Obstetrics for NursesReed, Charles B. (Charles Bert)
Science
Obstetrics for Nurses
Reed, Charles B. (Charles Bert)
Maternity nursing
The breasts can not be said to be fully developed until lactation has
occurred, nevertheless, the glands show pronounced changes as a result
of marriage and pregnancy.
The size of the gland, as well as the size and appearance of the nipple
and areola, varies greatly in different women; but under the stimulation
of pregnancy the whole gland enlarges, including the connective tissue
stroma.
About the fourth month a pale yellow secretion can be squeezed from the
nipple. This is called _colostrum_. The pigmentation extends over a
wider area and deepens in color, while the increased vascularity is
shown by the appearance of the blue veins under the thin tender skin.
Light pinkish lines sometimes radiate from the nipple. These are striæ
and are more evident in blondes.
The milk comes into the breasts about the third day after labor, and
normally continues to flow for six, to ten or twelve months.
Why the pregnancy and labor induce such marked mammary activity is not
known, but the fact is patent.
=The skin= reacts both mechanically and biologically to the stimulus of
pregnancy.
[Illustration: Fig. 25.—Striæ Gravidarum. (Edgar.)]
_Striæ Gravidarum._—Striæ gravidarum appear on the abdomen similar to
those observed on the breasts and are due to the same cause—mechanical
stretching. When fresh, they are pinkish in color and variable in length
and breadth, but attain the greatest size below the umbilicus.
Occasionally they extend to the thighs and buttocks.
After labor, they become pale, silvery, and scar-like and are called
linea albicantes. They are sometimes found in other conditions than
pregnancy, such as tumors or ascites.
_Increased Pigmentation._—Pigmentation is not limited to the breasts. On
the abdomen, a dark line will appear between the umbilicus and the
pubes. This is the linea nigra, and it becomes most conspicuous in the
latter half of pregnancy. In the groins, the axillæ, and over the
genitals, the deposit is common, and sometimes patches appear on the
face, either discrete or in coalescence, to form a continuous
discoloration, called chloasma; or when extensive, the “mask of
pregnancy.” The pigmentation is absorbed, or at least greatly
diminished, after labor. The sebaceous and sweat glands are more active.
_The hair_ may fall out and the teeth decay. “With every child a tooth,”
is the cry of tradition. These changes are due to imperfect nutrition,
or to the presence of toxins in the circulation.
_Eruptions_ of an erythematous, eczematous, papular or pustular type are
not uncommon; and itching, either local or general, may make life
miserable.
=The blood= undergoes certain modifications that are fairly constant.
The total amount is increased, but the quality is poorer, especially by
an increase in water and white cells and a diminution of red cells. The
amount of calcium is slightly increased and the fibrin is diminished up
to the sixth month, when it rises to normal again at term.
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