Pregnancy and Confinement    

Pregnancy occurs when the female ovum is fertilized by the sperm or the male seed. The first indication is usually a stopping of the monthly period. During early months of pregnancy there is sometimes a feeling of morning sickness or actual vomiting in the morning. The normal duration of pregnancy is 40 weeks.

It is important to have a regular check to see that all is going well. The pregnant woman may require advice about diet and general hygiene, etc., so that she can remain in good health during the time she is carrying.

The future health and happiness of children depends on the health, both mental and physical, of the mother and father, especially the former.

The hygiene of pregnancy holds a key position in all our efforts to promote national health and national stamina.

A pregnant mother should not overload the stomach. She should not indulge in every captice of appetite.

Travelling is safe during the first half of pregnancy. Long journeys are not advisable in the last four weeks of pregnancy.

The expectant mother should lead a quiet life free from all unhealthy excitement, quarrels, etc. She may attend to duties but she must not overwork.

Unhealthy boys and girls should not be married till they recover their health completely. Early marriage and early concept with unhealthy body and mind have been responsible for the production of unhealthy, weak children.

Pregnancy needs attention. The health of the mother should be carefully maintained. The expectant mother should be properly handled. Knowledge of these matters will minimize deaths, both of the mother and of the child.

Care of the child and of the mother is of very great importance. The future generation lies in the womb of the mothers. Expectant mothers and those who are responsible for their care should know what to do and what to avoid during pregnancy.

The diet of pregnant woman must be good, nutritious, simple, bland, easily digestible and moderate. She should take at least one pint of milk a day on account of the calcium it contains. Cheese also should be taken for its calcium. The fetus in the womb needs calcium for its bones.

Iron-containing foods are also important for the development of the fetus, red blood cells. She should take green, leafy vegetables, especially spinach and watercress, as these contain iron. Vitamins are also of great importance to the pregnant woman and these are present in milk, cheese, butter, whole meal bread, brown bread, fresh vegetables and fruits especially oranges, lemons, carrots, potatoes and tomatoes.

Too much pungents, salt, and gas and bile producing foods should be avoided.

Constipation should be avoided by a suitable diet containing vegetables, fruits and the like.

The skin should be kept in good condition by regular bathing.

Late hours must be avoided. The dress should be easy.

The expectant mother should be active and avoid sedentary habits.

She must not take any drug.

Always encourage natural delivery.

Foment the lower abdomen in scanty uterine discharge and pain.

Linseed poultice also may be applied.

Care of the Expectant Mother

With the advance of medical science the maternal and foetal mortality have been considerably reduced. Antenatal care is not an end in itself, but is a means to an end, namely, the safe delivery of the child.

As soon as the pregnancy is diagnosed, the mother should be advised to attend antenatal clinic provided by the State. If this is not possible, at least her progress should be watched either by a doctor or an experienced mid-wife. She should be advised to undergo routine medical examination once a month up to the fifth month of pregnancy, once a fortnight up to the eighth month, and then once a week until delivery. It is very important to gain the confidence of the expectant mother and make her feel that she is progressing normally and is in safe hands.

During the routine examination the following points should be carefully considered:

I. History of her previous delivery (if any), whether normal or abnormal.

II. Current History: Examine her digestive and excretory systems, e.g., if there is morning sickness, quantity of passing urine, etc. The bowels should be taken care of.

Blood system should be examined. If there is anemia, it should be treated.

Venereal diseases (if any) should be treated for the safety of the mother and the baby.

Nervous systems, mental condition and sleep should be taken into account.

Blood pressure and weight should be taken note of. Both increase and decrease of urine is a sure sign of developing toxemia. This should also be noted.

III. It is very important to have a careful pelvimetry taken, that is, to find out whether the head of the baby would easily pass through the pelvic canal.

IV. It is still more important to find out the position and presentation of the baby in the womb so that proper precaution can be taken before conducting the delivery.

Advice to the Expectant Mother

The first and foremost thing is to impress upon her that the delivery will be quite safe. Do not alarm her about the minor ailments; on the other hands, she should be assured that the minor symptoms like the swelling of leg, etc., would abate if proper steps were taken. Reliever her mental anxiety by every means.

Diet

It should be simple, light and nutritious.

The pregnant mother should be specifically told that there is no necessity to eat more, as she has to sustain the baby in addition to herself. Too much of rich food, untimely meals and excessive protein are all undesirable. Rich carbohydrate articles should be taken in limited quantities. The diet should largely consist of fruit and green, leafy vegetables and a fair amount of milk. It is better to note that the vitamin contents of the diet are properly balanced. Fresh water should be liberally taken.

Exercise

Light, moderate exercise is always beneficial. Heavy, strenuous work and vigorous exercises should be avoided. In addition to her household duties, the expectant mother is advised to take regular walks in the open air during the whole course of her pregnancy. It is inadvisable to have long automobile drives especially on bad roads.

Clothing

Clothing should be light and loose. If possible, the clothing can be suspended on the shoulders instead of round the waist.

Care of Teeth

Pyorrhea and other infections round about the decayed tooth will favor puerperal sepsis. Hence they should be attended to.

Care of Breasts

They should be properly supported. In the latter weeks of pregnancy, the nipples should be washed and drawn out, so that the baby will find no difficulty in suckling.

Bowels

The bowels should always be kept regular during the whole course of pregnancy, chiefly by adjusting the diet. No purgatives should be given in the early stages. There is no harm in taking liquid paraffin, if necessary. In the later weeks, after the 7th month half an ounce of castor oil may be given once every fortnight.

Bath

Daily warm bath is of great value. Extreme temperatures should be avoided.

Sexual Intercourse

Sexual intercourse should be avoided completely after the sixth month for fear of infection and premature delivery.

Mental Hygiene

Excitement of any kind should be strictly avoided. It is advisable to read some good, light literature, preferably religious works. The expectant mother should be assured that the delivery is a physiological process and as such should have no anxiety at all.

She must have proper, sound sleep.

Doctor’s Guidance

The expectant mother is advised to consult the doctor on the following points:
1. Bleeding.
2. Reduction in the quantity of urine passed.
3. Swelling of the lower extremities.
4. Continuous headache.
5. Dimness of vision.
6. Pain in the epigastrium.
7. Cramps in the leg.
8. Painful contraction of the uterus.
9. Rupture of the membrane.
10. Minor ailments like pelvic pain, varicose veins, hemorrhoids or piles and increased vomiting.

 Care of the Nursing Mother

The care of the nursing mother can be classified under two sections, viz., (I) Immediate care after Labor, and (ii) Subsequent Care till the Weaning Period.

Immediate Care
Just after the third stage of labor, i.e., expulsion of the placenta, care should be taken to see that the uterus is completely contracted and whether there is any tendency to hemorrhage. Examine the mother’s plus rate. The external genitalia should be washed with dettol or any other antiseptic lotion, and dried and painted with Tr. Benzoin Co. Sanitary pads should be applied over the genitalia and it should be changed every three hours and every time after urination and defecation. The genitalia should be cleaned with sterile dettol swabs, wiping from above downwards and never from below upwards.

Abdominal bandage should be properly applied for the first forty-eight hours to prevent the uterus from getting distended with cloth. It should be removed afterwards, and the patient may then slowly exercise her abdominal muscles.

After Pain
The nursing mother complains of very severe pain after the labor. This is mostly caused by over distention of the uterus in the primipara and the presence of clots inside the uterus. The pain is due to lack of tone of the uterine muscles.

Care During the Second Period
For the first eight ten days after the delivery (peurperium) the following points should be noted:
1. General condition of the patient.
2. Temperature, pulse and respiration.
3. Sleep.
4. Rate of involution and condition of the uterus.
5. Lochia, its nature and quantity.
6.  Condition of the bladder.
7. Condition of the bowels
8. Condition of the breasts.

Rest is very essential for the woman after labor. It is better to restrict the visitors during the first week. Immediately after delivery and when settled in bed, she generally goes to sleep and walks up quite refreshed. The mother should be made to realize that she should not be confined to bed for too long, even though plenty of rest is essential. She can be propped up in the bed on the third day, made to sit on the 5th and allowed to walk about a little after the 7th day. If everything goes on well she can be allowed to move about freely from the 10th day onward. If any complication is present, the period of rest should be prolonged as per the medical guidance.
Diet
The old idea of restricting the diet and fluids to the puerperal woman is now obsolete. For the first two days liquid diet is advisable. When once the bowels have moved, the diet should be increased. The ordinary diet can be resumed after the 5th or 6th day.
Temperature
Normally, there should not be any temperature during the puerperal period. Or, even if there is slight temperature after delivery on the first day, it will automatically come down to normal. Any rise in temperature after that will be presumed in favor of sepsis or any inter-current disease, which should be treated at once.
Pulse-rate
The increase in pulse-rate always associates with the increase in temperature. Pulse-rate above 90 will indicate that there is some abnormality and, therefore, doctor’s aid is necessary.
Respiration
Any inter-current disease like pneumonia might be associated with sepsis, as a result of which respiration might be increased.
   Bowels
A dose of castor oil on the third day after labor is beneficial to evacuate the bowels. Care should be taken to clean and protect the genitalia after every evacuation. Enema is preferred when perineum is sutured. Brisk purgative may be given when temperature rises due to constipation. It also helps involution of the uterus and aids the bladder to empty itself.
Bladder
Utmost care should be taken to see that the bladder is normally emptied after delivery. Even if there is the slightest difficulty in evacuating the bladder, the lower part of the abdomen can be gently massaged and bearable hot water may be poured over the genitalia, while the woman is propped up in bed. In resistant cases catheterization has to be resorted to and the patient may be treated with urinary antiseptics later.
   Involution of the Uterus
It is very important in the peurperium. Usually the fundus of the uterus is almost at the level of the umbilicus. If on the third or the fourth day the uterus is not palpable in the abdomen, backward displacement of the uterus is suspected. There should be progressive involution of the uterus. It should come down a finger’s breadth a day, and by the 10th or the 12th day it should be a pelvic organ.
The Lochia
It is a discharge from the uterus after delivery. Any abnormality in the quantity, quality, odor and method of staining should be drawn to the attention of the medical attendant. In septicemia, there will be either suppression or retention. The diaper should be very often changed when lochia is abundant and offensive.
Sleep
Sleep is very essential during peurperium. Sleeplessness is the earliest indication of sepsis or puerperal insanity. A glass of hot milk at bedtime, a well ventilated room and assuring the patient not to have any worry over her child-are all-conducive to her sleep. Even the child, if possible, should be prevented from disturbing the mother during her sleep. Sedatives are not desirable except in the patients of nervous temperament.
General Condition
Daily sponging and powdering, fresh air and light, a cheerful atmosphere and restriction of the visitors, are advisable. Light literature, pleasant conversation, relieving her anxiety and worry and favoring good sleep at night will hasten her peurperium.
Subsequent Care of the Nursing Mother
Nothing can replace mother’s milk, and it is a great help to a growing baby. Breast milk also makes the baby resistant to diseases in its early days. Modern educated women are afraid of nursing. It is easy to nurse a bay than to prepare a safe and suitable artificial feed. It is very important to impress upon every mother the need for breast-feeding in the interest of the baby. It is the best and safest.

Just after delivery the mother is allowed to take rest. Even though there is no milk, the baby is put to the breast after the mother has had her rest. Unlike mammals, milk is not secreted by the mother till the second or the third day of the peurperium. A thin secretion called colostrums is available for the baby for one or two days. This helps the baby to evacuate its meconium from the intestines since it has got a laxative effect. Slowly the breasts become larger and fuller, and milk begins to secrete in large quantities as the child is put regularly to the breast.

Any food that is good for the mother and is agreeable to her should not cause the baby’s digestion to be upset. She should take good and proper food, with due mastication. Sufficient rest is needed for the nursing mother, as also equally sufficient exercise in the form of household duties, walking in the open air, etc.

A nursing mother should note that the reappearance of the menstrual period does not necessarily mean that she should stop nursing the baby. Usually the menses appear after the seventh month. She should also note that nursing the baby does not prevent conception even though menstruation has not been resumed.