Fig. 102.—Drawing showing how prolapsed cord may be pressed between baby’s head and pelvic brim, thus cutting off placental circulation.
The elevated Sims position is often effective. Or, a straight chair may be upturned and pushed under the mattress, from the foot toward the head, in such a way that the patient will be lying on an incline which slopes upward from the head of the bed toward the foot. Or the chair may be placed in the same position on top of the mattress, with the top of the chair-back under the patient’s shoulders. The chair should be padded with pillows in order to minimize the patient’s discomfort as she lies in this trying position.
Post-partum Hemorrhage. Should a post-partum hemorrhage occur, in the absence of the doctor, the nurse should massage the fundus, unless she has been instructed not to, and have some one elevate the foot of the bed on blocks or the seat of a firm, straight chair. The use of ice bags or cold compresses on the abdomen is sometimes helpful and some physicians advise placing the baby at the mother’s breast immediately, since the suckling stimulates the uterine muscles to contract.
In anticipation of a post-partum hemorrhage, the nurse must have a clear understanding of the doctor’s wishes, particularly in regard to the administration of pituitrin and ergot which are so widely and efficaciously used to check post-partum bleeding.
ANESTHETICS
Those of us who are accustomed to seeing anesthetics used to relieve patients of the worst of their pain, during labor, find it hard to realize that until comparatively recent years women went through this suffering without mitigation.
The use of anesthesia was introduced into obstetrical practice, in 1847, by Sir James Y. Simpson of Scotland, who first used ether but later adopted chloroform when he learned that it also had anesthetic properties. Its use in America was subsequently introduced by Dr. Channing of Boston.
In the early days, the idea of using anesthesia during labor was greeted with a storm of protest, both from the clergy and the laity, because of their belief that the relief of women in childbirth was contrary to the teachings of the Bible, as set forth in God’s curse on Eve, when He said, “In sorrow thou shalt bring forth children.”
There is to-day practical unanimity of opinion concerning the advantages which are derived from the use of anesthesia when any operative procedures are employed; but there is still some objection to its use in spontaneous deliveries. This is partly on medical grounds because of the possible ill effects of anesthetics and is partly a persistence of the early religious protest. However, in the vast majority of cases, some kind of an anesthetic, or analgesic, is administered to the woman in labor because the advantages of its use are generally conceded.