29 Jonathan 17 Pascal 5 Charity
30 David 18 Sibyl 6 Eustace
31 Sylvester 19 Duustan 7 Watkyn
PART III [Chapter 3]
DELIVERY I PURPOSELY do not intend to enter minutely upon this subject, as the treatment of every lady, at such a period, should be regulated by her own medical adviser. It is, however, when rationally considered, a healthful and natural process. It should, provided the previous admonitions have been attended to, be productive of no more evil than any other constitutional relief.
It is, when properly and morally considered, the natural consequence of matrimony, and should by rights create no more danger than any other of the ordinations under which humanity exists.
It is however, often made the reverse by months of pondering over an approaching and dreadful crisis, by the officious advice of well-intentioned friends, by the crowding together of busy females, who love to flock around a fellow-creature at the very time when her condition implores for silence and a sufficiency of fresh air.
I do not mean to assert that a lady, in the hour of her agony, should be left alone and permitted to endure her pains in solitude. I am very far from recommending such a course to be pursued; but I should certainly discountenance the admission of all who are not absolutely necessary to the comfort of the patient. The feelings should, in these matters, be respected. The husband should be by her side when his presence can confer confidence on his wife; the doctor should be admitted as often as the patient may desire his presence. In these matters, the feelings of the person principally concerned alone should regulate the behaviour of those around her.
From disregarding the above maxim, too many a midwifery case has terminated fatally. Everything depends upon keeping up the spirits of the patient; anything like the enforcement of petty rules, trivial conventionalities, or supposed specifics, is equally wrong, and in many cases dangerous.
A lady, at such a time, is not precisely mistress of herself; but she is not in a condition to be subjected to the indulgences of whims and fancies. She is suffering under the strong wrench of animal nature, and will desire which does not appeal to her condition. Let her alone, and be content simply to humour the promptings of her will; for in thus acting-always supposing obedience to be regulated by reason-you will secure the probable safety of both mother and child.
Above all things, let me counsel a lady not to look into anything approaching to a midwifery-book: such works necessarily treat largely of morbid cases, and consequently fill the mind with bad anticipations. The lady thus prepared meets her dangers ready to fancy all manner of contingencies. She imagines such a pain must be indicative of such or such an accident; and thus unconsciously she fills her mind with vain and perilous conjectures at the time when an unclouded brain is so essential to her healthful relief.
Another caution I have to give to such patients is, to avoid the companionship of those very sage women who love to flock around and to alarm a lady when in what the world generally terms “a delicate condition”. Such people generally have at their fingers’ ends a ready list of nostrums, which, if not highly injurious, are never really beneficial, and therefore do injury by taxing the resolution, or wasting the energy, of the party principally concerned.
Such persons are to be avoided; so likewise are those aged people who are too often spoken of with commendation as experienced nurses. A woman much past the prime of life, cannot be fully equal to the fatigues and anxieties attendant upon the lying-in chamber. As years advance, so do the senses become blunted. The mind rather grows reflective than acutely alive to outward objects. I have known a matron of seventy years old sleep soundly in her easy chair, while the enfeebled new mother endeavoured in vain, by such noises as her shattered strength was equal to, to disturb the snoring slumberer. This want of vigilant attendance retards recovery; since nothing is more common than for ladies to suffer under a sense of faintness, which incapacitates them from calling loudly for assistance. Haemorrhage may then be taking place; when, if aid be not ready and energetic, life may be lost from excessive depletion. Moreover, there is such a thing at this peculiar time, when the slightest exertion is frequently attended with danger, as the limbs becoming cramped, or the position of the body requiring to be changed.
Besides these things, there are many occasions when help is necessary.
For my own part, I prefer a middle-aged and healthy woman as a nurse. I care not for her learning, so that she be blest with a quick comprehension and a feeling heart. The old stereotyped phrases of-pull at the towel, hold your breath, drink a little warm tea, etc.-by diverting the attention from the real requirements of the patient, are calculated to effect serious mischief. An attendant, on such an occasion, requires to do little more than any attentive female would of herself suggest. She must, however, be quick at interpreting signs; for frequently, after parturition there is almost an invincible disinclination to exert the voice.
Another great objection to the selection of elderly women, is the prejudice such females generally entertain in favour of brandy and other stimulants. They will allow the chamber to be wanting in every other necessary till the one which they esteem is abundantly supplied. Moreover, such people have a maxim which they insidiously inculcate to the lady committed to their charge- that “the doctor need not know everything.” And I have, in more instances than one, had to counteract feverish symptoms which I was morally convinced had arisen from the evil and injudicious administration of spirituous liquors.
When writing the above, I do not mean to assert that the common treatment adopted in such cases is entirely free from blame. It is too generally thought imperative to advise a diet, after parturition, which cannot restore the strength, but may foster a prolonged debility. Gruel, not “porridge,” stands low in the scale of dietetics. It will not restore the strength; it will not revive an exhausted frame; but in cases where fever threatens, it may be the most appropriate form of nourishment. But I knew one case where the medical man used to quit the chamber, leaving directions for a basin of gruel and a sound sleep to be taken directly: and the lady, immediately on being left to herself, used to enjoy a glass of porter and a mutton chop. This imposition went on for years; nor was the gentleman, so far as I am aware, even conscious that his directions were not literally fulfilled.
Experience has taught me that such violations of strict orders are by no means uncommon; consequently I esteem it to be the better practice, in these cases, to leave the promptings of nature as much as possible to the discretion of the patient, rather than encumber a sick room with a quantity of impotent formula.
The lady is but too often surrounded by those who are too happy to violate small commands.
The doctor, however much his aid may be sought in particular moments, is never, in the long run, cheerfully submitted to; and his mandates or commands may be respectfully listened to, only to be disobeyed on his departure.
It is usual to speak very learnedly of the nervous shock; but this term implies no more than can be conveyed by a fashionable slang. It is customary, at the present day, for medical men to attribute every effect and consequence to the nervous system. Unfortunately, many ladies have died in confinement; and the most careful dissection has been unable to discover any particular derangement, either with the nerves, their centres, or their source.
It requires no particular phase to account for that sense of exhaustion which is consequent upon the loss of so large a portion of the living body of the mother. The child, previous to birth, is nourished by the same vital stream which sustains the parent. If one dies, the other must perish or suffer: they are so closely united, that no violent emotion can disturb the parent, without violently endangering the existence of the being which lives within her.
That the violent separation of the two should be attended with a sense of exhaustion-that an act which employs all the strength, and taxes all the endurance of the frame-that the birth, which may be protracted for hours, and even days and nights, should not leave a lady in a fit condition for an evening party-is surely no legitimate cause for wonder. Neither does it require any particular phraseology to account for so evident a sequence.
Much, however, of this natural effect may be the judicious administration of chloroform.
I do not, as a rule, approve of the production of total insensibility by means of this anaesthetic agent. To administer its fumes to this point will require more scientific assistance than the accoucheur can generally command in the lying-in chamber. But the exhibition of chloroform to that point which shall deaden the pain and blunt the pangs of labour is certainly most advisable.