This treatment was first used widely in Freiburg. Following an enthusiastic report from there upon a large number of cases in which it had been used, there was such a clamor for it by American women, that its temporary use was practically forced upon obstetricians in this country. It was given what appears to have been a fair trial, but its continued use in this country has not been widespread. Those obstetricians who object to its use describe its disadvantages as follows: It cannot be used outside of a well-conducted hospital; it requires the constant attendance of a well-trained obstetrician or obstetrical nurse throughout the entire course of labor; it is suitable for use in certain selected normal cases only; it prolongs the second stage and increases the percentage of cases in which operative interference is necessary; it has an asphyxiating effect upon the child and increases the percentage of fetal deaths.
On the other hand, the use of scopolamin and morphin is a routine in certain excellent maternity hospitals, and by many obstetricians of the first rank, who maintain that with a nurse in attendance and the observance of ordinary precautionary measures, the advantages far outweigh the disadvantages of a modified “twilight sleep.” An anesthetic is usually administered during the second stage, after the use of the scopolamin-morphin treatment.
Complete Anesthesia. If an emergency should arise and the nurse be required to change from the light anesthesia à la reine, and to give complete anesthesia, her responsibilities increase, for she must watch carefully the patient’s pulse, respirations, color and pupils. The flat pillow which is ordinarily left under the patient’s head during normal labor, should be removed and the inhaler should be held closely over her face with the nurse’s fingers so placed as to hold it in position and also to hold the patient’s jaw forward and up. (Fig. [106].)
The ether should be dropped in clean drops, not poured, upon the inhaler. The dripping should be steady, but slow at first, gradually increased as the patient becomes accustomed to the fumes.
Fig. 106.—Method of holding inhaler and supporting patient’s jaw in giving ether for complete anesthesia. (From photograph taken at Johns Hopkins Hospital.)
With the average, normal patient who is taking ether well the respirations become somewhat stertorous and more rapid, increasing to possibly 36 or 40 per minute; the pulse starts at a little above the normal rate and increases to 116 or 120 and then drops to normal, which is slightly below the rate at which it started; the color is normal at first and then may become crimson, or it may change very little; the pupils first dilate, and then contract almost to a pin point.
Unfavorable signs are: respirations that are rapid and shallow, then possibly slow, but still shallow; increasing pulse rate, this being so serious that the ether is usually stopped if the pulse approaches 140, and stimulation is promptly given; cyanosis which is slight at first and then extreme, and dilated pupils.
It is obviously not wise nor possible to attempt, by means of a few paragraphs and illustrations to teach a nurse so technical and important a procedure as the administration of an anesthetic, but it is hoped that these general suggestions may be helpful, particularly to the nurse who is unexpectedly confronted by an emergency.
Under all conditions the nurse must remember that no matter what anesthetic is given, nor by whom it is administered, she must guard against the very prevalent tendency to talk freely while the patient is going under, in the belief that she is unaware of what is going on about her. Many patients suffer great mental distress because of hearing, or partly hearing conversation not intended for their ears, which takes place in their hearing while they are incompletely anesthetized.