Femina, A Work for Every Woman

by John A. Miller

The choice of a physician should not be delayed until the last moment, but it should be made several months before the expectation of delivery, and a woman should never engage a doctor for her confinement, unless she knows that he has had practical experience in at least ten cases of confinement, for some of our leading medical colleges and all of the poor ones, graduate hundreds of doctors each year who never attended a single case of confinement, and some have, even, never seen one; yet the newly fledged doctors are turned loose upon the unsophisticated communities to attend women in the most trying period of their lives, and at a time when both the experience and science of her physician should be her sheet anchor of hope. A physician who is not always sober, of good moral character, and cleanly in his habits and appearance, should never be allowed in the lying-in chamber, nor one who is prating of the many severe confinements he has attended, or who boastingly speaks of the number of times it was necessary for him to use instruments, for it is quite likely, that the many severe confinements of which he spoke, were either fictitious or due to his ignorance of the subject, and the frequency with which he used instruments was owing to a lack of patience on his part or to a desire to be meddlesome and make himself officious. There are a great many medical gentlemen who are not charlatans in disguise, and these should be singled out. The pregnant female should have herself thoroughly washed and bathed just before confinement, and the vagina should be thoroughly rinsed out with half a gallon of warm water in which a tablespoonful of pulverized borax has been dissolved; this precaution will wash out any infectious germs that may cause inflammation.

The bed in which the confinement is to take place should be scrupulously clean, and in order to insure this, it should be made a rule that the bedstead be taken apart, and taken out-of-doors where it is thoroughly washed and afterwards exposed to the purifying influence of the sun and air. The mattress must also be taken out for a similar dusting and cleaning, and kept for a time exposed to sun and air. The confinement chamber should go through the same renovating ordeal; the carpet of this particular chamber should be taken up, the floor thoroughly scrubbed and the walls and ceiling washed off and whitened. It will be better if a few clean mats or rugs can be substituted, and the old carpet not relaid until after the confinement, when the woman is up and around again. These precautions will guard against the possibility of infection and the dangers of childbed fever, and the many different phases of inflammation which are the result of carelessness in the details of cleanliness. Of course, the nurse and attending physician must be equally anxious of their own personal cleanliness. If he or she leave any of the infectious diseases, like scarlet fever, measles, typhoid fever, erysipelas and puerperal fever, either of them is quite sure to communicate the contagion to the innocently ignorant lying-in woman, and entail upon her endless suffering and death. In France and Germany, stringent precautions for nurse and physician against the dangers of infections are mandatory under the laws, but in free America such legal injunctions would be considered as curtailing our liberty; in the meantime, innocent lives are sacrificed, through lack of systematized regulations, at the cost of liberty degenerating into license.

On the day of confinement the bed is held in readiness for the occasion, by spreading over the mattress a large piece of oiled cloth, or what is preferable, rubber cloth; this must reach up high enough so as to afford proper protection and lap over the side of mattress and bedstead. Beside the bed an extra mat should be laid, to catch any fluid that may run down the rubber cloth on the floor.

The preliminary signs of labor pains that make themselves felt by the pregnant female, are of considerable interest to her and I believe, that if she will familiarize herself with their character she will have less anxiety and more confidence in a happy termination of her condition. For some days, and occasionally for two or three weeks prior to the commencement of actual labor, a sense of uneasiness about the uterus will be felt by the female; this uneasiness will be observed several times during the day and night. When the patient complains of this local disturbance, she may feel, by placing her hands over the region of the womb, that the organ becomes hard for the time being, and as soon as the sense of uneasiness passes away, the womb becomes soft again. These symptoms are called the “independent contractions of the uterus” and in the first pregnancy they are felt earlier than afterwards. This is simply a muscular irritability of the womb and is not accompanied by “bearing down” which is the true characteristic of labor. These preliminary skirmishes must not be mistaken for the commencement of labor, otherwise great mischief may be done by harassing the case into a premature delivery which might sacrifice the child. The pregnant female will often become very anxious when she first experiences these independent pains and she may imagine that something is wrong; for this apprehension there is no reason, because experience has taught that the greater this local disturbance before the beginning of labor, the more favorable the progress of labor will be when true labor pains set in.

“The righting of the organ” will be observed for some days previous to the confinement, by a change of the position of the pregnant womb. The womb places itself, as it were, in readiness for the expulsion of the child, which is shortly to begin. This is done by the body of the uterus inclining forwards and sinking downwards, and correspondingly relieving from pressure the organs of the chest; this makes breathing easier, and in proportion as the body of the womb comes down, so will the lower portion of the organ descend, and this may give rise to irritation of the bladder and frequent desire to pass water; sometimes the passage of urine may be entirely obstructed, so that the water must be drawn off by means of a catheter. Some women become very nervous just before the commencement of labor; this is generally due to fear or anxiety, for which there is no reason, and agreeable companionship will generally dispel all evil forebodings and restore her to self-confidence.

Labor pains are divided into true and false, and this distinction is entirely based upon their different sources. True labor pains are due to the contractions of the muscles of the uterus, and at the beginning they are slight. They commence in the back and run on down to the thighs; one feature about them is that they are intermittent, that is, that they are not continuous; there is always an interval, especially at the beginning of labor, in which there is no pain at all. When labor sets in, the pains are grinding or cutting, but as soon as the mouth of the uterus is fairly opened or dilated, the character of the pain changes to a bearing down or forcing out nature. If the hand is applied over the region of the womb, during the presence of a pain, the organ can be felt hardened and swollen; this subsides with the pain, and in the interval, the organ relaxes. This is a wise provision of nature, for it gives the woman an opportunity to recover and regain fresh strength for each succeeding effort. False labor pain has no connection with the process of child-bearing, but is only an incidental complication. It may be caused by gas in the intestines, indigestion, diarrhea, constipation, disease of the kidney, neuralgia, or rheumatism of the muscles of the abdomen or bowels, and by the passage of gallstones; where the false pains have been traced to their origin they can be properly dealt with.

A muco-sanguineous discharge from the vagina is another sign that labor has begun, but it will sometimes happen that it is absent, and this constitutes a dry labor. The mucous discharge which is thus observed, subserves a very important object in lubricating the parts and relaxing the neck of the womb and the vagina. There is often a slight tinge of blood, due, perhaps, to a rupture of small blood vessels in the mouth of the womb; this is called a show, which some women have for several days before labor commences.

“Stages of labor” are arbitrary divisions, so as to simplify the explanation of the entire process of labor from the time the womb begins to act, up to the last act of parturition, which is the expulsion of the afterbirth, and these have usually been divided into three stages. The first stage is the dilation or opening of the mouth of the womb, including also the breaking of the membraneous sac which holds the fluid in which the child floats, so as to protect it from pressure that the walls of the uterus would be continually exercising, which would prevent its proper development. In this stage the woman should not exert herself by bearing down; this will only waste her strength which she should preserve for the second stage, when the mouth of the womb has opened and the progress of the child into the world has commenced; during this stage, the female should make an attempt to relieve her bladder, and if she has had no stool for several hours before, it will be a good thing to use an enema of warm water, and empty the bowels.

The second stage of labor begins when the bag of water has broken and the waters escape; the contractions of the womb increase now in violence and become decidedly of a bearing down character. At this period the patient should be furnished with something that she may grasp with her hands; a sheet attached to the post of the bed is the best for this purpose, and with her feet steadily braced, holding her breath she bears down whenever a pain comes on; bearing down between pains, only exhausts the patient and does no good. During this stage of labor, the pain in the patient’s back will sometimes become intense, she exclaims: Oh, dear, doctor, my poor back feels like breaking! what shall I do? The greatest relief that can be given at this time is to support the back with the flat surface of the hand, or by folding a towel and placing it under the back, the two ends being held by assistants.

As the birth of the child progresses and it approaches the vulva, the patient will feel an urgent inclination to go to stool; upon this she must not insist, for at this advanced period of labor she may injure herself and child. The desire is caused by the pressure of the child’s head against the rectum; any fecal matter that is thus pressed out should be at once removed by the nurse.