
Clinic, prenatal, 4.
Clothes:
For baby, 23, 2 6 -2 7 , 36.
For expectant mother, 1 5 -1 6 , 20,
32.
For premature baby, 51, 5 2 -5 3 .
Cocoa, 7 -1 1 , 47.
Cod-liver oil:
For expectant mother, 11, 18.
For nursing mother, 48.
Prevention of rickets by, 57, 60.
Coffee, 9, 11, 47.
Cold cream, 20, 44.
Cold weather:
Fresh air in, 14.
Sun baths for nursing mother, 48.
Sun baths for premature baby in,
57.
W arm clothes for, 15-1 6.
Colds:
In expectant mother, 32.
In premature baby, 54.
Colic in baby, 47.
Colicky pains, 17.
Colostrum, 4 3 -4 4 , 59.
For premature baby, 56.
Complications of pregnancy, 3 1 -3 4 .
Conception, 59.
Confinement, 6, 3 5 -4 2 , 59. See also
Delivery.
Constipation:
Definition, 59.
In expectant mother, 7,10-11,1 7,31 .
In nursing mother, 47.
Cooked fruit, 9 -1 1 , 48.
Cooking:
Fried foods, 12.
W ith milk, 7 , 9, 10, 47, 48.
Cord, navel:
Bobbin, for tying, 24, 25.
Connects fetus and placenta, 60.
Dressings for, 24, 25, 26, 41, 51.
Tying, 3 8 -3 9 .
Corsets, 16.

INDEX
Costs and fees:
Doctor’s, 22.
Hospital, 22.
Special nurse’s, 5, 22.
Visiting nurse’s, 5.
Cottage cheese, 7, 11.
Cotton, absorbent, in mother’s sup­
plies, 24, 25.
Cotton pledgets or swabs, 25, 27, 40.
Cough, 32.
Cow’s milk for baby. See Artificial
feeding.
Crackers, 29.
Cracks in nipples, 45.
Cramps in legs, 30.
Cravings for certain foods, 12.
Cream, 7 , 9, 10.
Creamed dishes, 7, 9, 10, 47, 48.
Criminal abortion, 33, 59.
Crusts on nipples, 20, 44.
Custards, 7, 9, 10, 48.
Dancing, 32.
Dark-colored breads and cereals, 17.
See also Whole-grain breads
and cereals.
D ate of birth, probable, 2, 3.
Decay of teeth. See Teeth.
Delivery, 3 5 -3 7 .
Abnormal, 22. See also Premature
delivery.
Bed for, 2 3 -2 4 , 36, 38.
Cost of, 22.
D ate of, probable, 2, 3.
Definition, 59.
Emergency, 3 8 -3 9 .
H om e or hospital, 22.
In previous pregnancy, 3.
N o tub bath a t beginning of, 18.
Pads, 24, 25, 38.
Premature, 14, 20, 3 2 -3 3 , 50.
Room for, 5, 2 3 -2 4 , 38.
Supplies and equipment for, 2 3 -2 6 .
Dental arch, baby’s, 18, 59.
Dentist, 4, 19, 32.
Desserts, 7 -1 0 , 12, 48.
Diapers, 23, 26.
For premature baby, 51, 52.
D iet. See Food.
Dietary essentials, 6, 7—10, 12, 47.
Digestion, 1 2 ,1 4 , 47. See also Stomach
and Intestines.


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Digestive

organs, 3, 59.
See also
Digestion.
Disease, constitutional, 32, 59.
Disinfection:
Of attendant’s hands, 38.
Of delivery supplies. See Steriliza­
tion.
Disorders, common, of pregnancy, 2 9 30. See also Complications
of pregnancy.
District nurse, 5.
Diving, 14.
Dizziness, 31.
Doctor:
Delivery by, 3 5 -3 7 .
Delivery before arrival of, 38—39.
Examinations by, 1, 2, 3, 22, 34,
35, 42.
First visit to, 1, 3 -4 .
Supervision of breast feeding 'by,
4 3 -4 9 .
Supervision of care of newborn
baby by, 40.
Supervision of care of premature
baby by, 5 0 -5 7 .
Supervision of prenatal care by,
1 -34 .
Douches, 30, 59.
Dresses:
B aby’s, 27.
Maternity, 16.
Dressings in supplies for delivery, 2 4 26, 38, 39, 41, 51.
Dried fruit, 48.
Dried milk, 7, 48.
Driving an automobile, 14, 32.
‘ ‘ D ry birth,” 37.
Ear infections in premature baby, 54.
Eggs, 6, 8 -1 1 , 18, 47.
Elimination of body wastes, 7 , 1 0 -1 1,
14, 1 7 -1 8 , 31.
Emergency, delivery in, 38. *
Enema can in supplies for delivery, 24.
Enemas, 17, 36, 59.
Engorgement of breasts, 45.
Equipment and supplies for delivery,
2 3 -2 8 , 50.
Eructation, 29.
Evaporated milk, 7, 48.
Examinations by doctor, 1, 2, 3, 22, 34,
35, 42.

66
Excretion.

INDEX
See Elimination of body
wastes.

Exercise:
After childbirth, 42.
For expectant mother, 13 -1 4, 17,
32.
For nursing mother, 48.
Expression of breast milk, 46, 55.
Eyes, baby’s, care of, 40.
* Eyes, expectant mother’s, spots before
or blurring of, 31.
Face, baby’s, turning blue during birth,
38.
Face, expectant mother’s, puffiness of,
31.
Father, 13, 2 0 -2 1 .
Fatigue:
After delivery, 39.
In expectant mother, 13, 14, 21,
32.
In nursing mother, 48, 49.
See also Rest, daily.
Fats in diet, 6, 12.
Fears, 21.
‘ ■Feeling life, ” 2.
Feet. See Shoes.
Fetus, 32, 33, 59, 60.
*‘ Fever, childbed. ” See Puerperal sep­
ticemia.
Fish, 8 -1 1 , 47.
Food:
For baby, 4 3 -4 9 .
For expectant mother, 6 -1 2 ,1 8 , 19.
For mother during labor, 36.
For nursing mother, 46, 4 7 -4 8 .
For premature baby, 50, 51, 5 5 -5 7 .
Fountain syringe in supplies for de­
livery, 24.
Fresh air:
For expectant mother, 13, 14, 19,
2 1 ,3 2 .
For nursing mother, 48.
Fried foods, 12.
Fruits, 6, 8 -1 1 , 17, 18, 47, 48.
Gain in weight. See W eight.
Gardening, 13.
Garters, 16.
Gauze in supplies for delivery, 24, 25,
39, 40, 41.
Gland, thyroid, 3, 11.


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Glands:
In neck of uterus, 30.
M ilk. See Breast feeding.
Sweat, 14.
Goiter, 11, 60.
Golf, 14, 32.
Green vegetables.
Gums, 19.

See Vegetables.

H abit training for baby, importance of
early, 21 , 44.
Hands, puffiness of, 31.
Head, baby’s, delivery of, 38,
Health rules, 3 1 -3 2 .
Heart, examination of, 3.
Heartbeat o f unborn baby, 2.
Heartburn, 29.
Heels for wear during pregnancy, 15, 16.
Hemorrhage. See Bleeding.
Hemorrhoids, 29.
Hom e delivery, 2 2 -2 6 , 3 8 -3 9 .
Home, harmonious, 2 0 -2 1 .
Horseback riding, 14, 32.
H ospital:
Costs, 22.
For expected abnormal delivery,

22

.

For expected premature delivery,
50.
For premature baby, 5 0 -5 1 .
W h at to bring to, 23.
W hen to start for, 36.
H ot weather, sun baths in :
For nursing mother, 48.
For premature baby, 57.
Housework:
For expectant mother, 13, 14, 21,
32, 34.
For nursing mother, 48, 49.
Husband, 13, 2 0 -2 1 .
Hygiene:
Definition, 60.
Of pregnancy, 3, 4, 6 -2 1 .
Of the nursing mother, 4 7 -4 9 .
See also Breast feeding.
Hygiene, mental, 2 0 -2 1 , 4 7 -4 8 .
Ice, for helping uterus to contract, 39.
“ Impressions, maternal,” 21.
Indigestion. See Digestion.
Infant Care (U. S. Children’s Bureau
Bulletin N o. 8), 46, 50.

INDEX
Infection:
Definition, 60.
Of expectant mother through birth
canal, 18.
Of baby’s eyes at birth, 40.
Of mother’s breasts, 44, 45.
Protecting premature baby from,
51, 54.
W ith syphilis, 60.
See also Puerperal septicemia.
Intercourse, sexual, during pregnancy,
20, 32, 60.
Internal examinations, 2, 3, 35, 42.
Intestines, 7, 1 0 -1 1 , 17, 60. See also
Elimination of body wastes
and Digestive organs.
Involution of uterus, 42, 60.
Iodine to prevent goiter, 11.
Jaw, formation of baby’s, 18.
Joints, pelvic, 30.
Jolting, 32.
Journeys, 14, 32.
Kidneys, 3, 1 0 -1 1 , 17 -1 8, 60.
Urine.

See also

Labor. See Delivery.
Labor pains, 3 5 -3 7 , 38.
Lacerations, 39, 42.
Lactation, 60. See also Breast feeding.
Laundering clothes outside hospital, 23.
Laxative:
Definition, 60.
Diet, 10 -1 1, 17, 47.
Layette. See Clothes for baby.
Legs:
Burning in, 29.
Cramps in, 30.
Puffiness in, 31.
Tingling in, 29.
Veins of, 29.
Leucorrhea, 30.
Ligatures for navel cord:
Bobbin for making, 24, 25.
Tying, 3 8 -3 9 .
Lime in diet. See Calcium.
Lime water, 19.
_
Liquids in diet, 11, 17.
Lochia, 42.
Lungs, 3, 17.
Lying-in period, 5, 42.


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Magnesia, milk of, 19.
Manual expression of breast milk, 46,
55.
Marital relations. See Sexual inter­
course.
“ M arking” the baby, 21.
Massage:
Definition, 60.
Of breasts, 45.
O f legs, 30.
O f uterus, 39.
“ Maternal impressions,” 21.
Maternity garments. See Clothes for
expectant mother.
M eat, 6, 8 -1 2 , 32, 47.
Meconium, 41.
Medical examinations. See Examina­
tions by doctor.
Membranes surrounding fetus, 33, 35,
37, 39, 59.
Menstruation, 1, 3, 13, 20, 33, 42, 49,
60.
Mental hygiene:
For expectant mother, 3 0 -2 1 .
For nursing mother, 4 7 -4 9 .
Menus, sample:
For expectant mother, 7 -1 0 .
For nursing mother, 47—48.
M ilk, breast. See Breast feeding.
M ilk, cow’s:
Dried, 7, 48.
Evaporated, 7, 48.
For baby. See Artificial feeding.
For expectant mother, 6 -1 1 , 18.
For nursing mother, 47, 48.
H ot, 39.
Skimmed, 7.
Top, 10, 48.
Whole, 7, 8, 9, 10, 47, 48.
M ilk puddings, 48.
M ilk sugar, 44.
M ilk of magnesia, 19.
Minerals in diet, 6, 7, 18.
Miscarriage, 3 2 -3 3 , 60. See also 13, 14,
20, 50.
“ Morning sickness,” 1, 29. See also
Nausea.
Mother’s milk. See Breast feeding.
Motoring, 14, 32.
M outh hygiene, 19.
Mucus to be wiped from newborn
baby’s face, 40.

68

INDEX

Naps, 14, 21. See also Sleep.
Nausea, 1, 12, 29, 60.
Navel, definition of, 60.
Navel cord:
Bobbin, for tying, 24, 25.
Connects fetus and placenta, 60.
Dressings for, 2 4 -2 6 , 41, 51.
Tying, 3 8 -3 9 .
Neck. See Goiter and Thyroid.
Nerves, overwrought, 20, 48.
Nervous system, 21.
Nervousness, 21, 48.
Neuralgic pains, 31.
Newborn baby, 39, 4 0 -4 1 . See also
Premature baby.
Nipple shields, 45.
Nipples:
Brassière loose over, 16.
Care of, during pregnancy, 20.
Dried scale on, 20, 44.
N ot to be touched in expressing
milk, 55.
Protection of, in early weeks of
nursing, 45.
See also Breasts and Breast feeding.
Nipples, rubber, 43.
Nitrate of silver, 40.
Nurse:
District, 5.
Engaging, 3, 5.
Public-health, 5, 26.
Special, for premature baby, 51.
Visiting, 5.
W et, for premature baby, 55.
W ork of, 35, 36, 40, 44.
Nursing mother. See Breast feeding.
Obstetrical

packages, 25. See also
Supplies and equipment for
delivery.
Oil, warm, for breasts, 45.
Oiling of newborn baby, 41, 51.
Olive oil:
For cleansing newborn baby, 26,
41.
In diet, 17.
Ophthalmia neonatorum, 40.
Orange juice for premature baby, 57.
Outdoor life, 13, 14, 18, 21, 48.
Overeating, 12, 32.
Overweight woman, 7, 10, 12.
Oxygen. See Fresh air.


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Pads, delivery, 24, 25, 38.
Pads, sanitary, 24, 25, 39.
Pain:
After delivery, 37.
Colicky, 17.
Headache, 31.
In abdomen, 17, 33.
In breasts, 45.
In legs, 30.
In pit of stomach, 31.
Labor, 35—37, 38.
Neuralgic, 31.
See also Colic in baby.
Pelvic cavity, 42, 60.
Pelvic examination, 3.
Pelvic girdle, 30.
Pelvic joints, 30.
Pelvic organs, 2.
Pelvis:
Definition, 60.
Measurements of, 3.
Perspiration, 14.
Petrolatum, liquid, 26, 41.
Petroleum jelly, 24, 41.
Phosphorus in diet, 18.
Physical examinations. See Examina­
tions by doctor.
Physician. See Doctor.
Piles, 29.
Placenta:
Baby nourished through, 6.
Definition, 60.
Expelling of, after delivery, 35, 37,
39.
Loosening of, a cause of miscar­
riage, 33.
Pledgets, cotton, 25, 27, 39, 40.
Postnatal period, 5, 42.
Potatoes, 6 -1 0 , 47.
Powdered milk, 7, 48.
Pregnancy, previous, 3.
Pregnancy a reason for weaning, 49.
Premature baby, care of, 5 0 -5 7 .
Premature delivery, 1 4 ,2 0 ,3 2 ,3 8 , 5 0 ,6 0 .
Prenatal center or clinic, 4, 60.
Prickling in breasts, 1.
Proteins in diet, 6, 7.
Public-health nurse, 5, 26.
Puerperal septicemia (blood poisoning),
18, 20, 33, 35, 59, 60.
Puffiness of face, hands, or legs, 31.
Pump, breast, 45, 46, 55.

INDEX
“ Q u ickening/’ 2.
Railroad trips, 14.
Raw fruit, 8 -1 1 , 48.
Raw vegetables, 6 -1 0 .
Recreation:
After lying-in period, 42.
For expectant mother, 21, 32.
For nursing mother, 48.
Rectal examinations, 35.
R ectu m :
Definition, 60.
Varicose veins in (piles), 29.
Rennet, 7.
Rest, daily:
For expectant mother, 13 ,14, 21 ,3 2 .
For nursing mother, 46, 47, 48.
See also Sleep.
Rest in bed:
During lying-in period, 5, 42, 44.
During pregnancy—
For abdominal pain, 33.
For bleeding, 33, 34.
For preventing miscarriage, 32.
For varicose veins, 29.
Rickets, 57, 59, 60, 61.
Riding:
Automobile, 14, 32.
Horseback, 14.
Roughage in diet, 17, 60.
Rubber sheet:
For delivery bed, 24, 36, 38.
For premature baby’s bed, 53.
Rubbing. See Massage.
Salads, 8 -1 0 , 47.
•
Salt in diet, 11, 12, 32.
Salts, mineral. See Minerals in diet.
Sanitary pads, 24, 25, 39.
Scale on nipples, 20, 44.
Schedule for baby’s feedings, 44.
Sea trips, 14, 32.
Septicemia. See Puerperal septicemia.
Sewing machine, running, 32.
Sexual intercourse during pregnancy,
20, 32.
Shaving of external parts, 35, 38.
Shoes, 15, 16.
“ Show ” of blood at the beginning of
labor, 36.
“ Sick pregnancy,” 31.
Signs of pregnancy, 1 -2 .
Silver, nitrate of, 40.
Skating, 32.
Skin, 10, 17, 18.


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Sleep:
After delivery, 39.
Am ount needed, 14, 21, 32.
Broken by need to urinate, 2.
For nursing mother, 48, 49.
In intervals between labor pains,
36.
Windows open during, 14.
See also Rest.
Soda. See Baking soda.
Sore throat, 32.
Soups, 7, 9, 10, 11, 48.
“ Sponges” of gauze, 24, 25.
Sports, 13, 14, 32.
Spots before eyes, 31.
Stages of labor, 3 5 -3 7 .
Starches in diet, 6, 29.
Sterile obstetrical supplies,
2 4 -2 6 ,
35, 38.
Sterilization, 60.
Of delivery supplies, 2 5 -2 6 .
Of nursing bottles and nipples, 43.
Of utensils for use in expressing
breast milk, 45, 55.
Sterilized dressings, 25, 26, 35, 38, 51.
Stillbirths, 32.
Stinging in breasts, 1.
Stomach:
Eructations from, 29.
Examination of, 3.
Pain in pit of, 31.
Upset by wrong food, 12, 29.
See also Digestion and Nausea.
Stools, 41, 60.
Sugar in diet, 6 -1 0 , 29, 47.
Sugar in urine, 29.
Sugar, milk, 44.
Sunshine:
For expectant mother—
As help to digestion, 12.
Cod-liver oil a substitute for,
11, 60.
For general health, 13.
For mental health, 21.
In delivery room, 23.
T o build baby’s teeth and
bones, 13, 18,
For nursing mother, 48.
Prevention and cure of rickets by,
60, 61.
Supplies and equipment for delivery,
2 3 -2 6 , 50.
Supplies, baby’s, 2 6 -2 8 .
Swabs. See Pledgets, cotton.
Sweat glands, 14.

70

INDEX

Sweeping. See Housework.
Swelling. See Puffiness of face, hands,
or legs and Goiter.
Swimming, 14.
Syphilis, 32—33, 60, 61. See also
Blood test.
Syringe, fountain, in supplies for
delivery, 24.
T ea, 9, 11, 48.
Tears (lacerations), 39, 42.
Teeth, expectant mother’s, 1 8 -1 9 .
Examination of, 3.
Injured by undernourishment, 6.
Protected by right diet, 7.
Teeth, building baby’s, 6, 11, 14, 18, 59.
Temperature of premature baby, 5 1 -5 4 .
Tennis, 14, 32.
T ests:
Of blood, 3, 32, 60, 61.
Of urine, 4, 1 7 -1 8 , 29, 31.
Throat:
Burning in, 29.
Examination of, 3.
Sore, 32.
See also Tonsils.
Thyroid:
Definition, 61.
Enlargement of, 11, 60.
Examination of, 3.
Iodine for, 11.
Toast, 8—10, 29, 48.
Tobacco, 13.
Toilet tray, baby’s, 27.
Tonsils:
Definition, 61.
Examination of, 3.
Toxemia, 3 1 -3 2 .
Training of baby from birth., 21, 44.
Traveling, 14, 32.
Tuberculosis, 43.
Ultra-violet light, 61. See also Sun­
shine.
Umbilical cord. See N avel cord.
Underweight woman, 7, 9 -1 0 .
Urine:
Analysis of, 4, 1 7 -1 8 , 29, 31.
Frequent passing of, 1, 2.
Uterus:
Contraction of, after delivery, 37,39.
Definition, 61.
Dilatation of mouth of, in labor,
3 5 -3 6 .


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U ter us— C ontinued.
Expulsion of afterbirth from, 37,
39, 59.
“ Feeling life” in, 2.
Glands in, 30.
In miscarriage, 3 2 -3 3 .
Involution of, 42.
Massage of, 39.
Pressure of, on intestines, 17.
Pressure of, on blood vessels, 29,
30.
Vagina:
Bleeding from, during pregnancy,
34.
Definition, 61.
Discharge from, during pregnancy^
30.
Discharge from, after delivery, 38,
39, 42.
Examinations by, 2, 35, 42.
See also Birth canal.
Vaginal examinations, 2, 35, 42.
Varicose veins, 29.
Vegetables, 6 -1 2 , 17, 18, 47, 48.
Ventilation:
Of house, 32.
O f room for premature baby, 52.
See also Fresh air.
Viosterol, 11, 61.
Visiting-nurse association, 5, 25.
Vitamins, 6, 7, 18, 57, 61.
Vomiting:
A sign of pregnancy, 1.
Relieving slight occasional, 29.
Serious or persistent, 31.
Walking, 13, 48.
Washes, mouth, 19.
Washing. See Housework.
Wassermann test, 32, 60, 61.
Wastes, body, elimination of, 7 , 1 0 -1 1 ,
14, 17, 18, 31, 60.
W ater, drinking:
For baby, 44^
For expectant mother, 11, 17, 32.
For premature baby, 51, 56.
Waters, bag of, 36, 37, 38. ,
Weaning, insufficient reasons for, 4 5 -4 6 ,
49.
W eight:
Of baby, 45.
Of expectant mother, 3, 7 -1 2 .
Of premature baby, 50, 5 6 -5 7 .

INDEX
W e t nurse for premature baby, 55.
W hite sauce, 7.
W hites. See Leucorrhea.
Whole-grain cereals and breads, 6 -9 ,
11, 17, 18.
W hole milk, 7, 8, 9, 10, 47, 48.
Winter. See Cold weather.
W om b. See Uterus.


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W ork for expectant mother:
And diet, 8 -1 0 .
And rest periods, 13, 14, 21.
Excessive, 13, 32.
W ork for mother after delivery, 42.
W ork for nursing mother, 4 8 -4 9 .
Worry, 21, 47, 49.

o

71


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