Prenatal Care Practices: An Era Gone By

Old medical books give us insight into the world of nurses, doctors and patients of the early 1900s. They educate, intrigue, and scare us with old practices. Enjoy this article about prenatal care in an era gone by. Nurses Announcements Archive Article

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"Open wide Mrs. Smith, I need to check your teeth. I don't see any pus but two of your teeth need to be pulled. We can arrange that later. Today we will be doing a blood test called the Wassermann test(a test for syphilis that could also detect TB or lupus). Now that you are pregnant, you may not wear a corset or binder because it causes low birth weight in newborns. I know many young women who have tried to hide their pregnancy by wearing a corset but it is detrimental to the newborn. It needs room to grow. Now I want you to start bathing regularly and try to walk every day. The fresh air and exercise will be good for you and the baby.

Um, any history of epilepsy, alcoholism or rheumatism? No?

Well, then my nurse will be in directly to take the blood and answer any questions."

This may have been what a prenatal visit would have sounded like in the 1920s. The Health Care of the Baby by Louis Fischer M.D. seventeenth edition published in 1929 reveals some captivating facts about prenatal care in the early 1900s. Fischer talks about the importance of looking at the teeth of pregnant women for pus. In our world, oral hygiene is a part of everyday life (or should be).

To think that brushing teeth did not become important until post World War II, about 1945, is hard to imagine. The soldiers brought the practice of routine teeth brushing home after the war. I'm so glad they did!

Prenatal care did not become common practice until the early 1900s so preventative care was a lone venture. Hygiene and hereditary disease were just beginning to make their appearance on the questionnaire for newly pregnant mothers. In the twenty years preceding, nursing was just beginning to gain the professionalism it deserved with the formation of the ANA (American Nurses Association) in 1911.

Among the professionals was Mary D. Osborne, known for promoting maternal and prenatal care in this era which paved the way for the medical field to increase standards for pregnant women. With the focus on prenatal care evolving and the increased involvement of nurses, the expectant mother received better health care and therefore decreased infant mortality.

Prenatal care can start before a woman is pregnant nowadays. She may begin taking prenatal vitamins, stop smoking, begin exercising, or change her diet to make sure she is in the best shape possible for her baby. She can take a test at home and find out very early that she is indeed pregnant. Maternity clothes have changed from loose pleated blouses/dresses to form fitting shirts that proudly display the blossoming belly. Societal views of pregnancy have changed over the last hundred years; unwed mothers are as common as nude pregnancy photos.

Looking back on historical medical practices gives us insight into what patients went through and allows us to reflect on how far we have come.

This is the beginning of a series of "An Era Gone By." Future articles will educate and entertain with the following topics: care of infants, treatment of medical conditions and diseases, public and personal health. These articles will come directly from books of the past meant to educate nurses of that time.

Series Update:

Nursemaids and Common Medical Conditions: An Era Gone By

Disease Transmission and Treatment: An Era Gone By

References

Fischer, Louis, M.D. The Health-Care Of the Baby. 17th ED. Funk & Wagnalls Company: New York, 1929. Print.

Judd, Deborah M. Nursing in the United States From 1900s to the Early 1920s. Web. 30 Dec. 2014.

Specializes in Med nurse in med-surg., float, HH, and PDN.

Wish I had my mom's nursing texts from the 1930's. I do remember there was a 'photo plate' of 9 pregnant ladies, naked, and standing sideways to the camera, each person holding a triangled cloth over their faces to avoid identification. The idea was to be able to tell the number of months a lady was pregnant by viewing the size of their bellies. HA!

Specializes in Gastrointestinal Nursing.
jitomim said:
My mother is a midwife, and she has told me many (literally) old wive's tales about things that have been done in the past to help the baby get born. Notably, in an older book of a country doctor, he answered a call for a birthing mother. Upon performing an examination, checking dilation, etc., he feels something gritty in the woman's lady parts. Apparently an old 'knowledgeable' woman placed sugar inside, to lure out the baby

That is crazy! I love learning of practices long ago. Thanks for sharing. Your mother should write them down and share with us!

Specializes in Gastrointestinal Nursing.
Red Kryptonite said:
Oh God....can you imagine the yeast infection?

The human compulsion to meddle with birth is amazing.

Wonder what the treatment would have been?!#%@

Specializes in Gastrointestinal Nursing.
jitomim said:
Yes, not just with birth, but giving advice to nursing mothers, infant care... I recently read a super interesting book about the representations of procreation and birth during the Baroque period - it was full of pretty funny ideas. Like testing to see if a woman was able to conceive by sitting her on a stool with garlic under her - if you could smell the garlic, that meant her 'tubes' weren't 'clogged' and she should be able to conceive !

Here's to living in the present, eh ?

That is just gross, but sounds like a great book!

Specializes in Gastrointestinal Nursing.
No Stars In My Eyes said:
The doc who delivered my mom had come right from other home visits and never washed his hands (1918). My mom's mother ended up with erysipelas, scarlet fever and rheumatic fever. She had chronic illnesses for 12 years and died at the age of 30. Tragic and preventable.

That is horrible, I'm so sorry you lost your mom so young. Yes, just like in the wars when they would go from one soldier to another cutting off limbs etc and not washing hands. I'm sure the men died from complications.

Red Kryptonite said:

The human compulsion to meddle with birth is amazing.

Red Kryptonite, amen to that.

We are at the point that we treat pregnancy as a disease. No other species on Earth needs annual genital (reproductive) exams starting at puberty all the way through (and beyond) menopause. Then with pregnancy comes the barrage of repeated lady partsl exams, membrane stripping, etc, culminating in a C section.

Quote
...Lee Memorial Health System tells us they have only 40 lady partsl birth after C-section (VBAC) cases in the past year...

..."I generally encourage people to try the lady partsl route first because it is already a path that's in place, doctor Sarah Digiorgi said...

...[Dr. Sarah] Digiorgi says it's almost impossible to schedule a natural birth; a woman can be in labor from an hour to three days...

...And since insurance companies require a doctor be present at all times during a VBAC, from a logistical standpoint it's nearly impossible...

This is truly insane! Do I really need to comment on anything that this doctor said???

Healthcare wonders why women are returning to midwives.

Now we are treating natural childbirth as a crime. Read the Huffington Post story, "Pregnant Mom Says Hospital Threatened To Call Child Services Unless She Has C-Section"

I put the the links to show that this is a real problem. A simple Internet search yields thousands of similar stories. In the NBC story, "Lee Memorial Health System says their number of VBAC cases is low and they are working on it." Even the World Health Organization has noticed "Caesarean sections without medical indication."

There is no argument that healthcare is over-medicalized. (Note: It is the over-medicalization that is the problem, not the real emergencies that require intervention.) Perhaps "The Health Care of the Baby" by Louis Fischer M.D., seventeenth edition, published in 1929 is a better guideline than what we have today.

I guess the theory that the human race was influenced and cultivated by aliens has been proven true; because looking at modern healthcare (especially related to reproduction), it is impossible for the human race to have survived millions of years without advanced technological interventions...

banterings said:

We are at the point that we treat pregnancy as a disease. No other species on Earth needs annual genital (reproductive) exams starting at puberty all the way through (and beyond) menopause. Then with pregnancy comes the barrage of repeated lady partsl exams, membrane stripping, etc, culminating in a C section.

No doubt an unnecessary number of c-sections are performed in many first world countries, but in many poor countries there aren't enough c-sections done. Too few c-sections will lead to an increase in morbidity and mortality in mothers and neonates. In my country 17% of deliveries are through c-sections and we do have very low infant and maternal mortality rates.

I don't think that the medical community have reached a research-based concensus on a ideal percentage but I believe that the WHO have previously presented a theoretical estimate of at least 5-10% and an upper limit of 15%.

About the annual exams. It is my personal and professional opinion that regular gynecological exams have health benefits. Screening like for example pap smears is a good example.

macawake said:
About the annual exams. It is my personal and professional opinion that regular gynecological exams have health benefits. Screening like for example pap smears is a good example.

I agree with this statement, but it is ultimately up to the individual (patient) to determine what care is best for them. They must be able to choose WITHOUT coercion or penalty. That is my whole point.

There are coercive practices in healthcare such as the forced C section that I mentioned. Here is another example: "Holding Birth Control Hostage." (Source: MotherJones)

The pap smear is over-medicalized. Physicians push it annually when it recommended only once every 3 years.

Over-medicalization includes providers insisting that do what patients can do themselves, such self-adminstered pap tests. Furthermore, the ACOG recommends "the pelvic exam should be dropped from routine care. (Source: USA Today) The pelvic exam is a different procedure than the pap smear and not required to perform a pap smear.

The ultimate proof of the over-medicalization that exists, read "Why Doctors Die Differently." (Source: The Wall Street Journal)

macawake said:
In my country 17% of deliveries are through c-sections and we do have very low infant and maternal mortality rates.

Can I ask where?

In developing countries dehydration from diarrhea, sepsis, pneumonia, and tetorifice, account for approximately a quarter of all neonatal deaths, additionally are the issues of sanitation, access to clean drinking water, immunization against infectious diseases. (Source: UNICEF) Note: "Low rate of C sections" is not on the list...

Again, it is not about percentages it is about patient autonomy and the right to choose what happens to one's own body. The same dynamics that developed countries have been criticized for doing to developing countries.

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
macawake said:

About the annual exams. It is my personal and professional opinion that regular gynecological exams have health benefits. Screening like for example pap smears is a good example.

Screening paps are recommended only every 3 years (and then after age 30, every 5).

klone said:
Screening paps are recommended only every 3 years (and then after age 30, every 5).

Which is why I wrote "regular gynecological exams".

Also screening protocols may vary in different parts of the world, but I agree that that is the current recommendation.

The annual exams part of may post was a general response to "no other species" etc. Well, no other species (as far as I know of) visit a dentist on a regular basis either, the way humans do. I still believe that it's a good idea to do so.

Specializes in Med nurse in med-surg., float, HH, and PDN.

Not to be high-jacking the thread, but ooooh so many people don't​ do the 'regular' dental thing.....

Specializes in as above.

enjoy the process! Remember when the babe is born, if it gets diaper rash, icing sugar! It works! But do enjoy the pregnancy and dont hide it. You WILL be asked a lot of questions. These days people want to know if its a boy or girl. We answered, dont know. Technology can give us too many answers. Just Enjoy!