The first duty of the physician, following the third stage of labor, is to
see that the womb is well contracted and control of this organ should be
continued for at least one hour after delivery. This generally prevents
excessive loss of blood. If necessary to promote womb contraction one
teaspoonful of ergot can be given. After the womb has been kept in a state
of contraction, the room should be rid of all evidences of labor and the
woman made comfortable. The buttocks and thighs which have been soiled
during the labor should be bathed with warm water and soap and the
external genitals sprayed with an antiseptic solution, then dried with
sterile gauze or cotton, the dressing applied to the vulva and the
temporary bed removed, her night dress pulled down and the patient thus
lying in a clean, comfortable bedding. The woman may then have a cup of
weak tea, hot milk or broth and be left to rest; but during the first
sleep the womb should be carefully watched lest it relax and serious, if
not fatal, bleeding occur. In a normal confinement the dressings need not
be changed, as a rule, oftener than six times in twenty-four hours, for
the first few days. As soon as convenient after the first toilet is
finished the physician sterilizes his hands and with the patient on her
left side introduces one finger into the rectum and the thumb into the
vagina to discover the condition of the perineum. Washing out of the
vagina is not necessary as a rule.
[OBSTETRICS OR MIDWIFERY 537]
The binder is considered indispensable, and should be made of unbleached
muslin and wide enough to extend from the pubic (bone) to the breast-bone,
and long enough to go around the patient's body and slightly lap. The
binder should be pinned or sewed tightest in the middle, but it should not
be so tight as to press upon the womb and crowd it backward or to either
side. It acts as a splint to the muscles and assists in resting them to
their natural condition.
Rest.--Complete rest of the body and mind is essential to the well being
of the lying-in woman. She is better off without any company, and should
see no one except her family for the first week or two. Outside visitors
should be prohibited. The lying-in room should be kept free from noise and
confusion, and the patient should be protected from annoyances of every
kind. She should remain lying on her back for a few days and immediately
following delivery she should not have a pillow for her head. Sleep is
very necessary and desirable, and mild medicines should be given to
produce it, if necessary. It is best not to sit up in the bed until the
womb shall have had time to become smaller, and has resumed its natural
position behind the pubis. Among the upper classes, when it takes the womb
longer to regain its normal size, three weeks is a good rule to go by
before sitting up in the room, and she should remain in her room until the
end of the fourth week. Among healthy women of the laboring class, whose
muscular system has not been injured by "culture" and social excesses, the
womb and appendages regain their normal proportions more rapidly; but even
they should remain in bed two weeks.
AFTER-PAINS.--Women who have borne children frequently suffer from the
after-pains, occurring at irregular intervals, for two or three days and
they may give rise to much distress. A few drops of spirits of camphor on
a lump of sugar will often give relief when they are not severe. Also a
drop of tincture of blue cohosh taken every two or three hours is
valuable.
THE BLADDER.--If the patient is not able to pass urine it should be drawn
once in eight or twelve hours or oftener if required. A No.7 rubber
catheter is best. After it has been used, it should be sterilized by
boiling and then kept in a bichloride solution (1-2000). It should be
washed off with boiled water again before being used to remove the
bichloride solution and greased with sterile oil. The parts should be
exposed to pass the catheter, the labia separated by the finger and thumb,
and the opening of the urethra and surrounding parts bathed clean with an
antiseptic solution; unless you are clean decomposing discharges from the
vagina may be introduced into the bladder and a cystitis set up. The care
of the bladder is very important. It is not so sensitive after the labor
and the woman may have urine when she does not think so. Sometimes she
passes a little after trying and then thinks there is no more in the
bladder. Even the attendants are deceived sometimes. I once had a case
where the mother was the nurse. At each visit I inquired as to the amount
of urine passed. I was told each time it was sufficient. She suffered
severely the second day in the evening. I went to see her and against the
protests of the mother I used the catheter and took away an enormous
quantity of urine. In such cases the bladder should be emptied slowly to
save the woman from shock.
A physician cannot always depend upon the patient's knowledge of her
condition even in such matters and sometimes even the nurse is at fault.
[538 MOTHERS' REMEDIES]
THE BOWELS.--There should be a movement of the bowels the second or third
day, and a soap and water enema containing a small teaspoonful of spirits
of turpentine and one-half ounce of glycerin, will usually be sufficient.
Later cascara cordial, castor oil, etc., may be used. Should the breasts
be much swollen and painful and fever arise, saline laxatives are needed
for two or three days, such as citrate of magnesia, rochelle salts,
hunyadi water or seidlitz powder may be given.
Care of the Breasts.--Careful attention should be given them from the
first. The nipples should be bathed after labor, with an antiseptic lotion
(bichloride, 1-2000), dried and then covered with castor oil, a small
square of clean sterile gauze being laid over each to protect the
clothing. Bathe the nipples before and after each nursing with a warm
saturated solution of boric acid and dry them carefully. The breasts may
be supported by a binder, made of a strip of muslin sufficiently wide to
extend from above to well below the breasts. If they are heavy and sagging
place a layer of cotton at the outer border of each breast and they should
be raised toward the middle line, the binder being pinned only tight
enough to hold without pressing upon them. The breasts should not be
pressed upon by anything. Shoulder straps can be pinned or sewed on the
binder if it has a tendency to slip down. Should the breasts be much
swollen relief can be obtained by massage with warm olive oil and by the
use of a breast pump. The tips of the fingers only should be used in
giving massage and the stroke should be light, from the circumference to
the center. Roughness and pressure must be avoided.
INFLAMMATION OF THE BREAST, Abscess; Broken Breast.--This usually results
from germs. The breast inflames, the milk tubes are choked and distended,
there may be fever. There is sometimes severe local pain, hard swelling
and an abscess forms and if this breaks it is called broken breast.
[OBSTETRICS OR MIDWIFERY 539]
Treatment, Preventive.--Support breast with a binder. The milk should not
be allowed to accumulate and cake. The breasts and nipples should be kept
clean and dry. Breast pump should be used if necessary to get out the
surplus milk. If the lumps continue and are painful, put cold applications
to the breast. Have child nurse at the other breast. If it continues and
will suppurate, apply moist heat, such as fomentations or poultices, and
then open thoroughly. Poke root makes a splendid poultice for caked
breasts. I have great faith in it. At the same time I give of the tincture
one drop doses every hour. It is a splendid remedy and the poultice and
remedy frequently stop the trouble. Inflammation of the breasts sometimes
occurs in babies, generally in the first weeks. The swelling can be
reduced by mild rubbing with warm carbolized oil used every day. Do not
rub hard enough to hurt the baby. After the rubbing, absorbent cotton with
carbolized oil should be applied and cover all with a thick layer of
cotton held on with adhesives. If the breasts form pus they must be
opened.
MOTHERS' REMEDIES. 1. Sore Breasts, a Never-Failing Remedy for.--"Take a
pint of raw linseed oil and four ounces tincture of camphor, mix and apply
a cloth saturated in the liniment to the affected parts, taking care that
the whole surface of the inflamed parts is covered with the liniment. When
the breasts become swollen or painfully inflamed, apply the liniment often
to prevent gathering." Even if they have gathered it is an excellent
outward application. It allays pain, is extremely soothing and seldom
fails to effect a cure.
2. Swollen Breasts, an Herb Treatment for.--"Chamomile flowers one ounce,
marshmallow roots one ounce, bruise and boil in one quart of water down to
a pint. Foment the breast with this liquor as hot as can be borne; and
then place the flowers and roots in a cloth and apply as a poultice."
3. Sore Breasts, a Hot Poultice for.--"Apply hot pancakes made of sour
milk, saleratus and wheat flour, large enough to cover affected parts.
Keep them changed often enough, so they will not be cold. This is an
excellent remedy to steam out the inflammation." This is an old tried
remedy and one to be relied upon. The steaming relieves the swelling and
inflammation and gives relief quickly.
4. Caked Breasts, Fresh Hops for.--"Fry one pint of fresh hops in a half
cup of lard until the lard is a rich brown, then strain, set away to cool
and use as a salve."
5. Sore Breasts, a Poultice of Peach Leaves for.--"Take enough peach tree
leaves to mix well with meal and water to the consistency of a poultice."
This poultice should be applied hot, but should only be used in cases
where the breast has matter or pus in it.
MOTHERS' REMEDIES.--l. Sore Nipples, a Good Wash for.--"Brandy and water
mixed together and put on the nipples will harden them but should be
washed off before the child nurses. If they are cracked, apply glycerin
with starch, or arnica ointment."
2. Sore Nipples, Good Family Ointment for.--"Four ounces of white wax, one
ounce bayberry wax, three ounces of spermaceti, one pint olive oil. Mix
briskly over a slow fire, taking care to stir it briskly until cool." This
is an excellent ointment for mothers when troubled with sore nipples; it
moistens the skin and forms a coating. It is good for dry, scurvy, chapped
hands, blotches on the face and all sores which require a mild ointment,
but should be assisted with internal remedies when the case requires it.
[540 MOTHERS' REMEDIES]
The Lochia.--By this term is meant the discharges from the womb and soft
parts after labor. They are mixed with blood at first and contain dark
clots, mucus, shreds of the after-birth and pieces of the membrane. They
become paler in color from the end of the third to the sixth day. After
this the color is yellow, greenish and contains pus and fatty cells, with
a little blood. This discharge varies in different women. In those who
menstruate freely and do not nurse they are usually copious; when
decomposed, they smell badly and the odor is penetrating. The flow may
cease entirely between the second and sixth week. It is increased by
exertions at about the time the patient begins to move about.
Diet.--This should consist at first of liquid, unstimulating food, given
in small quantities and frequently. If the baby does not nurse, the
liquids should be restricted. Some women on the first day can take milk,
milk toast, or if desired, dry or buttered toast with coffee, tea, weak
cocoa, according to the patient's taste. Water may be given if desired. On
the second and third days, simple soups or any of the following may be
added to the dietary: Meat broths, beef tea, soft boiled or poached eggs,
raw or stewed oysters (no vinegar or spices) and some simple dessert, such
as boiled custard or junket. During the next few days, chicken (white
meat), scraped beef or mutton in small quantities, baked potato, rice and
cereals may be given and by the end of the week a gradual return to the
ordinary diet may be made. Should there be any tendency to constipation,
the bowels should be opened by a simple enema (as before stated) or
glycerin enema, etc.; or by one or more doses, 2 drams, of the compound
licorice powder repeated in three or four hours, if necessary; or a half
ounce of castor oil, or a half glass of hunyadi water. Cooked fruits for
the constipation may also be given.
Bleeding After Delivery, Post-Partum Hemorrhage.--Bleeding from the womb
occurring six hours after delivery is called post partum and after that
time, is known as puerperal child-birth bleeding or hemorrhage.
Causes.--A relaxed condition of the womb, the retention of clots or parts
of the membranes, etc., in the womb, a full rectum or bladder, fibroid
tumors, deep tears of the cervix.
Symptoms.--If the bleeding is profuse, the pulse is fast, the woman looks
pale, anxious and feels cold, restless, gaping, usually it comes from a
relaxed, softened and enlarged womb.
[OBSTETRICS OR MIDWIFERY 541]
Treatment.--In severe forms no time must be lost in securing contraction
of the womb and the method employed for expelling the after-birth should
be employed to expel clots. Grasp the womb over the abdomen, employ firm
but gentle kneading, pressing downward. The pillows should be removed, the
foot of the bed elevated twelve to eighteen inches, a preparation of ergot
given by the mouth or hypodermically in the thigh. If these measures fail
the hand and arm should be sterilized and inserted in the womb, all clots,
etc., removed and pressure made over the abdomen on the womb while the
hand is still there. This pressure and presence of the hand close the
bleeding vessels in the womb. The hand should remain, while the kneading
goes on externally, on the womb.
This kneading should be kept up until the womb contracts. The hand can
then be removed from the vagina, while gentle kneading is slowly kept up
over the womb. The womb should be closely watched for hours after.
Bleeding very seldom occurs again, but it might. If the bleeding is more
of an oozing, an injection of very hot water, 120 degrees F., through a
long douche nozzle, directly into the womb cavity may be given. This is
very effective for any kind of bleeding. Lemon juice or boiled vinegar can
be added to the injection. Everything used must be perfectly clean or
child-bed fever may be caused by these measures. After the womb has
thoroughly contracted, it is sometimes of benefit to place a rubber bag
filled with cold water over the pubic bone to prevent subsequent
relaxations of the womb. Weakness can be met by hypodermics of whisky or
brandy and strychnine, one-thirtieth of grain, injected hypodermically to
stimulate the heart.
Pulse and Temperature.--The temperature may rise one to one and one-half
degrees without the case being abnormal. The pulse falls after labor,
ranging between sixty and seventy. A rise of temperature, a rapid pulse, a
flushed face, a chill, pain or tenderness of the abdomen, and abnormal
increase or decrease of the discharge, bleeding, or offensive odor of the
discharge should cause suspicion of child-bed (puerperal) fever. This is a
grave condition and results from infection which has taken place during
labor or afterward. The septic matter may be carried in on the fingers or
instruments by the physician or attendants, etc. The most usual sources
are unclean hands, instruments and clothing which come in contact with the
woman's genitals. The attack is usually ushered in during the second to
the fourth day by a chill, or chilly sensations, etc., rise of
temperature, rapid pulse, accompanied by headache and a feeling of
weariness. The discharge may be increased at first, but later diminished
and may cease; or it may be abundant, frothy and of a very fetid odor.
Secretion of milk may fail, the bowels are usually constipated, pain in
the abdomen develops.
Treatment.--If the interior of the womb is smooth, a single antiseptic
womb injection should be given; if it contains foreign material or is
rough, it should be scraped and then a douche given. This must be done
carefully and with absolute cleanness. Turpentine stupes should be placed
hot on the abdomen for the pain, or where cold feels more grateful the ice
bag or cloths wrung out of cold or ice water should be applied over the
abdomen, and covered with several thicknesses of flannel and changed as
soon as they become heated. Medicines to relieve the pain may be given.
Hot and cold sponging may be given to reduce the temperature, a little
alcohol can be added to the water or the cold or hot pack may be used.
[542 MOTHERS' REMEDIES]
Diet.--This should be nourishing and supporting, and at first, liquid and
consist largely of milk; but concentrated broths, jellies, and liquid
beef, peptonoids, are useful. Stimulants should be given in these septic
conditions. From one to two ounces of whisky may be given every three to
four hours in the form of milk punch and, if possible, as much red or port
wine also. Women in this condition can stand this treatment. Salines
(salts) should be given to keep open the bowels.
CONVULSIONS. (Eclampsia).--All forms of convulsions may occur during
pregnancy. They may occur during pregnancy and during labor. These are
usually the result of kidney trouble. The attacks occur most often during
the last three months of pregnancy. Their frequency is one to three
hundred to one to five hundred cases. It occurs oftener in the first
pregnancy, three to one.
Treatment.--Inhalation of chloroform to control the convulsion. Morphine
in one-half grain dose can be given if no chloroform is handy. Place the
patient in a hot water or vapor bath, or wrap blankets wrung out of hot
water around her, and pile the bedding on until a profuse sweat is
started. The sweating aids in eliminating the poison. Change the hot wet
blankets as often as necessary. If the convulsions do not cease the womb
must be emptied of its contents. If the convulsions occur during labor
they should be treated in the same manner. The mortality then is about
seven per cent. Chloral hydrate in thirty to sixty grain doses in three
ounces of water may be injected into the rectum if the other remedies
fail.
MILK LEG.--This is due to infection. It usually arises from an extension
of a blood clot (thrombosis) of the womb or pelvic veins, to the thigh
(femoral) vein, resulting in a partial or complete obstruction of the
vein. It may come in less frequent cases, from a lymphatic infection.
Symptoms.--They may develop at any time between the tenth and thirtieth
days or even later. These are general feelings of weariness, stiffness and
soreness of the leg, especially when it is moved. There may first be pain
in the region of the groin; or pain from the ankle to the groin and
followed by swelling. The skin of the leg becomes markedly swollen, white
and shiny. Later there is pitting on pressure, but not at first, because
the skin is extremely stretched. Fever may accompany the attack, but it
will subside long before the swelling of the leg has disappeared.
The vein may be felt as a hard lash-like cord, a red line of inflammation
marking its course along the inner and under side of the thigh. The
disease may last weeks, depending upon the severity of the trouble. The
affected leg is disabled for a number of months after recovery. Recovery
takes place as a rule. Absorption of the clot takes place, or the vessel
remains closed, and another (compensatory) circulation is established.
[OBSTETRICS OR MIDWIFERY 543]
Treatment.--The patient should lie in bed with the leg elevated and
swathed in flannel or cotton wet with some quieting lotion. The following
is a good lotion:--
Compound Soap Liniment 6 ounces
Laudanum 1-1/2 ounces
Tincture Aconite Root 1/2 ounce
Tincture Belladonna 1/2 ounce
Wet the flannel or cotton with this. After the acute symptoms have passed
the following ointment may be put on the leg:--
Ichthyol 45 grains
Iodide of Lead 45 grains
Chloride of Ammonium 10 grains
Alboline 1 ounce
The parts should not be rubbed lest a clot be loosened and travel in the
general circulation and thus endanger life.
Diet.--Should be supporting. Salts for the bowels.
[544 MOTHERS' REMEDIES]