Obstetrical Nursing / A Text-Book on the Nursing Care of the Expectant Mother, the Woman in Labor, the Young Mother and Her Baby

by Carolyn Conant Van Blarcom

The patient is given a final scrubbing with green soap and sterile water and an antiseptic solution, by some one with clean hands, and is further protected by means of sterile leggings, a sterile towel across the abdomen and one covering the inner surface of each thigh, held in place by sterile clips or safety pins. The lower half of the bed is covered with a sterile sheet while a sterile delivery pad is slipped under the patient’s hips. (Fig. [82].)

If the delivery is made with the patient lying on her side, the sterile dressings are so arranged as to cover all but the perineal region after she is placed in the desired position.

This brings up the question of the nurse’s obligation to protect her patient from the embarrassment of unnecessary exposure at any time during labor. The field which is prepared must be uncovered temporarily, and while the patient is being draped for examination or delivery a certain amount of exposure is unavoidable; but there are many little ways in which the nurse may show her consideration for the patient in this connection and the patient always appreciates the protection.

During the second stage, the preservation of asepsis, watching the progress of labor and watching for unfavorable symptoms, are of even greater importance than during the first stage. After the patient has been prepared and draped with sterile dressings, neither they nor the perineal region should be touched with anything unsterile.

If for any reason it has not been possible to sterilize sheets and towels, or more are needed after the prepared supply has been exhausted, the inner surfaces of towels and sheets that have been ironed either by hand or machinery, and folded with the ironed surfaces inside without being touched, may be regarded as practically sterile.

As the second stage advances, the patient may greatly aid the progress of labor by voluntarily bearing down during pains, and the nurse in turn may be called upon to help by encouraging her and explaining just what she should do. At the beginning of a pain the patient should take a deep breath, close her lips, brace her feet and strain with all her strength. If she opens her mouth and cries out, she fails to use her pains to the best advantage. The effect of this bearing down may be increased by providing the patient with straps, attached to the foot of the bed, upon which she may pull during the contractions, as she bears down. (Fig. [83].) Or, what is often a great comfort to her, she may pull upon the nurse’s hands as the latter braces herself so as to offer strong resistance. If the nurse can be spared from other duties to give this kind of assistance, it is indeed a comfort to the patient, who appears to derive from it both a moral and physical sense of being helped in her struggle. It is also important to assure the patient, between pains, that she is doing well, and that her efforts are advancing the baby, if this is true; and if not, she may under ordinary conditions be urged to make greater effort.

Fig. 83.—Patient pulling on straps while bearing down during second stage pains. (From photograph taken at Johns Hopkins Hospital.)

Before the head can be seen at the outlet or its advance noted by perineal bulging, the stage of its descent is often ascertained by palpating through the perineum, the fingers of a gloved hand pressing upward, on one side of the vulva. (Fig. [84]. See Figs. [85], [86], [87], and [88] for appearance, advance and birth of head during normal delivery.)

Immediately after the birth of the head, and before the birth of the body, the nurse is frequently asked to wipe the baby’s mouth and eyes and sometimes to drop nitrate of silver into the eyes. In such a case she should wipe out the mouth very gently with a bit of sterile gauze, wet with boric, wrapped about her little finger, reaching well back into the throat; the eyes should be wiped from the nose outward, a separate wipe being used for each eye. The purpose of these maneuvers, when they are employed, is to favor respiration from the beginning by removing mucus that might impede it and to remove possible infective material from the lashes before it is spread to the conjunctivæ by the baby’s winking. The silver solution is to destroy germs that may have gotten into the eye.