Carolyn Conant Van Blarcom

“ And as recovery progresses the patient becomes aware, perhaps only vaguely, of another change which is not always a welcome one. For nine months she has been the centre of interest in her immediate circle; she has been the object of unremitting concern and solicitude, and much as she and her family may have tried to keep her life normal, she and her needs have constantly been given the first consideration. The very mystery of the child developing within her has created an attitude of respect, almost of reverence, which was never her portion before. ”

“ Perhaps it will be well for the nurse to pause just here for a fresh reminder that the end really to be desired through prenatal care is not so much the mere prevention of death among mothers and infants, as the promotion of health, as well; our charges must be not only saved but saved to mental and physical health, vigor and well-being, capable of being useful, productive citizens. Happily, both life and health are conserved by the same measures, and effort toward either end helps to accomplish both. ”

“ But to the woman herself, who must resume the functions of mother, homemaker, wife and general utility person, the disability may be enough to make life endlessly dreary and discouraging. And yet, she is perhaps only just below the physical level upon which she could live her life with joy and eagerness; and proper care when the baby came would have left her upon that level.
The effect of the mother’s impairment reaches far beyond her own invalidism, for such women are not as well able to rear and care for their children satisfactorily as are fresh, buoyant mothers. ”

“ That fact must not be overlooked for each patient is an entirely new and different problem and not like any other that the nurse has had before. But the nurse who is sincere and sympathetic and who earnestly tries to put herself in her patient’s place and see things from her standpoint, will, by virtue of that very attitude, accomplish much toward sensing the patient’s temperament and establishing harmonious relations. Moreover, the patient, herself, will all unconsciously make something of an adjustment to the nurse when she feels the nurse’s sincerity and her eagerness to be of service. ”

“ The nurse who is able to go into a home quietly and unobtrusively and accept what she finds, even carpets and draperies, and still do clean work, is doing better nursing than the one who arranges a faultless room but upsets her patient and disrupts the household in the process. ”

“ There can be no doubt that nervous and emotional disturbances are detrimental to the physical well-being of the patient in labor, also, and this fact alone is enough to warrant an effort to avert them. If the nurse appreciates the significance of the emotional influence and shapes her attitude and conduct accordingly, she will thereby help to increase the ease and safety of the actual delivery. Just what that attitude shall be, no one can say, for it must be developed, in each case, in such a way as to win the confidence and meet the needs of that particular patient. ”

“ She should never lose sight of the fact that she is not being trained solely to conform to any one hospital routine or to become expert in only one method of nursing care. She is being prepared to go out and give nursing care to any young woman and her baby who need it, no matter where or how they are situated or by what methods they are treated.
If conditions are such that the doctor’s orders and the patient’s requirements seem impossible of fulfillment, then the nurse must attempt the impossible and attempt it with confidence of success. ”

“ The average nurse has a deep maternal instinct. She may not be conscious of it as such, but it is this instinct which prompts her to select nursing from the wide range of occupations and professions which are open to her. And it is entirely natural that she should derive great satisfaction from this vicarious motherhood—this giving of her knowledge and skill in service to the woman with a baby in her arms. ”

“ It is hoped that the nurse may understand from this discussion that the conflicting thoughts which her patient does not discuss, but buries and keeps below the surface of her mind, are the factor that works harm in her mental life. If the nurse can get her patient to ventilate these thoughts, they will be robbed of much of their power to injure. But this patient, like any one else, will talk freely only when she talks spontaneously and she will do this only when she senses in her nurse a sympathy and a sincere concern over her troubles. ”

“ The opportunities for self-expression which are open to the nurse who gives this form of service make us wonder if she should not be included in the enviable group of those others 14whose life work is an expression of themselves—the poets and painters; the architects, musicians, and sculptors—those who create and build because of an urge within them. Surely, the spirit and the results of the work of the nurse who thus gives of herself may be ranged with the efforts of those others whose work is an expression of themselves. ”

“ When the time comes, and it seems to be approaching, that pregnancy, labor, the puerperium and infancy are regarded as crucial periods in the life history, demanding all the preventives and safeguards that all branches of medicine and nursing can offer, these periods will cease to be so enormously destructive of life and health.
We cannot build a strong race with sickly and maimed mothers and babies, and we can scarcely have other than sickly and maimed mothers and babies without care. ”

“ And so, the young woman, to whom we refer so impersonally as “the patient,” is an intensely personal being at this time, experiencing a number of the most poignant of the human emotions: awe, expectancy, doubt, uncertainty, dread and in some cases fear amounting almost to terror. And through it all her body is being racked and exhausted with pain that grows harder and harder to bear. ”

“ As long as the nurse remains with her patient, therefore, she must try to impress upon both the patient and the members of her household that the most important single factor in the care of the new baby is the sustained and regular care which the nursing mother should take of herself. For it must be remembered constantly that it is not alone breast feeding, but satisfactory breast feeding that nourishes and builds and protects the baby. ”

“ England and New Zealand, as countries, have pointed the way toward accomplishing a nation-wide reduction of maternal and infant mortality and morbidity by making provision for widely organized prenatal care. They recognize the problem as one of public concern. They get at the heart of it: ignorance on one hand and poor or inadequate care on the other. They apply a practical solution, comprising a system of preventive, instructive prenatal care, together with improved and increased facilities for medical and nursing care at the time of delivery and afterward. ”

“ If accustomed to a fairly simple, well-balanced, mixed diet, the average expectant mother will need to make little or no change, excepting to make her evening meal light if it has been a hearty one; for she uses her nutritive material with surprising economy and does not have to “eat for two,” as is so commonly believed. It is a safe general principle that an amount and kind of food that keeps the expectant mother, herself, in a state of health and good nutrition, is favorable to satisfactory development of the fetus until the latter part of pregnancy. ”

“ 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 outdoor exercise we almost think that whatever else may be neglected, this is indispensable, since it promotes digestion, stimulates the functions 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, also strengthens some of the muscles that are used during labor. ”

“ For this reason, the most conscientious and painstaking nurse imaginable may destroy her usefulness, by adopting the wrong attitude toward her patient during this period of enforced intimacy. Some women want, and even need to be indulged and petted; but, on the other hand, a certain type of reserved and dignified woman is affronted by such attention or by the easy air of familiarity that another courts; one patient is exhausted by the unvarying punctuality and precision of a conscientious, but unadaptable nurse, while that very punctuality and precision is satisfying and restful to another. ”

“ It is at this point that nurses are more and more being given opportunity for immensely gratifying service. A private patient who is in the care of an obstetrician is, of course, supervised and instructed by her doctor. But there are other patients—women who cannot afford this individual care, but who need care none the less. And it is these expectant mothers that nurses are helping the doctors to instruct in the principles of right living, 114and are watching for danger signs, through visiting nurse societies, out-patient departments of hospitals and through prenatal clinics. ”

“ Poor hygienic conditions may enter into the causation of rickets, and infection may be a factor in the occurrence of pellagra, but neither disease appears among those who are suitably fed while both diseases may be produced by faulty diet and both may be cured with suitable food.
But probably of graver importance to the public welfare than the well defined nutritional disturbances, themselves, is the fact that between a state of good health and the level upon which a disease is recognizable is a long scale, along which are ranged an uncounted army of under-par, half-sick people. ”

“ Considering the need for cleanliness in a very broad and practical sense, the nurse will realize that the test of her ability to protect her maternity patients from infection is not what she is able to do in a hospital where there is every facility for clean work. It is not the ability to maintain asepsis in a tiled operating room that counts, where she is aided by sterilizers, basins, and solutions of various kinds and colors, a wealth of ingenious appliances and a corps of co-workers. ”

“ While in some cases the patient is a selfish, overindulged woman who objects to motherhood because of its inconveniences, in others, she is tortured by fear of inability to go through her pregnancy successfully, though sincerely wanting to; or she may be bewildered and overwhelmed by the prospect of the dangers of childbirth and responsibilities of motherhood, a truly pathetic figure whose distress may often be greatly relieved by the nurse who has enough insight to grasp the situation. ”

“ From one such locality we learn that when a woman goes into labor the first passing teamster is hailed, or perhaps a member of the family hurries down the road for the nearest tanner or blacksmith, or any one else, who in total ignorance will fearlessly rush in to meet the great emergency. The results of this practice—dismembered infants and badly injured or dead mothers,—are too sickening to describe, but may be imagined by any nurse who has seen good obstetrical work and appreciates its value. ”

“ After one has traced the development of the human body in the uterus, and even faintly understood its growth and method of nourishment, it is impossible to believe that the mother’s thoughts or experiences could in any way deform or mark her child, or alter its sex. That the mother’s “reaching up,” for example, could slip the cord around the unborn baby’s neck is manifestly absurd, as well as the previously mentioned superstitions about the eight-month baby’s slender chances for survival. ”

“ While we do not advise nor elect to have carpets, draperies and upholstery in a delivery room, we know that they need not menace the patient’s welfare if all details of the work about the patient, herself, are scrupulously clean. That is the one point which the nurse must bear constantly in mind, the paramount importance of clean work about the patient. ”

“ Therapeutic abortions are resorted to when the patient’s condition is so grave that it is apparently necessary to empty the uterus in order to save her life. Such a condition may exist, for example, when pregnancy is complicated by pulmonary tuberculosis, heart disease, toxemia, hemorrhage or some condition which is inherent to pregnancy. An abortion induced under these circumstances is countenanced by law, as it is performed to prevent the loss of life from disease; but an abortion is not legal if brought on to save the woman from suicide, because of her unwillingness to become a mother. ”