In 96 per cent. of all cases, the head of the child is the presenting part. At first the long diameter of the head is in the oblique diameter of the pelvis; as it passes the pelvic brim, it turns so as to lie across from back to front, the chin pressing upon the breast, and the crown of the head advancing. The first pains are grinding, scattered and irregular, felt mostly in the anterior portion of the pelvis and groin. With these, dilatation of the os progresses, which is often accompanied by severe sufferings, especially when diseased conditions exist. Afterward the pains are in the abdomen. As the head advances there is great suffering in back, hips and groin, with a disposition to bear down.
This disposition need never be urged by attendant, nor forced by the patient. Old ladies often say, “Bear down! make an effort!” supposing that this will facilitate labor. The fact is that these attempts to assist nature are retarding instead of helpful, and are often the cause of accidents. Nature indicates all effort essential to progress.
The bag of waters consists of the membranes which enclose the fetus and liquor-amnii.
Protruding through the os, when dilatation is effected, it precedes the head, prepares the way for it, and lessens the liability of contusion of the soft parts. These membranes usually rupture with an expulsive effort, before the close of the labor. The uterus then contracts firmly on the body of the child, and labor advances rapidly to completion. In rapid labor, however, the bag is sometimes expelled entire with the child.
The physician requires the assistance of but one attendant besides the husband. This should be an educated nurse or a friend, who can command herself in emergencies. The old time custom of having a neighborhood party on the occasion of an increase of the family, has happily gone out of date.
When this custom was in vogue both patient and physician were often seriously annoyed by the crowd of neighbors who thronged the house. Many times the grand “set out” for the table was so expensive as to take the whole month’s salary of the working man, while perhaps the “doctor’s bill” remained long unpaid.
Conversation should be cheery and foreign to the occasion. Obscene anecdotes and direful childbirth experiences should be avoided. During the entire process of parturition, the patient should have the advantage of pleasant, comfortable and sanative surroundings. Her mind should be free from care and anxiety. The best in the house should be appropriated to her use. Her room should be light and airy.
Every necessity and convenience should be in readiness for the occasion. Provide two yards of rubber cloth for protecting the bed, a fountain syringe, a hot water bottle, safety pins, antiseptic absorbent cotton, glycerine, arnica, ammonia, carbolic and castile soap, calenduline, olive oil, and cosmoline. Also have an abundant supply of soft rags. They should be large and clean. Remove the seams and buttons. Old sheets torn in quarters or pillow slips are the most desirable.
Make the bed as if one were going to sleep in it. Place the rubber cloth over the under sheet. Cover it with an old quilt or comfort that will wash easily. Have the bed set out from the wall so that both sides can be used. Prepare the side for the patient that will enable the physician to use the right hand.
Let the patient wear the garments she desires to have on after confinement, having care to protect them by folding back smoothly, and fastening a sheet loosely about the waist. After labor begins, she should take only liquid food. The bladder should be relieved frequently. If the bowels have not been moved within twenty-four hours, a copious enema of warm water should be taken.