Normally, the duration of pregnancy is nine months. The best mode of reckoning is to count two hundred and eighty days, or forty weeks, from the last day of the last menstrual period. (See Obstetric Table under PREGNANCY.) The duration of labour is very varied. Frequently the pains begin some days before labour is accomplished. From four to six hours is the average duration of the severe pains, but some women have hardly any pain at all. Towards the latter end of the time the child sinks lower in the abdomen than it was before, and the woman becomes smaller around the waist than she has been for some weeks before. Labour is often preceded by nervous symptoms, trembling, disposition to tears, low spirits. Looseness of the bowels should not be interfered with. The actual onset of labour is announced by a slight reddish discharge, called a “show.”
General Treatment.–The care of a woman in child-birth must only be undertaken by a doctor or a midwife, but there are points in the general management of the patient, both before and after confinement, that ought to be attended to. Under BREASTS I have described the attention that ought to be paid to them during the later months of pregnancy. The best ordinary preparation is attention to the general health, taking plenty of plain, unstimulating food and open-air exercise. Sometimes at the beginning of labour, and occasionally two or three days, or even weeks, before the actual onset of it, women suffer from “false pains.” These may be relieved by medicines.
Medicines.–(Every hour or two.)
Actea rac. 3.–
This may be given three times a day almost as routine practice for the last six weeks of pregnancy. It has great effect in assisting the organism to prepare for the effort, and in promoting normal delivery.
Nux vomica 3.-
Pains in abdomen and back; constipation; in passionate persons.
Pains in abdomen and loins, as if from continued stooping; stiffness; aching and dragging in thighs; diarrhoea or constipation from eating fat or indigestible food. In mild- tempered persons.
During Labour.–Drugs and stimulants of all kinds should be avoided.
Flooding.–This is one of the most dangerous incidents of child- birth, and it is well that every nurse should know how to deal with it, as a doctor cannot be always obtained immediately. A certain amount of bleeding is natural, and need give no alarm.
Also the waters mixed with blood give an appearance of excessive bleeding when there is actually not much. It is when the blood comes away in gushes, after the child is born, that the condition is dangerous.
Treatment.–Keep the patient perfectly quite. Give no warm drinks. Let the patient smell a little vinegar. Place the hand on the body low down and press so as to get the womb to contract and expel the after-birth. If this fails, introduce the hand into the womb and take firm hold of the after-birth (not the cord. but the whole after-birth), and draw it out, keeping pressure with the left hand on the body all the time. If the bleeding does not then cease, inject water as hot as the hand can be borne
Medicines.–(Every five minutes until bleeding is arrested.)
When there is giddiness, faintness, or loss of consciousness.
When there is nausea or vomiting.
After Delivery.–The patient must be kept perfectly quiet for an hour. If, after the lapse of this time there is no bad symptom, especially no bleeding, she may have her things changed and her bed made. A bandage (or “blinder”) should always be applied immediately after delivery, and this can be done without disturbing the patient.
After Pains are troublesome contractions that come after delivery in women who have borne children before. They seldom occur in first labours. They may be checked by medicines.
Medicines.–(Every hour until relief.)
Not very violent; accompanied by a feeling of soreness.
In nervous, excitable patients, with restlessness.
Pulsatilla 3.– In persons of mild and gentle disposition.
Belladonna 3.– Much bearing down; fulness of the head; tenderness and fulness of abdomen.
Duration of Confinement.–This will depend on the individual patient. The usual period is nine days, and that should be the least allowed. The patient may get up for a time on the tenth day if all has gone well. But if there has been any drawbacks she must be kept in bed longer.
The Diet should be at first very light, consisting chiefly of gruel, milk, and farinaceous food, beef-tea, and eggs. After a few days a mutton chop may be given as gradually ordinary diet may be returned to.
Diarrhoea sometimes occurs during the period of confinement. This is a bad symptom, and must be attended to at once.
(Every hour until relief.) When there is much ineffectual straining; chilliness; mucous discharge; in night and early morning. See also DIARRHOEA.
Constipation is a normal state for the first few days and need not be interfered with. After five or six days medicines may be given (every three or four hours until relief). Sometimes an enema is necessary. A pint and a half of warm barley-water makes a very good one.
Bryonia 3.– When there is fulness in the head and pains in the bowels.
Nux vomica 3.–
After Bryonia See CONSTIPATION.
For care of breasts and nipples, see BREASTS.
For the management of the child, see INFANTS.
For weaning and milk affection, see MILK and MILK-FEVER. See also WHITE LEG.