If the woman has been examined, the vagina should be sponged out with tincture of iodine. The abdomen is shaved, scrubbed with green soap, nail brush, and hot water for five minutes. It is then rinsed with ether and painted with iodine.
The presentation of the child, the presence and location of the heart tones must be determined before operation.
The patient is anæsthetized with ether, chloroform or gas.
The incisions are made; the child delivered to the proper assistant; the placenta and membranes removed; the sponges counted; and the uterus and abdominal wall sutured.
After-care.—The nurse watches the patient for sighing respiration, rapid pulse, pallor, and other symptoms of hæmorrhage, either external or internal. Artificial heat is supplied. Hæmorrhage from vagina should be looked for. It is normal. Salt solution by hypodermoclysis may be required. Hot water by mouth in small sips or tap water by rectum (drop method) will relieve the thirst. Morphine may be given if pain is extreme. An enema may be given on the second day or calomel may be started in the morning of the second day. Distention from gas, with or without nausea and vomiting, hiccough and rise of temperature are all signs of danger. No milk should ever be given on account of the gas it causes.
The child is put to breast as usual after twelve hours.
The stitches are to be taken out on the tenth or twelfth day.
Symphyseotomy is a separation of the pelvis at the pubic joint and is done with a scalpel or a specially devised knife.
Pubiotomy is the division of the pelvis, three or four centimeters to the right or left of the pubic joint. The division passes through the pubic bone and is usually done with a serrated wire called the Gigli saw. It is introduced subcutaneously by a special instrument called a pubiotomy needle. Both symphyseotomy and pubiotomy are preparatory to delivery. Pubiotomy is the more desirable and successful operation. The ends of the severed bones separate from one and a half to two inches, and the child delivers easily through the enclosed opening. The after-care is usually simple.
Instruments.—