Duties Of A Nurse During Labor
( Originally Published Early 1900's )
—Articles Needed in the Lying In Room—Preparation of the Bed—Personal Clothing of Patient-Number of Persons in the Room-Caution in Conversation-Attention to the State of the Bladder—Food—Vomiting—Cramp—Fomenting the Perineum in First Labors.
If the nurse is not already in the house, the appearance of the first discharge or " show " is a sufficient warning that she should be summoned. No time should be lost in obeying the call, for many women, especially if they have borne children previously, pass through all the stages of labor very quickly. On arriving at the house the nurse should make the necessary changes in her dress, and appear before the patient ready for duty. An opportunity will soon occur of forming a judgment as to whether the patient is really in labor, and, if so, how far it has advanced. If labor has actually commenced, the patient will, before long, cease speaking, suddenly grasp the nurse's arm, or the 'back of a chair, or whatever happens to be at hand, and exhibit other signs of suffering. The nurse will know, by the characters enumerated on a previous, page, whether this is a genuine labor-pain or not, and will observe how long it lasts and the degree of its severity. When it is over, she should inquire when the pains began, how often they return, whether the waters have been discharged, ' and other similar questions, in order that she may know what kind of message she is to send to the medical attendant, who ought at once to be informed that his patient is in labor.
Let me now suppose that the nurse has made sure that her patient is in labor, and that she has acquainted the medical attendant.
If the bowels have not been freely opened within the last six hours, it will be desirable to give a simple enema of soap and water. The emptying of the lower bowel will facilitate the labor, and will save both the patient and attendant the annoyance caused by the passing of fæces during a later stage. This having been attended to, the patient may be allowed to sit up in a chair or walk about the room, according to her inclination, provided it is clear that the labor has not yet reached its second stage. If it is night-time, however, it is better for her to remain in bed, in order that she may, if possible, get a few moments' sleep between the pains. During the early stage of labor it is of no use for patients to "hold their breath and bear down" during each pain, as they are often urged to do by untrained and inexperienced nurses. It must always be left to the medical attendant to decide when bearing-down efforts have become desirable and ought to be eucourouraged.
It is often a great relief to a patient for the nurse to support her back with her flat hand during a pain. In the meantime she should see that all things are in readiness for the actual confinement.
In addition to the above it is advisable to have in the room some good brandy, a fan, a syringe, a foot-bath, and a nursing-apron.
The Binder usually consists of two pieces of stout twilled cotton, each. two yards long and of good width, the edges of which are stitched together so as to make the binder of double thickness. On an emergency, a small tablecloth or cotton sheet, suitably folded, answers the purpose very well.
The Receiver should be of flannel made of double thickness, and large enough to wrap the child thoroughly. The flimsy receivers sometimes used are only fit to protect a doll. A good thick flannel petticoat, or a cot blanket, is as good as anything.
The Thread or Worsted for Tying the Cord must be made ready in the following way: Twelve equal lengths, measuring about a foot, are to be laid side by side and arranged evenly. Six of these lengths, are then to be knotted together at a distance of about two inches from each end, and the remaining six in the same way, Having been thus prepared, the threads must be laid on the dressing-table, and a pair of good scissors by the side of them, ready for handing to the medical attendant at the proper moment.
The Preparation of the Bed is a matter of considerable importance, and ought to be attended to during the early part of labor. Women. are usually delivered lying on the left side, with the knees drawn up towards the abdomen. The right side of the bed, therefore, is the one which requires preparing, and that part of it near the foot is preferable because the upper part of the bed is thus kept clean and comfortable for the patient when the labor is over, and because of the help derived from being able to plant the feet firmly against the bed-post during the pains.
The mattress being uncovered,. a large piece of rubber cloth is to be spread over it, and upon this a sheet folded several times. Next to this should come the clean under-sheet, on which the patient is to lie, and upon that another piece of waterproof sheeting, large enough to reach above the hips. Over this upper rubber, and ready to be removed with it after the labor is over, are to be then placed a folded blanket, and, lastly, a folded cotton sheet, both of which should reach well above the hips, so as to absorb the discharges.
Two pillows are then to be put in the centre of the bed, so that the patient may lie with the upper part of the body directly across the bed, the hips being as near the edge as possible. The upper bed-clothing during labor should consist of a sheet, one blanket, and a thin counterpane, which should completely hide from exposure every part of the patient's person, except the head and neck. A long roller-towel should be fastened to the bed-post at the patient's feet. Nurses often make the mistake of fixing this to the post at the opposite corner, or even to one of the posts at the bed's head. A very little consideration, how-ever, will make the inconvenience of this arrangement apparent, By grasping the end of a towel, attached in the way I have recommended, the patient pulls herself still closer to the edge and foot of the bed; whereas, by pulling at a towel fastened to one of the posts on the further side of the bed, she drags herself away from the very position which it is desirable she should preserve. The same objection, of course, applies to supplying the place of the towel by means of the hands of an attendant standing on the left side of the bed. This should never be encouraged, as it always has a tendency to displace the patient, and to render it difficult for the medical attendant to give needful assistance.
As labor advances, and it becomes necessary for the patient to be placed in bed, she should put on a clean chemise and night-dress, which should be rolled up under the armpits out of reach of the discharges, while the soiled chemise and night dress should be slipped down from the arms and shoulders, and loosely fastened round the waist. (Amongst the working classes it is still too much the custom for women to he confined in their every-day dress. It is a practice that ought always to be discountenanced.) The hair should be dressed in such a way that the continuous lying in bed after the confinement will not drag upon or entangle it more than is inevitable.
It is very undesirable for a woman in labor to be surrounded by a number of friends and neighbors. In most cases the nurse herself is the only attendant that is really needed, although the presence of one other person (the husband) should not be objected to, if the patient wishes it.
No nurse should ever allow herself to be teased into prophesying that the labor will be over by a certain hour. If such prophesies turn out incorrect, as they are most likely to do, the patient loses courage and confidence. All gossip ii to be avoided, and nurses should be particularly careful to make no reference to their past experiences, especially such as have been unfavorable. A good, kind nurse will not be at a loss for a few helpful and encouraging words as labor goes on, and will not need to have recourse either to foolish promises or dismal anecdotes.
Every now and then the patient should be reminded to pass water, lest the bladder should become so full as to hinder labor. This point is often neglected, partly because the attention is so preoccupied that the desire to empty the bladder is scarcely perceived, and partly because when the waters have broken, the escape of a little gush of amniotic fluid during each pain often misleads the patient, making her think she has passed urine when really she has not.
Food for the Patient.—In the early part of labor when pains are slight and the intervals long, there is no reason for interfering either with the character or regularity of the patient's ordinary meals, provided there exist the desire for solid food. During the later stages, however, it is wise to confine her to fluids, such as beef-tea, gruel, milk, and tea, and to administer them in small quantities at a time, so as not to overload the stomach and excite sickness. Patients often ask for a little cold water, and many nurses, influenced by old traditions, fear to gratify the wish. A sip of pure water can never do harm, only it must be a "sip" and not a tumblerful, the patient being assured that small draughts, frequently repeated, assuage thirst far better than larger quantities. On no account must stimulants be given, except when expressly ordered by the medical attendant.
Vomiting is a troublesome symptom and distresses the patient, but its influence on the progress of the labor is in no way unfavorable. Should it, however, be excessive, it is well to give a little iced effervescing water from time to time.
Cramps During Labor.—Many patients suffer very severely from cramp during labor. Relief can frequently be obtained by stretching the limb straight out, and at the same time bending the ankle so as to put the muscles of the calf well on the stretch. Gentle rubbing of the affected part with the hand also affords great comfort.
In the case of patients who have not borne children previously, it is an excellent plan to diligently foment the perineum from the very outset of labor, so as to render the skin softer and more yielding, and lessen the risk of tearing