The Eugenic Marriage, Volume I. (of IV.)
W >> W. Grant Hague, M.D. >> The Eugenic Marriage, Volume I. (of IV.)THE MANAGEMENT OF THE ACTUAL BIRTH OF THE CHILD.--Near the end of the
second stage of labor it will be observed that the pains have grown strong,
expulsive, and more frequent. Very soon the advancing head will begin to
push outward the space between the front and back passage; the rectum is
pushed outward and the lips of the vagina open. If an anesthetic is to be
used these are the pains that call for it. A few drops may be dropped
singly on a small clean handkerchief held up by the middle over the nose,
its ends falling over the face. A few drops will just take the edge off the
pains, and render them quite bearable. As soon as the pain is over the
patient should rest, relax completely, and not fret and exhaust herself
worrying about the pains to come. It is astonishing how much actual rest a
woman can get between pains if she will only try; and it is astonishing how
much concentrated mischief a willful, unreasonable woman can do in the same
time. She will not try to rest, but cries and moans and pleads for
chloroform, until she succeeds in giving everyone except the physician and
nurse the impression that she is suffering unnecessarily. Her husband or
her mother, whichever is present, gets nervous; they begin to wonder [100]
if the physician is really trying to help; assume a long, sad, serious
face! forget their promise to look cheerful, and mayhap offer sympathy to
the woman. It is a trying moment and needs infinite patience and tact. The
physician attends strictly to his duty, which will now be to guard the
woman against exerting too great a force during the last few pains. About
this time, or before it in many instances, the "waters will break." This
means simply that the bag or membrane in the contents of which the child
floated burst because of the pressure of a pain. This is a perfectly
natural procedure and should not cause any worry: simply ignore it as if it
had no bearing on the labor in any way. As soon as the oncoming head has
dilated the passage sufficiently, so that the edges of the entrance to the
vagina will slip over the head without tearing, the physician allows the
head to be born. It takes some time to do this, and he must hold the head
back until just the right moment. It is best not to let the head slip
through at the height of a pain, or rupture is sure to occur. Wait till it
will slip through as a pain is dying out, and if you have waited long
enough and handled the head skillfully, the conditions will be just right
at a certain moment to permit this without tearing the parts. There are
some cases where a tear, and a good tear, is impossible to guard against.
It is not a question of patience, or tact, or skill; it is a combination of
conditions which patience, tact, and skill are powerless against.
POSITION OF WOMAN DURING BIRTH OF CHILD.--The position of the woman is a
matter of choice and is not contributory to the results at all. She can lie
on her back, which is the ordinary way, or on her side, as the physician or
the patient prefer. As soon as the head is born the physician should see
that the cord is not round the child's neck; if it is, release it. The
shoulders will most likely be born with the next or succeeding pain. The
physician will permit the lower shoulder to slip over the soft parts first;
this is done by retarding the upper shoulder by pushing it gently behind
the pubic bone of the mother. When the shoulders are through, the rest[101]
of the body of the child slips out without effort.
DUTY OF NURSE IMMEDIATELY FOLLOWING BIRTH OF CHILD.--As soon as the child
is born the nurse should sit by the side of the mother and hold the womb
until the after-birth is expelled. The womb can be easily felt in the lower
part of the woman's abdomen as a hard mass. It feels about the size of an
extra large orange. The object of holding it is to prevent the possibility
of an internal hemorrhage. It can be readily appreciated that the interior
of a womb, immediately after a child is born, is simply a large bleeding
wound. So long as the womb remains firmly contracted there is very little
chance for an extensive bleeding to take place. As a rule the womb remains
sufficiently contracted to preclude a hemorrhage until the after-birth is
out. After the after-birth is expelled, the womb usually closes down firmly
and the liability to bleed is very much reduced. Because there is a
distinct chance or tendency for the womb to bleed freely during the time
the after-birth remains in, it is customary, as stated above, to watch it
closely and to hold it securely. It is best held with the right hand. The
fingers should surround the top of the womb and exert a slight downward
pressure. Should it show any tendency to dilate or fill with blood, get it
between the fingers and the thumb and squeeze it, pushing downward at the
same time.
EXPULSION OF AFTER-BIRTH.--The after-birth is usually expelled in about
twenty minutes after the child is born. Great care should be experienced in
its expulsion. It should not be pulled at any stage of its expulsion. If it
does not come easily give it a longer time,--it takes time for the womb to
detach itself from the after-birth; and some after-births are very firmly
attached. Eventually it will come out with a little encouragement in the
way of frictional massage of the womb through the abdominal walls. If the
membranes remain in the womb after the body of the after-birth is out, do
not pull on them. Take the after-birth up in the palm of your hand and turn
or twist it around, and keep turning it around gently, thereby loosening
the membranes from the womb instead of pulling them, which would surely
break them, leaving the broken ends in the womb, and, as a result, the[102]
chance of developing serious trouble.
The patient should now be given one teaspoonful of the fluid extract of
ergot, which should be repeated in an hour. Should there be an excessive
flow of blood after this period it may be again repeated at the third hour.
CUTTING THE CORD.--As soon as the child is born, and of course long before
the after-birth is expelled, the physician will tie the cord. This is best
done at two places, one about two inches from the child, and the other two
or three inches nearer the mother. Cut the cord about one-half inch beyond
the first ligature, which will be between the two ligatures. The cord
should be tied with sterile tape made for the purpose, or heavy twisted
ligature silk, or a narrow, ordinary, strong tape, previously boiled. It
should be tied firmly and inspected a number of times within one hour of
its birth. It is possible for a baby to lose enough blood from a cord badly
tied to cause its death. A very good way to ensure against such an accident
is to cut the cord one inch from the ligature nearest the baby, then turn
this inch backward and retie with the same ligature, thus making a double
tie at the same spot. Cut the cord with scissors that have been boiled and
reserved for this purpose.
WASHING BABY'S EYES AND MOUTH IMMEDIATELY AFTER BIRTH.--As soon after birth
as is practicable, wash the baby's eyes with a saturated solution of
boracic acid.
Immediately after the eyes have been washed the physician will drop into
them a solution of silver nitrate, three drops of a two per cent. solution
in each eye, or argyrol, three drops 20 per cent. solution. This precaution
is taken against possible infection during labor and, as explained
elsewhere, it is a preventive against certain diseased conditions which, if
present, would result in blindness.
The physician should then wind a little sterile cotton round his moistened
little finger, dip it in the boracic solution, and holding the baby up by
the feet head down, insert this finger into the throat, thus clearing it of
mucus. The tongue and mouth may be gently washed with the same [103]
solution.
After the baby has cried lustily as an evidence of life and strength, he
should be wrapped up in a warm blanket quickly, and immediately put in a
cozy basket in a warm place, and left there undisturbed, with his eyes
shaded from the light until the nurse is ready to attend to him. The baby
should be laid on his right side.
CONDUCT IMMEDIATELY FOLLOWING LABOR.--As soon as the physician is satisfied
that the patient is well enough to be left in care of the nurse or
attendant, every effort should be made to favor a long, refreshing sleep.
Nothing will contribute to the patient's well-being so much as a quiet,
restful sleep after labor. The nurse will therefore take the baby into
another room, fix the mother comfortably, and give her a glass of warm
milk,--draw the shades or lower the light and tell the tired-out mother to
go to sleep. As a rule she will sleep easily, as she is sore and exhausted.
AFTER-PAINS.--In women who have had children the womb does not as a rule
contract down as firmly as after the first confinement. This condition
permits of slight relaxation of the muscular wall, at which times there is
a slight oozing of blood. This blood collects and forms clots in the
uterine cavity which acts as irritants, exciting contractions in the effort
to expel them. These contractions cause what are commonly known as
"after-pains." These pains last until the womb is free from blood-clots.
They may be severe the first twenty-four hours and then gradually die out
during the following two or three days. Ordinarily in uncomplicated
confinements they rarely annoy the patient longer than a few hours. It is a
rare exception to observe them after the first confinement.
REST AND QUIET AFTER LABOR.--Sometimes the birth chamber is the rendezvous
for all the inquisitive ladies in the neighborhood. No one should be
permitted in the lying-in chamber until the patient is sitting up, except
the husband and the mother. This should be made an absolute rule in every
confinement. This is a period that demands the maximum of uninterrupted
rest and repose. The world and all its concerns should remain a blank to a
woman during the whole period of her confinement. This is the only
successful means of obtaining mental rest. The husband and mother [104]
should be instructed to present themselves just often enough to demonstrate
their interest in the welfare of the patient and the baby.
POSITION OF THE PATIENT AFTER LABOR.--After delivery a woman should be
instructed to lie on her back, without a pillow, for the first night. On
the following morning she may have a pillow, but she must remain on her
back for the first week. Sometimes an exception may be made to this rule by
letting the patient move around on the side, with a pillow supporting the
back, on the fourth day. These exceptional cases are those whose womb has
contracted firmly, as shown by the quick change in the amount and color of
the lochia. Women should be told why they must remain on their backs as
explained in the chapter: "How long should a woman remain in bed?"
THE LOCHIA.--The discharge which occurs after every labor is called the
lochia. Its color is red for the first four or five days; for the
succeeding two or three days it is yellow; for the remainder of its
existence it is of a whitish color. It lasts from ten days to three weeks.
The odor of the lochia is at first that of fresh blood; later it has the
odor peculiar to these parts. If at any time the odor should become foul or
putrid it is a danger signal to which the nurse should immediately draw the
physician's attention.
If the amount of the lochia should be excessive it should be investigated.
THE EVENTS OF THE DAY FOLLOWING LABOR.--We will assume that the patient
enjoyed a long sleep and wakes up refreshed, and with a thankful feeling
that all is over and that baby is safely here. She will want to see and
caress baby, of course. Lay the baby down in bed beside her and let her
love and mother it. Tell her not to lift it, for the strain might injure
her, then quietly steal away for ten or fifteen minutes, for these are
precious, sacred moments. Motherhood--that angel spirit, whose influence
every human heart has felt--that guards and guides the world in its
sheltering arms--is born in its divine sense, into the heart of every woman
for the first time, as she gazes in ecstasy and wonder at her [105]
first-born. She feels that she has begotten a trust,--a trust direct from
her Creator, and she makes a silent resolve, as she gently and timidly
feels the softness of baby's cheek, that she will watch over it, and guide
it, and do all a mother can for it, with God's help. It is good for the
race that mothers do feel this way: and it is good for all concerned that
they be given the opportunity to be so inspired.
Just as gently take the baby away at the expiration of the allotted time.
Take it with a cheerful, smiling word, and do not comment upon mother's
happy, thoughtful face, she will quickly collect herself and enter into the
spirit of quiet congratulation that should now permeate the home.
THE FIRST BREAKFAST AFTER LABOR.--If the patient has passed a comfortable
night, feels well, and is free from temperature, and has a normal pulse,
breakfast will consist of a cup of warm milk, or a cup of cocoa made with
milk, a piece of toasted bread, and a light boiled egg; or if preferred a
cereal with milk and toasted bread. This will be the breakfast for the two
following days also. The milk, or the cocoa (whichever is taken), must be
sipped, while the attendant supports the patient's head. The cereal, or the
egg (whichever is taken), must be fed to the patient out of a spoon. The
patient must not make any physical effort to help herself; she must remain
relaxed. Even when she sips her milk, or cocoa, she must not make any
effort to raise her head; the nurse must support its entire weight. This
will be the absolute routine of every meal until the physician gives
permission to change the procedure. It is a waste of time to formulate
rules only to disobey them.
Shortly after breakfast the patient's toilet should be attended to. She
should have her hair combed, and her face and hands washed. The hair on the
right half of her head should be combed while the head rests on the left
side, and vice versa. The water used for washing the hands and face should
be slightly warmed. It is best to keep the hair braided and to consult the
wishes of the patient as to the frequency of combing it. [Page 106]
THE IMPORTANCE OF EMPTYING THE BLADDER AFTER LABOR.--An effort should be
made now to have the patient urinate. This is very important at this time,
as it is not an uncommon experience to find that the abdominal muscles are
so worn out and overstrained with the fatigue of labor that they refuse to
act when an effort is made to urinate. As a consequence the bladder becomes
distended and may have to be emptied by other means. This condition is a
temporary and a painless one, and will rectify itself in a day or two;
meantime, if this accident has occurred, it is essential that the bladder
should be emptied from time to time until the patient can do it herself. To
test this function place the patient on the bed pan into which a pint of
hot water has been put, and give her a reasonable time to make the effort
to pass her water. Should she fail, take an ordinary small bath towel and
wring it out of very hot water, just as hot as she can tolerate, and spread
it over the region of the bladder and genitals: if there is running water
in the room, turn it on full and let it run while the towel is in position
as above. If the bladder is full, there is a peculiar, irresistible desire
to urinate when one hears running water. If this effort fails, report the
fact to the physician when he makes his daily call; he will draw the urine
and it will be part of his daily duty to give specific instructions
regarding this function until nature reestablishes it.
No particular attention need be paid to the bowels for the first two days.
On the morning of the third day, if they have not acted of their own
accord, the physician will give the necessary instructions to move them.
The means necessary to accomplish the first movement after a confinement is
a matter of choice. The old-time idea was to use castor oil, and while
other remedies are now more or less fashionable, castor oil is still an
excellent agent. Enemas are frequently used, but their use is questionable
in this instance, inasmuch as a movement has not taken place for three
days, the object is to clean out the whole length of the intestinal tract,
and an enema is limited to part of the large intestine only,--according to
how it is given. If the small intestines are not thoroughly emptied, [107]
particles of food may remain there, and if so, they will putrify and the
patient runs the risk of developing gas,--sometimes to an enormous extent.
This affliction is painful, and dangerous, and nearly always unnecessary.
It is always, therefore, more safe, and more desirable, to use some agent
by the mouth, and we know of no better one than castor oil; and as castor
oil can be so masked as to be practically tasteless at any drug-store soda
fountain there can be small objection to it. My custom is to send the nurse
or husband with an empty glass to the drug store to have the mixture made
there and brought back ready for use. We have frequently obtained it in
this way and given it to the patient without her knowing what it was. The
best time to give castor oil is two hours after a meal, and two hours
before the next meal--i.e., on an empty stomach. It works quicker and does
not nauseate when the stomach is empty.
INSTRUCTING THE NURSE IN DETAILS.--The nurse will attend to the patient's
discharges by changing the napkins frequently. The bruised parts should be
washed twice daily, for the first three or four days. If the nurse is a
trained graduate nurse a few directions will suffice. If she is not a
trained nurse the physician should be explicit in his instructions. It
would be better if he actually showed her just how he wanted this work
done. The best way to cleanse the vulvae or privates is to take an ordinary
douche bag at the proper height (about three feet) and allow the solution
(1 to 2,000 bichlorid) to run over the parts into the douche pan, but do
not touch any part of the patient with the nozzle of the douche bag. While
she is directing the water with the left hand she should have a piece of
sterile cotton in the right hand with which she will gently mop the parts.
This method ensures disengaging any clotted blood and is aseptic. Dry the
parts afterwards with a soft sterile piece of gauze and apply a clean
sterile napkin.
DOUCHING AFTER LABOR.--A nurse should never give a vaginal douche without
instructions from the physician. Douches are not necessary in the
convalescence of ordinary uncomplicated confinement cases. When it is [108]
necessary to give vaginal douches after a confinement, there are good
reasons why they should be given, and it is therefore absolutely essential
that they should be given properly, and with the highest degree of aseptic
precautions. If these rules are not observed, the danger of causing serious
trouble is very great, and as the physician is directly responsible for the
conduct of the case, he should in justice to himself and his patient, do
the douching himself.
HOW TO GIVE A DOUCHE.--The proper way to give a vaginal douche after a
confinement, when the parts are bruised and lacerated, and when, as a
consequence, the possibility of infection is very great, is as follows:
Instruct the nurse to boil and cool about two quarts of water and have
another kettle of water boiling. Boil the douche bag and its rubber tubing
and the glass douche tube (do not use the hard rubber nozzle that comes
with the ordinary douche bag). Drain off the water after it has boiled for
ten minutes, but instruct the nurse not to touch the bag or tube, to leave
them in the pan, covered, till the physician uses them. When the physician
calls, place the patient on a clean warm douche pan while he is sterilizing
his hands and making the solution ready. While he is douching the patient
the nurse will hold the bag. The bag should not be held higher than two
feet above the level of the patient.
ADVANTAGES OF PUTTING BABY TO THE BREAST EARLY AFTER BIRTH.--The patient
can now take, and will likely be ready for, an hour's nap. After the rest
it is desirable to put the baby to the nipple, first carefully cleaning the
nipple with a soft piece of sterile gauze dipped in a saturated solution of
boracic acid. The reasons for this are as follows:
1st. There is in the breasts of every woman after confinement a secretion
known as "colostrum" which has the property of acting as a laxative to the
child, in addition to being a food.
2nd. It is advisable that the child's bowels should move during the first
twenty-four hours and the colostrum was put there partly for that purpose.
3rd. The act of suckling has a well-known influence on the womb, in [109]
that it distinctly aids in contracting it, and thereby expelling
blood-clots and small shreds of the after-birth which might cause trouble
if left in.
4th. By nursing the colostrum out of the breasts, it will favor and hasten
the secretion of milk.
5th. It is frequently easier for the baby to get the nipple before the
breast is full of milk, and having once had the nipple it will be easier to
induce him to take it again when it is more difficult to get.
THE FIRST LUNCH AFTER LABOR.--Lunch will be next in order, and that should
consist of a clear soup,--chicken broth, mutton broth, beef broth with a
few Graham wafers or biscuits, and a cup of custard or rice pudding. This
will be the lunch for the two following days also. The same precautions are
to be observed in giving this as were observed with breakfast and as will
be observed with all other meals as clearly stated before, and repeated
again, so that no mistake may be made. In the middle of the afternoon the
patient can take a cup of beef tea or a cup of warm milk.
THE FIRST DINNER AFTER LABOR.--Dinner will consist of more broth, or a
plate of clear consomme with a dropped egg, or a cereal, a little boiled
rice with milk, and stewed prunes, or a baked apple.
After the bowels have moved, on the third day, and provided the temperature
and pulse have been normal since the confinement, the patient can be put on
an ordinary mixed diet, particulars regarding which are given on page 121
under the heading "Diet for the nursing mother."
* * * * *
[111]
CHAPTER IX
CONFINEMENT INCIDENTS
REGARDING THE DREAD AND FEAR OF CHILDBIRTH--THE WOMAN WHO DREADS
CHILDBIRTH--REGARDING THE USE OF ANESTHETICS IN CONFINEMENTS--THE
PRESENCE OF FRIENDS AND RELATIVES IN THE CONFINEMENT CHAMBER--HOW LONG
SHOULD A WOMAN STAY IN BED AFTER A CONFINEMENT?--WHY DO PHYSICIANS
PERMIT WOMEN TO GET OUT OF BED BEFORE THE WOMB IS BACK IN ITS PROPER
PLACE?--LACERATIONS, THEIR MEANING AND THEIR SIGNIFICANCE--THE
ADVANTAGE OF AN EXAMINATION SIX WEEKS AFTER THE CONFINEMENT--THE
PHYSICIAN WHO DOES NOT TELL ALL OF THE TRUTH
REGARDING THE MORE OR LESS PREVALENT DREAD OR FEAR OF CHILDBIRTH.--Much has
been written, and much more could be written upon this subject. Inasmuch as
this book is largely intended for prospective mothers to read and profit
thereby, and is not for physicians and nurses whose actual acquaintance
with confinement work would render such comments superfluous, it will not
be out of place to consider this phase of the subject briefly, from a
medical standpoint. When one considers that "a child is born every minute"
as the saying goes, and which is approximately true, and at the same time
remembers that statistics prove, as near as can be estimated, that there is
only one death of a mother in twenty thousand confinements, it would really
seem as though we were "looking for trouble" to even regard the subject as
worthy of the smallest consideration. It is much more dangerous to ride
five miles on a railroad, or on a street car, or even take a two-mile
walk,--the percentage possibility of accident is decidedly in your favor to
stay at home and have a baby. Almost any disease you can mention has a
higher, a much higher fatality percentage than the risks run by a [112]
pregnant woman. The real justification for actual fear of serious trouble
is so small that it barely exists. These are facts that cannot be argued
away by any specious if or and. Why, therefore, should there be any real
fear?
Did you ever hear of the remarks made by a famous philosopher who was given
a dinner by his friends in celebration of his 85th birthday? In replying to
the eulogisms of his friends he said in part:
"As I look back into those blessed years that have faded away, I can recall
a lot of troubles and many worries as well as much happiness and pleasure,
and thinking of it all this evening I can truthfully say my worst troubles
and worries never happened."