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

Destructive Operations have as their purpose the crushing or dismembering of the child in utero so that it may pass through the pelvis. In the early days such operations were resorted to fairly often in the presence of conditions that threatened the mother’s life and which apparently could not be met in any other way. They are performed less and less frequently to-day because of the success attending the performance of Cæsarean section, version, pubiotomy and forceps operations. They are never sanctioned by the Catholic Church in cases where the child is alive.

Induced Abortions and Premature Labors. As was explained in the chapter on complications and accidents of pregnancy, it is sometimes deemed advisable, or necessary to terminate pregnancy by artificial means, in the interests of the mother or child or both.

The procedures are termed induced abortion, induced premature labor and accouchement forcé. The effects of these operations, per se, when skillfully performed, for therapeutic purposes, are not usually considered more serious for the mother than a normal delivery, since they can be performed with deliberate care and cleanliness and can be followed by adequate aftercare. When the reverse conditions prevail, as in criminal abortions, the patient’s subsequent suffering or ill health are more likely to be due to the poor obstetrics and unclean work which is characteristic of practitioners who are willing to do illegal operations, than to the termination of pregnancy itself. It is important that the nurse fully appreciate this and be as scrupulously careful in her preparations for, and assistance with these operations as for a major operation or a normal delivery.

Induced abortion applies to the termination of pregnancy before the child is viable, or before the end of the twenty-eighth week, and is performed solely in the interests of the mother, as the fetus is always lost. It is resorted to in those cases where the mother is suffering from some condition, which may or may not be inherent to pregnancy, which threatens her life or health but which it is believed may be cured or arrested if uncomplicated by pregnancy. Such conditions may be toxemic vomiting; nephritis, particularly with evidences of increasing renal insufficiency; bleeding, due to an incomplete abortion; a dead fetus; infection following an attempt at criminal abortion. Contracted pelves and pulmonary tuberculosis are sometimes taken as indications for inducing abortions, but with the development and improvement of obstetrical operations, more and more women are able to go nearly, or quite, to term and be delivered of live babies; while increasing medical knowledge concerning the care of patients with tuberculosis, and also with some heart lesions, is applied so successfully during the prenatal period that some pregnancies which formerly would have been terminated, are now allowed to continue, and with happy results.

The methods of induction depend upon the stage to which pregnancy has advanced and also upon the importance of haste. In the very early stages, one method is for the operator to dilate the cervix with a dilator; insert one finger into the cervix and up into the uterus and separate the placenta from its uterine attachment, while making pressure on the uterus from above with the other hand on the abdomen. Another method is to introduce a gauze pack into the cervix, packing it and the vagina firmly and leaving the packing for twenty-four hours. When it is removed the ovum frequently follows. Sometimes the membranes are ruptured, after which the amniotic fluid drains off and the ovum is expelled; or vaginal hysterotomy is sometimes performed when the patient’s condition is such that haste is imperative. The termination of pregnancy before viability is never sanctioned by the Catholic Church, because of the almost certain loss of the child.

Induction of premature labor. This procedure is the termination of pregnancy after the twenty-eighth week, or after the child is viable, and may be performed to save either the mother or the child or both, from conditions which would evidently work destruction if allowed to persist. The indications for inducing labor prematurely may be a seriously overtaxed heart or kidneys; pulmonary tuberculosis; preëclamptic toxemia or nephritic toxemia; chorea, neuritis; pyelitis; placenta prævia; a fetus that has been dead for two weeks, with no signs of labor; in some cases of nephritis when the fetus during previous pregnancies has died, and it is believed that the child may be saved by inducing labor before the stage in pregnancy at which the others perished.

Labor is sometimes induced when the mother’s pelvis is normal, but the child has grown as large as is safe in anticipation of a spontaneous labor, and particularly if the expected date of confinement has passed.

Fig. 111.—Rubber bougie used in inducing labor.

A common method of inducing labor when haste is not important, is to introduce one or more bougies (Fig. [111]) through the cervix into the uterine cavity between the membranes and the uterine wall. The presence of the bougies will often stimulate the uterine contractions and bring on labor, with expulsion of the fetus, in from six to twenty-four hours.