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

In tedious labors the woman becomes fatigued, the loss of sleep is much felt, her spirits become depressed, and the stomach is more or less disturbed, but when the other bodily functions are performed regularly, the skin is cool, the pulse quiet, the tongue clean and moist, there is no headache, and the pains recur tolerably regularly, the condition of the patient is favorable, though the pains are inefficient and vary in their duration and frequency. There is usually loud outcry during the pain in the first stage of labor, but there is often sufficient remission of the suffering for the woman to get some quiet sleep, and generally there is progress to the labor.

Inefficient action of the uterus occurs most commonly in women confined for the first time, and sometimes we can ascribe it to no cause but constitutional peculiarity, or a deranged state of the digestive organs, or mental depression; in other cases it may be caused by irritation of the os and cervex uteri.

The skilled nurse may properly send for a medical man, though he is not indispensably necessary in such cases. The best thing which she can give in such cases is a quarter grain dose of morphine to suspend the pains and induce sleep, or if this is not thought best it may be proper to give physic or stimulating enemata. Never give ergot to increase the pains, but it may be proper to give several grains of quinine. However, giving medicine must be left as much as possible to the physician.

Excessive amount of liquor amnii with undue distention of the uterus in some cases renders the pains inefficient. The unusually large size, and the fluctuation of the abdominal tumor may be obvious, but although an accoucheur might deem it advisable to evacuate the waters, the skilled nurse who could not be certain that there was a favorable presentation, should not do it. She must exercise patience herself and encourage the patient to do so, and time will probably do the work, though it is better to commit the case to a doctor.

An undilatable os uteri, which remains rigid although the pains are severe, may sometimes be felt with its edges thin and stretched over the head, and sometimes thick and tough. In the majority of cases patience and time may overcome the obstacle, but as it is best in some cases to give chloroform, chloral, &c., and in some instances to use local means to relax or dilate the os, the physician should be sent for. The nurse may properly give the patient a hip bath.

Premature escape of the liquor amnii and OBLIQUITY OF THE UTERUS are both causes of tedious labor, but not cause for apprehension or special interference. I have already given some hints in regard to the treatment of the latter class of cases.

The posterior lip of the cervix uteri in some instances is retracted while the anterior is drawn tightly over the crown of the head. In such cases it has been my practice to draw with my finger the anterior lip forward, and during the time of the pain to press my finger against the head of the child. I do this believing that the anterior lip is caught between the head and symphasis pubis, and that it will be better retracted while support is given to the head.

POWERLESS LABOR.

“Definition. The labor is prolonged in the second stage by causes which act on the uterine powers primarily or secondarily, rendering the pains feeble and inefficient or totally suppressing them.” In consequence of the stage at which the delay takes place, certain symptoms arise which render speedy delivery imperative.

The second stage may continue twenty hours or more without any bad symptoms, but usually if it exceeds twelve hours some of the following symptoms may be observed: The pains become irregular as to recurrence and force—perhaps become weaker—there may be rigors or shiverings—the vomiting may be distressing—there may be constant restlessness and fever—the vagina and uterus may be hot and tender to the touch—and the pressure of the child’s head may prevent the evacuation of the bladder. The same causes (weak constitution, mental emotion, disease, &c.), which in the first stage rendered the labor tedious without bad symptoms, now occasion these and perhaps even more alarming indications. If an experienced accoucheur now arrives to take charge of the case he will be likely to apply the forceps, but it would have been better if he had been there and applied them sooner, before the patient had undergone so much suffering; and the midwife who attends a woman in the first stage of the labor should ascertain if any of the following causes of powerless labor exists: Is there a weak constitution or one exhausted by disease? Is it a first labor and the woman of advanced age? Has the patient had very many children? Is there excess of liquor amnii? Is there malposition of the uterus? No midwife should undertake to manage such a case alone.