CONCEPTION
Six to eight months have passed. The picture of the young family we followed in the last chapter is now very different. The girl in a smart little pair of shorts and red shoes, comes briskly in by herself at 5 o’clock. She is going to take a tap dancing class for some children. Her husband is now in the water polo team. They both belong to the Concert Party. They have a passing acquaintance with twenty families of their own age, but they are they are the firm friends of one young couple who are shortly going to have a second baby.
This bond is sealed by the as yet undisclosed fact that our young family also is pregnant. They have said nothing so far, but it has not missed their notice that the other wife is going frequently to the laboratory and that their friends have had more than one family consultation recently. They broach the subject. “Yes, you should go upstairs and tell the Doctor. They see you through the whole time as you know and help you with the baby too. I only wish we had been members before we had our first. It’s so easy here to get to know all you want, and things don’t go wrong as they did with us. It’s because you start right from the beginning, I suppose”.
Later that same evening our couple are dancing again, this time not only together but with other good dancers too. They see the biologist, who having just finished the evening overhauls, is coming leisurely through the crowd talking to this one and to that couple. “I’ll speak to him now, Flo”. The two men talk tor a while. “Yes, she’s over in the cafeteria; we will go over; where is your wife ?” The three go over to the other side of the bath and there find the woman biologist who carried out the Wife’s overhaul. ”Are you free? Come into the office a minute”. The four go in; the news is broken; congratulations follow; everyone is pleased. On leaving the little office the pair go straight upstairs to the Receptionist and make an appointment for the wife to come to the laboratory the next day. With the announcement of conception we are brought to one of the most critical phases in the life cycle of the family; critical and moving for them but critical also for us as biologists because conception heralds one of the periods of phenomenal change when the family undergoes very rapid development. Like the ovum after fertilisation, by conception the parent-organism too is thrown into a fluid or plastic phase and is ready to differentiate. It is keenly alive, questing, sensitive, and in its expectancy peculiarly open to new influences.
Through their previous health overhaul this couple have gained a knowledge of their physical condition and of the presence of any disorders or deficiencies, and they have had time to put these right. Through their use of the Club they have exercised and developed their physical and social faculties and by now have probably reached a high water mark of fitness. They want their baby. They are conscious of taking a great stride forward at conception.
In such a setting it is no surprise to find that one of the first fruits of the Centre’s work has been the preponderance not only of wanted babies—most babies are wanted after a certain stage in the pregnancy—but of wanted pregnancies. Apart from the emotional aspect of a conception welcomed by both husband and wife, its significance for the development of health is very great. In view of the subtlety of the mutual relations of a physical order, discussed in chapter *, it is clear that we could only hope to begin to see the full expression of functioning in a family acting in unison.Were the relationship between husband and wife not of a harmonious and mutualising character from the outset of pregnancy, and indeed from the early stages of their association, their later functional expression must inevitably be arrested. Any factor tending to dislocate this mutual relationship early in the pregnancy must disturb the smooth rhythm of interwoven endocrinological events, and thereby blur the functional picture for which we as biologists are looking.
In the case of the young family we have been following, both husband and wife were shy, and their tempo in taking hold of new knowledge to match their actions, somewhat measured. There are other families who grasp more quickly the significance of what they hear at their first family consultation and of what they see around them in the Centre; families who understand the significance of the fact that from the moment of conception the very tissues of the future child and the quality of its nutriment depend upon the moment to moment state of the mother, varying directly with her relation to her internal and external environment.They realise in a flash that it is of the greatest importance that both parents should be in their fullest health before conception occurs.
The action of such young families has been even more arresting. Quite spontaneously they have come some months beforehand asking for instance, that their periodic health overhaul might be put forward because they were expecting to go on their holiday such and such a date, and hoped to start their first baby then. They wanted to know that they were as fit as they could be when conception occurred. This thoughtful and express use of the consultation service arose within two years of the Centre’s establishment, and it seems to us that this, perhaps more than any other happening, affords confirmation of the sure grounding of the Centre as an organisation capable of promoting health. The same intelligent use of the consultation service is also to be found in families joining after the birth of their first child, before they set out on a second.
More significant still, there are young families who before joining the Centre had determined never to have any, or any more children, but who after being members for a year or two also seek a consultation to tell us that they now intend to have a baby. They have changed their minds owing to their fuller and different understanding of the meaning of pregnancy and the ease and success with which they see it accomplished by members of the Centre.
59 out of the 91 babies born within Centre membership were conceived after their parents had joined. Of these 59 conceptions :—
- 6 were actively resented ;
- 23 were accidental but more or less readily accepted.
- 30 were deliberate. Of these 30 wished-for babies :—
10 were born of parents who had previously determined to have no, or no more children, or not to have children until after some looked for but uncertain improvement in their financial position.
- 3 were born of parents whose marriages had not been consummated at the time they joined the Centre.
- 6 were born of parents who were previously infertile and who responded to treatment.
The birth of 19 children can therefore be said to be directly attributable to Centre.
Of these 19,1 was a fourth child,1 a third child and 2 second children, the rest being first children.
These actual happenings, pointing to a changed outlook towards pregnancy brought about by the Centre, should be of the greatest interest and encouragement to those concerned with the problem of the falling birth rate. One of the acknowledged difficulties about the birth rate is its apparently consistent fall with what is called a ‘rising standard of living’ and increase in ‘education’ These advantages of modern life induce what appears to be a reflective mood in many young couples, leading some to prefer one child for whom a higher standard, so hardly gained, can be maintained, rather than many children open to unknown hazards. Others suffering from an access of fear, believe that their children, only to be born into industrial deadlock and war, were better unborn. In either case, their attitude would seem to imply a failure to appreciate either intuitively as in the past, or consciously—as some members of the Centre have come to do—the significance of children in the cycle of their own development. Such negation of function is a sign of devitalisation and such a line of argument indicative of a lack of ‘culture’—in the legitimate use of that word—if ever there were one.
In this alarming and common staying of natural development which finds its expression in reaction against having children, we discern once again, the mechanism of compensation at work. The high incidence of disorder, much of it of a cryptic nature, the greater proportion of disorder present in women than in men, and the relatively high incidence of disorder in the child-bearing period of women, all of which the Centre has disclosed among its members, must represent fairly accurately conditions that are general throughout the populace. Here then, is a physical basis capable of inducing an attitude of retreat from the adventure of functioning—a retreat from living. Unaware of their own devitalisation, the family quite naturally rationalise their situation and attribute their reluctance to have children to one or other externalcause—financial, domestic, or occupational considerations.
Although in the healthy there is power to adapt to almost any environment, an arid environment deficient in chances for action and experience at the time of courtship and early marriage may operate to stay subsequent development and cause the organism to turn in and feed upon itself, ultimately consuming its own reserves endogenously. In the field of function nothing is more clear than that man does not live by bread alone. But the more a couple is subjected to long-continued and often unrecognised, want, the less facultised it will become; hence the more physiologically diseconomic become its limited actions and so the bread i.e. material goods—it wants and clings to. It cannot d* satisfaction in what is enough for those whose earlier experience has led them to more accurate co-ordination and who have therefore developed a more efficient mechanism for utilisation.
This only emphasises the need for an environment adequate in variety of chances for the family at the early and critical phases of its growth and differentiation.
Perhaps at this time which should be that of the young family’s natural development through the bearing of children, we see more clearly than at any other period, the pivotal work that the Centre is doing in providing the young couple with an environment in which their physical and social capacities may progressively find expression, and also with a continuous source of information to draw upon at each stage of their unfolding relationship. With knowledge at hand their outlook is widened and they expect change and development as their relationship deepens, and so they come to look for children as the expression and confirmation of their own increasing maturity. They see life with new perspective, and begin to taste its fruits in their own growing experience. This imperceptibly but profoundly affects their actions.
2 PREGNANCY
Let us come back to the young family we have been following. The next day the wife comes for her laboratory appointment. She already knows the receptionist and the Sister who is a midwife. The laboratory technique is familiar to her—in fact it is all just like her first overhaul a few months ago; weight, height and all the tests over again. As she goes out she makes her appointment to see the woman biologist, not as at an Antenatal Clinic where her attendance would immediately make public her pregnancy, where she would know no one and where the doctor would be a stranger to her, but by an appointment with her own ‘doctor’ as for any other consultation in the Centre. On this next visit she strips as before and puts on her examination gown. This time there is a quiet expectancy about her entry the consulting room. The examination is a complete one before and the woman biologist, and Sister who is also present, give special attention to the physiological details of her daily life such as food, sleep, clothing, domestic routine, etc. As she goes out, the wife makes an appointment for their first ‘parental consultation’ so that the results of her examination can again be given to husband and wife as a family.
Through the means of the first periodic health overhaul, which took place before pregnancy was in question, all pathological obstructions to function in the family have where possible been eliminated, and the wife has already been examined with a view to her functional capacities. Moreover the pair have lived in an environment in which the physical and social equipment of the biologist have become a natural part of their daily life. Thus pregnancies occurring within membership of the Centre begin under far more favourable auspices than do the majority. From before the time of conception the biologist has been proceeding as a cultivator anticipating growth and development— not as a doctor warding off danger after pregnancy has occurred. So, in the Centre we do not expect to find ‘morning sickness’, general indisposition and depression as the first ‘signs’ of pregnancy. These conditions, common among the general public and among those families who join the Centre after the pregnancy has begun, have become for us’signs’ of cryptic disorder or deficiency. As such they are immediately attended to if they occur, but their occurrence is the exception among those who have used their previous overhauls in preparation for the future. In chapter 2 we saw how after nidation of the fertilised ovum in the wall of the womb, there springs into existence a new functional entity, ‘the pregnancy’. Here mother and foetus are linked into a unity by a special organ—the placenta—newly formed for that purpose, and built into the wall of the womb by their joint operations, both of them contributing to its substance and to its construction. It is through the selective membranes of this placenta that the many and varied contents of the maternal blood and lymph reach the foetus, there to be built up into its organised substance under the unified control of ‘the pregnancy’.It is through the membranes of the placenta equally, that pass the substances from the foetus which stir further developmental changes in the maternal body and at the same time lead to preparation of the food necessary to the child when born.
It is then directly from the placental blood-pools derived from other’s blood that the growing embryo draws its nutriment shout the pregnancy. Thus, what the biologist as cultivator of the soil looks to from now onwards is the sustenance of a high concentration of all the woman’s reserves, so that she, as direct purveyor to ‘the pregnancy’, can meet the demands of the accelerated, versatile and qualitative synthesis that has been set in train.
The rise and fall of some important reserves can be followed in the laboratory. Comparison of the results obtained at previous health overhauls with those found during the pregnancy yield valuable material not usually obtainable. Let us take the iron content of the blood as an example.
In “Biologists in Search of Material” we have shown that out of 1,660 individuals examined by us in the first eighteen months’ work, 657 gave evidence of iron deficiency from the biological standpoint; that is to say their Hb. value on examination proved to be less than they were capable of reaching when freed from disorders, when an additional supply of iron was given, when stimulated to lead a more active life physically, or in face of all these conditions together. We are now able to give further figures derived from a total of 4,002 individuals. These substantiate our previous contention that the iron reserves of the majority are, from the biological point of view, inadequate. We would particularly call attention to the figures for women in the child-bearing period, where there is a conspicuous rise in the number of those showing a deficiency. [For a comparative table showing the Hb deficiency, from the biological standpoint, found in men and women, see Appendix VI below.] Indeed, it is far worse than this, for the degree of Hb. deficiency reached by women at this age is markedly greater than in the other sex or than in adult female at a later age. From the functional standpoint this can only mean that women, on whom the future generation depends, are not in an optimum condition when conception occurs.
In the Centre, as we have shown, a large number of women who become pregnant have already had their first periodic overhaul and have therefore had—and taken—the chance of bringing Hb. up to what for each is a high level. Out of 101 pregnant women studied we found that two [It is perhaps worth mentioning that these two were sisters] were able to retain their previous high level of blood-iron (90%—100°/) up till term without substitution. From this we gather that it is possible for the reserves to be naturally maintained in the face of the enhanced demands made by pregnancy.
In all the others (99 out of 101), the iron content has begun to suffer a steep fall at or about the fourth month. We can give no indication as to how far this might have fallen, because in the event of any fall below 90% of Hb., every pregnant woman at the Centre has been provided with an iron or liver-iron substitute to bring her iron up to her own highest possible level. Thus, in face of a persistently low level of fixed reserves in her body, an attempt is made to sustain a floating reserve so that the developing child, who needs iron to make its own blood, shall suffer no deficiency. [This has been done with every substance a deficiency of which we could trace or suspected. As the attempt to substitute for existing deficiencies was part of an experimental investigation that the Staff of the Centre were pursuing, in this case, contrary to our usual procedure, all drugs and substitutes were provided free of charge to the pregnant family.]
The question at once arises, does substitution of iron for example, in the maternal body at this time serve the purpose of mutual synthesis for ‘the pregnancy’, and for the future child? Our experiments indicate the probable answer to both these questions. In a few cases the iron content of the blood was maintained at about 90% as long as the liver-iron substitute continued to be given, but began to fall within 14 days if it were left off. In the majority it was not maintained at a satisfactory level; i.e. above 90% Hb., but was brought to a higher level than it would have stood at had the woman not taken the iron, for, when iron administration was stopped, the level fell still lower.
Subjective evidence from the family as to the benefit to the woman of the iron substitution is strong. Wives have “never felt better” nor ever been more active “in spite of” the pregnancy; or, they have never felt so well in any previous pregnancy—i.e. before joining the Centre. Their vigour and appearance of health, their sleep and activity bear this out in a most remarkable fashion. This is further confirmed objectively by the rise in general tone, by the maintained or raised blood-sugar values, and in the blood pressure readings as registered in the Plesch tonoscillograph. It therefore seems clear that the mother is able to take advantage of supplementation during this period of unusually active turn. This is only what we as biologists, aware of the formative nature of this phase of pregnancy in which rapid and impending differentiation is taking place in the family, would expect to have.
Now as to the child. There is already some factual evidence that it can benefit from substances fed to ‘the pregnancy’. Among our infants born within Centre membership is a higher proportion in whom the iron-content of the blood remains at a level above 90% Hb. during the first year of life, than among those infants whose families joined the Centre only after their birth. There is practically no iron in breast milk, so that the child must lay in sufficient store during foetal life to carry it over the suckling period till it can take iron-containing table foods. Though nearly all the infants born members of the Centre started their weaning on to table foods at about the fourth month, so also did the majority of infants whose families joined within two months of the birth of the child, so that the higher percentage of iron in the blood of infants born within Centre membership does not depend on their early weaning. We must therefore infer that the difference is to be correlated with the circumstances that obtained during foetal life.
No clinician considers an infant ‘normal’ in whom the blood iron content is low, and it is common practice to give iron by the mouth to such infants. It is, however, recognised that postnatal iron administration has to be continually repeated because the child tends to relapse and does not seem to have the immediate capacity to retain the iron given as a drug after birth. In the light of our knowledge of function this is what we should expect. The interpretation we put upon it is that through the process of mutual synthesis carried on in a pregnancy amply supplied with iron, the floating reserves of the mother have been familiarised for the inexperienced foetal mechanism; whereas iron administered after birth to a child that has been subject to a deficiency during foetal life is inadequately dealt with because the child is not sufficiently familiar with the process of iron utilisation. The infant starved of iron as foetus has been conditioned to a low iron standard and has to learn late, without the ‘physical’ guidance of the parental body and therefore with difficulty, to conduct its own adequate iron metabolism.
The importance of the nurtural principle—through the familiar to the foreign—as Nature demonstrates it in the functional relationship of foetus and mother, is here again illustrated. The learner requires the guidance of the parental mechanism for its first lessons. We met this principle in chapter 2 in a general consideration of the progress of the ovum and the process of pregnancy. Here we see it borne out in practice in the progeny with sufficient emphasis to afford a guide not only for the cultivative procedure of the biologist but also for the corrective procedures of the physician.
The practical importance to the health practitioner of the foregoing strong indication that the progeny can take advantage of the floating reserves of the maternal body is great. It gives ground for an experimental attempt to produce from a stock of low physiological efficiency—i.e. poor stock—progeny of a higher physiological efficiency. If this proves possible, it means that it is not necessary to rely exclusively on selective mating among the sporadically healthy and vigorous as the geneticist (and totalitarian) would claim, and as in practice the stock breeder invariably has done. If the regressive process can be reversed by the supplementation of deficiencies at formative phases in the functional life cycle—of which pregnancy is one— it is not the closed and vicious circle it has hitherto seemed to be. It means in fact that, if we recognise Nature’s impetus to differentiation as the time to choose for enriching the soil, and use Nature’s instrument, the family-organism, for the familiarisation of the food fed to the new generation, then nurture will prove to be a factor as potent as inheritance.
It is possible that dietary substitution might also prove to have an enhanced effect at other formative periods in the life of the family, such as at courtship and marriage, or at formative periods in the life of the individual such as at adolescence. Time has not yet allowed us to make observations on these points. In the psychological parlour it is well recognised, for instance, that a change in the physique of an individual frequently coincides with ‘falling in love’, or with a satisfactory marriage. The change is attributed by the psychologist to emotional release, but it may well have a physical basis of which the emotion is but the outward expression.
In the question of raising the standard of the human stock must be warned against over optimism, for complete rehabilitation is likely to need several generations. This has been found be the case in animal experimentation where, for instance, feeding with a varied vital diet and the maintenanceof adequate hygiene, it takes six or more generations to secure a disease-free rat that will maintain a standard weight, and be likely to throw a standard litter without fatality.In humans look for more than the ‘standard’ animal. It is the expression of the full potentiality of the individual with his unique specificity that we seek;this can only come through the operation of parenthood bringing about the familiar nurture of the child cradled in an environment adequate both in richness and diversity. The study of nutrition in pregnancy is one that is particularly enlightening in several aspects. A woman who has appeared well in every way at repeated overhaul, her deficiencies cloaked by a life tempered to her powers by the process of compensation, may within a week or two of conception, when a new and further demand is made on her reserves, manifest clear signs of deficiency. Or, a woman who having shown signs of a deficiency, has successfully adjusted the condition after her overhaul and has been able to maintain her apparent recovery, will often lapse with the onset of pregnancy and, with the little knowledge at present available, it may prove impossible to eliminate this by substitution during the whole course of the pregnancy as far as the mother is concerned; though the child always appears to benefit. Indeed many a mother in this category has remarked how different her last baby is from any of the others, not only in appearance but also in behaviour and contentment.
Owing to the close contact we have with all pregnant women and their co-operation in the use of the laboratory, we have been in a very favourable position in the Centre to observe these points.There is no doubt that adequate nutrition is no mere matter of the supply of a good and balanced diet.Unless an Scient mechanism is there to synthesise that food into the bodily requirements, the food itself is largely wasted. For example no amount of vitamins, no amount of calcium by whatever route given—by the mouth, injected intramuscularly or given in the form of live fresh cow’s milk—will with certainty maintain an adequate calcium balance in those who manifest calcium deficiency. Moreover, no amount of iron, vitamins, etc., fed to a woman who sits hands folded throughout the pregnancy will effect the adjustment. On the other hand, an efficient mechanism can convert what would seem an inadequate supply into sufficient to meet the requirements of the child.
For solution of the problem of adequate nutrition, it is the body’s constitution or diathesis that demands study, for in nutrition utilisation is as important as is the quantity and the quality of the food consumed. At the present time new knowledge of the quantity and quality of foods occupies the minds of all and fires the imagination—to the exclusion of the utilisation factor. The public hence is in danger of being led to believe that the mere provision of food—free meals to nursing mothers, to infants and school children, communal feeding centres, etc., will solve the whole problem of malnutrition, operating not only as a means of national economy in time of war but as a routine mass therapeutic measure. But, as we have shown elsewhere, the more disordered and the less active the individual the less able is he to take advantage of the food he eats. To feed the pregnant woman and the school child without giving them opportunity for spontaneous activity and leaving them with infestation of worms or other disorders, is both unscientific and diseconomic. It is likely in the long run to prove just one more disappointment.
The work of the Centre shows that if nutrition is to be satisfactory in pregnancy, it is no good setting about it at the third or fourth month after conception—or later. Disorders and deficiencies in the parents must be removed beforehand and, where they have been present, a close watch be kept on the whole course of the pregnancy for the first indications of reappearance during this time of maximal demand placed not only on the woman’s reserves but also on the efficiency of the mechanism that has to deal with them.
When it comes to the quality of food the experimenter is faced with many difficulties. We wished to ensure a full diverse diet for certain selected families later to become pregnant, either to sustain a normal physiology or to replenish the reserves of a deficient physiology. We assumed that the ordinary market should yield good rich vital milk and vegetables. This turned out not to be so. The available milk was either not guaranteed clean and tubercle free and therefore not usable, or was only to be had at a prohibitive price, [Mllk locally obtainable in Peckham from T.T. and Attested herds cost 8d. a pint in 1938.] or was pasteurised in which case it no longer retained its vital characteristics. Or again, spinach, said to provide iron hence to relieve an iron deficiency, in fact only does so in some specimens. Whether it does so or not probably depends the nature of the soil in which it is grown.The result of this has been that in order to control these dietetic factors we have had ourselves to establish a Home Farm to grow vegetables and produce milk—an illustration of the difficulties met with in this kind of experiment.
In view of this equivocal position with regard to food in the open market, it is easy to tell why substitutes for vital foods are now-being so widely used by the public as well as in medical practice. The food available cannot be relied upon to contain the requisite vital factors for maintenance of adequate nutrition. But clearly the use of substitutes is a therapeutic—not a biological procedure. Indeed, it is neither rational nor practical to go through elaborate commercial processes to extract from food substances essential to life and then to feed those substances to substitute for the inadequacies of the food itself. Furthermore, it is already known that however careful the extraction process, it destroys the vital balance of the product as found in well grown fresh food; and the balance as between the different vitamins for example is as important as is any individual vitamin.
The human body in health is the most efficient machine, and the most economic for the extraction of essential factors from food. Disease and disorder may call for therapeutic assistance: health does not. Artificially made vitamins are essentially drugs for curing or alleviating disorder: not food for the healthy.
The practical study of nutrition in health entails some form of controlled farming directed by agricultural biologists working in co-operation with human biologists. The agricultural biologist must supply the diet known to contain the vital factors in balance; the human biologist, by studying the factors concerned in utilisation, must see that the utilisation of the food supplied is efficient. Just as in engineering where the study of oil and petrol is essential to the study of the machine work, the chemist and the engineer work hand in glove, so the agriculturalist (and horticulturalist) with the human biologist must together study the processes of health.
During the first year of the Centre’s work,a Home Farm seven miles from Peckham [At Bromley Common, Kent. See also Appendix II.] was acquired with the purpose of providing ‘vital’ fresh food—milk, vegetables and fruit—for the use of the young families of the Centre. Within a year, live T.T and attested milk from this farm was on sale in the Centre at the current price of ordinary milk in the district. A year later vegetables and fruit were beginning to come from the garden from soil already in process of being revitalised by the Indore compost method. [Cf An Agricultural Testament. Sir Albert Howard, C.I.E. Oxford University Press.1940.] Little by little the importanceof these products is beginning to be realised by the member-families; little by little their value appreciated. Both the production of vital foods and the education of the family in their significance are however long-term undertakings. For this the Centre with its social field for the growth of an enlightened tradition among its families, together with the Farm situated within half an hour’s journey, and thus able to draw upon the mothers’ help in the fruit picking season and on the fathers’ leisure for the harvest and haymaking, forms a nucleus offering great promise and enlightenment for the future.
Let us now go with our young family to their parental consultation following the wife’s ante-natal overhaul. Like all family consultations, this consultation is conducted by the man and woman biologist together. Unusual though it is in all but middle and upper class practice for the husband to meet the doctor who is looking after his wife in pregnancy, the presence of the man biologist at the consultation makes this appear at once a perfectly easy and natural routine.The husband is anxious and eager to hear that all is in order and to discuss the new situation into which the family has moved. He at once slips into complete acceptance of his part in the mutual experience that they are entering upon. He is often quicker than his wife to grasp the meaning of what is happening to them and to adjust their lives to the new situation.
In the Centre it is the rule for pregnancy to open favourably for the family. Thus in the first parental consultation we can usually at once pass on to the routine consideration of the findings of the wife’s recent overhaul.These are given one by one, and this compared with the findings of the previous overhauls. If, for example, the iron-content of the blood has already shown a tendency to fall, the significance of this is discussed for the pregnancy. The pair already understand from previous consultations that the iron-content is a measure of the oxygen-carrying capacity of the blood stream—transport service of the body and that the oxygen it carries is the fuel for the body’s factory. When the ‘factory’ is no longer at mere maintenance turn-over but has gone into full production for the term of pregnancy an adequate blood iron-value is thus more necessary than ever. The growing foetus also needs iron in order to make its blood, and still more to lay in a store for the period of breast feeding when but little will be forthcoming. “What can we do about this?” the prospective father asks.”If your wife’s haemoglobin is lower than it was and she takes a suitable liver-iron preparation while she is carrying, her body will use it to sustain her own needs and to supply the baby with what it requires. A form of iron which by experience we have found to be effective, can be had from the receptionist, and the laboratory is there for your wife to check up once a fortnight on its efficacy”.So once again the family is given the opportunity of gathering such knowledge as is available and of acting upon it for itself.
This seeming indifference on the part of the observer as to whether information is acted on or not, arises on the one hand out of his desire to find out what the family will do with the facts if they have them, and on the other hand as a deliberate method of leaving them free to act for themselves. We have found that the goodwill of the family concerning all its members is a factor consistently operative in the face of knowledge and understanding of any situation that concerns them.The mere fact of themselves taking the initiative heightens their capacity take the next step that will present itself—and in formative periods such as at marriage and during pregnancy this capability initiative is at its highest. Hardly ever have we known any pregnant family fail to respond to opportunity arising in this way. When all the laboratory findings have been gone through one by one, there follows a short talk recalling the way in which the baby is being built up;—not out of the food the mother eats, but from the very tissues of her body, the essence of all of which is carried round in the blood ‘qualified’ for the specific feeding of the growing child.
“From this we can see how important it is that the circulation of the blood should be kept in the highest working order.The essentials for this are an ample diet throughout pregnancy and an active life. To be sure of obtaining the best diet available you can order and buy from the cafeteria, vegetables, fruit and milk from the Centre’s Farm specially planned to supply young families like yourselves. Contrary to what is generally supposed in health the woman’s body during pregnancy is at the very height of its functional capacity,each organ utilising its reserves, so that, far from being afraid to do things at this time, she can confidently look forward to strength and vigour as long as her reserves are adequately maintained”.
The woman feeling the exhilaration of her pregnancy often at this point in the consultation shows a glow of pleasure. To the man it usually comes as something of a surprise. But, following on what has gone before, though strange, it has the ring of reason about it. It comes moreover from the man biologist who should “be talking sense to a fellow”. So our family from the beginning is unafraid of an active life during their pregnancy.
But the consultation is not yet finished. “What about delivery? How are you placed? In view of all that this very remarkable process of pregnancy means to you as a family, you will naturally want to get the most out of it, and therefore to be as much together as possible throughout the whole time and directly the baby is born”. Then follows a short review of the possibilities open to them for delivery so that they may discuss their plans together and with knowledge, before making their decision as to how to proceed.
In the course of the consultation one of the things that always impresses us is the gradual change in the man’s outlook. Instead of his wife’s pregnancy appearing to him as a process of which he can only be the shy and anxious spectator, his attitude changes to one of intelligent interest and active partnership.There is no regret for what has happened: no dread of what lies ahead. This parental consultation provides them both with food for thought to be digested at their leisure. It comes at a time when their emotional urge is at its height and can carry them to new situations and actions that would be impossible to them at any other time.
From now onwards, fortnight by fortnight, the wife visits the laboratory for a repeat overhaul, and watches with keen interest the results of the tests made there. Month by month she comes see the biologist and Sister in consultation. During these visits there is opened a wide field of topical interest over which range her own food, clothing and routine of life and the incidents that arise out of it; how the baby is growing and affecting her; discussion of the baby clothes she is making, preparation of their flat for the baby,- etc.—many of which things later become a topic of lively discussion with her friends in the building. Continual social contact with families who have made use of this knowledge at an earlier date makes its acceptance by her easy and natural. In this way the social life of the Centre is a familiarising influence for the continuous apprehension and absorption of knowledge by all its member families.
Thus the woman grows into the new situation as the embryo grows in the womb, and gaining confidence step by step she becomes mentally as well as physically fitted to fulfil her coming task. These frequent consultations afford an opportunity for her to learn as she goes along all that is happening in the pregnancy. As she approaches labour she is anxious to know how it is accomplished, her interest in what she is going to achieve heightening as the time approaches.
Pregnancy—to culminate in labour that is no longer of dread foreboding—has become something to look forward to, something wholly to be enjoyed! It is now clear that it is not going to interfere with the couple’s ordinary life but to enhance it; not to keep them more and more indoors, but rather to carry them into a wider social sphere? They come to badminton next evening? as usual, the girl decides not to fall out of the ‘keep fit’ class, she swims and carries on right up to the week before confinement, usually choosing the women’s swimming club afternoons when she goes in with twelve or more other friends. Not that she is shy. Something remarkable has happened to her during 9 months.Her face has lost its hard lines, her complexion cleared, her eyes are bright, calm and steady, she has a poise both mental and physical which has changed.She carries herself differently from most women in pregnancy.The change calls to mind a flower unfolding.It is arresting to watch her during this period.
She sits in the cafeteria after her swim knitting. There are others knitting the same sort of garments. They may already have met in the reception room upstairs at some of their visits to the laboratory or to the biologist. They talk of their experiences and compare their own with those of their sisters and acquaintances who are not members of the Centre. “. . . . I always dreaded it. I thought Fred and I would never be able to go out together once I became pregnant. Lisa’s always sick and ill all the time she’s carrying and her husband gets so fed up with her; and, would you believe it, for the last three months she never goes out except in her mackintosh for half an hour after dark before he goes off to the Club. But Fred’s not like that, and I feel so well and alive”. . . .
There are also those who were knitting the same sort of garment a month ago. They now come from the consulting room with their babies. Our young mother begins to take a peculiar and personal interest in babies—which she never did before. “How lovely this one is”. She will soon have her own now, and she goes down with the young baby and its mother to see the afternoon Nursery. There she finds out something about the handling of a baby. She soon gets to know the Nursery Sister and may even volunteer to come down and help one or two afternoons a week. She will learn that way. (She did not want to learn before.) So all goes forward and when the baby comes she is to some extent already at home with the whole situation and all the possibilities it holds for her and for her family.
Her gathering experience sustains her as she moves into the future. How different from the woman who carries the burden of ignorance and progressive debility into a future for her full of fear . . .
Extract from conversation in the Cafeteria, 2nd June, 1939:
Mrs. X came in to tell us that Mrs. Y had had her (first) baby.The following conversation took place:
Mrs. X.”She did her ironing yesterday afternoon—at 6 o’clock was waiting to go in and by 10.30 she’d had it ! ”
Mrs. P. “What a difference the Centre has made to having babies. I’m not going to have another if the Centre closes”.
Mrs. N. “And all of us mothers who come round here would only have had one if it hadn’t been for the Centre and now when the baby is fourteen to fifteen months we are planning for the next. I think it’s marvellous. And not minding coming in pregnant— that makes a difference too—instead of creeping out after dark— to come round here in the afternoons”.
Mrs. X. “I never went out the last fortnight while I was having Beryl but with John I was here four hours before; and there’s Mrs. Y in here all the afternoon the day before.”
3 DELIVERY
Pregnancy to the biologist is no state of emergency from which the mother may (hopefully uninjured) be returned to ‘normality’ after the birth of the child.It is a highly active, potent, developmental process of the family going forward to its natural culmination in delivery. Delivery is a critical stage; yes;but critical because nicely timed by the endocrine balance of the family bringing the pregnancy to a crescendo of function at term. That delivery has come to be regarded as a critically dangerous ordeal is no wonder, for the co-ordinations that bring about natural labour and culminate in successful delivery cannot be induced at the last minute and in the presence of fear. They result from the healthy functioning of the family from the moment of conception—or even earlier. Hence to provide for the time of courtship, to make knowledge and a fuller life available for the young married couple, to give them the chance of setting in order any physical defects and deficiencies before conception —all these are essential to the maternity practice of the biologist. They are the cultural procedures without which he does not expect to see natural and spontaneous delivery at the culmination of pregnancy.
It is often forgotten by doctor and layman alike that with nidation in the womb there is set in train a series of physiological events destined to call into use all the reserves of the maternal body. How great are these physiological reserves we know. Each organ is capable of some seven or eight times its average resting output, so that some seven-eighths of the body’s capacity remains latent in reserve for demand, as indeed we have seen in considering the power of compensation for disorders. The extent of the reserves can be appreciated for example in the musculature of the womb, each fibre of which enlarges during the course of pregnancy to eight or ten times its non-pregnant size. This is no mere anatomical device to enable the womb to contain the growing foetus. The contractile capacity of these muscle fibres has likewise increased, as indeed it must if they are to play their part in the great event of birth.
In pregnancy every organ of the body can respond in like fashion—the abdominal musculature, the heart, the kidneys, the skin, etc. These reserves of the body can in many cases be measured from observation on isolated organs in the physiological laboratory; and the clinician is also well aware of them, for instance, in the insane and the dying, where they are regarded as ‘uncanny’ in their power. We cannot yet measure the sum of the co-ordinated functional reserves derived from mutual synthesis of the organism in health. In full functional coordination they must be even more powerful than in the extremities of sickness, or than in the conditioned environment of the physiological laboratory.
Behind ‘the pregnancy’, then, lies a great storehouse of organismal energy and material which in health is freely available. In full production these reserves are, as we have seen, called into use, turned over, qualitatively changed [The mother is sensitised to her child, and the foetus to its mother.] and added to by mutual synthesis. The pregnancy backed by a full reserve store is throughout gradually calling this into service. As the ‘slack’ in all the maternal tissues is taken up in the increasing turnover, the woman becomes conscious of an exhilaration and deepening confidence born of her gathering capacity. She knows—cannot help knowing in view of the usual attitude towards pregnancy—the dread with which ‘confinement’ is approached by others around her, and indeed by the medical profession, but she has a quiet inner assurance of being able to fulfil her purpose unaided and successfully. So it is with rising capacity and full confidence that the mother reaches her time, attuned to maximum effort but not tense—like an athlete in training awaiting the starting pistol.
The foetus has been developing in strength and stature pari passu with the mother. Thus still in mutuality, still operating through the placental organ as we saw in an earlier chapter, ‘the pregnancy’ is brought to term through the mutual action of mother and of foetus. [This is no new theory in obstetrics; but it does imply new practice.] It is not then the mother and not the obstetrician, but the pregnancy that labours and is delivered.
So here, in the Centre we see a wholly unaccustomed picture of pregnancy; one of a gradually rising flood of capacity of foetus and mother reaching full tide at the approach of labour. It presupposes, as we have already said, a family not only in logical balance at the timeofconception;not only the functioning in full mutual synthesis during the course of the pregnancy, but also freed from disorder and deficiency before the pregnancy began and having a full complement of reserves maintained throughout its course. It is in fact a family freed fear and from the causes of fear before entering upon labour. Nature has destined the woman to be at her best in pregnancy. Hence in biology there is no basis for relegation of the pregnant woman at the time of delivery to the position of ‘patient’, to which modern civilisation has condemned her. Neither is there any basis for the conversion of the natural crisis of birth into the catastrophic crisis that delivery at the present day is tacitly accepted to be — above all by the so-called ‘health authorities’.
It will already have become clear to the reader that the ordinary conditions available to-day for ‘confinement’ are not those suitable for delivery in a functioning family. The family in full function will want to continue in the greatest intimacy as delivery approaches and immediately after it is accomplished. Like all nesting animals, they will want labour to take place in the ‘nidus’ or nest they have prepared, and which through long weeks has already become ‘familiarised’ for the infant.
The woman reaching the acme of her functional potentiality through pregnancy will sense her capacity to bring her child to birth. She will not wish for nor tolerate the dulling of her instinctive responses by anaesthesia, twilight sleep, induction of labour — even Caesariansection — therebyforegoing her part in themutual action that is to effect birth.Nor will she seek ‘confinement’ after delivery. Having together with the foetus accomplished labour, she will want and be ready to get up and go straight on with life.Her baby demands attention when it is born and the mother is its jealous collaborator. She will want to have and to handle it forthwith. And rightly too, to anyone who has watched the cow licking her new-born calf will have noticed the effect of each bout of licking on the spontaneous contraction of the uterus, hastening the delivery of the after-birth and the subsequent contraction of the womb, to say nothing of the stir and stimulus that her familiar contact must for the establishment of the new circulation and physiological orientation of the calf itself. The mother too will want to lose no chance of knowing the baby’s responses—and her own with them—to the circumstances so rapidly changing for both of them Nor indeed do these desires change with the birth of the second or subsequent children. In health each successive child seems to have the same arresting and instinctive interest for the parents ” . . . . Doctor, I must tell you something. When I look at and hold baby, it’s just as if she were my first ….the wonder and the closeness of it makes me cry.I can’t help it … .” [Extract from conversation with mother aged 30, two days after the birth of her second child.] The biologist cannot deny the significance of this natural emotion in the physiology of the family organism. The obstetrician cannot deny that the unfortunate circumstances of the Maternity Hospital which separate mother from baby, and both from the father, place them and him at a disadvantage in the conduct even of a pathological confinement—for it was not mere sentiment that that mother expressed ; it was modern endocrinology.
The Centre provides families, especially young families, with circumstances in which the chance of proceeding through pregnancy in very full function is present. But it cannot provide for them dwellings in which a nidus fit for the birth of the child can be suitably made. The houses from which member-families come are for the most part wholly unsuitable for the conduct of labour.There is no room for an attendant to assist the mother ; if there are other children, nowhere for them to go ; often no running water on the floor of their flat and only one lavatory for the whole house, shared perhaps by two or more other families —all of which conditions, in relation to the possible circumstances of modern life, are inadequate. Clearly in such circumstances delivery at home can seldom be recommended.Private Nursing Homes, were they desirable, are financially out of the question, so the Hospital becomes the only possible solution for the very large majority.
It is clear that families approaching labour as the Centre makes it possible for them to do, could not be submitted to labour in conditions in which the expectant mother is regarded and treated as a ‘patient’. Some sort of special provision had to be made to mitigate the circumstances with which they would inevitably be faced. Owing to the courtesy of the staff of one of the teaching hospitals in the vicinity of the Centre, we were able the Centre opened to make arrangements whereby our theirs could be received for the period of 48 hours covering the delivery, after which they return home with their babies. Thus, they are relieved of the necessity of ‘confinement’ as invalids among the sick for a fortnight following the birth of the baby. Although this arrangement does not meet all the functional requirements of the family, it is a very valuable compromise to have been able to make in moving towards fuller health.
The young family have decided that they will be together at the earliest possible moment after delivery, bringing their baby into the intimacy of the ‘nest’ for the establishment of lactation. They have chosen for the delivery the special circumstances described above and offered by us only to member-families approaching pregnancy in a reasonable degree of health. The wife arranges to go to Hospital for 48 hours, that is to say, for the labour and the sleep that follows it, and to return home at once with her baby. She has been absolved from the routine of the Ante-Natal Department, but has already seen the obstetrician before arriving for delivery, once when going to book up at the Hospital, and once at the 36th week on a second visit made in order that he may satisfy himself that her obstetric condition is as it should be. On this second occasion she takes with her the results of her last periodic health overhaul and the fortnightly laboratory dossier of her pregnancy from the Centre, so that the obstetrician has full knowledge of her diathesis, of her condition before conception as well as detailed information of the course of the pregnancy. Relations between the obstetrician and the biologist are those of a common understanding of this unusual position of a young family approaching labour in a full degree of function. Everyone concerned expects delivery to be satisfactory—and quick.
Forty-eight hours later, the Sister from the Centre is standing the doorstep of our family’s house to receive the ambulance which the mother and baby arrive from Hospital. The mother to bed and is made comfortable, and the baby is put to rest. There is no hurry, she knows the Sister, and important the Sister has known the family for some time—their physiology and their psychology—and therefore knows just what to do for the mother, and where to put in a word to set any remnant of the father’s anxiety at rest. For the following week she will visit daily to look after the mother, who the next day may herself wash the baby and who with the Sister will look at and discuss the way it feeds, its stools, its sleep, its clothing, etc., in those crucially important first days of the new orientation of the family life.
About the fourth day, the baby is brought to the Centre by the grandmother, by a friend or sometimes by the father himself to have its laboratory examination and its first overhaul by the biologist. When they return the mother may be up waiting for them. She hears that the biologist at the Centre has examined the baby—and it is feeding time. She is content.
We do not suggest that the picture we have given of pregnancy applies to all family members of the Centre. Far from it. It applies to very few indeed. There were only twelve families out of the 101 pregnancies in the Centre who were in sufficiently good health, whose housing accommodation was adequate and whose circumstances otherwise made it possible for us even to offer them this provision. Of these, eight only accepted the opportunity. [Six mothers returned home with their babies within 48 hours, one was retained for a further three days, and one remained for the full period of confinement.]
This picture we have given of pregnancy as seen in the Centre is in some measure a composite one. Not all those women who show an increase in capacity during pregnancy remain fully active up to delivery. Take swimming as an example: not all were swimmers to begin with, and only some of the more confident would venture to learn to swim during pregnancy. Of those who were swimmers, only three or four swam regularly up to fourteen days before delivery, and only one to within four days of this time. But where they have done so, nothing but benefit has resulted. Then again, not all families work in perfect co-ordination and are courageous. Where the wife has enterprise, the husband may be timid and so tend to exert a restraining influence on her activities, either from over concern or from social or purely conventional habituation. Courage is verylargelya matter of health itself. Health—wholeness—in family function invokes adventure, but the woman’s courage is dependent upon reserves, and, as we have shown, the number of women inthe reserves are adequate is small indeed.
Many families joined the Centre only after pregnancy had begun [By the end of the first two years, the ease and success with which pregnancy and the rearing of the infant are accomplished in the Centre has become known in the district, so that many families have joined after pregnancy supervened in order, as they thought, to enjoy these advantages.] and many others were not members long enough beforehand for their reserves to be built up—even in those directions in which we have some knowledge of the deficiencies to which they are likely to be subject, and accurate knowledge of the nature, extent and means of measurement of these is still relatively meagre. Then, mere administration of the deficient substance is not always enough. As we have said, it is utilisation that is the important factor. If the ‘habitus’ of a woman does not permit of effective utilisation, either through failure to establish the necessary co-ordinations in youth (diathesis), through lack of essential complementary substances, lack of activity or what not—there will be little chance of success in an attempt made to supplement her deficiencies half-way through her pregnancy. In these families we could not hope to find the expression of function. And we must from our experience stress this point: these families untouched by the Centre before pregnancy, represent the average families in the populace. We have already seen that 90% of our members on first examination were subject to deficiency and disorder. We have no reason to believe that this differs for the rest of the country, except in the social problem groups where there is excess or poverty, in which case the condition is in some respects likely to be worse.
4 THE PUERPERIUM
The puerperium is the name given to the ten days or fortnight following labour when the womb is reassuming its non-pregnant state, and during which it is the almost universal practice to keep the ‘patient’ in Bed—as though the puerperium were an illness and not a natural state.
Pregnancy is a mutual process engaged in by mother and foetus alike, and this mutuality of action does not cease with delivery; it is continuous into the next phase. From the biologist’s point of view, therefore, the puerperium cannot be regarded or treated as a period to be devoted to the care of the mother as a separate entity—-as is all too often the case. Its progress and satisfactory accomplishment is intimately bound up with the infant linked so closely to her not only by the breast but in a full functional sense—as we shall see in the next chapter.
But looked at merely as a physiological operation birth is an evacuation of the uterus and must be expected to follow the same principles as all other evacuatory processes of the body—for example, of the bowel, the bladder, etc. We must then expect to find preceding the birth a series of contractions of the viscus proximal to the mass to be extruded—the foetus in this case. These contractions—the labour ‘pains’—ease the mass towards the outlet, which, through co-ordinated automatic innervation now simultaneously dilates, permitting gradual onward passage of the foetus. The evacuation, like all other evacuations, is then followed by general contraction of the empty viscus, first in strong rhythmic periodicity—the ‘after pains’—to be followed later by general tonic contraction of the womb.
In a body the general tone of which is well sustained, that is to say, in a woman reaching her time in full activity with her reserves well engaged, these natural contractions are strong. Following the physiological law of summation of stimuli, any general muscular movement after evacuation enhances them, thus hastening contraction of the womb. During the puerperium these natural and necessary contractions of the womb are still further promoted and stimulated by the process of lactation.
So, when the woman comes to delivery in the fulness of her functional capacity, we must not only anticipate but deliberately plan both for her continued activity and for lactation, knowing that these factors contribute to the natural rebound of the womb in progressive contraction. To keep a mother, whose physiological tone is such that her involuntary responses are live and instant, reclining in bed as an invalid and isolated from her baby at this time is to invite puerperal debility and the pathological conditions that hang upon it. It is as important that a woman in full function should be up and about her business and in constant contact with her child—at least in so far as it demands service—after she has had a sleep following delivery, as that a debilitated woman whose musculature and tone are flaccid, and whose unsustained reserves are at a low ebb, should be kept in bed and every measure taken to regain what is regarded as her ‘normal’ condition.
This means that in the future, as health comes to be better understood, the need will arise for two different provisions for Maternity.
- for the ‘expectant family’ ;
- for the invalid wife who is pregnant.
A Maternity Service for invalid and sick mothers will always remain a necessity, but a Nation determined to renew its policy and practice after the war, whilst not omitting to make provision for the invalid, must essentially ground its basic plan upon the needs of the valid.