The face may be sponged and a cold towel laid across the eyes. Rubbing of the back and legs will bring great comfort, and cramps of the limbs may be removed by straightening the legs and rubbing the muscles underneath. Everything is now ready for the delivery. If the husband insists upon being in the room, he should take off his coat and vest and wear a gown, or if the labor is in the home, drop a clean night robe over his clothes.
The prepared room will show at close hand-reach, the basins of solutions, the pledgets of cotton, tape or clamp for cord, scissors, nitrate of silver solution (1 per cent) for the eyes, with dropper, the sterile douche can in readiness for hæmorrhage and a large reserve of supplies. Whatever anæsthetic has been chosen for the second stage, is now administered. Throughout this stage, the heart tones of the child must be watched, as well as those of the mother, for intra-partum death may occur at any moment.
A second examination may be desirable now to confirm the diagnosis and to secure an estimate of the advance. As a rule, the examinations should be as few as possible on account of the danger of infection.
This is the period of greatest responsibility for the doctor whose duty it is to watch and, if necessary, to restrain the advance of the head in order to protect the perineum from rupture.
This may be done at times most successfully, or in the case of too few assistants, most desirably, by delivery on the side. To secure this, as the head becomes more and more visible, the woman is turned upon her left side; a pillow rolled tightly and pinned in a sterile covering is placed between the knees, and a sheet flung across the body.
Fig. 57.—Delivery in side position. The hands should be gloved and the upper leg raised on a hard cushion or pillow. (American Text Book.)
The hips must be brought to the edge of the bed while the chest and head are pulled over to the other edge of the bed, leaving the legs just enough space to double up along the side of the bed parallel with its long axis.
The doctor may now sit on the edge of the bed, or on a high stool at the back of the patient and facing the buttocks. This is a most convenient and easily managed position.
As the head is born, the fæcal matter, blood and discharges must be sponged away, and the field kept clean, with the whole perineum visible. Always sponge from vagina toward rectum and throw away the sponge. Should the hand touch nonsterile things or septic material, like fæces, the glove must be changed. The hands must be kept surgically clean.