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OBSTETRICAL NURSING
[Illustration]
THE MACMILLAN COMPANY
NEW YORK · BOSTON · CHICAGO · DALLAS · ATLANTA · SAN FRANCISCO
MACMILLAN & CO., LIMITED
LONDON · BOMBAY · CALCUTTA · MELBOURNE
THE MACMILLAN CO. OF CANADA, LTD.
TORONTO
[Illustration:
THE CARESS
_From the painting by Gari Melchers_
]
I hold you close: and I could cry
Because you seem so new and dear;
And such a helpless warder I
To keep your candle burning clear:
The curious candle of your breath,
Body’s and spirit’s throbbing breath.
FANNY STEARNS GIFFORD.
OBSTETRICAL NURSING
A TEXT-BOOK ON THE NURSING CARE OF THE EXPECTANT MOTHER, THE WOMAN IN
LABOR, THE YOUNG MOTHER AND HER BABY
BY
CAROLYN CONANT VAN BLARCOM, R.N.
FORMERLY, ASSISTANT SUPERINTENDENT AND INSTRUCTOR IN OBSTETRICAL NURSING
AND THE CARE OF INFANTS AND CHILDREN AT THE JOHNS HOPKINS HOSPITAL
TRAINING SCHOOL FOR NURSES
Author of
“The Midwife in England”
WITH 200 ILLUSTRATIONS AND 8 CHARTS
New York
THE MACMILLAN COMPANY
1922
_All rights reserved_
PRINTED IN THE UNITED STATES OF AMERICA
COPYRIGHT, 1922,
BY THE MACMILLAN COMPANY.
Set up and electrotyped. Published May, 1922.
Press of
J. J. Little & Ives Company
New York, U. S. A.
THIS BOOK IS DEDICATED
TO THE
SPIRIT OF HELPFULNESS
WHICH HAS MADE ITS PREPARATION
POSSIBLE WITH THE HOPE THAT IT
MAY BE OF HELP TO THOSE NURSES
WHO TAKE YOUNG MOTHERS AND BABIES
INTO THEIR CARE.
------------------------------------------------------------------------
PREFACE
In writing this book on obstetrical nursing I have been influenced by
certain steadily deepening impressions which have been received in the
course of my contact with maternity work in this country, Canada and
England during the past twenty years. It has been borne in upon me, in
the first place, that very often there is something akin to bewilderment
among those nurses who have been trained to care for patients according
to the teachings of one group of obstetricians and who later find
themselves nursing the patients of other doctors who hold different, or
even opposite views. And not infrequently I have found in the nurses a
degree of loyalty to their training which made them sceptical, or even
intolerant, of nursing methods which differed from those which they had
been taught.
I have become convinced, therefore, that a book on obstetrical nursing
which would be helpful to and widen the outlook of all nurses, no matter
where nor by whom trained, must of necessity describe the underlying
principles of obstetrical nursing and offer a survey of the nursing
methods which are employed in maternity wards and hospitals of
recognized excellence and in the practice of acknowledged authorities
upon obstetrics.
This is, I am aware, a unique attitude, for the present text books on
obstetrics for nurses reflect, in each instance, the wishes of one
doctor, almost entirely, or advocate the methods employed in one
hospital. My experience in teaching obstetrical nursing makes me feel
that a parallel description of dissimilar nursing procedures serves to
broaden the nurse’s attitude toward her work and her grasp of the entire
subject, both because she becomes aware of the fact that methods, other
than those with which she is familiar, are employed in hospitals of high
standing and because she appreciates the fact that these unfamiliar
methods may be as efficacious as those in which she has become expert.
Accordingly I have devoted the better part of the past year and a half
to a study of the scope and methods of the present training in maternity
nursing in several hospitals, in this country and Canada, in which the
obstetrical work is of a conspicuously high character, and have
presented a composite of this teaching in the succeeding pages.
But that there might not be apparent inconsistencies in the different
methods of maternity care described, I have given an explanation of the
purposes and general principles of the care, including nursing, which
the nurse is likely to find is given to all obstetrical patients, the
country over.
For the sake of simplicity and clarity I have divided the book into
seven parts, following an introduction which describes the requisites
and opportunities of obstetrical nursing and the importance of the
nurse’s own attitude toward her work and her patient. The first two
parts, dealing with the normal anatomy and physiology of the female
generative tract and the development of the fetus, are designed to
supply the nurse with enough technical information to make her
ministrations intelligent and effective. In this respect, I have
doubtless given less than some nurses will wish and possibly more than
others will think necessary, but I have given about the average amount
of instruction that is found satisfactory in the training schools of
high standing. Four of the succeeding parts are devoted respectively to
a description of the nurse’s duties during pregnancy, labor, the
puerperium and early infancy. In each of these I have explained, first,
the normal physiological processes which take place; then, the nurse’s
duties under average conditions and finally, her responsibilities in the
event of complications or abnormalities. A separate part is devoted to a
description of the organized care and instruction of the maternity
patient, by public health nurses, both before and after delivery, which
have proved to be satisfactory.
While describing various hospital procedures, I have deemed it of
practical importance to explain, in each instance, how similar results
might be obtained, with improvised appliances, in a patient’s home
whether in a city or a rural community. In short, I have endeavored to
make clear the essentials of obstetrical nursing without regard to the
status or location of the patient.
Since the patient’s state of nutrition and her frame of mind are of
vital importance throughout pregnancy, labor and the puerperium, I have
not only dwelt upon them in all descriptions of the nurse’s duties
during these periods but have devoted an entire chapter to a simple
explanation of the principles of each of these two important subjects.
My varied contact with obstetrical nurses has convinced me that those
nurses who appreciate the never ending wonder and beauty of this miracle
of the beginning of a new life, derive peculiar satisfaction from the
care of the maternity patient. At the same time, in many hospitals, even
where the patients are given the most conscientious care, the nurses are
often so nearly overwhelmed by the long, irregular hours and the
insistent demands of routine duties, that they do not grasp the
significance of the event in which they are participants. Accordingly, I
have made a sustained effort throughout the following pages to give the
young nurse something of a feeling of reverence for this great mystery
of birth.
In the course of my survey of the present training in obstetrical
nursing, I have met the warmest generosity on the part of the
obstetrical and nursing staffs in all of the hospitals which I have
visited. Accordingly, I find it very difficult to find adequate
expression for my sense of gratitude to the doctors and nurses of the
Montreal Maternity Hospital; the Burnside Obstetrical Department of the
Toronto General Hospital; The Hospital of the University of
Pennsylvania; Bellevue Hospital; The Long Island College Hospital; The
Brooklyn Hospital; The Cleveland Maternity Hospital and to Dr. J.
Whitridge Williams and Miss Elsie Lawler for making available the entire
resources of the wards, clinics, laboratories and class and lecture
rooms at Johns Hopkins Hospital.
I wish to offer an expression of deepest possible appreciation to Dr.
John W. Harris for the generosity with which he has given of his time,
thought and wide experience in an effort to provide accurate and
practical information, and to set a high standard of work and ideals for
those nurses who would be influenced by this book. Having taught and
lectured to nurses, as well as medical students, for years, Dr. Harris
is in a position to give counsel and criticism of peculiar value to a
book on obstetrical nursing and he has given these throughout the entire
preparation of this book.
Because of their concern with any effort to better the state of mothers
and babies, I have been given suggestions, assistance and inspiration
with the most selfless generosity by The Reverend Father John J. Burke;
Dr. J. Clifton Edgar; Dr. Frederic W. Rice; Dr. J. P. Crozer Griffith;
Dr. Caroline F. J. Rickards; Dr. Esther Loring Richards; Dr. E. V.
McCollum; Miss Nina Simmonds and Dr. John R. Fraser. Among the many
nurses with whom I have conferred, I have met a characteristic spirit of
helpfulness which has expressed itself in their eager readiness to pass
on to other nurses the benefits of their own training and experience.
Those to whom I am especially indebted, for aid and suggestions, are
Miss Calvin MacDonald; Mrs. Bessie Amerman Haasis; Miss Robina Stewart;
Miss Caroline V. Barrett; Miss Katherine de Long; Miss Jean Gunn; Miss
Mary E. Robinson; Miss Sara Cooper; Miss Laura F. Keesey; Miss Chelly
Wasserberg; Miss Kate Madden; Mrs. Minnie S. Brown; Miss Anne Stevens;
Miss Madge Allison and Miss Katherine Tucker.
To Mrs. Elizabeth Porter Wyckoff I am under heavy obligation for most
discriminating editorial assistance and for her farsighted criticisms
toward increasing the clarity of the text. And I feel sure that the
tender little poem on the miracle of motherhood, which Mrs. Elizabeth
Newport Hepburn wrote expressly for this book, will be as warmly
appreciated by my readers as it is by me.
I wish to express my deep gratitude to Mr. Max Brodel for his invaluable
counsel and guidance in planning and assembling the illustrations to
elucidate the text. And I am very grateful to Mr. Gari Melchers for the
spirit which I believe is infused into this book through the
reproduction of two of his lovely paintings of a mother and baby, and to
Mr. Russell Drake for his valuable drawings. I wish further to thank Mr.
J. Norris Myers, of The Macmillan Company, for unfailing courtesy and
helpfulness in facilitating all matters relating to the publication of
this book.
For statistical information I am indebted to Dr. Louis I. Dublin and for
authority in offering the scientific background of the teaching I have
drawn from “The Practice of Obstetrics” by J. Clifton Edgar;
“Obstetrics” by J. Whitridge Williams; “The Diseases of Infants and
Children” by J. P. Crozer Griffith and “The Prospective Mother” by J.
Morris Slemons.
CAROLYN CONANT VAN BLARCOM.
New York City, 149 East 40th Street
TABLE OF CONTENTS
PAGE
PREFACE xi
INTRODUCTION 3
PART I.
ANATOMY AND PHYSIOLOGY
CHAPTER
I. ANATOMY OF THE FEMALE PELVIS AND GENERATIVE ORGANS 19
II. PHYSIOLOGY 45