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

No one can decide certainly from simply seeing a patient in the beginning of labor, whether her labor will be natural and spontaneous, or artificial; but I have many times when first looking at a lady, if her complexion was fair, and her form good, but rather tall, predicted that her accouchement would proceed regularly and favorably. But in forming our opinion we need to know something of the previous health and present ailments of the patient, and, if a multipara, the character of former labors. If nausea and vomiting or any other ailment has reduced her strength so that she is exceedingly weak, this may give rise to some reasonable apprehension; but I have known a woman that could scarcely retain a morsel of food on her stomach for seven or eight months, that had become very weak indeed and exceedingly emaciated, who yet endured her labor well and soon recovered. The general rule is, that the more perfect the woman’s health is, the better she is fitted for child bearing, but if her general health and strength is reduced below its proper standard by some previous or accompanying disease, such for example as consumption, she may endure the labor very well, and succumb to the disease afterwards.

Pregnant women are liable to be attacked with epidemic, endemic, and sporadic diseases. Eruptive fevers, etc., may attack parturient women, and if they do, the disease and labor in every case will have a reciprocal influence on each other—the disease will complicate the case. Influenza or intermittent fever may attack a woman at any period of gestation, and there may be no serious results. Cholera, small pox, typhoid fever, scarlet fever, measles, pneumonia, and jaundice are liable to cause abortion, and there is danger of fatal results, or either of them would be a dangerous complication at the time of labor. Syphilis would be a cause of abortion or premature labor, and any disease which allows the mother to carry the child the full term may reduce and weaken her. Glandular engorgements and scrofulous ulcers improve during gestation, but if the woman is suffering from a fracture, the bones will not unite very well. Tumors in the abdomen and pelvis may be an obstacle to delivery, and ulcerations of the cervix may also be harmful and protract the labor, as also may constipation, dropsy, and albuminuria.

The latter may not be detected without an analysis of the urine, but dropsy will be obvious as soon as it exists. The evidences of tumors and ulcerations are found by palpation and the touch—sometimes by the use of the speculum.

After learning the present appearance and the former history of the patient it may be necessary to examine further perhaps by palpation.

By PALPATION we may sometimes (but not always) distinguish the head of the child, and perhaps tell to which side its back is turned. When making the examination let the patient lie on her back, make gentle pressure when the pains are off and the abdomen is relaxed; press the ends of your fingers above the body of the pubis; by pressing downwards you may perhaps feel the head if it has descended into the pelvis. You will need to press the abdomen carefully all over to ascertain if there are tumors, and also to ascertain if the body or some other part presents at the cervix uteri.

If auscultation is used we may determine positively the position of the fœtus by observing just where the sounds of the fœtal heart may be most plainly heard.

The VAGINAL TOUCH is the usual mode of determining whether there is an unfavorable presentation of the child, as well as whether there is deformity of the pelvis, tumors in the vagina, ulcerations, &c.

When the head presents in the commencement of labor, if the fundus of the uterus is not too much inclined forwards, and there is no deformity of the pelvis, the os may easily be reached, and the hard round head of the child be felt without difficulty. Should a hard presenting part not be felt either through the dilated os or the walls of the uterus, it may be because there is a breech or body presentation, or there may be twins, or there may be an unusual amount of water in the uterus, or the child may have hydrocephalus—in either of these cases it might not be possible to decide immediately about the presentation and position.

Face presentations cannot be detected very early in the labor. Before the membranes are ruptured the head is high and difficult of access. When it is reached the forehead is first encountered, afterwards we may feel the nose and mouth. It is unfortunate for us that we cannot usually distinguish a face presentation in the early stage of labor. It is not so important that we make an early diagnosis of presentation of the breech, as there is no danger to the mother involved in the latter.

Presentation of the body should always be detected early, at least as soon as the membranes are ruptured. The abdomen of the mother is much longer in the transverse diameter than is usual, and the head of the child may sometimes be felt in the iliac fossa. The form of the mother’s abdomen is irregular as the fœtus lies curved on itself. When we are able to touch the fœtus, if the shoulder presents, we first feel a small bony projection, the acromion point of the shoulder; then other points, including the acute angle of the shoulder blade. We should ascertain as soon as possible on which side the head lies, and also the posterior plane of the child.