An address to British females on the moral management of pregnancy and labour, and some cursory observations on medical deportment

by William Cooke

At the time of child-birth, there are some practices which are extremely hurtful, and which cannot always be guided by professional advice. And it would be well for ladies themselves to predetermine in what manner these things should be regulated. The exhaustion consequent to child-birth, has occasioned the pretty general custom of allowing the patient to lay an hour undisturbed; but at the end of this hour, it is often inevitable, whatever the degree of indisposition, that the patient must be raised into an erect posture, before she can be placed in bed, owing to the improper arrangement of dress and bed-clothes.

Hemorrhage, fainting, and many inconveniences under these circumstances, are not unusual. Amongst the higher and more intelligent nurses this practice certainly is nearly unknown. Where there is time before-hand, dress and bed-clothes should be so managed, that there shall be no occasion to raise the patient from the horizontal posture. However trivial this may seem, it is, without the smallest doubt, a frequent cause of very serious alarm; and no practitioner can safely leave a house till this removal has been undergone. It would be commendable if ladies themselves exercised their thoughts on this subject, and on which they may take counsel, with great propriety, previous to the commencement of indisposition.

We are not now presuming to address the members of the profession. Yet, for the sake of female practitioners of midwifery, the unnatural and improper custom of giving opiates immediately after every case of parturition must be decried. The apology for this practice is to ease the after-pains; that is, to counteract those contractions of the womb, by which it regains its natural state.

Truly cases happen in which the constitution sympathizes so greatly with these pains—the patient becomes so irritable, that an opiate, seasonably interposed, acts almost as a charm; but when administered through habit, it checks secretion—constipates the bowels—prolongs the after-pains—and very seriously affects the head.

To practitioners of this description, I would also say, that especially in lingering cases, the management of mind is truly important. The mind is in the condition of the quickest sensibility. Every thing transacted about the patient should be done openly. All whisperings or attempts at secrecy, excite the utmost curiosity, and essays at evasion only heighten the distress. All allusion to unfavourable cases should be most sacredly avoided. Nothing should tempt the individual on whom reliance is placed in these instances, to concede the truth—a falsehood once detected, contravenes all future trust; and however there may be exhibited the external signs of belief the mind will be harassed with the most painful suspicion. A most guarded prognostic too, not only in reference to the issue, but the duration, is essentially requisite. The endurance of pain, ever raises more or less anxiety for ease; and as in child-birth it is known there is a limit—a period when the trouble shall instantly cease—there is peculiar desire to ascertain the probable duration of suffering. The hopes and wishes of practitioners often seduce them into a definition. The period arrives, and is succeeded by disappointment—another is fixed, which equally disappoints the expectation, and ceaselessly enervates the patient. A disposition in the attendants to excite unwarrantable expectation too, should be early checked. The solicitous inquiries of the patient, must be met by a candid avowal of her situation—a decided assurance, that although it is not possible to define the duration, the procedure is perfectly safe. A distinct assurance should be given, that although there are numerous little circumstances which retard or expedite delivery, they do not affect the termination. That with the prospect of a safe deliverance, a somewhat prolonged suffering is comparatively trivial. And, in most cases, however serious, it is easy to suggest some exemption, for the absence of which thankfulness should be cultivated.

Varied as the cases of parturition are, if the principle is kept in view, an intelligent mind will supply the deficiency. And a female will be conducted through a lingering labor with much less suffering, and much less exhaustion than under more unguarded treatment. The choice of food under these circumstances, certainly is not indifferent. In the time of labor, all the functions are disturbed—not only by sympathy, but by the positive influence of pain. Such diet should be adopted as is least irritating, and with most facility is converted into nutriment. Gruel, preparations of arrow-root, sago, &c., without wine (except under peculiar circumstances) are best, and the patient should be encouraged to take them at proper intervals.

After labor, quietude is the chief subsidiary; but some regard must be had to the state of the patient. The sudden transition from long-suffering to almost entire case, produces a striking moral effect, and effusions of grateful expression generally succeed. The stimulus of distension and pain, being withdrawn, a great degree of faintness often supervenes. The administration of a small quantity of brandy or wine in some gruel, is highly proper where this happens in any threatening degree—but should only be continued till that sensation is removed. Some ether in camphorated mixture, we have often seen very speedily remove the faintness and agitation which succeed delivery.

Soon there is an adaptation to the change—the functions regain their accustomed office—the palpitation of the heart subsides—the pulse, which might have been fluttering and intermitting, becomes regular, though still quick and full. Stimulant substances must be entirely withdrawn, and gruel, or other simple articles of nutrition must be substituted.

Often, early after labor, pain and throbbing in the head, aversion to light and sound arise; attended sometimes with a quick, at others, a very slow pulse; the latter, indicating a great degree of congestion, or accumulation of blood in the head. In this case, medical advice ought to be promptly solicited, especially if it has not subsided by a gentle aperient—as castor oil. Powerful doses of purging medicine will become necessary; and, perhaps, bleeding from the arm, or leeches to the temples, may be required.

Whenever the body becomes sore and painful, especially if it be attended with suppression of the discharge, constipated bowels, and fever, no time should be lost in demanding medical assistance.