Prenatal Care (1913), by Mary Mills West

Prenatal Care is an educational booklet written by Mary Mills West of the US Children’s Bureau and published by the US Government Printing Office in 1913. The Bureau distributed West’s booklets in response to their field studies on infant mortality, which found that lack of access to accurate health and hygiene information put women and infants at greater than normal risk of death or disease. In Prenatal Care, West offers advice on nutrition, exercise, and personal hygiene during pregnancy and describes the processes of labor and birth. Soon after publication, women all over the US requested copies of Prenatal Care. Millions of copies of Prenatal Care were distributed nationally between 1921 and 1928 as part of educational programs funded by the Sheppard-Towner Act, and the infant mortality rate declined during that period.

In 1912, the US Children’s Bureau was established by the federal government as an agency tasked with addressing issues of child welfare. Under Julia Lathrop, its first chief, the Bureau focused on lowering the infant mortality rate in the US. To identify factors that influenced infant mortality, the Bureau conducted field studies in several US cities. The results of those studies indicated that poverty and lack of information about pregnancy and infant care contributed to high rates of infant death. By distributing publications like Prenatal Care, the Bureau sought to educate women on such topics and to prevent the deaths of infants.

West authored the first edition of Prenatal Care in 1913 at the request of Lathrop. Lathrop chose West to write the booklet because in addition to being an experienced, college educated writer, West was also a mother of five children. Lathrop argued that a woman who had firsthand experience of pregnancy and motherhood was the best person to communicate the advice in Prenatal Care to a female audience. West wrote the booklet with input from Bureau staff, mothers, and physicians. Her name appears as Mrs. Max West on the booklet, Max West being her husband.

In Prenatal Care, West offers advice to women in several sections, with topics that span the course of pregnancy and childbirth. West includes information about identifying signs of pregnancy, calculating due dates, and managing proper diet, exercise, and personal hygiene during gestation. She discusses potential complications such as miscarriage and the development of disease and outlines what actions to take if complications occur. Step-by-step instructions are included on how to deliver an infant if it must be born at home, with an emphasis on avoiding infection through disinfecting techniques. The final section of the booklet covers nursing and how to maintain a healthy diet while breastfeeding an infant. In the back of the publication, West includes a glossary defining technical words, as well as an index.

In the booklet’s first section, “Pregnancy,” West describes how a woman can determine if she is pregnant and when she is due. West claims the end of menstruation is the most obvious sign of pregnancy and mentions other indicators like morning sickness, breast tenderness, and the need to urinate frequently. Instructions are included on how to calculate the due date by counting backwards from the last day of the woman’s last menstrual cycle, though West cautions that it is only an estimate and cannot be relied on to predict the exact day of birth.

In the next section, “Personal Hygiene,” West advises women about diet, exercise, clothing, and personal care during pregnancy. West recommends a nutritious diet that consists of fresh fruits and vegetables and minimal meat, along with increased liquids like water, milk, and broths. She stresses the importance of maintaining bowel health during pregnancy and advises readers on how to prevent and treat constipation. Included under “Personal Hygiene” are recipes for bran bread and laxative pastes made of senna leaves and prunes. Warning that enemas and medicinal laxatives can be harmful if overused, West advises readers to use such methods only when all others have failed. Eating larger amounts of food early in the pregnancy is likely unnecessary, West writes, because most fetal growth occurs in the last few months. During those months, West recommends drinking extra glasses of milk between meals to provide extra nutrition for the rapidly growing fetus. She concludes her advice on diet with a warning against the consumption of alcohol during pregnancy, mentioning that it might adversely affect the fetus.

In the same section, West recommends that pregnant women get plenty of fresh air and engage in mild exercise like gardening and walking. She emphasizes the benefits of spending leisure time outdoors and taking time off from household duties to rest, noting that even a short period of relaxation during a stressful day can help lower anxiety and promote health. West does not recommend strenuous exercise, as she argues it is important to conserve strength during pregnancy and to avoid becoming overly fatigued.

Next, West makes recommendations on how women should dress during pregnancy, advising that light petticoats, less bulky skirts, and long undergarments are best suited to maternity wear. She discourages the use of stiff boned corsets, recommending instead specialized maternity corsets that allow for the changes in body shape and size associated with pregnancy. To reduce the risk of falling, West also recommends avoiding high heeled shoes during pregnancy.

In the final part of the “Personal Hygiene” section, West stresses the importance of healthy skin and a clean body and advises pregnant women to wash every day and to take long, warm baths with soap at least twice a week. Reiterating the importance of fresh air, she suggests that those who live in balmy climates sleep with their windows open to get proper ventilation. Lastly, she warns that pregnancy can hasten tooth decay and advises pregnant women to consult a dentist if possible.

In the next section, “Complications of Pregnancy and How to Avoid Them,” West covers several potential problems that can occur during pregnancy including disease, discomfort, and miscarriage. She also addresses and discredits the theory of maternal impressions, the claim that a mother’s thoughts can adversely affect the development of the fetus.

West advises pregnant women to observe the frequency and color of their urine to monitor levels of hydration and kidney health, and encourages them to submit regular urine samples to a physician who can run chemical tests to identify abnormalities. She provides directions on how to collect such a sample and prepare it for the physician. West recommends dealing with morning sickness by eating frequent small meals or chewing on dry crackers, as well as getting plenty of fresh, cool air. She also provides descriptions of remedies for heartburn, informing the reader that the burning sensation in the throat is caused by stomach acid, and despite its name has nothing to do with the heart. She warns women not to ignore symptoms like persistent vomiting, blurry vision, and severe pain, because such symptoms could indicate a serious complication known as toxemia, which West defines as a condition resulting from a buildup of waste in the pregnant woman’s blood. She notes that many women think constant discomfort is a part of pregnancy, so they ignore potentially life-threatening symptoms. To avoid such complications, West urges women to record and report such symptoms to a physician.

West also addresses the topic of miscarriage in “Complications of Pregnancy and How to Avoid Them.” West explains that most miscarriages occur during the first few months of pregnancy, and although it is best to avoid heavy activity to reduce risk, sometimes miscarriages are unavoidable. She explains that the causes of miscarriages can be difficult to identify, such as an abnormality in the embryo or an issue with the physiology of the woman’s uterus. As such, West attempts to reassure women that losing a pregnancy due to miscarriage does not indicate a moral failing on their part, although she acknowledges that the belief is common. West describes how tissue left in the body after a miscarriage can cause disease and urges women to overcome any misplaced sense of shame that might keep them from sending for a physician to attend to them after a miscarriage. There should be no greater stigma attached to miscarriage, West argues, than to any other physical ailment.

In the last part of “Complications of Pregnancy,” West addresses what she calls maternal impressions. She describes the concept of maternal impressions as the popular belief that a mother’s mental states or experiences can physically deform or injure a fetus. According to the belief, she explains, a pregnant woman who sees someone with a physical disability or witnesses someone being injured will give birth to a sick or deformed child. West assures women that maternal impressions are a superstition and that physicians and scientists have not found any evidence in support of the claim. She argues that there is no physical mechanism connecting the internal thoughts of the mother to the development of the fetus. She also argues that everyone experiences hardships during pregnancy, and therefore if maternal impressions affected fetal development, then nearly every child would be born disfigured. West concludes the “Complications of Pregnancy” section by suggesting that women should not worry about maternal impressions. Even if such ideas were valid, she explains, they would be beyond a woman’s personal control. Instead, she argues that it is better to focus on what women can proactively do to maintain healthy pregnancies, like ensuring adequate nutrition.

In “Preparation for Confinement,” West discusses how to establish and maintain communication with physicians and nurses in preparation for birth. West recommends maintaining contact with a physician throughout the pregnancy so the physician can address potential complications as soon as possible. When the time to give birth arrives, West notes that many women prefer to give birth at a hospital with a professional staff. If it is not possible to go to a hospital, West recommends obtaining the services of a traveling nurse to assist with the birth. West spends the remainder of the section describing how to prepare necessary materials for a home birth, such as gauzes, sponges, towels, and antiseptics. She also gives advice on preparing simple clothing and nursery equipment such as cribs.

In the section “Birth of the Baby,” West acknowledges that labor sometimes begins before a qualified attendant can reach the woman. In that case, it may be necessary for a family member or other non-professional to assist with the birth. West lays out instructions on how to guide a woman through labor and attend to the newborn. She stresses the importance of hand washing, preparing disinfectant solutions, and maintaining as sterile an environment as possible. If the woman suffers from excessive bleeding before or after labor, West provides instructions on how to minimize blood loss while waiting for a physician.

Under the heading “Care of the Baby,” West gives further direction on how to care for a newborn. She suggests putting antiseptic drops in the infant’s eyes after it is born, as bacteria transferred from the birth canal during delivery can cause an infection that leads to blindness. West describes how to properly bathe a newborn and how to assemble cloth diapers.

Under “Nursing the Baby,” West provides advice on how to nurse the infant, describing the composition of breast milk and why it is the healthiest option. Young infants should be exclusively breastfed if possible, she argues, because bottle feeding is difficult to do safely. If a woman must bottle feed, West claims that the bottle and all related implements need to be properly sterilized. Infants that are fed inadequately can become malnourished, and so West suggests that the infant should be weighed weekly to see whether it is getting enough nutrition.

In the booklet’s last section, “Diet for a Nursing Mother,” West lays out her dietary advice for women who are breastfeeding. The diet she promotes is similar to the one she recommended during pregnancy, with lots of fruits and vegetables. If the woman is not producing enough milk, West suggests an increase in food intake. Lastly, she attempts to reassure women who are experiencing anxiety over poor milk production that the condition is likely not permanent, and she encourages them to continue attempting to nurse their infants.

Soon after it was published in 1913, women throughout the US began to request copies of Prenatal Care, requiring multiple printings to keep up with the demand. In 1914, West wrote an additional educational booklet for the Children’s Bureau titled Infant Care, wherein she offered advice on raising infants, covering such topics as breastfeeding, toilet training, and how to arrange the nursery. Prenatal Care and Infant Care became the Children’s Bureau’s most widely distributed publications, with millions of copies printed. Historians note that for some women, particularly those living in rural areas, the booklets were the only source of pregnancy and birth information available.

In 1919, Lathrop reached out to medical organizations in an effort to assemble a committee of professionals to review subsequent Children’s Bureau publications on pregnancy and infant care. The committee objected to West appearing as the sole author of Prenatal Care and Infant Care because the booklets contained medical advice and West was not a physician. West continued to write updated editions of the booklets until 1921, although the booklets were published without an author’s name attached. After 1921, all of the Bureau’s publications on infant health and hygiene were written by medical professionals.

In 1921, the passage of the Sheppard-Towner Act provided federal funding for state programs aimed at educating women on pregnancy and infant care. Children’s Bureau agents and volunteers distributed millions of Copies of Prenatal Care and Infant Care through those programs. In 1928, the Children’s Bureau reported that infant mortality due to preventable diarrheal diseases had decreased in the US by forty-seven percent. Although many programs created with Sheppard-Towner funds ended when the act was repealed in 1929, Prenatal Care remained one of the Children’s Bureau’s most widely distributed publications. In 1929, the Children’s Bureau estimated that the reach of the booklets was so wide that half the infants in the US at that time had been affected by the booklets’ advice. New editions of Prenatal Care continued to be updated and printed through the 1980s.