Fig. 15.—Lying on the side with hips elevated to relieve swelling or varicose veins of the vulva. (By courtesy of the Maternity Centre Association.)
Hemorrhoids, or “piles,” are virtually varicose veins which protrude from the rectum, but, unlike those in the legs, are extremely painful. As it is the straining in constipation that causes these enlarged veins to protrude from the rectum, this is one more reason for preventing constipation, for a pregnant woman whose bowels move freely every day rarely has hemorrhoids. If hemorrhoids appear, and give pain, the first step is to soften the fingers with vaselin and gently push the hemorrhoids back into the rectum. You can do this quite easily for yourself. You should notify your doctor if you have hemorrhoids, but while waiting to see him, if you are very uncomfortable you will be almost certain to find relief in lying down with your hips elevated on one or two pillows; applying an ice bag to the rectum, or ice-cold cloths or cloths wrung from equal parts of water and witch hazel. Sometimes the hemorrhoids are worse during the first few days after the baby is born but as a rule they disappear when the ultimate cause is removed, which in this case is pressure made by the baby.
Cramps in the legs, numbness or tingling may be caused by pressure of the large, heavy uterus upon nerves supplying the lower extremities. Lying down, applying heat and rubbing the painful parts will usually relieve the discomfort.
Shortness of breath is sometimes very troublesome toward the end of pregnancy, and as may be easily understood, is due to the upward, and not downward pressure of the uterus. For this reason the discomfort is made worse by lying down and relieved by one’s sitting up or being well propped up on pillows or a back rest.
Vaginal Discharge. Although the normal vaginal discharge is increased during the later months of pregnancy you should tell your doctor if your discharge is very free. You should not take douches to remove it, unless your doctor orders them, for the normal discharge gives you a certain amount of protection against infection. If it is irritating or causes itching or burning you may obtain relief by avoiding the use of soap and by bathing the uncomfortable parts with water, containing a teaspoonful of sodium bicarbonate to a pint, or with olive oil.
Itching of the skin is a fairly common discomfort, and is possibly a result of irritating material being excreted by the skin glands and deposited upon the surface of the body. The local irritation usually may be relieved, if not very severe, by bathing the uncomfortable areas with the solution of sodium bicarbonate as above, or a lotion consisting of a pint of lime water, half an ounce of glycerin and thirty drops of carbolic acid. It is a good plan, also, to drink more water, in order to promote the activity of the skin, kidneys and bowels, and thus dilute the material that may be responsible for the itching and increase its elimination through all channels.
Some women complain of discomfort caused by the stretching of the skin over the enlarged abdomen. There is a very old belief that rubbing the skin with oil will relieve this sensation and also prevent the appearance of the purplish streaks described in a previous chapter. There seems to be little foundation for this belief, but if a woman fancies that she is safer and more comfortable after oiling her abdomen, there is certainly no reason why she should not do so.
I have described to you the details of personal hygiene which your doctor is likely to want you to adopt during your months of expectancy, and some of the simple things that you may do to relieve minor discomforts when they arise, for having these things in black and white may make the whole matter a little easier for you.
But there is still more that you can do to help the doctor help you. You can tell him about any discomfort or any new condition that appears, and follow his advice instead of talking it over with your family or friends. This will make it possible for him to prevent serious complications by treating them in the very beginning.
You have probably learned, in one way or another, that the complications associated with childbirth that are most serious are infections (childbed fever), convulsions, abortions or miscarriages and severe bleeding, but perhaps you have not heard that you, yourself, can help greatly in the prevention of all of these conditions, in your own case, and chiefly by little more than exercising good common sense.
Your part in preventing childbed fever, if your baby is to be born at home, lies in having in readiness a clean room, sterile sheets, towels, gauze pads, etc., as will be described in the next chapter.
Concerning the other complications we shall say a word here.
Convulsions. You can do a great deal toward preventing the condition that causes convulsions by following the advice about your personal care that we have just gone over and by making it possible for the doctor to treat early symptoms promptly. In fact, after looking over the records of many thousands of mothers who have had prenatal care, it seems almost safe to say that the expectant mother who follows such a course will not have convulsions.
One of the commonest of the early symptoms is headache, sometimes persistent and very severe. Others which you can detect are blurred vision, spots before the eyes, dizziness, vomiting which is more persistent or severe than could be called “morning sickness,” puffiness under the eyes or elsewhere about the face or hands, swelling of the feet and ankles and severe pain in the stomach. It might be that if you had even one of these symptoms your doctor would think it worth while to put you to bed and give you nothing but milk, or only water, for a day or two, not because you were sick, but to keep you from being so, on the same principle that you darn a thin place in a stocking to keep a hole from coming.
In any event, tell your doctor about the symptoms and let him decide what is to be done, for therein lies your safety.
Miscarriages. The question of abortions, miscarriages and premature births is one of enormous importance, and one about which there is a good deal of misunderstanding. As to the meaning of the terms, many women are puzzled to know the difference between them. Doctors are not likely to use the word miscarriage, but will describe as an abortion a termination of pregnancy which occurs before the end of the seventh month and as premature labors those occurring from that time until the expected date of confinement. In the minds of lay people, however, the term abortion is often associated with criminal practice, miscarriage being a term loosely applied to all births occurring before the seventh month, while the premature baby is the one born after the seventh month of pregnancy but before the expected date of confinement.
Of all of these accidents, abortions are the most frequent, though in the nature of things it is impossible to say how often they occur. They sometimes happen so early in pregnancy that the expectant mother is unaware of the accident; or if she does know of it she may make the mistake of taking no notice of it or regard it of so little consequence that she does not consult a doctor. But such information as is available suggests that at least one out of every five pregnancies ends in abortion, the tragedy of this being that it is very largely a preventable disaster.
Since the ovum is insecurely attached to the uterine lining until the sixteenth or eighteenth week, an abortion is more likely to occur during this time than later, while of this period, the second and third months seem to be the most perilous. Abortions are less likely to happen during first pregnancies than succeeding ones and their frequency seems to increase with the number of pregnancies. They occur more often among women over thirty-five years than in younger ones, and in all cases are most likely to take place at the time when menstruation would fall due were the woman not pregnant.
The prevention of abortions is of such obvious importance and there is so much that you can do to this end, that we shall take up the question somewhat at length. Preventive treatment really begins very early. In the discussion about menstruation we referred to the importance of finding out the cause of painful periods, in the interest of good obstetrics, since inflammation of the uterine lining or a misplaced uterus might be responsible for the pain and if neglected might cause an abortion later on. The correction of such troubles, no matter when they are discovered, is an early step toward preventing abortions.
But after pregnancy has actually begun, there are certain preventive measures which have proved to be very effective. A woman who is pregnant for the first time, and who, therefore, does not know whether she is likely to have an abortion or not, should avoid such risks as fatigue, sweeping, lifting or moving heavy objects, running a sewing machine by foot, running, jumping, dancing, traveling or any action which might jar or jolt her during the first sixteen or eighteen weeks.
An expectant mother who has had an abortion will have to take even greater precautions, as she is in more danger than is a woman who has not had this experience. It is of prime importance, to begin with, that she have the cause of her previous abortion discovered, and if possible corrected. And since the accident is most likely to be repeated at about the same time, or a little earlier, in each succeeding pregnancy it is a wise precaution for the expectant mother to remain quietly in bed for at least a week before and after the time when an abortion may be feared.
Complete rest and relaxation are such effective preventive measures that patients with a tendency to have abortions who have been willing to stay in bed during most of their pregnancy have sometimes been rewarded by going through the entire period and in the end giving birth to a normal, fully developed baby. As out-of-door exercise is clearly impossible in such cases, it is important that the patient keep her room very well ventilated all of the time, and possibly, under the doctor’s direction, have massage or bed exercises.
The marital relation is usually considered inadvisable in all cases after the eighth month of pregnancy, and among women who have had abortions or miscarriages it is best omitted throughout the entire period. This is particularly true of women over thirty-five who are pregnant for the first time.
To sum it up in a word, your part in preventing an abortion or miscarriage after pregnancy has begun, consists largely of avoiding fatigue; resting when tired; avoiding physical shocks such as blows upon the abdomen, jolts or falls particularly during the first sixteen or eighteen weeks and at the time when menstruation would ordinarily occur if you were not pregnant, and avoiding overwork during the later weeks of pregnancy.
The common symptoms of abortions or miscarriages are bleeding, often accompanied by recurring pain, beginning in the small of the back and finally felt as cramps in the lower part of the abdomen. Since menstruation is suspended during pregnancy you should always regard bleeding or a bloody discharge as a symptom of a possible miscarriage, whether you have pain or not. Upon its appearance you should send for the doctor, go to bed at once and keep absolutely quiet.
Should you be so unfortunate as to have a miscarriage, in spite of all your precautions, bear in mind that you will need to stay in bed quite as long afterwards and have the same care as though you had given birth to a fully developed baby. It is because so many women fail to appreciate this that abortions and premature births are often followed by ill health and invalidism. Under proper care, an abortion or premature labor is not, of itself, any more serious for a woman than a normal delivery.
Bleeding from the vagina, or a sudden increase in the size of the abdomen with perspiration and a sudden feeling of faintness, may be the beginning of severe bleeding, or hemorrhage, from any one of a number of causes, and in such a case the expectant mother should notify her doctor, go to bed at once and keep quiet until he arrives.
Summing up the whole question of preventing complications, we find that the following symptoms may be forerunners of serious trouble and therefore should be watched for and reported to the doctor as soon as they are noticed:
These are generally accepted as the danger signs of pregnancy, any one of which, alone or in combination with one or more of the others, is of importance. In addition to these it really is important that you talk to your doctor or your nurse freely if you are feeling worried or depressed about anything at all. Sometimes one feels blue without knowing why, and if you should feel so during your pregnancy you should not keep it to yourself but talk it over with your doctor or your nurse.
When all is said and done, what we want for each expectant mother is little more than that she shall live a normal, regular, wholesome life; that she shall be able, and what is of equal importance, be willing to weave into her everyday life the principles of personal care which every one should adopt; that she shall watch and be watched for symptoms of complications throughout the entire period of pregnancy, in order that they may be detected early, speedily treated and serious troubles thereby prevented.
The adoption of such simple precautions will pave the highroad to health and happiness for yourself and your baby.