The Matron's Manual of Midwifery, and the Diseases of Women During Pregnancy and in Childbed / Being a Familiar and Practical Treatise, More Especially Intended for the Instruction of Females Themselves, but Adapted Also for Popular Use among Students and Practitioners of Medicine

by Frederick Hollick

When everything is arranged the assistant should take his seat on the right hand of his patient and repeat the examination. If the head presents, he need not concern himself much further at present, but if it be any other part, he should prepare at once to change it, or assist, as the case may be. At this second examination the parties present, and the female herself are usually anxious to know if the child is coming right, and how long the labor is likely to last. The answer to these inquiries should be guarded and circumspect in regard to the duration, because of its uncertainty, but if the presentation is right, it is well to say so at once, because this gives great comfort and encouragement. If it be unfortunately wrong, it is best not to say so abruptly, but remark that it is rather obscure, or cannot yet be fully distinguished, and so keep up the spirits of the female while you await the proper time, or make the necessary arrangements, to interfere; and then tell her there is a little difficulty which requires to be righted, but which will not be serious, nor cause much delay.

If the labor steadily progresses it is necessary to remain with the female and attend to it; but if it be delayed, and everything remains natural, she may be left for a time with advantage. When the second stage is fairly commenced however, and especially after the membranes are broken, the attention should be unremitting. The state of the parts should be ascertained frequently, so that the actual progress may be known, and any necessary assistance rendered. The state of the bladder especially should be observed, and if it be full and the female unable to urinate, the catheter should be passed. Neglect of this precaution may lead to serious accidents. While making the examinations, the hand should be introduced with great care, so as not to bruise or lacerate the parts, and it should not remain longer than absolutely necessary.

Many females exhaust themselves unnecessarily by bearing down, and straining, with great force, from the very commencement of labor, under the mistaken idea that it is necessary to do so, or will assist. They should be told not to do so however, till after the membranes are broken, and not even then unless the neck of the womb begins to dilate. They should also be told not to make any effort except during a pain, as it will not assist at any other time.

No attempt should be made, under ordinary circumstances, to rupture the membranes, or dilate the mouth of the womb, even though nature may be slow in doing so. Patience must be practised, both by the female and by her assistant, and sometimes it is severely tried.

When the waters have escaped, and the orifice is opened, an examination must be made, to discover whether the cord has descended, or either of the arms, as is sometimes the case, and if so, they must be returned if possible.

As the head descends to the bottom of the pelvis it compresses the rectum, and produces a feeling as if the bowels must be moved, or even causes them to be so. This is apt to distress the female, and make her wish to rise, which cannot be permitted. If anything of the kind occurs no notice should be taken of it, or she may even be assured she is mistaken, while a clean napkin may be interposed. This, as Dr. Chailly observes, will soothe her delicacy. Such an accident is very apt to occur towards the end of the labor.

When the head has rotated, and presents at the external opening, or vulva, and begins to distend it, the greatest care is required. This is a critical period, during which the accoucheur can render more real assistance than at almost any other. There is danger at this time, as formerly explained, of the head passing through too quickly, before the parts are sufficiently relaxed, and so causing them to rupture. This is particularly the case with the perineum, against which the head presses with great force. It is necessary therefore to support the perineum, as it is termed, to prevent this accident. This is done by passing the right arm under the patient's right thigh, and placing the palm of the hand flat against the perineum, with the thumb encircling one side of the vulva, and the forefinger the other. The hand is then gently, but firmly, pressed against the part during every pain, so as to prevent the head passing too quickly, and also to elevate it, and thus relieve the perineum of part of the strain, and throw the occiput under the pubes.

Some practitioners also pass the left hand over the thigh, at the same time, and grasp the back of the head with it, thus holding the head as it were between the two hands, so as to direct it at pleasure.

The manner of doing this is represented in plate XXXIX.