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

9. When free hemorrhage occurs prior to delivery, it may depend upon placenta previa; that is, upon the placenta being attached very near or over the mouth of the womb; in such a case obtain a physician to take charge of the case if possible. You may yourself give half a teaspoonful of extract of ergot in the emergency.

10. During the progress of the labor you must always remember that the unassisted, natural powers are in most instances fully sufficient to bring the labor to a safe termination, and whatever you do should be of the kind that is not harmful. The important thing for the attendants to possess is gentleness and patience, and it is a good thing for the patient if she can be kept tranquil and cheerful.

11. A little light food may be offered the patient at any time during labor.

12. During the first stage of labor the patient must not strain or bear down to the pains, but it is my practice when I examine my patient and find that the head has not yet entered the pelvis, at the same time that the touch stimulates the uterus to contract, I direct the patient to bear down during each pain. After the head is fully engaged in the bones, no stimulus to pain is needed; however, as the bearing down pains come on, she should be advised to strain or press down.

13. Towards the last, when she is in great pain, if she be inclined to cry out, let her do so; never reprove her.

14. I approve of giving chloroform in some cases, but I do not advise the skilled nurse to give it except when a physician is present to direct its use.

15. During the latter part of the labor the only assistance you can render the woman is to support the back, and to give her something to pull upon if she is so inclined. A sheet tied to the foot of the bed may be useful for this purpose. At the very last, bearing down efforts should be discouraged.

16. When the head is about to be expelled we always fear there may be slight or severe lacerations of the perineum. Do not in any way hasten the expulsion, even if there should be a number of pains in which a part of the head presents externally during the pain, and then recedes when the pain goes off. I have not always been able to prevent laceration, but the following directions are the best that I can give: Endeavor to have the patient extend her legs, and do not have her knees drawn up close to the body at the last. When the perineum is put on the stretch, place the thumb and forefinger of the right hand on either side of the perineum, and press so as to aid the stretching or distention. When the perineum is distended and protruding you may cover the hand with a soft napkin and apply it across the perineum, also by the sides of the vulva, and make firm, moderate pressure during the pain. Endeavor to have the pressure equable around the head of the child.

17. When the head is expelled an attendant should make steady gentle pressure upon the uterus and follow it down, keeping her hand firmly upon it for several minutes, perhaps for half an hour, or if you have given a little attention to the child, you yourself may put your hand on the contracted uterus and firmly knead it for ten minutes.

18. It is not necessary to extract the body immediately after the expulsion of the head. It is better to wait three or four minutes for the return of a pain before making any traction.