7. It is generally well to have your physician see you a month before the time that you expect to be confined.—Indeed, I would have you consult with your physician during the whole period of your pregnancy. You may get very full directions from this book, but still, where it is practicable, I advise that you consult with some skilled medical friend, who knows your idiosyncracies, and can suggest modifications of the directions as your own case demands. Specimens of your water should be analyzed each week during the last month, if there are any signs of albuminaria, etc., (especially if the face and ankles are bloated.) If there is inability to pass the water, it may be necessary to draw it with a catheter.
8. Submit yourself entirely to the direction of your physician.—Do not indulge in any opinion that may clash with his, even if that opinion is founded upon what is here written; you cannot expect to know more than he. It may be that he will wish to examine you by palpation, etc., to know if the fœtus lies as it should do, as something may be done to correct a malposition by external manipulation if the effort is made early. No good physician will permit that your sensibilities should be shocked by an unreasonable demand. If you have studied this book diligently you will be prepared to converse intelligently with your physician, and you will understand and appreciate any directions that he may give. If you have taken any medicine prepared from formula herein inserted, you know, and can inform him what the medicine is; this is better than it would be if you had taken patent medicine, of the ingredients of which you are ignorant. Consult with your physician in regard to the choice of a nurse, as he will be likely to know those that understand their business, and that are in the habit of following the doctor’s directions, or he may know whether the one you selected is now attending a woman that has contagious disease.
9. Choose a good nurse.—You should have the best possible aid that the nature of circumstances will permit. Do not get a fine lady nurse that requires to be constantly waited on by a servant, and do not get a croaker that discourses of the sad and dreadful cases that have occurred in her experience. Do not get any one that is addicted to intemperance, or a potterer that is devoid of method and efficiency; that does the wrong thing in the wrong way, and that is always out of her proper place. Get a nurse that will not dose and medicate either the mother or child when they are under the care of a physician, or assume any duty or responsibility that belongs to him; that admits that the doctor is the one to give orders. Get one that never reveals the private concerns of her former employers; one that is not a mischief-maker, causing dissention and disagreement in the household. Do not get one that is young, if she is giddy and thoughtless and inexperienced, nor one that is old, if she is deaf and stupid. Get, preferably, a married woman or a widow; one that has at some time had the care of infants; one that has a pleasant countenance, and is naturally cheerful; one that has calmness and self possession, and firmness, and at the same time is gentle, kind, good-tempered and obliging; she should have a light step, a pleasant voice, a cheering smile, a dextrous hand, a gentle touch, and be gifted in cooking for the sick. By preference, engage a monthly nurse; she will not be so likely to come to you from a case of scarlet fever or erysipelas, or other contagious disease.
If you can find a nurse of the kind described above, and if she be properly instructed and educated, she will be invaluable to you, and if she devotes her talents and her best energies to you and your infant, she should be liberally paid. But there are many such women all over the country, or will be when we can induce them to qualify themselves by study and special effort. But, as really good nurses are full of engagements, it may be necessary for you to engage her in the early months of your pregnancy; only stipulate in the start that you will be obliged to dispense with her services, if it happens that immediately preceding your confinement she had been attending a woman that had puerperal fever.
I do not say that you should necessarily engage a nurse that is educated as a midwife. But such a one is to be preferred even if you have a physician, and then the latter need not be detained from his patients for so long a period of time; and if the last stage of the labor is so rapid that the child is born before the doctor arrives, there need be no trepidation; she will know well what to do. Thousands are born in this country without the slightest assistance from a doctor, he not being at hand nor not being in time, and yet both the mother and babe do well almost invariably. As a rule the nurse that has studied and learned the most is the best prepared to discharge the duties resting upon her.
A NURSE MAY PROPERLY BE IN ATTENDANCE A WEEK OR MORE BEFORE THE TERMINATION OF PREGNANCY, if circumstances permit or require it. If present she will attend to the following things: Choose a good airy room for the lying-in chamber—one that can be well ventilated, where the temperature can be kept at from 60° to 65°; one that is removed as much as possible from noise and disturbance, and where the patient need not be exposed to draughts. Provide needed articles of clothing for mother and child, and dressings for the bed; short gowns to wear over the chemise or ordinary night gown; a proper bandage of heavy muslin, as much as one and a quarter yards in length and fourteen inches in width. I prefer to have it of several thicknesses, and if it is quite long so that the ends meet to be folded it keeps in place better, and if it is gored it should be in such a manner that it is narrower at the lower edge than it is two inches above, so as to prevent it when adjusted from sliding upwards; the child’s binder, preferably some woolen material about five inches in width and fourteen inches in length; the child’s shirt (woolen or cotton, not starched); both a long and a short petticoat; a frock or slip; a shawl or flannel blanket; napkins and muslin diapers; also pieces of old muslin to be used to absorb blood and water. Provide also for dressing the bed, a piece of impervious oiled cloth, oiled silk, or rubber cloth; old sheets and comfortables; a piece of carpet; have in readiness a pair of shears or scissors, a small box of prepared lard or vaseline or a flask of salad oil, a package of pins one and a half inches in length, besides ordinary pins; tape, bobbin or wrapping twine; fine toilet soap; fine sponge for washing the child; soft linen or carbolated cotton for dressing the naval; a box of unirritating powder; a pile of towels, and a little aromatic ammonia or brandy to be used in an emergency. Let every thing be placed in such order that either may be found without hurry or bustle at a moment’s notice. Hot and cold water should always be in readiness.
CHAPTER V.
DIRECTIONS TO THE MONTHLY NURSE.
If you attend a woman to whom the physician has already been called, you will thereafter be subject entirely to his orders. Whatever your opinion is, notwithstanding you have this book or any good authority for your opinion, if it seems to conflict with his directions, obey him; on him rests the responsibility and he is presumed to know what is best. But it is best that you should confide in each other—be on such relations that you can communicate to him anything you have learned about the case; be free to ask of him explicit directions and instructions. But your duties may precede his as well as accompany them, and I wish now to give special directions in regard to things that first demand your attention.
1. A nurse may properly provide a soft rubber catheter and also a syringe; this should be constructed so that it acts as an enema apparatus when one pipe is used, and as a vaginal syringe when the other pipe is applied. The holes in this pipe should be made so that the fluid injected is thrown backward.
It is important that this last direction be observed. I know of one instance where the vaginal pipe of a Davidson syringe was used, yet the fluid injected passed through the cavity of the uterus and through the Fallopian tube and entered the cavity of the peritoneum, causing severe pain and inflammation.