Calculation of the Time of Labour.
The period of pregnancy, from conception till confinement, is calculated at ten lunar months, or forty weeks, which amount to 280 days. It is sometimes reckoned at nine calendar moths, that is 273 days, or thirty-nine weeks; forty weeks, however, is the safer reckoning. When the date of conceptions is known, the reckoning begins from that day. If that be not known, the calculation must commence from the last monthly appearance. If the period of the last monthly course cannot be remembered, them the time of quickening, or when the motions of the child are first perceived (usually about four and a half moths after conception), may be made use of, but this is not a very reliable basis for calculation.
Since it is highly important that the period of labour be known, we add a calendar showing 280 days form any given date.
Its service will be especially appreciated by the newly- married lady, who, through delicacy, might hesitate to seek advice on this important point. Much time might often be saved, and great anxiety avoided, by being able to reckon approximately the hour of solicitude and hope. In point of economy, too, the advantage of bespeaking medical and other assistance at the proper time, is self-evident.
Those, however, who make use of the calendar should bear in mind that the period of pregnancy is slightly altered by the age of the parties concerned; the fact being fully proved that the younger the husband and wife the shorter the period of utero- gestation; and, vice versa, as age increases, the term of gestation is proportionally lengthened (Clay).
In reference to this subject, DR. Clay adduces a curious experiment on the eggs of domestic fowls. Poult eggs can be easily distinguished from those of hens of three or more years old. A certain number of the former were placed under a young hen, and an equal number of eggs from older fowls under an old hen. The result was, that every chick had escaped from its shell under the young hen at least twenty-four hours, some even as much as thirty-six, sooner than those of the old hen. The difference is very remarkable in so short a period of incubation. He infers from this and other circumstances, that the duration of the gestative period is far more definite than has hitherto been supposed, and that where the circumstances are similar, the result as to the length of term is very nearly the same. Maintaining that utero-gestation is definite and regulated by age, we do not calculate by that of the mother aloe, by the combined ages of both parents.
SYMPTOMS OF LABOUR. The Earliest is a diminution in the size of the waist, form the child’s sinking lower in the abdomen. The more immediate indications are agitation, lowness of spirits, flying-pains, frequent desire to pass water, etc. A slight discharge of mucus tinged red, technically called the “show,’ is the most certain sign that labour has commenced.
Our sole intention in this manual is so to describe the general course of a perfectly absence of a medical man, any intelligent person may be enabled to act with some degree of correctness, and to modify any distressing symptoms which may arise, by means of suitable remedies. 1. No unqualified person should assume the office of accoucheur. Nurses and others who are properly qualified, will find much useful information in the sections ‘Preparations for Labour,” “How to act in the absence of a Medical Man,: and :Treatment after Delivery,” in the Lady’s Manual, when their services are requires.
Towards the close of gestation, ladies are apt to suffer from pains which may be mistaken for those of labour, but which the following table will aid in distinguishing:
(1) Come on and go off regularly gradually in creasing in frequency and severity.
(2) Are situated in the back and loins.
(3) Are grinding or bearing-down, according to the stage of labour.
(4) Arise from the contraction of the uterus, and the resistance made to its effort, and produce dilatation of the mouth of the womb.
(5) Are usually attended with a “show.”
(1) Are irregular, Cimicifuga may be given in like manner. If yet the pains increase, then the Section on Miscarriage should be consulted.
(2) Are chiefly confined to the abdomen.
(3) Are of a colicky nature.
(4) Are caused by cold, flatulence, indigestion, spasm, fatigue, etc., and have no effect upon the mouth of the womb, which is found closed
(5) Are unattended with a “show.”
If the character of the pains points to true labour, although the proper time has not arrived, Pulsatilla will generally quiet the abnormal tendency. If, after a few doses at intervals of fort or sixty a few doses symptoms continue, cimicifuga may be given in like manner. If yet the pains increase, then the Section on Miscarriage should be consulted.
Assuming the proper time for childbirth to the arrived, and the symptoms of labour to have set in, an occasional dose of one of the forementioned remedies may be administered with advantage, unless some other be indicated.
TREATMENT. Gelsemium. To produce relaxation of a rigid, unyielding os uteri in labour, this remedy, in from one to five drops of the strong tincture, every half-hour, is probably superior to every other.
Chamomilla. Excessive painfulness in highly sensitive, irritable patients.
Coffea. Extreme nervous restlessness, sharp and severe pains.
Pulsatilla. Irregularity, uncertain and fitful pains recurring regularly for a time, and then ceasing. Two or three doses are usually sufficient.
Secale. Pains that are too weak and seem to be declining.
Cimicifuga. Violent, spasmodic pains, cramps in the limbs, a tendency to convulsions, nervous irritability and dejection.
Nux Vomica. Spasmodic pains.
Belladonna. Flushed face, throbbing headache, confusion of idea; a tendency to wander; convulsive movements, sensitiveness to noise, light, etc., etc. Belladonna is also sometimes useful when the pains are strong and normal, but an apparent resistance in the womb itself impedes progress.
Aconitum. Feverishness, palpitation, etc.
Caulophyllum is preferable to ergot as a uterine excitant.
Administration. A dose every fifteen, twenty, or thirty minutes, as the case may require. If no relief follows the third or fourth dose, another remedy should be selected.
ACCESSORY MEANS. No drugs, stimulants, spirituous liquors, etc., should be taken, as they often increase the difficulties and dangers of parturitions. A calm, assured manner in the attendant, and in all persons concerned, is necessary to dissipate alarm and anxiety. All whispering or sings should be avoided, as the patient is very susceptible at this period, and is ready to apprehend every kind of evil. Friction over the abdomen, with moderate pressure, especially during the pains in the latter stages of labour, is often of much service, by exciting the action of the womb. This should be continued till the placenta is detached. Protracted labour should always be expected to terminate favourably. 1. If a difficult labour be anticipated Arnica should be taken three times a day, for a month, before the calculate time
Patience is most important on the part of both the mother and attendant.
XLII. After Delivery.
After the birth, all being otherwise satisfactory, a dose of Arnica may be given every forty minutes for three or four times; this remedy will help to prevent soreness and After pains. When the after-birth has been expelled, lotion of the same remedy, twenty drops of the tincture in a tumbler of water, may be applied by means of a saturated napkin, and renewed as often as necessary.
The child should be applied to the breast as soon as possible; it needs nourishment, and the breasts need to be relieved if distended with milk, or excited and stimulated, if the milk be not yet ready. Moreover, the child’s sucking at the breasts, by reflex action, causes a contraction of the womb, which is absolutely necessary to the mother’s welfare. When the application of the child to the breast is duly attended to, Flooding is an unlikely occurrence. Should the milk be delayed for a day or two, the child should still be occasionally applied to the breast, and fed meantime with pure cow’s milk made sufficiently warm and thin by the addition of an equal quantity of hot (but not boiling) water, Nothing else whatever ought to be given to the infant.
The patient having been made comfortable, and the child applied to the breast, the first few hours should be essentially hours of repose. The patient should not be disturbed, except to remove the soiled napkins, apply the binder, and otherwise to render her as comfortable as possible. IF after good management she be left to herself, on or two hours refreshing sleep will have wonderfully beneficial effect. After this, should no untoward circumstances forbid, she may be changed and placed in bed, preserving thee horizontal posture, and not making the slightest effort herself.
After-pains, if not prevented by Arnica, may require Chamomilla or Coffea, if the patient is sensitive and irritable, or Gelsemium if the pains are the only indication present. Others remedies are, Pulsatilla, Secale, Ignatia, Xanth., Etc.
Coffea. Sleeplessness, nervous excitement, and restlessness. Two pilules, or a drop of the tincture, may be administered in teaspoonful of water, every hour until sleep ensues.
Aconitum may be substituted for Coffea, and given in thee same manner, should there be any symptoms of fever.
The diet should be simple and nourishing and given not at regular intervals, but it should not bee restricted to gruel even thee first day.
XLIII. Flooding after Delivery.
This is one of the most serious accidents which complicate the expulsion of the afterbirth. The Haemorrhage often occurs with a rush a few minutes after the child is born; sometimes it does not come on for several hours; or, in rare cases,. even for several days. But this need scarcely ever occur; and will not occur if the various suggestions before pointed out are faithfully acted upon, and no serious constitutional or accidental circumstance occasion it.
SYMPTOMS. Pallor of the face, dimness of vision, fainting, etc. When the blood appears externally, there need be no doubt about the case; but at times thee discharge is confined to the cavity of the womb, and can only be detected by the above symptoms.
TREATMENT. Secale, Pulsatilla, Sabi., Ipecac., Croc., Cham, m or Belladonna, may be required: for indications see Menorrhagia, etc., page 50. China should follow any other remedy after the discharge has abated.
ACCESSORY MEANS. After delivery the patient should enjoy the most absolute repose of mind and body for an hour or two. A clean warm napkin should be applied to the vulva as soon after delivery as possible, and be examined every few minutes, by nurse. Thus any excessive discharge may be easily detected. After flooding, the patient is naturally inclined to sleep; this tendency should not be interrupted too soon, as sleep wonderfully recruits the exhausted powers. The patient must not, however, be left alone, for she will require frequent examinations.
XLIV. The Cleansings-Lochia.
After delivery a healthy discharge takes place, which in colour and appearance at first resembles that of menstruation. Gradually, however, it becomes lighter, yellowish, and before its cessation is but slightly coloured. This change form red to a yellowish tinge, is generally effected in about a week. The discharge varied considerably in different females: in some it is thin and scanty, and continues only a few days; in others it is so profuse as almost to amount to Flooding, and lasts for weeks
TREATMENT. Aconitum. Plethoric patients with profuse bright-red discharge, and quick pulse.
Pulsatilla. Simple scanty discharge.
Belladonna. Scanty discharge; headache; flushed face; confusion of ideas; offensive Lochia.
Secale. Very offensive dark discharge.
Sabina. Similar discharge to that described under Aconitum, but without the febrile symptoms; also when the red flow is too persistent.
Bryonia. Suppression of the Lochia, with intense headache, fulness and heaviness, aching in the back, and hot, and scanty urine. In such a condition, Aconite or Belladonna may be alternated with Bryonia, according to the special symptoms.
ACCESSORY MEANS. If the discharge is too bright, or continues too long, the patient should retain horizontal posture, and be kept quite, and fed with simple diet. In suppression of the Lochia, warm moist applications should be made to the external parts. or, if necessary, injections of a warm infusion or camomile flowers. Of course the discharge must not be allowed to become offensive for want of frequent ablutions.
XLV. Constipation and Urinary Difficulties after Deliver.
Contrary to the ordinary practice of interference with the operations of nature adopted by the old school of medicine, Homoeopathy does not recognize the necessity of acting freely upon the bowels on the third day after delivery. When the system is so remarkably susceptible to morbid impressions, and occupied in transferring heightened vascular and nervous functions from one part of the female economy to another, where is the wisdom of disturbing the whole organism by the administration of purgative, and forcibly interrupting a process, which in some constitutions nature has scarcely power to effect? At such a moment the most passive condition of the system is that which every good physician should study to secure, rather than set up new morbid actions, the issue of which no one foresee. This unphilosophical practice, adopted from age to age by the physicians of the old school, fully accounts for the direful consequence which, in delicate, sensitive women, so frequently attend the puerperal state.
For the bowels to remain unmoved for a few days after delivery is natural; it conserves the strength of the patient, and never requires interference.
In four or five days, however, if the patient has had no evacuation, and complains of pain in the bowels or fulness in the head, one or two doses of Bryonia, at intervals of three hours, will generally afford relief.
After this, if necessary, Nux Vomica and Sulphur may be given in alternation every four hours for several times.
The inability to pass water which sometimes follows parturition, may generally be relieved by Aconitum; but if after a few doses this does not succeed, and there is great urging, Camphor may be given every twenty minutes for three or four times.
ACCESSORY MEANS IN CONSTIPATION. The moderate use of plain, unstimulating solid food, at suitable intervals after confinement, will furnish the proper impulse to the intestinal canal, and be more likely to facilitate an evacuation than the exclusive use of liquids. When the bowels do not act duly even after the administration of the remedies, an injection should be given by means of an enema-syringe, page 124. But the writer has ample ground for stating that Castor-oil or other aperients, are never required.
XLVI. Diarrhoea after Confinement.
This is a more serious condition than the former, and suitable means should be taken to correct it as early as possible.
TREATMENT. Pulsatilla. Diarrhoea caused by too rich or fatty food; occurring chiefly at night.
China. When there is much weakness.
Phosphoric Acid. Obstinate, painless, watery Diarrhoea.
Administration. A dose every two hours, or after every evacuation until relieved.
ACCESSORY MEANS. Quietude, and the recumbent posture; cool or cold digestible food.