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

19. Although a little traction can be made on the head, it is a better way while an attendant presses on the uterus, and while you hold on to the child’s head with one hand, insert a finger of the other hand into the axilla, (under the child’s arm) and gently extract the body.

20. The child may be born apparently asphyxiated—its face swollen—and of a dark livid color, and at first make only feeble and gasping efforts at respiration; if there is the least beating of the heart can be perceived, there is fair hopes of its recovery. The cord should at once be tied and the child removed from the mother. If one or two slaps on its body does not make it cry, try immediately artificial respiration by the Sylvester method perhaps, not omitting at first and afterwards to throw a little cold water on its body. If these efforts fail I would try to induce respiration by placing my hand over its nostrils and blowing into its mouth, and immediately afterwards compressing its lungs.

21. As soon as the child cries, as it most generally will as soon as it is born, proceed to tie and separate the cord. Tie the cord tight, so that it is thoroughly compressed and the vessels obliterated, applying the ligature about one and a half inches from the child, and then cut the cord one inch further from the child. The child can be rolled in flannel and removed, and you can attend to the mother and to the removal of the afterbirth.

22. In only a very few cases I have had post partem hemorrhage or adherent placenta to trouble me, and I commend to you the method that I have used for the removal of the placenta. I do not tie the cord until circulation has ceased in it. I then sever it, and usually two or three ounces of blood may flow from it. This I suffer to run into some vessel to avoid soiling the bed uselessly, and then wind the cord around my right hand so that I can hold it. If I cannot have an attendant to make proper pressure on the uterus, I immediately endeavor to compress it as much as I possibly can with my left hand, but I make very little traction on the cord. I usually instruct some one else to make strong and firm pressure upon the uterus, and I pass two fingers of one hand into the vagina, and learn thereby when the placenta descends, and if necessary assist in its removal. Although we should never hurry in removing the afterbirth, I believe that it always is easily removed if we make the effort very soon after the child is born, and if it is necessary for you to pass your hand into the uterus you can do so then better than at any other time. Judging from my own experience in cases of retained placenta, if you pass your hand along the cord into the uterus, you will find that an hour-glass contraction retains the afterbirth (whether adherent or not) in the fundus. You will have to press your fingers through the constricted portion and grasp it, and you can remove it steadily and slowly, but not stopping to give it “one or two turns in the vagina.”

23. Post partem hemorrhage is liable to occur; when it does, obtain a physician as soon as you can, but some things must be done immediately. 1. Some one must grasp and compress the womb continually. 2. Remove the pillows and raise the foot of the bed so that the patient’s body lies higher than her head. 3. If you have it, give a small teaspoonful of extract of ergot, or twenty drops spirits turpentine or (F. 96.) 4. Examine to know if possible, the source of the hemorrhage; if it comes from the vagina or perineum where there is laceration, it is not very dangerous. Inject hot water of the temperature of 115° into the uterus, and apply a dry cotton cloth, heated as hot as possible, to the abdomen externally. 5. Before using the injections remove all clots from the vagina. 6. Quinine and stimulants may be exhibited if there is sinking, and ice may be applied to the abdomen and to the internal surface of the uterus, if the bleeding continues. I will here direct another thing which is very effectual, and which might be used at first in preference to anything else. 7. After removing the clots take a handkerchief or piece of muslin, saturated with vinegar, in your hand, pass it entirely into the uterus, and let it remain there 15 or 20 minutes, and your hand also. Your hand will compress the open blood vessels, and keep a clot in the mouth of them, and the vinegar will act as the best astringent that can be used. In one case of violent flooding I simply held my hand still in the uterus for five minutes, and the flow ceased. After the hemorrhage subsides you must be careful not to raise the patient’s head above the level suddenly; her life may be put in jeopardy by suddenly raising her so that she sits up.

After pains are very seldom severe in primapara cases, and they are less likely to be severe if the proper manipulations have compelled the womb to close completely, expelling all clots, &c. But sometimes there is a peculiar irritability or neuralgic condition of the womb which gives rise to excruciating pains. Ordinarily you may use Tully’s powder. (F. 123, 93, 95, 107.)

Retention of urine in some cases necessitates repeated visits of the physician, and he will appreciate a nurse who can introduce the catheter. If the patient cannot at first void the urine, perhaps the application of a hot wet sponge over the pubis may enable her to do so. But it may be necessary to introduce a catheter two or three times a day until she regains her power over her bladder, or until the swelling of the urethra subsides.

It is well for the nurse to know that owing to the distensible state of the abdominal parietes, the patient will lay twelve or fourteen hours, perhaps, after the child is born, without manifesting a desire to void the urine, though her bladder may be very full, and you should remind her of the necessity of passing the water, lest it produce cystitis. In some instances the urethra and neck of the bladder are extremely irritable, causing strangury, and there may be some difficulty in passing the catheter, but the urine must be evacuated, and afterwards it may be necessary to use ergot, laxatives, opiates and fomentations. (F. 125, 126, 162.)

CHAPTER III.
CONVALESCENCE.

Variations from ordinary convalescence will, under ordinary circumstances, receive necessary attention from the physician, but the skilled nurse should know as much about them as possible, and I here make a brief reference to some of them.