Before passing on to the consideration of the management of the confinement into which the wife has now entered, a few words may be appropriately said upon the
CAUSE OF LABOR.
Neither the size nor the vigor of the child has any influence in bringing about delivery at full term. The ancient theory—which received the support of the distinguished naturalist Buffon—that the infant was the active agent in causing its own expulsion, is an exploded one. It was asserted by some that hunger excited the fœtus to struggle to free itself from the womb; others were disposed to attribute its efforts to accomplish its entrance into the world, to the need of respiration which it experienced. But all these ingenious theories, which presupposed the embryo to be actuated by the same feelings which would influence a grown person if shut up in such a confined abode, are unsatisfactory, and not tenable. It is well known that the child may die in the womb, without retarding or interfering in any way with the coming on of the process of labor. This fact alone shows that the fœtus is, or at any rate may be, absolutely passive either in regard to the induction or advancement of delivery. The determining cause of labor is seated in the womb itself. The contractions of this organ occasion the 'pains' and expel the child, assisted by the muscles of the abdomen and the diaphragm. That the assistance of the latter forces is not necessary, is conclusively proved by the occurrence of childbirth after the decease of the mother. For instance, a case is on record in which labor commenced and twins were born after the mother had been dead for three days.
CARE DURING LABOR.
We will suppose labor to have commenced. The preparation of the bed for the occupancy of the mother is now to be attended to. As she is to lie on the left side of the bed, this is the side, and the only one, which is to be dressed for the occasion. In order to do so, remove the outer bed-clothes one at a time, folding them neatly on the right side of the bed so that they can easily be drawn over when desired. The permanent dressing is to be placed beneath the lower sheet and upon the mattress. A soft impervious cloth—which, in speaking of the preparation for confinement, we directed to be procured—is placed next to the surface of the bed. The upper edge should be nearly as high as the margin of the bolster, and it should extend down to a distance at least a foot below the level of the hips, so as to certainly protect the bed from the discharges. Upon the top of this a blanket or sheet is laid, and the whole fastened by pins. The lower sheet of the bed, which had been turned over to the right side, to permit the application of the dressing, is now to be replaced. Over the position of this permanent dressing, on the top of the bed-sheet, a neatly-folded sheet, with the folded edge down, is adjusted and pinned in its place. It is upon this sheet that the patient is to be drawn up after her confinement, which will take place upon the temporary dressing of the bed now to be arranged. It consists of an oil-cloth, which should extend up beyond the lower edge of the permanent dressing, overlapping the folded sheet which has been placed above it, and should fall over the side and bottom of the bed. A comfortable or any soft absorbent material is placed over this impervious cloth and covered with a folded sheet, completing the temporary dressing. The bed-clothes may now be adjusted, concealing the dressings from view until they are wanted. The valances at the foot of the bed should be raised, and a piece of carpet placed on the floor. The bed should have no foot-board, or a very low one.
The dress of the mother.—Either a folded sheet should be adjusted around the waist as the only skirt, so as not to interfere with the walking, or a second chemise should be put on, with the arms outside the sleeves, to extend from the waist to the feet. Then the chemise next the body should be drawn up and folded high up around the breast. It should be plaited neatly along the back, and brought forward and fastened by pins. This should be thoroughly done, so that the linen may not be found wet nor soiled when it is drawn down after confinement. A wrapper or dressing-gown may be worn during the first stage of labor, before it is necessary to go to bed. When, however, that time comes, the wife will take her place on her left side on the temporary dressing, with a sheet thrown over her, her head on a pillow so situated that her body will be bent well forward, and her feet against the bed-post. A sheet should be twisted into a cord and fastened to the foot of the bed, for her to seize with her hands during the accession of the 'bearing-down pains.' Care should be taken to have a number of napkins, a pot of fresh lard, and the basket containing the scissors, ligature, bandage, etc.—which have been previously enumerated in the remarks on preparations for childbirth—at hand, for the use of the doctor.
We have now noted all that it is useful for the wife to know in regard to the preparation for and management of confinement, when a physician is in attendance, as, for obvious reasons, he should always be. In some instances, however, the absence of the doctor is unavoidable, or the labor is completed before his arrival. As a guide to the performance of the necessary duties of the lying-in room under such circumstances, we give some
HINTS TO ATTENDANTS.
The room during confinement should be kept quiet. Too many persons must not be allowed in it, as they contaminate the air, and are apt by their conversation to disturb the patient, either exciting or depressing her. So soon as the head is born, it should be immediately ascertained whether the neck is encircled by the cord; if so, it should be removed or loosened. The neglect of this precaution may result fatally to the infant, as happened a short time since in our own practice; the infant, born a few minutes before our arrival, being found strangled with the cord about its neck. It is also of importance at once to allow of the entrance of air to the face, to put the finger in the mouth to remove any obstruction which may interfere with respiration, and to lay the babe on its right side, with the head removed from the discharges. The cord should not be tied until the infant is heard to cry. The ligature is to be applied in the following manner:—A piece of bobbin is thrown around the navel-string, and tied with a double knot at the distance of three fingers' breadth from the umbilicus; a second piece is tied an inch beyond the first, and the cord divided with the scissors between the two, care being taken not to clip off a finger or otherwise injure the unsuspecting little infant, as has occurred in careless hands more than once. When the child is separated from the mother, a warm blanket or a piece of flannel should be ready to receive it. In taking hold of the little stranger, it may slip out of the hands and be injured. To guard against this accident, which is very apt to occur with awkward or inexperienced persons, always seize the back portion of the neck in the space bounded by the thumb and first finger of one hand, and grasp the thighs with the other. In this way it may be safely carried. It should be transferred, wrapped up in its blanket, to some secure place, and never put in an arm-chair, where it may be crushed by some one who does not observe that the chair is already occupied. The head of the child should not be so covered as to incur any danger of suffocation.