During the latter part of the first stage, and during the second stage, the patient has an almost continuous desire to empty her bowels, because of pressure made upon the rectum by the descending head. This is another point which the nurse explain to her patient, in assuring her that frequent attempts to use the bed-pan will give no relief.
The end of the first stage is reached when the cervix is fully dilated, at which time the pains occur about every two minutes, are stronger and more severe, and the patient begins to feel like bearing down. The membranes frequently rupture at this point and the vaginal discharge is blood tinged. The patient should remain in bed and not be left alone from this time on.
To sum up the nurse’s duties during the first stage of labor, when the patient is almost entirely in the nurse’s care:
1. She must be a sympathetic, encouraging friend to the patient. 2. She must help the patient to preserve her strength by giving her light nourishment about every four hours; by advising her not to bear down; not to exhaust herself by walking about too much but to lie down when tired. 3. She must watch the progress of labor and watch for symptoms of complications. 4. She must employ strictest aseptic and antiseptic methods. 5. She must prepare for the birth of the baby.
SECOND STAGE
The second stage is shorter, harder and more perilous than the first. The uterine contractions are stronger; more frequent and more expulsive, and the baby steadily curves and rotates its way down through the birth canal.
With the onset of the second stage the nurse should complete the preparations for the baby’s birth, bearing in mind that with a primipara the baby probably will not come for an hour and a half or two hours, but may come in half an hour or less if the patient is a multipara. Everything which is to be used should be conveniently placed, but the packages are not necessarily opened at this time.
In addition to the sterile dressings, basins, gloves, instruments and various other articles which have been enumerated, the nurse must remember that there should be for the baby a box or basket lined with a blanket and containing one, or preferably two, hot-water bottles at 125° F.; in hospitals, an adhesive strip for the baby’s name or a name necklace; a binder of flannel or sterile gauze, according to the custom of the doctor; sterile olive oil or albolene for the first oiling and one or two tubs, in case the baby needs to be resuscitated.
There will be needed, also, a covered basin for the placenta; chloroform and an inhaler; Wassermann tubes, for those doctors who make this test as a routine; hypodermic syringe and needles, with pituitrin, ergotole and drugs for stimulation which the doctor may specify. (Figs. [79], [80].)
In the meantime, the force and frequency of the pains should be noted, and some doctors require a record of both the fetal and maternal pulse rate every half hour, and notification if the baby’s is over 150 or below 116, or the mother’s over 100 or below 60. Extreme restlessness, distress, vaginal bleeding, prolapsed cord, a temperature of 100° F., or any marked change must be communicated to the doctor immediately, if it occurs before he has started for his patient.