Maternal care

“ In order that such a discussion may not seem irrelevant to obstetrical nursing, the nurse must remind herself anew, that the object of obstetrics to-day is not only to carry a woman safely through childbirth, but to give her such care from the beginning of pregnancy that she and the baby shall emerge from this experience, not merely alive, but well and vigorous and with every prospect of continuing to be so.
It is the acknowledged obligation of those engaged in obstetrical work to strive toward improving the health of the race at its source—the health of the mothers and babies. ”

“ 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. ”

“ Happily, the present-day obstetrician, who assumes the care of an expectant mother, does so with confidence and optimism because of the available knowledge upon which he may draw for her benefit. Progress in the various branches of medicine and nursing is steadily pointing the way toward greater and more effective safeguards for the maternity patient and her baby. ”

“ But notwithstanding its frequency and fearful character, a mother may do much to overcome a constitutional predisposition to this disease, and thus prevent its appearance; as also she may assist greatly in promoting its cure, when it does occur. Hence it is most important that a mother should be acquainted with the measures of prevention; and also, when it does manifest itself, that clear and accurate information should be possessed, upon what may be said to constitute the maternal management of the disorder. ”

“ 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. ”

“ This makes us hope that before long good care during pregnancy, childbirth and young motherhood will be available to every woman in the land. But quite as earnestly do we also hope that every woman in the land who is looking forward to motherhood will seek this care. Certain it is that the expectant mother who does seek care, whether from a doctor in his office or through a prenatal clinic, is approaching her motherhood in the only way that is safe for herself and her baby. ”

“ Many trivial matters greatly affect the mother during child-birth, and the few succeeding hours. We have known a stupid remark by an incompetent nurse spoil a mother's health for months. The greatest care must be exercised by all concerned to say only cheerful and soothing things to the sufferer. Even the aspect of the room is important. ”

“ So sincerely do doctors now believe in the urgency of having all maternity patients under supervision and care during the nine months before the baby comes and the first several weeks afterwards, that they not only care for those women who come to their offices, but also give of their knowledge and skill to organizations engaged in prenatal and maternity work. ”

“ The maternity nurse follows a routine which she is incapable of modifying to suit the particular case. She has old-fashioned ideas and notions which she carries out as a matter of course, and she overestimates the great importance of her experience to the extent of wholly disregarding the advice of the physician. She assumes the care of the patient and baby, and regards this as her right, and as a result she is frequently responsible for much injury to the mother and child. ”

“ In early infancy, as in advanced old age, the hold on life is slight, normal and abnormal are soon interchanged, and there is needed not only more knowledge on the part of mothers and nurses, and even of physicians, of the hygienic side of medicine as applied to the physiological life of the mother and her infant, but also personal care and assistance to enable the mother to apply the useful information and advice given by the public health nurse. ”

“ Believing that many more mothers than do so should nurse their babies, we have carefully tabulated a number of aids to the milk supply, which we hope will be most earnestly tried before the baby is taken from the breast—for so many, many more bottle-fed babies die during the first year than the breast fed. The dangers of infection, the worry of the food preparation, the uncertainty of results, all call for a most untiring effort on the part of every doctor, nurse, and mother, in their endeavors to secure maternal nursing. ”

“ Practical suggestions have been generously contributed by other doctors, and by nurses, in this country and Canada, whose effective work is inspired by their belief that the future welfare of our race depends upon the care given to-day to maternity patients and their babies. ”

“ When disease attacks the child, the mother has then a part to perform, which it is especially important during the epochs of infancy and childhood should be done well. I refer to those duties which constitute the maternal part of the management of disease.
Medical treatment, for its successful issue, is greatly dependent upon a careful, pains-taking, and judicious maternal superintendence. No medical treatment can avail at any time, if directions be only partially carried out, or be negligently attended to ”

“ 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. ”

“ Whether it will have the vitality to develop its inherent possibilities depends, to a great degree, upon its intra-uterine environment,—and its intra-uterine environment depends upon the health of its mother and the quality of the blood she is feeding it upon. After birth its health, its success, its efficiency, depends upon the care it gets and the quality of its mother's milk. A mother therefore must be in good physical and mental health if she hopes to do her full duty as a mother. ”

“ This country has been strangely laggard in making widespread, organized effort along these lines, to safeguard its mothers and babies, through prenatal care. But sporadic, volunteer effort has been made in certain cities, and has been crowned with brilliant success. ”

“ If the mother cannot supply it, a wet-nurse should be procured, and, if the infant has not the strength to suckle, the milk should be drawn from the breast and fed with a medicine-dropper or a spoon.
In addition to providing proper food and maintaining an even body- temperature, care must also be taken to protect these infants from various harmful influences such as too much handling, strong light, and loud noises. Although every precaution be observed, frequently all counts for nothing; but if the child does thrive, there is no reason for worry about its ultimate development. ”

“ Often they're exhausted, in pain, and faced with an overwhelming set of new responsibilities. Many first-time mothers also need more than 24 hours in the hospital to receive instruction in basic infant care and breast feeding. ”

“ Only ten babies, instead of 40 per 1,000 born alive, die before they are one month old.” Obviously, then, only a few—too few—American women are receiving the minimum of care that makes child-bearing a reasonably safe adventure. ”

“ The maternity nurse almost inevitably becomes deeply attached to her baby patient, whether he is sick or well, and she is eager to protect him and safeguard him as long as possible. She may continue to serve him, even after he has passed from her trained hands, if she will teach his mother how to take care of him, should she be inexperienced, particularly if the young mother is to have full charge of her baby after the nurse leaves, or is to have only the assistance of a partly trained nursery maid. ”

“ Those institutions which are connected with a foundling hospital are exceptions in this respect, for some of the women enter the foundling hospital as wet nurses. In the interest of the child it is, above all, necessary that the mother should be well cared for after delivery, for it is during the first three or four weeks after birth that the child is most of all dependent upon the maternal breast. ”

“ THE MOTHER WHO ONLY NURSES HER INFANT WHEN IT SUITS HER CONVENIENCE OUGHT NOT.—The mother who cannot make up her mind exclusively to devote herself to the duties of a nurse, and give up all engagements that would interfere with her health, and so with the formation of healthy milk, and with the regular and stated periods of nursing her infant, ought never to suckle. It is unnecessary to say why; but I think it right, for the child's sake, to add, that if it does not sicken, pine, and die, disease will be generated in its constitution, to manifest itself at some future period. ”

“ S. Josephine Baker, consulting director, Children’s Bureau, United States Department of Labor, an authority on babies, whose articles regularly appear in the Ladies’ Home Journal and who is constantly asked for advice by women throughout the country. Healthy Mothers deals almost entirely with the mother’s care of herself, and tells explicitly how she may best meet her responsibility to her baby, how she may have better health for herself, and the finer mental attitude that comes with physical well-being. ”

“ This branch of work is of absolute importance to the internes, and of the greatest value to the nurses.
Not less interesting or successful is the maternity work of these hospitals. A great deal of the chronic trouble from which working women suffer so severely comes from want of proper care while they are exercising the functions of childbearing. The poor applicant to the maternity department is seen by the woman physician, who gives her advice as to previous care of herself, and she has in the hospital that thorough rest and care which are indispensable to full restoration to health. ”

“ A complete maternity service which includes prenatal work, service at time of confinement, post-partum care and subsequent supervision of mother and baby is essential if adequate results are to be accomplished. Anything less than this complete service does not give full protection to the life of the mother and the baby. The Philadelphia Visiting Nurse Society has found that the inclusion of service at time of confinement has given a tremendous stimulation to both their prenatal and postnatal service. ”

“ First, our administration has worked hard to make sure all women have access to prenatal care. We know when women get medical attention before a baby is born, that child is much more likely to be born healthy. And good health is the most precious gift we can offer a child or a family. ”

“ A variety of educational programs and support services—both public and private—have encouraged more and more pregnant women to protect the lives of their unborn children through proper nutrition and prenatal care. ”

“ Or, to put it the other way round, good care started during early pregnancy and continued throughout labor and the lying-in period gives both mother and baby enormously increased 9chances to live and enjoy good health. One reason why the baby is so much better off is that good care practically always enables his mother to nurse him, for, except in extremely rare cases when there is a definite physical disability, as tuberculosis for example, every mother can nurse her baby if she really wants to and if she, the doctor and nurse bend all their energies to accomplish this happy end. ”

“ There are classes for mothers on the care of their health during pregnancy, infant feeding, home nursing, cooking and needlework. Poor mothers unable to contribute get free dinners for three months previous to the birth of their child and for nine months after if the child is breast-fed. Two doctors are in attendance, and mothers are encouraged to bring their children fortnightly to be weighed, and receive advice. The average attendance is ninety. A baby is said to have “graduated” when it is a year old. ”

“ If it can be shown that our babies would be better off if part of their time was passed in other care than their mothers’, then such other care would be right; and it would be the duty of motherhood to provide it. ”

“ Patients who, the doctors think, give promise of having complicated labors and who prefer to remain at home are advised to engage a doctor, and to arrange with the Henry Street Settlement for nursing care at the time of delivery and during the puerperium, as the Maternity Centre nurses do not perform this service. ”

“ It seldom happens that the mother who has had good prenatal care, followed by good care during and after labor, is unable to nurse her baby if she orders her own life in the way that is known to be necessary to promote and maintain the production of breast milk. ”