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Confinement.These are the characteristics of the true labor pains, which may be and should be thereby distinguished from various other so-called pains which are apt to occur about this time. During these early pains there usually appears what is known as the M show " - a discharge of mucus and blood from the mouth of the womb. Yet this must not be relied upon as the invariable sign of beginning labor, since it is sometimes scarcely observed, either because but little blood appears, or because the secretions from the part are already so excessive as to make the further increase pass unnoticed. Although the woman does not necessarily take to her bed during the early part of labor (in fact, most women cannot be persuaded to recline, but insist upon sitting or walking), yet these early pains should be taken as the signal for preparing the bed and such utensils as may be required during labor. - Much inconvenience and annoyance can be avoided subsequent to delivery by adopting a certain arrangement before labor begins. The bed may be conveniently arranged by placing upon the bed-stead the following articles in the order indicated, from below upward : Mattress. Newspapers or oilcloth. Lower sheet. Fourfold sheet (pinned down). Oilcloth - four or five feet square. Quilt. Sheet to cover quilt. The three articles last named can be removed without disturbing the patient materially after the labor is over, leaving her comfortably placed upon clean linen with ample protection of the mattress from subsequent discharges. The woman herself should be provided with certain articles. First, it is of course desirable that her garments shall, so far as possible, escape soiling during labor ; hence, the first requisite is brevity, which may be attained either by turning up and pinning or stitching the ordinary chemise, or, perhaps better, by preparing short gowns for the purpose. Another plan is to have the chemise tucked above the hips, its lower part being substituted by a folded sheet fastened about the waist. A second article which it will be found usually desirable to employ is a bandage. This should be made of unbleached muslin, long enough to encircle the hips and broad enough to extend from above the prominence of the hips half way down the thigh ; its average length, therefore, will be about four feet, its average breadth fifteen to eighteen inches. The size varies, of course, with different persons, and it may be fitted in advance to each individual; the pattern may be obtained by measuring the body at about the fourth month of pregnancy. For the child there may prepared flannel or woolen underclothing and a narrow flannel bandage four or five inches in breadth and fourteen or fifteen inches in length. There will be required, also, a bottle of fresh sweet oil and two lengths of twisted or braided thread ; a paper of large pins and one of smaller ditto ; some fine sponges previously washed and pounded so as to be free from sand ; a box of unirritating toilet powder ; some fine soap ; a small pair of scissors ; an abundance of clean towels ; a piece of old linen or cotton wadding, for dressing the naval string. All these articles should be properly arranged in advance within easy reach ; perhaps the best way is to place them in a basket devoted to the purpose, which may be kept in the room. The first stage of labor, which may very from a few hours to one or two days, consists in the dilatation of the mouth of the womb. During this time the woman ordinarily prefers to remain upon her feet, and thus usually finds relief and comfort. This period is apt to be especially long and tedious at the first confinement, and may be quite short in subsequent labors of the same individual. During this time the pains have nothing of that bearing-down character which they subsequently acquire ; they are described rather as " grinding, " are felt in the front, and have what has been called a " wave-like " course - that is, a regular crescendo and minuendo of intensity. During these pains the abdomen may be felt to become hard, the breathing is somewhat retarded and the pulse increased in frequency. During this time, also, the genital canal becomes bathed with the secretions, which may or may not be tinged with blood. This is the period which is apt to be especially trying to the soul of the young wife. For hours she is annoyed and made restless by frequently-recurring pains, which seem to accomplish no good and merely exhaust her strength and patience. She should remember that this apparently useless annoyance is a most essential and unavoidable part of the process, and that little can be done by herself or by the physician to accelerate or shorten the process. She should not waste her strength by attempting to " bear down," for she will subsequently require all her energies for this purpose. When the mouth of the womb has become dilated, the expulsion of the child begins - a change of programme indicated to the mother by the altered character of the pains ; these now become more frequent, severe and prolonged, while at the same time the woman now is conscious of an effort to expel a body from the abdomen,- to bear down - and naturally summons to her aid the voluntary muscles capable of assisting in the accomplishment of this object. This consciousness that she is working to overcome an obstacle usually confers a certain satisfaction upon the woman, who may have been discouraged and exhausted by twenty-four hours of annoying pains which seem to have no object, and hence present no hope of completion. The commencement of this, the second stage of labor, is often indicated by several occurrences which may alarm the inexperienced. Not infrequently the conclusion of the first stage is marked by the occurrence of a severe chill, which may be so violent as to shake the bedstead upon which the patient reclines. This seems to be a natural part of the process and calls for no interference other than warm coverings, and perhaps a hot drink. A second phenomenon is the escape of the " waters " - an occurrence which usually happens during the latter part of the first or the early portion of the second stage of labor. When the pains assume the expulsive character indicating that the second stage of labor has begun, the woman's inclination is usually to take to her bed. Yet to assist in her voluntary efforts of expulsion she almost invariably desires to have something to pull against; hence it is advisable to tie a twisted sheet to the corners of the bedstead, at the foot, so arranged that the middle of the rope thus formed shall be at a convenient distance for the woman's hands. While this ordinarily satisfies the demands of her nature at this time, yet one must be prepared for curious freaks and fancies. During the pains of the second stage, the expulsive efforts are often accompanied by such physical contortions as to excite the alarm as well as the sympathy of friends. It may be said, however, that no damage ever results to the patient from the excessive violence of her own efforts ; no matter how long her respiration be arrested, nor how blue and distorted her face becomes; these are all natural accompaniments of the process, which need occasion no anxiety nor interference on the part of the friends at least. It is certainly desirable, in the interest of the patient and her child, that a physician should be called in every case of labor. In many cases, it is true, his services are not imperatively demanded ; in many others, professional skill saves the life of mother or child, or both. Since it is impossible to predict in advance as a rule what cases will proceed quietly and easily and what ones will present serious complications, the only safe plan is evidently the presence of the best medical skill in every instance. Yet in many cases, particularly in the country, it is either impossible to secure the services of a physician, or if a medical man be engaged, he is often unable to arrive until delivery has occurred. In such cases, it is desirable for friends to observe certain precautions in the care of the parturient woman. During the first and early part of the second stage of labor, the woman should be allowed complete liberty as to position, food, drink, etc. Care should simply be taken that she be not annoyed by the well-meant, though over-officious attentions and inquiries of friends. But few individuals should be admitted to the lying-in chamber. No examination of the parts by a non-professional person will be apt to afford any particular advantage or information, until the head of the child appears at the outlet of the vagina. At this period, it is often possible for the skilled hand, by judicious manipulation, to prevent a rupture of the parts, and subsequent disease of the sexual organs. It is impossible to convey in a few words the information necessary for the performance of such manipulation ; it may be useful, however, to remark that if the pains be severe, and the head rapidly advancing, the hand of an attendant (covered by a towel) may be applied at the lower edge of the orifice in such a way as to force the head in its progress toward the upper edge of the opening; never let the child drop into the bed. So soon as the child's head is born, the finger may be applied to the neck to discover whether it be encircled by the umbilical cord ; if such be the case, a gentle effort may be made to slip this coil over the head, whereby two objects are accomplished : the breathing of the child is secured and the escape of its body facilitated. A finger may be passed into the child's mouth to remove mucus, etc. The birth of the head-usually a moment of extreme agony to the woman, indicated by a piercing cry-is followed by a period of rest and relief, during which the patient recovers in part her exhausted energy and courage ; then follows with much less effort and pain, the birth of the child's body, usually accompanied by a considerable flow of blood. Both mother and child should now receive especial attention. As to the former, a hand should be placed upon the abdomen, where a distinct firm ball, occupying the lower part of the abdominal cavity, should be felt; this may be gently and continuously pressed, whereby a certain amount of contraction of the womb will be secured. Meantime, another attendant should observe whether the child breathes, and if it does not, should take immediate measures to secure this action. Usually, so soon as the mucus has been removed by the insertion of the attendant's finger -or, indeed, without this precaution-the child responds with a lusty cry ; if not, it may be stimulated by a few gentle taps with the open hand upon the most conveniently situated part of its anatomy, or by a few strokes with the wet end of a towel, or by sprinkling cold water violently upon its body. If one or all of these measures fail to induce vigorous breathing, it will be necessary to perform artificial respiration. This is a somewhat rare necessity, and may be most conveniently accomplished, after clearing out the infant's mouth and nostrils by the application oi the attendant's lips to those of the child (the nose of the child meanwhile being held), whereby his own breath can be forced into the lungs of the infant-and then, of course, permitted to escape-at the rate of eighteen or twenty times per minute. This is a delicate and not altogether unobjectionable proceeding, which should be performed, if possible, by a medical man; and may be performed by others only as a last resort. If there be any delay in persuading the child to breathe, the cord may remain uncut until respiration is established. So soon as breathing has begun (or before, of course, if any prolonged efforts are necessary to establish the respiratory functions, and there be no pulse in it) the cord may be cut. The piece of twisted thread, previously prepared for this purpose, is tightly tied around the cord at a distance of about two and a half or three inches from the child's body ; a second piece is similarly tied about an inch further from the child, and the cord is then cut between the two. The objection to using tape, as is so often done for this purpose, is merely that the tape, because broad, cannot be made to penetrate the jelly-like substance of the cord, and does not, therefore, secure a compression of the artery and veins enclosed within the jelly-like material ; hence there sometimes occurs a serious loss of blood from the cut end of the cord. The tape, too, slips more readily than thread, and if not very tightly tied, may even after several hours, slip off entirely and permit serious or even fatal hemorrhage. In cutting the cord care should be taken - particularly if the operation be performed under the bedclothes - that nothing except the cord, that is, no fingers nor toes of the child be accidentally caught between the blades of the scissors. The infant is now removed from the bed and received upon a blanket or piece of flannel held in the hands of a nurse, upon which the child should be transferred to a place of safety, such as a bed in a neighboring room ; sometimes, in the excitement of the moment, the infant will be deposited in a large arm-chair or similar receptacle, where it may easily be smothered or crushed by individuals not aware of its presence. Caution is necessary in handling the child ; for being covered with an unctuous material it may readily slip from a careless hand. Indeed, the only way for securing a grasp at once firm and yet not severe, is to place one hand under the back of the neck, so that the neck lies between the thumb and forefinger, while both knees are similarly held in the thumb and forefinger of the other hand. The child may be left wrapped up in its blanket or flannels - space being allowed it to breathe - while the mother receives the attention which she requires. After the birth of the child there usually occurs a cessation of activity in the womb for ten to thirty minutes. During this time a sense of coldness, even positive chills, may occur. Within half an hour after the birth of the child it will usually be found that the afterbirth has been detached from the womb and is lying in the vagina, whence it may be extracted by gently pulling upon the cord. In every case it is desirable, however, to keep the hand upon the abdominal wall over the womb, as already directed in speaking of the birth of the child. It will be found that after some minutes the womb becomes hardened and presently decreases materially in size, indicating the expulsion of the afterbirth. If this do not occur spontaneously in fifteen or twenty minutes the process may be materially hastened by grasping the womb through the abdominal wall in the hand, and gently compressing the organ at intervals of a minute or two. This kneading movement may be repeated and pressure continued until the afterbirth is delivered. Meanwhile the cord may be very gently pulled, never with any considerable force, for it should be remembered that if there be any obstacle to the delivery of the placenta the application of force to the cord may result not in pulling the afterbirth away, but in tearing in two the cord, or even in turning the womb inside out. After the removal of the afterbirth, the womb should be distinctly felt as a very firm, hard body, about the size of a cocoa-nut, in the lower part of the abdomen. And it is important that the condition of the womb be observed from time to time for several hours after delivery. For one of the serious complications of labor arises from a failure of the womb to contract properly or to stay contracted ; as a result of which failure hemorrhage may occur to a serious or even fatal degree. If at any time the womb, which has thus properly contracted after delivery, be found to have increased in size and to have become softer, it is probable that blood is escaping into its cavity. In this case energetic compression and kneading of the womb through the abdominal wall should be performed. The three uppermost articles on the bed next to the patient's body may now be moved a little - six or eight inches toward the foot of the bed, so as to give an opportunity for cleansing the mother. This may be best performed by simple washing with warm water, to which a little alcohol may be added if desired. If her garments have been soiled, they should at once be replaced by clean ones, and then the upper sheet, quilt and oilcloth may be removed from the bed without disturbing the patient further than by the elevation of her hips. In this way she is brought to rest upon a clean fourfold sheet. A large folded napkin should be placed between her thighs, but not brought upward and pinned as is so often done, so as to close the orifice of the vagina. For by this latter plan the fluids which must necessarily escape into the vagina are retained in that cavity and may give rise to disease by undergoing putrefaction there ; by simply placing the napkin between the thighs we do not impede the escape of these discharges. The bandage may now be applied ; either the one already indicated, or, in case this is lacking, an ordinary bolster cover will answer the purpose. The bandage should be first fastened in the middle, large pins being placed at distances of one or two inches ; it may be drawn tight enough to feel snug, but nothing is gained by excessive pressure. After the mother has been comfortably placed in a clean bed, and after the child has been applied to the breast, she should be left in quiet to repose for an hour or two, with strict injunctions under no circumstances to change her position from the recumbent posture ; this rule is rendered necessary by the danger of hemorrhage consequent upon the erect position or even upon raising the body to the sitting posture in the bed. A cup of tea or a glass of wine may be refreshing, and should be granted if desired, but need not be forced upon the patient. It will be necessary often to change the napkins, and the opportunity should be improved to wash the parts with warm water and alcohol. This process should be repeated at less frequent intervals during the first few days, as often and as long as is necessary to secure perfect cleanliness. Every day the bandage maybe loosened and the womb compressed gently for a few minutes, after which the bandage may be reapplied with a comfortable degree of pressure. This is a most important measure, by which we may hope to avoid not only the severity of the usual after-pains, but also to escape the dangers of puerperal diseases or " childbed fever. " After the first week, the bandage has fulfilled its purpose, and may be dispensed with, unless the patient complains of a sense of insecurity, when its adjustment should be moderately loose. The bandage is useful so long as it can grasp and compress a solid body, i. e., the womb. When this can no longer be felt, it has done its real work, and if (tightly) persisted in, may even contribute to prolapsus of the womb. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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