Philosophy of Osteopathy

by A. T. Still

But more than ninety per cent of all cases are of a very simple nature. The mother is warned by pains in back and womb, coming and repeating at intervals of one-half hour to less time. When by the finger the doctor can tell the mouth of the womb has opened to the size of a quarter or half dollar, he then may know that labor will soon start in good earnest, and at this time it is well to call for a twine, cut two strings about a foot long, to tie around the navel cord.

CAUTION.

The first duty of the obstetrician is to carefully examine the bones of the pelvis and spine of the mother, to ascertain if they are normal in shape and position. If there is any doubt about the spine and pelvis being in good condition for the passage of the head, through the bones, and you find pelvic deformity enough to prohibit the passage of the head, notify the parties of the danger in the case at once, and that you do not wish to take the responsibility alone, as it may require instruments to deliver the child, as there is danger of death to the child and mother also, but less danger to the mother than to the child. Now you have done that which is a safeguard against all trouble following criminal ignorance.

I will give you a condensed rule of procedure in all normal cases of obstetrics. With index finger, examine os uteri; if closed and only backache, have patient turn on right side, and press hand on abdomen above pelvis, and gently press or lift belly up just enough to allow blood to pass down and up pelvis and limbs. Relax all nerves of the pelvis at pubes.

SECOND EXAMINATION.

Caution: Wait a few hours; examine os again. If still closed and no periodical pains are present, you are safe to leave case in the hands of the nurse, instructed to send for you if regular pains return at intervals. On your return, explore os again, if found to open as large as a dime, you are by this notified that labor has begun its work of delivery. You now place patient on her back, propped to an easy angle of near thirty degrees, with rubber blanket in place. After you find os, dilated to nearly the size of a dollar, then relax nerves at pubes. Soon you will find in mouth of womb an egg-shaped pouch of water, which you must not press with fingers till very late in labor, for fear of stopping labor for perhaps many hours. Remember the head can and does turn in pelvis to suit the easiest passage through the bones, while in the fluids of the amniotic sack. Now, as you know why not to rupture sack and spill fluids, you are prepared to proceed to other duties, which are to prevent rupture of perineum. Place the left hand on the belly, about two inches above symphesis and push the soft parts down with the left hand; support the perineum with the right hand until head passes over. This is necessary to prevent rupture of perineum.

LASCERATION NEED NOT OCCUR.

If you follow this law of nature, lasceration may occur in one out of a thousand cases, and you will be to blame for that one, and may be censured for criminal ignorance. Now you have conducted head safely through pelvis and vagina to the world. You will find pains stop right short off for about a minute, which is the time to learn whether the navel cord is wrapped around the child's neck.

CARE OF CORD.

If it is found all around the neck once or more, you must slip finger down neck and loosen cord to let blood pass through the cord till next pain comes, in order to ward off asphyxia of child.