Prenatal Care

Recent Change in Medical Attitude

Predelivery medical care has greatly changed in the last few decades. Until the last decade or two physicians felt their task to be wholly a technical one. Their goal was simple, to conduct pregnancy so that it ended with a healthy mother and a perfect infant. The concept that having a baby could and should be a full, happy experience, bereft of fear and anxiety, was virtually nonexistent. In their attitude toward pregnancy and labor doctors were as well starched intellectually as they were externally. They conducted prenatal care with the viewpoint, ‘Don’t bother your pretty young head about pregnancy and labor; expunge them from your thoughts; this is an area of my concern, not yours. And as for my answering your questions, a little knowledge is a dangerous thing.’ Obstetric hospitals thought along the same lines; the concept of giving patients emotional support or confidence through antenatal instruction was foreign to their responsibilities.

Today both physician and hospital have executed an about face. Recognizing the immense value of knowledge in the eradication of fear, they are attempting to deprive reproduction of its mystery through instruction in the facts of conception, pregnancy, labor, and infant care. This campaign to replace ignorance with understanding has been waged with the help of many media: the printed page, motion pictures, mothers’ classes, radio, television, the internet, lay tours of hospital obstetric facilities, and discussions betweeen the doctor and his patient. The latter have become so frank that physicians feel there is no question which the pregnant woman and her husband may not ask.

Classes for Expectant Parents

The great number of classes for expectant parents in all communities, given under such varied auspices as the Red Cross, Visiting Nurse Service, churches, hospitals, and even private physicians is the tangible expression of this change in attitude.

At the Mount Sinai Hospital we offer two courses for our pregnant patients, a day course of nine classes and an evening course of seven classes. The day course has seven classes in the afternoon which the woman attends alone, and two evening sessions for husband and wife. The evening course is an example of complete togetherness—husband and wife go to each meeting. Instruction is under the direction and supervision of a public health obstetric nurse, but additional faculty consists of obstetricians, dietitians, physiotherapists, psychiatrists, and pediatricians. At one of the sessions key personnel with whom the patient will have contact during her hospital stay, such as residents, anesthetists, and head nurses are introduced. This is to make her feel at home and secure when it is time for her confinement. For the same reason, one of the classes for husbands and wives includes a tour of the labor and postpartum floors. The delivery room and its equipment are demonstrated, including the complex-looking anesthesia machine. Nurseries and postpartum accommodations are inspected. A trial run is made of the proper door to enter and where to go if the stork starts landing by the light of the moon. The resolution of such simple doubts may dispel the insomnia of some expectant parent

The content of the course includes a thorough discussion of sex anatomy, conception, pregnancy, prenatal care, signs of labor, labor, and delivery. The matters of rooming in, natural childbirth, pain relief, breast feeding, demand feeding, and early ambulation are considered.

The baby’s layette, formula preparation, and infant bathing are demonstrated. The psychiatrist explains the normal mood swings of pregnancy and the early postpartum period, and offers a program of early infant training. The pediatrician talks about the care of the baby: feeding, bathing, circumcision, diaper-changing, stools, crying, rashes, and other happenings in the life of a newborn child. The dietician offers sample menus of the normal pregnancy diet and calorie-restricted meals, as well as listing the foods safe to consume when salt must be restricted. The physiotherapist conducts exercises for muscle-strengthening and shows the patients how to relax, which is particularly useful for those who plan ‘natural childbirth.’

This is a far cry from the medical care and guidance given the pregnant woman half a century ago. What happened then?

Prenatal Care Is New

In 1912 Tom Smith stopped Dr. Jones on Main Street ‘Hey, Doc, Emily’s expecting, and we’re wondering whether you wouldn’t look out for her.’ ‘Why, I’d be pleased and honored, Tom. When is it coming off?’ ‘Well, as near as we can reckon, the week after Easter.’ ‘Good, my boy. Just send for me when things get started. Ill be there. You know my slogan—Doc Jones hasn’t missed a baby yet.’ So long, boy. I’ll be seeing you after Easter.’ They parted, Tom happy in the knowledge that Emily was being watched over by Providence and Doc Jones, and Dr. Jones happy in the knowledge that Mrs. Jones was assured of a new Easter dress.

Even less than fifty years ago such a conversation between the expectant father and his doctor might have happened anywhere in the civilized world. That a physician could protect the woman’s life by carefully examining and advising her at frequent intervals during pregnancy (prenatal care) was a brand-new idea in the first years of the twentieth century. Prenatal care was first given t© the well-to-do and the very poor by a handful of newfangled specialists, obstetricians (Latin: ‘one who stands in front’). The very poor were poor enough to attend the great university clinics, where these newfangled specialists studied and taught; while the wealthy were rich enough to pay their extra tariff. This expert medical supervision of the woman throughout pregnancy, America’s main contribution to the safety of childbirth, has gradually spread so that now most gravid women in occidental countries receive it

Unsolicited Unprofessional Advice

Almost any woman who has had a baby feels specially qualified to give managerial advice to pregnant relatives, friends, and even strangers. A parallel exists in the male’s relationship to our national pastime. As long as the spectator has worn a baseball mitt at some time in his life, no matter how transient or inglorious his career as player, he feels similarly qualified to advise. The shouts of ‘Take him out’ ‘Leave him in,’ or ‘Bunt you dope,’ attest this. However, the difference between pregnancy and baseball is a real one; the pregnant woman pays attention to her advisers, often to her detriment It is not so with either baseball player or manager. As the result of the pregnant woman’s low resistance to advice from anybody at any time, the doctor frequently has to correct all manner of false notions and ideas.

From more than thirty years’ experience in obstetric practice, I could give pages of examples. I shall content myself by citing a few. A very intelligent patient, the wife of a physician, asked me if it was dangerous to raise her arms above her head. I was startled to hear so primitive a question from so sophisticated a mouth. On inquiry I discovered that one of her mother’s friends had gratuitously warned her that the child might be strangled in the loops of its cord should she stretch her arms aloft. Another patient asked me if a friend’s contention was correct, that coitus during pregnancy would make the child over-sexed. A third told me that her mother-in-law had warned her against high heels because they would make the child cross-eyed. All sorts of bizarre dietary restrictions are imposed by these lay boards of strategy with their notions passed on by one gullible generation to the next.

Maternal Impressions

It is hardly necessary to inform the modern reader that no experience or thought which the pregnant woman has could possibly influence the body form, intelligence, or character of her unborn child. There is no shred of scientific evidence that any component of a baby’s makeup is influenced in utero by factors other than heredity, nutrition, and maternal health. All the hours spent by our pregnant forebears in their attempts favorably to influence unborn children by classical music to which they were antipathetic, by famous art for which they had no liking, or by serious literature for which they had no relish, were wasted. Both the fortunate and unfortunate fetal outcome must be attributed to sources other than maternal impressions.

I cannot refrain from inserting an anecdote which happened many years ago. At that time we had on the faculty of the Johns Hopkins a famous, gemiitlich, jolly German-born professor, Max Brodel, and an equally famous, serious-minded German savant, Isidro Hofbauer. One day as the savant and I entered the Women’s Clinic Max stopped us. He said to my companion, ‘Isidro, what do you think of maternal impressions?’

My companion replied, ‘Ach, that’s monkey business, not science.’

The professor said, ‘I wouldn’t be so sure it’s monkey business. I’ll tell you what happened to a friend of mine. When seven months pregnant, she went to the zoo and as she stood before the bear’s cage the huge animal growled and made a lunge at her with his paw. She fainted, and two months later her baby was born with bare feet.’ ‘That’s impossible, that cannot be, that’s foolishness,’ refuted the savant.