When requested to see a woman supposed to be in labor, it is always advisable to be prompt in paying the visit, because delivery sometimes comes on suddenly and unexpectedly, and both mother and child may be in great danger if no one is near to assist.
Some time before the event is expected, it is advisable to provide certain articles, which will or may be needed at the time, and which should not have to be looked for at the last moment. A pair of sharp scissors, with a piece of strong thread or cord, are indispensable, and a female catheter may be needed. A quill with the feather part on, may also be useful; and some pure lard or sweet oil is frequently called for. The professional accoucheur will also find it a good precaution to have his stethoscope in his pocket, and a lancet, if he ever relies upon bleeding in any contingency. A small box of extract of Belladonna also, may often be of great and immediate service.
PRELIMINARY PROCEEDINGS.
The first thing required when visiting the patient, is of course to ascertain positively whether she be pregnant, and whether labor is really commenced, and if so how far it has progressed. This necessitates an examination, the proposal and making of which require the most delicate tact, particularly if it be with a comparative stranger, or in a first labor. No allusion to it should be made to the patient herself by the assistant; he should converse with her about indifferent matters, or merely upon her health, and state his wishes to the nurse or female friend, and then retire. This gives them time to inform her of what is required, and to make the necessary preparation. On entering the room again, he should not proceed abruptly, but resume the conversation, and make some of the necessary arrangements while carrying it on. He should seat himself by the side of the bed, with his right hand next her, and his face opposite hers. Then passing his hand under the bed clothes, after having lubricated it with lard or oil, he can proceed with the examination as if it were a simple ordinary proceeding. By exhibiting no hurry, and appearing to think it nothing unusual or in any way strange, the female herself will cease to think it so, and will not be flurried or shocked.
The hand must be passed under the female's right thigh, her knees being elevated. She should, of course, lie on her back, and as near to the edge of the bed as convenient. Not the slightest exposure is necessary, nor allowable under ordinary circumstances.
The fore-finger being introduced, ballotment may be practised, to ascertain if pregnancy really exists; and if the evidence from this source is not sufficient, auscultation must be resorted to. After being satisfied on this point, the mouth of the womb must be carefully examined, and its degree of dilatation noticed. If the female has pains, their character and frequency must also be noticed, and the effects they produce on the parts. It will generally be possible by these means, to discover how far the labor has progressed, and even to form an opinion how long it is likely to last. The general form of the parts and their size, should also be noticed; particularly of the pelvis, so that any deformity or deficiency may be discovered. And lastly, the presentation should be ascertained, if possible, so that it may be known in time whether nature will be sufficient herself or will require helping. The position need not be cared for at present, because it is of little consequence when the presentation is favorable.
The time required to make the examination need not be long, and should always be as short as possible.
While conversing with the patient, much useful information may be gained. The general state of her health, the nature of her pains, and the time they first commenced, should all be known; and if she has had children before, it will be highly useful to know what kind of a labor she had; whether it was long or short, easy or difficult, and particularly if attended with any accident likely to occur again.
It need scarcely be remarked that great caution is needed in these cases, many eminent men having been deceived as to the patient's condition, as already stated in our chapter on the signs of pregnancy. And many times the doctor has been summoned under the supposition that labor had begun, while it was yet far off. The pains may be false ones, such as frequently occur towards the end of pregnancy, and may all pass away. These false pains, however, can usually be distinguished, being continuous and irregular, while the true ones intermit with periods of almost perfect ease, and are tolerably regular. The false pains are also felt in various parts, while the true ones are chiefly fixed in the uterus and vagina. Sometimes, however, the difficulty in distinguishing them is very great, and the accoucheur has often waited for several hours and even days; the labor meanwhile making no progress; and eventually all has passed off, and the patient has risen again from her bed. I know one case, where a gentleman attended nearly three days, at the end of which time the patient rose and walked down stairs. She was not put to bed till six weeks after. I can scarcely think, however, that these mistakes can happen very frequently, if the examination be properly conducted.