MANAGEMENT OF LABOR.
Women in general are ignorant of parturition or delivery. Almost all of them are under the impression that labor is completed more by art than nature; hence the most noted accoucheurs are employed to attend during this interesting period; and professional men, in general, have no wish to undeceive them on this subject, as their interest is too much concerned. It is often astonishing to see the credulity and ignorance manifested on these occasions. Thanks and blessings have been poured forth, under the idea that he had saved their lives in labor, when the accoucheur had merely looked on and admired the perfectly adequate powers of nature, and superintended the efforts of her work; and it is nature that accomplishes all, while the accoucheur gets the credit of it. There is not one case in a thousand in which he can do more than remain a silent spectator, except to calm the fears of the ignorant and timid attendants. The mischief and injury that are done by the untimely interference of art are incalculable.
In pregnancy women are bled till they have not strength enough to accomplish delivery; and, when it takes place, the forceps or other instruments are used, which often prove fatal to the mother or child, or both.
There are various particulars to be avoided, and several things to be done, in the management of women during labor. We have room here to state only a few, and shall begin by pointing out the course to be pursued in
Natural Labor.
When called to a woman supposed to be in labor, ascertain if her pains are true or false, which may be easily known by a little inquiry. If the female complains of flying or unsettled pains about the system, occurring mostly toward evening or during the night, and being slight or irregular, it may be taken for granted that they are spurious or false. If these symptoms prove troublesome, an infusion or tea of hops may be taken; or, if this is not sufficient to relieve them, or procure sleep, an anodyne may be taken; and it may be necessary also to give laxative medicines or an injection, with a little laudanum.
True pains may be known by the pain being more concentrated in the lower part of the belly, through the loins and hips.
The pains now increase in regularity and force, returning every ten or fifteen minutes, and leaving the woman comparatively easy in the intervals.
When the pains become regular and severe, there is a discharge of slimy matter, tinged with blood, known by the name of shows. At this period of labor it will be proper for the person who attends the labor to examine, in order to ascertain what part of the child presents, which may be done by requesting the female to sit in the chair or on the side of the bed, and to extend the legs, when the longest finger, dipped in sweet oil, may be passed up the vagina to the part which presents, and the sense communicated will determine the nature of the presentation. In nineteen cases out of twenty, or in almost every case, the head will be felt. Frequent examinations should be avoided.
Dr. Bard, speaking of examinations, remarks: “What terms shall I use to condemn, as it deserves, the abominable practice of boring, scooping, and stretching the soft parts of the mother, under the preposterous idea of making room for the child to pass. It is impossible to censure this dangerous practice too severely; it is always wrong; nor can there be any one period in labor, the most easy and natural, the most tedious and difficult, the most regular or preternatural in which it can be of the least use; in which it will not unavoidably do great mischief: it will render an easy labor painful; one which would be short, tedious; and one which, if left to nature, would terminate happily, highly dangerous.”
“All that is proper to be done in a case of natural labor, from its commencement to its termination,” says Dr. McNair, “will suggest itself to any person of common understanding; and I have long labored under the conviction, that the office of attending women in their confinement should be intrusted to prudent females. There is not, according to my experience, and the reports of the most eminent surgeons, more than one case in three thousand that requires the least assistance. I am aware, however, that there are crafty physicians who attempt, and often succeed, in causing the distressed and alarmed female to believe that it would be altogether impossible for her to get over her troubles without their assistance; and, for the purpose of making it appear that their services are absolutely necessary, they will be continually interfering, sometimes with their instruments, when there is not the least occasion for it. There is no doubt in my mind but that one-half of the women attended by these men are delivered before their proper period; and this is the reason why we see so many deformed children, and meet with so many females who have incurable complaints.”
It is a very common circumstance for an inexperienced (or he may be an experienced, but ignorant) practitioner to attempt a rupture of the membranes, and in doing so, rupture the bladder, which would render the woman miserable during life. We are acquainted with twenty-five or thirty females who have met with this sad misfortune, and many of them have been attended by those who are termed our most successful, or old experienced physicians.
Dr. Rush, speaking of child-bearing among the Indians, says, “that nature is their only midwife; their labors are short and accompanied with little pain; each woman is delivered in a private cabin, without so much as one of her own sex to attend her: after washing herself in cold water, she returns in a few days to her usual employment; so that she knows nothing of those accidents which proceed from the carelessness or ill management of midwives or doctors, or the weakness which arises from a month’s confinement in a warm room.”
Dr. Whitney remarks; “I have had many cases where I found the attendants alarmed, and some in tears, from supposing that they should have had help sooner, fearing the worst consequence from delay; but, admitting that the ‘doctor knew best,’ they would wait calmly for hours, when in nature’s time all ended well. I pledge myself as a physician, that all honest doctors will tell you that labor is the work of nature, and she generally does it best when left to herself.”[[48]]
“Among the Araucanian Indians,” says Stevenson in his Twenty Years’ Residence in South America, “a mother, immediately on her delivery, takes her child, and going down to the nearest stream, washes herself and it, and returns to the usual labor of her station.”
“The wonderful facility with which the Indian women bring forth their children,” say Lewis and Clark in their well known journal, “seems rather some benevolent gift of nature, in exempting them from pains which their savage state would render doubly grievous, than any result of habit. One of the women who had been leading two of our pack horses, halted at a rivulet about a mile behind, and sent on the two horses by a female friend. On enquiring of one of the Indian men the cause of her detention, he answered, with great appearance of unconcern, that she had just stopped to lie in, and would soon overtake us. In fact, we were astonished to see her in about an hour’s time come on with her new-born infant, and pass us on her way to the camp, apparently in perfect health.”
Washington Irving, in his work entitled Astoria, relates a similar incident in the following language: “The squaw of Pierre Dorion (who, with her husband, was attached to a party travelling over the Rocky Mountains in winter-time, the ground being covered with several feet of snow) was suddenly taken in labor, and enriched her husband with another child. As the fortitude and good conduct of the woman had gained for her the good will of the party, her situation caused concern and perplexity. Pierre, however, treated the matter as an occurrence that could soon be arranged, and need cause no delay. He remained by his wife in the camp, with his other children and his horse, and promised soon to rejoin the main body on their march. In the course of the following morning the Dorion family made its appearance. Pierre came trudging in advance, followed by his valued, though skeleton steed, on which was mounted his squaw with the new-born infant in her arms, and her boy of two years old wrapped in a blanket, and slung on her side. The mother looked as unconcerned as if nothing had happened to her; so easy is nature in her operations in the wilderness, when free from the enfeebling refinements of luxury and the tampering appliances of art.”
When it has been ascertained that the labor is natural, or that there are no impediments or obstacles, there will be very little more to do than superintend the process. It will be necessary to give instructions to the attendants to make suitable preparation, or have everything required in readiness.
The woman may be delivered upon a bed or a cot, as is most convenient; if a bed be used, all but the mattress should be turned back toward the head, and it should be so prepared that the moisture from the uterus and other discharges may not add to the discomfort of the woman. A dressed skin, oilcloth, or folded blanket may be placed on that part of the mattress on which the body of the woman is to rest; a coarse blanket folded within a sheet, ought to be laid immediately beneath the patient, to absorb the moisture, which must be removed after delivery; the rest of the bed-clothes are to be put on in the ordinary way. The woman, when she is no longer able to remain up may lie down, with her head elevated in any position which is most desirable; and in nearly every case that I have ever attended the back has been preferred, although most all writers recommend that the woman be placed upon her side: the latter practice is unnatural and wrong, for obvious reasons; it retards the labor pains, and prevents the midwife from superintending the progress of the labor; the pillow that is directed to be placed between the knees, to keep them widely separated, soon gets displaced by the motion or change of the female; and the legs, instead of being kept apart, again come in contact, and thus the passage of the child is obstructed: but when the female is placed upon her back this difficulty is obviated, a free passage is permitted, the pains are more effectual, the spine is better supported, and better access can be had to the parts during labor and after the delivery of the child; in short, there is a decided advantage in this position in every respect.
The dress of women in labor should be light and simple, both to keep themselves from being overheated, and to prevent anything from being in the way of what assistance is necessary. In addition to the means recommended, I direct a sheet to be placed around the waist of the woman, to prevent the blood, excrements or waters from coming in contact with the linen or clothes, and, as much as possible, the bed; her linen may be tucked or pushed up so far that there will be no necessity of a removal after delivery.
Every thing being thus adjusted, very little more will be necessary but to wait patiently the efforts and operations of nature. There should be but few attendants in the room, and these are not to whisper to each other, or to express any fears or doubts.
A humane midwife will use every ingenious effort in her power to quiet the useless fears, and support and comfort the patient. A crowd of frightened, hysterical women, assailing the ears of the woman with tales of woe and sad disasters that have happened should be admonished. Half a dozen midwives, each making pretensions to great skill, ambition, and competition for obstetric fame, assembled around a feeble woman when labor is of a lingering character, is always an unfortunate circumstance, and it would be much better if nearly every one were afar off.
When the pains become very severe, quickly succeeding each other, the midwife, or the person who officiates, may sit by the side of the woman, and, upon every severe pain, may keep her hand upon the parts, even though no manner of assistance can be afforded, and occasionally, when the head of the child presses hard, it may be gently touched or pressed with the longest finger, in order to ascertain the parts that prevent the progress of labor, as well as to be able to give from time to time suitable encouragement: not only so; in the last stage of labor the hand may be kept near the parts, to know the moment when the head of the child presents, as some little assistance at this time is called for; but not by supporting the perinæum, as some advise, but,
First. To remove any obstruction which often arises from the clothes.
Second. To support the child in its passage, and in the interval of pains; and to keep the head from pitching downward, and thus obstructing the labor.
Third. To detach the umbilical cord or navel-string from the neck when it encircles it, as is often the case, and which endangers the life of the child.
Fourth. To deliver the woman in case of hemorrhage or great flooding; but at the same time there must be no further interference of art; little or nothing can be done toward facilitating the delivery of the child, except when a large bag or collection of water presents and opposes, when it may be ruptured with the longest finger, which often affords much aid, although such is the ignorance and credulity of some women, that they suppose almost everything to be accomplished by art. Physicians or midwives who watch only the process of labor, and do little or nothing, are pronounced inhuman and cruel, and perhaps ignorant, because they are honest in not interfering with the simple and beautiful process of labor, or in other words, for relying upon the great resources of nature: but such is the fashion and credulity of mankind, or rather womankind, that physicians are obliged to take the advantage of such ignorance and credulity, and regulate their proceedings accordingly. We have often been obliged to stand for hours over a woman, under pretence of aiding delivery, when, in reality, we did nothing at all. The labor would have progressed just as well had we been out of the room; but this deception we have been obliged to practise, in order to satisfy ignorant, gossiping, or crying attendants. When the woman is disposed to make much noise, she should be directed to hold her breath during the pains, and aid or assist them by pressing downward as much as possible. The feet may press against the bed-post, and the woman take hold of a handkerchief and pull when a pain occurs; or she may grasp the hand of an assistant for that purpose. Sometimes, from various causes, labor is very much retarded, from rigidity of the parts, the situation of the child, debility, &c.; when this occurs, and labor is tedious and protracted, our reliance must still be upon the powers of nature. We may, however, aid her efforts, by warm fomentations of bitter herbs, often applied to the lower part of the belly, which will prove relaxing, and will facilitate the labor; warm diluent drinks may also be given, such as tansy, pennyroyal, &c.
If the labor still continues stationary, we have nothing to fear, provided there is a right presentation; but should the pains become feeble or lessened from flooding, debility, or any cause, or should they prove unavailable, after a reasonable length of time, a drachm of spurred rye or ergot may be put into a tea-cup, and a gill of boiling water poured upon it, and, when cool, a tablespoonful given every fifteen minutes. This will increase the pains, and speedily accomplish a delivery; but it should be very seldom, or never, used, except when there is a right presentation, and under the most urgent circumstances.
It is prudent, by judicious precaution and care, to remove obstructions, prevent accidents by holding or supporting the child in a proper position, and giving such aid as reason and judgment will dictate. Receiving the child, preventing its fall, securing the navel cord, assisting in the removal and disposal of the after-birth, are objects which are to be accomplished, and all in the most calm and simple manner; no hurry or excitement is necessary, but, on the contrary, they embarrass. Yet how common is it that females in general, married and unmarried, are so uninformed and ignorant, that, instead of attending to those duties, if necessary, or in cases of emergency, they are thrown into the greatest consternation, and perhaps run out of the room and let the child suffocate by the bed-clothes, or by the navel cord twisted about the neck, and die merely for the want of a little common sense and knowledge, which might be acquired in an hour. Is it not highly disgraceful, if not criminal, that farmers can, and do, attend to those duties toward their stock, and yet remain entirely ignorant of them toward their nearest relations? Young women and men are taught music, dancing, drawing, needle-work, and many ornamental branches considered so essential to a polite education; yet they are suffered to remain entirely ignorant on a subject of so much vital importance. Is there any hope or prospect of enlightening this generation, or must it be delayed till the next, and have them look back with amazement at our ignorance? We hope there is something yet redeeming in a large proportion of the community; that the people will yet awake to their own interests.
When the head is delivered, all that is necessary to do is, to support it, and wait for the pains to expel the child; except it seems livid and in danger of injury, or when the cord is twisted around the neck, when assistance must be rendered, to accomplish the delivery. The face of the child must now be turned upward, and the cord freed from the neck or body; the person who assists will pass a narrow piece of tape around the cord or navel-string, about an inch from the body, and tie as tight as it can be drawn, otherwise hemorrhage or bleeding will take place; and another must be tied at a little distance from it, above, and be separated between them with a pair of scissors. The child is then to be given to the nurse, to be washed, dried, and dressed. The woman must now be covered, and directed to lie quiet.
The After-birth.—The after-birth or placenta must be detached or removed, if nature does not accomplish it in a short time. Generally, after about twenty or thirty minutes, a pain is felt, which may be sufficient to expel it; if it should not, and should there be no pain, gentle manual attempts may be made to remove it.
The head and breast may be elevated, and the cord taken hold of by the left hand: the two first fingers may be carefully introduced into the vagina, and the anterior or forepart of the placenta or after-birth held in this situation for some minutes, in order to excite a contraction of the uterus. The woman may now be directed to hold her breath and press down, which forces it forward; and at the same time a little extension may be made upon the cord with the left hand, while extension is made upon the after-birth with the right; this will almost invariably extract it in a few minutes. If from any cause it should not, no farther attempts must be made for the present, but left for a few hours, when, if the natural contractions of the uterus do not remove it, it must be done in the manner recommended, with this difference, that a little more force be used. In the interval, however, everything wet must be taken away.
Subsequent Treatment.—After the labour has been thus completed, if the woman is not too weak, assistants may raise her up, and seat her upon the side of the bed or cot, while another removes all the wet clothing from the patient and her bed, and with a little warm spirits washes off the blood, water, &c., that remain on her person. This is particularly necessary, as the omission of it may give rise to puerperal fever. We know not that others have practised this method; but we have found it conducive to the comfort as well as the health of the patient. Some practitioners will not suffer the woman to be removed from the situation in which she has been delivered under twelve or twenty-four hours, for fear of hemorrhage or flooding; but this is a great and dangerous error. It is impossible to tell what mischief may arise in consequence of suffering her to remain drenched in water and blood for this length of time.
After these precautions have been observed, and the bed properly prepared, on which has been placed folded blankets, skin, or oilcloth, covered with a warm sheet, she may be laid down, and a diaper or suitable piece of muslin laid to the parts to absorb the lochial discharges. A bandage may be also placed around the abdomen or belly, and made moderately tight, but not so as to render her uncomfortable. A large tub, previously well dried, may be placed by the side of the bed, and the woman directed to place her feet in it, and, when she is lifted up, everything that is around her wet to be passed into it. It prevents the necessity of afterward washing the floor and carpet, which might prove injurious by causing a check to perspiration.
Preternatural labor, or cross-births, are those in which some other part than the head presents. We cannot in general assign any reason for such occurrences, nor can the woman, by any sensation of her own, be assured that the presentation is unusual. Apprehensions of this kind should not be indulged in. If the feet or breech present, the delivery is to be accomplished by properly accommodating the position of the child to the capacity of the pelvis, but no force should be employed; and though there is always some risk to the life of the infant, yet there is none to the mother. If the arm, shoulder, or sides of the child present, the delivery is not impossible, but difficult, until the infant be turned and the feet, brought down into the passage. This is an operation which may be done with comparative ease and safety, if the wrong position of the infant be discovered before the waters are discharged; but other wise both mother and child are in considerable danger, though there is often a spontaneous evolution, and delivery is effected. The womb closely contracting round the body of the infant when the water is drained away, and being soft and spongy in its texture, it is liable to be torn if much force be employed, and then either the child may escape into the cavity of the belly, or, if it be extracted by the feet, blood may be effused from the womb into that cavity, and such injury be done as to prove fatal. Women too frequently add to the danger of the operation of turning, by their restlessness and impatience; they should remember how much is at stake, and exert all their fortitude, so as not to embarrass the practitioner.
The labor having been thus accomplished, it will be necessary to guard against any subsequent symptoms which may occur or take place.
In tedious and very difficult labors, and where common physicians use the lancet, the hot bath will be found of extraordinary benefit in facilitating labor, by its relaxing the system without debility; altogether better than bleeding. First apply spirits, water, and salt to the head; then let the woman continue in the bath about fifteen minutes.
Still-born Infants.—This occurs from difficult labors, or the cord encircling the neck; or a membrane may cover the head or body. When anything of the kind occurs, the membrane should be immediately removed. If no signs of life appear, the infant may be put into the warm bath, and the mouth and body wiped dry. A little cold water may be dashed into the face, the lungs inflated by some person, and a slight motion made upon the chest in imitation of breathing. The navel-string may be permitted to bleed a little.