Obstetrics for Nurses

by Charles B. Reed

The nurse, meanwhile, has wrapped the legs of the patient in the ends of a sterile sheet, the bulk of which covers the abdomen. The knees are spread apart. The vulva cleansed with pledgets of cotton soaked in lysol solution. One or two pledgets are used on either side of the vulva and the same number for cleansing the introitus.

The fingers are now introduced.

The internal examination may be conveniently postponed until the waters break, or it may be omitted altogether if the heart tones of the child remain good, the labor progressive, and the head continually advances into the pelvis, as determined by the external examination. The great advantage of an internal examination at this time is the diagnosis of the degree of dilatation and the assurance that the cord has not been washed down into the vagina by the rush of fluid.

If the first stage is prolonged, the nurse should try to get the patient to rest, and she should herself snatch a few moments of repose if possible.

Fig. 56.—Patient draped for internal examination. (Williams.)

The condition of the os and the character of the pains may make the doctor feel safe in leaving the house, but his whereabouts and telephone number should be ascertained and the exact time of his return.

Second Stage.—During this stage, the patient should go to bed and the doctor should remain nearby. The nurse may observe the vulva at intervals and note bulging, if present, or she may press a finger against the soft parts outside the labia and see if the hard resistant head has come into the outlet.

The pains are severe and all accessory muscles are called into action. Partial anæsthesia should be maintained in most cases, which should merge into complete narcosis as the head passes the vulva. The nurse may have to administer this.

When this stage begins, or is well under way, the patient should be prepared. A sterile pad should be placed under her, then a sterile bed pan. The nurse having prepared her hands and arms as previously directed for the doctor, scrubs abdomen, legs, and vulva with green soap and warm water, followed by lysol solution 0.5 per cent and a rinsing with sterile water. The cleansing of the patient should take about ten minutes. Cover with a sterile towel and put on the sterile linen.