Fig. 92.—Wrong and right method of tying knot in cord ligature. A will slip. B will not.
As soon as the cord ceases to pulsate, it is usually clamped with two clamps about two inches apart (Fig. [91]) and cut between the clamps. The scissors should have blunt points, in order not to scratch or cut the baby, who may be wriggling vigorously by this time. The cord is tied tightly with a sterile cord ligature, in a square knot that will not slip (Fig. [92]), about an inch from the abdominal wall. It is considered a safe precaution, after removing the clamp, to bend the cord back upon itself and tie it a second time with the same ligature, as the danger of hemorrhage from a loosely tied cord is serious when the baby is kept sufficiently warm. The placental end of the cord is also tied, or it remains clamped until the placenta is expelled, because of the possibility of there being another child in the uterus and the danger of its bleeding to death through the open cord.
Some doctors do not tie the cord, but crush the vessels with a clamp which is left on the cord for about half an hour and then permanently removed, but this should not be done by a nurse upon her own responsibility.
Very often the person who performs the delivery removes the blood, mucus and vernix from the baby’s body, as soon as the cord is tied, by sponging it thoroughly with albolene or olive oil; wraps the cord stump with a sterile, dry or alcohol sponge and applies the abdominal binder while an assistant holds the baby by the feet, head down. It is also very common simply to oil the baby with unsterile lard, oil or vaseline, cover the cord with sterile gauze and leave the bath, cord-dressing and binder to be attended to later.
If the delivery takes place in a hospital the baby must be marked before it is taken from the delivery room, with adhesive plaster, upon which its mother’s name is plainly printed, or with the name necklace, now so frequently used.
The baby is once more wrapped in a warm blanket and placed, with a hot-water bottle, at 125° F., in the basket or box, which was prepared for it. Although the baby should be well covered, care must be taken to leave the face fully exposed as a young baby is easily suffocated. It was formerly customary to lay the new baby on its right side, but with the present fuller knowledge of the fetal circulation and the changes which take place after birth, this practice has been largely done away with.
Resuscitation of the Newborn Baby. If the baby breathes feebly, or even if it does not cry vigorously, the effort to stimulate the respirations may have to be continued for an hour or more after the cord is tied. In addition to the simple methods, previously described, which are very commonly employed at the time of labor, such as stroking the baby’s back or holding him by the feet and spanking him (Fig. [93]), the following measures are sometimes resorted to if the baby’s condition demands it:
Fig. 93.—Stimulating respirations by holding the baby head downward and sharply spanking him. Note the method of grasping the baby’s ankles with one finger between them to prevent his slipping from the nurse’s hand.
One method is to hold the baby with its chest resting on the palm of one hand, with head, legs and arms hanging forward, thus compressing the chest wall and favoring expiration (Fig. [94]), and then turning it over on its back, in the other hand, in which position the head, legs and arms hang backward, thus expanding the chest and favoring an inspiratory movement. (See Fig. [95].) Alternate repetitions of these positions, about twelve times a minute, will often stimulate the child to breathe satisfactorily.