Until the last stage, the patient can assume any position affording the most comfort. Usually, she is inclined to change frequently, sitting, lying, walking and even kneeling. When expulsive efforts occur, she ordinarily prefers to recline upon her back, with knees flexed and hips elevated. At this time, she naturally pushes with her feet, and pulls with her hands. A padded box should be firmly fixed at the foot of the bed for the feet. She can grasp the hand of an assistant, or have some reliable mechanical contrivance for her hands. The simplest is a strip of new muslin, ten inches wide, put around the foot of the bed, and tied, leaving it the desired length for a good purchase. In a prolonged labor, the obstetric harness is the most valuable assistance. This is a padded belt for the back, with straps extending to the knees and feet. From the knees are counter straps, with handles for the hands. With this simple contrivance, a physician requires less assistance.
Supporting the perineum is not only absolutely unnecessary, but also apt to be exceedingly injurious. Meddlesome midwifery is always to be deprecated. A natural labor needs no manual local interference. Although many authors and teachers recommend support to the perineum in the last stages, yet more ruptures may be attributed to this practice than to leaving it entirely untouched. A Canadian physician asserts that he has attended 1,700 women in confinement without giving support to the perineum, and yet in no case did rupture occur.
When the head is born receive it in the hand and support it until the shoulders are expelled. If the next contraction does not bring them, put a finger in the axilla of the child, and make slight traction. The whole body will soon be born. Pass both hands under the child and lay it as far from the mother as possible without stretching the cord. Place it upon the right side, shoulders and head slightly elevated. Wipe any mucus there may be from mouth and nostrils. Cover baby with a warm, soft flannel. Make the mother comfortable. Change her position, straighten the bed, put dry cloths to her, give her a drink, etc., leaving the infant until the pulsation has entirely ceased in the cord. This will require from ten minutes to half an hour.
Usually, as the child is ushered into the world, it sets up a lusty cry, indicating that respiration is established. Crying is not essential, as some authors claim, and the prompt covering usually causes it to desist. If it does not breathe at once, a little brisk spatting on the breast and thigh may establish respiration. If this is not effectual, dash cold water in the face and on the chest. Still failing, artificial respiration must be established. To do this, close the nostrils with two fingers, blow into the mouth, and then expel the air from the lungs by gentle pressure upon the chest. Continue this as long as any hope of life remains.
Sever the cord when pulsation has entirely ceased in it. Use a dull pair of scissors, cutting about two inches from the child’s navel. Following these directions, no tying is essential. This method has its advantages. By tying, a small amount of blood is retained in vessels peculiar to fetal life. This blood by pressure or irritation may prevent perfect closure of the foramen ovale, and be a cause of hemorrhage. Besides, it must be absorbed in the system, causing jaundice and aphtha, so common in young babes. Prejudices exist against adopting this treatment, as it is contrary to that usually adopted.
I first heard of this manner of treating the cord in 1870. It was so clearly explained that I was convinced that leaving the cord untied would result in great gain to the child. Still, my education and habit had been to the contrary, and my prejudices prevented my venturing upon the new method. A few years after this I met a German physician who had not tied a cord in eighteen years. He said: “Don’t be afraid; your babies will do better, and there is less danger of losing them.” I tested it and proved to my own satisfaction that it is the best method. One has only to recollect to wait until the pulsation in the cord ceases entirely, and sever as before stated.
By no means wash and dress the baby as soon as it is born. Consider the marvelous change that has taken place in all its functions. Respiration is established and the blood, instead of going to the placenta for oxygenation, goes to the lungs; the stomach and all the organs of digestion and elimination are brought into action; the skin, also, with its innumerable perspiratory ducts, begins its work. Give nature time to establish these processes before the system is taxed by being washed and dressed. An Indian papoose might be plunged into water at once without detriment, but no white baby of this country has sufficient vitality to safely undergo this shock. Rub the baby all over with olive oil, cover warmly, and leave it to rest and sleep.
While the baby is resting the mother demands especial attention. Contractions of the uterus will soon be renewed to expel the placenta. Usually these do not recur for half an hour, and it may be two hours before the after-birth is expelled. Should there be no hemorrhage and the walls of the uterus contract, there is no cause for uneasiness.
For expelling the placenta contractions can be induced by laying upon the bowels cloths wrung from cold water, or by manipulating the abdomen after dipping the hands in cold water. Also, the patient may blow into her closed hand, or give a slight cough. If there is hemorrhage, the vein of the umbilical cord should be injected with cold water. This, in many cases, removes a retained placenta. This valuable suggestion is a fact unknown to many practitioners. The placenta does not adhere as often as some suppose. If attached there is seldom danger from delay in removal, unless there is hemorrhage. After it is expelled it should be burned or buried.
The mother must be bathed in tepid water, sponging carefully her back, abdomen, thighs and perineum. Lay a cloth to the vulva wrung from a lotion of arnica, one tablespoonful to a quart of water. If there is soreness in the pelvic region a compress wet in the same lotion can be worn.