Mother's Remedies, Thomas Jefferson Ritter [reading well .TXT] 📗

that bearing down character which they afterward acquire; they are described as "grinding," are usually felt in the front. The genitals become bathed with secretions, which are sometimes tinged with blood. This is an especially trying period to a young wife, for she cannot see that the pains are doing any good, only making her restless, tired and nervous. Little can be done by the physician in this stage except to encourage and explain what is really being accomplished by these seemingly futile pains and by tact and proper encouragement, a physician tides this stage over and gives great comfort to the needy patient. This stage ends with the opening and dilation of the mouth of the womb and the second or expulsive stage sets in, with pains altered in character.

Second Stage.—The pains now become more frequent and severe and last longer, and the patient now manifests a strong desire to expel the contents of the womb. The woman now feels better in bed and when the pains come she involuntarily bears down, with each contraction she sets her teeth, takes a deep breath, fixes the diaphragm, contracts the muscles of the abdomen and bears down hard if you allow her to do so. The knowledge that she is working to overcome an obstacle gives her some satisfaction and she feels that she is accomplishing something by the efforts she is making. The physician can aid greatly by suggesting to the patient how to use the pains and how much bearing down to do. He can tell her when not to bear down, and so save her strength for the next real pain when bearing down will do good. Although the pains are really harder in this stage, nervous women suffer no more, for their mind is now concentrated upon the work at hand. Sometimes at the beginning of this stage the patient feels chilly or has a severe chill; a hot drink and more covering counteract this. Another phenomena is the escape of the waters and a lull in the pains for a little time, when they come on more effectively than before as the womb contracts down upon the child and is not hindered by the "bag of water." The pains keep on at intervals until the child is born and the physician can now be of help by guiding, directing and assisting the birth of the head. This stage averages about two hours.

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Third Stage.—The birth of the head is very soon followed by the shoulders and the rest of the body, and the woman is now at comparative rest. The cord is now tied and cut and the child laid away, if all right, in a warm place until it can be washed and dressed. Following the birth of the child there is a short resting period, the contractions of the womb cease and it becomes smaller through retraction. After a few minutes the pains begin again, the after-birth separates from its attachment in the womb, and together with the membranes is extruded into the vaginal canal and vulvar opening; whence it can be easily delivered by pressing upon the abdomen over the lump (womb) and by guiding the after-birth with the cord. This should be done slowly so that the membranes will all come away with the after-birth.

This should always be examined to be certain that everything has come away. A greater or less amount of clots of blood come with the after-birth. The contraction of the womb stops the bleeding, one hand should be kept on the abdomen over the womb, to see that it remains hard and retracted. The womb moves under the hand. If it softens, gentle rubbing should be kept up and the womb will soon remain contracted. This stage averages about fifteen minutes.

MANAGEMENT OF LABOR.—Preparation of the Bed.—The bed should be high, springs not soft, with a firm and smooth mattress. It should be placed so that both sides are accessible. The bed should be made up on the right side as a rule, as the woman usually lies on her left side when delivered. Place a rubber, or an oil cloth sheet, over the mattress, and over this an ordinary muslin sheet and secure this with safety pins to the corners of the mattress. This is the permanent bed; on top of this is the second rubber sheet and this is covered with another muslin sheet and both held by safety pins. This is the temporary bed. Plenty of hot and cold boiled water should also be at hand. Frequently only a temporary bed is made with rubber or oil cloth underneath, blanket and sheet above this. They should be fastened so that the movements of the woman will not disorder them. These can be removed after the confinement and new, clean warm clothes put in their place. The objection to this is the woman may be too tired to be moved, while, with the permanent and temporary bed arrangement she need not be moved at all, only lifted, while the temporary bed is being removed and she is then let down easily upon clean bedding.

Preparation of the Patient.—The patient, if she desires, can take a full bath. The bowels should be moved thoroughly with a soap and water injection so that the rectum will be fully emptied. This makes labor not only easier, but pleasanter, as no feces will be discharged during labor. The bladder should also be emptied. The external organs should be scrupulously cleansed and bathed with some antiseptic solution, like glycothymoline, listerine, borolyptol, etc. A fresh suit of underwear may then be put on and over this a loose wrapper.

[OBSTETRICS OR MIDWIFERY 531]

Examination of the Patient.—The physician needs to satisfy himself as to the position of the child, etc. This can be done by an examination of the abdomen and also of the vagina. He must determine whether the child is alive, its position, the condition of the cervix and mouth of the womb. In making such examination a routine plan should be adopted. The coat must be removed, the shirt sleeves turned up and the hands and arms washed with soap and water. The abdomen should be thoroughly palpated (felt) and listened to with the ear or stethoscope to determine the character of the child's heart beat, whether it be very slow, one hundred and twenty or less, or a very rapid one, one hundred and fifty or more. It may indicate danger to the child and necessitate a hurried delivery. After these things have been done, the hands and arms must again be thoroughly washed and sterilized, the fingers anointed with carbolated vaselin and the examination of the vagina made.

This cleanliness is necessary, and if this plan were carried out by everyone connected with the patient during the whole confinement, there would be fewer cases of "child-bed" fever, with its resultant diseases. The patient should lie on her back with the knees drawn up. There is no need for any exposure now, for the covering can be held up by an attendant so that it will not touch the physician's hands. The soft parts are now separated by the fingers of one hand while the examining fingers are introduced into the vagina. These fingers should never touch any external part and especially the parts near the anus. If the cervix is found to be long and the canal still undilated, or only slightly so, and especially if it is the first child (primipara), the physician's presence is not needed and he may safely leave for an hour or two. But if the mouth (os) of the womb is dilated to the size of a silver dollar he should on no account leave the house.

Frequent examination of the vagina should not be made. In ordinary cases during the first stage, the woman should be up and encouraged to walk about the room, to sit or assume any comfortable position. During a pain she may stand beside the bed resting her hands upon something or kneel in front of the bed or chair. The standing position assists in the birth. The bladder should be emptied frequently, as a distended bladder retards labor and may even stop the womb contractions. The pains become more frequent and severe as the end of this stage approaches and each contraction is now accompanied by straining or a bearing down effort on the part of the woman, and as a rule the membranes rupture spontaneously about this time. An examination of the vagina should now be made with the woman in bed, and if the membranes have not broken and the womb is completely dilated as shown during the pain, they may be ruptured by pressing against them with a finger-nail during a pain. Sometimes we use every means to retain the membranes intact, but that is when protection for the child is needed for sometime longer. If the suffering is very severe, during this stage, fifteen grains of chloral hydrate, well diluted with water, may be given every fifteen or thirty minutes until sixty grains have been given. (This medicine should never be given to a person with heart trouble). I find one drop doses of the tincture of Gelsemium every fifteen to thirty minutes of benefit, especially if the womb does not dilate well, or the patient is very nervous. The patient may receive and can receive light nourishment during this stage.

[532 MOTHERS' REMEDIES]

Management of the Second Stage.—After the rupture of the membranes the labor proceeds faster and a termination may be expected within a reasonable time. There is a short lull in the pains, usually, after the waters have escaped and during this time the patient should remove her clothing and put on a night dress, and to prevent its being soiled roll it well up under the arms and retain it there. After labor it can be very easily pulled down and made comfortable for the patient. A folded, clean, sterile sheet is now placed about the body and extremities and held in place by a cord around the waist. The opening in the sheet should be in the right side, as this will allow the assistance being given as needed. The powerful force of the abdominal muscles is now brought into action; the force is best utilized with the woman lying on her back.

She should now be encouraged to bear down during the pains and she will be greatly assisted by pulling on a sheet or long towel tied to the foot of the bed, or by holding the hand of the nurse. A support for her feet frequently aids the woman. Pressing low on her back relieves her to some extent. In the intervals between the pains she should rest, do nothing, and be perfectly passive. It is now that an anesthetic may be used to relieve the suffering. She should not be put completely under its influence for that is not only unnecessary, but injurious. Chloroform when used should be given on a handkerchief opened and loosely held over the woman's face, and administered drop by drop on the handkerchief. The handkerchief should be placed over the face at the beginning of the pain and be taken away as soon as the pain is stopped. The woman inhales the chloroform during the pains and their sharpness is blunted. Given in that way it is not considered dangerous. It should only be pushed to unconsciousness during a forceps delivery, and even then it is not always necessary to render the woman unconscious. I have used the forceps without giving an anesthetic. They should be placed without causing any special pain, and assist in delivery without causing any more pain when the head is down low. Of course if the forceps must be used when the head is high up a greater amount of anesthetic is needed.

Dr. Manton, of Detroit, says:—"The dangers of anesthetics are the same when employed for obstetric purposes as in surgery, and then use should be governed by the same rules in each instance." As soon as the head begins to dilate the vulvar opening, the patient should be turned on her left side with her knees drawn up and her body lying diagonally across the bed, with the buttocks close to and parallel with the edge. This position allows the physician to give better assistance and is no harder for the patient.

[OBSTETRICS OR MIDWIFERY 533]

The physician with his hands thoroughly sterilized and with a clean sterilized gown, seats himself on the edge of the bed and watches the progress of the labor, ready to assist the woman at any moment. And at this time he can do much by words of encouragement and proper directions to the laboring woman how to use her pains so as to get the most