Fig. 75.—Patient draped for vaginal examination; vulva covered with sterile towel. (From photograph taken at Johns Hopkins Hospital.)
After the surrounding areas have been prepared, the labia are separated and the inner surfaces scrubbed, first across, then from above downward, and flushed by pouring the solution directly between the folds. After the patient has been given this preparation, a dry sterile towel or pad is placed over the vulva; the douche pan is removed, the back and hips are dried, after which the patient is so draped with a clean sheet that only the perineal region is exposed, and a sterile towel is slipped under the buttocks. (Fig. [75].)
To summarize the preparation for vaginal examination or delivery:
1. Trim nails and scrub hands with soap and hot water. 2. Shave vulva. 3. Scrub and soak hands. 4. Scrub vulva, inner surface of thighs and lower abdomen with green soap and sterile water, alcohol, 70%, and lastly bichloride 1–1000 or lysol 1% or 2%, using sterile sponges and taking care not to contaminate vulva from surrounding fields. 5. Cover vulva with sterile towel or pad.
This may be taken as a description of a fairly typical method of preparing a patient for vaginal examination or for delivery, which is widely employed and with satisfactory results. But it is by no means the only satisfactory procedure, for many other and different methods of preparation also are followed by excellent results, as measured by the patient’s temperature during the puerperium.
The details of preparation vary so greatly, even among different doctors in the same hospital, that the nurse will simply have to bear in mind the general principles of asepsis and antisepsis, and adjust herself to the practices of the individual doctor. And she must remember that in spite of the best planning, there will be emergencies and precipitate labors, when the preparation will necessarily be modified, and sometimes so curtailed that even the bath and enema are omitted.
But in all cases the nurse can, and must, bear in mind that on one point there is virtually no difference of opinion among obstetricians of to-day; and that is the imperative necessity of having everything sterile that is brought to the perineal region or used in any way in connection with the delivery, or as nearly sterile as is possible under the circumstances.
By many doctors this is considered the most important factor, as to surgical cleanliness, in the entire preparation. In their opinion the local preparation of the patient may, with safety, be restricted to clipping the pubic hairs (instead of shaving), and scrubbing the vulva with only soap and water. But these doctors believe at the same time that the patient is dangerously susceptible to infection which may be conveyed to her from without, and accordingly they do not permit vaginal examinations to be made during labor, and make the most exacting demands concerning the maintenance of perfect surgical technique, by all who assist with the delivery.
