In the hospital the following rules for summoning the resident physician may be found useful:
1. For multipara, when pains are regular and five minutes apart.
2. For primipara, when pains are regular and two minutes apart, or when head is visible if pains are less frequent.
3. If a precipitate is imminent, delivery must be delayed until arrival of attending man by—
(a) Turning patient on side with legs straight;
(b) Instructing patient to breathe deeply or to cry out with mouth wide open; then
(c) Place sterile towel over vulva, and at time of pain prevent expulsion by compressing the head by means of locking the hands over a towel on the vulva.
It is possible thus to delay delivery two hours, or until the doctor arrives. Do not permit a precipitate.
After the nurse has completed her preliminary observation, she starts her history, notes the character of the pains, the pulse, temperature and respiration. All unusual phenomena should be recorded; and after the visit of her attending man, his examination, if any, and the conditions found, are put down. Then she prepares the patient and sets up the room for the delivery.
Preparation.—As soon as the patient is known to be in labor, the bowels are thoroughly cleansed with a soapsuds enema. A toilet jar should be used and not the water closet. The bladder must be emptied at the time of preparation and at frequent intervals throughout the labor. As soon as the bowels and bladder are emptied, the patient is given a bath and thoroughly soaped. The shower is preferred lest the water, contaminated by bacteria from the skin and external genitals, should enter and pollute the vagina.