THE BABY’S ARRIVAL
During the past nine months you have had the happiness of guarding the
little life within you and of making soft, warm garments to have in
readiness for the baby when he comes. You have prepared your room and
his; folded up the packages of gauze and cotton and prepared all sorts
of other things to be pressed into service upon the baby’s arrival, and
through it all you have dreamed and planned and built the loveliest of
castles in Spain.
And now, at last, the baby is coming!
It almost takes your breath away to realize it after all those months of
waiting and dreaming, and though it scarcely seems possible, the waiting
is almost over.
This same waiting grows very hard toward the end for you are tense with
expectation and suspense. The hours and days seem endlessly long, as
they pass without giving the looked-for signs that the baby has started.
You find it very hard not to grow discouraged and impatient, he seems so
long in coming. Your physical discomfort is aggravated by the greater
pressure made by the baby during this period, and you cannot get away
from it day or night. The desire to urinate is almost constant; your
back aches; your feet feel heavy and swollen and the baby disturbs your
nights by his increasingly vigorous kicking.
But this does not last long, so try to minimize the fatiguing effects of
it all by resting and sleeping as much as possible during the day. The
time does slip by and the baby really does come and you don’t want to be
tired before the big event.
The miracle of the baby’s origin at the moment of conception; of his
growth and the development of the intricate parts of his little body, is
equaled only by the miracle of his birth—his separating from your
protecting body and coming into the world as a new human being when the
time comes that he is able to exist separately and independently.
Since very early in pregnancy, you will remember, your uterus has been
growing alternately hard and soft as the muscles have contracted and
relaxed. But these contractions have been as painless, and so far as we
know, as fruitless as the contractions of a boy’s biceps as he clenches
his fist and produces a hard lump on his arm.
But when the baby is ready to take up his life among the rest of us
human beings, the contractions of your uterine muscles are altered in
such a manner that you gradually become conscious of them and they
become so purposeful that they are able slowly but steadily to force the
baby down through that narrow part of the pelvis called the inlet,
through the cervix, and finally out into the world.
Since, at the proper time you will be able to help these altered
muscular contractions to accomplish their high purpose, you will want to
watch their progress, with your mind’s eye, as far as possible.
Recall, for a moment, the fact that the baby is contained in a sac of
fluid in the cavity of the uterus, above the cervix; that the cervix,
below, is a canal drawn in tightly at the upper end, or internal os, and
also at the lower end, or external os.
Quite evidently after the baby’s head has been squeezed through the
pelvic inlet by pressure of the uterine contractions, the cervix must
open widely in order that he may pass through it, too. And so Nature
gradually stretches this narrow canal by using the lowermost part of the
bag of waters as a water-wedge and forcing it down into the internal os,
a little farther with each pain. The opening grows wider and wider as
the bag of waters is pressed farther and farther down into the cervical
canal, which also widens slowly, and finally the external os, too, is
stretched wide open by the water-wedge. Fig. 22 shows how the cervix
looks with the bag of waters pressed against the upper opening and how
the entire canal is gradually dilated by this wedge, as it is pressed
downward.
As you doubtless know, the process of your baby’s emergence into the
world and separation from your body is termed =labor=. The onset of
labor is usually marked by the expectant mother becoming conscious of
the uterine contractions through dragging pains which are felt first in
the small of the back and then in the lower part of the abdomen and
thighs. In the beginning the pains are feeble and infrequent, but they
gradually grow more severe and more frequent. Sometimes the first sign
of labor is a gush of fluid, caused by the rupture of the membranes, or
the appearance of blood, but these are not typical. Intestinal colic is
sometimes mistaken for labor pains by women who are pregnant for the
first time, but when the cramps come regularly and the uterus is felt,
through the abdominal wall, to grow hard as the pain increases, and soft
as it subsides, there can be no doubt that they are labor pains.
This is the time, usually, when you will go to the hospital, if your
baby is to be born there, or when you will notify your doctor that you
think you are in labor. If you are to remain at home the doctor may want
you to send for the nurse at once, in which case he depends upon her to
communicate with him. Or he may prefer that you notify him and let him
send the nurse. Either arrangement is simple and easy to carry out, but
you must be sure that you understand just what the doctor wants you to
do when you think labor has started. It is not a bad plan to write down
his instructions about this, with the telephone number and street
address of the one to be summoned, so that you will know exactly how to
proceed when the time comes.
[Illustration:
FIG. 22.—Diagrams showing how the cervix is dilated as the bag of
waters is forced downward by the uterine contractions.
]
The entire duration of labor may vary from a few moments to several
days, but the average length of the first labor is about eighteen hours
and of subsequent births about twelve hours. The process is usually
described as being divided into the first, second and third stages of
labor, approximately as follows:
_First stage_ _Second stage_ _Third stage_ _Total_
First labor 16 hours 1¾ hours 15 minutes 18 hours
Later labors 11 hours 45 minutes 15 minutes 12 hours
The first stage begins with the onset of labor and lasts until the
cervical canal is completely dilated; the second stage begins when the
cervix is dilated and lasts until the baby is born; the third stage
begins with the birth of the baby and lasts until the afterbirth is
expelled.
=First Stage.= The pains are mild at first and occur at intervals of
from fifteen to thirty minutes, but they gradually increase in frequency
and intensity until by the end of fourteen to sixteen hours, they are
very severe, and recur every three or four minutes, each pain lasting
about one minute. The pains begin in the back, then pass slowly forward
to the abdomen and down into the thighs.
The average woman is entirely comfortable between pains and until they
become very frequent she will usually prefer to be up and about, but if
she is on her feet when a contraction begins she will usually seek
relief by leaning forward on something secure, as the foot of the bed or
a table, or by sitting down until the pain subsides. As time passes,
there is an increasing, sometimes persistent desire to empty the bowels
and bladder because of pressure upon these two organs by the baby’s head
as it is forced slowly downward. There may be vomiting, also when the
cervix becomes nearly, or quite dilated.
In the course of the stretching process, the cervix sustains many tiny
tears from which blood oozes and tinges the vaginal discharge. This
bloodstained discharge is often called the “show” and usually appears
toward the end of the first stage.
When the cervix is fully dilated, the membranes, or bag of waters,
usually rupture, and there is a sudden gush of fluid, but the rupture of
the membranes does not necessarily mark the end of the first stage.
Sometimes, though not often, they break before labor begins, thus
producing what is known as a “dry” labor. They may rupture before the
cervix is fully dilated or they may not rupture at all until the doctor
punctures them to facilitate the baby’s birth.
If the nurse is delayed in reaching you, there is a good deal that you
can do and have done, during this first stage of labor, in the way of
preparing for the baby’s arrival, this preparation relating in general
to yourself and to the room including placement of the sterile
dressings.
As to yourself, try first to picture what takes place during the fifteen
or sixteen hours of the first stage. The baby’s head has usually passed
through the pelvic inlet and not much happens, now, beyond the widening
of the cervical canal, as the bag of waters is forced down by the
squeezing of the uterus each time that it contracts. (See Fig. 23.) As
the contractions grow stronger and more frequent you may have a desire
to help matters by “bearing down,” or straining, but this is very unwise
for nothing that you can do will hasten the dilation of the cervix. The
bearing down will tire you and then you will not be able to make as much
helpful effort during the second stage as you would in a fresh and
rested condition. For this reason, if your pains begin at night, don’t
get up, but stay in bed and try to get as much sleep as possible. If
they begin during the day, keep up and about during most of the time,
but lie down often enough and long enough to prevent your getting tired.
But above all don’t bear down during the first stage.
[Illustration:
FIG. 23.—Drawing showing the baby’s descent at the time of birth. The
head is passing through the inlet and pressure by the bag of waters
has started to dilate the cervix. (Drawn by Max Brödel. Used by
permission of A. J. Nystrom and Co., Chicago.)
]
Take a warm soapsuds enema; a thorough, warm, sponge or shower bath,
scrubbing the inner surface of the thighs and lower abdomen thoroughly,
but do not bathe between the labia. Put on a freshly laundered
nightgown, stockings, dressing-gown and slippers and braid your hair,
preferably in two braids.
Drink all of the water you want and about every three or four hours take
some form of liquid nourishment such as milk, cocoa, strained soup or
broth, with toast or crackers. Such nourishment will help to keep you
from getting tired and will do no harm, but it may not be altogether
wise to take anything more solid without your doctor’s permission. It is
not uncommon for one to feel nauseated toward the end of the first stage
and this tendency may be aggravated by taking solid food.
One thing to remember is the very great importance of your poise and
favorable mental attitude. So much of proved value has been done, and
still is being done, to safeguard you and your baby, that you have every
reason to feel calm and secure, and it is of very practical importance
that you cultivate this attitude. The woman who allows herself to become
excited, nervous and apprehensive has much harder time than the one who
asserts her self-mastery and preserves a tranquil state of mind. This is
so definitely the case that for the sake of your own comfort I cannot
urge you too strongly to remember it and to exclude disturbing or
exciting influences as far as possible. One of the most troublesome of
these is excitable but well-meaning and officious friends or relatives.
Accordingly, if your nurse is not at hand try to have some one
cool-headed woman with you and insist upon excluding those who would be
upsetting or likely to offer advice and suggestions. In getting yourself
ready, then, it is advisable to take a bath and an enema; put on clean
clothing; not to stay in bed entirely throughout the first stage, but on
the other hand to try to keep mind and body fresh and rested by lying
down when you begin to feel tired, taking light nourishment regularly,
not bearing down during pains and denying yourself to visitors who might
be excitable.
This is all simple enough and you will not find it difficult to carry it
out. And, happily, the preparations relating to the room are equally
simple and uncomplicated.
Either you or the friend who is with you, may make the bed—you if you
feel like it, she, if you are tired. The mattress is covered with the
larger of the two pieces of rubber sheeting that you have in readiness
and over this is placed the lower sheet, stretched very smooth and tight
and tucked well under the mattress at head, foot and sides. If the sheet
is not very large, it may be made secure by being pinned with
safety-pins to the under side of the mattress. The smaller rubber is
then placed across the middle third of the bed and over this a muslin
sheet, folded once through the middle, tucked well under the sides of
the mattress. Next, the upper sheet, a light blanket and a thin
counterpane, all left open at the foot, and a pillow.
The packages of sterile dressings, douche pan, fountain syringe,
pitchers and basins may be placed on the tables, and the washstand
equipped for the doctor’s hands with soap, sterile nail-brush, nail
scissors and file. A large kettle or pail of water should be boiled,
covered and put aside to cool and a large receptacle such as a
wash-boiler, half or two thirds full of water put on to boil when the
pains begin to come about every five minutes.
The baby’s bathtub should be near at hand for sometimes babies do not
breathe quite satisfactorily at first and are helped to do so by being
held in a tub of warm water. There should be, also, a box, basket or
crib, in readiness to receive the baby, furnished with a clean blanket
and hot water bottle with a flannel cover.
These are the preparations which may be made during the first stage—that
period when the cervix is being slowly but steadily dilated by the bag
of waters as it is forced downward by the uterine contractions. You feel
these as pains beginning in the back, and finally in the lower abdomen
and thighs, gradually growing stronger and more frequent.
=Second Stage.= The first stage is ended, and the second stage begins,
when the cervix is wide enough for the baby to pass through. From this
time on you should stay in bed and if neither the doctor nor the nurse
has arrived, your cool-headed friend must stand by and not leave you
alone. The bag of waters usually, though not always, breaks at this
time, and there is a rush of fluid. But the character of the pains
changes even though the membranes do not rupture. They come about every
two minutes, now, from the beginning of one pain to the one following,
each pain lasting about a minute. They are stronger and more forcible
and you begin to have an uncontrollable desire to strain or bear down.
If the doctor or nurse is with you, they will tell you how to use your
pains to advantage, but if they are not there you would better avoid
bearing down since you want to retard the baby’s birth, if possible,
until one or the other arrives. In such a case, you may delay matters by
opening your mouth and breathing deeply during pains and by lying on
your side.
We all know that in spite of the most careful planning, babies are
sometimes born before the arrival of doctor or nurse and that the mother
and her cool-headed friend, who is standing by, meet the emergency
together. Fortunately, births occurring under such circumstances are not
the ones that are likely to be associated with trouble for either mother
or baby, so there is little or no cause for concern. Most doctors feel
that the wisest course for the cool-headed friend to follow at such a
time is to do nothing at all. So if the baby arrives in advance of the
doctor, why, he is here, and that is about all there is to it! The
moment you have been longing for, for nine long months, has come; your
anxiety and waiting are all over, and with much less trouble than you
expected.
=Third Stage.= After the baby is born, your pains will subside for a few
moments and then the uterus will begin again to contract and gradually
detach the placenta from its inner surface, forcing it out just as the
baby was expelled.
In the meantime the baby is lying on the foot of the bed with the cord
connecting him with the placenta which is still within your uterus.
Under no circumstances should anyone pull on the cord to aid in the
expulsion of the placenta. It will come away, naturally, in due time.
When the placenta is finally expelled, the third and last stage of labor
is over.
In case you and your cool-headed friend feel that something should be
done, perhaps I would better assure you once more that when a baby is
born so quickly and easily that he arrives before the doctor, you have
cause for relief only—not anxiety. Practically the only unfavorable
conditions which may arise are hemorrhage in your case and failure to
breathe satisfactorily, on the part of the baby, and you and your
cool-headed friend may as well understand how simply these possibilities
may be met.
Although, as everyone knows, there is normally a certain amount of blood
lost at the time of confinement, varying from one half to one pint, this
is accepted as a matter of course. A serious hemorrhage very rarely
occurs because of one of Nature’s ingenious provisions. The tiny muscle
fibers that make up the uterine wall run in every direction,
criss-cross, up and down and around, forming a veritable tangle. After
the placenta comes away, all of these little fibers contract, or grow
shorter, and the result is that the muscles squeeze down upon the
blood-vessels so tightly that they are closed and blood cannot escape.
Accordingly, as long as the uterine muscles are contracted there can be
no hemorrhage. The fortunate thing about this is that you can find out
if they are contracted, and if they are not, you, yourself can stimulate
them to do so. If you will press your fingers down deep into your
abdomen, near the navel, you will feel the uterus as a hard round mass,
which is often likened to a baseball. If it continues to feel hard and
round there cannot be any serious amount of bleeding, but if it becomes
soft, the tiny muscle fibers are relaxing their grip on the vessels and
bleeding may possibly occur. Quite naturally the thing to do, then, is
to stimulate the muscles to contract and this is done by kneading the
uterus through the abdominal wall. You will feel it grow hard under your
hand and then you will know that everything is all right.
Your friend may want to bathe you and put on a pad but it would be
better to leave this for the doctor or nurse for this reason: Childbed
fever is the result of introducing infective material into the vagina.
Remember that. If no germs gain entrance, there will be no childbed
fever. When your baby came quickly and there was a rush of water, your
vagina was well washed out. If you and your friend keep fingers and
everything else away from the vaginal outlet and the area immediately
surrounding it, it will remain clean and you need not worry about the
possibility of infection.
Perhaps I have given more space to all of this than seems warrantable,
but I want you to know just what is going on so that you will not be
worried. And also, in order that you will not make trouble for yourself
by trying to do something when all that you really need do is to lie
still, as comfortably as possible, keep your hand on the uterus and
knead it enough to keep it hard.
If your friend can slip out the wet sheet and put a dry one in its
place, without your having to turn over, you will be just that much more
comfortable, but the doctor will attend to everything else when he
comes.
Next the baby. Presumably he is lying there on the foot of the bed, all
safe and sound, trying to get used to the new order of things. He is
probably making his presence known by crying lustily and though the day
may come when that sound will not be altogether pleasant, it is nothing
short of music to you now, for you have been waiting a long time to hear
it. The baby has come from a very warm place and has suddenly undergone
the most abrupt change in his entire mode of living that he will ever
experience, so the transition should be made as easy for him as
possible. There are two things which he must do immediately, that your
body has been doing for him. He must breathe through his lungs and he
must keep his body warm. If he has cried loudly, your faithful
cool-headed friend may just wrap a little blanket about him, letting him
lie as he is until the doctor comes, taking care that his face is not
covered for he needs plenty of air. If the room is chilly she might
place a flannel covered bag of warm water beside him outside the
blanket.
If the baby has not really cried lustily, as we know that even the
youngest baby can, he should be made to cry, as that is the way he gets
his breathing apparatus to running as it should. Your friend may take
one of the clean little gauze squares that you prepared, and wrapping it
around her little finger reach well back into the baby’s mouth and
remove any mucus that may be lodged there and interfere with his
breathing. She will do this more easily and thoroughly if she will pick
the baby up by the feet, with one finger between his slippery little
ankles so that her grip will be firm, and wipe out his mouth as he hangs
head down.
[Illustration:
FIG. 24.—Helping the new baby to breathe by holding him head downward
and sharply spanking him. Note that the nurse has one finger between
the baby’s ankles to prevent his slipping from her hand.
]
The main thing to remember is that the lining of that new little mouth
is as delicate as a rose leaf and if it is wiped with other than the
gentlest stroke the surface may be injured and give trouble later on.
While he is hanging, head down, your friend may rub his back or stroke
it with her free hand and in all probability you will then hear the baby
use his lungs to your heart’s content. But if he still does not cry well
he may be sharply spanked two or three times as shown in Fig. 24. In
this picture the cord has been cut and the baby is removed from the bed,
but that is not necessary for it is very common to hold the baby up,
wipe out his mouth, stroke his back or spank him, before the cord is
cut.
You need not be at all disturbed if your baby needs these little forms
of encouragement, at first, for remember that all of a sudden he is
given some very complicated and taxing work to do and it is only
reasonable that he should have all possible help as he undertakes it.
Remember, too, in looking forward to this event, that the probability
that you or your friend will have to think of any of these things is
very remote for the doctor and nurse are almost certain to be with you,
and you will be able to give yourself over entirely to being very happy
that at last your baby has come.
THE MIRACLE[1]
_By_
ELIZABETH NEWPORT HEPBURN
The wind blows down the street,
A shutter bangs somewhere,
While twilight falls as softly as
A woman’s flowing hair.
Within a quiet room,
Adventurers at rest,
A mother holds her new-born son,
Safe, now, upon her breast!
For out of Night and Pain,
The womb of mystery,
Is sprung this miracle of Life
That she can touch and see.
No seer’s prophetic dream,
No star in all the skies
Burns with a luster half so bright
As happy mother eyes.
No questor for the Grail,
No searcher for the Truth,
Counts more than those who bear and rear
And love and nurture Youth!
Within her curving arm,
All safe and warm he lies,
The heir of all that Man has won
Down countless centuries!
Footnote 1:
Written expressly for “Obstetrical Nursing” by Carolyn Conant Van
Blarcom.