In changing the upper sheet, it should be pulled off from below, and the clean one carried down in its place from above, underneath the other clothing, which can be readily accomplished by plaiting the lower half. In introducing a clean under-sheet, one side of it should be plaited and placed under the patient, lying on her left side; when she turns on her back, the plaits can then be readily drawn out. These directions, though apparently trivial, are important. The object is to guard against the great danger to which the mother is exposed by sitting up in bed for even a few minutes during the first week.
Cathartic medicine should not be administered the first, the third, or any other day after confinement, unless it is needed. If the patient is perfectly comfortable, has no pain in the abdomen, no headache, and is well in every respect, she should be let alone, even if her bowels have not been moved. If a laxative be called for, citrate of magnesia is much pleasanter and equally as efficacious as the castor-oil so frequently administered on this occasion.
TO HAVE LABOR WITHOUT PAIN.
Is it possible to avoid the throes of labor, and have children without suffering? This is a question which science answers in the affirmative. Medical art brings the waters of Lethe to the bedside of woman in her hour of trial. Of late years chloroform and ether have been employed to lessen or annul the pains of childbirth, with the same success that has attended their use in surgery. Their administration is never pushed so as to produce complete unconsciousness, unless some operation is necessary, but merely so as to diminish sensibility and render the pains endurable. These agents are thus given without injury to the child, and without retarding the labor or exposing the mother to any danger. When properly employed, they induce refreshing sleep, revive the drooping nervous system, and expedite the delivery.
They should never be used in the absence of the doctor. He alone is competent to give them with safety. In natural, easy, and short labor, where the pains are readily borne, they are not required. But in those lingering cases in which the suffering is extreme, and, above all, in those instances where instruments have to be employed, ether and chloroform have a value beyond all price.
MORTALITY OF CHILDBED.
The number of the pregnancy affects the danger to be expected from lying-in. It has been declared by excellent authority, that the mortality of first labors, and of childbed fever following first labors is about twice the mortality attending all subsequent labors collectively. After the ninth labor the mortality increases with the number. A woman having a large family, therefore, comes into greater and increasing risk as she bears her ninth and successive children.
The age of the woman also affects the mortality accompanying confinement. The age of least mortality is near twenty-five years. On either side of this, mortality increases with the diminution or increase of age. The age of the greatest safety in confinement therefore corresponds to the age of greatest fecundity. And during the whole of child-bearing life, safety in labor is directly as fecundity, and vice versâ. Hence modern statistics prove the correctness of the saying of Aristotle, that 'to the female sex premature wedlock is peculiarly dangerous, since, in consequence of anticipating the demands of nature, many of them suffer greatly in childbirth, and many of them die.' As the period from twenty to twenty-five is the least dangerous for childbirth, and as first labors are more hazardous than all others before the ninth, it is important that this term of least mortality be chosen for entering upon the duties of matrimony. This we have already pointed out in speaking of the age of nubility.
The sex of the child is another circumstance affecting the mortality of labor. Professor Simpson of Edinburgh has shown that a greater proportion of deaths occurs in women who have brought forth male children.
The duration of labor also influences the mortality of lying-in. The fatality increases with the length of the labor. It must be recollected, however, that the duration of labor is only an inconsiderable part of the many causes of mortality in childbirth.