57. HOW TO ACT IN THE ABSENCE OF A MEDICAL MAN
Some labour are managed entirely by nurses who have had some preliminary training in lying-in hospital, where also, perhaps, a short course of lecture has been delivered; but ladies generally prefer a qualified medical man, in whose care, firmness, and superior ability they have greater confidence. Inasmuch, however, as labour sometimes comes on earlier than was anticipated, or its stages are gone through so rapidly as not to give sufficient time for the attendance of a medical man, it is desirable to know how to act till be arrives. Calmness, judgment, self-possession, and attention to the following points, are generally all that is necessary in ordinary cases for the safety and infant, at least until the arrival of the accoucheur.
Birth before the Doctor’s Arrival. If when the head is born, the face gets the exist of the shoulder should be aided by slight traction, by means of the index finger inserted in the axilla (armpit); but on no account should the head be pulled, for dislocation of the neck might result. After this the remaining exist of the body and nates (buttocks) should not be hurried.
When the child is born, the nurse should at once remove it out of the way of the mother’s discharges, place it where it has room to breath, and see that the mouth is not covered with clothes. The mouth should be examined, and any mucus in it removed. At the same time its very important to notice whether a coil of the funis (navel string) be tight round the infant’s neck; and if so, to instantly liberate it to prevent strangulation. If there are two or three-coils, they should be loosened a little to allow the child to breathe.
To tie the Umbilical Cord. The ligature a piece of twine, or four or five threads should be placed about two inches from the body of the infant, and tied firmly by a double knot round the umbilical cord; two or three inches farther from the body of the child a second ligature has to be similarly applied, and the cord then cut between the two ligatures with a pair of bluntpointed scissors. The cord should not be ligatured till the child has given signs of life by its cries or vigorous breathing, or until all pulsation in the cord has ceased.
The Placenta. The umbilical cord having been ligatured and divided, no attempt should be made, by pulling at it, or otherwise, to remove the placenta (afterbirth). The only justifiable interference is firm pressure and occasional friction over the region of the womb, which tends to encourage contraction of that organ, by which means detachments and expulsion of the placenta is effected. We may judge the placenta is detached by examining over the lower part of the abdomen; and if the womb is felt contraction, and hard like cricket; ball, the placenta is detached. A professional correspondent Dr. Ussher writes: “There is one very decided way of knowing when the placenta a is detached; it is as follows: Grasp the cord in the hand and squeeze it; if pulsation is felt, separation is not complete. For this purpose one finger is not enough, the thrill is best felt through all.” If the placenta be not expelled, it is in the vagina (passage to the womb); two fingers may then be passed up to the insertion of the cord, where the placenta may be grasped and brought away steadily and evenly, with a spiral movement, but without using force. The spiral movement tends to overcome the pressure of the atmosphere, and also winds the membranes into a kind of rope, of so that they are less likely to be torn. It is by no means necessary to wait for a griping pain or two to effect the expulsion of the afterbirth. Indeed, the removal is better effected before the griping pains come on.
Application of the Binder The binder may be made of strong linen or sheeting, about the twelve inches wine and a yard and a half long, so as to include the whole of the abdomen, and overlap a little. It should be applied moderately firm, secured by patent pains, and readjusted as soon as it becomes loose. The binder is useful in two respects; it favours contraction of the uterus, and thus tends to obviate haemorrhage; it also aids the return of the abdomen to its former size, and prevents the conditions called “pendulous belly.” The binder should be kept on for a week or ten days. It is only proper to and that medial men are not agreed as to the necessity of the binder, for while some always apply it, others discard it entirely. As, however, it can scarcely do harm, if properly applied, and may prevent haemorrhage or uterine displacement, we recommend its application before the patient is left.
Immediately after Labour. The first few fours after the birth of the child should be essentially hours of repose. For an hour, at least, the patient should maintain the same posture as during labour, and be no more disturbed than is necessary to apply the binder, remove the soiled napkins, and render her as comfortable as the circumstances will permit. She may not on any account make the slightest exertion herself, or haemorrhage is very liable to occur. One or two hours after labour the tendency to haemorrhage is much reduced. A cup of hot tea, or a little warm arrowroot or gruel, may be given her; but except in extreme cases, or under the advice of a medical man, no brandy or other stimulant should be permitted. If the patient desires to pass water soon after labour, she should do so in a lying posture, but on no account sit up for that purpose, as dangerous haemorrhage might thus be occasioned. By good management and quietude for two or three hours, a little sound and refreshing sleep is usually obtained, and her exhausted energies are soon renewed. After this, should no untoward circumstance forbid, she may be changed and placed in bed, preserving the horizontal posture. As soon as the infant is dressed and the mother made comfortable, the child should be presented to the breast. By this means the nipple is most likely to assume the proper form, the flow of milk is facilitated, and the activity thus excited in the breasts tends, by reflex action, to promote vigorous uterine contraction, and considerably reduces the danger of secondary haemorrhage. As suggested in the Section on “Flooding,” the nurse should examine the napkins very frequently at first, to ascertain if there by any undue haemorrhage. The labour being thus completed, the window blind should be let down, noise shut out, conversation forbidden, and everything done to induce the patient to sleep, at the same time making due provision for good ventilation. As soon as the child is washed and dressed, the nurse only should remain in the room.
Arnica. In order to anticipate and prevent soreness as much as possible, it is well to administer Arnica internally, especially when the labour has been a hard and protracted one; a few drops of the 1x or 2x dilution, in half a tumbler of water; a desert- spoonful to be given every hour or two for three or four times. When the afterbirth has been expelled, Arnica may also be applied externally to the parts by wetting a napkin with Arnica lotion (twenty drops of the tincture to a tumbler of warm water), renewing the application as soon as may be required. If the patient liable to Erysipelas, Hamamelis lotion should be used in preference.
Coffea. Sleeplessness, nervous excitement, and restlessness.
Aconitum may be substituted for Coffea, and given in the same manner, should be feverish symptoms occur.