Fig. 85.—The Naegele perforator. (Hammerschlag.)
The time of election is when the woman is at term but not in labor. This, of course, can be determined by the history, but more certainly by careful measurements of the child.
When it becomes necessary to operate on a woman who has been in labor a long time and especially if she has been examined frequently, the mortality is disproportionately high.
It is a hospital operation, but may be done in the house. If not an emergency, the bowels are emptied by a laxative and enema the day before. Regular preparations for laparotomy are made, plus the equipment necessary for tieing the cord and resuscitating the child. A table must be found large enough to hold the patient in the horizontal position at full length. Solutions of lysol 1 per cent and sterile water are placed on each side of the table. The instrument table carries towels and suture material as well.
On a stand behind the operator is placed the hot bath and tracheal catheter. This center is presided over by someone skilled in the treatment of respiratory difficulties in the new born. Altogether, five assistants are required for the operation: an anæsthetizer, a clean nurse, and a nonsterile nurse to manage supplies, an operating assistant and one to take charge of the child.
Rubber gloves must be worn by the clean assistants.
Instruments.—
2 scalpels.
2 scissors.
8 eight-inch forceps.