LABOR.
THE PRECURSORY SYMPTOMS OF LABOR.
448. A day or two before the labor commences, the patient usually feels
better than she has done for a long time; she is light and comfortable;
she is smaller, and the child is lower down; she is more cheerful,
breathes more freely, and is more inclined to take exercise, and to
attend to her household duties.
449. A few days, sometimes a few hours, before labor commences, the
child “falls,” as it is called, that is to say, there is a _subsidence—a
dropping—of the womb_ lower down the belly. This is the reason why she
feels lighter and more comfortable, and more inclined to take exercise,
and why she can breathe more freely.
450. The only inconvenience of _the subsidence of the womb_ is that the
womb presses on the bladder, and sometimes causes an irritability of
that organ, inducing a frequent desire to make water.
451. The _subsidence—the dropping—of the womb_ may then be considered
_one_ of the earliest of the _precursory symptoms_ of _the_ labor, and
as _the_ herald of the coming event.
452. She has, at length, slight pains, and then she has a “show,” as it
is called; which is the coming away of a mucous plug, which, during
pregnancy, had hermetically sealed the mouth of the womb. The “show” is
generally tinged with a little blood. When a “show” takes place, she may
rest assured that labor has actually commenced. One of the _early_
symptoms of labor is a frequent desire to relieve the bladder.
453. She has now “_grinding pains_,” coming on at uncertain periods;
sometimes once during two hours, at other times every hour or half hour.
These “grinding pains” ought not to be interfered with; at this stage,
therefore, it is useless to send for a doctor; yet the monthly nurse
should be in the house, to make preparations for the coming event.
Although, at this early period, it is _not_ necessary to send for the
medical man, nevertheless, it is well to let him know that his services
might shortly be required, in order that he might be in the way, or that
he might leave word where he might quickly be found.
454. These “grinding pains” gradually assume more regularity in their
character, return at shorter intervals, and become more severe. About
this time, shivering, in the majority of cases, is apt to occur, so as
to make the teeth chatter again. Shivering _during labor_ is not an
unfavorable symptom; it proves, indeed, that the patient is in real
earnest, and that she is making progress.
455. She ought not, on any account, unless it be ordered by the medical
man, to take brandy as a remedy for the shivering. A cup either of _hot_
tea or of _hot_ gruel will be the best remedy for the shivering; and an
extra blanket or two should be thrown over her, which ought to be well
tucked around her, in order to thoroughly exclude the air from the body.
The _extra_ clothing should, as soon as she is warm and perspiring, be
gradually removed, as she ought not to be kept very hot, or it will
weaken her, and will thus retard her labor.
456. _Sickness_ frequently comes on in the beginning of the labor, and
may continue during the whole process. She is not only sick, but she
actually vomits, and she can keep little or nothing on her stomach.
457. Now, sickness in labor is rather a favorable symptom, and is
usually indicative of a kind and easy confinement. There is an old
saying that “sick labors are safe.” Although they may be safe, they are
decidedly disagreeable!
458. In such a case there is little or nothing to be done, as the less
an irritable stomach is meddled with the better. The sickness will
probably leave as soon as the labor is over. Brandy, unless prescribed
by the medical man, ought not to be given.
459. She must not, on any account, force down—as her female friends or
as a “pottering” old nurse may advise to—“grinding pains:” if she do, it
will rather retard than forward her labor.
460. She had better, during this stage, either walk about or sit down,
and not confine herself to bed; indeed, there is no necessity for her,
unless she particularly desire it, to remain in her chamber.
461. If, at the commencement of the labor, the “waters should break,”
even if there be no pain, the medical man ought immediately to be sent
for; as, in such a case, it is necessary that he should know the exact
presentation of the child.
462. After an uncertain length of time, the character of the pains
alters. From being “grinding,” they become “bearing down,” and are now
more regular and frequent, and the skin becomes both hot and perspiring.
These may be considered the _true_ labor pains. The patient ought to
bear in mind then that “the true labor pains are situated in the back
and loins; they come on at regular intervals, rise gradually up to a
certain pitch of intensity, and abate as gradually; it is a dull, heavy,
deep sort of pain, producing occasionally a low moan from the patient;
not sharp or twinging, which would elicit a very different expression of
suffering from her.”[86]
463. As soon as the pains assume a “bearing down” character, the medical
man ought to be in attendance; if he be sent for during the _early_
stage, when the pains are of a “grinding” character, and when they come
on “few and far between,” and at uncertain intervals (unless, as before
stated, “the waters should break” early), he can do no good; for if he
attempt in the _early_ stage to force on the labor, he might do
irreparable mischief.
464. _Cramps_ of the legs and of the thighs are a frequent, although not
a constant, attendant on labor. These cramps come on more especially if
the patient be kept for a lengthened period in one position; hence the
importance of allowing her, during the first and the second stages of
labor, to move about the room.
465. Cramps are generally worse during the third or last stage of labor,
and then, if they occur at all, they usually accompany each pain. The
poor patient, in such a case, has not only to bear the labor pains but
the cramp pains! Now, there is no danger in these cramps; it is rather a
sign that the child is making rapid progress, as he is pressing upon the
nerves which supply the thighs.
466. The nurse ought to well rub, with her warm hand, the cramped parts;
and, if the labor be not too far advanced, it would be well for the
patient to change her position, and to sit on a chair, or, if she feel
inclined, to walk about the room; there being of course an attendant,
one on each side, to support her the while. If either a pain or a cramp
should come on while she is thus moving about, let her instantly take
hold of the bedpost for support.
467. I observe, in a subsequent paragraph, that in a case of labor, a
four-post mahogany bedstead without a foot-board is preferable to either
a brass or an iron bedstead. It will now be seen that this was one of my
reasons for advising the old-fashioned bedstead; as the support of a
bedpost is oftentimes a relief and a comfort. The new-fashioned mahogany
bedsteads made with _fixed_ foot-board, and both the iron and brass
bedsteads with railings at the foot, are each and all, during the
progress of labor, very inconvenient; as the patient, with either of
these kinds of bedsteads, is not able to plant her feet firmly against
the bedpost—the foot-board of the former and the railings of the latter
being in the way of her doing so. The man who invented these new-fangled
bedsteads was an _ignoramus_ in such matters.
468. Labor—and truly it may be called “labor”[87]—is a natural process,
and therefore ought not unnecessarily to be interfered with, or woe
betide the unfortunate patient.
469. I firmly believe that a woman would stand a much better chance of
getting well over her confinement _without_ assistance, than if she had
been hurried _with_ assistance.
470. In a natural labor very little assistance is needed, and the doctor
is only required in the room occasionally, to ascertain that things are
going on rightly. Those ladies do best, both at the time and afterward,
whose labors are the least interfered with. Bear this in mind, and let
it be legibly written on your memory. This advice, of course, only holds
good in natural confinements.
471. Meddlesome midwifery cannot be too strongly reprobated. The duty of
a doctor is to watch the progress of a labor, in order that, if there be
anything wrong, he may rectify it; but if the labor be going on well, he
has no business to interfere, and he need not be much in the lying-in
room, although he should be in an adjoining apartment.
472. These remarks are made to set a lady right with regard to the
proper offices of an obstetrician; as sometimes she has an idea that a
medical man is able, by constantly “taking a pain,” to greatly expedite
a natural labor. Now, this is a mistaken and mischievous, although a
popular notion.
473. The _frequent_ “taking of a pain” is very injurious and most
unnatural. It irritates and inflames the passages, and frequently
retards the labor.
474. The _occasional_, but only the _occasional_, “taking of a pain” is
_absolutely_ necessary to enable the medical man to note the state of
the parts, and the progress of the labor; but the _frequent_ “taking of
a pain” is very objectionable and most reprehensible.
475. As a rule, then, it is neither necessary nor desirable for a
medical man to be much in a lying-in room. Really, in a natural labor,
it is surprising how very little his presence is required. After he has
once ascertained the nature of the case, _which it is absolutely
necessary that he should do_, and has found all going on “right and
straight,” it is better, much better, that he retire in the daytime to
the drawing-room, in the night season to a bedroom, and thus to allow
nature time and full scope to take her own course without hurry and
without interference, without let and without hindrance. Nature hates
hurry and resents interference.
476. The above advice, for many reasons, is particularly useful. In the
first place, nature is not unnecessarily interfered with. Secondly, it
allows a patient, from time to time, to empty her bladder and
bowels,—which, by giving more room to the adjacent parts, greatly
assists and expedites the progress of the labor. Thirdly, if the doctor
is not present he is not called upon to be frequently “taking a pain,”
which she may request him to do, as she fancies it does her good and
relieves her sufferings; but which frequent taking of a pain in reality
does her harm, and retards the progress of the labor. No; a doctor ought
_not_ to be much in a lying-in room. Although it may be necessary that
he be near at hand, within call, to render assistance toward the last, I
emphatically declare that in an ordinary confinement—that is to say, in
what is called a natural labor—the only time, as a rule, that the
presence of the doctor can be useful, is _just_ before the child is
born; although he ought to be in readiness, and should therefore be in
the house some little time before the event takes place. Let the above
most important advice be strongly impressed upon your memory. Oh! if a
patient did but know what a blessed thing is patience, and, in an
ordinary labor, the importance of non-interference!
477. Bear in mind, then, that in every well-formed woman, and in every
ordinary confinement, nature is perfectly competent to bring, _without
the assistance of man_, a child into the world, and that it is only an
ignorant person who would, in a natural case of labor, interfere to
assist nature.[88] Assist nature! Can any thing be more absurd? As
though God in his wisdom, in performing one of his greatest wonders and
processes, required the assistance of man! It might with as much truth
be said that in every case of the process of _healthy_ digestion it is
necessary for a doctor to assist the stomach in the process of digesting
the food! No; it is high time that such fallacies were exploded, and
that common sense should take the place of such folly. A natural labor,
then, ought _never_ to be either hurried or interfered with, or
frightful consequences might, and in all probability will, ensue. Let
every lying-in woman bear in mind that the more patient she is, the more
kind and the more speedy will be her labor and her “getting about.” Let
her, moreover, remember, then, that labor is a natural process—that all
the “grinding” pains she has are doing her good service, are dilating,
softening, and relaxing the parts, and preparing for the final or
“bearing down” pains; let her further bear in mind _that these pains
must not, on any account whatever, be interfered with_ either by the
doctor, by the nurse, or by herself. These pains are sent for a wise
purpose, and they ought to be borne with patience and resignation, and
she will in due time be rewarded for all her sufferings and anxieties by
having a living child. Oh, how often have I heard an ignorant nurse
desire her mistress to bear down to a “grinding” pain, as though it
could do the slightest good! No, it only robs her of her strength and
interferes with the process and progress of the labor. Away with such
folly, and let nature assert her rights and her glorious prerogative! It
might be thought that I am tedious and prolix in insisting on
non-interference in a natural labor, but the subject is of paramount
importance, and cannot be too strongly dwelt upon, and cannot be too
often brought, and that energetically, before the notice of a lying-in
woman.
478. Fortunately for ladies, there is great talent in the midwifery
department, which would prevent—however anxious a patient may be to get
out of her trouble—any improper interference.[89]
479. I say _improper_ interference. A case sometimes, _although rarely_,
occurs, in which it might be necessary for the medical man to properly
interfere and to help the labor; then the patient must leave herself
_entirely_ in the hands of her doctor—to act as he thinks best, and who
may find it necessary to use promptness and decision, and thus to save
her an amount of unnecessary lingering pain, risk, and anxiety. But
these cases, fortunately, are exceptions—_rare exceptions_—and not the
rule.
480. It is, then, absolutely necessary, in some few cases, that a
medical man should act promptly and decisively; delay in such
emergencies would be dangerous:
“If it were done when ’tis done, then ’twere well
It were done quickly.”
481. There are times, and times without number, when a medical man is
called upon to do but little or nothing; and there are others—few and
far between—when it is imperatively necessary that he should do a great
deal. He ought at all times to be, as gentle as a lamb, but should, in
certain contingencies, be as fearless as a lion!
482. _Should the husband be present during the labor?_ Certainly not;
but as soon as the labor is over, and all the soiled clothes have been
put out of the way, let him instantly see his wife for a few minutes, to
whisper in her ear words of affection, of gratitude, and consolation.
483. The _first_ confinement is generally twice the length of time of an
_after_ one, and usually the more children a lady has had, the quicker
is the labor; but this is by no means always the case, as _some_ of the
_after_ labors may be the _tedious_, while the _early_ confinements may
be the _quick_ ones.
484. It ought to be borne in mind, too, that _tedious labors_ are
oftentimes _natural labors_, and that they only require time and
patience from all concerned to bring them to a successful issue.
485. It may be said that a _first_ labor, as a rule, lasts six hours,
while an _after_ labor probably lasts but three. This space of time, of
course, does not usually include the _commencement_ of labor pains, but
the time that a lady may be _actually_ said to be in _real_ labor. If we
are to reckon from the commencement of the labor, we ought to double the
above numbers—that is to say, we should make the average duration of a
first labor twelve; of an after labor, six hours.
486. When a lady marries late in life—for instance, after she has passed
the age of thirty—her _first_ labor is usually much more lingering,
painful, and tedious, demanding a great stock of patience from the
patient, from the doctor, and from the friends; notwithstanding which,
if she be not hurried and be not much interfered with, both she and the
baby generally do remarkably well. Supposing a lady marries late in
life, it is only the _first_ confinement that is usually hard and
lingering; the _after_ labors are as easy as though she had married when
young.
487. Slow labors are not necessarily dangerous; on the contrary, a
patient frequently has a better and more rapid recovery, provided there
has been no interference, after a tedious than after a quick
confinement—proving beyond doubt that nature hates hurry and
interference. It is an old saying, and, I believe, a true one, that a
lying-in woman _must_ have pain either _before_ or _after_ a labor; and
it certainly is far preferable that she should have the pain and
suffering _before_ than _after_ the labor is over.
488. It is well for a patient to know that, as a rule, after a _first_
confinement she never has after pains. This is some consolation, and is
a kind of compensation for her usually suffering more with her _first_
child.
489. The after pains generally increase in intensity with every
additional child. This only bears out, in some measure, what I before
advanced, namely, that the pain is less severe and of shorter duration
_before_ each succeeding labor, and that the pain is greater and of
longer duration _after_ each succeeding one.
490. The after pains are intended by nature to contract—to reduce—the
womb somewhat to its non-pregnant size, and to assist clots in coming
away, and therefore ought not to be needlessly interfered with. A
judicious medical man will, however, if the pains be very severe,
prescribe medicine to moderate—not to stop—them. A doctor fortunately
possesses valuable remedies to alleviate the after pains.
491. Nature—beneficent nature—ofttimes works in secret, and is doing
good service by preparing for the coming event, unknown to all around.
In the _very earliest stages of labor_ pain is not a necessary
attendant.
492. Although pain and suffering are the usual concomitants of
childbirth, there are, nevertheless, well-authenticated cases on record
of _painless parturition_.[90]
493. A natural labor may be divided into three stages. _The first_, the
premonitory stage, comprising the “falling” or _subsidence of the womb_,
and the “show.” _The second_, the dilating stage, which is known by the
pains being of a “grinding” nature, and in which the mouth of the womb
gradually opens or dilates until it is sufficiently large to admit the
exit of the head of the child, when it becomes _the third_, the
completing stage, which is now indicated by the pains being of a
“bearing down” expulsive character.
494. Now, in the first or premonitory stage, which is much the longest
of the three stages, it is neither necessary nor desirable that the
patient should be confined to her room; on the contrary, it is better
for her to be moving about the house, and to be attending to her
household duties.
495. In the second or dilating stage, it will be necessary that she
should be confined to her room, but not to her bed. If the drawing-room
be near at hand, she ought occasionally to walk to it, and if a pain
should come on the while, lie on the sofa. In this stage it is not at
all desirable that she should keep her bed, or even lie much on it. She
is better up and about, and walking about the room.
496. In the first and the second stages she must not, on any account,
strain or bear down to the pains, as many ignorant nurses advise, as, by
robbing her of her strength, it would only retard the labor. Besides,
while the mouth of the womb is dilating, bearing down cannot be of the
slightest earthly use—the womb is not in a fit state to expel its
contents. If by bearing down she could (but which fortunately she
cannot) cause the expulsion of the child, it would, at this stage, be
attended with frightful consequences—no less than the rupture of the
womb! Therefore, for the future, let not a lady be persuaded, either by
any ignorant nurse or by any officious friend, to bear down until the
last or the complete stage, when a gentle bearing down will assist the
pains to expel the child.
491. In the third or completing stage, of course it is necessary that
she should lie on a bed, and that she should, as above advised, bear
gently down to the pains. The _bearing_ down pains will indicate to her
when to _bear_ down.
498. If, toward the last, she be in great pain, and if she feel inclined
to do so, let her cry out,[91] and it will relieve her. A foolish nurse
will tell her that if she make a noise, it will do her harm. Away with
such folly, and have nothing to do with such simpletons!
499. Even in the last stage, she ought never to bear down unless the
pain be actually upon her; it will do her great harm if she does. In
bearing down, the plan is to hold the breath, and strain down as though
she were straining to have a stool.
500. By a patient adopting the rules just indicated, much weariness
might be avoided; cramp, from her not being kept long in one position,
might be warded off; the labor, from her being amused by change of room
and scene, might be expedited; and thus the confinement might be
deprived of much of its monotony and misery.
501. Nurses sometimes divide a labor into two kinds—a “back labor,” and
a “belly labor.” The latter is not a very elegant, although it might be
an expressive, term. Now, in a “back labor,” the patient will derive
comfort by having her back held by the nurse. This ought not to be done
by the _bare_ hand, but let the following plan be adopted: Let a pillow
be placed next to the back, and then the nurse should apply firm
pressure, the pillow intervening between the back and the nurse’s hand
or hands. If the above method be followed, the back will not be injured,
which it otherwise would be by the pressure of the hard hand of the
nurse. Where the _bare_ hand alone has been applied, I have known the
back to continue sore and stiff for days.
502. During the latter stage of labor, the patient ought always to beep
her eyelids closed, or the straining might cause an attack of
inflammation of the eyes, or, at all events, might make them bloodshot.
503. Let a large room, if practicable, be selected for the labor, and
let it be airy and well ventilated; and, if it be summer, take care that
the chimney be not stopped. If the weather be intensely hot, there is no
objection to the window being from time to time a little opened.
504. The old-fashioned four-post mahogany bedstead is the most
convenient for a confinement, and is far preferable either to brass or
to iron. The reasons are obvious: in the first place, the patient can,
in the _last_ stage of labor, press her feet against the bedpost, which
is often a great comfort, relief, and assistance to her. And secondly,
while she is walking about the room, and “a pain” suddenly comes on, she
can, by holding the bedpost, support herself.
505. If there be a straw mattress and a horse-hair mattress, besides the
bed, let the straw mattress be removed; as a high bed is inconvenient,
not only to the patient, but to the doctor.
PREPARATIONS FOR LABOR.
506. I should strongly urge a patient _not_ to put everything off to the
last. She must take care to have in readiness a _good_ pair of scissors
and a skein of whity-brown thread. And she ought to have in the house a
small pot of fresh lard—that is to say, _unsalted_ lard,[92] that it may
be at hand in case it is wanted. Let everything necessary both for
herself and the babe be well aired and ready for _immediate_ use, and be
placed in such order that all things may, without hurry or bustle, at a
moment’s notice, be found.
507. Another preparation for labor, and a most important one, is,
attending to the state of the bowels. _If they are at all costive_, the
moment there is the slightest _premonitory_ symptom of labor, she ought
to take either a teaspoonful or a dessertspoonful (according to the
nature of her bowels, whether she be easily moved or otherwise) of
castor oil. If she object to taking the oil, then let her have an enema
of warm water, a pint, administered. By adopting either of the above
plans she will derive the greatest comfort and advantage. It will
prevent her delicacy from being shocked by having her bowels opened,
without her being able to prevent them, during the last stage of labor;
and it will, by giving the adjacent parts more room, much expedite the
confinement and lessen her sufferings.
508. The next thing to be attended to is the way in which she ought to
be _dressed for the occasion_. I would recommend her to put on her clean
night-gown, which, in order to keep it clean and unsoiled, should be
smoothly and carefully rolled up about her waist; then she ought to wear
over it a short bed-gown reaching to the hips, and have on a flannel
petticoat to meet it, and then she should put on a dressing-gown over
all. If it be winter, the dressing-gown had better either be composed of
flannel or be lined with that material. _The stays must not be worn_, as
they would interfere with the progress of the labor.
509. The valances of the bed, and the carpet, and the curtains at the
foot of the bed, had better all be removed; they are only in the way,
and may get soiled and spoiled.
510. “_The guarding of the bed._”—This is done in the following way:
Cover the _right_ side of the bed (as the patient will have to lie on
her _left_ side), with a large piece—a yard and a half square—of
waterproof cloth, or bed-sheeting, as it is sometimes called, which is
sold for the purpose;[93] over this, folded sheets ought to be placed.
If a waterproof cloth cannot be procured, an oil-cloth table-cover will
answer the purpose. Either of the above plans will effectually protect
the bed from injury.
511. The lying-in room should be kept not hot, but comfortably warm; if
the temperature of the room be high, the patient will become irritable,
feverish, and restless.
512. Every now and then, in order to change the air, let the door of the
room be left ajar; and if, in the early periods of the labor, she should
retire for awhile to the drawing-room, let the lying-in room window be
thrown wide open, so as to thoroughly ventilate the apartment, and to
make it fresh and sweet on her return. If the weather be very warm, the
lower sash of the window may for a few inches be opened. It is wonderful
how refreshing to the spirits, and how strengthening to the frame, a
well-ventilated room is to a lying-in patient.
513. Many attendants are not only unnecessary but injurious. They excite
and flurry the patient, they cause noise and confusion, and rob the air
of its purity. One lady friend besides the doctor and the monthly nurse
is all that is needed.
514. In making the selection of a friend, care should be taken that she
is the mother of a family, that she is kind-hearted and self-possessed,
and of a cheerful turn of mind. At these times all “chatterers,”
“croakers,” and “potterers” ought to be carefully excluded from the
lying-in room. No conversation of a depressing character should for one
moment be allowed. Nurses and friends who are in the habit of telling of
bad cases that have occurred in their experience must be avoided as the
plague. If nurses have had bad cases, many of them have probably been of
their own making; such nurses, therefore, ought on every account to be
shunned.
515. During the progress of the labor, boisterous and noisy conversation
ought never to be permitted; it only irritates and excites the patient.
Although boisterous merriment is bad, yet at such times quiet, cheerful,
and agreeable conversation is beneficial.
516. A mother on these occasions is often present; but of all persons
she is the most unsuitable, as, from her maternal anxiety, she tends
rather to depress than to cheer her daughter. Though the mother ought
not to be in the _room_, it is, if practicable, desirable that she
should be in the _house_. The patient, in the generality of cases,
derives comfort from the knowledge of her mother being so near at hand.
517. Another preparation for labor is to soothe her mind by telling her
of the _usual_ safety of confinements, and by assuring her that, in the
generality of instances, it is a natural process; and that all she has
to do is to keep up her spirits, to adhere strictly to the rules of her
doctor, and she will do well.
518. Tell her that “sweet is pleasure after pain;”[94] tell her, too, of
the exquisite happiness and joy she will feel as soon as the labor is
over, as perhaps the greatest thrill of delight a woman ever experiences
in this world is when her babe is _first_ born. She, as if by magic,
forgets all the sorrow and suffering she has endured. “A woman when she
is in travail hath sorrow, because her hour is come; but as soon as she
is delivered of the child, she remembereth no more the anguish, for joy
that a man is born into the world.”[95] Keble, in the _Christian Year_,
well observes:
“Mysterious to all thought,
A mother’s prime of bliss,
When to her eager lips is brought
Her infant’s thrilling kiss.”
Rogers, too, in referring to this interesting event, sweetly sings:
“The hour arrives, the moment wished and feared;
The child is born, by many a pang endeared!
And now the mother’s ear has caught his cry—
Oh! grant the cherub to her asking eye!
He comes—she clasps him; to her bosom pressed,
He drinks the balm of life, and drops to rest.”
519. The doctor, too, will be able to administer comfort to her when he
has “tried a pain” or has “taken a pain,” as it is called, and when he
can assure her that it “is all right and straight”—that is to say, that
the child is presenting in the most favorable position, and that
everything is progressing satisfactorily. He will, moreover, be able to
inform her of the _probable_ duration of the labor.
520. Let me in this place urge upon the patient the importance of her
allowing the medical man to inquire fully into her state. She may depend
upon it that this inquiry will be conducted in the most delicate manner.
If there be anything wrong in the labor, it is in the _early_ stage, and
_before_ the “waters have broken,” that the most good can be done. If a
proper examination be not allowed to the medical man whenever he deems
it right and proper (and a judicious doctor will do it as seldom as he
can), her life, and perhaps that of her child, might pay the penalty of
such false delicacy.
521. French brandy, in case it is wanted, ought always to be in the
house; but let me impress upon the minds of the attendants the
importance of withholding it, unless it be ordered by the doctor, from a
lying-in woman. Numbers have fallen victims to brandy being
indiscriminately given. I am of opinion that the great caution which is
now adopted in giving spirits to women in labor is one reason, among
others, of the great safety of the confinements of the present day,
compared with those of former times.
522. The best beverage for a patient during labor is either a cup of
warm tea, or of gruel, or of arrow-root. It is folly in the extreme,
during the progress of labor, to force her to eat: her stomach recoils
from it, as at these times there is generally a loathing of food, and if
we will, as we always ought to, take the appetite as our guide, we shall
never go far wrong.
523. A patient during labor ought frequently to make water; by doing so
she will add materially to her ease and comfort, and it will give the
adjacent parts more room, and will thus expedite the labor. I wish to
call attention to this point, as many ladies, especially with their
first children, have, from false delicacy, suffered severely from not
attending to it; one of the ill effects of which is inability after the
labor is over to make water without the assistance of the doctor, who
might in an extreme case deem it necessary to introduce a catheter into
the bladder, and thus to draw the water off.
524. I recommended, in a previous paragraph, that the doctor ought to
have either the drawing-room or a bedroom to retire to, in order that
the patient may, during the progress of the labor, _be left very much to
herself_, and that thus she may have full opportunities, whenever she
feels the slightest inclination to do so, of thoroughly emptying either
her bladder or her bowels. _Now, this advice is of very great
importance_, and if it were, more than it is, attended to, would cause a
great diminution of misery, of annoyance, and suffering. I have given
the subject great attention; as I have had large experience in midwifery
practice; I therefore speak “like one having authority,” and if my
advice in this particular be followed, this book will not have been
written in vain.
525. If the patient, twelve hours after the labor, and having tried two
or three times during that time, is _unable_ to make water, the medical
man ought to be made acquainted with it, or serious consequences might
ensue.
CHLOROFORM IN HARD AND IN LINGERING LABOR.
526. Mothers and doctors are indebted to Dr.—now Sir James—Simpson for
the introduction of chloroform, one of the greatest and most valuable
discoveries ever conferred on suffering humanity.
527. Sulphuric ether was formerly used to cause insensibility to pain;
but it is far inferior to chloroform, and is now, in this country, very
seldom employed; while the inhalation of chloroform, especially in cases
of hard and of lingering labor, is every day becoming more general, and
will do so still more extensively as its value is better understood, and
when, in well-selected cases, its comparative freedom from danger is
sufficiently appreciated.
528. Chloroform, then, is a great boon in midwifery practice; indeed, we
may say with Dr. Kidd,[96] that in labor cases “it has proved to be
almost a greater boon than in the experimental and gigantic operations
of the surgeon.” It may be administered in labor by a medical man with
perfect safety. I have given it in numerous instances, and have always
been satisfied with the result.
529. The inhalation of chloroform causes either partial or complete
unconsciousness, and freedom from pain either for a longer or for a
shorter time, according to the will of the operator. In other words, the
effects might with perfect safety be continued either for a few minutes,
or from time to time for several hours; indeed, if given in proper
cases, and by a judicious medical man, with immense benefit.
530. Chloroform is more applicable and useful in a labor—more especially
in a first labor—when it is lingering, when the pains are very severe,
and when, notwithstanding the pain, it is making but little
progress,—then chloroform is a priceless boon.
531. Chloroform, too, is very beneficial when the patient is of a
nervous temperament, and when she looks forward with dread and
apprehension to each labor pain.
532. It might be asked,—Would you give chloroform in _every_ case of
labor, be it ever so easy and quick? Certainly not: it is neither
advisable nor expedient, in an ordinary, easy, quick labor, to
administer it.
533. The cases in which it is desirable to give chloroform are _all_
lingering, hard, and severe _ordinary_ labors. In such I would gladly
use it. But before administering it, I would, as a rule, wait for at
least six hours from the commencement of the labor.
534. Oh, the delightful and magical effects of it in the cases here
described! the lying-in room, from being in a state of gloom,
despondency, and misery, is instantly transformed, by its means, into
one of cheerfulness, hope, and happiness!
535. When once a lying-in woman has experienced the good effects of
chloroform in assuaging her agony, she importunately, at every
recurrence of “the pain,” urges her medical man to give her more! In all
her subsequent confinements, having once tasted the good effects of
chloroform, she does not dread them. I have frequently heard a lady
declare that, now (if her labor be either hard or lingering) she can
have chloroform, she looks forward to the period of childbirth with
confidence and hope.
536. It might be asked,—Does the inhalation of chloroform retard the
patient’s “getting about”? I emphatically declare _that it does not do
so_. Those who have had chloroform have always, in my practice, had as
good and as speedy recoveries as those who have not inhaled it.
537. One important consideration in the giving of chloroform in labor
is, _that a patient has seldom, if ever, while under the effects of it,
been known to die_; which is more than can be said when it has been
administered in surgical operations, in the extraction of teeth, etc. “I
know there is not one well-attested death from chloroform in midwifery
in all our journals.”[97]
538. One reason why it may be so safe to give chloroform in labor is,
that in the practice of midwifery a medical man does not deem it needful
to put his patient under the _extreme_ influence of it. He administers
just enough to ease her pain, but not sufficient to rob her of total
consciousness; while in a surgical operation the surgeon may consider it
necessary to put his patient under the _full_ influence of chloroform:
hence the safety in the one, and the danger in the other case. “It is
quite possible to afford immense relief, to ‘render the pains quite
bearable,’ as a patient of mine observed, by a dose which does not
procure sleep or impair the mental condition of the patient, and which
all our experience would show is absolutely free from danger.”[98]
539. There is another advantage in chloroform,—the child, when he is
born, is usually both lively and strong, and is not at all affected by
the mother having had chloroform administered to her. This is a most
important consideration.
540. The doctor, too, as I before remarked, is deeply indebted to Sir J.
Simpson for this great boon: _formerly_ he dreaded a tedious and hard
labor; _now_ he does not do so, as he is fully aware that chloroform
will rob such a lying-in of much of its terror and most of its pain and
suffering, and will in all probability materially shorten the duration
of the confinement.
541. Chloroform ought never to be administered, either to a labor
patient or to any one else, except by a medical man. This advice admits
of no exception. And chloroform should never be given unless it be
either in a lingering or in a hard labor. As I have before advised, in a
natural, easy, everyday labor, nature ought not to be interfered with,
but should be allowed to run its own course. Patience, gentleness, and
non-interference are the best and the chief requisites required in the
_majority_ of labor cases.
HINTS TO ATTENDANTS IN CASE THE DOCTOR IS UNAVOIDABLY ABSENT.
542. It frequently happens that after the _first_ confinement the labor
is so rapid that the child is born before the doctor has time to reach
the patient.
543. It is consequently highly desirable—nay, imperatively necessary—for
the interest and for the well-doing both of the mother and of the baby,
that either the nurse or the lady friend should, in such an emergency,
know _what to do and what_ NOT _to do_. I therefore, in the few
following paragraphs, purpose, in the simplest and clearest language I
can command, to enlighten them on the subject.
544. In the first place, let the attendants be both calm and
self-possessed, and let there be no noise, no scuffling, no excitement,
no whispering, and no talking, and let the patient be made to thoroughly
understand that there is not the slightest danger; as the principal
danger will be in causing _unnecessary_ fears both as to herself and her
child. Tens of thousands are annually delivered in England, and
everywhere else, without the _slightest_ assistance from a
doctor,[99]—he not being at hand or not being in time; and yet both
mother and child almost invariably do well. Let her be informed of this
fact—for it is a fact—and it will be a comfort to her and will assuage
her fears. The medical man, as soon as he arrives, will soon make all
right and straight.
545. In the mean time let the following directions be followed:
_Supposing a child to be born before the medical man arrives_, the nurse
ought then to ascertain whether a coil of navel-string be around the
neck of the infant; if it be, it must be instantly liberated, or he
might be strangled. Care should be taken that he has sufficient room to
breathe, that there be not a “membrane” over his mouth;[100] and that
his face be not buried in the clothes. Any mucus about the mouth of the
babe ought, with a soft napkin, to be wiped away, or it might impede the
breathing.
546. Every infant, the moment he comes into the world, ought to cry; if
he does not naturally, he should be made to do so by smacking his
buttocks until he does cry. He will then be safe:
“We came crying hither.
Thou know’st, the first time we smell the air
We waul and cry.”[101]
547. If the doctor has not arrived, cheerfulness, quietness, and
presence of mind must be observed by all around; otherwise, the patient
may become excited and alarmed, and dangerous consequences might ensue.
548. If the infant should be _born apparently dead_, a few smart blows
must be given on the buttocks and on the back; a smelling-bottle ought
to be applied to the nostrils, or rag should be singed under the nose,
taking care that the burning tinder does not touch the skin; and cold
water must be freely sprinkled on the face. The navel-string, as long as
there is pulsation in it, ought not to be tied.
549. The limbs, the back, and the chest of the child ought to be well
rubbed with the warm hand. The face should not be smothered up in the
clothes. If pulsation has ceased in the navel-string (the above rules
having been strictly followed, and having failed), let the navel-string
be tied and divided,[102] and then let the child be plunged into warm
water—98° Fahr. If the _sudden_ plunge does not rouse respiration into
action, let him be taken out of the warm bath, as the keeping him for
any length of time in the water will be of no avail.
550. If these simple means should not _quickly_ succeed, although they
generally will, Dr. Marshall Hall’s _Ready Method_ ought in the
following manner to be tried: “Place the infant on his face; turn the
body gently but completely _on the side and a little beyond_, and then
on the face, alternately; repeating these measures deliberately,
efficiently, and perseveringly, fifteen times in the minute only.”
551. Another plan of restoring suspended animation is by artificial
respiration, which should be employed in the following manner: Let the
nurse (in the absence of the doctor) squeeze, with her left hand, the
child’s nose, to prevent any passage of air through the nostrils; then
let her apply her mouth to the child’s mouth, and breathe into it, in
order to inflate the lungs; as soon as they are inflated, the air ought,
with the right hand, to be pressed out again, so as to imitate natural
breathing. Again and again, for several minutes, and for about fifteen
times a minute, should the above process be repeated; and the operator
will frequently be rewarded by hearing a convulsive sob, which will be
the harbinger of renewed life.
552. Until animation be restored, the navel-string, provided there be
pulsation in it, ought not to be tied. If it be tied before the child
has breathed, and before he has cried, he will have but a _slight_
chance of recovery. While the navel-string is left entire, provided
there be still pulsation in it, the infant has the advantage of the
mother’s circulation and support.
553. If Dr. Marshall Hall’s _Ready Method_ and if artificial respiration
should not succeed, he must be immersed up to his neck in a warm bath of
98° Fahrenheit. A plentiful supply of warm water ought always to be in
readiness, more especially if the labor be either hard or lingering.
554. _Should the child have been born for some time before the doctor
has arrived_, it may be necessary to tie and to divide the navel-string.
The manner of performing it is as follows: A ligature, composed of four
or five whity-brown threads, nearly a foot in length and with a knot at
each end, ought, by a double knot, to be _tightly_ tied, at about two
inches from the body of the child, around the navel-string. A second
ligature must, in a similar manner, be applied about three inches from
the first, and the navel-string should be carefully divided midway
between the two ligatures. Of course, if the medical man should shortly
be expected, any interference would not be advisable, as such matters
ought always to be left entirely to him.
555. _The after birth must never be brought away by the nurse_: if the
doctor has not yet arrived, it should be allowed to come away (which, if
left alone in the generality of cases, it generally will) of its own
accord. The only treatment that the nurse ought in such a case to adopt
is, that she apply, by means of her right hand, _firm_ pressure over the
region of the womb: this will have the effect of encouraging the
contraction of the womb, of throwing off the after birth, and of
preventing violent flooding.
556. If the after birth does not soon come away, say in an hour, _or if
there be flooding_, another medical man ought to be sent for; but on no
account should the nurse be allowed to interfere with it further than by
applying firm pressure over the region of the womb, and _not touching
the navel-string at all_; as I have known dangerous, and in some cases
even fatal, consequences to ensue from such meddling.
REST AFTER DELIVERY.
557. A lady ought never to be disturbed for at least an hour after the
delivery; if she be, violent flooding might be produced. The doctor, of
course, will make her comfortable by removing the soiled napkins, and by
applying clean ones in their place.
558. Her head ought to be made easy; she must still lie on her side;
indeed, for the first hour let her remain nearly in the same position as
that in which she was confined—with this only difference, that if her
feet have been pressing against the bedpost, they should be removed from
that position.
CLOTHING AFTER LABOR.
559. She ought, after the lapse of an hour or two, to be moved from one
side of the bed to the other. It ought to be done in the most tender and
cautious manner. _She must not, on any account whatever, be allowed to
sit erect in the bed._ While being moved, she herself should be
passive—that is to say, _she ought to use no exertion, no effort_, but
should, by two attendants, be removed from side to side; one must take
hold of her shoulders, the other of her hips.
560. A patient, _after_ delivery, usually feels shivering and starved;
it will therefore be necessary to throw additional clothing, such as a
blanket or two, over her, which ought to envelop the body, and should be
well tucked around her; but the nurse ought to be careful not to
overload her with clothes, or it might produce flooding, fainting, etc.;
as soon, therefore, as she is warmer, let the _extra_ clothing be
gradually removed. If the feet be cold, let them be wrapped in a warm
flannel petticoat, over which a pillow should be placed.
561. A frequent change of linen after confinement is desirable. Nothing
is more conducive to health than cleanliness. Great care should be taken
to have the sheets and linen well aired.
REFRESHMENT.
562. A cup of cool, black tea, directly after a patient is confined,
ought to be given. I say cool, not cold, as cold tea might chill her.
Hot tea would be improper, as it might induce flooding.
563. As soon as she is settled in bed, there is nothing better than a
_small_ basin of warm gruel.
564. Brandy ought never, unless ordered by the medical man, to be given
after a confinement. Warm beer is also objectionable; indeed, stimulants
of all kinds must, unless advised by the doctor, be carefully avoided,
as they would only produce fever, and probably inflammation. Caudle is
now seldom given; but still, some old-fashioned people are fond of
recommending it after a labor. Caudle ought to be banished the lying-in
room; it caused in former times the death of thousands.
BANDAGE AFTER A CONFINEMENT.
565. (1) This consists of thick linen, similar to sheeting, about a
yard and a half long, and sufficiently broad to comfortably support
the belly. It ought to be put on moderately tight; and should be
retightened every night and morning, or oftener, if it become slack.
(2) Salmon’s Obstetric Binder is admirably adapted to give support
after a confinement, and may be obtained of any respectable
surgical-instrument-maker.
566. If there be not either a proper bandage or binder at hand—(3) a
yard and a half of _unbleached_ calico, folded double, will answer the
purpose. The best pins to fasten the bandages are the patent safety
nursery-pins. The binder requires no pins.
567. A support to the belly after labor is important: in the first
place, it is a great comfort; in the second, it induces the belly to
return to its original size; and lastly, it prevents flooding. Those
ladies, more especially if they have had large families, who have
neglected proper bandaging after their confinements, frequently suffer
from enlarged and pendulous bellies, which give them an unwieldy and
ungainly appearance.
POSITION.
568. _The way of placing the patient in bed._—She ought _not_,
immediately after a labor, under any pretext or pretense whatever, to be
allowed to raise herself in bed. If she be dressed, as recommended at
paragraph 508, her soiled linen may readily be removed; and she may be
drawn up by two assistants—one being at the shoulders and the other at
the legs—to the proper place, _as she herself must not be allowed to use
the slightest exertion_.
569. Inattention to the above recommendation has caused violent
flooding, fainting, bearing down of the womb, etc., and in some cases
even fatal consequences.
THE LYING-IN ROOM.
570. _The room to be kept cool and well ventilated._—A nurse is too apt,
after the confinement is over, to keep a large fire. Nothing is more
injurious than to have the temperature of a lying-in room high. A little
fire, provided the weather be cold, to dress the baby by, and to
encourage a circulation of the air, is desirable. A fire-guard ought to
be attached to the grate of the lying-in room. The door must
occasionally be left ajar, in order to change the air of the apartment;
a lying-in woman requires _pure_ air as much as any other person; but
how frequently does the nurse fancy that it is dangerous for her to
breathe it!
571. After the affair is over, the blinds ought to be put down, and the
window curtains should be drawn, in order to induce the patient to have
a sleep, and thus to rest herself after her hard work. Perfect stillness
must reign both in the room and in the house.
572. It is really surprising, in this present enlightened age, how much
misconception and prejudice there still is among the attendants of a
lying-in room; they fancy labor to be a disease, instead of being what
it really is—_a natural process_; and that old-fashioned notions, and
not common sense, ought to guide them.
573. The patient should, after the labor, be strictly prohibited from
talking; and noisy conversation ought not to be allowed; indeed, she
cannot be kept too quiet, as she may then be induced to fall into a
sweet sleep, which would recruit her wasted strength. As soon as the
baby is washed and dressed, and the mother is made comfortable in bed,
the nurse ought alone to remain; let every one else be banished the
lying-in room. Visitors should on no account, until the medical man
gives permission, be allowed to see the patient.
THE BLADDER.
574. _Ought a patient to go to sleep before she has made water?_—There
is not the least danger in her doing so (although some old-fashioned
person might tell her that there is); nevertheless, before she goes to
sleep, if she have the slightest inclination she should respond to it,
as it would make her feel more comfortable and sleep more sweetly.
575. Let me urge the importance of the patient, _immediately_ after
childbirth, making water while she is in a lying position. I have known
violent flooding to arise from a lying-in woman being allowed, soon
after delivery, to sit up while passing her water.
576. The “female slipper”[103] (previously warmed by dipping it in very
hot water and then quickly drying it) ought, at these times, and for
some days after a confinement, to be used. It is admirably adapted for
the purpose, as it takes up but little room and is conveniently shaped,
and readily slips under the patient, and enables her to make water
comfortably, she being perfectly passive the while. It should be passed
under her in front, and not at the side of the body.
577. If there be any difficulty in her making water, the medical man
must, through the nurse, be _immediately_ informed of it. False delicacy
ought never to stand in the way of this advice. It should be borne in
mind that, after either a _very_ lingering or a severe labor, there is
frequently _retention of urine_,—that is to say, that although the
bladder may be full of water, the patient is, without assistance, unable
to make it.
578. After the patient, while lying down, trying several times to pass
her water, and after, allowing twelve or fifteen hours to elapse, and
not being able to do so, it will be well for her to try the following
method: Let the _pot de chambre_ be well warmed, let the rim be covered
with flannel, let her, supported the while by the nurse, kneel _on_ the
bed, her shoulders being covered with a warm shawl; then let her, with
the _pot de chambre_ properly placed between her knees on the bed, try
to make water, and the chances are that she will _now_ succeed.
579. If she does not, twenty-four hours having elapsed, the doctor must
be informed of the fact; and it will then be necessary, absolutely
necessary, for him, by means of a catheter, to draw off the water. It
might be well to state that the passing of a catheter is unattended
_with either the slightest danger or pain_; and that it is done without
exposing her, and thus without shocking her modesty.
THE BOWELS.
580. The bowels are usually costive after a confinement. This confined
state of the bowels after labor is doubtless a wise provision of nature,
in order to give repose to the surrounding parts—especially to the womb;
it is well, therefore, _not_ to interfere with them, but to let them
have perfect rest for three days. Sometimes before the expiration of the
third day the bowels are relieved, either without medicine or merely by
the taking of a cupful of warm coffee. If such be the case, all well and
good; as it is much better that the bowels should be relieved _without_
medicine than _by_ medicine; but if, having taken the coffee, at the end
of the third day they are not opened, then early on the following—the
fourth—morning, a dose of castor oil should be given in the manner
recommended at paragraph 281. Either a teaspoonful or a dessertspoonful,
according to the constitution of the patient, will be a proper dose. If,
in the course of twelve hours, it should not have the desired effect, it
must be repeated. The old-fashioned custom was to give castor oil on the
morning after the confinement; this, as I have before proved, was a
mistaken plan.
581. After a lying-in, and when the bowels are not opened either
naturally or by the taking of a cupful of warm coffee, if medicine be
given by the mouth, castor oil is the _best_ medicine, as it does not
irritate either the patient’s bowels, or, through the mother’s milk,
gripe the infant. Aperient pills, as they most of them contain either
colocynth or aloes, or both, frequently give great pain to the babe, and
purge him much more than they do the mother herself; aperient pills,
therefore, after a confinement ought never to be taken.
582. If the patient object to the taking of castor oil, let the nurse,
by means of an enema apparatus, administer an enema. This is an
excellent, indeed the best, method of opening the bowels, as it neither
interferes with the appetite nor with the digestion; it does away with
the nauseousness of castor oil, and does not, in the administration,
give the slightest pain. If the first enema should not have the desired
effect, let one be given every quarter of an hour until relief be
obtained. One of the best for the purpose is the following:
Take of—Olive oil, two tablespoonfuls;
Table salt, two tablespoonfuls;
Warm oatmeal gruel, one pint;
To make a clyster.
Another capital enema for the purpose is one made of Castile soap
dissolved in warm water.
583. If the patient object both to the taking of the castor oil and to
the administration of an enema, then the following draught will be found
useful; it will act kindly, and will neither gripe the mother nor the
child:
Take of—Concentrated Essence of Senna, half an ounce;
Syrup of Ginger, one drachm;
Distilled Water, seven drachms:
To make a draught. To be taken early in the morning.
If in twelve hours the above draught should not have the desired effect
(although, if the essence of senna be good, it usually does long before
that time), let the draught be repeated. If the bowels be easily moved,
_half_ of the above draught is generally sufficient; if it be not so in
twelve hours, the remainder should be taken. But let every lying-in
woman bear in mind that as soon as her bowels will act, either naturally
or by the taking of a cupful of warm coffee, without an aperient, not a
particle of opening medicine should be taken.
584. But, after all that can be said on the subject, there is no better
method in the world for opening a lying-in patient’s bowels, when
costive, than (if the cup of coffee be not sufficiently powerful) by
giving her an enema, as advised in a previous paragraph. An enema is
safe, speedy, painless, and effectual, and does not induce costiveness
afterward, which castor oil, and all other aperients, if repeatedly
taken, most assuredly will.
585. An enema, then, is an admirable method of opening costive bowels,
both during suckling and during pregnancy, and deserves to be more
universally followed than it now is; fortunately, the plan just
recommended is making rapid progress, and shortly will, with ladies at
such times, entirely supersede the necessity of administering aperients
by the mouth.
586. Aperients, after a confinement, were in olden times, as a matter of
course, repeatedly given both to the mother and to the babe, to their
utter disgust and to their serious detriment! This was only one of the
numerous mistakes and follies that formerly prevailed in the lying-in
room. Unfortunately, in those days a confinement was looked upon as a
disease, and to be physicked accordingly. A better state of things is
happily now dawning.
587. When the patient’s bowels, for the first few days after the
confinement, require to be opened, she ought to use either the French
bed-pan or the bed-pan of the Liverpool Northern Hospital. Either the
one or the other of these pans is a great improvement on the
old-fashioned bed-pans, as they will readily slip under the patient, and
will enable her, while lying down and while she is perfectly passive in
bed, to have her bowels relieved, which at these times is very
desirable. The French bed-pan or the bed-pan of the Liverpool Northern
Hospital is admirably adapted for a lying-in room; indeed, no lying-in
room ought to be without either the one or the other of these useful
inventions. “A flannel cap for the toe-part, held on by strings round
the heel, will afford considerable comfort to the patient.”[104]
“CLEANSINGS”—ABLUTIONS.
588. _The “Cleansings.”_—This watery discharge occurs directly after a
lying-in, and lasts either a week or a fortnight, and sometimes even
longer. It is, at first, of a reddish color; this gradually changes to a
brownish hue, and afterward to a greenish shade; hence the name of
“green waters.” It has in some cases a disagreeable odor. A moderate
discharge is necessary; but when it is profuse, it weakens the patient.
589. Some ignorant nurses object to have the parts bathed after
delivery; they have the impression that such a proceeding would give
cold. Now, warm fomentation twice a day, and even oftener, either if the
discharge or if the state of the parts requires it, is absolutely
indispensable to health, to cleanliness, and comfort. Ablutions, indeed,
at this time are far more necessary than at any other period of a
woman’s existence.
590. There is nothing better for the purpose than a soft sponge and warm
water, unless the parts be very sore; if they be, a warm fomentation,
two or three times a day, of marshmallows and chamomile,[105] will
afford great relief, or the parts may be bathed with warm oatmeal gruel,
of course without salt. In these cases, too, I have found warm barm
(yeast) and water a great comfort, and which will soon take away the
soreness. The parts ought, after each fomentation, to be well but
quickly dried with warm, dry, soft towels.
591. If the _internal_ parts be very sore, it may be necessary, two or
three times a day, to syringe them out, by means of an india-rubber
vaginal syringe,[106] with either of the above remedies. Hence the
importance of having a good monthly nurse, of having one who thoroughly
understands her business.
592. Let the above rules be strictly followed. Let no prejudices and no
old-fashioned notions, either of the nurse or of any female friend,
stand in the way of the above advice. Ablution of the parts, then, after
a confinement, and that frequently, is absolutely required, or evil
results will, as a matter of course, ensue.
REST AND QUIETUDE.
593. A horizontal—a level—position for either ten days or a fortnight
after a labor is important. A lady frequently fancies that if she
supports her legs, it is all that is necessary. Now, this is absurd; it
is the womb and not the legs that requires rest; and the only way to
obtain it is by lying flat either on a bed or on a sofa: for the first
five or six days, day and night, on a bed, and then for the next five or
six days she ought to be _removed_ for a short period of the day either
to another bed or to a sofa; which other bed or sofa should be wheeled
to the side of the bed, and she must be placed on it by two assistants,
one taking hold of her shoulders and the other of her hips, and thus
lifting her on the bed or sofa, she herself being perfectly passive, and
not being allowed to sit erect the while. She ought, during the time she
is on the sofa, to maintain the _level_ position.
594. She ought, after the first nine days, to sit up for an hour; she
should gradually prolong the time of the sitting; but still she must,
for the first fortnight, lie down a great part of every day. She should,
after the first week, lie either on a sofa or on a horse-hair mattress.
595. The above plan may appear irksome, but my experience tells me that
it is necessary, absolutely necessary. The benefit the patient will
ultimately reap from it will amply repay the temporary annoyance of so
much rest. Where the above rules have not been adopted, I have known
flooding, bearing down of the womb, and even “falling” of the womb,
frequent miscarriages, and ultimately ruin of the constitution, to
ensue.
596. “Falling of the womb” is a disagreeable complaint, and the
misfortune of it is, that every additional child increases the
infirmity. Now, all this might, in the majority of cases, have been
prevented, if the recumbent posture for ten days or a fortnight after
delivery had been strictly adopted.
597. If a patient labor under a “falling of the womb,” she ought to
apply to a medical man, who will provide her with a proper support,
called a pessary, which will prevent the womb from “falling down,” and
will effectually keep it in its proper place.
598. It is only a medical man, accustomed to these matters, who can
select a pessary suitable for each individual case. A proper kind of,
and duly-adjusted, pessary is a great comfort to a patient, and will
enable her both to take her proper exercise and to follow her ordinary
employments; indeed, if a suitable pessary be used, it is so comfortable
that the patient often forgets that she is wearing one at all. Those
pessaries ought only to be employed that can be removed every night, as
there is not the least necessity for a patient to sleep in one, as the
womb does not usually come down when the patient is lying down.
Moreover, a pessary ought to be kept perfectly clean, and unless it be
daily removed it is utterly impossible to keep it so. It is a great
comfort and advantage to a patient to be able both to introduce and to
remove the pessary herself, which, if a proper kind be employed, she
can, when once taught, readily do.
599. If “falling of the womb” be early and properly treated, there is a
good chance of a patient being perfectly cured, and thus of being able
to dispense with a pessary altogether.
DIETARY.
600. _For the first day_ the diet should consist of nicely made and
well-boiled gruel, arrow-root and milk, bread and milk, tea, dry toast
and butter, or bread and butter; taking care not to overload the stomach
with too much fluid. Therefore, either a cupful of gruel, or of
arrow-root, or of tea, at a time, should not be exceeded, otherwise the
patient will feel oppressed; she will be liable to violent perspiration,
and there will be a too abundant secretion of milk.
601. _For the next—the second day.—Breakfast_,—either dry toast and
butter, or bread and butter, and black tea. _Luncheon_,—either a
breakfast-cupful of strong beef-tea,[107] or of bread and milk, or of
arrow-root made with good fresh milk. _Dinner_,—either chicken or game,
mashed potatoes, and bread. _Tea_, the same as for breakfast.
_Supper_,—a breakfast-cupful of well-boiled and well-made gruel, made
either with water or with fresh milk, or with water with a tablespoonful
of cream added to it.
602. If beef-tea and arrow-root and milk be distasteful to the patient,
or if they do not agree, then for luncheon let her have either a light
egg pudding or a little rice pudding instead of either the beef-tea or
the arrow-root.
603. _On the third and fourth days._—Similar diet to the _second day_,
with this difference, that for her dinner the patient should have
mutton—either a mutton-chop or a cut out of a joint of mutton, instead
of the chicken or game. The diet ought gradually to be improved, so that
at the end of four days she should return to her usual diet, provided it
be plain, wholesome, and nourishing.
604. The above, _for the generality of cases_, is the scale of dietary;
but of course every lying-in woman ought not to be treated alike. If she
be weak and delicate, she may from the beginning require good
nourishment, and instead of giving her gruel, it may, from the _very
commencement_, be necessary to prescribe good strong beef-tea,
veal-and-milk broth,[108] chicken-broth, mutton-chops, grilled chicken,
game, the yelk and the white of an egg beaten up together in half a
teacupful of good fresh milk, etc. Common sense ought to guide us in the
treatment of a lying-in as of every other patient. We cannot treat
people by rule and compass; we must be guided by circumstances; we can
only lay down general rules. There is no universal guide, then, to be
followed in the dietary of a lying-in woman; each case may and will
demand separate treatment; a delicate woman, as I have just remarked,
may, from the very first day, require generous living; while, on the
other hand, a strong, robust, inflammatory patient may, for the first
few days, require only simple bland nourishment, without a particle of
stimulants. “And hence the true secret of success rests in the use of
_common sense_ and _discretion_—common sense to read nature aright, and
discretion in making a right use of what the dictates of nature
prescribe.”[109]
BEVERAGE.
605. _For the first week_, either toast and water, or barley-water and
milk,[110] with the chill taken off, is the best beverage. Wine,
spirits, and beer, during this time, unless the patient be weak and
exhausted, or unless ordered by the medical man, ought not to be given.
All liquids given during this period should be administered by means of
a feeding-cup; this plan I strongly recommend, as it is both a comfort
and a benefit to the patient; it prevents her from sitting up in bed
every time she has to take fluids, and it keeps her perfectly still and
quiet, which, for the first week after confinement, is very desirable.
606. When she is weak, and faint, and low, it may, as early as the first
or second day, be necessary to give a stimulant, such as either a
tumblerful of home-brewed ale or a glass or two of wine daily; but, as I
before remarked, in the generality of cases, either toast and water, or
barley-water and milk, for the first week after a confinement, is the
best beverage.
607. _After a week_, either a tumblerful of mild home-brewed ale or of
London or Dublin porter, where it agrees, should be taken at dinner; but
if ale or porter be given, wine ought not to be allowed. It would be
well to keep either to ale or to porter, as may best agree with the
patient, and not to mix them, nor to take porter at one meal and ale at
another.
608. Barreled, in this case, is superior to bottled porter, as it
contains less fixed air. On the whole, however, I should prefer
_home-brewed_ ale to porter. Either old, or very new, or very strong
ale, ought not, at this time, to be given.
609. Great care is required in the summer, as the warm weather is apt to
turn the beer acid. Such beer would not only disagree with the mother,
but would disorder the milk, and thus the infant. A nursing mother
sometimes endeavors to correct _sour_ porter or beer by putting soda in
it. This plan is objectionable, as the constant taking of soda is
weakening to the stomach and impoverishing to the blood. Moreover, it is
impossible, by any artificial expedient, to make either _tart_ beer or
porter sound and wholesome, and fit for a nursing mother. If beer or
porter be sour, it is not fit to drink, and ought either to be thrown
away or should be given to the pigs.
610. Sometimes neither wine nor malt liquor agrees; then, either new
milk and water, or equal parts of fresh milk and barley-water, will
generally be found the best beverage. If milk should also disagree,
either barley-water, or toast and water, ought to be substituted.
CHANGE OF ROOM.
611. _The period at which a lying-in woman should leave her room_ will,
of course, depend upon the season, and upon the state of her health. She
may, after the first fourteen days, usually change the chamber for the
drawing-room, provided it be close at hand; if it be not, she ought,
during the day, to remove—be either wheeled or carried in a chair—from
one bedroom to another, as change of apartment will then be desirable.
The windows, during her absence from the room, ought to be thrown wide
open; and the bedclothes, in order that they may be well ventilated,
should be thrown back. She should, at the end of three weeks, take her
meals with the family; but even then she ought occasionally, during the
day, to lie on the sofa to rest her back.
EXERCISE IN THE OPEN AIR.
612. The period at which a lady, after her confinement, ought to take
exercise in the _open_ air, will, of course, depend upon the season, and
upon the state of the wind and weather. In the _winter_, not until the
expiration of a month, and not even then unless the weather be fine for
the season. Carriage exercise will at first be the most suitable. In the
_summer_ she may, at the end of three weeks, take an airing in a
carriage, provided the weather be fine, and the wind be neither in an
easterly nor in a northeasterly direction. At the expiration of the
month she may, provided the season and weather will allow, go out of
doors regularly, and gradually resume her household duties and
employments.