Fig. 107.—The Sims position. (Kelly.)
The labor, if begun, should be expedited by forceps, or version and extraction. Bleeding during delivery should be looked upon as desirable. If more rapid measures of delivery seem demanded and obstacles exist, such as pelvic contraction, imperfect dilatation, or the prospect of a prolonged first stage, Cæsarean section or forcible delivery (accouchment forcé) may be attempted.
If the labor has not begun, when the convulsion occurs and a quick delivery by the normal passage does not seem feasible, then the Cæsarean operation may be the best treatment.
CHAPTER XVI
THE ABNORMAL PUERPERIUM
The practice of obstetrics has many features that are very gratifying to the nurse and physician.
Instead of a surgical operation, which has come unexpectedly and undesired; a disaster in which some part of the body is removed or altered by means of a procedure associated with extreme pain, mental tribulation and large expense, a much-wished for addition is brought to the family, with pain, to be sure, but a pain that is soon forgotten in the general joy. This is the normal condition that causes the nurse and the doctor to rejoice that such a delightful specialty has been chosen.
Then comes a case in which the labor may be complicated by some dreadful anomaly, or the puerperium burdened or disordered by some unwelcome invasion that tortures the souls of the family and may cost the life of the mother, or child, or both.
At such a time the nurse and the doctor feel the full weight of their responsibility, and after a series of anxious days and sleepless nights, they wonder why they did not choose gardening or a clerical position for their life work.
The disorders of the puerperium are many and various, but naturally the breasts and the pelvic organs are most frequently affected.
The breasts of the human female are not reservoirs of milk like the cow’s, but a pair of highly sensitive organs that functionate and produce only as the demand is made. It follows that when the milk comes in, the breasts become engorged and all the neighboring structures are involved in the new process. However, it is not milk that is overfilling the breasts, but serum, lymph and venous blood, which congest the tissues surrounding the glands and produce a hard painful mass.