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 nurse’s first visit to a patient is little more than a friendly one. In fact, she may have to make several such calls before she is able to so far win the patient’s confidence and friendship that she will consent to place herself under supervision. For in addition to obtaining her verbal consent, the establishment of this sympathetic relationship is found to be necessary before the nurse can feel sure that the patient will freely tell of her symptoms and follow the advice given.

Before making plans, or talking to the patient about prenatal care, the nurse ascertains what arrangements, if any, the patient herself has made for care at the expected confinement. She finds that the expectant mothers fall into four groups:

1. Those who have registered with a hospital. 2. Those who have arranged to be cared for by a physician. 3. Those who have arranged to be cared for by a midwife. 4. Those who have made no arrangements of any kind.

The nurse’s relation to a patient registered with a hospital for delivery depends upon the scope of the work of that particular institution. Some hospitals will register patients early in pregnancy, and assume the entire medical and nursing care and supervision from that time until after the baby is born. The Maternity Centre nurse, obviously, has no responsibility for these patients. But she does give nursing care and instruction to patients registered with hospitals which have not facilities for prenatal clinics or visiting nurses to send into the patients’ homes. The hospital resident, in these cases, assumes responsibility for medical supervision of the patients and receives a report from the Maternity Centre upon each nursing visit; and the nurse in turn urges the patient to return to the hospital, periodically, to see the doctor, in accordance with instructions received from the hospital.

This form of co-operation has proved to be so satisfactory that many hospitals now do not wait for the Maternity Centre nurses to discover patients registered with them, but each day notify the nurses of newly registered patients and ask that they be given the routine nursing care and supervision by a Maternity Centre nurse.

When a nurse finds, upon her first visit to a patient, that she has engaged a physician to attend her at the time of confinement, she gives no advice, but sends to the doctor a form letter, prepared by the Medical Board, offering to nurse that patient according to the routine of the Maternity Centre Association if he wishes, and to report to him upon each nursing visit. A very small percentage of physicians refuse this offer of assistance, the majority accepting it with eagerness. Patients who have engaged their own physician for delivery, naturally, are not asked to go to the Maternity Centre clinics for medical examination or advice, but are invited to go for the nurse’s instructions, and to attend the group conferences that will be described later.

If the patient belongs to the third group, having engaged a midwife, the nurse goes in person to see the midwife, as letters are usually of little avail. She asks the midwife to bring her patient to the clinic, explaining that, though midwives are taught to conduct deliveries, they are not taught to make the examinations that are now known to be so important to the future welfare of mothers and babies, but that such examinations can be made at the clinic by the doctor. If the initial examination discloses any abnormality, this fact is explained to the midwife and also that the rules governing her practice forbid her caring for such a patient. The nurse, midwife and patient then plan for adequate care at the time of delivery. In this way the nurses win and retain the confidence and good will of the midwives; and since these women exert a powerful influence over their patients and their families, their co-operation is of considerable value in persuading the patients to accept more skilled care than midwives can offer.

If, on the other hand, the initial examination does not disclose any abnormality, the midwife is simply asked to allow the nurse to visit the patient at regular intervals, in a supervisory way, and to have the patient report to the clinic doctor for his periodic observations and advice. The intelligent midwives, who speak English, are usually co-operative, but the others are sometimes suspicious and persuade their patients to refuse the nurse’s supervision.

For the patients in the fourth group, those who have made no arrangement for care at the time of delivery, the nurse is even more responsible. The plans for these patients include three fundamental requirements: a complete physical examination; the correction of physical defects, so far as is possible, and a study of the environment and social status of the patient; this in order to adapt the care during pregnancy and at the time of delivery to each individual’s condition and circumstances.

From time to time the nurse explains to the patient, as much as she can, about pregnancy and the changes that accompany it and the reasons for the advice that is given, in order to secure her intelligent co-operation. Experience has taught that it is not enough to advise the patient to do thus-and-so because the doctor thinks best. But if she understands that examination of her urine, for example, may disclose conditions that can be cured, but which if neglected may cause headaches, or convulsions, she is much more likely to provide a specimen for examination than if she is asked for one without explanation.