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LETTER OF TRANSMITTAL.

U. S. DEPARTMENT OF LABOR,

CHILDREN'S BUREAU,

Washington, D.O., July 15, 1913. Sir: I transmit herewith monograph entitled “ Prenatal Care," being the first of a contemplated series on the care of children. . A preliminary survey of the field prescribed by law for the Bureau's investigations showed at once the urgency of the question of infant mortality. The United States Census Bureau estimates that 300,000 babies less than 1 year old died last year in this country, and it is authoritatively stated that at least half these deaths were needless. Accordingly the Bureau's first field inquiry is upon the subject of infant mortality. The studies preliminary thereto have induced us to begin our series on the care of children with this monograph on prenatal care, for considerations of which the following statement is significant.

The latest reports of the Bureau of the Census on mortality statistics show that slightly more than 42 per cent of the infants dying under 1 year of age in the registration area in 1911 did not live to complete the first month of life, and that of this 42 per cent almost seven-tenths died as a result of conditions existing before they were born or of injury and accident at birth. Of those that lived less than one week about 83 per cent died of such causes, and of the number that lived less than one day 94 per cent died of these causes.

Thus the Children's Bureau was drawn inevitably to begin its contemplated series of monographs on the care of children by a statement regarding prenatal care for mother and child.

The preparation of such a statement has been requested by the National Congress of Mothers and by members of other representative bodies of women. It has been written by Mrs. Max West, of the staff of the Bureau, from the standpoint of a woman who has university training, experience in Government research, and who is herself the mother of a family of young children. It has been prepared after careful study of the literature of the subject. It has been read and criticized by a large number of well-known physicians and nurses, and by many mothers. To mention by name all those to whom the

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Bureau is indebted for valuable aid in its preparation would be impossible, but especial appreciation may be expressed of the generous assistance of Dr. J. Morris Slemons, professor of obstetrics and gynecology in the University of California.

This monograph is addressed to the average mother of this country. There is no purpose to invade the field of the medical or nursing professions, but rather to furnish such statements regarding hygiene and normal living as every mother has a right to possess in the interest of herself and her children. A standard of life for the family high enough to permit a woman to conserve her sirength for her family, if she knows the facts essential for her guidance, is necessarily taken for granted. The attempt is made here to present some of the most important of these facts. Respectfully submitted.

Julia C. LATHROP, Chief. Hon. WILLIAM B. Wilson,

Secretary of Labor.

PRENATAL CARE.

PREGNANCY.

SIGNS OF PREGNANCY, The first and most natural question which occurs to the prospective mother is how pregnancy manifests itself. The presumptive signs of pregnancy are these:

(1) Cessation of menstruation.
(2) Changes in the breasts.
(3) Morning sickness.
(4) Disturbances in urination.

The first of these is generally the most commonly significant, and although other causes may operate to suspend the menstrual flow, it is usually true, especially if menstruation has heretofore been regular, that the missing of two successive periods indicates the existence of pregnancy.

If, at the same time, unusual sensations in the breasts, such as tenderness to pressure, stinging, prickling, and the like are felt, they support the probability of pregnancy.

What is known as morning sickness, namely, the occurrence of pausea, usually upon rising in the morning, with or without vomiting, is noted in nearly two-thirds of all cases, and is especially noticeable in the first pregnancy.

Urination may be troublesome. In the beginning of pregnancy there is often the desire to empty the bladder frequently, or there may be other annoying symptoms. These are chiefly due to the irritation caused by the pressure of the growing uterus against the bladder, and disappear after the first few weeks.

One of the more significant signs of pregnancy is the movement of the child in the uterus. This is commonly called the “quickening," and is usually felt by the mother about the sixteenth or eighteenth week. After this there can scarcely be room for doubt that pregnancy exists, although there are other signs upon which physicians rely, and only a physician can make a positive diagnosis.

DURATION OF PREGNANCY.

From an observation of countless cases of childbirth, in many countries and under all conditions, the length of the period of human gestation has come to be regarded as approximately 39 weeks, or 273 days.

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Counting 30 days to the month, it will be seen that the commonly accepted period of nine months is nearly correct. To estimate the date at which a given birth will occur, physicians employ a rule, which although far from exact, gives as close a reckoning as can be made. This method consists in counting forward 280 days from the beginning of the last menstrual period, thus allowing 7 days for the menstrual period, or, what comes to the same thing, counting backward 85 days. The simplest method is to count back 3 months and add 7 days, which is the average difference between three months and 85 days. In only about one out of twenty instances will the birth occur upon the exact date thus arrived at; some will occur a few days before and some a few days later; nevertheless this is as good a rule as can be found.

An example of the method of calculation is as follows: If the last menstruation began on October 30, counting back three months to July 30, and adding 7 days gives August 6 as the presumptive approximate date of confinement.

PERSONAL HYGIENE.

DIET DURING PREGNANCY.

The food of a woman during pregnancy need not differ materially from that to which she has been accustomed, provided that her diet previously has been chosen with due regard to its suitability. Any food or drink which causes distress, or even discomfort, because of indigestion, should be avoided at all times, but with this exception a pregnant woman may safely follow the dictates of her appetite as to the choice of her food.

There are, however, certain general principles that she should take into consideration. One of these is that the excretory organs—the bowels, the kidneys, and the skin—should be kept in the best possible condition, because during pregnancy the mother must get rid of not only her own waste products but also those of the unborn child. It will be found, therefore, that a light, laxative diet, which is at the same time satisfying and nutritious, will tend to keep her in health. An ideal diet includes a relatively large proportion of liquids, a small proportion of meats, and a correspondingly generous proportion of fresh fruits and vegetables. Most physicians prefer that meat should not be eaten oftener than once a day, but allow a wide latitude in the choice of other foods.

It is well to understand that the accumulation of waste products in the system is the cause of various minor ailments of pregnancy, as well as of some of the more serious complications. Since liquids help the bowels, kidneys, and skin to throw off these waste products, and therefore do away with some of the sources of danger at this

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