It is a part of the nurse’s duty tactfully to warn the doctor when such a thing occurs, as it may happen accidentally while his attention is concentrated elsewhere, and a conscientious man will be grateful for the information. As the head passes the perineum the anæsthesia should be deepened.
As soon as the head is born and the first respiration established (see Asphyxia, p. [278]), the cord is cut and clamped. There is rarely any necessity for haste in this maneuver. The eyes are treated, and if in a hospital, a numbered tape is tied about the wrist and a tape with a corresponding number about the mother’s wrist.
The baby is now placed in the receiving blanket on its right side, with artificial warmth at its back and feet. The head must be lower than the body so any retained mucus can drain out of nose and mouth. Meanwhile, the doctor (or nurse) keeps a hand on the fundus of the uterus to watch its contraction, see that it does not balloon up, and massage it occasionally if necessary while he awaits the onset of the third stage.
Third Stage.—The patient is turned upon her back as soon as the child is delivered. The pulse and face must be watched for signs of hæmorrhage. While waiting for the placenta, the perineum is examined to note the degree of laceration, if any. To do this, the vulva must be spread apart with clean fingers so as to bring the posterior wall into view, and the discharge is sponged away with cotton pledgets taken from the lysol solution and squeezed dry.
The patient may now have the saturated dressings removed and clean, dry ones substituted. The new pads catch the oozing blood and give an estimate of its amount.
At this time, if desirable, the perineum can be repaired. The woman is partly unconscious, the tissues numbed, and the needle hurts much less than it will later. Nevertheless, anæsthesia may be required.
In a period varying from a few minutes to an hour, the hand on the uterus will note a hardening, the mass will become smaller, more globular, and rise slightly in the abdomen. A gush of blood appears at the vulva and usually the placenta follows. If it does not, or if hæmorrhage or the condition of the mother requires it earlier, the uterus may be compressed (see Credé expression) and the placenta constrained to deliver.
The nurse holds a sterile basin for its reception. As the mass drops into the pan, the membranes drag after and it should be gently twisted, or the loose portions drawn upon until the end slips out. The placenta is set aside for examination, and ergot or pituitrin may be given to enforce the uterine contraction. The process of expulsion is generally assisted by a strong voluntary contraction of the abdominal muscles.
After a short rest, the blood is washed off the genitals, clean linen and clean pads applied, and the abdominal binder or girdle is put on to hold the pads. Warm blankets are thrown over the patient and within an hour, a glass of hot milk is administered.
The legs should be kept together, and in case of hæmorrhage, the feet crossed.