CARE OF THE BODY DURING PREGNANCY

The Breasts: The Maternity Brassiere

Breast care, like most routines of pregnancy, has been greatly simplified. The nipples are kept clean, and if colostrum—the sticky, colorless secretion of pregnancy—cakes on them it is washed off with warm water and soap. Some doctors advocate giving the nipples special treatment during the last month by stripping each between the fingers once a day for a minute or two. It is claimed that the procedure lengthens and toughens the nipple, improving it for suckling. After stripping, the nipple and areola—the dark skin ring surrounding the teat—are massaged in a circular fashion for a moment or two by a washcloth moistened with warm water. This is thought to further toughen the nipples and to prepare the milk ducts for the freer flow of milk postpartum.

Be sure to buy maternity brassieres. Ask for your usual size, plus one cup deeper than usual. For example, if you have been wearing a 34B, it is likely that you will now need a 34C. To be safe, ask to be measured. Be certain to get a sturdy cotton brassiere which does not give to any extent Among the popular lines, Leading Lady, Hollywood-Maxwell, Materna-Line, Charma, Ann Alt, and Warner are specially recommended. A well-fitting maternity brassiere should come high up over the sides of the breasts, toward the underarm, embracing and supporting the sides firmly. The occasional patient, finding that pull from the weight of the breasts as she turns disturbs sleep, asks to be allowed to wear her brassiere all night There is no objection if it is not too tight

Ordinarily the maternity brassiere cannot double as a nursing brassiere. You may wear your maternity bras the first few days after delivery, but you will have to change to the nursing type as soon as milk flow is well established. If you do not nurse, continue to wear your maternity brassieres until the breasts shrink to their prepregnant size.

It is not unusual to observe that one breast is larger than the other; this difference in size may become accentuated as pregnancy progresses. Some asymmetry between two identical anatomic structures on opposite sides of the body is common and normal.

The Abdomen: The Maternity Girdle

The retention of youthful shapeliness has been one of the main concerns of womankind probably since the days of Mother Eve. Therefore, in all ages remedies have been employed to prevent the belly from sagging after delivery. The preventives were most elaborate and consisted of two types: the wearing of an abdominal support and the anointment of the abdomen with some greasy medicament. The supports were of two varieties: either a specially treated animal skin, or a broad linen swath ‘made fit for the purpose to support her Belly.’ The rubbing ointments were legion, and each author seems to have had several of his own special concoction; the very number leads one to suspect their efficacy.

Today some people still retain this partiality for rubbing the abdomen. Most physicians are skeptical of its value; however, if the patient strongly desires to do it we permit her to use a non-injurious substance like cocoa-butter or cold cream.

We have abandoned dogskins and swaths in favor of nothing or a well-fitting special maternity corset As a rule, the athletic woman who through tennis, golf, dancing, or swimming has developed such good abdominal muscle tone that she never had to wear a supporting girdle when not pregnant, does not require one when pregnant. As a matter of fact, a maternity girdle usually subtracts from such a woman’s comfort rather than adding to it; it makes her feel as though her abdomen were encased in a strait jacket. There is no inherent value in a maternity girdle except personal comfort; it neither prevents the muscles from stretching nor prevents the abdominal skin from developing pregnancy marks—striae. Nor does it aid in the disguise of the pregnant silhouette, since it lifts the abdomen through its support and does not flatten it.

I do not imply that the maternity girdle has no place in obstetrics, for it clearly has. Its use is almost obligatory for the woman who has been accustomed to wearing a girdle all her adult life, and a maternity girdle may give comforting support to the pregnant patient whose abdominal wall is lax and stretched from previous childbearing. Occasionally backache or just a tired feeling across the small of the back is relieved in the last third of pregnancy by a maternity girdle. Also, the woman who is going to deliver twins usually feels less uncomfortable in a girdle.

Neither wear nor be fitted with a maternity girdle until the fourth or fifth month of pregnancy. If you buy one at this time, be sure it has a six- to eight-inch let-out. The saleswoman should measure you for the correct size, and the measuring should be done at the heaviest part of your hips. While you are being fitted, always test the girdle for its comfortable quality by sitting down in it for a few minutes. This is very important, for the garment may bind and be too tight when you are in this position.

Girdles may be priced anywhere from five dollars to twenty-five dollars. Do not buy the cheapest or the most expensive. I know of a corsetiere who decorates her more expensive garments with embroidered forget-me-nots to give them the desired custom-made look. A medium-priced garment around eight or nine dollars will be well made and of good quality.

Lie down when you put your girdle on; preferably, adjust it before arising in the morning. Hook it from the bottom up.

No method is known for preserving the tone and integrity of the skin and abdominal musculature during pregnancy. Their preservation depends on the sinewy strength of the abdominal wall before pregnancy, the relative length of the abdomen, its capacity, and the degree of distention during pregnancy. The latter is increased by multiple pregnancy, excessive amniotic fluid (hydramnios), and an oversized fetus. Even if the abdominal wall bulges and sags immediately after delivery, it will spontaneously regain much of the tone it previously possessed within the first six to ten postpartum weeks.

Bathing

Today both showers and tub baths are permitted throughout pregnancy. The previous ban on the latter during the late months or weeks has been rescinded. The only time that tub baths are strictly taboo is after the membranes have ruptured. Pregnancy makes no special requirements as far as the temperature of the bath or shower is concerned.

Care of the Genitals

No special hygiene of the genitals is recommended. They should be carefully cleansed with a soft washcloth and soap and water as usual.

In the normal woman, douching is not necessary during pregnancy or at any other time. However, some women feel unclean unless they douche, and since in moderation it does no harm, douching is permitted during pregnancy up to the last four weeks; obviously, this does not include the patient whose membranes have ruptured or who has had any vaginal bleeding. A douche can or bag must be used, not a bulb syringe, and the source of water should be kept low, lower than two feet. The nozzle is inserted no more than a distance of two inches within the vaginal entrance, and the lips of the vagina are not held closed by the fingers, so that the water may flow in and out freely. Most physicians feel that douching should not be performed more than two or three times a week. Plain water is not advised. Three tablespoons of white vinegar or table salt to two quarts of water in the douche bag or can make a satisfactory mixture. If the patient feels the need for a deodorant in her douche, she may use Meta Cine—two teaspoonfuls to two quarts—or Massengill Powder—one heaping teaspoonful to each pint. Since medical opinion is divided about the safety of the douche during pregnancy, be sure to consult your own doctor before taking one.

Clothing

We have already considered the matter of brassieres and maternity corsets. Clothing should in general be loose, com- fortable, and, if possible, hung from the shoulders to prevent constriction of the waist. The weight of clothing and underclothing should be the same as usual. Circular garters should not be worn; they act as tourniquets and serve to increase the likelihood of varicose veins, which are common in pregnancy because of the normally increased pressure in the veins of the pelvis and legs. Suspensory garters are therefore to be worn instead. Shoes with broad toes and low, flat rubber heels are usually more comfortable at this time. The extra weight that the woman carries in front tends to disturb her sense of balance, and she is liable to trip and fall forward; low heels prevent this in large measure. However, if balance remains undisturbed, one’s accustomed heel is wholly permissible.

Teeth ‘Each child a tooth’ is one of the commonest aphorisms about pregnancy; its author remains anonymous.

But it is no longer necessary to use teeth as coin to pay for babies. Early in pregnancy the woman should go to the dentist and reveal her secret; strict attention to small cavities at this time and throughout pregnancy will save many a tooth. In addition, the calcium content of the diet must be adequate to take care of her own needs as well as those of the fetus.

The gums in some patients have a tendency to overgrowth during pregnancy; they become spongy in texture and bleed consistently when the teeth are brushed. Try massaging the gums vigorously twice a day with dry sodium perborate liberally sprinkled on the index finger. If this does not control the bleeding, consult your dentist.

Sexual Intercourse

Desire for intercourse is variable during pregnancy. In most women it is unaffected, while in some, particularly those for whom contraception was a burdensome chore, both sex interest and response are greatly heightened. The occasional pregnant woman may develop total aversion to intercourse— usually a temporary reaction almost always disappearing after delivery. If it does not disappear, either a physician well oriented in this field or a professional marriage counselor should be consulted. It is in no way harmful for a woman to experience orgasm during pregnancy; actually, its achievement is just as beneficial and important as at any other time.

There is still division of medical opinion about the safety of sexual intercourse during pregnancy. A small segment of physicians forbid it throughout the nine months—an unnecessary and impractical recommendation, in my view. Others urge that it be omitted during the days of the month when the first few menstrual periods would be due. In the absence of vaginal bleeding or a history of repeated miscarriages, sexual intercourse is permissible, desirable, and safe at any time during pregnancy until four weeks before the expected delivery date—unless, of course, there has been premature rupture of the membranes. Coital frequency during gestation is wholly a matter of the desire of the two marital partners, which naturally varies markedly from couple to couple. Position during coitus may have to be modified as pregnancy progresses; many women find it more comfortable astride the man or lying on the side. If there is vaginal discomfort preliminary lubrication by one or both with Vaseline or cold cream may be helpful. When there is any staining or bleeding after sexual intercourse, abandon complete sex relations until you see your doctor. Under such circumstances intercourse between the thighs may be temporarily substituted.

Obviously, contraceptives need not be used during pregnancy. As has been mentioned previously in this article, douching after intercourse is unnecessary, but the fact that a woman is pregnant does not make it unsafe.

Smoking and Drinking

Smoking during pregnancy is no more or less injurious for the mother than smoking when not pregnant. We are not so sure about the fetus. It is known that some substance from the tobacco smoke, probably nicotine, passes from the mother’s blood-stream to the infant’s via the placenta. The result is a temporary and harmless speeding up of the baby’s heart rate. However, recent studies by the great collaborative Child Development Study financed by the National Institutes of Health suggest that the size of the infant is affected by the mother’s smoking more or less in proportion to the number of cigarettes she smokes per day. The study indicates that the heavy cigarette smoker is more likely to have a very small or even premature-sized baby than is the non-smoker.

There is no logical reason to prohibit the moderate use of alcohol during pregnancy to the patient who enjoys and tolerates it. Alcohol diffuses rapidly across the placenta and soon attains equilibrium in the two circulations. This knowledge may dissuade the pregnant woman from taking just one more, since she cannot know and never will know whether her fetus will enjoy the additional drink as much as she thinks she may. It is to be remembered that alcohol is rich in calories, so that the pregnant woman who is gaining too rapidly had best omit or strictly limit its consumption. Such patients should be cognizant of the fact that ordinarily straight liquor has fewer calories than fancy cocktails or beer. If a patient develops any tendency to high blood pressure during pregnancy, her doctor is likely to put her strictly on the water wagon.