Getting ready to be a mother

We shall see that taking care of your baby before he is born means taking such care of yourself throughout pregnancy, that you not only keep your own body in its usual good running order, but in addition, so effectively promote the activities of your various organs that you also keep the baby’s body going, his body that is growing all the time.

Quite reasonably this requires extra work on the part of some of your organs, particularly those concerned with digestion and the process of throwing off impurities. The latter is of the greatest possible importance for in addition to excreting the usual amount of impurities from your own body you must excrete also those thrown off by your baby. The amount of waste from him is not large but it seems to be of such a character that it harms the mother if it is not steadily excreted.

Good digestion and satisfactory excretion are dependent upon a number of factors and fortunately most of them are within your own control.

Your frame of mind is one of the most important factors of all. I know that to suggest the cultivation of a cheerful, hopeful mental attitude is easier said than done. But after all it really is largely a matter of habit which you can acquire if you set yourself to it, particularly if you realize that your physical condition will be benefited by your going through pregnancy happily. And remember that whatever is good for you is good for your baby.

Continue with the work, amusements and exercise that you are used to and enjoy, except of course such activities as the doctor may forbid. In general, try to forget that you are pregnant, so far as you can do this and still remember to take proper care of yourself.

Above all, don’t worry. Worry will interfere with your sleep and it will also upset your digestion quite as seriously as will wrong food. Try not to be too self-centered or too watchful of your symptoms, but at the same time avoid the dangerous habit of thinking that any unusual condition which develops is due to your being pregnant, for a sick pregnancy is not normal.

It will relieve you of a great deal of anxiety if you report to your doctor everything you do not understand, for the consciousness that he will know just what to do, if anything is necessary, will help to keep you from worrying.

It is important, too, for you to get rid of the depressing beliefs in connection with pregnancy that have come down to us through the ages.

For instance, do not believe for a moment that anything you do, think or see can “mark” or deform your baby, for remember that after conception you give him nothing but nourishment. The only communication between you and the baby is through your and his blood, and blood does not carry mental impressions. Accordingly, no effects of fear, horror or unpleasant memories which you may have can possibly reach him. It is true that once in a while a woman does see something shocking and later gives birth to a marked or deformed baby. But there is little doubt, now, that such an occurrence is merely a coincidence. If you will stop and think for a moment you will realize that most expectant mothers see or hear or think something unpleasant at some time during pregnancy, and yet most babies are born without mark or blemish. Anger, fright or sudden shock may upset your digestion, but it does not directly affect your baby.

As for that common belief that in “reaching up” the mother may slip the cord around the baby’s neck—if you will picture for a moment how the baby lies within the uterus you will realize how impossible this is, for the mother’s arms have no connection with him or the cord.

So dismiss these doubts and fears from your mind and dwell instead upon the loveliness of what is in store for you, for, I repeat, your physical condition will be benefited if you go through pregnancy happily. And remember again that whatever is good for you is good for your baby.

So your first step toward caring for the little life already within your charge is to follow the example of Mrs. Wiggs, who constantly wiped the dust from her rose-colored spectacles.

Now for the more specific details of your care. Of these the question of your diet is of enormous importance.

Let us consider first what your food accomplishes if it is suitable and conditions are favorable for its use by you and the baby. It should provide nourishment for your various tissues, as under ordinary conditions; it should promote the activities of your skin and kidneys, as well as bowels, since it is through them that the waste from your own and your baby’s body must be excreted, and your food should be adequate also, to build and nourish the baby’s body without his having to draw materials from your tissues. Strange as it may seem, the baby’s physical needs are supplied before yours are met, and if there are not enough food materials for you both, your bones, teeth and muscles will be deprived. Furthermore, taking proper food during pregnancy is an important step toward preparing yourself to nurse your baby, after he is born, which is quite as urgent as nourishing him before birth.

To accomplish these ends you not only must eat suitable food, but you must digest and absorb it as well. This requires that you constantly guard against overeating, constipation and indigestion of any kind. Indigestion may be avoided during pregnancy exactly as it is at other times, by eating proper food, by cultivating a happy frame of mind; by having sufficient exercise, fresh air, rest and sleep.

If you are accustomed to a fairly simple, well balanced, mixed diet, you probably will need to make little or no change, except to have the evening meal light if it has been a hearty one. It may surprise you to learn that you need not “eat for two,” in quantity, as is so commonly believed necessary, for during pregnancy you make so much better use of food materials than usual that an amount and kind of food that keep you in good condition will be adequate to meet your baby’s needs, too, until the latter part of pregnancy. On the other hand, it is very unwise for an expectant mother to cut down her diet, with the idea of keeping the baby small and thus make labor easy, except under the direction of her doctor. In general it is the size of the baby’s head that makes labor easy or difficult, and not the amount of fat distributed over his body. And if the mother cuts down the minerals in her diet to make the baby bones soft, the only result is that her own bones and teeth are softened, because the baby extracts from them enough lime to supply what the food lacks.

Three meals a day will usually be enough during at least the first half of pregnancy and they should be taken with clock-like regularity, eaten slowly and masticated thoroughly. The possible need for slight additional food during the later weeks may be supplied more satisfactorily by lunches of milk, cocoa or broth and crackers or toast, between meals and upon retiring, than by taking larger meals. An expectant mother who has a tendency to nausea early in pregnancy often feels better for taking a small lunch regularly five or six times daily instead of the usual three full meals.

It is of the greatest importance that every pregnant woman drink an abundance of fluid to act as a solvent for her food and waste material and promote the activity of her kidneys, skin and bowels. She needs about three quarts daily, most of which should be water, the remainder consisting of milk, cocoa, soup and other liquids. Alcohol should not be taken except upon the doctor’s orders and only moderate amounts of coffee and tea, unless he gives permission for more.

The expectant mother will be wise to avoid fried food, pastry, rich desserts, rich salad dressings and any other food which would ordinarily disagree with her.

Since the enjoyment of one’s meals promotes digestion at all times, the expectant mother should try to eat the things that she enjoys most and that agree with her. The average pregnant woman who has no symptoms of complications will usually be able to supply her own and her baby’s needs and at the same time keep within the bounds of safety if she selects her diet from the foods included in the following groups:

Animal Foods. Milk and eggs are the most satisfactory, but for the sake of variety and to tempt her appetite the expectant mother will usually be allowed to take rather sparingly, and preferably only once a day, of fish, the various kinds of shell fish, beef, lamb, chicken or game. Pork, veal and goose should be avoided as a rule, and particularly by women with whom they ordinarily disagree.

Soups. Thin soups and broths have little food value but because of their appetizing flavor and aroma are an aid to digestion, and frequently by stimulating a flagging appetite will help the expectant mother to eat and assimilate more than she would without them. But cream soups and purées have a high food value and, like thin soups and broths, also supply a definite amount of fluid which she must have.

Vegetables. The group of vegetables generally designated as “leafy” are of even greater importance to the expectant mother than they are to the average person. Of these she may safely eat onions, asparagus, celery, string beans, spinach, and she should make a point of taking a green salad, such as lettuce, cress or romaine, at least once daily. Sweet potatoes, white potatoes, rice, peas, Lima beans, tomatoes, beets and carrots, also, may be eaten with safety, as a rule, but cabbage, cauliflower, corn, egg-plant, Brussels sprouts, parsnips, cucumbers and radishes should be taken with great caution and avoided altogether if they cause gas or any kind of distress.

Fresh Fruits. A necessary part of the diet is fresh fruit, and among those fruits which are both beneficial and usually harmless are apples, peaches, apricots, pears, oranges, figs, cherries, pineapple, grapes, plums, strawberries, raspberries, blackberries and grapefruit. These are more likely to be laxative if eaten alone, as before breakfast and at bedtime. Cooked fruits are also valuable articles of diet, but are probably less laxative than raw fruit. Some of the citrous fruits, oranges, grapefruit or lemons, should be taken daily because they possess a certain indispensable food value which is peculiar to them.

Cereals. For their nourishing and laxative qualities, cereals are important and their food value is increased by the milk and cream which are usually taken with them. Cooked cereals should invariably be cooked longer than the usual directions suggest. Bran, eaten alone as a cereal or in combination with other grains, is an excellent laxative.

Breads. Graham, cornmeal, whole wheat and bran bread are all good, in general the expectant mother will be on the safe side if she eats sparingly, if at all, of very fresh or hot breads and hot cakes.

Desserts. Desserts are very important for they add to the attractiveness of most people’s meals, and if wisely chosen and properly made, may supply a good deal of easily digested nourishment. They may include, in addition to fresh and cooked fruits and preserves, ice-cream, a wide variety of custards, creams and puddings made largely of milk, eggs and some ingredient to give substance and firmness, such as gelatin, cornstarch, rice, tapioca, farina, arrow-root and similar materials.

In general the expectant mother should eat an abundance of fruit and vegetables, taking at least some uncooked fruit and a green salad, daily, and make sure that her food contains a good deal of residue, such as is provided by fruit and coarse vegetables. This residue increases the bulk of the material in the intestines, and this helps to overcome the tendency toward constipation. As fat is less easily digested than starchy foods, and more likely to cause nausea during pregnancy, it is better to eat no more fat than usual but to supply the additional material which is needed after about the sixth month, by taking a little more starchy food. However, a slight increase only is necessary, and this chiefly during the last three or four weeks.

The Kidneys. It is scarcely possible to say enough about the importance of keeping your kidneys in normal working order during pregnancy, for through them is excreted much of the waste matter from your baby’s body as well as your own. Sometimes when these impurities are not thrown off as they should be the expectant mother has convulsions. You will be glad to know how much you yourself can do toward preventing convulsions by drinking plenty of water and by faithfully measuring your urine and taking a specimen to the doctor when he asks you to. As I said before, you should drink at least three quarts of fluid every day. Most of this should be water, the remainder being milk, cocoa, soup, tea, coffee, and so on.

The doctor will probably want you to measure your urine and take a specimen to him once a month during the first half of pregnancy and every two weeks afterward, or even every week toward the end. He can tell by examining the urine whether your kidneys are acting as they should and if they are not he may save you serious trouble by putting you to bed for a few days with no nourishment but milk and water.

In preparing a specimen you will need a covered corked vessel large enough to hold all the urine passed in twenty-four hours, and it must be thoroughly washed and scalded. The next step is to pass urine, suppose we say at eight o’clock in the morning, and throw it away. All of the urine which you pass after this time until eight o’clock the next morning must be saved in the vessel and kept in a cool place to prevent its decomposing. If you will put a teaspoonful of chloroform or boracic acid powder into the vessel it will tend to preserve the urine and will not injure the specimen. At the end of twenty-four hours the urine should be shaken to mix it thoroughly and about half a pint poured into a bottle that has been washed and scalded. Carefully cork and label this with the date, your name and address and the total amount of urine passed in the twenty-four hours. The vessel for collecting the urine and whatever you use as a measure should be reserved for these purposes only. If you have no tin or glass measure, a regular-size quart tomato can will prove entirely satisfactory.

If you find, when measuring your urine, that you pass less than a quart and a half in twenty-four hours, you may know without being told that this is not enough and that you should drink more water.

The Skin. People are likely to think of the skin as being simply a covering for the body, whereas, in reality, it is a very complicated and active organ which helps to regulate the body temperature and constantly throws off impurities, just as the kidneys do. This latter function is performed by the sweat glands which open upon the surface of the skin as the “pores,” and we are told that in all there are some twenty-eight miles of these tiny tube-like structures in the skin. These glands should be, and usually are, constantly active; they pour upon the surface of the body an oily substance which keeps the skin soft; they also excrete something more than a pint of water daily, which contains impurities that are harmful if retained in the body. We are not aware of this constant excretion of fluids, which is termed “insensible perspiration,” but it continues even in cold weather and must not be stopped if health is to be preserved. If the oil, dust, particles of dead skin and the waste material left by dried perspiration are allowed to remain upon the surface of the body they will clog the pores, or gland openings, and thus interfere with their action. The removal of this material, then, is necessary to maintain health, and is done automatically in part for the fluid evaporates and much of the solid matter is rubbed off on the clothing. The most important aids to the skin’s activity are the drinking of plenty of water, deep breathing, exercise and warm baths.

Regular and thorough bathing serves the double purpose of removing waste matter already on the surface, and of stimulating the glands to increased activity in giving off still more.

Many doctors advise a warm, not hot, shower or tub bath every day, with soap used freely over the entire body, followed by a brisk rub. The best time for this warm, cleansing bath, as a rule, is just before retiring, as it is soothing and restful, and tends to induce sleep. Very hot baths are fatiguing, particularly during pregnancy, and should never be taken except with the doctor’s permission; but cold baths usually may be continued throughout pregnancy if one is accustomed to them and reacts well afterwards. Under these conditions the morning cold plunge, shower or sponge is beneficial, as it stimulates the circulation and thus promotes the activity of the skin. Some doctors forbid tub bathing of any kind after the seventh month, on the ground that as the expectant mother sits in the tub her vagina is filled with unsterile water and should labor occur shortly afterward an infection, or fever, might result. And as she is heavy and somewhat uncertain on her feet, there is also the danger of her slipping and falling while getting in or out of the tub. Other doctors permit tub baths throughout pregnancy, up until the onset of labor; while as to hot foot baths, since there seems to be no reason for or against them at any time during the nine months, they may be taken or not at will.

Bathing in a quiet stream or lake is apparently harmless but sea bathing, if the surf is rough, is inadvisable because of the beating of the waves upon the abdomen and the general violence of the exercise.

The importance of keeping the body evenly warm throughout pregnancy cannot be overemphasized, for a sudden chilling or wetting may so check action of the skin as to impose more of a burden upon the kidneys than they can meet, in their effort to throw off the skin’s share of the body waste. Accordingly, a single chilling will sometimes be enough to cause convulsions. This may be one reason why convulsions occur more frequently during cold weather or after a sudden drop in the temperature after warm or mild days.

The Bowels. The bowels, also, throw off a certain amount of impurities and if they do not move thoroughly at least once a day these impurities may be taken into the system and again the kidneys be given extra work.

Unhappily a great many pregnant women are constipated, particularly during the later weeks, while women who have always had a tendency of this kind may have trouble with their bowels from the very beginning of pregnancy. Your bowels should move regularly every day, and to this end you should attempt to empty them at the same hour each day, immediately after breakfast being the best time. The importance of regularity in making the attempt cannot be overemphasized, even though the bowels do not always move.

The measures which tend to prevent constipation, as already pointed out, are drinking plenty of fluids, and eating fresh fruit, coarse vegetables and bulky cereals such as bran; also taking a glass of hot or cold water just before going to bed and the first thing in the morning. You should not take enemas or cathartics without your doctor’s order, but you may safely increase the amount of fluids which you drink and the bulk of your food, in order to regulate your bowels.

Senna and prunes cooked together prove to be helpful in keeping the bowels regular and they are entirely harmless. A simple way of preparing them for this purpose is to pour a quart of boiling water over an ounce of senna leaves and allow them to stand for about two hours. A pound of well washed prunes should soak overnight in this liquor, after it has been strained, and then cooked in it until tender. They may be sweetened with two tablespoonfuls of brown sugar, and the flavor improved by adding a stick of cinnamon or slice of lemon while they are cooking. Half a dozen of these prunes, with some of the syrup, may be taken at the evening meal to start with, and increased or decreased in number as necessary.

Clothes. The chief purpose of clothes under all conditions is to aid in keeping the body warm, thus helping to preserve an even circulation of the blood and the activity of the sweat glands. As has been pointed out, this is of especial importance during pregnancy. The expectant mother’s clothes should be not only sufficiently warm, but they should be equally warm over her entire body. They should be light and porous, and fairly loose, so as not to interfere with the circulation or other bodily functions. There must be no pressure on chest or abdomen; no tight garters, belts, collars or shoes.

The clothes of the mother-to-be, like every other detail of her care, must be adapted to her surroundings and mode of living. If her house is well and evenly heated during the cold months, she may quite safely dress lightly while indoors; if it is not, she should wear underwear with high neck, long sleeves and drawers, both indoors and out, except when the weather is warm enough to cause perspiration. At all times, however, the warmth of her clothing should be suited to the temperature of the home, the climate and the state of the weather.

Remembering that it is important for you to keep up the diversions and amusements that you enjoy, it is worth while to have your clothes as pretty and becoming as possible, for you are much more likely to go about and mingle with your friends if you feel that you are becomingly and well dressed. At the same time your clothes should be so made that their weight will hang from the shoulders instead of from the waistband.

And that brings us to the question of corsets, a much discussed garment. Women who have not been accustomed to wearing corsets will scarcely feel the need of adopting them during pregnancy except, perhaps, during the later weeks when the heavy abdomen needs to be supported for the sake of comfort. This need is felt particularly by women who have had children and whose abdominal walls are somewhat weakened in consequence.

If you have been wearing comfortable, well fitting corsets, you probably will not feel the need of making a change until the third or fourth month. But by this time the baby will have pushed up out of the lower pelvis into the abdomen and your corsets then, if you wear any, must be so constructed that they will not compress nor disguise your figure, but will provide support and accommodate themselves to an abdomen that is steadily increasing in size and changing in shape. Such corsets are made of soft material; have elastic inserts and have lacings at the sides as well as in the back. They come well down and fit snugly over the hips. (See Fig. 10.) Some women find comfort in attaching shoulder straps to their corsets thus suspending some of the abdominal weight from the shoulders. But as a rule, the most comfortable arrangement is a short-waisted maternity corset worn with a brassière that supports the breasts and does not compress the nipples.

I hope this description will make clear to you why the same style corsets as you ordinarily wear cannot be satisfactory during pregnancy, no matter how large they are, and may even prove harmful.

Even a properly fitting maternity corset may become uncomfortable during the last few weeks of pregnancy, and have to be replaced by an abdominal supporter of linen or rubber. And when this stage is reached, even the woman who has worn no corsets may find that she is more comfortable if she adopts such a support, particularly at night. There are many admirable binders on the market, or such an one as is illustrated in Figs. 11 and 12 may easily be made at home as well as comfortable and inexpensive stocking supporters, made from tapes or strips of muslin, as in Fig. 13.

Your shoes, also, merit some thought, for your feet will probably be larger during the latter part of pregnancy, partly because of the possibility of their being somewhat swollen and partly because the increased weight of your body tends to spread them. This added weight also increases the strain put upon the arch and as a result, flat-foot is fairly common among expectant mothers who have not taken pains to have their arches well supported. Your shoes would better be an inch longer than those you ordinarily wear; they should have broad, common sense heels and fit snugly over the instep, in spite of being full large. If your shoes are not comfortable you will find yourself tiring easily and for this reason will tend to take less exercise than you should.

Another reason for the need of proper shoes is that as pregnancy advances the expectant mother becomes rather unsteady on her feet, and broad, firm heels help to make her feel more secure. The heels need not be flat at first, if you have been accustomed to wearing high ones, for the sudden lowering of the heels may injure your arches, but as the weeks wear on you would better adopt moderately low heels. High French heels should be avoided because they not only increase the difficulty and discomfort of walking but cause backache, as well, by forcing a position that adds to the pressure on the lower part of the abdomen. They increase the risk of turning the ankles, too, and of tripping and falling, which is a very serious accident for the expectant mother.

Fresh Air. If you realize by this time how important it is to keep your digestion in good order and promote the activity of all your excretory organs, you probably suspect how important fresh air and exercise are to you and your expected baby, because of their effect upon your entire well-being.

The average individual uses up in a minute’s time the oxygen contained in four bushels of air, and since the pregnant woman takes in through her lungs the oxygen for both herself and her baby, she must have a sufficient quantity of air to supply at least this amount.

Accordingly, you should make a point of spending at least two hours of each day in the open air. If the weather is so stormy or severe as to make it undesirable for you to go out from under cover, because of the danger of getting wet or chilled, you can wrap up well and take your airing on a protected porch or in a room with all the windows wide open.

But this is only a part of it, for the air in your house or rooms must be kept fresh all day by being constantly changed; this requires a steady inpouring of fresh air and outpouring of stale air.

A very good way to accomplish this is to have one or more windows open slightly, top and bottom, all the time. But there must be no sudden changes of temperature, nor drafts, for fear of chilling your skin. At night you should sleep in a room with the windows open, taking care to be well protected by light, warm coverings.

Exercise. Each detail of the expectant mother’s daily routine seems to be more important than the last. And so when we come to the question of regular out-of-door exercise we are almost persuaded to believe that whatever else may be neglected, this is indispensable, since it promotes digestion, stimulates the activity of the skin and lungs, steadies the nerves, quiets the mind and promotes sleep. And more than that, walking, which is probably the most satisfactory form of exercise for her to take, also strengthens some of the muscles that are used during labor. But exercise is downright injurious if continued to the point of fatigue, no matter how little has been taken. Each woman must be a law unto herself in this matter, therefore, and must be impressed with the importance of stopping before she is tired. It may be a good plan for you to start by walking only a short distance at a time, increasing this gradually until you are able to walk possibly as much as an hour in the morning and an hour in the afternoon without fatigue.

All violent exercise and sports are of course to be avoided, particularly swimming, horseback riding and tennis. While motoring and carriage driving are pleasant diversions, they cannot be classed as exercise. They should be taken only in comfortable vehicles and over smooth roads, so that there will be no jarring nor jolting, and the expectant mother should not do the driving herself.

A certain amount of exercise, in the shape of light housework, may be taken indoors. This is distinctly beneficial if not continued to the point of fatigue, both because of the exercise which it provides, and also the diversion and interest, for these promote mental and physical health. But this indoor exercise must not interfere with, nor to any degree replace the daily exercise which you take out of doors; nor must it include heavy work, such as washing, sweeping, heavy lifting, running a sewing machine by foot or much running up and down stairs.

However, the amount and kind of work which the expectant mother may comfortably and safely do, are so related to what she has been accustomed to, that it is not possible to do more than describe what has proved of benefit for the average woman.

There are women to whom massage and gymnastics are helpful during pregnancy when for some reason the out-of-door activities are not possible or advisable. This might be true of an expectant mother with heart trouble, for example, or of one who is being kept in bed to prevent an abortion and accordingly is a matter which is closely directed by the doctor.

Traveling. In general, traveling is less dangerous for the expectant mother of to-day than formerly because it causes less strain, discomfort and fatigue than in the old days. But the question cannot be settled once for all women nor for all stages of pregnancy. Each woman’s general condition must be considered; her tendency to nausea; the length of the journey and the ease with which it may be made; also, whether or not she has ever had or been threatened with an abortion. As a rule, it is considered wise to avoid traveling during the first sixteen and the last four weeks of pregnancy, and at the time of the month when menstruation would ordinarily occur. Certainly a journey should not be undertaken at any time during pregnancy without a doctor’s permission.

Rest and Sleep. When we studied the changes that take place during pregnancy we found that as the abdomen increased in size and weight the expectant mother was required to make a constant, though unconscious effort to stand upright. This is probably one reason for the fatigue which she so often feels without apparent cause, and why, upon exertion, she tires more easily than usual.

Accordingly, you may find it necessary to rest frequently during the day in order to avoid the ill effects of fatigue. It is a good plan to work and exercise in short periods rather than long, always lying down when tired, and for an hour or two after the noon meal. You should be careful not to be over active or to overexert yourself at the time when menstruation would occur if you were not pregnant, for fear of bringing on an abortion. This precaution is particularly important during the first four months, the period when abortions occur most frequently.

Since eight hours’ sleep is usually considered necessary to keep the average person in good condition, you can scarcely expect to get along satisfactorily with less. In fact, this is so important to your general well-being that you should make a serious effort to secure it.

Fresh air during the day and open windows at night; prudent eating; a comfortable bed furnished with warm but light bedding; warm baths; a hot water bag to the feet and a hot drink upon retiring are all conducive to sleep.

But in addition to these, and perhaps of even more importance, are cheerfulness and a tranquil, untroubled state of mind.

Breasts. Breast feeding is the most urgent single need of the baby, for whose coming we are making preparations, and practically every mother, excepting those with definite physical disability, can supply this need of her baby’s if she gives herself proper care both before and after his birth. You will be glad to know in this connection that everything that promotes your general health helps to prepare you to nurse your baby, but there is need also for care of the breasts and nipples themselves, to make the nursing satisfactory, and to prevent sore nipples and possibly even breast abscesses.

Briefly, this local care consists of supporting heavy breasts, but avoiding pressure; bringing out flat or retracted nipples and toughening the skin which covers them.

After they become heavy and uncomfortable the breasts may be supported by brassières, which are snug below the breasts, loose over the breasts themselves and suspended from shoulder straps; or by some such binder as is shown in Fig. 11, which answers the same purpose.

If your nipples are flat or retracted, you should begin about the fifth month to make them more prominent in order that when the baby nurses he may be able to grasp them easily. There are several ways of accomplishing this, all of them in the nature of massage, but whatever is done must be done regularly and persistently. One simple and effective method is to grasp the nipple between the thumb and forefinger, draw it out, hold it for a moment, then release it and allow it to retract. This should be done over and over, two or three times daily. Or the unstoppered opening of a warm bottle may be placed over a flat nipple and held in place until the nipple is drawn up into the neck of the bottle as it cools and a partial vacuum is formed.

The toughening of the nipples should be begun eight weeks before the baby is expected. There are two general methods which seem to give about equally satisfactory results. One is to soften the skin, and the other is to harden it. In either case the nipples should first be scrubbed gently with a soft brush or cloth, warm water and soap, for about five minutes night and morning. After the scrubbing they should be rubbed with lanolin, cocoa butter or vaselin and covered with a piece of clean soft cloth or gauze, to protect the clothing. Or, they may be bathed with a wash consisting of equal parts of a saturated solution of boracic acid and 95 per cent alcohol. You will probably have to have a druggist prepare this for you because of the alcohol.

But no matter which course is followed the care must be regular to be effective. You will find that matters will be simplified if you will assemble in one place and keep in readiness the soap, brush and lotion or ointment which you use each time, using them for no other purpose.

Care of the Teeth. It is very important for the expectant mother to give her teeth scrupulous care from the beginning of pregnancy, for in addition to the ordinary wear and tear with which we all have to cope, her tendency to have an acid stomach makes her mouth acid and this is bad for her teeth. Accordingly, in addition to using dental floss and brushing your teeth after each meal, you should use an alkaline mouth wash several times daily, particularly after vomiting and before retiring, for much damage may be done by the acid secretions in the mouth if they are allowed to bathe the teeth during the long night stretches. Common baking soda (a teaspoonful to a tumbler of water), lime water or milk of magnesia all make excellent mouth washes. It is important, also, that you consult a dentist as soon as you know that you are pregnant and have any necessary repairs done promptly, for delay may be serious.

COMMON DISCOMFORTS DURING PREGNANCY

You may have a number of minor ills and temporary disturbances during pregnancy which are not serious but capable of making you very uncomfortable, and which you may sometimes relieve yourself. But should they be severe or persistent, you should consult your doctor at once. The most common of these minor discomforts may be grouped as digestive disturbances and “pressure symptoms.”

Chief among the digestive disturbances are “morning sickness,” “heartburn,” “distress” and flatulence or “gas.”

“Morning sickness” is probably the commonest discomfort of pregnancy as it occurs in about half of all cases. Because of the expectant mother’s tendency to nausea during the early months, it may be brought on by slight causes which would not produce nausea under ordinary conditions. While it is true that grief, anxiety, fright, shock, incessant worry, fits of temper or brooding may induce nausea when the diet is entirely satisfactory, nausea and even vomiting may be caused in the expectant mother just as they may in any one else by indiscretions in diet, rapid or overeating. On the other hand, simple, light food taken in small quantities, five or six times daily, eaten slowly and masticated thoroughly; the cultivation of a happy frame of mind; exercise and fresh air all tend to prevent this very uncomfortable condition.

Prevention is of great importance, as the habit of vomiting is acquired easily but broken up with difficulty.

When “morning sickness” occurs, however, the sufferer is often relieved by eating two or three hard, unsweetened crackers or crisp toast, immediately upon awaking and then lying still for half or three quarters of an hour. She should then dress slowly, sitting down as much as possible while doing so, and eat her regular breakfast. Lying flat, without a pillow for a little while after meals, or whenever having the slightest feeling of sickness, will frequently prevent, and also relieve nausea. Sometimes comfort is derived from the use of either hot or cold applications over the stomach. Some expectant mothers find that they can prevent nausea by having hot coffee, or even a full breakfast before arising. But the habit of having breakfast in bed should not be cultivated lightly, for in spite of yourself it is likely to make you feel like an invalid, the thing you should carefully avoid. So don’t do it unless your doctor orders it.

“Heartburn,” so called, which is suffered by so many expectant mothers, has nothing to do with the heart. It is due entirely to too much acid in the stomach and is usually felt as a burning sensation, which starts in the stomach and rises into the throat. It may be prevented, as a rule, by taking a tablespoonful of olive oil or a cupful of cream or rich milk fifteen or twenty minutes before meals and avoiding fat and fried food at the meals themselves. Or, it may be enough simply to avoid eating fats and fatty foods. Since the painful, burning sensation is directly due to too much acid in the stomach, it usually may be relieved by taking a tablespoonful of lime water; a teaspoonful of sodium bicarbonate in water; a small piece of magnesium carbonate; or a drink of any alkaline water that one fancies.

“Distress.” Another common discomfort of pregnancy is called “distress” by the sufferers themselves, and occurs after eating. It may be neither heartburn nor pain, but resemble both and make the expectant mother very miserable. It is usually suffered by women who eat rapidly, do not chew their food thoroughly or who eat more at one time than the stomach can hold comfortably. This is one more reason for taking small amounts of food at a time, eating slowly and masticating thoroughly.

Flatulence, or “gas,” may or may not be associated with heartburn, but is fairly common among expectant mothers, and is rather uncomfortable. A daily bowel movement is of prime importance in preventing and relieving flatulence and at the same time foods which form gases should be carefully omitted from the diet. The chief offenders are parsnips, beans, corn, fried foods, sweets of all kinds, pastry and very sweet desserts. Yeast cakes and artificially fermented milk sometimes help to prevent flatulence.

Pressure Symptoms. Under the general heading of pressure symptoms are several forms of discomfort resulting from pressure of the enlarged uterus (containing the baby) on the blood-vessels which return from the lower part of the body, thus interfering with the flow of blood back to the heart. The commonest pressure symptoms are swollen feet, varicose veins, hemorrhoids (piles), cramps in the legs and shortness of breath. They may appear at any time during the last half of pregnancy and they grow worse as the weeks wear on.

Swelling of the feet is very common, and when very slight may not be serious or particularly uncomfortable. The swelling may be confined to the back of the ankle, which grows white and shining, or it may extend all the way up the legs to the thighs. Sitting down, with the feet resting on a chair, or lying down with the feet elevated on a pillow will give a certain amount of relief. If the swelling and discomfort are extreme, the expectant mother may have to go to bed until they subside, but very often she will be relieved by elevating her feet or assuming the right-angled position shown in Fig. 14, for even a little while, several times a day. But while employing these harmless measures to make yourself comfortable, you must remember that the swelling of your feet and ankles is one of the symptoms that your doctor wants to know about. For this reason you should promptly report to him even the slightest swelling and begin to measure and save your urine for examination.

Varicose veins are not peculiar to pregnancy but they are among the pressure symptoms which frequently appear during the later months, particularly among women who have borne children. The enlargement of the veins is not usually serious but it may cause a good deal of discomfort. While varicose veins may occur in the vulva, they are usually confined to the legs, and both legs are about equally affected. Sometimes, however, the veins in the right leg are more distended than those in the left, or the right side alone may be affected.

Considerable relief may be obtained by keeping off the feet, particularly by elevating them, and also by the use of elastic bandages. When an expectant mother finds it difficult or nearly impossible to sit or lie down for any length of time, she may secure great relief in a few moments by lying flat on the bed with her legs extended straight into the air, at right angles to her body, resting against the wall or head board, as shown in Fig. 14. This right-angled position for five minutes, three or four times a day, will accomplish wonders in reducing varicose veins.

A spiral elastic bandage, also, will give comfort and help to prevent the veins from growing larger, if applied freshly after each time that the leg is elevated. The most satisfactory bandages, from the standpoint of expense, comfort and cleanliness, are of stockinette or of flannel cut on the bias, measuring three or four inches wide and eight or nine yards long. If made of flannel, the selvages should be whipped together smoothly so that there is neither ridge nor pucker at the seam. The bandage should be wrapped around the leg with firm, even pressure, starting with a few turns over the foot to secure it, and leaving the heel uncovered, carried up the leg to a point above the highest swollen vessels. As a rule the bandage may be left off at night.

There are satisfactory elastic stockings on the market, but they are fairly expensive, often cannot be washed and seem to offer no practical advantage over the bandages.

Swollen veins in the vulva may be relieved by lying flat and elevating the hips, or by lying on the side with the hips elevated on a pillow for a few moments several times a day, as shown in Fig. 15.