Getting ready to be a mother

During the past nine months you have had the happiness of guarding the little life within you and of making soft, warm garments to have in readiness for the baby when he comes. You have prepared your room and his; folded up the packages of gauze and cotton and prepared all sorts of other things to be pressed into service upon the baby’s arrival, and through it all you have dreamed and planned and built the loveliest of castles in Spain.

And now, at last, the baby is coming!

It almost takes your breath away to realize it after all those months of waiting and dreaming, and though it scarcely seems possible, the waiting is almost over.

This same waiting grows very hard toward the end for you are tense with expectation and suspense. The hours and days seem endlessly long, as they pass without giving the looked-for signs that the baby has started. You find it very hard not to grow discouraged and impatient, he seems so long in coming. Your physical discomfort is aggravated by the greater pressure made by the baby during this period, and you cannot get away from it day or night. The desire to urinate is almost constant; your back aches; your feet feel heavy and swollen and the baby disturbs your nights by his increasingly vigorous kicking.

But this does not last long, so try to minimize the fatiguing effects of it all by resting and sleeping as much as possible during the day. The time does slip by and the baby really does come and you don’t want to be tired before the big event.

The miracle of the baby’s origin at the moment of conception; of his growth and the development of the intricate parts of his little body, is equaled only by the miracle of his birth—his separating from your protecting body and coming into the world as a new human being when the time comes that he is able to exist separately and independently.

Since very early in pregnancy, you will remember, your uterus has been growing alternately hard and soft as the muscles have contracted and relaxed. But these contractions have been as painless, and so far as we know, as fruitless as the contractions of a boy’s biceps as he clenches his fist and produces a hard lump on his arm.

But when the baby is ready to take up his life among the rest of us human beings, the contractions of your uterine muscles are altered in such a manner that you gradually become conscious of them and they become so purposeful that they are able slowly but steadily to force the baby down through that narrow part of the pelvis called the inlet, through the cervix, and finally out into the world.

Since, at the proper time you will be able to help these altered muscular contractions to accomplish their high purpose, you will want to watch their progress, with your mind’s eye, as far as possible.

Recall, for a moment, the fact that the baby is contained in a sac of fluid in the cavity of the uterus, above the cervix; that the cervix, below, is a canal drawn in tightly at the upper end, or internal os, and also at the lower end, or external os.

Quite evidently after the baby’s head has been squeezed through the pelvic inlet by pressure of the uterine contractions, the cervix must open widely in order that he may pass through it, too. And so Nature gradually stretches this narrow canal by using the lowermost part of the bag of waters as a water-wedge and forcing it down into the internal os, a little farther with each pain. The opening grows wider and wider as the bag of waters is pressed farther and farther down into the cervical canal, which also widens slowly, and finally the external os, too, is stretched wide open by the water-wedge. Fig. 22 shows how the cervix looks with the bag of waters pressed against the upper opening and how the entire canal is gradually dilated by this wedge, as it is pressed downward.

As you doubtless know, the process of your baby’s emergence into the world and separation from your body is termed labor. The onset of labor is usually marked by the expectant mother becoming conscious of the uterine contractions through dragging pains which are felt first in the small of the back and then in the lower part of the abdomen and thighs. In the beginning the pains are feeble and infrequent, but they gradually grow more severe and more frequent. Sometimes the first sign of labor is a gush of fluid, caused by the rupture of the membranes, or the appearance of blood, but these are not typical. Intestinal colic is sometimes mistaken for labor pains by women who are pregnant for the first time, but when the cramps come regularly and the uterus is felt, through the abdominal wall, to grow hard as the pain increases, and soft as it subsides, there can be no doubt that they are labor pains.

This is the time, usually, when you will go to the hospital, if your baby is to be born there, or when you will notify your doctor that you think you are in labor. If you are to remain at home the doctor may want you to send for the nurse at once, in which case he depends upon her to communicate with him. Or he may prefer that you notify him and let him send the nurse. Either arrangement is simple and easy to carry out, but you must be sure that you understand just what the doctor wants you to do when you think labor has started. It is not a bad plan to write down his instructions about this, with the telephone number and street address of the one to be summoned, so that you will know exactly how to proceed when the time comes.

The entire duration of labor may vary from a few moments to several days, but the average length of the first labor is about eighteen hours and of subsequent births about twelve hours. The process is usually described as being divided into the first, second and third stages of labor, approximately as follows:

The first stage begins with the onset of labor and lasts until the cervical canal is completely dilated; the second stage begins when the cervix is dilated and lasts until the baby is born; the third stage begins with the birth of the baby and lasts until the afterbirth is expelled.

First Stage. The pains are mild at first and occur at intervals of from fifteen to thirty minutes, but they gradually increase in frequency and intensity until by the end of fourteen to sixteen hours, they are very severe, and recur every three or four minutes, each pain lasting about one minute. The pains begin in the back, then pass slowly forward to the abdomen and down into the thighs.

The average woman is entirely comfortable between pains and until they become very frequent she will usually prefer to be up and about, but if she is on her feet when a contraction begins she will usually seek relief by leaning forward on something secure, as the foot of the bed or a table, or by sitting down until the pain subsides. As time passes, there is an increasing, sometimes persistent desire to empty the bowels and bladder because of pressure upon these two organs by the baby’s head as it is forced slowly downward. There may be vomiting, also when the cervix becomes nearly, or quite dilated.

In the course of the stretching process, the cervix sustains many tiny tears from which blood oozes and tinges the vaginal discharge. This bloodstained discharge is often called the “show” and usually appears toward the end of the first stage.

When the cervix is fully dilated, the membranes, or bag of waters, usually rupture, and there is a sudden gush of fluid, but the rupture of the membranes does not necessarily mark the end of the first stage. Sometimes, though not often, they break before labor begins, thus producing what is known as a “dry” labor. They may rupture before the cervix is fully dilated or they may not rupture at all until the doctor punctures them to facilitate the baby’s birth.

If the nurse is delayed in reaching you, there is a good deal that you can do and have done, during this first stage of labor, in the way of preparing for the baby’s arrival, this preparation relating in general to yourself and to the room including placement of the sterile dressings.

As to yourself, try first to picture what takes place during the fifteen or sixteen hours of the first stage. The baby’s head has usually passed through the pelvic inlet and not much happens, now, beyond the widening of the cervical canal, as the bag of waters is forced down by the squeezing of the uterus each time that it contracts. (See Fig. 23.) As the contractions grow stronger and more frequent you may have a desire to help matters by “bearing down,” or straining, but this is very unwise for nothing that you can do will hasten the dilation of the cervix. The bearing down will tire you and then you will not be able to make as much helpful effort during the second stage as you would in a fresh and rested condition. For this reason, if your pains begin at night, don’t get up, but stay in bed and try to get as much sleep as possible. If they begin during the day, keep up and about during most of the time, but lie down often enough and long enough to prevent your getting tired. But above all don’t bear down during the first stage.

Take a warm soapsuds enema; a thorough, warm, sponge or shower bath, scrubbing the inner surface of the thighs and lower abdomen thoroughly, but do not bathe between the labia. Put on a freshly laundered nightgown, stockings, dressing-gown and slippers and braid your hair, preferably in two braids.

Drink all of the water you want and about every three or four hours take some form of liquid nourishment such as milk, cocoa, strained soup or broth, with toast or crackers. Such nourishment will help to keep you from getting tired and will do no harm, but it may not be altogether wise to take anything more solid without your doctor’s permission. It is not uncommon for one to feel nauseated toward the end of the first stage and this tendency may be aggravated by taking solid food.

One thing to remember is the very great importance of your poise and favorable mental attitude. So much of proved value has been done, and still is being done, to safeguard you and your baby, that you have every reason to feel calm and secure, and it is of very practical importance that you cultivate this attitude. The woman who allows herself to become excited, nervous and apprehensive has much harder time than the one who asserts her self-mastery and preserves a tranquil state of mind. This is so definitely the case that for the sake of your own comfort I cannot urge you too strongly to remember it and to exclude disturbing or exciting influences as far as possible. One of the most troublesome of these is excitable but well-meaning and officious friends or relatives. Accordingly, if your nurse is not at hand try to have some one cool-headed woman with you and insist upon excluding those who would be upsetting or likely to offer advice and suggestions. In getting yourself ready, then, it is advisable to take a bath and an enema; put on clean clothing; not to stay in bed entirely throughout the first stage, but on the other hand to try to keep mind and body fresh and rested by lying down when you begin to feel tired, taking light nourishment regularly, not bearing down during pains and denying yourself to visitors who might be excitable.

This is all simple enough and you will not find it difficult to carry it out. And, happily, the preparations relating to the room are equally simple and uncomplicated.

Either you or the friend who is with you, may make the bed—you if you feel like it, she, if you are tired. The mattress is covered with the larger of the two pieces of rubber sheeting that you have in readiness and over this is placed the lower sheet, stretched very smooth and tight and tucked well under the mattress at head, foot and sides. If the sheet is not very large, it may be made secure by being pinned with safety-pins to the under side of the mattress. The smaller rubber is then placed across the middle third of the bed and over this a muslin sheet, folded once through the middle, tucked well under the sides of the mattress. Next, the upper sheet, a light blanket and a thin counterpane, all left open at the foot, and a pillow.

The packages of sterile dressings, douche pan, fountain syringe, pitchers and basins may be placed on the tables, and the washstand equipped for the doctor’s hands with soap, sterile nail-brush, nail scissors and file. A large kettle or pail of water should be boiled, covered and put aside to cool and a large receptacle such as a wash-boiler, half or two thirds full of water put on to boil when the pains begin to come about every five minutes.

The baby’s bathtub should be near at hand for sometimes babies do not breathe quite satisfactorily at first and are helped to do so by being held in a tub of warm water. There should be, also, a box, basket or crib, in readiness to receive the baby, furnished with a clean blanket and hot water bottle with a flannel cover.

These are the preparations which may be made during the first stage—that period when the cervix is being slowly but steadily dilated by the bag of waters as it is forced downward by the uterine contractions. You feel these as pains beginning in the back, and finally in the lower abdomen and thighs, gradually growing stronger and more frequent.

Second Stage. The first stage is ended, and the second stage begins, when the cervix is wide enough for the baby to pass through. From this time on you should stay in bed and if neither the doctor nor the nurse has arrived, your cool-headed friend must stand by and not leave you alone. The bag of waters usually, though not always, breaks at this time, and there is a rush of fluid. But the character of the pains changes even though the membranes do not rupture. They come about every two minutes, now, from the beginning of one pain to the one following, each pain lasting about a minute. They are stronger and more forcible and you begin to have an uncontrollable desire to strain or bear down.

If the doctor or nurse is with you, they will tell you how to use your pains to advantage, but if they are not there you would better avoid bearing down since you want to retard the baby’s birth, if possible, until one or the other arrives. In such a case, you may delay matters by opening your mouth and breathing deeply during pains and by lying on your side.

We all know that in spite of the most careful planning, babies are sometimes born before the arrival of doctor or nurse and that the mother and her cool-headed friend, who is standing by, meet the emergency together. Fortunately, births occurring under such circumstances are not the ones that are likely to be associated with trouble for either mother or baby, so there is little or no cause for concern. Most doctors feel that the wisest course for the cool-headed friend to follow at such a time is to do nothing at all. So if the baby arrives in advance of the doctor, why, he is here, and that is about all there is to it! The moment you have been longing for, for nine long months, has come; your anxiety and waiting are all over, and with much less trouble than you expected.

Third Stage. After the baby is born, your pains will subside for a few moments and then the uterus will begin again to contract and gradually detach the placenta from its inner surface, forcing it out just as the baby was expelled.

In the meantime the baby is lying on the foot of the bed with the cord connecting him with the placenta which is still within your uterus. Under no circumstances should anyone pull on the cord to aid in the expulsion of the placenta. It will come away, naturally, in due time. When the placenta is finally expelled, the third and last stage of labor is over.

In case you and your cool-headed friend feel that something should be done, perhaps I would better assure you once more that when a baby is born so quickly and easily that he arrives before the doctor, you have cause for relief only—not anxiety. Practically the only unfavorable conditions which may arise are hemorrhage in your case and failure to breathe satisfactorily, on the part of the baby, and you and your cool-headed friend may as well understand how simply these possibilities may be met.

Although, as everyone knows, there is normally a certain amount of blood lost at the time of confinement, varying from one half to one pint, this is accepted as a matter of course. A serious hemorrhage very rarely occurs because of one of Nature’s ingenious provisions. The tiny muscle fibers that make up the uterine wall run in every direction, criss-cross, up and down and around, forming a veritable tangle. After the placenta comes away, all of these little fibers contract, or grow shorter, and the result is that the muscles squeeze down upon the blood-vessels so tightly that they are closed and blood cannot escape.

Accordingly, as long as the uterine muscles are contracted there can be no hemorrhage. The fortunate thing about this is that you can find out if they are contracted, and if they are not, you, yourself can stimulate them to do so. If you will press your fingers down deep into your abdomen, near the navel, you will feel the uterus as a hard round mass, which is often likened to a baseball. If it continues to feel hard and round there cannot be any serious amount of bleeding, but if it becomes soft, the tiny muscle fibers are relaxing their grip on the vessels and bleeding may possibly occur. Quite naturally the thing to do, then, is to stimulate the muscles to contract and this is done by kneading the uterus through the abdominal wall. You will feel it grow hard under your hand and then you will know that everything is all right.

Your friend may want to bathe you and put on a pad but it would be better to leave this for the doctor or nurse for this reason: Childbed fever is the result of introducing infective material into the vagina. Remember that. If no germs gain entrance, there will be no childbed fever. When your baby came quickly and there was a rush of water, your vagina was well washed out. If you and your friend keep fingers and everything else away from the vaginal outlet and the area immediately surrounding it, it will remain clean and you need not worry about the possibility of infection.

Perhaps I have given more space to all of this than seems warrantable, but I want you to know just what is going on so that you will not be worried. And also, in order that you will not make trouble for yourself by trying to do something when all that you really need do is to lie still, as comfortably as possible, keep your hand on the uterus and knead it enough to keep it hard.

If your friend can slip out the wet sheet and put a dry one in its place, without your having to turn over, you will be just that much more comfortable, but the doctor will attend to everything else when he comes.

Next the baby. Presumably he is lying there on the foot of the bed, all safe and sound, trying to get used to the new order of things. He is probably making his presence known by crying lustily and though the day may come when that sound will not be altogether pleasant, it is nothing short of music to you now, for you have been waiting a long time to hear it. The baby has come from a very warm place and has suddenly undergone the most abrupt change in his entire mode of living that he will ever experience, so the transition should be made as easy for him as possible. There are two things which he must do immediately, that your body has been doing for him. He must breathe through his lungs and he must keep his body warm. If he has cried loudly, your faithful cool-headed friend may just wrap a little blanket about him, letting him lie as he is until the doctor comes, taking care that his face is not covered for he needs plenty of air. If the room is chilly she might place a flannel covered bag of warm water beside him outside the blanket.

If the baby has not really cried lustily, as we know that even the youngest baby can, he should be made to cry, as that is the way he gets his breathing apparatus to running as it should. Your friend may take one of the clean little gauze squares that you prepared, and wrapping it around her little finger reach well back into the baby’s mouth and remove any mucus that may be lodged there and interfere with his breathing. She will do this more easily and thoroughly if she will pick the baby up by the feet, with one finger between his slippery little ankles so that her grip will be firm, and wipe out his mouth as he hangs head down.

The main thing to remember is that the lining of that new little mouth is as delicate as a rose leaf and if it is wiped with other than the gentlest stroke the surface may be injured and give trouble later on. While he is hanging, head down, your friend may rub his back or stroke it with her free hand and in all probability you will then hear the baby use his lungs to your heart’s content. But if he still does not cry well he may be sharply spanked two or three times as shown in Fig. 24. In this picture the cord has been cut and the baby is removed from the bed, but that is not necessary for it is very common to hold the baby up, wipe out his mouth, stroke his back or spank him, before the cord is cut.

You need not be at all disturbed if your baby needs these little forms of encouragement, at first, for remember that all of a sudden he is given some very complicated and taxing work to do and it is only reasonable that he should have all possible help as he undertakes it.

Remember, too, in looking forward to this event, that the probability that you or your friend will have to think of any of these things is very remote for the doctor and nurse are almost certain to be with you, and you will be able to give yourself over entirely to being very happy that at last your baby has come.