499. Even in the last stage, she ought never to bear down unless the pain be actually upon her; it will do her great harm if she does. In bearing down, the plan is to hold the breath, and strain down as though she were straining to have a stool.

500. By a patient adopting the rules just indicated, much weariness might be avoided; cramp, from her not being kept long in one position, might be warded off; the labor, from her being amused by change of room and scene, might be expedited; and thus the confinement might be deprived of much of its monotony and misery.

501. Nurses sometimes divide a labor into two kinds—a “back labor,” and a “belly labor.” The latter is not a very elegant, although it might be an expressive, term. Now, in a “back labor,” the patient will derive comfort by having her back held by the nurse. This ought not to be done by the bare hand, but let the following plan be adopted: Let a pillow be placed next to the back, and then the nurse should apply firm pressure, the pillow intervening between the back and the nurse’s hand or hands. If the above method be followed, the back will not be injured, which it otherwise would be by the pressure of the hard hand of the nurse. Where the bare hand alone has been applied, I have known the back to continue sore and stiff for days.

502. During the latter stage of labor, the patient ought always to beep her eyelids closed, or the straining might cause an attack of inflammation of the eyes, or, at all events, might make them bloodshot.

503. Let a large room, if practicable, be selected for the labor, and let it be airy and well ventilated; and, if it be summer, take care that the chimney be not stopped. If the weather be intensely hot, there is no objection to the window being from time to time a little opened.

504. The old-fashioned four-post mahogany bedstead is the most convenient for a confinement, and is far preferable either to brass or to iron. The reasons are obvious: in the first place, the patient can, in the last stage of labor, press her feet against the bedpost, which is often a great comfort, relief, and assistance to her. And secondly, while she is walking about the room, and “a pain” suddenly comes on, she can, by holding the bedpost, support herself.

505. If there be a straw mattress and a horse-hair mattress, besides the bed, let the straw mattress be removed; as a high bed is inconvenient, not only to the patient, but to the doctor.

PREPARATIONS FOR LABOR.

506. I should strongly urge a patient not to put everything off to the last. She must take care to have in readiness a good pair of scissors and a skein of whity-brown thread. And she ought to have in the house a small pot of fresh lard—that is to say, unsalted lard,[[92]] that it may be at hand in case it is wanted. Let everything necessary both for herself and the babe be well aired and ready for immediate use, and be placed in such order that all things may, without hurry or bustle, at a moment’s notice, be found.

507. Another preparation for labor, and a most important one, is, attending to the state of the bowels. If they are at all costive, the moment there is the slightest premonitory symptom of labor, she ought to take either a teaspoonful or a dessertspoonful (according to the nature of her bowels, whether she be easily moved or otherwise) of castor oil. If she object to taking the oil, then let her have an enema of warm water, a pint, administered. By adopting either of the above plans she will derive the greatest comfort and advantage. It will prevent her delicacy from being shocked by having her bowels opened, without her being able to prevent them, during the last stage of labor; and it will, by giving the adjacent parts more room, much expedite the confinement and lessen her sufferings.