MEDICINAL TREATMENT. So long as labour is progressing naturally and satisfactorily, the less is interfered with in any way, so much the better will it be for the patient’s comfort and recovery; but now and again cases are met with which require one or other of the following remedies to modify the course of the labour, or to remove some annoying or painful symptom: Aconite, Belladonna, Caulophyllum, Cim., Gelsemium, puls., Secale.
LEADING INDICATIONS FOR THESE REMEDIES.
Aconitum. Feverishness, palpitation, etc.
Belladonna. Flushed face, throbbing headache, confusion of ideas; a tendency; to wander may occur; or there may be convulsive movements, sensitiveness to noise, light, etc.
Caulophyllum. As a uterine excitant.
Cimicifuga. Spasmodic, painful, too violent, intermitting pains, sometimes with cramp in the limbs, and a tendency to general convulsions; also nervous irritability and dejection.
Coffea. Excessively violent pains, with restlessness and great mental depression and nervous excitement.
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.
Pulsatilla. Irregularity, uncertain, and fitful pains, confined chiefly to the back.
ADMINISTRATION. A dose every fifteen, twenty, or thirty minutes, as required. If no relief follows the third dose, another medicine may be chosen.
ACCESSORY MEANS. When the pains are flagging friction, with moderate, well-directed pressure over the abdomen, often stimulates the womb to increased activity. The pressure should be exerted until the placenta is detached.
CHLOROFORM IN LABOUR. A natural labour is best, and its attendant pains should be patiently borne, especially when all is going on well. Chloroform is probably less frequently used now than it was a few years ago; still, with proper precautions, it is often a great blessing to those who are undergoing the “perils of childbirth.” It may slightly retard parturition by somewhat weakening, or rendering less frequent, uterine contraction; still a lady may be delivered naturally under its influence. It is unattended with danger to the child, or tend to the production of Puerperal Mania. The pulse and the respiration furnish reliable indications as to the extent to which it may be carried, and the length of time the inhalation may be continued. When requested by a patient to administer it, and no objection to its use exists, the author never hesitates to do so. It should not, however, be administered except by the sanction and under the care of a qualified medical man. It may be given by pouring a sufficient quantity into a tumbler, and letting the patient inhale it in small doses, well diluted with atmospheric air, when the stomach is empty. One or two minutes’ inhalation is generally necessary to effect a sensible diminution of the pain; its administration should be commenced when the dilation pains of the first stage of labour are past, and have been succeeded by the forcing, expulsive pains of the second stage. It should he inhaled just as a pain comes on, and he discontinued directly it goes off, or ceases to be felt. Unless during instrumental delivery, the patient need not be made entirely unconscious by it. Talking in the room should not be allowed while she is inhaling the chloroform. Her head should not be raised, and she should not be allowed to sit up in bed for some hours after its administration.
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.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."