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

OBSTRUCTED LABOR.

“Definition. The progress of the labor is impeded by some mechanical obstruction in the passages connected with the soft parts, which by causing delay in the second stage leads to the developement of symptoms of powerless labor.”

The symptoms that arise and that cause anxiety are the same as in a case of powerless labor, except that while in the latter kind the pains are feeble, in the case of obstructed labor the pains may be vigorous and severe but ineffective in consequence of obstacles. I may say, however, that these obstacles have not been often met with in my practice. Since I commenced the practice of midwifery three thousand cases of pregnancy have been under my observation for treatment, and I have not yet met with any of the following causes of obstructed labor: Occlusion of the os uteri, cancer of the os uteri, undilatable vagina, tumors in the pelvis, or diseased ovary, stone in the bladder, imperforate hymen, hernial protrusion into the vagina, or blood effusions, or swelling of the soft parts. I have met with one case of excessive œdematous effusion of the vulva, which I relieved by puncturing the skin; one case of cystocele which I relieved by first drawing the water and then returning the bladder, before the head of the child descended into the pelvis; one case of ovarian tumor that was not at that time in the pelvis; one case of small fibrous tumor on the neck of the uterus, which did not much obstruct the labor; and numerous cases where hardened feces in the rectum was an obstacle until they were removed by the use of enemata. In cases of obstructed labor the skilled nurse will show her wisdom by detecting the obstructions and sending for an accoucheur.

DEFORMED PELVIS.

“Definition. The progress of the labor impeded by abnormal deviations in the form of the pelvis, giving rise to delay in the second stage, or rendering the descent of the child impossible without assistance, or altogether impracticable. The symptoms are those of powerless labor.”

The EQUALLY ENLARGED PELVIS, enlarged in all its parts, is not often met with, and is of no obstetric importance. If in any case this condition is diagnosed preceding or during labor, the patient should be watched by the nurse lest labor close so precipitately that the child falls to the ground.

The equally contracted pelvis—equally contracted in all its diameters, generally renders the labor difficult and tedious but not impracticable, by the natural powers. Other distortions such as has often been caused by rickets, &c., offer great obstruction to the passage of the child. In some cases a modification of the position of the child allows it to descend, but in many cases it is necessary to interfere and terminate the labor artificially. The nurse should not wait for unfavorable symptoms to appear before she sends for a man that is able to use the forceps, &c.

MALPOSITION AND MALPRESENTATION OF THE CHILD.

Unnatural or abnormal labor may be caused by some peculiarity on the part of the child, in the position or presentation. These cases demand the services of the skilled accoucheur, and I do not intend to hint that the nurse should ever attempt to do what an educated physician should be called to do in these cases.

Face presentations sometimes retard the labor so much in the second stage as to give rise to unfavorable symptoms. In cases where the action of the uterus is so energetic as to finally expel the child, the sufferings of the mother are severe and prolonged. I have in my practice met with four cases, three of which were delivered by the natural powers, the children living; in one case craniotomy was performed. The mothers all lived. The diagnoses of face presentations is not easy at an early stage of labor. The finger first touches the forehead, which may be mistaken for the vertex. When the membranes are ruptured we may be able to make out the presentation. We may distinguish the edges of the orbits, the prominence of the nose, the mouth, &c. The bridge of the nose is the best guide, it being prominent, firm, and unlike any part of the breech or vertex. The face becomes tumefied during the labor, and the cheeks pressed together to resemble the nates, and it may be mistaken for a breech presentation. But in either presentation the proper course for the nurse is to leave the case alone in the expectation that the natural efforts will be sufficient to complete delivery. The child when born has a frightful appearance from the swelling and discoloration of one cheek, &c., but the injuries pass away in a day or two.