Fig. 76.—Wrong and right methods of boiling gloves. Note that gloves in basin at the left are partly above the surface of the water and therefore will not be sterilized. Those in basin at the right are kept below the surface by the weight of the towel and will be sterilized by the boiling water.
In this connection, much depends upon the actual sterilization of the rubber gloves, either by boiling or by steam under pressure; and the method of putting on the gloves, in order that once having been sterilized, they may be kept so. It is useless to attempt to sterilize gloves by boiling, if they are thrown loosely into a kettle of water. There will practically always be enough air in the fingers to keep at least a part of the gloves out of the water, and consequently unaffected by its heat. They should be put into a covered wire basket that will be entirely submerged, or they may be wrapped in a towel, the weight of which will carry them below the surface of the water (Fig. [76]), and insure their being completely covered while boiling, which should continue for ten to fifteen minutes. The doctor will usually want boiled gloves placed in a large basin of bichlorid solution, 1–1,000, or lysol 2 per cent., from which he may remove them after scrubbing his hands. If dry gloves are used, there should be in readiness a sterile towel and powder with which to dry and powder the hands before putting on the gloves. (Fig. [77].)
Fig. 77.—Powdering hands before putting on dry gloves. (From photograph taken at the Brooklyn Hospital.)
Whether boiled or steamed, the cuffs of the gloves should first be turned up toward the hand, to make it possible to put them on without touching the glove fingers with ungloved hands. (Fig. [78].) For no matter how long and carefully the hands are scrubbed and soaked, they cannot be made absolutely sterile, and therefore, in relation to the gloves which are sterile, the bare hands must always be regarded as unclean. Too much thought and attention cannot be given to the sterilization and handling of the gloves, for the patient’s very life may depend upon their aseptic condition.
After the doctor has seen the patient, the nurse will make observations and communicate with him in accordance with instructions which she must make sure to obtain from him at that time. Many doctors wish to be with a primipara continuously from the time the cervix is completely dilated, and with multiparæ after it is half dilated. But that, of course, is a matter which each doctor decides for himself. The nurse’s responsibility is to learn his wishes.
Fig. 78.—Successive steps in proper method of putting on sterile gloves to avoid contaminating outside of gloves with bare fingers. (From photographs taken at the Long Island College Hospital.)
Watchfulness, then, is of extreme importance; watching for symptoms of complications or change in the patient’s condition, and watching the progress of labor in order to keep the doctor fully informed about his patient’s condition. Nurses are very frequently taught to make rectal examinations for the sake of increasing the value of their assistance in this respect.
Although unexpected symptoms do not, as a rule, develop suddenly during the first stage, the nurse must be none the less vigilant for them. The doctor should be notified if the pains suddenly grow either more or less frequent, or more or less severe; if there is any bulging of the perineum; if the membranes rupture; if there is any bleeding or a prolapsed cord; if there is extreme restlessness or any evidence of unusual distress; a rising temperature or pulse; a temperature of 100° F. or a pulse of more than 100 or less than 60; a fetal heart rate of more than 150 or less than 116, or any marked change of any kind in the patient’s condition.