I wish to express my deep gratitude to Mr. Max Brodel for his invaluable counsel and guidance in planning and assembling the illustrations to elucidate the text. And I am very grateful to Mr. Gari Melchers for the spirit which I believe is infused into this book through the reproduction of two of his lovely paintings of a mother and baby, and to Mr. Russell Drake for his valuable drawings. I wish further to thank Mr. J. Norris Myers, of The Macmillan Company, for unfailing courtesy and helpfulness in facilitating all matters relating to the publication of this book.

For statistical information I am indebted to Dr. Louis I. Dublin and for authority in offering the scientific background of the teaching I have drawn from “The Practice of Obstetrics” by J. Clifton Edgar; “Obstetrics” by J. Whitridge Williams; “The Diseases of Infants and Children” by J. P. Crozer Griffith and “The Prospective Mother” by J. Morris Slemons.

Carolyn Conant Van Blarcom.

New York City, 149 East 40th Street

TABLE OF CONTENTS

PAGE
Preface[xi]
Introduction[3]
PART I.
ANATOMY AND PHYSIOLOGY
CHAPTER
I.Anatomy of the Female Pelvis and Generative Organs[19]
II.Physiology[45]
PART II.
THE DEVELOPMENT OF THE BABY
III.Development of the Ovum, Embryo, Fetus, Placenta, Cord and Membranes[61]
IV.Physiology of the Fetus[84]
V.Signs, Symptoms, and Physiology of Pregnancy[93]
PART III.
THE EXPECTANT MOTHER
VI.Prenatal Care[111]
VII.Mental Hygiene of the Expectant Mother[145]
VIII.Preparation of Room, Dressings, and Equipment for Home Delivery[155]
IX.Complications and Accidents of Pregnancy[164]
PART IV.
THE BIRTH OF THE BABY
X.Presentation and Position of the Fetus[217]
XI.Symptoms, Course, and Mechanism of Normal Labor[232]
XII.Nurse’s Duties During Labor[243]
XIII.Obstetrical Operations and Complicated Labors[295]
PART V.
THE YOUNG MOTHER
XIV.Physiology of the Puerperium[317]
XV.Nursing Care During the Normal Puerperium[323]
XVII.The Nursing Mother[357]
XVII.Nutrition of the Mother and Her Baby[368]
XVIII.Complications of the Puerperium[391]
PART VI.
THE MATERNITY PATIENT IN THE COMMUNITY
XIX.Organized Prenatal Work[405]
XX.Care of the Mother and Baby by Visiting Nurses[437]
PART VII.
THE CARE OF THE BABY
XXI.Characteristics and Development of the Average New-born Baby[451]
XXII.Nursing Care of the Average New-born Baby[461]
XXIII.Common Disorders and Abnormalities of Early Infancy[518]
XXIV.A Final Word[544]

LIST OF ILLUSTRATIONS AND CHARTS

ILLUSTRATIONS
Anatomy and Physiology.
FIG. PAGE
1 a.Normal female pelvis[21]
b.Normal male pelvis[21]
2.Diagram of pelvic inlet seen from above[22]
3.Diagram of pelvic outlet seen from below[23]
4.Sagittal section of the pelvis[24]
5.Two types of pelvimeters[25]
6.Diagram showing method of measuring distance between crests, spines and trochanters[26]
7.Diagram showing method of measuring Baudelocque’s diameter[27]
8.Diagram showing method of estimating true conjugate[28]
9.Diagram showing method of measuring intertuberous diameter[29]
10.Anterior view of external and internal female generative organs[31]
11.Diagrams of sections of virgin and multiparous uteri[32]
12.Sagittal section of female generative tract[35]
13.Diagram of external female genitalia[39]
14.Sagittal section of breast[42]
15.Front view of breast[43]
16.Diagram of human ovum[47]
Development of the Baby
17.Diagram of human spermatozoa[61]
18.Diagram of segmenting rabbit’s ovum[65]
19.Ovum about 13 days old embedded in the decidua[66]
20.Diagram of developing fetus, cord, membranes and placenta in utero[69]
21.Diagram of structure of placenta[71]
22.Photograph of placental vessels[72]
23.Maternal surface of the placenta[74]
24.Fetal surface of the placenta[75]
25.Embryo about 5.5 cm. long in amniotic sac[77]
26.Outlines of fetus at different stages[78]
27.Full term fetus in utero[81]
28.Diagram of fetal circulation[85]
29.Diagram of circulation after birth[87]
30.Side and top view of fetal skull[90]
The Expectant Mother.
31.Height of fundus at different stages of pregnancy[94]
32.Contour of abdomen at ninth month[95]
33.Contour of abdomen at tenth month[95]
34.Front view of home-made abdominal binder[123]
35.Side view of same[123]
36.Back view of same[123]
37.Abdominal binder used in above[124]
38.Front view of home-made stocking supporters[124]
39.Back view of same[124]
40.Patient in right-angled position to relieve varicose veins[138]
41.Elevated Sims position[139]
42.Gloves, ready for dry sterilization[160]
43.Delivery pad of newspapers and old muslin[161]
44.Diagram of centrally implanted placenta prævia[174]
45.Partial placenta prævia[175]
46.Diagram of marginal placenta prævia[176]
47.Champetier de Ribes’ bag inserted in uterus[177]
48.Patient in hot pack given with dry blankets[197]
49.Method of giving infusion[202]
The Birth of the Baby.
50.Attitude of fetus in uterus at term[217]
51.Illustration from first text-book on obstetrics[218]
52.Attitude of fetus in breach presentation[219]
53.Attitude of fetus in vertex presentation[220]
54.Diagram of six positions in a vertex presentation[222]
55.Diagram of six positions in a face presentation[223]
56.Diagram of six positions in a breech presentation[223]
57.First maneuver in abdominal palpation[225]
58.Second maneuver in abdominal palpation[226]
59.Third maneuver in abdominal palpation[227]
60.Fourth maneuver in abdominal palpation[228]
61.Diagrams showing positions of nurse’s hands in four maneuvers of abdominal palpation[229]
62.Ascertaining position of fetus by rectal examination[230]
63, 64, 65, 66.Diagrams showing stages of dilatation and obliteration of cervix[234]
67.Characteristic position of patient during first stage pains[235]
68.Diagram indicating rotation and pivoting of head during birth[236]
69.Anterior shoulder being slipped from under symphysis[237]
70.Birth of posterior shoulder[238]
71.Diagrams of Duncan and Schultze mechanisms of placental separation[239]
72.Section showing thinness of uterine wall before birth of fetus[240]
73.Section showing thickness of uterine wall immediately after labor[241]
74.Preparing patient for vaginal examination or delivery[250]
75.Patient draped for vaginal examination[251]
76.Wrong and right methods of boiling gloves[253]
77.Powdering hands before putting on dry gloves[254]
78.Successive steps in proper method of putting on gloves[255]
79.Bed and simple equipment ready for normal delivery[258]
80.Instruments shown in Fig. [79][260]
81.Old prints showing early methods of delivery[261]
82.Patient draped with sterile dressings for delivery[262]
83.Patient pulling on straps while bearing down during second stage[264]
84.Palpating baby’s head through perineum[265]
85.Baby’s head appearing at vulva[266]
86.Head farther advanced[267]
87.Holding back head at the height of a pain[268]
88.External rotation following birth of head[269]
89.Wiping mucus from baby’s mouth[270]
90.Stroking baby’s back to stimulate respirations[271]
91.Two clamps on cord after pulsation has ceased[272]
92.Wrong and right method in tying knot in cord ligature[272]
93.Stimulating baby’s respirations[274]
94, 95.Stimulating baby’s respirations[275], [276]
96, 97.Resuscitating baby by holding under warm water[277], [278]
98.Resuscitation by means of direct insufflation[279]
99.Delivery of the placenta[280]
100.Twisting membranes while withdrawing placenta[281]
101.Massaging fundus through abdominal wall[282]
102.Showing prolapsed cord between head and pelvic brim[285]
103.Giving chloroform for obstetrical anæsthesia[287]
104, 105.Giving ether for obstetrical anæsthesia[289], [290]
106.Giving ether for complete anæsthesia[293]
107.a. Tarnier forceps, b. Simpson forceps[301]
108.Patient in position and draped for forceps operation[302]
109.Forceps sheet used in Fig. [108][303]
110.Two types of leggings for obstetrical use[304]
111.Rubber bougie[311]
112.Champetier de Ribes’ bag[311]
113.Voorhees’ bag[312]
114.Bag held in forceps for introduction into uterus[312]
115.Syringe for filling above bags after insertion[312]
The Young Mother.
116.Height of fundus on each of first ten days after delivery[327]
117.Patient draped for postpartum dressing[336]
118.Equipment in rack used in Fig. [117][337]
119.Method of covering nipples with sterile gauze[339]
120.Baby nursing through a nipple shield[341]
121.Nipple shield used in Fig. [120][342]
122.Supporting heavy breasts by means of folded towels[343]
123.Ice caps applied to engorged breasts[344]
124.Y binder before application[345]
125.Y binder applied[346]
126.The same seen from the other side[347]
127.Indian binder[347]
128.Method of stripping[348]
129, 130, 131, 132, 133, 134, 135.Bed exercises taken during the puerperium[350] to [353]
136.Knee-chest position[354]
137.Exercising by walking on all fours[354]
138.Position of mother and baby for nursing in bed[359]
139.The Nursing Mother (from a painting by Gari Melchers)[361]
140.Baby partially blind as a result of a faulty diet[378]
141.Rachitic and normal babies of the same age[381]
142.Chest walls of normal and rachitic rats of the same age[383]
143.Interior of specimens in Fig. [142][384]
The Maternity Patient in the Community.
144.Baby’s bed improvised from a market basket[415]
145.Layette recommended to expectant mothers by Maternity Centre Association[416]
146.Breast tray recommended to expectant mothers by Maternity Centre Association[417]
147.Baby’s toilet tray recommended to expectant mothers by Maternity Centre Association[417]
The Baby.
148.Diagram of first teeth[456]
149.Umbilical cord immediately after birth[457]
150.The same four days later[457]
151.Umbilicus immediately after separation of cord[458]
152.Well healed umbilicus[458]
153.Nursery at Manhattan Maternity Hospital[465]
154.Bathing the baby[467]
155.Preparation for circumcision[468]
156.Baby draped with sterile sheet, in above[469]
157.Cord dressed with dry sterile gauze[470]
158.Abdominal binder applied over cord dressing[471]
159.Satisfactory baby clothes[473]
160.Diagonally folded diaper applied[474]
161.Longitudinally folded diaper applied[474]
162.Sutton poncho to protect baby for outdoor sleeping[479]
163.Training the baby to use a chamber[481]
164.Stiff cuffs to prevent thumb sucking[483]
165.Hammer cap to prevent ruminating[484]
166.Ruminating cap applied[485]
167.Proper method of carrying baby[487]
168.Preparing the baby’s milk[493]
169.Giving the baby his bottle[496]
170.Holding baby upright after feeding[497]
171.Dr. Griffith’s table of fat percentages[500]
172.Reverse side of above card[501]
173.Baby in a basket ready to travel[507]
174.Quilted robe with hood for the premature baby[509]
175.Premature baby in lined basket, being fed with Boston feeder[510]
176.Bed for premature baby improvised from small clothes basket[511]
177.Putting the baby in a wet pack[521]
178.Baby in wet pack[522]
179.Diagrams showing successive steps in giving the baby a pack[522]
180.Baby wrapped in blanket preparatory to gavage[523]
181.Gavage[524]
182.Obtaining a fresh specimen of urine from the baby[526]
183.Obtaining a 24–hour specimen of urine from the baby[527]
184.Band to hold baby’s legs while obtaining specimens of urine[527]
185.Belt used to hold tube for specimen[528]
186.Giving the baby an enema[530]
187.Irrigating the eye with a blunt nozzle[536]
188.Method of holding baby for treating gonorrhœal ophthalmia[537]
CHARTS.
No.
1.Showing drop in blood pressure and albumen, after delivery, in eclampsia[204]
2.Showing persistence of high blood pressure and albumen in the urine, after delivery, in nephritic toxæmia with convulsions[206]
3.Showing temperature curve in streptococcus infection[397]
4.Showing temperature curve in gonorrhœal infection[398]
5.Showing normal weekly gain in weight during first year of life[454]
6.Showing normal daily gain in weight during first two weeks[520]
7.Showing loss of weight in inanition fever contrasted with No. 6[520]
8.Showing rise in temperature in inanition fever[520]

OBSTETRICAL NURSING

“Can there be any higher work than this?