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 usually tired and cold at the conclusion of labor, and may even have a nervous chill. Although this chill is not serious, the patient is none the less uncomfortable, and she should be warmly covered, be given something hot to drink, and a hot-water bag placed at her feet.

All possible effort must now be made to secure for her rest, quiet, and an opportunity to sleep. Every one but the doctor and the nurse had better be excluded from the room, which should be absolutely quiet, somewhat darkened and well ventilated. In addition to this, the majority of doctors now require that either they or the nurse shall stay with the patient and keep one hand resting on the fundus for at least an hour after delivery as a safeguard against post-partum hemorrhage. As long as the fundus is felt through the abdominal wall as a firm, hard mass, its irregularly arranged muscle fibres are contracted upon the blood vessels, and will prevent an escape of blood. But if the fundus feels soft and boggy, its muscles are relaxed, the constrictions are somewhat released from the open vessels, and serious bleeding may occur unless they are stimulated to contract again.

If the Doctor Is Delayed. It sometimes happens that labor progresses with unexpected rapidity, or that the doctor is delayed in his arrival and the nurse is accordingly confronted with the emergency of being alone with the patient during part or all of the delivery.

When the baby is making such rapid descent that the nurse fears it may be born before the doctor’s arrival, she may somewhat retard labor by covering her hand with a folded, sterile towel, if she has not had time enough to put on gloves, and hold back the head by pressing against the perineum during pains, at the same time instructing the patient to open her mouth, breathe deeply and try not to bear down. It is sometimes easier for the patient not to bear down if she lies on her side.

If by mischance, or in spite of her efforts, the baby so far descends that the brow appears before the doctor’s arrival, the nurse cannot safely hold it back longer because of the danger of the baby becoming asphyxiated. She should, up to this point, hold the head back during pains in order that the perineum may be stretched slowly, with the hope of preventing a tear. (See Fig. [87].) It is the sudden distension of the perineum and expulsion of the baby’s head at the height of a pain that frequently causes lacerations. If fecal matter is expressed during pains, the field should be wiped, downward, with sterile sponges and bathed with the antiseptic solution at hand.

After the brow is born, the nurse may gradually release the pressure and allow the head to emerge, and remembering the position of the child and the mechanism of its birth, assist Nature in its complete delivery. After the head is born, it drops down toward the mother’s rectum, after which external rotation, or restitution, takes place. (See Fig. [88].) A finger should be slipped around the neck in search of coils of cord, which, if felt, should be slipped over the baby’s head. Otherwise, pressure upon the cord in that unnatural position might so interfere with the circulation as to asphyxiate the baby.

The shoulders may be born spontaneously or the nurse may grasp the head with both hands, curving the fingers of one hand under the baby’s chin, and of the other, under the occiput, and make gentle, downward traction (See Fig. [69].) in order to slip the anterior shoulder from under the symphysis; and then pull gently upward, to deliver the lower or posterior shoulder (see Fig. [70].), after which the rest of the body follows easily.

This description of how a nurse may conduct a normal delivery by fairly typical and generally approved methods is only intended to guide her in an emergency, when there has been no understanding between her and the doctor about what she should do in event of his absence; or when he has authorized her to use her best judgment in safeguarding the lives of mother and baby.

It is obviously of extreme importance for the nurse to ascertain definitely the doctor’s wishes in this connection, as he sometimes will be unwilling to have the nurse give any attention to either mother or baby, even to tie the cord, before his arrival.

Prolapsed Cord. If the umbilical cord should prolapse at any time during labor, in the absence of the doctor, or lacking instructions, the nurse should elevate the patient’s hips, in order that gravity may lessen the pressure on the cord as it lies between the presenting part and the pelvic brim. Otherwise, the interference with the placental circulation may result in asphyxiation of the baby. (Fig. [102].)