CHAPTER XII
OPERATIONS
Complications during labor may arise from abnormal positions of the head, such as face or brow; from abnormal presentations of the child, such as breech, transverse or shoulder; from twin labors; or from prolapse of a part like the foot, arm or cord.
The mother may be responsible for some of these abnormalities through having a contracted pelvis, a rigid os, or a rigid pelvic floor.
The uterus, too, may functionate abnormally by acting too vigorously, as in precipitate labor, or too slowly, as in uterine inertia. The membranes may rupture prematurely and produce a dry birth.
There may be hæmorrhages before labor (ante partum hæmorrhage) during labor (intra partum), and after labor (post partum hæmorrhage), or the labor may be preceded, accompanied, or followed by that extreme example of toxæmia known as eclampsia.
Face and brow presentations are rare and come to the attention of the nurse only when an operation is required for their relief. Further conditions may arise, such as danger to mother or child, which demand an acceleration of the labor.
If the head is engaged, forceps is the operation most commonly undertaken, and if not engaged, the problem may be solved either by an early version and extraction or by forceps later. The dangers to the mother are not usually difficult to diagnose if the case has been followed carefully.
Signs of danger to child must be looked for constantly. Such are:
(a) Alteration of the heart tones.
(b) Retardation of pulse in cord between pains.