Femina, A Work for Every Woman

by John A. Miller

The third stage of labor consists in the expulsion of the placenta or afterbirth.

There is a natural detachment of the placenta and a natural expulsion, but one must have the patience to wait. What presumption of the officious doctor or midwife to suppose that nature was so derelict as to require some meddlesome assistant, immediately after the birth of the child, to drag or pull on the placenta: no, more than that, carry the hand up into the cavity of the womb and detach the placenta with the fingers and bring it down and out. When I first started out to practice I was foolish enough to believe and do the same thing, and afterwards I congratulated myself how wonderfully skilled I was, but now I am convinced that this procedure was due to ignorance of the laws of nature. The truth of the matter is, that the sooner and the more one pulls and feels on the placenta, the more irritable the womb becomes, and the more will the uterus contract, as though it protested against interference.

I have had it happen, and others must have had the same experience, that the womb closes and contracts firmly in ten to twenty minutes after delivery, the afterbirth becoming tightly inclosed so that one not experienced would be frightened into the belief, Oh! here the placenta has grown to the womb. This is a delusion which may lead to an interference that may entail dangerous consequences to the mother. The condition is simply this, that as the afterbirth was not completely detached at the birth of the child, the uterus contracted immediately upon and around the retained placenta, and for two physiological reasons: (1) to accomplish the very object which was imagined was not accomplished, namely, by contracting, the uterus naturally peels itself off from the placental attachment, and (2) were it not for this immediate contraction of the uterus after the expulsion of the child, the mother would likely flood from the uterine vessels of the partly detached placenta. Of late years I never experienced a single case in which the placenta did not detach itself, and if I had known twenty years ago as I do now, I never would have had one.

After the delivery of the child, the woman should be made as comfortable as possible for the time being, and by the time the child is washed and dressed, the placenta will generally present itself in the vulva. If the afterbirth has not come away at once there is no need to become alarmed. I have waited for six to eight hours for that event to take place, and if there is delay over an hour, two teaspoonfuls of fluid extract of ergot will so excite contractions of the womb that its contents will be expelled.

Whether the afterbirth comes away immediately after the birth of the child, or is delayed, it must not interfere with putting the mother in a warm, dry, comfortable condition. Everything that is damp from perspiration or wet from the waters, both dress and bed linen must be removed and replaced with warmed, dry, clean linen; this insures against taking cold. To me it looks like a crime against science and nature to allow a woman to remain in the wet and soiled bed after her confinement for twelve or more hours, and the doctor or nurse who permits this, is ignorant and negligent of his duties.

After the placenta is removed, the binder or bandage is applied; this is simply a piece of unbleached muslin about eighteen inches wide and long enough to reach one and a half times around the body; it should be brought down to cover the hips and then fastened with strong safety pins. The object of the binder is to give support to the flabby and relaxed abdominal muscles, which is a great comfort and aid to restore the muscles to their former shape.

How a woman should lie after confinement is of much greater importance than how she should lie during childbirth; in fact it does not matter much how she lies during labor so long as she feels comfortable, but after confinement and during her convalescence, her position in bed has an important bearing on her recovery; to avoid repetition I refer the reader to pages 73 and 250 of this work. Vaginal douches of hot water, of a temperature of 104 degrees F. serve a very useful purpose in washing out the secretions that will naturally accumulate in the vagina, and after a short time undergo septic decomposition; these rinsings also assist nature to repair and heal the tissues. The quantity of fluid that should be used at once is half a gallon of water in which a tablespoonful of powdered borax has been dissolved. Great care should be exercised by the nurse, lest the bed and linen of the patient get wet, and through this she become liable to take cold. The second day after the delivery is about the right time to begin using the douche, and about this time the mother should also get a mild laxative, either of castor oil or of Femina laxative syrup, which is very palatable and suitable for the occasion.

The last throes of labor which usher the child into the world constitute the climax of the parturient effort and as there is little or no interval between the pains, the pains at this period have been appropriately termed double labor pains. There is more or less excitement and apprehension on the part of the lying-in female and the experienced practitioner or nurse will concentrate his effort to calm and encourage the sufferer in the last minutes of her travail.

It is best to wait a few minutes after the child is born before tying the cord, so as to give the circulation time to equalize itself; especially is this desirable when the cord was wound around the child’s neck or when it is otherwise compressed. The cord is tied about an inch above the navel, and half an inch higher the cord is cut with a pair of sharp scissors. In the meantime, the nurse, if properly instructed, will have in readiness on the side of the bed a warm flannel or blanket which is to receive the little stranger. There is a proper way to pick up a newborn babe, so that it will not roll or slip from the hands, which I have known to happen. The little baby must be taken hold off with the same gentle firmness as an older child. To prevent any accident, place the posterior surface of the child’s neck in the space bounded by the thumb and index finger of one hand, and with the other hand gently seize the thighs and in this manner place it into the blanket, to be conveyed to a warm place of safety,—the newborn child must be kept warm, for its very life may depend upon it. After the mother has had her temporary wants satisfied, the nurse prepares for the first toilet of the child.

The care of the baby is differently understood by different persons, and as a result of this difference of opinion I have observed a great many unfortunate consequences. There is no reason why the care of the baby should be resigned to custom and habit for both are often extremely hazardous to the life of the child, and this I will illustrate in the course of my remarks.