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

Under such circumstances the nurse must feel under compulsion to do all in her power to make the home delivery satisfactory, from the standpoint of the patient’s happiness and contentment and from the standpoint of surgical cleanliness and efficiency as well, so that normal cases, at least, may be attended with reasonable safety at home.

We know that the deaths, incident to childbirth, throughout this country at large, have not declined during the past decade, in spite of improved obstetrical methods and skill and the large percentage of recoveries in hospitals where they are applied. In the homes, in general, young mothers continue to die in distressingly large numbers, chiefly from infection, which we know is largely preventable. Apparently, then, in some important particulars the conditions surrounding the majority of home deliveries are still such as to be almost a menace to life and health. And as it is manifestly impossible for all obstetrical patients to be cared for in hospitals, home deliveries need to be made safer, which virtually means, made cleaner.

This grave need cannot be dismissed by the nurse as something outside of her province. She may aid greatly, and therefore is under obligation to do so, in making home confinements surgically clean, by being conscientious and thoughtful and thorough in her preparations and assistance.

A relatively small percentage of obstetrical patients require operative assistance, but without a single exception they all require cleanliness; cleanliness of appliances and cleanliness of methods.

As the first labor is usually longer and more difficult than later ones, and the percentage of lacerations and operative interference is higher, primiparæ should be delivered in hospitals when possible, as well as all cases presenting any complication or abnormality. But women who are normal, particularly multiparæ, and these constitute the vast majority of obstetrical patients, should be able to remain at home in safety.

In most instances the patient who is to be delivered at home will have to occupy her accustomed room and there is no alternative. Should there be a choice of rooms, however, one should be selected that is cool and shady, if the confinement takes place during the summer, but bright and sunny for occupancy during most of the year; it should be conveniently near a bathroom if possible, and have an adjoining room for the nurse and baby to occupy.

The arrangement and furnishings of the room will not of necessity vary greatly from those of a room which is to be occupied by any patient. Carpets, upholstered furniture, heavy draperies and curtains are no more suitable in this than in any patient’s room.

The ideal is: A room with a washable floor with small, light rugs; freshly laundered curtains at the windows; a single, brass or iron bedstead, about 30 inches high, with a firm mattress, and so placed as to be accessible from both sides and with the foot in a good light, either by day or by night; a bedside table and two others (folding card tables are a great convenience); a bureau; a washstand, unless there is a bathroom on the same floor; one or two comfortable chairs, two or three straight chairs and a couch or chaise longue, all of which should be of wood or wicker or covered with freshly laundered chintzes.

Barrenness is not only unnecessary but is to be avoided, for the room should be as cheerful and pretty as is compatible with cleanliness. There is usually no objection to pictures on the wall, but the room should be free from useless, small articles which are dust catchers, give the nurse unnecessary work, and occupy space needed for other things. Between such a room as this and the one which the nurse finds must be used, there may be a dismaying difference, and so once more she must exercise her ingenuity and resourcefulness; change and improve where it is possible and make the best of conditions that cannot be altered, for the baby is coming and the mother must be safeguarded from infection and other disaster, no matter what the room is like.

Much as we should like ideally to equip and prepare every room to be used for a home confinement, we cannot overlook the importance of having preparations made with as little disturbance as possible to the patient and her household. Preparations made with bustle and ostentation are suggestive of inefficiency; are bad for the patient, frequently causing her great alarm, and in the main had better be omitted. The nurse who is able to go into a home quietly and unobtrusively and accept what she finds, even carpets and draperies, and still do clean work, is doing better nursing than the one who arranges a faultless room but upsets her patient and disrupts the household in the process.