OBSTETRICS.
Overloading--Similarity of Stomach and Womb--Births--Preparation
for Delivery--Caution--Lasceration Need Not Occur--Care of
Cord--Severing Cord--Putting on Belly Band--Delivery of
Afterbirth--Preparing for Mother's Comfort--Post-Delivery
Hemorrhage--Treatment for--Food for Mother--Treatment for Sore
Breast.
OVERLOADING.
When in the course of human events and actions of life, a woman
disregards the laws of nature to such an extent as to overload the
stomach beyond its powers and limits; or another way to present the
thought, we will say, if you fill the stomach so full as to occupy all
space, or so much of the space as to cripple the laws of digestion and
retain the food, the decomposition sets up an irritation of the nerves
of mucous membrane to such a degree as to cause sickness and vomiting,
or any other method of disgorging the stomach, which is the natural
process to unload an overloaded vessel. When the nerves cannot take up
nutrition, they will then take up destruction and other elements which
are detrimental to the process of nutrition, and there is no other
process for relief but to unload. The loading that has been deposited
in the stomach was for the purpose of sustaining a being. The stomach
itself is a sack. When filled to its greatest capacity, it irritates all
the surroundings, and in return they irritate the stomach. Thus it
unloads naturally for relief. Now we wish to treat of another vessel
similar in size, similar in all its actions, which receives nourishment
for a being, which nourishment is contained in the blood, and conveyed
from the channels commonly known as uterine arteries. To all intents and
purposes this nourishment is taken there to sustain animal life, after
having constructed the machinery then it appropriates the blood to the
growth and existence of a human being. One is the womb, the other the
stomach. The placenta in the womb is provided with all the machinery
necessary to the preparation of blood, such as is used for all purposes
in forming and developing a child. Which is the stomach? Which is the
womb? and what is the difference? Both receive and distribute
nourishment to sustain animal life. Both get sick, both vomit when
irritated and discharge their loading by the natural law of "throw up"
and "throw down." Now note the difference and govern yourselves
accordingly. One is mid-wifery, or treatment of the lower stomach during
gestation and delivery. The other is the upper stomach that takes
coarser material and refines the unrefined substances, keeps the outer
man in form and being; the other contains the inner man or child, and by
the law of ejection, when it becomes an irritant, it is thrown out by
the nerves that govern the muscles of ejection.
BIRTHS.
To illustrate: I will say, just as long as digestion and assimilation
keep in harmony and the mother generates good blood in abundance, the
child grows, and by nature the womb is willing to let the work of
building the body of the child go on indefinitely; but nature has placed
all the functions of animal life under laws that are absolute and must
be obeyed. We by reason are asked to note the similarity of the stomach
and the womb, as both receive and pass nutriment to a body for
assimilation and growth. When a stomach gets overloaded, sickness
begins, as digestion and assimilation has stopped, then the decaying
matter is taken up by the terminal nerves, and conveyed to the solar
plexus, and causes the nerves of ejection, to throw the dying matter out
of the stomach which is above. Try your reason and see the stomach below
sicken and unload its burden. Is this sickness natural and wisely
caused? If this is not the philosophy of mid-wifery what is? As soon as
a being takes possession of its room, the commissary of supplies begins
to furnish rations for that being, who has to build for itself a
dwelling place. The house must be built strictly to the letter of the
specifiction. Much bone and flesh must be put into the house of life,
and some of all elements known to the chemist, must be used and wisely
blended to give strength; also all material to be used in the house must
be exact in form and given strength equal to all forces, that may be
necessary to execute the hard and continued labors of the machinery that
may be used in all transactions and motions of mind and body. Now we
must go to the manufacturing chief, and have him through the
quartermaster deliver and keep a full supply of all kinds of material
for the work, and when the engine is done, put it on an inclined plane
and cut the stay-chains and let it run out of the shop. Be careful and
not let the engine deface nor tear the door as it comes out. A question
is asked: On what road does the quarter-master send the supplies? As
there is but one system over which an engine can bring supplies, we will
call that road the uterine system of arteries. The mechanic reports that
he will open the door of this great shop of manufacturing, and let it
roll out the engine by the power and methods prepared to run out
finished work. First you see a door open because the lock is taken off
by a key that opens all mysteries; and the great ropes that have been
far inferior to the force of resistance, that has held the door shut,
are all sufficient in power. By getting sick, muscles become convulsed
to rigidity of great strength with force enough to push the new engine
of life out into open space easily, by nature's team that never fails to
obey orders to deliver all goods intrusted to its care.
PREPARATION FOR DELIVERY.
A student of mid-wifery can only learn a few general principles, before
he gets into the field of experience. Actual contact with labor teaches
him that much that he has read and had told to him by professors of
mid-wifery in the lectures, is of but little use to him at the bedside.
What he needs to know is, what he will have to do after he gets there.
He must know the form and size of the bones of a woman, how large a hole
the three bones of the pelvis make, for the reason that the child's head
will soon come through that hole. He must know a normal head cannot come
through a pelvis that has been crushed in so much as to bring the pubis
within one and one-half to two and one-half inches of the sacrum. He
must examine and know, and do this soon after he is called, for the
reason, that he will have to use instruments in such deformities, and
may wish the counsel of an older and more experienced doctor. And this
precaution will give him time to be ready for any emergency.
But more than ninety per cent of all cases are of a very simple nature.
The mother is warned by pains in back and womb, coming and repeating at
intervals of one-half hour to less time. When by the finger the doctor
can tell the mouth of the womb has opened to the size of a quarter or
half dollar, he then may know that labor will soon start in good
earnest, and at this time it is well to call for a twine, cut two
strings about a foot long, to tie around the navel cord.
CAUTION.
The first duty of the obstetrician is to carefully examine the bones of
the pelvis and spine of the mother, to ascertain if they are normal in
shape and position. If there is any doubt about the spine and pelvis
being in good condition for the passage of the head, through the bones,
and you find pelvic deformity enough to prohibit the passage of the
head, notify the parties of the danger in the case at once, and that you
do not wish to take the responsibility alone, as it may require
instruments to deliver the child, as there is danger of death to the
child and mother also, but less danger to the mother than to the child.
Now you have done that which is a safeguard against all trouble
following criminal ignorance.
I will give you a condensed rule of procedure in all normal cases of
obstetrics. With index finger, examine os uteri; if closed and only
backache, have patient turn on right side, and press hand on abdomen
above pelvis, and gently press or lift belly up just enough to allow
blood to pass down and up pelvis and limbs. Relax all nerves of the
pelvis at pubes.
SECOND EXAMINATION.
Caution: Wait a few hours; examine os again. If still closed and no
periodical pains are present, you are safe to leave case in the hands of
the nurse, instructed to send for you if regular pains return at
intervals. On your return, explore os again, if found to open as large
as a dime, you are by this notified that labor has begun its work of
delivery. You now place patient on her back, propped to an easy angle of
near thirty degrees, with rubber blanket in place. After you find os,
dilated to nearly the size of a dollar, then relax nerves at pubes. Soon
you will find in mouth of womb an egg-shaped pouch of water, which you
must not press with fingers till very late in labor, for fear of
stopping labor for perhaps many hours. Remember the head can and does
turn in pelvis to suit the easiest passage through the bones, while in
the fluids of the amniotic sack. Now, as you know why not to rupture
sack and spill fluids, you are prepared to proceed to other duties,
which are to prevent rupture of perineum. Place the left hand on the
belly, about two inches above symphesis and push the soft parts down
with the left hand; support the perineum with the right hand until head
passes over. This is necessary to prevent rupture of perineum.
LASCERATION NEED NOT OCCUR.
If you follow this law of nature, lasceration may occur in one out of a
thousand cases, and you will be to blame for that one, and may be
censured for criminal ignorance. Now you have conducted head safely
through pelvis and vagina to the world. You will find pains stop right
short off for about a minute, which is the time to learn whether the
navel cord is wrapped around the child's neck.
CARE OF CORD.
If it is found all around the neck once or more, you must slip finger
down neck and loosen cord to let blood pass through the cord till next
pain comes, in order to ward off asphyxia of child.
When pain comes, gently pull child's head down toward the bed. There is
no danger of hurting the perineum now since the head has passed the soft
parts. At this time the danger is suffocation of child. Never draw child
too far away from mother's birth place by force, as you may tear navel
string from the child and cause it to bleed to death. If you value the
life of the child, then you must be careful not to place the navel end
of the string in any danger of being torn off. Now you have made a good
job for both mother and child so far. The child is in the world; and you
want to show the mother a living baby for her labor and suffering of the
past nine months. The baby is born and the mother is not torn, but the
baby has not yet cried. Turn it on its side, face down, run your finger
in its mouth and draw out all fluids, thick or thin, to let the breath
pass to the lungs. Then blow cold breath on its face and breast to cause
its lungs to act.
SEVERING CORD.
Baby cries, all is safe now. Baby is born safely and cries nicely, but
still has cord fastened to afterbirth. It has no further use for cord,
as life does not depend upon blood from the afterbirth any longer. Take
the cord about three inches from the child's belly, between thumb and
finger, and strip towards child to push bowels out of the cord if there
should be any in it, as a safeguard for bowels, then tie a strong string
around cord, first three inches from child's belly, second, four inches;
take the cord in your hand and look what you are doing. If baby's hand
should fall back to cord, you might cut off one or two fingers, or wound
the hand or arm very seriously. Cut cord between the two ties just made
on navel string. Look out for your scissors; pass the child over to the
nurse to be washed and dressed, while you deliver the afterbirth from
pelvis or womb.
PUTTING ON BELLY BAND.
When the child's shirt is on, cut a hole the size of your thumb in a
doubled piece of cloth, five inches long by four wide, put the hole two
inches from one end, and run the cord through the hole. Lay the cloth
across the child's belly, then fold the cloth lengthwise over the cord,
which must lie across the child so it will not stretch cord by handling
or straightening child out. Now you are ready to finish the delivery of
the afterbirth. You have a plug of soft and tender flesh to get out of
the womb and vagina.
DELIVERY OF AFTERBIRTH.
As the afterbirth has been grown tight to the womb during all the days
of mother's pregnancy, and furnished all the blood to build and keep the
child alive in the womb for nine months, it has done all it can do for
the child, and is now ready to leave the womb.
You are there to assist it to get out of the place it has occupied so
long. You must begin first to rotate or roll the placenta first one way
and then another, up, down and across the vagina, by gently pulling the
cord. Look out or you will pull the cord loose from the placenta; then
you will have made your first blunder,--no cord to pull placenta with,
and the mother bleeding and faint from loss of blood. Now is the time
and place to save life. Pass your hand forward into the soft parts to
get your fingers behind the placenta; now give a rolling pull and bring
it out with the hand. You will find it an easy matter to get your hand
into the vagina and womb after the birth of the child. Get all the
placenta out, then take a wad of cloth or rags as large as the child's
head, and press it under the cross bone of the pelvis; push the cloth
under and up, so as to completely plug the pelvis. Now pull the hair
gently over the symphesis, which will cause the womb to contract by
irritation.
PREPARING FOR MOTHER'S COMFORT.
All is now done but to provide for the mother's comfort, which is your
next duty. Draw her chemise down her back and legs until it is straight,
then with safety pins, pin the chemise on inner side of thighs so that
the chemise will go around both thighs separately. Now you have the
shirt fast to keep it from sliding upwards, and you are ready to make a
band of the chemise to support the womb and abdomen. Bring the chemise
tightly together for two or three inches above the pelvis to form a
band. Previous to pinning, draw the lump (womb) you feel above
symphesis, up, then pin, and the belt you have made of the chemise will
support the womb. All is safe now, but you must not leave for two hours.
You may have delivered a feeble woman, who may flood to death after
delivery of the child, if you do not leave her safe. I have in mind one
case who flooded all of two quarts at a single dash. The first symptom
was a pain in the head.
POST-DELIVERY HEMORRHAGE.
I know of only two causes that would produce hemorrhage or bleeding
after the child is delivered. One is when the afterbirth (placenta), is
separated from its attachment to the womb and still retained in the
womb or vagina, or when a part is separated and still lies in the womb,
that retention of placenta prevents the natural circular contraction of
the womb, to close on itself and retain it, with force enough to prevent
the further discharge of blood, would give a chance for a continued
stream. Then should the patient bleed profusely after the placenta has
been removed, another cause would be in pulling away the afterbirth, as
part of the upper portion of the womb may be pulled to an inverted
position, which would be like a hat if you press the top down with the
hand. Then there is a chance for leakage because of this unnatural fold
made in the womb.
TREATMENT FOR.
My method of relief is to insert the hand, and with back of fingers
smooth out all folds. Before you draw the right hand from the womb place
left hand on abdomen, catch the womb between the thumb and finger and
withdraw hand. With the left hand pull the hair above symphesis or
scratch the flesh just above across the region of the symphesis, just
enough to make an irritation. After the hand is out of vagina pass a
small bundle of cloths as far under the symphesis as would be necessary
to hold everything up, then fasten chemise; beginning at symphesis draw
it tight for about two inches above symphesis and with strong pins
fasten it. Be sure you keep garment tight by pulling down between limbs.
The coarser the chemise the better, as you want to make a strong bandage
at that point so as not to push the womb down into the pelvis. If the
patient's general health is fairly good let her tell you what she wants
to eat, and go and get it. Let her diet be after her usual custom. You
must remember she has just left the condition of a full abdomen. Lace
her up, fill her up and make her comfortable for six hours; then change
her bedding.
FOOD FOR MOTHER.
Remember this, if you stop digestion on her for some hours with teas,
soups and shadows to eat, you carry her to the condition where it would
be dangerous to give her a hearty meal. My experience and custom for
forty years has been crowned with good success. I never lost a case in
confinement. I have universally told the cook to give her plenty to eat.
TREATMENT FOR SORE BREAST.
If she begins to have fever followed by chilly sensations, with swelling
of one or both breasts, I relieve that by laying her arm ranging with
her body. Let some one hold the arm down to the bed, then I place both
of my hands under the arm, pull it up with considerable force till I
get it as high or higher than normal position of the shoulder. Then pull
her shoulder straight out from the body a fairly good pull, then pull
the arm up on a straight line with the face, and be sure that you have
let loose the axillary and mammary veins, nerve and artery, which have
been cramped by pulling the arm down during delivery. No breast should
become caked in the hands of an Osteopath. Do not bother about the
bowels for two or three days. It may be necessary to use the catheter if
the water should fail to pass off after inhibiting the pubic system.
This is straight mid-wifery and will guide you through at least in
ninety per cent of the cases you will meet in normally formed women.
Right here I wish to say one word: I think it is very wrong to teach,
talk and spend so much time with pictures, cuts, talks and lectures, and
hold up constantly to the view of the student, births coming from the
worst imaginable deformities and call that a knowledge of mid-wifery. It
is normal mid-wifery you want to know and be well-skilled in. The
abnormal formations are few and far between, and when a case of that
kind does appear, it is your knowledge of the normal that guides you
through the variations. You will very likely never find two abnormals
presenting the same form of bone. As this is intended to only present
to the student natural delivery I will let the subject drop with one
word about the sore tongue of the mother. Adjust her neck, relieve
constrictor and all other muscles that would impede any blood vessel
that should drain the mouth and tongue. Remember this, that a horse that
is always hunting bugars never finds a smooth road.