Читать книгу Mother, Nurse and Infant - S. P. Sackett - Страница 11

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True labor pains are distinguished from the false by the fact that they are felt considerably in the back, passing down to the thighs, and by their coming on at regular intervals. At first they recur nearly every two hours, and they steadily increase in number and frequency, and are grinding in their character. There are other signs which denote the actual commencement of labor; there is usually a frequent desire to empty the bowels and bladder, perhaps shiverings or rigors unattended with a sensation of cold, sometimes a severe rigor, and these signs are preceded or accompanied or followed by a discharge of mucus and blood, called the show.

It is well now to send for the medical man, though if he lives near by it is only necessary to let him know that his services may shortly be required. If the patient suffers from nausea, vomiting, or chills and shiverings, let her know that they are only incidents of her labor and not unfavorable. Do not let her increase the pains or attempt to increase them in any way; it is much better that the labor should progress in a natural manner, even if it is very slow.

The preparation of the bed for the occupancy of the mother is now to be attended to. Cover the right side of the bed (as the patient will probably lie on her left side) with a piece of water-proof cloth or oil cloth; upon the top of this a sheet is to be placed and fastened with safety pins. Over this permanent dressing (on the top of the bed sheet) a neatly folded draw sheet is adjusted (and a second rubber and draw sheet is desirable), which, after the labor, can be removed, leaving the first clean and dry. This second draw sheet and rubber, and also a folded comfortable can be placed a little nearer the foot of the bed than the other, and after the lady’s confinement she can be drawn up on the permanent dressing, and the temporary dressing can be easily removed. The other bedclothes may be adjusted in the usual manner.

A piece of carpet can be thrown on the floor by the side of the bed, and it is well to have a hassock to put between the patient’s feet and the foot-board or bed-post.

To dress for the occasion, a folded sheet should be adjusted around the waist (or, instead of this, or above this, a petticoat), to extend from the waist to the feet. (These will be removed after the delivery.) Then a chemise should be put on in the usual manner, and drawn up and folded high under the arms. She should then have on a clean nightgown, and over it a warm wrapper; this can easily be slipped off when she is about to go to bed, and the night-dress, if it is a long one, can be folded up under her arms, so that it will not be soiled.

The STAYS must not be worn, as that prevents the free action of the muscles of the chest and abdomen. The patient, during the first stage of labor, may walk about or sit down, and need not confine herself to the bed. She may be allowed such food as she can eat, but should not be urged to take food.

The best beverage for her is either a cup of warm tea, or of gruel or arrowroot. Cold water will not hurt her if she desires it. A patient ought, during labor, frequently to pass water. Some women, from false delicacy, do not attend to it, and suffer severely for it.

The doctor ought to have some room to retire to that the patient may be left very much to herself, and that she may have opportunity whenever she desires to of thoroughly emptying either the bladder or bowels. It is better that not more than two women be present with her, and even one of these can be dispensed with if necessary.

The room should be kept quiet.—Let the attendants be quiet and self-possessed, and let there be no noise, or excitement, or whispering. There may be ordinary cheerful conversation, but when the pains become very frequent and severe, it is best that this should be hushed enough to have the patient feel that the attendants are not neglectful of her, or careless about her. Cheerful words spoken to the patient of the blessed relief that will come after enduring so much pain will do good.

When the membranes are ruptured and the waters discharged, the doctor should be called in immediately. When he is present you will be subject entirely to his direction.

If the medical man cannot be present pretty soon, I advise any nurse who has diligently studied this book to make a digital examination, and ascertain if there is a head presentation; if there is, there need not be any anxiety about getting a doctor.

If the child is born before the doctor has time to reach the house, let the patient be made to understand that there is not the slightest danger; and, for yourself, observe the following directions:

Ascertain if a coil of naval string be about the neck of the infant; if there is, remove it immediately. See that it has room to breathe; that there is not a membrane over its mouth, and that its face is not buried in the clothes or the discharges. If the child cries, give a minute’s attention to the mother, to see that she is in an easy position, and for a few minutes make pressure with one hand over her abdomen. If the child does not cry the moment it is born, give it a smart blow on the back, sprinkle a little cold water upon it, and put your finger in its mouth to remove any mucus that may interfere with respiration.

After the child cries, and when no pulsation can be felt in the cord, tie and cut it. Tie with a strong and not too fine a string, about one and a half inches from the child’s body, and cut so as to leave that portion of the cord attached to the child’s body about two and a half inches long. Cut far enough from the ligature so that it will not be liable to slip off. The ligature should be drawn tight when applied, and it ought to be examined afterwards to know that it does not continue to bleed.

I shall here summarize, in a very brief way, what you are to do in the absence of the doctor: After the child is breathing properly and the cord is cut, the mother may receive your attention. If the placenta is not expelled spontaneously, place one or both your hands over the uterus, and by friction, squeezing and pressure there, you will probably cause enough contraction of the womb to start the placenta from its attachments. You may then make slight traction on the cord, pulling only gently, and it will probably come down; as it emerges from the vagina gently twist or turn over the afterbirth, and you will secure the removal of the membranes.

The soiled articles are now to be removed, a binder applied, the patient placed nicely in bed and kept quiet; no talking, no visiting, no excitement allowed.

The baby may now be attended to—be washed and dressed. Have at hand a bowl of warm water, a small quantity of lard or oil, soap, fine sponge, and the articles of clothing, including a binder, and by preference a piece of flannel for washing. It is well also to have a small tub large enough to dip the child in. If the child is much covered with the “vernix caseosa,” rub it over with some unctuous substance, and then wipe it off with the flannel or some soft cloth, being careful at the same time that nothing gets into the eyes of the child, and being careful to remove all the cheesy matter from the angles of the joints, and from behind the ears. Have the water for the bath warm, but not hot; take hold of the feet of the child with your right hand and putting the left under its back and shoulders, lower it into the water, supporting its head by your arm. While supporting its head with your left hand, wash it all over, using toilet soap and (if you have it) a fine, clean sponge; then lift it out into a warm towel and dry it thoroughly. Dust with fine starch powder, made of wheaten flour, under the arms and between the legs, and dress the naval by using a soft piece of linen dipped in vaseline and having a hole in the center. It is well to put another piece of linen around the cord, which may then be turned upward or to the left side, and the binder applied. Some prefer to put absorbant cotton around the cord. The binder or belly-band should be made of flannel, and should be cut bias. Care should be taken to apply it tight enough not to slip, but too tight an application should be particularly avoided. All the garments of the child should be made subservient to comfort and not to show; should be warm and not too small; should consist in part of flannel during cool weather. When dressing the child put one garment inside the other, and put the whole on over the feet. But few pins need to be used if the clothes be properly arranged; three pins are sufficient for the binder. The washing or dressing of the child should be done quickly; a little cold water should be given it; it should be all the time in a warm room, and may be laid where it is quite warm.

The mother may demand a little more attention before the child is applied to the breast. A folded napkin should at first have been applied to the vulva. Look to it and see if it is much soiled with blood. When it is, apply a clean one, and observe particularly that one is placed so that it is partly under her; observe if her bandage is well retained in its place, and if it presses well on the lower portion of the bowels. If the binder is kept well adjusted it does good; it is of no use if it is allowed to slip up from its place. A towel folded and laid over the lower portion of the bowels, under the bandage, is useful as a compress, and helps to keep the binder in place.

Everything should be arranged so that the patient can have rest and quietness; but before she goes to sleep put the child to the breast. If the nipple is retracted, an ordinary tobacco pipe may be used to draw it out so that the child can get hold of it. If the child draws on the breast, the milk which it obtains will serve to physic it, and it should be applied to the breast every four or five hours; nothing else need be given it, except perhaps a little sugar and water.

If necessary to induce the child to take the breast, a little sweetened water or sweetened milk may be applied to the nipple. While the child is nursing the mother may lay upon her side, and receive the child upon the arm of that side upon which she is lying. Perhaps, in order to draw out the nipple so that the child can grasp it in its mouth, it may be necessary to use some bottle with a flat, smooth mouth; fill the bottle with hot water; after a minute, empty it and place the mouth of the bottle immediately over the nipple; as the bottle cools there will be sufficient suction to elevate the sunken nipple.

Soon after the termination of the labor the woman may partake of some light food—tea and toast, panada, or anything of a light, unirritating character. From the very first, under ordinary circumstances, the woman may be permitted to change her position as she may desire, from side to side, or to be propped up in bed. Before going to sleep she ought to urinate—in a lying position, if so inclined, or she can be raised up and supported in a sitting position for a few minutes, if she desires to be. The patient must not be allowed to exert herself, or remain too long in a sitting posture. But I have never known a woman to be harmed by being raised up and sitting for a minute at this particular time.

Unless there is unusual suffering from afterpains or hemorrhage, or something that requires the attention of the physician, the patient will now be desiring and seeking sleep, and everything should be arranged for this object.