CARE DURING LABOR.
We will suppose labor to have commenced. The _preparation of the bed_ for the occupancy of the mother is now to be attended to. As she is to lie on the _left side_ of the bed, this is the side, and the only one, which is to be dressed for the occasion. In order to do so, remove the outer bed-clothes one at a time, folding them neatly on the right side of the bed so that they can easily be drawn over when desired. The _permanent dressing_ is to be placed beneath the lower sheet and upon the mattress. A soft impervious cloth--which, in speaking of the preparation for confinement, we directed to be procured--is placed next to the surface of the bed. The upper edge should be nearly as high as the margin of the bolster, and it should extend down to a distance at least a foot below the level of the hips, so as to certainly protect the bed from the discharges. Upon the top of this a blanket or sheet is laid, and the whole fastened by pins. The lower sheet of the bed, which had been turned over to the right side, to permit the application of the dressing, is now to be replaced. Over the position of this permanent dressing, on the top of the bed-sheet, a neatly-folded sheet, with the folded edge down, is adjusted and pinned in its place. It is upon this sheet that the patient is to be drawn up after her confinement, which will take place upon the _temporary dressing_ of the bed now to be arranged. It consists of an oil-cloth, which should extend up beyond the lower edge of the permanent dressing, overlapping the folded sheet which has been placed above it, and should fall over the side and bottom of the bed. A comfortable or any soft absorbent material is placed over this impervious cloth and covered with a folded sheet, completing the temporary dressing. The bed-clothes may now be adjusted, concealing the dressings from view until they are wanted. The valances at the foot of the bed should be raised, and a piece of carpet placed on the floor. The bed should have no foot-board, or a very low one.
_The dress of the mother._--Either a folded sheet should be adjusted around the waist as the only skirt, so as not to interfere with the walking, or a second chemise should be put on, with the arms outside the sleeves, to extend from the waist to the feet. Then the chemise next the body should be drawn up and folded high up around the breast. It should be plaited neatly along the back, and brought forward and fastened by pins. This should be thoroughly done, so that the linen may not be found wet nor soiled when it is drawn down after confinement. A wrapper or dressing-gown may be worn during the first stage of labor, before it is necessary to go to bed. When, however, that time comes, the wife will take her place on her left side on the temporary dressing, with a sheet thrown over her, her head on a pillow so situated that her body will be bent well forward, and her feet against the bed-post. A sheet should be twisted into a cord and fastened to the foot of the bed, for her to seize with her hands during the accession of the "bearing-down pains."
Care should be taken to have a number of napkins, a pot of fresh lard, and the basket containing the scissors, ligature, bandage, etc.--which have been previously enumerated in the remarks on preparations for childbirth--at hand, for the use of the doctor.
We have now noted all that it is useful for the wife to know in regard to the preparation for and management of confinement, when a physician is in attendance, as, for obvious reasons, he should always be. In some instances, however, the absence of the doctor is unavoidable, or the labor is completed before his arrival. As a guide to the performance of the necessary duties of the lying-in room under such circ.u.mstances, we give some
HINTS TO ATTENDANTS.
The room during confinement should be kept quiet. Too many persons must not be allowed in it, as they contaminate the air, and are apt by their conversation to disturb the patient, either exciting or depressing her.
So soon as the head is born, it should be immediately ascertained whether the neck is encircled by the cord; if so, it should be removed or loosened. The neglect of this precaution may result fatally to the infant, as happened a short time since in our own practice; the infant, born a few minutes before our arrival, being found strangled with the cord about its neck. It is also of importance at once to allow of the entrance of air to the face, to put the finger in the mouth to remove any obstruction which may interfere with respiration, and to lay the babe on its right side, with the head removed from the discharges. The cord should not be tied until the infant is heard to cry. The ligature is to be applied in the following manner:--A piece of bobbin is thrown around the navel-string, and tied with a double knot at the distance of three fingers" breadth from the umbilicus; a second piece is tied an inch beyond the first, and the cord divided with the scissors between the two, care being taken not to clip off a finger or otherwise injure the unsuspecting little infant, as has occurred in careless hands more than once. When the child is separated from the mother, a warm blanket or a piece of flannel should be ready to receive it. In taking hold of the little stranger, it may slip out of the hands and be injured. To guard against this accident, which is very apt to occur with awkward or inexperienced persons, always seize the back portion of the neck in the s.p.a.ce bounded by the thumb and first finger of one hand, and grasp the thighs with the other. In this way it may be safely carried. It should be transferred, wrapped up in its blanket, to some _secure_ place, and never put in an arm-chair, where it may be crushed by some one who does not observe that the chair is already occupied. The head of the child should not be so covered as to incur any danger of suffocation.
ATTENTION TO THE MOTHER.
When the after-birth has come away, the mother should be drawn up a short distance--six or eight inches--in bed, and the sheet which has been pinned around her, together with the temporary dressing of the bed removed, a clean folded sheet being introduced under the hips. The parts should be gently washed with warm water and a soft sponge or a cloth, after which an application of equal parts of claret wine and water will prove pleasant and beneficial. We have also found the anointing of the external and internal parts with goose grease, which has been thoroughly washed in several hot waters, to be very soothing and efficient in speedily allaying all irritation. This ought all to be done under cover, to guard against the taking of cold. The chemise pinned up around the breast should now be loosened, and the woman is ready for the application of the bandage, which is to be put on next the skin. If properly and nicely adjusted, it will prove very grateful. The directions for making it have already been given. In order to apply it, one half of its length should be folded up into plaits, and the mother should lie on her left side; lay the plaited end of the bandage underneath the left side of the patient, carrying it as far under as possible, and draw the loose end over the abdomen; then let the mother roll over on her back upon the bandage, and draw out the plaited end. If the abdominal muscles are much relaxed and the hip-bones prominent, a compress of two or three towels will be wanted. The bandage should be first tightened in the middle by a pin applied laterally, for strings should never be employed. The pins should be placed at intervals of about an inch. The lower portion of the bandage should be made quite tight, to prevent it slipping up. The mother is now ready to be drawn up in bed upon the permanent dressing: this should be done without any exertion on her part. A napkin should be laid smoothly _under_ the hips (never folded up), to receive the discharges. If she prefer to lie on her left side, place a pillow behind her back.
ATTENTION TO THE CHILD.
The baby may now be washed and dressed. Before beginning, everything that is wanted should be close at hand, namely a basin of warm water, a large quant.i.ty of lard or some other unctuous material, soap, fine sponge, and a basket containing the binder, shirt, and other articles of clothing. First rub the child"s body thoroughly with lard. The covering can only be removed in this way; the use of soap alone will have no effect unless the friction be so great as to take off also the skin. The nurse should take a handful of lard and rub it in with the palm of the hand, particularly in the flexures of the joints. In anointing one part, the others should be covered, to prevent the child from taking cold. If the child is thus made perfectly clean, do not use any soap and water, because the skin is left in a more healthful condition by the lard, and there is risk of the child"s taking cold from the evaporation of the water. But the face may be washed with soap and water, great care being taken not to let the soap get into the child"s eyes, which is one of the most frequent causes of sore eyes in infants. The navel-string is now to be dressed. This is done by wrapping it up in a circular piece of soft muslin, well oiled, with a hole in its centre. The bandage is next to be applied. The object of its use is to protect the child"s abdomen against cold, and to keep the dressing of the cord in its position. The nature, shape, and size of the binder have been described. It should be pinned in front, three pins being generally sufficient. The rest of the clothing before enumerated is then put on.
The child is now to be _applied to the breast at once_. This is to be done, for three reasons. First, it very often prevents flooding, which is apt otherwise to occur. Secondly, it tends to prevent milk fever, by averting the violent rush of the milk on the third day, and the consequent engorgement of the breast and const.i.tutional disturbance.
The third reason is, that there is always a secretion in the breast from the first, which it is desirable for the child to have; for it acts as a cathartic, stimulating the liver, and cleansing the bowels from the secretions which fill them at the time of birth. There is generally sufficient nourishment in the b.r.e.a.s.t.s for the child for the first few days. The mother may lie on the one side or the other, and receive the child upon the arm of that upon which she is lying. If the nipple be not perfectly drawn out so that the child can grasp it in its mouth, the difficulty may be overcome by filling a porter-bottle with hot water, emptying it, and then placing the mouth of the bottle immediately over the nipple. This will cause, as the bottle cools, a sufficient amount of suction to elevate the sunken nipple. The bottle should then be removed and the child subst.i.tuted,--a little sugar and water or sweetened milk being applied, if necessary, to tempt the child to take the breast.
FURTHER ATTENTION TO THE MOTHER.
The patient should be cleansed every _four or five hours_. A soft napkin, wet with warm soap and water, should for this purpose be pa.s.sed underneath the bed-clothing, without exposing the surface to a draft of air. After using the soap and water, apply again the dilute claret wine and the goose grease. Much of the safety of the mother depends upon the observation of cleanliness. The napkin should not be allowed to remain so long as to become saturated with the discharges.
The mother should maintain rigidly the rec.u.mbent position for the first few days, not raising her shoulders from the pillow for any purpose, and should abstain from receiving visitors, and from any social conversation for the first twenty-four hours.
For the first three or four days, until the milk has come and the milk fever pa.s.sed, the mother should live upon light food,--oatmeal gruel, tea and toast, panada, or anything else of little bulk and unstimulating character. Afterwards the diet may be increased by the addition of chicken, lamb, mutton or oyster broth, b.u.t.tered toast, and eggs. The object of light nourishment at first is to prevent the too rapid secretion of milk, which might be attended with evil local and const.i.tutional effects. If, however, the mother be in feeble health, it will be necessary from the outset that she shall be supported with nourishing concentrated food. _Beef-tea_ will then be found very serviceable, particularly if made according to the following recipe:--Take a pound of fresh beef from the loins or neck. Free it carefully from all fat. Cut it up into fine pieces, and add a very little salt and five grains of unbroken black pepper. Pour on it a pint of cold water, and _simmer_ for forty minutes. Then pour off the liquor, place the meat in a cloth, and, after squeezing the juice from it into the tea, throw it aside. Return to the fire, and boil for ten minutes.
After the first week, the diet of the lying-in woman should always be nutritious, though plain and simple. The development of the mammary glands, the production of the mammary secretion, and the reduction which takes place in the size of the womb, all require increased nourishment, that they may be properly performed.
After the third or fourth day _the dress should be changed_. The dress worn during labor, if our directions have been carried out, will not have been soiled. The clothing should be changed without uncovering the person, and without raising the head from the pillow. Pull the bed-gown from over each arm, and draw it out from under the body. Then unfasten the chemise in front and draw it down underneath her so that it can be removed from below, as it should not be carried over the head. Place her arms in the sleeves of the clean chemise, throw its body over her head, and, without lifting her shoulders from the bed, draw it down. Then change the bed-gown in the same manner.
In changing the upper sheet, it should be pulled off from below, and the clean one carried down in its place from above, underneath the other clothing, which can be readily accomplished by plaiting the lower half.
In introducing a clean under-sheet, one side of it should be plaited and placed under the patient, lying on her left side; when she turns on her back, the plaits can then be readily drawn out. These directions, though apparently trivial, are important. The object is to guard against the great danger to which the mother is exposed by sitting up in bed for even a few minutes during the first week.
_Cathartic medicine_ should not be administered the first, the third, or any other day after confinement, unless it is needed. If the patient is perfectly comfortable, has no pain in the abdomen, no headache, and is well in every respect, she should be let alone, even if her bowels have not been moved. If a laxative be called for, citrate of magnesia is much pleasanter and equally as efficacious as the castor-oil so frequently administered on this occasion.
TO HAVE LABOR WITHOUT PAIN.
Is it possible to avoid the throes of labor, and have children without suffering? This is a question which science answers in the affirmative.
Medical art brings the waters of Lethe to the bedside of woman in her hour of trial. Of late years chloroform and ether have been employed to lessen or annul the pains of childbirth, with the same success that has attended their use in surgery. Their administration is never pushed so as to produce complete unconsciousness, unless some operation is necessary, but merely so as to diminish sensibility and render the pains endurable. These agents are thus given without injury to the child, and without r.e.t.a.r.ding the labor or exposing the mother to any danger. When properly employed, they induce refreshing sleep, revive the drooping nervous system, and expedite the delivery.
They should never be used in the absence of the doctor. He alone is competent to give them with safety. In natural, easy, and short labor, where the pains are readily borne, they are not required. But in those lingering cases in which the suffering is extreme, and, above all, in those instances where instruments have to be employed, ether and chloroform have a value beyond all price.
MORTALITY OF CHILDBED.
_The number of the pregnancy_ affects the danger to be expected from lying-in. It has been declared by excellent authority, that the mortality of first labors, and of childbed fever following first labors is about twice the mortality attending all subsequent labors collectively. After the ninth labor the mortality increases with the number. A woman having a large family, therefore, comes into greater and increasing risk as she bears her ninth and successive children.
_The age of the woman_ also affects the mortality accompanying confinement. The age of least mortality is near twenty-five years. On either side of this, mortality increases with the diminution or increase of age. The age of the greatest safety in confinement therefore corresponds to the age of greatest fecundity. And during the whole of child-bearing life, safety in labor is directly as fecundity, and _vice versa_. Hence modern statistics prove the correctness of the saying of Aristotle, that "to the female s.e.x premature wedlock is peculiarly dangerous, since, in consequence of antic.i.p.ating the demands of nature, many of them suffer greatly in childbirth, and many of them die." As the period from twenty to twenty-five is the least dangerous for childbirth, and as first labors are more hazardous than all others before the ninth, it is important that this term of least mortality be chosen for entering upon the duties of matrimony. This we have already pointed out in speaking of the age of nubility.
_The s.e.x of the child_ is another circ.u.mstance affecting the mortality of labor. Professor Simpson of Edinburgh has shown that a greater proportion of deaths occurs in women who have brought forth male children.
_The duration of labor_ also influences the mortality of lying-in. The fatality increases with the length of the labor. It must be recollected, however, that the duration of labor is only an inconsiderable part of the many causes of mortality in childbirth.
WEIGHT AND LENGTH OF NEW-BORN CHILDREN
The average weight of infants of both s.e.xes at the time of birth is about seven pounds. The average of male children is seven and one-third pounds; of female, six and two-thirds pounds. Children which at full term weigh less than five pounds are not apt to thrive, and usually die in a short time.
The average length at birth, without regard to s.e.x, is about twenty inches, the male being about half an inch longer than the female.
In regard to the relation between the size of the child and the age of the mother, the interesting conclusion has been arrived at, that the average weight and length of the mature child gradually increases with the age of the mother up to the twenty-fifth year. Mothers between the ages of twenty-five and twenty-nine have the largest children. From the thirtieth year they gradually diminish. The first child of a woman is of comparatively light weight. The first egg of a fowl is smaller than those which follow.
The new-born children in our Western States seem to be larger than the statistics show them to be in the various States of Europe, and apparently even than in our Eastern States. In the Report on Obstetrics of the Illinois State Medical Society for 1868, it is stated that Quincy, Ill., produced during the year six male children whose average weight at birth was thirteen and a quarter pounds, the smallest weighing twelve pounds, and the largest seventeen and a half, which was born at the end of four hours" labor, without instrumental or other interference. A recent number of a Western medical journal reports the birth at Detroit, in February last, of a well-formed male infant twenty-four and a-half inches long, weighing sixteen pounds. The woman"s weight, _after labor_, is stated as only ninety-two pounds. An English physician delivered a child by the forceps which weighed seventeen pounds twelve ounces, and measured twenty-four inches. These are the largest well-authenticated new-born infants on record.
DURATION OF LABOR.
The length of a natural labor may be said to vary between two and eighteen hours. The intervals between the pains are such, however, that the actual duration of suffering, even in the longest labor, is comparatively very short. The first confinement is much longer than subsequent ones.
The _s.e.x_ of the child has some influence on the duration of labor.
According to Dr. Collins of the Lying-in Hospital of Dublin, the average with _male_ births is one hour and four minutes longer than with _female_. The _weight_ of the child also affects the time of labor.
Children weighing over eight pounds average four hours and eight minutes longer in birth than those of less than eight pounds weight.
STILL-BIRTHS.
The statistics of nearly fifty thousand deliveries which occurred at the Royal Maternity Charity, London, show a percentage of nearly five still-born, or one in twenty-seven.
There are more boys still-born than girls. We have already spoken of the fact that male births are more tedious, and that a larger number of males die in the first few years of life than females. This series of misfortunes has been attributed to the large size which the male ftus at birth possesses over the female.
IMPRUDENCE AFTER CHILDBIRTH.
After the birth of the child at full term, or at any other period of pregnancy, the womb, which had attained such wonderful proportions in a few months, begins to resume its former size. This process requires at least six weeks after labor for its full accomplishment. Rest is essential during this period. A too early return to the ordinary active duties of life r.e.t.a.r.ds or checks this restoration to normal size, and the womb being heavier, exposes the woman to great danger of uterine displacements. Nor are these the only risks incurred by a too hasty renewal of active movements. The surface, the substance, and the lining membrane of the womb are all very liable, while this change from its increased to its ordinary bulk is occurring, to take on inflammation after slight exposure. The worst cases of uterine inflammation and ulceration are thus caused. A "bad getting-up," prolonged debility, pain, and excessive discharge, are among the least penalties consequent upon imprudence after confinement. It is a mistake to suppose that hard-working women in the lower walks of life attend with impunity to their ordinary duties a few days after confinement. Those who suffer most from falling of the womb and other displacements are the poor, who are obliged to get up on the ninth day and remain upright, standing or walking for many hours with an over-weighted womb. Every physician who has practised much among the poor, has remarked upon the great frequency of diseases of the womb, which is to be attributed to the neglect of rest, so common among them, after childbirth. If this be true of vigorous women accustomed to a hardy life, how much more apt to suffer from this cause are the delicately nurtured, whose systems are already, perhaps, deteriorated, and little able to resist any deleterious influences!
A mother should remain in bed for at least two weeks after the birth of the child, and should not return to her household duties under a month; she should also take great pains to protect herself from cold, so as to escape the rheumatic affections to which at this time she is particularly subject. If these directions were generally observed, there would be less employment for physicians with diseases peculiar to women, and fewer invalids in our homes.