I recall the recent confinement of a tall, blonde lady of 26 which was for her second baby, the first one having been attended by another physician who told her she would be unable to nurse her baby, hence put it upon artificial milk and reared it; who told me that she apparently had no milk for the preceding baby, but was anxious if possible to feed this one from her own breast. She was a mild mannered lady, who gave a history of having occasional shifting pains over her body, and whose emotional life was expressed by occasional tearful outbursts.
These symptoms were few but sufficient to suggest a remedy; that remedy was Pulsatilla, which made it possible for the mother to care for her baby in keeping with her desire and as nature has generally provided for. Three months since this prescription was made both mother and baby have come to their own in development and growth. The mother happy that she has been able to give to her baby that care and love which ties mother and child most intimately together, and all from the judicial selection of the indicated remedy.
Anyone can conduct a natural case of confinement so long as it is normal, a midwife, or friend. But it is when the abnormal appears that the physician has a chance to prove the worth of his teaching and experience. They ability to recognize and meet these exceptional cases tests the resourcefulness of the successful obstetrician.
In the development of a professional complex it is necessary to thoroughly understand theory and practice, but in addition to this one must have experience and know how to use that experience whenever a time should arrive for it. The late J. C. Sanders, emeritus professor of the University of Medicine and Surgery, used to demonstrate for the benefits of us young doctors the process of delivery in its various stages with a manikin and his leather doll.
He would imitate so far as his dramatic ability would allow him the various steps in the delivery of a baby. Beginning by saying, “Our patient is now in labor. We will make a preliminary examination and in it discover that the baby is making normal descent, the bag of water pouching out as it should.” He says, “Now we will wait thirty minutes, and during this time the waters will break , when,” he says, “we shall make another examination and ascertain what progress is being made and see if our previous diagnosis is correct.
With a suddenness that would electrify the young doctors, he would hesitate, and say, “Men , what have we here! It is not a head that we feel; it is something smaller; I believe it is a hand! Thus, gentlemen, what are we going to do with this case? We have a shoulder presentation, or we may have a prolapsed cord, either of which demands immediate attention and requires the skill of the artist to deliver the case safely to both mother and baby. In the former case podalic version must be performed; in the latter case, an effort to return the cord, if possible, if not, to use the forceps to make immediate delivery in order to save the baby”.
Every physician should school himself to be able to use what is known as “a poker face,” for in the presence of his patients he is being watched and judged as he exhibits his greatest skill and at the same time with calmness and assurance. He who meets these cases and does not rouse suspicion of just how grave they are, and his ability or inability to meet them, but finally works out a way , is the man whom the community at large comes to depend upon more and more, as well as love above all others for his talent.
The greatest asset of the physician is knowledge and how to use it. He should be able to diagnose the various positions of the presenting parts, and know what to do with them as the process of labor develops, and conduct them to a final termination that will do as little damage as possible to both mother and child. The ability to measure the parturient canal, its outlet and its inlet, so that in these extreme cases time may not be lost when a Caesarean section becomes imperative, or some mechanical means has to be used to conserve the strength of the mother, and assist if possible in delivering the child, which is the first duty of the true physician.