PART VII.
THE CARE OF THE BABY
XXI. CHARACTERISTICS AND DEVELOPMENT OF THE AVERAGE NEW-BORN BABY 451
XXII. NURSING CARE OF THE AVERAGE NEW-BORN BABY 461
XXIII. COMMON DISORDERS AND ABNORMALITIES OF EARLY INFANCY 518
XXIV. A FINAL WORD 544
LIST OF ILLUSTRATIONS AND CHARTS
ILLUSTRATIONS
ANATOMY AND PHYSIOLOGY.
FIG. PAGE
1 a. Normal female pelvis 21
b. Normal male pelvis 21
2. Diagram of pelvic inlet seen from above 22
3. Diagram of pelvic outlet seen from below 23
4. Sagittal section of the pelvis 24
5. Two types of pelvimeters 25
6. Diagram showing method of measuring distance between crests, spines and trochanters 26
7. Diagram showing method of measuring Baudelocque’s diameter 27
8. Diagram showing method of estimating true conjugate 28
9. Diagram showing method of measuring intertuberous diameter 29
10. Anterior view of external and internal female generative organs 31
11. Diagrams of sections of virgin and multiparous uteri 32
12. Sagittal section of female generative tract 35
13. Diagram of external female genitalia 39
14. Sagittal section of breast 42
15. Front view of breast 43
16. Diagram of human ovum 47
DEVELOPMENT OF THE BABY
17. Diagram of human spermatozoa 61
18. Diagram of segmenting rabbit’s ovum 65
19. Ovum about 13 days old embedded in the decidua 66
20. Diagram of developing fetus, cord, membranes and placenta in utero 69
21. Diagram of structure of placenta 71
22. Photograph of placental vessels 72
23. Maternal surface of the placenta 74
24. Fetal surface of the placenta 75
25. Embryo about 5.5 cm. long in amniotic sac 77
26. Outlines of fetus at different stages 78
27. Full term fetus in utero 81
28. Diagram of fetal circulation 85
29. Diagram of circulation after birth 87
30. Side and top view of fetal skull 90
THE EXPECTANT MOTHER.
31. Height of fundus at different stages of pregnancy 94
32. Contour of abdomen at ninth month 95
33. Contour of abdomen at tenth month 95
34. Front view of home-made abdominal binder 123
35. Side view of same 123
36. Back view of same 123
37. Abdominal binder used in above 124
38. Front view of home-made stocking supporters 124
39. Back view of same 124
40. Patient in right-angled position to relieve varicose veins 138
41. Elevated Sims position 139
42. Gloves, ready for dry sterilization 160
43. Delivery pad of newspapers and old muslin 161
44. Diagram of centrally implanted placenta prævia 174
45. Partial placenta prævia 175
46. Diagram of marginal placenta prævia 176
47. Champetier de Ribes’ bag inserted in uterus 177
48. Patient in hot pack given with dry blankets 197
49. Method of giving infusion 202
THE BIRTH OF THE BABY.
50. Attitude of fetus in uterus at term 217
51. Illustration from first text-book on obstetrics 218
52. Attitude of fetus in breach presentation 219
53. Attitude of fetus in vertex presentation 220
54. Diagram of six positions in a vertex presentation 222
55. Diagram of six positions in a face presentation 223
56. Diagram of six positions in a breech presentation 223
57. First maneuver in abdominal palpation 225
58. Second maneuver in abdominal palpation 226
59. Third maneuver in abdominal palpation 227
60. Fourth maneuver in abdominal palpation 228
61. Diagrams showing positions of nurse’s hands in four maneuvers of abdominal palpation 229
62. Ascertaining position of fetus by rectal examination 230
63, 64, Diagrams showing stages of dilatation and 65, 66. obliteration of cervix 234
67. Characteristic position of patient during first stage pains 235
68. Diagram indicating rotation and pivoting of head during birth 236
69. Anterior shoulder being slipped from under symphysis 237
70. Birth of posterior shoulder 238
71. Diagrams of Duncan and Schultze mechanisms of placental separation 239
72. Section showing thinness of uterine wall before birth of fetus 240
73. Section showing thickness of uterine wall immediately after labor 241
74. Preparing patient for vaginal examination or delivery 250
75. Patient draped for vaginal examination 251
76. Wrong and right methods of boiling gloves 253
77. Powdering hands before putting on dry gloves 254
78. Successive steps in proper method of putting on gloves 255
79. Bed and simple equipment ready for normal delivery 258
80. Instruments shown in Fig. 79 260
81. Old prints showing early methods of delivery 261
82. Patient draped with sterile dressings for delivery 262
83. Patient pulling on straps while bearing down during second stage 264
84. Palpating baby’s head through perineum 265
85. Baby’s head appearing at vulva 266
86. Head farther advanced 267
87. Holding back head at the height of a pain 268
88. External rotation following birth of head 269
89. Wiping mucus from baby’s mouth 270
90. Stroking baby’s back to stimulate respirations 271
91. Two clamps on cord after pulsation has ceased 272
92. Wrong and right method in tying knot in cord ligature 272
93. Stimulating baby’s respirations 274
94, 95. Stimulating baby’s respirations 275, 276
96, 97. Resuscitating baby by holding under warm water 277, 278
98. Resuscitation by means of direct insufflation 279
99. Delivery of the placenta 280
100. Twisting membranes while withdrawing placenta 281
101. Massaging fundus through abdominal wall 282
102. Showing prolapsed cord between head and pelvic brim 285
103. Giving chloroform for obstetrical anæsthesia 287
104, 105. Giving ether for obstetrical anæsthesia 289, 290
106. Giving ether for complete anæsthesia 293
107. a. Tarnier forceps, b. Simpson forceps 301
108. Patient in position and draped for forceps operation 302
109. Forceps sheet used in Fig. 108 303
110. Two types of leggings for obstetrical use 304
111. Rubber bougie 311
112. Champetier de Ribes’ bag 311
113. Voorhees’ bag 312
114. Bag held in forceps for introduction into uterus 312
115. Syringe for filling above bags after insertion 312
THE YOUNG MOTHER.
116. Height of fundus on each of first ten days after delivery 327
117. Patient draped for postpartum dressing 336
118. Equipment in rack used in Fig. 117 337
119. Method of covering nipples with sterile gauze 339
120. Baby nursing through a nipple shield 341
121. Nipple shield used in Fig. 120 342
122. Supporting heavy breasts by means of folded towels 343
123. Ice caps applied to engorged breasts 344
124. Y binder before application 345
125. Y binder applied 346
126. The same seen from the other side 347
127. Indian binder 347
128. Method of stripping 348
129, 130, Bed exercises taken during the puerperium 131, 132, 133, 134, 350 to 135. 353
136. Knee-chest position 354
137. Exercising by walking on all fours 354
138. Position of mother and baby for nursing in bed 359
139. The Nursing Mother (from a painting by Gari Melchers) 361
140. Baby partially blind as a result of a faulty diet 378
141. Rachitic and normal babies of the same age 381
142. Chest walls of normal and rachitic rats of the same age 383
143. Interior of specimens in Fig. 142 384
THE MATERNITY PATIENT IN THE COMMUNITY.
144. Baby’s bed improvised from a market basket 415
145. Layette recommended to expectant mothers by Maternity Centre Association 416
146. Breast tray recommended to expectant mothers by Maternity Centre Association 417
147. Baby’s toilet tray recommended to expectant mothers by Maternity Centre Association 417
THE BABY.
148. Diagram of first teeth 456
149. Umbilical cord immediately after birth 457
150. The same four days later 457
151. Umbilicus immediately after separation of cord 458
152. Well healed umbilicus 458
153. Nursery at Manhattan Maternity Hospital 465
154. Bathing the baby 467
155. Preparation for circumcision 468
156. Baby draped with sterile sheet, in above 469
157. Cord dressed with dry sterile gauze 470
158. Abdominal binder applied over cord dressing 471
159. Satisfactory baby clothes 473
160. Diagonally folded diaper applied 474
161. Longitudinally folded diaper applied 474
162. Sutton poncho to protect baby for outdoor sleeping 479
163. Training the baby to use a chamber 481
164. Stiff cuffs to prevent thumb sucking 483
165. Hammer cap to prevent ruminating 484
166. Ruminating cap applied 485
167. Proper method of carrying baby 487
168. Preparing the baby’s milk 493
169. Giving the baby his bottle 496
170. Holding baby upright after feeding 497
171. Dr. Griffith’s table of fat percentages 500
172. Reverse side of above card 501
173. Baby in a basket ready to travel 507
174. Quilted robe with hood for the premature baby 509
175. Premature baby in lined basket, being fed with Boston feeder 510
176. Bed for premature baby improvised from small clothes basket 511
177. Putting the baby in a wet pack 521
178. Baby in wet pack 522
179. Diagrams showing successive steps in giving the baby a pack 522
180. Baby wrapped in blanket preparatory to gavage 523
181. Gavage 524
182. Obtaining a fresh specimen of urine from the baby 526
183. Obtaining a 24–hour specimen of urine from the baby 527
184. Band to hold baby’s legs while obtaining specimens of urine 527
185. Belt used to hold tube for specimen 528
186. Giving the baby an enema 530
187. Irrigating the eye with a blunt nozzle 536
188. Method of holding baby for treating gonorrhœal ophthalmia 537
CHARTS.
NO. 1. Showing drop in blood pressure and albumen, after delivery, in eclampsia 204
2. Showing persistence of high blood pressure and albumen in the urine, after delivery, in nephritic toxæmia with convulsions 206
3. Showing temperature curve in streptococcus infection 397
4. Showing temperature curve in gonorrhœal infection 398
5. Showing normal weekly gain in weight during first year of life 454
6. Showing normal daily gain in weight during first two weeks 520
7. Showing loss of weight in inanition fever contrasted with No. 6 520
8. Showing rise in temperature in inanition fever 520
OBSTETRICAL NURSING
“Can there be any higher work than this? Can any woman wish for a more womanly work?” Florence Nightingale
INTRODUCTION
The avowed purpose of care given to the maternity patient to-day is to minimize the discomforts and perils of her pregnancy, labor, and the puerperium, and so safeguard her and her baby that both will emerge from the lying-in period in a satisfactory condition and with a bright prospect of having permanently good health.
The striking difference between obstetrics as practiced to-day, and that of former times, is that it now lays as much stress upon the future health of the mother and baby as it does upon their immediate safety.
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 value of these safeguards is attested to by the satisfactory results of the care which is given to the patients in well conducted hospitals or in their homes by careful physicians; by various out-patient departments and nursing organizations to patients within their reach. These results are in the form of a large proportion of mothers and babies who are well and continue to be well.
That is one view of the matter. Looking at it from another aspect, we discover that more than seven women still lose their lives for each 1,000 births that occur in this country, the actual number varying in different localities. Childbirth is still second to tuberculosis as a cause of death among women between fifteen and forty-five years of age, and in spite of the proved value of care in making maternity a safe adventure, the larger proportion of these women die from infection or toxæmia which are almost entirely preventable.
The incredible fact in this connection is that, while there has been a decline in the deaths from such other controllable conditions as typhoid fever and some of the infectious diseases of childhood, there has been an actual increase in deaths from preventable causes associated with child-bearing.
Dr. Dublin estimates that throughout the United States as a whole, during 1920, the total number of deaths due to childbirth was about 20,000.
In addition to the high death rate among mothers the mortality among babies is even greater. Dr. Dublin estimates that out of every 1,000 babies born during 1920, about 85 died before they were a year old, or about 200,000 in the course of the year, and that the large majority of these died from congenital causes, from infection or nutritional disturbances. Another 100,000 babies perish, yearly, through still births. As all of these conditions are preventable to a greater or lesser degree, we have to acknowledge that many babies die whom we know how to save. There is sound reason, therefore, for the belief that proper care would save the lives of about two-thirds of the mothers and half of the babies who now die and half of the babies who are born dead.
And let it be remembered that conditions which destroy life, also destroy or greatly impair health and resistance to disease. Although we may count the number of mothers and babies who fail to survive the too severe test to which they are put during crucial periods in the lives of both, we cannot count, nor even approximately estimate, the number of those who escape death only to be imprisoned in frail, deformed, or diseased bodies. Therein lies much of the tragedy which follows in the wake of neglect—the lifelong handicaps, suffering, and inefficiency that need not have been.
This lack of care is not due to limitations in medical knowledge, for the efficacy of known methods is being constantly demonstrated. And our instant and generous response, the country over, to appeals for help in relieving various forms of need and disaster does not suggest a national cold-bloodedness, or even indifference, to needless suffering. But still a legion of mothers and babies die each year from lack of care, and almost at our very thresholds.
Perhaps the root of the difficulty lies in the fact that childbirth, as well as the attendant suffering and death, are so familiar that they are regarded as being normal incidents in the ordinary course of affairs.
One of the most dramatic of all human events, the birth of a new being, is accepted casually, almost without concern, because it is so frequent—so commonplace.
Moreover, we are all accustomed to hearing stressed the fact that child-bearing is not a disease, but is a normal physiological function.
Not so generally, however, do we hear emphasis made upon the equally important facts that there is extreme danger of infection while these physiological functions are in progress, and that they subject the entire organism to such a strain that there results a dangerously narrow margin between health and disease.
Accordingly, too much is expected, or taken for granted, from the provisions which Nature has made to promote these functions, and not enough assistance is given to protect the mother, while they are in course, or to help the immature baby in adjusting himself to the greatest change which he makes during the entire span of his existence.
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.
Apparently, then, our national health is in a large measure dependent upon good obstetrics and good obstetrics includes good nursing.
Good nursing implies more than the giving of bed baths and medicines, boiling instruments and serving meals. It is more than going on duty at a certain time, carrying out orders for a certain number of hours and going off duty again. It implies care and consideration of the patient as a human being and a determination to nurse her well and happily, no matter what this demands.
In carrying on her work, the maternity nurse may be called upon to aid in prenatal supervision and instruction; to prepare for and assist with a delivery, or to give either exclusive or visiting nursing care to a young mother and her baby. These patients may be in a hospital or at home and the home may be of any kind from a palace to a hut or a tenement. The patients may be in a city, a small town, or a rural community, and in the care of doctors whose methods vary widely.
But in spite of the diversity of conditions and the fact that no two will be quite alike, the general need of all of these patients will be the same.
Their need is care, which includes cleanliness in order to prevent infection; suitable food; fresh air and exercise; regular and sufficient rest and sleep; an equable body temperature; early treatment of complications and correction of physical defects. In short, each patient needs to be watched; needs clean care and to practice the approved principles of personal hygiene from the beginning of pregnancy. This without regard to race, color, creed, occupation, status, or location. It means all maternity patients and their babies the country over.
There was a time when the obstetrician first saw his patient in labor or shortly beforehand, and when the care of the baby began at birth or soon afterward.
We know what this tardy attention has cost in human lives and suffering.
We know, too, that among the mothers, abortion, miscarriages, toxæmias, difficult or impossible labors may be largely prevented through prenatal care; while among babies, the enormously high death rate, during the first month of life from causes which begin to operate before birth, convinces us that we must begin to take care of the baby nine months before he is born, if he is to have the greatest benefits of present available knowledge. Such early care reduces still births and injury during labor; it reduces premature births, which is important, because the nearer the baby goes to term the better his chance of survival and of good health, and prenatal care also increases the prospects of satisfactory breast feeding.
Although we know that the ideal is to have all maternity patients supervised and instructed entirely by a physician from the beginning of pregnancy and then delivered in a well conducted hospital, it is scarcely probable that this ideal will ever be realized. There will always be patients who cannot afford to employ a doctor for so long a period; there will always be communities in which hospital provisions do not exist or are inadequate. There will always be expectant mothers whom it would be unwise to remove from home, excepting under pressing conditions, because of the influence exerted by their mere presence in keeping the family group intact. And so on, through a number of deterring conditions which will probably never cease to exist, and which will keep the patient at home.
Since patients who are supervised during pregnancy and delivered in hospitals usually recover, the high rate of death and injury, in this country, is to be found among women who are unsupervised before labor and subsequently delivered at home. Accordingly, if this widespread injury is to be reduced, the essentials of the care which is found to be efficacious must be made available for all patients throughout the length and breadth of the land.
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.
It is in this teaching that the nurse may be immeasurably helpful, in fact is indispensable, for the carrying of approved care into the home and the general teaching of personal hygiene are inextricably bound up with nursing.
The details of the care and teaching of patients are, of course, specified by a doctor or a medical board, but the effectiveness of the planning, whether for one or several patients, is very largely dependent upon the nurse’s intelligence, interest and conscientiousness, and her ability to teach.
This is borne out by the almost uniform recommendations, made by official bodies, for provisions looking toward the reduction of maternal and infant deaths including as they do the following:
1. The employment of public health nurses. (To give home care or instruction or both.)
2. The establishment of prenatal clinics and baby health centers. (In both of these the nurse aids in supervising and teaching the mother how to take care of herself and her baby.)
3. Trained attendance during labor. (The nurse aids greatly in preparing for and assisting with clean deliveries.)
4. Improved and increased hospital facilities. (There cannot be good hospital work without good nursing.)
5. Prompt and accurate registration of births. (Here, too, the nurse may be helpful by always making sure that the birth has been reported.)
Here is no light task nor mean privilege which is set before the nurse and in order to meet them fitly she must be prepared. The indispensable requisites for nursing and teaching the maternity patient, whether at home or in a hospital, are training, an exacting conscience, and genuine concern for her patient as an individual.
A certain amount of scientific knowledge is necessary, in this as in any other field, to give the nurse an intelligent background and a kind of definiteness and stability to her work. She should be trained in the essentials of general nursing, of surgical nursing and operating room technique, and in the care of babies. She must of necessity know something of the anatomy and physiology of the female generative organs; the physiological adjustments during pregnancy; the development of the baby within the uterus; the normal process, or mechanism, of labor, and the changes which ordinarily take place during the puerperium. Such information will make clear to her the reasons for the care which she gives to her patient, and accordingly her care will be more intelligent. And she will be better able to recognize the difference between evidences of normal physiological changes and the symptoms of complications.
Two of the newer branches of medicine—nutrition and mental hygiene or psychiatry—have a more and more apparent relation to the safety and welfare of the maternity patient, and accordingly are of moment to the maternity nurse. For, it must be remembered, it is the purpose of obstetricians to-day to establish future health for their patients as well as immediate safety. The nurse should endeavor to help with all that the doctor attempts to do toward these ends, and in order to help she must understand.
The maternity nurse can scarcely be expected to specialize in nutrition or in psychiatry, but she may give to her patients the practical benefits of many valuable discoveries in these fields. She may not be able to remember, for example, all of the sources and purposes of lime in the diet, nor of each of the protective substances, often referred to as vitamines, but any nurse can remember and be guided by the fact that her patient will not be satisfactorily nourished either before or after the birth of the baby unless she has a varied diet containing milk, eggs, and green vegetables. She also can explain to her patients that faulty dietaries are responsible for the tradition that each child costs the mother a tooth, as well as the fact there may be undernourishment even among babies who are fed at the breast, if the mother’s diet is inadequate.
And though the mass of nurses cannot be expected to grasp all of the intricacies of psychiatry, they may without exception apply one of its most important principles by adopting a warm and sympathetic attitude toward their patients and by this means win their trust and confidence. The restfulness of this; the relaxation and general state of mind that this will engender in a large proportion of patients will exert a definitely beneficial effect upon the physical well-being of the expectant mother, the woman in labor and the nursing mother.
These simple applications of important scientific discoveries that relate to the everyday life of her patient—these are things for the maternity nurse to bear in mind. She is nursing a human being who is passing through crucial periods and anything that affects her as a human being affects her as a patient.
Apparently, then, the work of the obstetrical nurse necessitates a training in general nursing and its various branches, in addition to obstetrics, for there seems to be no aspect of nursing which may not, under some condition, have its place in the care of the mother or her baby. All of this training, however, will prepare her for effective work only if she herself has a spirit of eagerness and enthusiasm. But if she has these and even a little training, she may do much.
Accordingly, let the nurse who has been prepared by a general and special training, and who wants to be of the greatest possible service to the maternity patient start by appreciating a few general principles which will be absolutely indispensable to the success of her work. They may be expressed somewhat as follows:
1. _Cleanliness_—under all conditions, to protect both mother and baby from infection.
2. _Watchfulness_—for early symptoms of complications in either mother or baby.
3. _Adaptability_—to the patient, the doctor, and the surroundings.
4. _Sympathy_—for every mental and physical stress which the patient may suffer.
If the nurse convinces herself of the import of these requirements and is exacting of herself in giving them broad interpretation, she cannot but nurse her patients well.
She will appreciate the invariable need for cleanliness and watchfulness if she will hark back to the fact that our mothers and babies die in distressingly large numbers from infections, toxæmias, and nutritional disturbances, all of which are usually amenable to preventive or early treatment.
In order to be always clean, always watchful, and always ready to execute, both in letter and spirit, the orders of doctors whose methods of treatment will differ, the nurse will need to be very adaptable. She will need to keep a clear head and an open mind and to remember always the ends that are being striven for: the immediate safety and the future wellbeing of the mother and the baby. And she may rest assured that, no matter how they vary as to details, all doctors want all of their patients to be given clean care; watched for symptoms of complications; and given good general nursing.
Considering the need for cleanliness in a very broad and practical sense, the nurse will realize that the test of her ability to protect her maternity patients from infection is not what she is able to do in a hospital where there is every facility for clean work. It is not the ability to maintain asepsis in a tiled operating room that counts, where she is aided by sterilizers, basins, and solutions of various kinds and colors, a wealth of ingenious appliances and a corps of co-workers. It is the understanding and imagination which will enable her, perhaps single-handed, to carry the principles of such work into a patient’s home; to do clean work, from the standpoint of avoiding infection, in a mountain hut or a city tenement where everything is dirty.
The nurse will do well to begin to develop her powers of adaptability while she is still in training. She may greatly increase the value of her hospital experience by trying always to understand the purpose of the care which she is giving and trying at the same time to imagine how, in an average home, she would accomplish the results of this or that procedure which is made easy of execution in the hospital by special equipment. She should never lose sight of the fact that she is not being trained solely to conform to any one hospital routine or to become expert in only one method of nursing care. She is being prepared to go out and give nursing care to any young woman and her baby who need it, no matter where or how they are situated or by what methods they are treated.
If conditions are such that the doctor’s orders and the patient’s requirements seem impossible of fulfillment, then the nurse must attempt the impossible and attempt it with confidence of success.
It is clear that the nurse must cultivate adaptability and resourcefulness if she is to give good care to all her patients under all conditions. But even the most efficient and intelligent work will not be wholly satisfactory unless it is infused with a spirit of sympathy for the woman as an individual.
The thing that counts in this connection is what the nurse, herself, means to the woman who is facing a very important and mysterious event, who, after every known aid has been given, must still go through a great deal alone, both mentally and physically. It is not helpful to a woman in such a situation to be told that women have borne children since the dawn of Creation and that they all have had pain; that she will have to go through with it, as they have, and that the less fuss she makes about it the better. But it does help her to have the nurse say that she has been with so many women in labor that she knows they suffer intensely, and because she knows it so well she wants to do all that lies in her power to give even a little relief. The nurse may never know just how she has helped and reassured; how a pain was made a little easier to bear, not only by the hand slipped under an aching back, but also by the sympathy that the act conveyed. But she may be sure that she has helped.
In such a connection, the nurse must guard against the mistake of dividing her patients into well defined groups: those who are poor and those who are more favored. If she unfailingly looks for the human being beyond the patient she will find some of the most sensitive and appreciative of women among the simplest and poorest and they will be warmly responsive to a thoughtful, considerate attitude. And at the same time, the patient in comfortable circumstances who seems to be surrounded by all that one could desire, is often pathetically lonely and isolated. She, too, will be appreciative of encouragement and an attitude of concern for her comfort.
Suffering and anxiety make no class distinctions and have a very leveling effect, for prince and pauper, alike, need sympathy when afflicted.
From the standpoint of the nurse herself, there might be discouragement in this description of what is expected of her, and what are her opportunities in this work of caring for mothers and babies, if she did not go straight to the heart of the matter and see that all that is needed, after all, is good nursing. She must realize, of course, that good nursing necessitates training and a spirit of such eager service that she will do for her patient all that lies in her perhaps limited power, and then try to learn of still more that she may offer. And she may rest assured that the value of her work will be quite as dependent upon such a spirit as upon her training.
Obstetrical nursing may be defined, with accuracy, as the nursing care of an obstetrical patient, but its true significance is limited only by the nurse’s ability, resourcefulness, and vision. And the more spirituality which pervades this work the more effective will be the nurse’s skilled ministrations and the more satisfying will it all be to her.
This aspect of maternity nursing—what it means to the nurse herself—should be given full recognition, for although the demands which are made upon her are exacting, she will find more than compensating interest and gratification in her work.
It provides a channel of expression for some of her most elemental and deeply rooted impulses. The desire to create exists within most of us, and surely the nurse tastes of the joys of creation when she watches the beautiful baby body grow and develop under her care. And she has a consciousness of patriotic service, too, for while helping to secure the immediate safety and future health of the baby citizen she is helping to build a strong race.
But this work goes still further and offers even more than these.
The average nurse has a deep maternal instinct. She may not be conscious of it as such, but it is this instinct which prompts her to select nursing from the wide range of occupations and professions which are open to her. And it is entirely natural that she should derive great satisfaction from this vicarious motherhood—this giving of her knowledge and skill in service to the woman with a baby in her arms.
The opportunities for self-expression which are open to the nurse who gives this form of service make us wonder if she should not be included in the enviable group of those others whose life work is an expression of themselves—the poets and painters; the architects, musicians, and sculptors—those who create and build because of an urge within them. Surely, the spirit and the results of the work of the nurse who thus gives of herself may be ranged with the efforts of those others whose work is an expression of themselves.
“The body is the crowning marvel in the world of miracles in which we live. Fearfully and wonderfully made, it claims our respect not only because God fashioned it, but because He fashioned it so well—because it is a thing of beauty, a perfection of mechanism.”
_The Splendor of the Human Body_—BISHOP BRENT.