Mother, Nurse and Infant / A Manual Especially Adapted for the Guidance of Mothers and Monthly Nurses, Comprising Full Instruction in Regard To Pregnancy, Preparation for Child-birth, and the Care of Mother and Child, and Designed to Impart so Much Knowledge of Anatomy, Physiology, Midwifery, and the Proper Use of Medicines as Will Serve Intelligently to Direct the Wife, Mother and Nurse in All Emergencies.

by S. P. Sackett

The length of a fœtus born at term is eighteen or nineteen inches, though the utmost limit is more than two feet. The usual weight is from six to seven pounds; children have been born, however, that were as much as eighteen pounds in weight. I suspect that this will never occur unless the term has been extended beyond the usual period.

At term the fœtus that is twenty inches long will generally measure ten and a half to eleven inches from the crown to the umbilicus. The different parts are well developed and partly covered by a smegma called the vernix caseosa; the head has attained the proper hardness, and the scrotum usually contain the testicles. In female children the nymphæ are generally covered entirely by the labia, the breasts project, and in both sexes contain frequently a milky fluid.

As soon as the child that has been carried the full time is born it usually cries, opens its eyes, and makes some struggling motions with its limbs; it soon passes urine and feces, and readily takes the breast.

With occasional exceptions the position of the child is unaltered from an early period of pregnancy to its termination, whether the head be upwards or downwards. The arms are generally folded over the chest, the knees drawn up to the abdomen; the back curved, and the head bent upon the chest, so as to occupy as little space as possible. In ordinary cases the head is directed downwards, and the face looks obliquely, so that in the first and second position the back of the fœtus is turned partly forwards, and the belly in the third and fourth. We are enabled in many cases to ascertain the position of the fœtus in the uterus before labor has commenced, by means of the stethescope, by noting whether the pulsation is felt on one side or the other of the abdomen and observing whether it is heard clearly or not.

The longitudinal diameter of the head is from 4 to 4½ inches, the transverse from 3½ to 4, the vertical 3 to 3¾ inches. The transverse diameter of the shoulders and thorax is 4¾ to 5½; the widest diameter of the hips 4 to 5 inches. In general the measurements are a little less in the female than in the male.

The head of the fœtus is large, and as it is less compressible at term than other portions it merits a particular description; we should be acquainted with all its characters, that we may recognize them and thereby determine the position during labor.

The fœtal head is ovoidal in form, the large extremity being posterior. Several bones enter into the formation of the cranium; they are, 1st, the frontal bone forming the forehead; in the fœtus even at term it is usually divided; 2d, the two parietal bones, one on each side of the head, meeting on the median line at the top of the head; they help to form the vault of the cranium; 3d, the occipital bone, forming the posterior and part of the base of the skull; and 4th, the temporal bones, one on the right and one on the left side below the parietal, completing the lateral portions of the cranium and contributing to form the base of it. The cranial bones are not united to each other by sutures as they are in the adult, but are separated, the parietal bones especially, by membranous intervals, the intervals being larger in some children than in others. These intervals, or sutures and fontanelles, must be carefully studied.

The sagittal suture is the antero-posterior one, and extends from the root of the nose to the occipital bone. It is formed in front by the interval that separates the frontal bone into two halves, and superiorly by that between the two parietals. There is a suture which crosses this, called the transverse or coronal suture, which is formed by the space existing between the frontal and parietal bones. When the sagittal suture arrives at the superior angle of the occipital bone, it seems to part and give rise to two oblique lateral sutures which are called lambdoidal; these are formed by the posterior borders of the parietal bones and the superior one of the occipital.

Just at the point where the coronal and the lambdoidal sutures join the sagittal one, two membranous spaces, larger than those just described, are found; these have received the name of fontanelles.

In cases of head presentation during labor, one or the other of the fontanelles may be felt by the attending practitioner, and this indicates to him the position of the head and the presentation.