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

from them; and also by manipulation of the soft parts and the head. The head advances more and more with each succeeding pain, and the perineum is put on the stretch, each contraction is followed by a resting pause during which the head slips back a little and relieves the perineum. Tear of the perineum is liable to take place when the head is about to escape through the vulvar opening, especially if the contractions are strong, the woman bears down forcibly and the interval between the pains is short, so that the head is forced out before the parts have time to completely dilate and soften. Here is where the physician's work comes in, by holding the head back and fully flexed (bent), chin upon the breast, and keeping the back of the head (occiput) well up towards the bone in front (pubic arch) until thc perineum is completely dilated.

The effect of the pains can be lessened, if necessary, also, by telling the woman to open her mouth and not to bear down during the pain for a few times. In this way the perineum will dilate properly and be torn little, if at all, and perhaps much future trouble for the woman saved. I always tell my patient why I ask her to do certain things in labor and I have never found any woman who, when able, was not willing to do as I asked. A torn perineum is not desirable, because even when sewn up immediately after labor, it may not unite thoroughly, and thus cause displacements of the womb in the future. A little time and care at the time of labor will save the perineum and every woman is willing to do her share when the conditions are plainly explained to her. It takes only a few minutes longer, and only a few more pains to bear. When the head begins to stretch the opening, the left hand of the physician should be carried over the woman's abdomen and between the thighs, her right leg being supported by a pillow placed between her knees, and this left hand presses the back of the head (occiput) forward and against the "pubic arch." The right hand may also press the head upward by being placed against the posterior portion of the dilated perineum. The edge of the perineum should now be closely watched. A small towel wrung out of a bowl of hot water placed handy on a chair, should be held constantly against the perineum to hasten the softening and dilatation of these tissues. Plenty of hot water and small towels should be at hand. The head advances with each pain and again recedes until the parts are properly dilated, and the perineum slips backward over the child's face.

[534 MOTHERS' REMEDIES ]

If torn, it should be sewed before the physician leaves, as it can be done easily and without pain to the mother. As the head of the child emerges, the anesthetic should be pushed, or the woman told to open her mouth and cry out. This lessens the pain and the child's head emerges slower, and the perineum is saved. The child's head should be received in the hand. After the head is born, there is a lull for a few moments. Then the shoulders rotate into the proper position and are easily born. There may then be a flow of watery fluid for a few seconds. Before this time the physician has examined to see whether the cord is around the child's neck, released it if it has been, and also cleaned out the child's mouth. The child usually cries a little about this time and it is soon seen whether it needs quick attention. The perineum should be guarded also while the shoulders are being born as it can be torn by them. The shoulders are generally born without any help. The child's head is held in the physician's hand. As soon as the body is born, the child should be laid upon the bed behind the mother's thighs, and the cord pulled down to prevent it pulling upon the after-birth. After the beating in the cord has ceased, generally from five to ten minutes have elapsed, the cord is then tied, tight enough so it will not bleed afterward, about one or one and one half inches (some say more) from the body and tied a second time an inch or so from the first ligature, and the cord cut between the two ligatures. Care should be taken so as not to cut a finger or toe of the baby. If the cord is very thick it is best to pinch it at the point of tying and the contents stripped away before the first ligature is applied. After the cord is cut it should be wiped off to determine that bleeding from the vessels has been permanently cut off, and if not it should be tied again. The child is now taken up by placing the back of its neck in the hollow between the thumb and forefinger, and the other hand over the backbone. It should then be placed in a warm receiving blanket, and put in a safe place.

Management of the Third Stage,—The contractions of the womb are renewed and with the second or third the after-birth may be expressed. The top (fundus) of the womb is grasped by the hand through the relaxed abdominal walls, and squeezed, and at the same time make a downward pressure. The after-birth is loosened from the womb and slides through the vagina and outlet, and it may be caught in a tray which has been placed between the patient's legs, or by the hand and given a few twists in order to roll the membranes together; while this is being done, gentle rubbing should be applied to the womb, when the membranes will slip out without tearing; no drawing on the cord should be done in delivering the after-birth.

From the time of the birth of the head to the delivery of the after-birth the womb must be controlled by the firm pressure of the hand on the abdomen. It is well for the nurse, when the after-birth is separating from the womb to follow the womb, throughout this whole stage, by keeping her hand upon it and if, while the physician is attending to the child, the womb softens and enlarges she should at once notify him. There may be bleeding within the womb. After the womb is empty, friction should be made over the womb whenever it softens at all in order to stimulate the womb to perfect contraction, and it should be kept up at intervals for one hour after the after-birth and membranes have been delivered.

[OBSTETRICS OR MIDWIFERY 535] THE CHILD.

The eyes should be washed soon and normal respiration established. If the child does not breathe well, cold water may be sprinkled in the face and chest and if this fails, immersions in hot water at 106 degrees F., and sprinkling with cold water must be resorted to. If necessary, artificial respiration must be given. Slap the child on the back and move the arms up and down by the side a few times, or breathing into the child's mouth.

Another method.—Face the child's back, put an index finger in each arm-pit and the thumbs over the shoulders, so that their ends over-lap the collar-bone and rest on the front of the chest, the rest of the fingers going obliquely over the back of the chest. The child is suspended perpendicularly between the operator's knees. Its whole weight now hangs on the first fingers in the arm-pit; by these means the ribs are lifted, the chest is expanded and inspiration is mechanically produced. The infant is now swung upward till the operative's hands are just above the horizontal line, when the motion is abruptly, but carefully, arrested. The momentum causes the lower limbs and pelvis of the infant to topple over toward the operator. The greater part of the weight now rests on the thumbs, which press on the front of the chest, while the abdominal organs press upon the diaphragm. By these two factors, the chest is compressed and we get expiration, mechanically. After five seconds the first position is resumed again, and the lungs expand and fill with air. This process may be repeated several times until the breathing seems to be going naturally, and with delicate infants it should be the last resort.

After the breathing has been established the child should be wrapped in a warm flannel with hot water bags or cans near it, and left until the mother has been cared for. Infants at birth are covered with a white greasy substance, vernix caseosa, or cheesy varnish; it is removed by applying olive oil, vaselin or fresh lard, and afterward rubbing the skin gently with a soft cloth. The eyes and mouth should be washed out with pure warm water—or a saturated solution of boric acid, used. Separate squares of soft linen being used for this purpose. If the baby is born too soon or is very small, weak and undeveloped, it should be given an oil bath, only, and then wrapped in cotton wool and kept at a temperature of not less than 80 degrees F., for ten days or two weeks.

[536 MOTHERS' REMEDIES]

To a fully developed child the first bath may be given at once. Have everything ready before beginning, a foot tub, warm soft towels, warm water, castile soap, olive oil or vaselin, small squares of muslin or linen, dusting powder, a dressing for the navel and clothing, the latter consisting of a diaper, a flannel band, a shirt, long woolen stockings, a loose long sleeved flannel petticoat and a simple soft white outside garment, the two last, long enough to more than cover the feet. The infant should be wrapped in flannel and only the part which is being bathed at the moment should be exposed. The eyes are first bathed separately and with different cloths, and afterward the face, no soap being used; the head is then washed with warm water; very little soap should be used with infants as it is more or less irritating, and it is likely to injure the fine texture of the skin. Next, one should carefully clean the parts behind the ears and the crevices of the neck, arm-pits and joints and those between the buttocks and the thighs, and it is well to notice if all the natural openings are perfect; finally the baby is put down into the tub of warm water at about 96 degrees F., and washed off, with the head and back firmly supported with the left arm and hand during the bath. The baby is lifted out in a minute of two, held face downward for a moment and rinsed off with clean warm water. It is then wrapped in a warm towel and flannel and dried by patting, not rubbing. It is best to do all this on a table, instead of on the lap, and it should be large enough to hold a bath tub, every thing necessary for the bath and a pillow upon which to place the baby. Everything then can be done without stooping and with greater comfort to the child. Powder should not be used except where there are signs of chafing, when stearate of zinc is the best to use.

The navel is then dressed. A hole is cut in the center of a square of sterilized lint or linen which is slipped over the cord and folded about it; the cord is then laid toward the left side, and over it is put a small sterilized cotton pad which is held in place by the flannel bandage and just tight enough to hold. The binder may be kept on by sewing it smoothly with half a dozen large stitches, thus doing away with any danger of being injured from the pins. A binder should only be tight enough to hold the dressing for the navel. After the cord drops off the looser knitted band should be used. The infant is not bathed in the tub again until after the cord has been dried up and ready to drop off, which usually occurs on the fifth or sixth day, although it may not drop off for nine days. The cord should not be redressed in the meantime. (See Baby Department for further directions).

THE MOTHER.

The first duty of the physician, following the third stage of labor, is to see that the womb is well contracted and control of this organ should be continued for at least one hour after delivery. This generally prevents excessive loss of blood. If necessary to promote womb contraction one teaspoonful of ergot can be given.