Prenatal care

“ Science wrangles over the rival importance of heredity and environment, but we women know what effects prenatal influence works in children. And, knowing this, what a mystery that we do not mold each thought and act in the interest of the children whose up-bringing will be our real life-work! How strange that mothers do not realize that the burden of maternal and domestic duties can be lightened by prenatal care and character molding.
Science has done much for the modern mother. ”

“ 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. ”

“ I would not advise pregnant women to worry, to be sick, to take poisonous medicines or to make attempts at abortion, but I merely bring up these points to emphasize to my readers not to take the necessity of prenatal care in too absolute a sense, and not to worry themselves unnecessarily if the conditions during their pregnancy are not all that could be desired. ”

“ Patients who are not to be examined by the doctors who delivered them are given a post-partum examination by a doctor at the Maternity Centre, to make sure that they are dismissed in good condition, or are referred to the proper agency for further care, this being the first step in prenatal care for the next baby. ”

“ Further reductions in other birth defects can be made using knowledge already available. Good prenatal care from the earliest weeks of pregnancy, or, better yet, even before pregnancy, can help protect the pregnant woman and her unborn child from potential factors known to cause these tragic defects. In addition, new information about genetics and the effects of drugs taken by a pregnant woman upon the developing child is being used to prevent these disorders.
Prevention is far better than a cure. ”

“ 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. ”

“ Certain foreign countries which have evinced more concern for the welfare of mothers and babies than has the United States have demonstrated that widespread prenatal care is entirely possible and practicable, and they regard it also as an imperative measure toward promoting the national welfare. ”

“ Today, pregnant women know they can get prenatal care for their sake and the sake of their unborn children. But under the Republican plan, hundreds of thousands of pregnant women could be denied regular checkups and other basic services that could lead to an increase in infant mortality or children born with irreversible problems. ”

“ Prenatal care, clean deliveries, and intelligent motherhood will go far toward solving the problem of a high maternal and infant death rate, and these require not widespread care, alone, but widespread teaching as well—impressing upon women and their families the importance of care and precautions in connection with childbirth. Important as it is for men to study and inform themselves in regard to the problems of finance and cattle raising, for example, it is still more important for both men and women to study and appreciate the problems of expectant and actual motherhood. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ Under the National Health Plan I have proposed, there would be no cost-sharing for prenatal and delivery services for all pregnant women and for acute care provided to infants in their first year of life. These preventive services have extremely high returns in terms of improved newborn and long-term child health. ”

“ Ballantyne, of Edinburgh, is generally regarded as the father of the prenatal work because of his work on abnormalities of pregnancy and his insistence upon the importance of what might be accomplished through intelligent care and supervision of all women, not alone abnormal cases, throughout pregnancy. ”

“ 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. ”

“ 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. ”

“ It may be at the end of two weeks, or it may not be until the close of four or five weeks, in the case of the mother who cannot nurse her child; for the nursing of the breast greatly facilitates the shrinking of the uterus. Extensive lacerations may hinder the involution as well as other accidents of childbirth, so it must be left with the physician to decide in each individual case when the mother may enter into the activities of life and assume the responsibilities of the care of the baby and the management of her home. ”

“ In the branches where a delivery service has been added, the prenatal service has increased fourfold. Both doctors and patients are enthusiastic and see far more reason for instruction and supervision from a nurse who is going to see the case through than from one who drops out at the crucial moment. It certainly has strengthened our whole maternity service, both as to results accomplished and in our relationship to the doctor and to the community. ”

“ A therapeutic induction of premature labor, like a therapeutic abortion, is not of itself usually considered any more serious for the mother than a normal delivery, since it can be performed with care and cleanliness, qualities not usually associated with the work of practitioners who are willing to do criminal operations. ”

“ One mother died for every 500 babies born. 2. One out of every 51 babies born, died under one month of age. 3. One out of every 42 babies was born dead. The Association does not usurp nor supplant, but endeavors to give impulse to public and private agencies alike in affording the best possible supervision and care for expectant and parturient mothers and their babies. ”

“ Such an infant might be deemed viable, but its chances for life are extremely precarious, even in most expert hands and with the help of an incubator. At the end of thirty-two weeks of gestation a foetus if born may be raised with skilful care, but the chances are not promising. It is viable. At the end of forty weeks the child is at term.
In 1876 Parry collected 500 cases of extrauterine pregnancy from medical literature, but when Tait in 1883 first operated on a case of ruptured tubal pregnancy attention was called to the subject. ”

“ Prevention of abortions is of course more satisfactory than remedial treatment, and a nurse may be very helpful in this respect, by explaining the underlying causes to the patients in her care, and winning their cooperation in preventing a deplorable accident. ”

“ The most obvious problem with any such argument is that viability is heavily dependent on factors that have nothing to do with the characteristics of a fetus. One is the state of neonatal care at a particular point in time. Due to the development of new equipment and improved practices, the viability line has changed over the years. In the 19th century, a fetus may not have been viable until the 32d or 33d week of pregnancy or even later. [51] When Roe was decided, viability was gauged at roughly 28 weeks. See 410 U. S., at 160. Today, respondents draw the line at 23 or 24 weeks. ”

“ 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. ”

“ The precautions are avoidance of fatigue and of sudden or severe strain upon the abdominal muscles that might produce a miscarriage. During the first three months, the placental attachment is relatively insecure and therefore more easily detached. The certainty of motherhood cannot be established until the third or fourth month, although some presumptive symptoms are manifested earlier. The woman who has left motherhood to chance, and who therefore is not preparing for necessary care during these earlier months, is the more liable to a miscarriage through disregard of due precautions. ”

“ At the same time, the viability standard takes account of the undeniable fact that, as the fetus evolves into its postnatal form, and as it loses its dependence on the uterine environment, the State's interest in the fetus' potential human life, and in fostering a regard for human life in general, becomes compelling. ”

“ Comprehensive Emergency Obstetric and Newborn Care (CEMONC) refers to lifesaving services for emergency maternal and newborn conditions/complications as in Basic Emergency Obstetric and Newborn Care plus the provision of surgical delivery (caesarian section) and blood bank services, and other highly specialized obstetric interventions. It also includes emergency neonatal care which includes at the minimum: newborn resuscitation, treatment of neonatal sepsis infection, oxygen support, and antenatal administration of (maternal) steroids for threatened premature delivery. ”

“ Some patients with defective uterine lining will have slight bleeding for a long time, possibly throughout the entire period of pregnancy, because a small area of the placenta has separated, leaving, however, a sufficiently large attached area to nourish the fetus. Such women should, of course, be under a doctor’s care and sedulously avoid all shocks to the uterine musculature, for the separated area may very easily be increased to such a size 170that the fetus will be unable to secure adequate nourishment, and die as a result. ”

“ Prevention is of course, the most important aspect of the treatment and is accomplished by means of the pre-natal care and supervision which were described in the last chapter. In this connection must be mentioned again the danger, during pregnancy, of overeating. ”

“ We are now concerned to know whether or not the remedy, in the shape of care and supervision during pregnancy, may be extended in proportion to the enormous multiplication of the problem, when instead of one patient we must think of millions. ”

“ EARLY SIGNS OF COMPLICATIONS OF PREGNANCY It is evident that by teaching the principles of personal hygiene to the expectant mother so convincingly that she will adopt them, and sometimes, by employing simple nursing procedures to relieve the various discomforts of pregnancy, much will be accomplished toward promoting the welfare of both the patient 142and the expected baby. But this is not enough. The nurse must also be on the alert to detect and report the early symptoms of complications, for there may be times when she will be the first one to see the patient after a symptom has developed. ”