Midwifery and the diseases of women

by Joel Shew

There should not be too many persons in the room when the woman is to be confined. In the country it is by far too much the fashion for a large company of women to get together on such occasions. This always renders the air of the apartment more foul than it otherwise would be, and for other reasons it ought not to be permitted.

I have many a time pitied the condition of women whom I have attended, who had but one room to live in, cook, wash, iron, and at last to be confined in; and yet those women have in general got along better than such as live in a more sumptuous way. Such women are, in fact, workers, and employment, as I have before remarked, is a most blessed thing in regard to preparing the system for the important function of labor.

The Bowels.—If the bowels should be constipated at the time when labor is about to come on—and such is likely to be the case—the woman should use clysters freely. This practice is, in fact, advisable in all cases, inasmuch as it can do no harm. If there is fecal matter in the colon, it is better that it be removed before the birth is about to take place. Hardened excrementitious matters in the lower bowel are always a hindrance to labor.

The Dress.—Formerly it was considered a matter of importance as to how a woman was dressed in labor. Different countries and provinces had their particular forms of gowns, jackets, chemises, and head-dresses. The great thing, however, to be observed, is simplicity; that is, nothing should be worn which at all interferes with the body in any of its functions or parts. If the dress is such as causes no constriction of the abdomen, the chest, or the neck, such as gives free motion to the limbs, and is of such material that it makes the body neither too hot nor too cold, it is all that is required. Generally too much clothing is worn at the time of labor. It is safer to be on the side of too great coolness than of the opposite extreme.

The Bed.—This has been called by different names; the lying-in bed, bed of labor, bed of pain, bed of misery, little bed, etc.

Some women will not make use of any sort of couch whatever. I know a lady in this city who has borne a pretty large family of children, who affirms that she gets along much better upon her hands and knees on the floor than in any other way. Some are delivered standing up, the elbows resting on some object, as the mantle-piece, bureau, the back of a chair, or some other piece of furniture, or perhaps upon the shoulders of a friend. “A strong and well-formed woman,” says Velpeau, “may be delivered in any posture, on a chair, on the floor, a bundle of straw, on foot, and on all the kinds of beds that have been proposed; so that it is only in the cases where nothing interferes with the accoucheur’s doing just what he thinks best, that he ought to attach some value to the composition of the lying-in bed; further, the only essential matter is, that the woman should lie as comfortable as possible, that she should not be incommoded, neither during the pains nor the intervals between them, and that the perineum may have room to dilate.”

Oftener than otherwise in this country, the woman is delivered on the same bed on which she sleeps. Sometimes, also, a cot is used, which also is a very convenient contrivance, since it allows of the free passing of the physician and others about it. It is, likewise, a healthful plan to move from one bed to another after labor; but this is by no means strictly necessary. Cleanliness, comfort, and good air—these are the great requisites in regard to the bed.

The Position.—If the patient is to lie upon a bed, which is doubtless the preferable plan in the majority of cases, what shall be her position?

This, like many other things, is a matter somewhat of fashion. In Great Britain the woman is always placed upon the left side, with the thighs flexed, that is drawn up toward the body, and the hips brought close to the right side of the bed. The same position is usually adopted in this country; but on the Continent, the woman is placed on her back to be delivered. This, I am inclined to think, is the most favorable, as well as most agreeable position, although perhaps not the most convenient for the medical attendant.

Exercise.—During a considerable portion of an ordinary labor, it is doubtless better for the patient, especially if she feel inclined to it, to sit up, and walk about a little from time to time. This not only affords some relief, but likewise aids in causing more efficient contraction of the uterus.