The White Memorial nutrition department cooperates with the White Memorial maternity clinic in conducting mothers' and fathers' classes. The mothers' classes are held each Tuesday from 9:30 to 11:00 A.M. Most of the women attending are having their first infant. The nutritionist participates in the sequential learning experiences by rethinking and re-evaluating with them the role of diet in the pre natal care. Five classes are conducted, the first being orientation to the general nutritional needs and the stating of the basic assumptions. The second class reviews the importance of protein in the maternity diet and contrasts the normal nutritional needs with those of pregnancy and lactation. Vitamins and minerals are reviewed in the third lesson. Cost and budgets are important considerations in the fourth lesson. The fifth and last of the food series is the study of the comparison of mother's milk and cow's milk. The nutritionist begins with the second class in the series of six lectures and demonstrations to integrate the nutritional needs to the patient care. Each class instills in the patient confidence in her ability to do the work!
The clinic is composed of three general groups of patients: Mexican, Negro, and Caucasian. A study of almost seven hundred pre natal patients showed that 20 per cent of the Mexican, 15 per cent of the Negro, and 9 per cent of the Caucasian patients were anemic according to laboratory reports. From a nutritional point of view this is significant, in the light of a calculation study made on more than 150 patients who submitted daily dietary pat terns and over 90 per cent of them were eating only seventy-five or less grams of protein, instead of the recommended eighty-five grams of protein needed daily in pregnancy. Objective evidence used in teaching patients begins the learning experiences.
It is not enough to lecture to patients who have much at stake; there must be some take- home values. Language is the bridge over which much of the information must be imparted. Misconceptions and misunderstandings must be cleared up in everyday words. The patient must be made to feel that although group teaching can help clear up her individual problems, she also has the opportunity to consult the dietitian about any specific problem that may not be common to the thirty or forty women in attendance that day.
Each individual patient has many past experiences that may not correlate with present-day nutrition thinking. She must be offered a better way to useful living. Sometimes this requires stopping leaks, bridging gaps, and making amends in specific skills and knowledge, and then again it involves discarding entirely the patterns of thought and attitude, and recovering lost ground by weaving heavier designs and making necessary dietary reforms. The nutritionist must size up the group through asking them to solve individual nutrition health problems on their own levels. This method of having them help plan the menus, plan the dietary cost allowance, and decide on food choices in season assists them in using the science and art of nutrition when they arrive home.
The need for recognition of individual differences and growth potential in the manipulation of forty different people is paramount. One cannot get up in a group of pregnant women and boldly state that "everybody has to ———," whatever that may be. The doctor and nurse in charge of the maternity clinic relax when they get into the patients' company and set them at ease and make the information as simple as- possible; therefore the food pattern should not be dictatorial. The democratic process demands that decisions are not handed down but that they are talked over and reasoned through with the patient and become a part of the interests of the individual family. The lessons are graded in difficulty so as to satisfy a growth potential. Many a college-trained woman is sitting next to a homemaker who may not have the same aptitudes, but each has her own knowledge, attitudes, and practices that she needs to use in the solution of her common nutritional problem. The food expert must hand tools out with the deftness of the expert mechanic who knows what tools that the individual can appropriate to his circumstances will do the job. The pupils are gently led to an understanding of the part they can play in contributing to the maximum in the preparation and service of foods. They are invited to state their problem in their own setting in simple words.
As the classes progress it becomes more apparent that the women are developing social skills and gravitating toward more uniform concepts of their responsibilities. The impact of the personalities is shown as they mingle before and after class. Abstractions do not enter into their conversations. They are exchanging ideas, recipes, notebook ideals, and asking for books with the latest on the science of eating. The maternity library is in a constant state of flux. Just as eddies, pools, fresh streams, and rivers mingle to make the mighty moving ocean, so does the planned and sequential learning experience direct the final behavior. The need for clear aims and a central philosophy coherent with individual and institutional objectives, is evident to all the participating instructors. The core correlations must be made by the well- trained public health nurse and the clinical supervisor in the maternity service. By the selection of the kind of information the teacher thinks the student will need, and then by the qualifying of this according to the needs and interests of the mothers, the integrated program moves to a happy climax. The pupils are self- motivated to attend the classes, and the reward is a certificate.
