LETTER OF TRANSMITTAL

U. S. DEPARTMENT OF LABOR,

CHILDREN'S BUREAU,

Washington, September 25, 1930.

SIR: There is transmitted herewith a complete revision of the bulletin Prenatal Care, originally published in 1913 as the first of the Children's Bureau series on the care of children.

This revision is the work of Dr. Robert L. De Normandie, chairman of the bureau's advisory committee of obstetricians, in cooperation with the members of the committee and with Dr. Blanche M. Haines, director of the maternity and infant hygiene division of the bureau. The members of the committee are: Dr. Robert L. De Normandie, instructor in obstetrics, Harvard Medical School, chairman; Dr. Fred L. Adair, professor of obstetrics and gynecology, University of Chicago; Dr. Rudolph W. Holmes, professor of obstetrics, Northwestern University Medical School, Chicago; Dr. Ralph W. Lobenstine, chairman medical advisory board, Maternity Center Association, New York; Dr. Frank W. Lynch, professor of obstetrics and gynecology, University of California Medical School; Dr. James R. McCord, professor of obstetrics and gynecology, Emory University School of Medicine, Atlanta; Dr. C. Jeff Miller, professor of gynecology, Tulane University of Louisiana School of Medicine, New Orleans; Dr. Otto H. Schwarz, professor of obstetrics and gynecology, Washington University School of Medicine, St. Louis; Dr. Alice N. Pickett, assistant professor of obstetrics, University of Louisville School of Medicine, Louisville. Assistance was also received from Dr. E. V. McCollum, professor of biochemistry, School of Hygiene and Public Health, Johns Hopkins University, who read the manuscript and made valuable suggestions on the diet section. Respectfully submitted.

Hon. JAMES J. DAVIS,

Secretary of Labor.

GRACE ABBOTT, Chief.

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PRENATAL CARE

Prenatal care is that part of maternal care which has as its object the complete supervision of the pregnant woman in order to preserve the happiness, health, and life of the mother and child. What this prenatal care should be is the subject matter of this book.

More important than anything else in planning the best possible care for mother and child is that the mother should go to a doctor for examination and advice just as soon as she thinks she is pregnant and should remain under his constant care until the baby is born. This book is not meant to take the place of this medical care. It is written in the hope that it will be helpful to those expectant mothers for whom medical aid is not at hand, and to those doctors who may wish their patients to have it as a supplement to their instructions.

SIGNS OF PREGNANCY

Early signs that a pregnancy is probably present are these:

1. Missing a monthly period.

2. Changes in the breasts.

3. Nausea or vomiting-"morning sickness."

4. Desire to pass urine more often than usual.

The first is the most significant. The missing of the monthly, or menstrual, period is especially suggestive of pregnancy in the case of a woman who has always had regular, normal monthly periods, and has had a recent opportunity of becoming pregnant. The missing of two monthly periods, one after the other, makes pregnancy more probable.

At the time of the first skipped period the breasts often get a little larger. They may also be tender to the touch and may have a stinging or prickling feeling. If the breasts have never felt like this before during the monthly period, the feeling is probably another sign that pregnancy exists.

A feeling of nausea, or sickness of the stomach, sometimes with vomiting, is a very common early sign of pregnancy. Most women who are troubled with this nausea feel it in the morning, and it is commonly called "morning sickness." Some women feel it in the

late afternoon or early evening. And some women do not feel it at all.

The desire to pass urine more often than usual is very common early in pregnancy. Women when pregnant sometimes have to get up during the night to pass urine who before had been able to sleep right through the night.

When all four of these signs appear, the woman is probably pregnant. A doctor can give a more definite opinion, however, after he has made an examination by the vagina, which is the lower part of the birth canal. This examination should always be made early in pregnancy, as it enables the doctor to make sure that the pelvic organs-those parts of the body directly connected with childbearing-are in good condition and position.

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At about four and a half months the mother can usually "feel life "that is, feel the baby move in the uterus, or womb, the organ in which it develops. This movement, which is also called the quickening," is a fairly certain sign of pregnancy. The movement of gas in the intestines, however, may cause a feeling so similar that a woman may mistake it for the quickening. The positive signs that a woman is pregnant are feeling the baby move and hearing the baby's heart beat. These can be determined by a doctor's examination about the fifth month or sometimes earlier.

nancy.

DURATION OF PREGNANCY

The probable length of pregnancy is about 40 weeks, or 280 days. If you count 30 days to the month, the 280 days come to just a little more than the 9 months commonly spoken of as the period of pregYou may determine the probable date of delivery by counting back from the beginning of the last monthly period 3 calendar months and adding 7 days. For example, if the last monthly period began on October 30, counting back 3 months to July 30 and adding 7 days gives August 6 as the estimated date of confinement. Many babies are born a few days earlier or a few days later than the expected date, some as much as 2 or 3 weeks later. In these cases the usual explanation is that the pregnancy began in relation to the period that was missed and not from the last period that appeared. Therefore, if the delivery does not come when it is expected, there is no reason, in by far the majority of cases, to think that anything is abnormal; it usually means that the patient did not become pregnant as early as it was thought.

ENGAGING THE DOCTOR AND THE NURSE

As soon as a woman thinks she may be pregnant she should choose her doctor and go to him at once for a complete physical examination and for advice as to the hygiene of pregnancy. At this first visit the doctor will ask her many questions about her medical history-what diseases and operations she has had, if any, with special detail for any involving the abdomen or the pelvis; whether her monthly periods have always been regular and normal; whether she has been pregnant before, and, if so, when her pregnancy and labor occurred

Talking it over with the doctor at the first visit

and what they were like. He will also ask her the date and character of her last monthly period, for from this he will estimate the date of delivery.

IMPORTANCE OF PHYSICAL EXAMINATION

A complete physical examination will include-besides an external abdominal and an internal pelvic examination and measurements of the pelvis, or bony framework-an examination of the teeth, tonsils, throat, thyroid, heart, lungs, kidneys, and digestive organs, taking of blood pressure and weight, and testing of the blood. This examination is most important for the mother's well-being, for it enables the doctor to find out whether her organs are in good condi

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