Chapter V
, so that ordinarily the moderately profuse yellowish or white discharge at this time has no particular significance. Its existence should be noted, however, and brought to the doctor’s attention, for a very profuse discharge is likely to be regarded as a possible evidence of gonorrhea. For this reason a smear is usually made, when the discharge is excessive, to establish or eliminate this diagnosis; if it is positive, it indicates the necessity for treatment to safeguard both mother and baby.
As the normal vaginal discharge has antiseptic properties, it should not be removed by douches, which many patients are eager to take; but if it is irritating and causes itching or burning the patient may be made entirely comfortable by avoiding the use of soap and by bathing the vulva with a solution of sodium bicarbonate or with olive oil.
=Itching of the skin= is a fairly common discomfort, and is possibly a result of irritating material being excreted by the skin glands and deposited upon the surface of the body. The local irritation usually may be allayed, if not very severe, by bathing the uncomfortable areas with a solution of sodium bicarbonate, or a lotion consisting of a pint of lime-water, half an ounce of glycerine and thirty drops of carbolic acid. It is a good plan, also, for the patient to increase the amount of fluids which she is taking, in order to promote the activity of the skin, kidneys and bowels, and thus dilute the material that may be responsible for the itching and increase its elimination through all channels. In other words the itching may be due to a mild toxemia.
Some women complain of discomfort caused by the stretching of the skin over the enlarged abdomen, which becomes so tense it feels as though it might tear apart. There is a very old and widely current belief that this sensation may be relieved by rubbing the abdomen with some kind of an oil or ointment. And, moreover, that such oiling will not only increase the elasticity of the superficial layers of the skin, but the deeper layers as well, and that by this means striæ may be prevented. There seems to be little foundation for the fear that the skin will tear, or belief in the efficacy of the oiling, but if a woman fancies that she is safer and more comfortable after oiling her abdomen, there is certainly no reason why she should not do so.
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 and 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.
The principal complications of pregnancy which are amenable to preventive or early treatment are the toxemias, premature terminations of pregnancy and hemorrhage.
The causes of these conditions and the details of treatment and nursing care are so inextricably associated with each other that they are discussed together and at some length in another chapter. But their most conspicuous, early signs are briefly noted here, since watching for them constitutes a part of routine prenatal care.
The =toxemias= are apparently caused by disturbed metabolism and impaired or inadequate excretory processes. Their prevention is to be accomplished largely by observing the principles of personal hygiene previously described, and in quickly treating early symptoms. One of the commonest of these symptoms is headache, sometimes persistent and very severe. Others are disturbed vision, dizziness and more persistent or severe vomiting than could reasonably be called “morning sickness”; puffiness under the eyes, or elsewhere about the face, or of the hands; anything more than very slight swelling of the feet and ankles; high or increasing blood pressure; mental depression; albumen in the urine, amounting to more than a trace, and epigastric pain, are all possible symptoms of toxemia. A patient in whom even one of these symptoms appears is usually placed under close observation; frequently put to bed and her diet restricted to milk, or even water, until the symptoms subside.
The common symptoms of =premature termination of pregnancy=, (an abortion, miscarriage or premature labor) are bleeding, with or without pain in the small of the back, followed by cramp-like pains in the abdomen. Bleeding or a bloody discharge, therefore, irrespective of pain should be regarded as a symptom of pending labor and the patient should be put to bed promptly, and kept quiet. Preventive treatment, after pregnancy has begun, consists largely of rest, particularly at the time when menstruation would ordinarily occur; avoidance of physical shocks and of overwork during the later weeks. Prolonged failure on the part of the patient to feel fetal movements or of the nurse or doctor to hear the fetal heartbeat after they have once been manifest usually indicates the death of the child and precedes its expulsion.
=Bleeding=, or a sudden increase in the size of the uterus with a rapid pulse or general symptoms of shock, may be the symptoms of hemorrhage caused by placenta prævia or premature separation of a normally implanted placenta; upon the appearance of any one of these signs the patient should be put to bed and kept absolutely quiet.
To sum up, we find that the following symptoms may be forerunners of serious complications, and therefore should be watched for and reported to the doctor immediately upon their discovery:
1. Persistent or severe vomiting.
2. Persistent or severe headache.
3. Dizziness.
4. Disturbed vision or the appearance of black spots before the eyes.
5. Puffiness under the eyes, or elsewhere about the face.
6. Swelling of the feet, ankles or hands.
7. Sharp pains, particularly in the epigastric region.
8. Prolonged failure to feel fetal movements after they have once been felt.
9. Cessation of the fetal heartbeat, or a marked change in its rate or rhythm.
10. Bleeding, or a bloody discharge.
11. Pain in the lumbar region, followed by cramp-like pains in the abdomen, before the expected date of confinement.
12. Albumen in the urine.
13. High, or increasing blood pressure.
14. Unwarranted mental depression, anxiety or apprehension.
These are generally accepted as the cardinal danger signs of pregnancy, any one of which, alone or in combination with one or more of the others, is of significance and should be reported to the doctor at once.
When all is said and done, our wish for the expectant mother is for little more than that she shall live a normal, wholesome life; that she shall be willing, and also be able to weave into her every day life the principles of personal hygiene which every one should adopt; that she shall be carefully watched for complications throughout the entire period of pregnancy, and that these complications shall be speedily treated.
Adoption of personal hygiene, then, and prevention of complications by their early detection and treatment—these we want for every woman who is looking forward to motherhood.
For lack of these things there are sick and blind and maimed babies and invalid women; there are lonely, motherless children and bereaved mothers in every corner of our land.
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