THE CARE OF THE WOMAN AND OF THE CHILD DURING LABOR


The most useful homeopathy remedies for Care of Women And Child During Labor symptoms from the book The diseases peculiar to women and young children by H.N.Guernsey…


THE CARE OF THE WOMAN DURING LABOR When summoned to attend upon a case of labor, it is better to go provided with a male and a female catheter, a pair of forceps, and a blunt-hook. Emergencies, may arise requiring in haste the use of one or more of these instruments, and no time should be lost in sending for what might so easily be taken in the first instance. Our little pocket-case of medicines we take with us, of course; for we should never go to church even without this potent weapon against evil.

Before entering the room our arrival should always be announced; that we may not shock our patient by our unexpected entrance. We should take especial care to be ourselves in a happy frame of mind that we may appear in an easy, unaffected manner. And we should have no other thought in our mind than to attend strictly to our business in as agreeable a manner as possible.

First we should inquire into the nature of the pains, with a view to prescribe for any abnormality that may appear in the sufferings of our patient (see Dystocia). After observing attentively, without seeming to look at the woman, the nature of her pains, we may, when we think it necessary, propose an examination per vaginam, in order to observe the condition of the internal organs, the presentation, &c.

It may not seem out of place to observe that the first object of search will be to see if the woman be pregnant; for it has some times happened that every preparation has been made for parturition when no pregnancy exists. The writer has met with such cases where the real facts were not revealed until examination was made per vaginam, as if to ascertain the presentation.

Having then determined the existence of pregnancy, the next thing is to learn if the patient is in labor, or whether she have not, instead, certain abdominal or lumbar pains, called “false pains. If she is really in labor, we shall find, on retaining the finger in the os uteri during a few pains, a rigidity and tenseness of the os accompanying every contraction, and followed, after the pain, by a corresponding looseness and state of relaxation. Or if the membranes are entire and become tight and firm under the contraction, relaxing as it passes off, the woman is certainly in labor.

The next step is to inquire, if she is at full term. This inquiry will of course be settled in our own minds affirmatively, if we find the neck of the uterus absolutely blended or spread out into the globe of the uterus. The internal os will not be felt, the orifice leading to the membranes now being simply that of the os tincae. If the internal os still remain closed or partially so, the cervix uteri will also be capable of being distinguished, as the full term has not arrived; and we must hasten, as in threatened abortion or premature labor, to arrest all further progress by means of quietness and the exhibition of the proper Homoeopathic remedy.

The next question to determine is, are the membranes ruptured? And this is not always an easy task, since they are some times so closely drawn over the scalp as to deceive a new practitioner. But during a pain, unless the head has already descended low down in the excavation, so much water will be forced down between the membranes and the scalp, as to make it quite apparent that the former are still intact. And besides, there is a certain greasy smoothness perceptible in the touch of the unruptured membranes, which differs from the sensation experienced in feeling the hairy scalp of the child. Bearing these things in mind, we never need to mistaken, if we press firmly down upon the scalp; for the rough, hairy condition of the uncovered scalp is never simulated by the unbroken membranes.

Next we wish to determine how far the labor has advanced, and what part of the child presents. In primiparae particularly, it is not always easy to find the os uteri; for sometimes it is not discoverable till we carry the finger far upwards and backwards, upon the anterior face of the sacrum, nearly up to its promontory. In such cases it may be necessary for the female to lie on her back till the anterior obliquity disappears; and this can be aided by the accoucheur elevating the fundus with one hand applied externally, and with a finger of the other hand in the os to draw it down.

If it now appear that we have a timely labor to treat, it will be necessary to provide for it accordingly. Where we can have our choice, the woman should be placed in a large, airy chamber, exposed to the sunny side of the house; and as much retired as possible, the above more important points being secured. The temperature of the room should be about sixty-five degrees during labor; about seventy degrees afterwards; the covering should be sufficient for the comfort of the patient. A strict adherence to these rules may prevent fatal, or at least dangerous accidents, such as hemorrhages, chills, metastases, &c. If her bowels have not been freely evacuated within twelve hours, she had better take a large injection at once, that no accumulation of feces remain in the rectum. She should now be suitably dressed for the occasion. Let her be arrayed in the dress she intends to wear in bed, but so adjusted that it cannot slip down below the waist. Next to this let an old sheet, or something of the kind be pinned around her, so as to cover all the lower part of the body, hips and legs. Next the bed must be suitably prepared for its own protection and for the comfort of the patient. An india-rubber sheet, about one yard wide, should be placed across the middle of the bed upon the mattress. A clean sheet should now be spread over the whole bed. Across the foot of the bed an oil-cloth, or another piece, of india-rubber, a yard wide, should be placed; and this covered with a thick doubling of blanket. The patient should lie upon this, with her feet placed against the foot of the bed as a purchase during the expulsive efforts of labor. She should lie with the breech near the edge of the bed, with her thighs flexed at right angles with her abdomen, and the legs at the same angle with the thighs. During the expulsive pains, an assistant may hold her hands, or a towel may be so attached that she can assist herself by drawing with her hands in the direction of the support of her feet.

The last rule to observe in relation to attendants, is to have only the husband, the nurse and the doctor. The husband at all events, and not more than two female friends; the doctor to be in and out, from time to time, as his judgment may dictate. It is better to be absent as much as possible and keep due surveillance over the case, till towards the close of the labor. In the first stage the female may make herself as comfortable as she best can, by walking about, sitting in her chair, or changing form one to the other. Unless the labor be very protracted, cold water is the only refreshment required.

When the head has commenced descending into the cavity of the pelvis, and the os uteri is fully dilated, the accoucheur should not absent himself from the patient long at a time. It will be better for him to take his seat at the patient’s bed, in a position to watch the appearance of her face, place the finger on the presenting part, mark well its progress, and be ready for any emergency that may arise. Some women are troubled with a terrible shivering during the early part of labor, or at its commencement, and sometimes it follows immediately afterwards; but it is of no account. When it occurs as a first symptom, the labor is apt to be correspondingly quick.

Patients are apt to be frightened at the noise of the rupture of the bag of waters; so that it is best to forewarn them in time to prevent any alarm. When the labor seems delayed by the tardy discharge of the waters, and the os is fully dilated, and yet the head is evidently kept back by something, it is better to plunge the finger forcibly into the sack, during a pain, and let the waters escape, then the labor will advance much faster. When the membranes are tightly drawn over the head, they can be scratched through by means of the finger nail, and then they may be torn up each way, by forcing the finger between them and the scalp.

Sometimes the child is very movable at the superior strait; and several portions presenting in alternation; in such cases when the head presents, the membranes may be ruptured, and the head thus caused to engage in the superior strait. Where there is evidently an over-distention of the uterus by excessive amount of liquor amnii, weakening the contractions, the membranes may be punctured at any time we are certain of such a complication.

During the first stage of labor the woman should never bear down; since her strength must be exhausted in making such useless efforts. It is only in the second stage, when the expulsive pains occasion a sort of involuntary forcing, that advantage can be taken of this effort, for then only is it useful. Too much voluntary exertion should not be used at the very last, for fear of rupturing the perineum. Nor should women be allowed to rise to the chamber, near the close of the second stage, for fear of accidents; however much she may desire to evacuate the bowels; for it is far easier to remove such discharges from the bed, than to extricate a new-born child from the chamber, as has sometimes been necessary in such cases.

H.N. Guernsey
Henry Newell Guernsey (1817-1885) was born in Rochester, Vermont in 1817. He earned his medical degree from New York University in 1842, and in 1856 moved to Philadelphia and subsequently became professor of Obstetrics at the Homeopathic Medical College of Pennsylvania (which merged with the Hahnemann Medical College in 1869). His writings include The Application of the Principles and Practice of Homoeopathy to Obstetrics, and Keynotes to the Materia Medica.