The child may be deformed.—The accoucheur should also carefully examine the child, to see if it be deformed in any way, or has met with any accident, because in some of these cases assistance is required immediately, and may be rendered at once.
The child's capability of endurance.—The capability of the new-born infant to endure extremes of cold is almost as great as that of its mother, and sometimes even it is benefitted by them. With many persons it is customary to plunge it in cold water, immediately when born; and in Russia, we are told, it is even rolled in the snow. In some cases these extremes may be beneficial, but in others I have no doubt they prove fatal. A medium course is best, in most instances, leaving the extreme to be resorted to when we wish a sudden stimulus.
When all these matters are carefully attended to, and both mother and child have remained for an hour or two without any unpleasant symptom, they may be left to the care of the ordinary attendants, giving them strict orders to send for proper assistance immediately, if anything unusual transpires.
SUBSEQUENT ATTENTIONS TO MOTHER AND CHILD.
The Bladder.—One of the most important points to attend to is the urine. A few hours after the delivery is fully effected, unless the female is reposing, she should be asked whether she has any desire to urinate; and, if she has, the convenience should be at once afforded to do so. There is always more or less danger of retention of urine, from the pressure that has been exerted on the bladder; and if it be allowed to continue too long its removal becomes exceedingly difficult. If on making the attempt the urine does not flow, the catheter must be used, and the sooner the better. The pain arising from retention of the urine has often been supposed to arise from inflammation of the womb, or bowels—neither patient nor physician knowing its real source, till the passage by the catheter gave relief. There have even been instances of females dying, merely from an overcharged bladder, while their attendants were industriously treating them for uterine inflammation. This accident therefore, should always be suspected, and a very little attention will prevent any mistake in regard to it. When allowed to become too full the swollen bladder may be felt, just above the pubes, hard and tender, so that the least pressure upon it causes great pain. If not relieved it will at last burst.
The Bowels.—If the bowels are not opened naturally, it will be well, the following day, to administer an injection of thin starch and water, or to prescribe a small dose of castor oil, or a seidlitz powder. This should also be repeated for two or three days, till the natural power is restored.
The Food.—But little solid food should be taken, and nothing stimulating. Gruel, milk, toast and water, Indian meal, light puddings, or broth, should be the chief articles for some time. Roast apples are also very good, being pleasant and relaxing. For refreshing drinks, if there be any fever, lemonade or tamarind tea may be taken.
The After Pains.—After the expulsion of the after-birth most females experience, more or less, severe pains, almost like those of labor, arising apparently from the further contraction of the uterine walls to expel the coagulated blood. These pains are seldom or never felt in first labors, but afterwards they are often most acute. I have known many patients suffer much more from them than they did during labor. They sometimes last only a few hours, or a day, and sometimes even extend to six or eight days. Nothing that we know of can prevent them, though many means are known of mitigating their severity. If there be no tendency to flooding, a large poultice may be placed over the abdomen, or it may be fomented, or covered with cloths wrung out in hot water. An injection may also be used, either in the Vagina or Rectum, consisting of warm thin starch, with about twenty drops of laudanum; or either of the following recipes may be used internally:—Pills of Gum Camphor, two, about the size of ordinary pills, to be repeated, if necessary, in an hour.—Or, Syrup of Poppies, two drachms; Mucilage of Gum Arabic, two ounces; and Solution of Sulphate of Morphia, ten drops; to be made into a mixture, one-half of which may be taken at first, and the remainder in two hours, if the patient is not relieved. This seldom fails.—It is necessary to bear in mind that the pains arising from inflammation have been mistaken for ordinary after-pains, and serious consequences have resulted from the error. The after-pains however, are concentrated, and intermittent, while the sensations from inflammation are more diffused and constant, and are also usually attended by fever.