If it appears from the examination that labor has really commenced, or is about to do so, everything should be at once prepared. All useless persons should leave the room, and also those who would be likely to alarm or grieve the patient by uttering cries, or exhibiting fear; but no objection should be made to any one being present whom she wishes to see, unless they cannot be depended upon. Thus some females always wish to have their husbands with them, but others do not, though they are averse to saying so. In these cases the accoucheur, if he be an attentive observer, will soon see what is really desired by his patient, and will manage matters accordingly.
The dress of the female should be perfectly loose, consisting of a wrapper or night-gown, but sufficiently complete and warm to allow of her getting up to walk in the chamber, if she desires it, as some do. No corsets, garters, or other tight bandages, however, should be allowed.
The bed should be prepared by placing the mattress on the top, or by removing all from it; and then placing a thick layer of blankets or quilts, with a folded sheet over them. This is to provide a firm level surface, in which the body will not sink, and also to prevent the fluids soaking through. It is an excellent plan, if the material can be obtained, to place a thin oil-skin or India-rubber cloth under the folded sheets, as this keeps all perfectly dry underneath. Some persons also place another folded sheet, or a cushion, under the pelvis, to keep it elevated; but this is not necessary, unless the bed sinks in very much. It is also advisable to leave a foot-board or other firm body, against which the female can press her feet when bearing down; and a long towel folded lengthways should be passed under the back, so that it can be raised up by a person lifting at each end. This will often be found a better mode of pressing the back, which nearly all patients call for, than by merely forcing the hand against it, which is both tiresome and insufficient. Another towel may also be firmly fixed to the bottom of the bed, so that she can pull by it, at the same time that she pushes with her feet.
Some persons are confined on a cot, but this is not a very good arrangement, because it sinks in too much in the middle, and is not sufficiently large and firm. It is advantageous in one respect, however, as it can be placed by the side of the bed, into which the patient can be lifted when all is over, and be comparatively dry and comfortable. This is the most frequent plan in France. If the bed be properly arranged however, the under sheet can be withdrawn, and clean warm napkins then passed under the body, which will be equally as good. The covering should consist of a sheet, with blanket or coverlid, according to temperature, and should, of course, never be removed, except under peculiar circumstances.
The chamber itself should be as quiet as possible, well ventilated, and not too warm. Nothing distresses the patient more than a close, hot atmosphere.
The accoucheur need not, of course, be present while these arrangements are being made; and when he retires he should suggest to the nurse that the female may attend to the bowels and bladder during his absence. This precaution may both facilitate the labor, and prevent much future annoyance. It would even be advisable to administer an injection if necessary, of thin starch and a little castor oil, rather than leave the bowels unmoved.
In regard to nourishment, nothing is needed or proper in the shape of solid food; because all the energies of the system are concentrated in the uterus, and as digestion cannot therefore go on, it would only be an evil. If the labor is much protracted however, some broth or soup may be taken, or a little milk. As a general rule, no spirituous liquors or stimulating drinks of any kind should be taken; because they impart no real strength, and may produce inflammation, or congestion on the brain. Some females always prefer tea to drink, others lemonade, toast water, gruel, or barley water, and others again simple cold water, which is perhaps the best of all. In cases of great exhaustion it is sometimes advisable, and even necessary, to give a little wine, or brandy and water, but it should always be cautiously administered.
In some parts it is customary for the female to lie on her side during delivery, with a pillow between the knees; some even choose this mode, and others will desire to stand, or place themselves on their knees. The most frequent position however, and certainly the most convenient, is on the back, though it may often be changed with advantage under peculiar circumstances. In the early stages of labor she can lie, or move about, as she chooses, or even rise if more agreeable.