The placenta is now inspected and not only its completeness or incompleteness noted, but anomalies of every kind should be looked for.
IMMEDIATELY AFTER LABOR
Perineorrhaphy must be done if required.
A lacerated cervix is not to be repaired at this time, except in case of hæmorrhage, for the tissues are greatly swollen, and if sutures are put in tight enough to allow for sufficient shrinkage, they will cut through; while if not tight, they will be useless in twenty-four hours.
Care of Mother.—
1. Cleanse genitals with lysol solution 0.5 per cent from above downward. 2. Put on sterile pad, with pad holder and binder. 3. Wash face and hands. 4. Take temperature, pulse, and respiration. 5. Glass of hot milk. 6. Keep on back four hours. Watch uterus for hæmorrhage and keep firm by occasional massage. 7. Put tape with case number on arm.
Care of Child.—
1. Clamp for the cord. 2. Place on right side with head lower than breech. 3. Keep warm and watch for cord hæmorrhage. 4. Treat eyes with silver nitrate solution 1 per cent, or argyrol solution, 15 per cent. Do not neutralize the 1 per cent silver nitrate solution. 5. Put tape with case number corresponding to mother’s on arm.
To preserve the perineum from rupture is an important duty, and in a definite percentage of cases, unsuccessful. Nevertheless, it is a duty, which, in the absence of the doctor, may fall upon the nurse. How shall she meet it?
The greatest danger to the perineum comes from a too rapid advance of the head; hence, the nurse retards the delivery by putting the woman on her side where she can not bear down so successfully, and instructs her to cry out with her pains. She may also delay the labor by holding the head back with a clean pad until the vulva stretches to its fullest capacity.