Women in general are ignorant of parturition or delivery. Almost all of
them are under the impression that labor is completed more by art than
nature; hence the most noted accoucheurs are employed to attend during
this interesting period; and professional men, in general, have no wish
to undeceive them on this subject, as their interest is too much
concerned. It is often astonishing to see the credulity and ignorance
manifested on these occasions. Thanks and blessings have been poured
forth, under the idea that he had saved their lives in labor, when the
accoucheur had merely looked on and admired the perfectly adequate
powers of nature, and superintended the efforts of her work; and it is
nature that accomplishes all, while the accoucheur gets the credit of
it. There is not one case in a thousand in which he can do more than
remain a silent spectator, except to calm the fears of the ignorant and
timid attendants. The mischief and injury that are done by the untimely
interference of art are incalculable.
In pregnancy women are bled till they have not strength enough to
accomplish delivery; and, when it takes place, the forceps or other
instruments are used, which often prove fatal to the mother or child, or
both.
There are various particulars to be avoided, and several things to be
done, in the management of women during labor. We have room here to
state only a few, and shall begin by pointing out the course to be
pursued in
_Natural Labor._
When called to a woman supposed to be in labor, ascertain if her pains
are _true_ or _false_, which may be easily known by a little inquiry. If
the female complains of flying or unsettled pains about the system,
occurring mostly toward evening or during the night, and being slight or
irregular, it may be taken for granted that they are spurious or false.
If these symptoms prove troublesome, an infusion or tea of _hops_ may be
taken; or, if this is not sufficient to relieve them, or procure sleep,
an anodyne may be taken; and it may be necessary also to give laxative
medicines or an injection, with a little laudanum.
_True pains_ may be known by the pain being more concentrated in the
lower part of the belly, through the loins and hips.
The pains now increase in regularity and force, returning every ten or
fifteen minutes, and leaving the woman comparatively easy in the
intervals.
When the pains become regular and severe, there is a discharge of slimy
matter, tinged with blood, known by the name of _shows_. At this period
of labor it will be proper for the person who attends the labor to
examine, in order to ascertain what part of the child presents, which
may be done by requesting the female to sit in the chair or on the side
of the bed, and to extend the legs, when the longest finger, dipped in
sweet oil, may be passed up the vagina to the part which presents, and
the sense communicated will determine the nature of the presentation. In
nineteen cases out of twenty, or in almost every case, the head will be
felt. Frequent examinations should be avoided.
Dr. Bard, speaking of examinations, remarks: “What terms shall I use to
condemn, as it deserves, the abominable practice of boring, scooping,
and stretching the soft parts of the mother, under the preposterous idea
of making room for the child to pass. It is impossible to censure this
dangerous practice too severely; it is always wrong; nor can there be
any one period in labor, the most easy and natural, the most tedious and
difficult, the most regular or preternatural in which it can be of the
least use; in which it will not unavoidably do great mischief: it will
render an easy labor painful; one which would be short, tedious; and one
which, if left to nature, would terminate happily, highly dangerous.”
“All that is proper to be done in a case of natural labor, from its
commencement to its termination,” says Dr. McNair, “will suggest itself
to any person of common understanding; and I have long labored under the
conviction, that the office of attending women in their confinement
should be intrusted to prudent females. There is not, according to my
experience, and the reports of the most eminent surgeons, more than one
case in three thousand that requires the least assistance. I am aware,
however, that there are crafty physicians who attempt, and often
succeed, in causing the distressed and alarmed female to believe that it
would be altogether impossible for her to get over her troubles without
their assistance; and, for the purpose of making it appear that their
services are absolutely necessary, they will be continually interfering,
sometimes with their instruments, when there is not the least occasion
for it. There is no doubt in my mind but that one-half of the women
attended by these men are delivered before their proper period; and this
is the reason why we see so many deformed children, and meet with so
many females who have incurable complaints.”
It is a very common circumstance for an inexperienced (or he may be an
experienced, but ignorant) practitioner to attempt a rupture of the
membranes, and in doing so, rupture the bladder, which would render the
woman miserable during life. We are acquainted with twenty-five or
thirty females who have met with this sad misfortune, and many of them
have been attended by those who are termed our most successful, or old
experienced physicians.
Dr. Rush, speaking of child-bearing among the Indians, says, “that
nature is their only _midwife_; their labors are short and accompanied
with little pain; each woman is delivered in a private cabin, without so
much as one of her own sex to attend her: after washing herself in cold
water, she returns in a few days to her usual employment; so that she
knows nothing of those accidents which proceed from the carelessness or
ill management of _midwives_ or doctors, or the weakness which arises
from a month’s confinement in a warm room.”
Dr. Whitney remarks; “I have had many cases where I found the attendants
alarmed, and some in tears, from supposing that they should have had
help sooner, fearing the worst consequence from delay; but, admitting
that the ‘doctor knew best,’ they would wait calmly for hours, when in
nature’s time all ended well. I pledge myself as a physician, that all
honest doctors will tell you that _labor_ is the work of _nature_, and
she generally does it _best_ when left to herself.”[48]
“Among the Araucanian Indians,” says Stevenson in his Twenty Years’
Residence in South America, “a mother, immediately on her delivery,
takes her child, and going down to the nearest stream, washes herself
and it, and returns to the usual labor of her station.”
“The wonderful facility with which the Indian women bring forth their
children,” say Lewis and Clark in their well known journal, “seems
rather some benevolent gift of nature, in exempting them from pains
which their savage state would render doubly grievous, than any result
of habit. One of the women who had been leading two of our pack horses,
halted at a rivulet about a mile behind, and sent on the two horses by a
female friend. On enquiring of one of the Indian men the cause of her
detention, he answered, with great appearance of unconcern, that she had
just stopped to lie in, and would soon overtake us. In fact, we were
astonished to see her in about an hour’s time come on with her new-born
infant, and pass us on her way to the camp, apparently in perfect
health.”
Washington Irving, in his work entitled Astoria, relates a similar
incident in the following language: “The squaw of Pierre Dorion (who,
with her husband, was attached to a party travelling over the Rocky
Mountains in winter-time, the ground being covered with several feet of
snow) was suddenly taken in labor, and enriched her husband with another
child. As the fortitude and good conduct of the woman had gained for her
the good will of the party, her situation caused concern and perplexity.
Pierre, however, treated the matter as an occurrence that could soon be
arranged, and need cause no delay. He remained by his wife in the camp,
with his other children and his horse, and promised soon to rejoin the
main body on their march. In the course of the following morning the
Dorion family made its appearance. Pierre came trudging in advance,
followed by his valued, though skeleton steed, on which was mounted his
squaw with the new-born infant in her arms, and her boy of two years old
wrapped in a blanket, and slung on her side. The mother looked as
unconcerned as if nothing had happened to her; so easy is nature in her
operations in the wilderness, when free from the enfeebling refinements
of luxury and the tampering appliances of art.”
When it has been ascertained that the labor is natural, or that there
are no impediments or obstacles, there will be very little more to do
than superintend the process. It will be necessary to give instructions
to the attendants to make suitable preparation, or have everything
required in readiness.
The woman may be delivered upon a bed or a cot, as is most convenient;
if a bed be used, all but the mattress should be turned back toward the
head, and it should be so prepared that the moisture from the uterus and
other discharges may not add to the discomfort of the woman. A dressed
skin, oilcloth, or folded blanket may be placed on that part of the
mattress on which the body of the woman is to rest; a coarse blanket
folded within a sheet, ought to be laid immediately beneath the patient,
to absorb the moisture, which must be removed after delivery; the rest
of the bed-clothes are to be put on in the ordinary way. The woman, when
she is no longer able to remain up may lie down, with her head elevated
in any position which is most desirable; and in nearly every case that I
have ever attended the back has been preferred, although most all
writers recommend that the woman be placed upon her side: the latter
practice is unnatural and wrong, for obvious reasons; it retards the
labor pains, and prevents the midwife from superintending the progress
of the labor; the pillow that is directed to be placed between the
knees, to keep them widely separated, soon gets displaced by the motion
or change of the female; and the legs, instead of being kept apart,
again come in contact, and thus the passage of the child is obstructed:
but when the female is placed upon her back this difficulty is obviated,
a free passage is permitted, the pains are more effectual, the spine is
better supported, and better access can be had to the parts during labor
and after the delivery of the child; in short, there is a decided
advantage in this position in every respect.
The dress of women in labor should be light and simple, both to keep
themselves from being overheated, and to prevent anything from being in
the way of what assistance is necessary. In addition to the means
recommended, I direct a sheet to be placed around the waist of the
woman, to prevent the blood, excrements or waters from coming in contact
with the linen or clothes, and, as much as possible, the bed; her linen
may be tucked or pushed up so far that there will be no necessity of a
removal after delivery.
Every thing being thus adjusted, very little more will be necessary but
to wait patiently the efforts and operations of nature. There should be
but few attendants in the room, and these are not to whisper to each
other, or to express any fears or doubts.
A humane midwife will use every ingenious effort in her power to quiet
the useless fears, and support and comfort the patient. A crowd of
frightened, hysterical women, assailing the ears of the woman with tales
of woe and sad disasters that have happened should be admonished. Half a
dozen midwives, each making pretensions to great skill, ambition, and
competition for obstetric fame, assembled around a feeble woman when
labor is of a lingering character, is always an unfortunate
circumstance, and it would be much better if nearly every one were afar
off.
When the pains become very severe, quickly succeeding each other, the
midwife, or the person who officiates, may sit by the side of the woman,
and, upon every severe pain, may keep her hand upon the parts, even
though no manner of assistance can be afforded, and occasionally, when
the head of the child presses hard, it may be gently touched or pressed
with the longest finger, in order to ascertain the parts that prevent
the progress of labor, as well as to be able to give from time to time
suitable encouragement: not only so; in the last stage of labor the hand
may be kept near the parts, to know the moment when the head of the
child presents, as some little assistance at this time is called for;
but not by supporting the perinæum, as some advise, but,
_First._ To remove any obstruction which often arises from the clothes.
_Second._ To support the child in its passage, and in the interval of
pains; and to keep the head from pitching downward, and thus obstructing
the labor.
_Third._ To detach the umbilical cord or navel-string from the neck when
it encircles it, as is often the case, and which endangers the life of
the child.
_Fourth._ To deliver the woman in case of hemorrhage or great flooding;
but at the same time there must be no further interference of art;
little or nothing can be done toward facilitating the delivery of the
child, except when a large bag or collection of water presents and
opposes, when it may be ruptured with the longest finger, which often
affords much aid, although such is the ignorance and credulity of some
women, that they suppose almost everything to be accomplished by art.
Physicians or midwives who watch only the process of labor, and do
little or nothing, are pronounced inhuman and cruel, and perhaps
ignorant, because they are honest in not interfering with the simple and
beautiful process of labor, or in other words, for relying upon the
great resources of nature: but such is the fashion and credulity of
mankind, or rather womankind, that physicians are obliged to take the
advantage of such ignorance and credulity, and regulate their
proceedings accordingly. We have often been obliged to stand for hours
over a woman, under pretence of aiding delivery, when, in _reality_, we
did nothing at all. The labor would have progressed just as well had we
been out of the room; but this deception we have been obliged to
practise, in order to satisfy ignorant, gossiping, or crying attendants.
When the woman is disposed to make much noise, she should be directed to
hold her breath during the pains, and aid or assist them by pressing
downward as much as possible. The feet may press against the bed-post,
and the woman take hold of a handkerchief and pull when a pain occurs;
or she may grasp the hand of an assistant for that purpose. Sometimes,
from various causes, labor is very much retarded, from rigidity of the
parts, the situation of the child, debility, &c.; when this occurs, and
labor is tedious and protracted, our reliance must still be upon the
powers of nature. We may, however, aid her efforts, by warm fomentations
of _bitter herbs_, often applied to the lower part of the belly, which
will prove relaxing, and will facilitate the labor; warm diluent drinks
may also be given, such as _tansy_, _pennyroyal_, _&c._
If the labor still continues stationary, we have nothing to fear,
provided there is a right presentation; but should the pains become
feeble or lessened from flooding, debility, or any cause, or should they
prove unavailable, after a reasonable length of time, a drachm of
_spurred rye_ or _ergot_ may be put into a tea-cup, and a gill of
boiling water poured upon it, and, when cool, a tablespoonful given
every fifteen minutes. This will increase the pains, and speedily
accomplish a delivery; but it should be very seldom, or never, used,
except when there is a right presentation, and under the most urgent
circumstances.
It is prudent, by judicious precaution and care, to remove obstructions,
prevent accidents by holding or supporting the child in a proper
position, and giving such aid as reason and judgment will dictate.
Receiving the child, preventing its fall, securing the navel cord,
assisting in the removal and disposal of the after-birth, are objects
which are to be accomplished, and all in the most calm and simple
manner; no hurry or excitement is necessary, but, on the contrary, they
embarrass. Yet how common is it that females in general, married and
unmarried, are so uninformed and ignorant, that, instead of attending to
those duties, if necessary, or in cases of emergency, they are thrown
into the greatest consternation, and perhaps run out of the room and let
the child suffocate by the bed-clothes, or by the navel cord twisted
about the neck, and die merely for the want of a little common sense and
knowledge, which might be acquired in an hour. Is it not highly
disgraceful, if not criminal, that farmers can, and do, attend to those
duties toward their stock, and yet remain entirely ignorant of them
toward their nearest relations? Young women and men are taught music,
dancing, drawing, needle-work, and many ornamental branches considered
so essential to a polite education; yet they are suffered to remain
entirely ignorant on a subject of so much vital importance. Is there any
hope or prospect of enlightening this generation, or must it be delayed
till the next, and have them look back with amazement at our ignorance?
We hope there is something yet redeeming in a large proportion of the
community; that the people will yet awake to their own interests.
When the head is delivered, all that is necessary to do is, to support
it, and wait for the pains to expel the child; except it seems livid and
in danger of injury, or when the cord is twisted around the neck, when
assistance must be rendered, to accomplish the delivery. The face of the
child must now be turned upward, and the cord freed from the neck or
body; the person who assists will pass a narrow piece of tape around the
cord or navel-string, about an inch from the body, and tie as tight as
it can be drawn, otherwise hemorrhage or bleeding will take place; and
another must be tied at a little distance from it, above, and be
separated between them with a pair of scissors. The child is then to be
given to the nurse, to be washed, dried, and dressed. The woman must now
be covered, and directed to lie quiet.
_The After-birth._—The after-birth or placenta must be detached or
removed, if nature does not accomplish it in a short time. Generally,
after about twenty or thirty minutes, a pain is felt, which may be
sufficient to expel it; if it should not, and should there be no pain,
gentle manual attempts may be made to remove it.
The head and breast may be elevated, and the cord taken hold of by the
left hand: the two first fingers may be carefully introduced into the
vagina, and the anterior or forepart of the placenta or after-birth held
in this situation for some minutes, in order to excite a contraction of
the uterus. The woman may now be directed to hold her breath and press
down, which forces it forward; and at the same time a little extension
may be made upon the cord with the left hand, while extension is made
upon the after-birth with the right; this will almost invariably extract
it in a few minutes. If from any cause it should not, no farther
attempts must be made for the present, but left for a few hours, when,
if the natural contractions of the uterus do not remove it, it must be
done in the manner recommended, with this difference, that a little more
force be used. In the interval, however, everything wet must be taken
away.
_Subsequent Treatment._—After the labour has been thus completed, if the
woman is not too weak, assistants may raise her up, and seat her upon
the side of the bed or cot, while another removes all the wet clothing
from the patient and her bed, and with a little warm spirits washes off
the blood, water, &c., that remain on her person. This is particularly
necessary, as the omission of it may give rise to puerperal fever. We
know not that others have practised this method; but we have found it
conducive to the comfort as well as the health of the patient. Some
practitioners will not suffer the woman to be removed from the situation
in which she has been delivered under twelve or twenty-four hours, for
fear of hemorrhage or flooding; but this is a great and dangerous error.
It is impossible to tell what mischief may arise in consequence of
suffering her to remain drenched in water and blood for this length of
time.
After these precautions have been observed, and the bed properly
prepared, on which has been placed folded blankets, skin, or oilcloth,
covered with a warm sheet, she may be laid down, and a diaper or
suitable piece of muslin laid to the parts to absorb the lochial
discharges. A bandage may be also placed around the abdomen or belly,
and made moderately tight, but not so as to render her uncomfortable. A
large tub, previously well dried, may be placed by the side of the bed,
and the woman directed to place her feet in it, and, when she is lifted
up, everything that is around her wet to be passed into it. It prevents
the necessity of afterward washing the floor and carpet, which might
prove injurious by causing a check to perspiration.
_Preternatural labor, or cross-births_, are those in which some other
part than the head presents. We cannot in general assign any reason for
such occurrences, nor can the woman, by any sensation of her own, be
assured that the presentation is unusual. Apprehensions of this kind
should not be indulged in. If the feet or breech present, the delivery
is to be accomplished by properly accommodating the position of the
child to the capacity of the pelvis, but no force should be employed;
and though there is always some risk to the life of the infant, yet
there is none to the mother. If the arm, shoulder, or sides of the child
present, the delivery is not impossible, but difficult, until the infant
be turned and the feet, brought down into the passage. This is an
operation which may be done with comparative ease and safety, if the
wrong position of the infant be discovered before the waters are
discharged; but other wise both mother and child are in considerable
danger, though there is often a spontaneous evolution, and delivery is
effected. The womb closely contracting round the body of the infant when
the water is drained away, and being soft and spongy in its texture, it
is liable to be torn if much force be employed, and then either the
child may escape into the cavity of the belly, or, if it be extracted by
the feet, blood may be effused from the womb into that cavity, and such
injury be done as to prove fatal. Women too frequently add to the danger
of the operation of turning, by their restlessness and impatience; they
should remember how much is at stake, and exert all their fortitude, so
as not to embarrass the practitioner.
The labor having been thus accomplished, it will be necessary to guard
against any subsequent symptoms which may occur or take place.
In _tedious_ and very _difficult_ labors, and where common physicians
use the lancet, the hot bath will be found of extraordinary benefit in
facilitating labor, by its relaxing the system without debility;
altogether better than bleeding. First apply spirits, water, and salt to
the head; then let the woman continue in the bath about fifteen minutes.
* * * * *
_Still-born Infants._—This occurs from difficult labors, or the cord
encircling the neck; or a membrane may cover the head or body. When
anything of the kind occurs, the membrane should be immediately removed.
If no signs of life appear, the infant may be put into the warm bath,
and the mouth and body wiped dry. A little cold water may be dashed into
the face, the lungs inflated by some person, and a slight motion made
upon the chest in imitation of breathing. The navel-string may be
permitted to bleed a little.