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.