Fig. 104.—Giving ether for obstetrical anæsthesia. Ether is poured into cone which is covered with nurse’s hand to prevent evaporation. When the beginning of a contraction is felt by hand on abdomen, the cone is placed about an inch from the patient’s face. (From photograph taken at the Maternity Hospital, Cleveland.)
As chloroform poisoning is likely to produce degenerative changes in the liver, and eclampsia also causes a liver necrosis, chloroform is not used for an eclamptic patient.
Fig. 105.—As pain increases and patient becomes accustomed to ether, the cone is lowered and held close to her face until pain subsides. Sufficient ether to control the next pain is then poured into cone. (From photograph taken at the Maternity Hospital, Cleveland.)
Ether, also, is used widely in normal obstetrics and is almost always preferred for continuous anesthesia, because of its being safer than chloroform. Unlike chloroform, ether is sometimes given in the first stage after the pains have become severe and frequent. About a dram of ether is poured into the cone which is held just off the patient’s face (Fig. [104].) until the beginning of a contraction, at which time it is lowered and held close to her face (Fig. [105].) As the action of ether is slower than chloroform, it should be poured into the cone in advance of a pain, which the nurse anticipates by feeling the uterus begin to grow hard under the hand which she keeps upon the patient’s abdomen. If the ether is not poured into the cone until a pain begins, its anesthetic effect may be lost because of the delay in its administration.
At the Cleveland Maternity Hospital, where ether is used during normal labor, the nurses are taught to give it as has just been described, with further instructions from Miss MacDonald, as follows: “A patient will vaporize about one dram of ether per pain during the early first stage, gradually vaporizing a greater amount until she will vaporize two or three drams per pain near the end of the second stage. Should the patient reach the excitement stage of ether before she is in the second stage of labor, discontinue the ether for from five to fifteen minutes, then give a lessened amount.
“Should it be necessary to control the descent of the presenting part, light anesthesia may be given. This may be managed by putting about two drams of ether in the cone at intervals frequent enough to sufficiently retard the descent of the presenting part. This procedure almost obliterates contractions. Lift the cone from the face for a few moments at frequent intervals to admit air. Keep the ether vapor of such concentration as avoids choking, coughing or vomiting. This may be done by administering a small amount frequently, rather than a large amount at longer intervals. When the desired stage is reached, try to keep the patient at this degree of anesthesia by giving a few drams of anesthetic at regular intervals.”
Nitrous Oxid Gas Analgesia. The effect of this drug is termed analgesia rather than anesthesia, because the patient does not lose consciousness but is unconscious of pain. From a medical standpoint it is considered practically ideal for use in obstetrics. If given skillfully it seems to have no bad effects upon the child; it tends to stimulate, rather than diminish uterine contractions; it may be started, with safety; as soon as the patient begins to suffer severely, and continued for several hours if necessary.
Its disadvantages are that it is very expensive; it can be given safely only by a skillful, trained person; the apparatus necessary for its administration is expensive, heavy and difficult to transport. But when these difficulties can be overcome, its use is attended with very satisfactory results.
“Twilight Sleep,” so called, or Dämmerschlaf, as it is termed in Germany, has been and still is discussed so widely, that the nurse should know something of it, whether or not she aids in its administration. It may be described as a state of amnesia, or forgetfulness, produced by the hypodermic injection of morphin and scopolamin. The patient, therefore, is conscious of pain at the time but speedily forgets it.