CHAPTER VI.
PREPARATION FOR LABOR.
Duration of Pregnancy. — In all calculations of the duration of pregnancy it is customary to assume as the starting point for the reckoning of gestation from the date of last menstruation. While the cessation of the menstrual period is not a positive sign of preg- nancy, it is a very important sign where pregnancy exists, as it is the starting point of gestation, and we count from that period. The duration of pregnancy is normally two hundred and eighty days, and we divide this space into ten (luna) months of twenty- eight days each, or nine (calender) months of thirty- one days each, or forty weeks. Another method is to add seven days to the date on which last menstrua- tion began and count forward nine months of thirty- one days each. The date thus obtained is said to be usuallv correct within a week. Naegele gives the following rule to compute this period: ''Count for- ward nine months from the first day of last menstrua-
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Fig-. 14 — Obstetric calendar devised by Dr. Wm. L. Kantar of New York will be found useful to nurses in cal- culating date of expected labor.
tion or backward three months, and add seven days After February in leap-year add six days." As for ex- ample, September 1st, was the first day of last menstruation, count backward three months, which gives June 1st, add -even days which gives June the 8th. as the expectant day of confinement. In first pregnancies,
or as we say, in case of primparae, labor is apt to begin a week or ten days earlier than this, as the uterus is not so tolerant of distention as it may afterwards be in later pregnancies. These are not always reliable guides, but are based on the theory that conception is most likely to take place just after the close of the menstrual period. "When the date of last menstruation cannot be obtained, we reckon the date of labor by adding twenty-two weeks to the date of quickening which is supposed to occur in the eighteenth week of pregnancy. It is the earliest movement of the fetus preceived by the mother, when she first feels life. But there is no rule or method which will insure accuracy in re- gard to the day on which labor will occur. The full term of pregnancy normally, is two hundred and eighty days. This may be prolonged to three hun- dred and yet be perfectly normal.
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Fig. 15 — Human embryos from the second to the fifteenth week
The Obstetrical Nurse. — The nurse like the phy- sician should be engaged early in pregnancy, and the best obtainable should be procured. This delicate branch of the profession requires higher skill than an}- other form of nursing, comprising, as it does of surgical, medical and infant nursing combined For these reasons only the best nurses, those with special aptitude for this particular branch of nursing should adopt this specialty. A certain date is usually agreed upon from which date the nurse is paid her full salary, her time from that date is her patient's and she is subject to her call. It is better, if con-
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venient for the patient; the nurse to be with her a day or two before expectant confinement, so as to see that everything is in readiness for the all impor- tant event. It is very desirable that the nurse sleep at the house at night after the time has expired, and baby is expected.
Outfit For Mother And Child. — If previous arrange- ments have been made with the expectant mother, the nurse should make out a list of needed articles .so that ample provision may be made. The following list contains the essentials articles, but a more ample and elaborate one according to the means or taste of the mother may be given. The outfits may be divi- ded into two parts. One consisting of articles re- quired for the mother's use ; the other the articles needed by the baby.
Outfit For The Mother. — For the mother is needed, one flannel wrapper or kimona of light material, six plain night gowns, four abdominal binders, one and one-half yards long by one half yard wide. These should be made of strong unbleached muslin. The length of the bandage differs with the size of the patent, according to her size. They should be torn the proper length and size and the selvage torn off; as this cuts and binds the tissue. Neither should they be hemmed. Leave the edges raw.
Six breast bandages, the length differs according to the size of the individual. But should be at least ten inches longer than the measure around the bust to allow for the increased width upon the estab- lishment of lactation. The best bandages are those cut like a waist, with arm holes and fitted to the figure as shown in illustration.
One dozen occlusion bandages or "swathe" to hold
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the dressings in place. A good quality of outing- flannel makes the best bandage for this purpose. It is softer and more comfortable for the patient. These may be hemmed. They should be about one yard long and about ten inches wide. It is best to have the abdominal, breast and occlusion bandages laund- ered, as it makes them softer and more comfortable.
Six draw sheets or large pads. These may be made of cheese cloth stuffed with cotton, nonabsor- bent or raw cotton, about two inches thick. They should be tacked to keep the cotton from slipping,, and when soiled can be burned. Or old clean sheets, folded together can be used for this purpose. Large quilted pads can be had at large dry goods stores they are excellent for this purpose. They can be laundered. The pads are used to protect the bed, the first three or four days when the flow is the greatest.
Two pounds of good sterilized absorbent cotton, five yards of plain sterilized gauze in a glass jar. Many pieces of old clean cotton or linen cloths sterilized in the oven, for wiping the anus and per- ineum during labor. Many physicians prefer the sterilized old cloths to absorbent cotton for this pur- pose, six clean sheets, these should be as freshly laundered as possible, two dozen towels, old ones that are without fringe are the best, six dozen safety pins, four dozen large and two dozen medium size. three hand brushes that can stand boiling. The best are those with plain wooden backs, costing about ten cents apiece, one pint of alcohol, 95 per cent, for dressing the nipples, and to be used for the patient's comfort, four ounces of fluid extract of witch hazel, one douche pan, the perfection pan is best, a douche pan is preferable to a bed pan as it can be used for either purpose, one small granite pitcher,
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holding about two pints, to use in giving the pitcher douches, one bottle of fluid soap, or six ounces of green soap, can be had at any drug store, three granite wash basins, a piece of rubber cloth, four feet by six feet for protecting the bed, white enamel oil cloth may be substituted for the rubber when economy requires, a piece of oil cloth for protecting the carpet by the side of the bed, or old newspapers may be used by spreading them out besides the bed a three quart fountain syringe, a hot water bag, a slop jar or bucket, a tube of white vaseline, one bot- tle, large size, of bichloride of mercury tablets, for making the solution, one pint of whiskey or brandy, one bottle of chloroform, fluid extract of ergot, three ounces, one pint of sterilized vinegar. Impress upon your patient the importance of having- this thoroughly sterilized, both jar and contents, to use in the non- contraction of the uterus or hemorrhage. If you have any doubts as to the proper sterilization of same, it is best to attend to it yourself. And when labor occurs there should be on hand six gallons of cool boiled water, and three gallons of boiling water, and ice in a convenient place in a basin of antiseptic, in case it is needed by the physician. Instruct your patient to have plenty of towels, sheets, pillow cases and gowns. It is so annoying to ask for these articles and find out there are none to be had. Especially towels. Have them within easy reach so if needed after labor can be had without confusion
Outfit For The Baby. — For the baby will be needed a bottle of olive oil, six ounces, for annointing the baby immediately after birth, one pint of saturated solution of boric acid, to be had at any drug store, to use for baby's eyes and mouth. Dilute one-half
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when using it. A piece of pure castile soap, one box of talcum powder, two soft sponges of different sizes, small one for the face, and larger size for the body, one skein of narrow linen bobkin tape, for tying the cord, Boric acid powder, three ounces, to use to dust around the cord and umbilicus after the cord is off, one soft hair brush for baby's hair, one powder puff, to brush off all superfluous powder from the body, or a little soft brush like the one used for brushing baby's hair is best, two large, soft bath towels, to wrap the baby in during its bath, four dozen cotton diapers. The cotton is prefered to linen as they are warmer and cheaper. They should be cut so they are twice as long as the}' are wide. As the "birdseye" comes in two sizes, it is well to have some of each. Several dozen large squares of old clean cloths to put in the baby's napkins the first few days until the intestinal track is entirely free of the meconium. These to be destroyed afterwards by burning. One soft woolen blanket to wrap the baby in immediately after birth, one bath tub or large wash bowl to use as a bath tub for the baby, six flannel binders, eighteen inches long and six inches wide, these like the mother's should have the selvage torn from them, unhemmed, and the edges left raw so as not to compress the tissue, four long sleeve flannel or silk shirts, six flannel pinning blankets, four flannel skirts, six night gowns, eight plain slips, two dozen safety pins, one dozen smallest size and one dozen medium. The foregoing wardrobe is the small- est possible one in which the mother and baby can be kept clean, sweet and comfortable. The mother's and baby's wardrobe should be laid away in separate convenient places where they will be accessible to
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both doctor and nurse. Bureau drawers are preferred which have been cleaned and prepared for this pur- pose. If you cannot have the clothing as you would like, do the best you can under the circumstances.
Selection Of The Room. — -The choice of the lying-in chamber is a matter of great importance. If to the nurse is left the selection, choose one that is large.. well ventilated and as far removed from the toilet and bathrom as possible ; one that can be kept at a uniform temperature of sixty-eight to seventy degrees Fahrenheit, and if possible, one that has the southern exposure. The sunlight is a very important agent in the sick room and should always be introduced when possible. An open fire place is a very desirable feature, as it serves a double purpose, heating and ventilating at the same time. Under no circumstances can a room be used which has been occupied by a patient suffering with a contagious disease or sup- purating wound, such as diptheria, scarlet fever, erysipelas or cancer ; nor any of the furniture used by such a patient be admitted into the lying-in room. If, however, the bed chamber is used as the lying-in room, and this is generally the customary rule, the unnecassary draperies, ornaments and all superfluous furniture should be removed and the room thoroughly cleaned. The walls brushed down so as to remove any particles of dust, the room well swept, and the furniture wiped with a damp cloth. During the day. if the room is not in use, the windows should be left open so it may be thoroughly aired and ventilated especially if used as a sleeping apartment during the night. In case an infectious disease has occurred in the house, have the house thoroughly disenfected. If you are with your patient see that these instructions
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are carried out. If not expected until labor is im- minent, leave instructions with the expectant mother and put stress on their being carried out one week before expected confinement. This will insure more safety for your patient, the cleanlinness of the room and its contents. Freedom as far as possible from germs and dust are of vital importance. The removal of unnecessary furniture will render it more con- venient for the doctor during labor and delivery, as it alllows him more freedom. The room, however, should not be made to appear bare or cheerless, and particular attention should be paid to artificial light. The best obtainable should be procured, and a drop light is best for this purpose. Where a coal oil lamp must be used, it should be in good condition and have a reflector.
STERILIZATION.
Labor Pads. — Labor pads, vulva pads, operating gowns and towels may be sterilized by putting them up in separate packages, wrapped in a sheet and securely pinned and steamed one hour. They are dried by placing them in the oven and baking them. Open only when needed. This is. however, not a very satisfactory method. They are hard to dry thorough- ly and should be used almost immediately as they will milldew if not perfectly and thoroughly dried It is best to get ready all things necessary, wrap each class of articles in a separate package, labeling each, then wrap all the packages together in a sheet making one large package, and have them sterilized at some hospital. If this is impossible, make your OAAm dressings, using for this purpose sterilized cot- ton and gauze. In making your own dressings, first clean your hands as for a surgical dressing, then with
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a pair of sterile scissors cut the gauze and cotton the size desired for the pads. These pads made in this manner are sterilized and surgically clean, and each pad can be made in this manner as needed. But we must use care to keep them surgically clean. Handle the gauze and cotton with clean hands and instru- ments. They must be surgically clean. Unroll the cotton and remove the cover from the jar before- cleaning and disenfecting the hands. Johnson & Johnson, also, put up two different maternity out- fits that are to be recommended, they are the "Simp- son's" and the "Cooke." These may be had through any drug store.
INSTRUMENTS. Rubber sheets or oil cloths may be sterilized by washing off with a one to a thousand bichloride of mercury solution. Rubber syringes and douche bags may be sterilized by boiling twenty minutes in plaii^ water. Hand brushes are sterilized by boiling twenty minutes in plain water. All instruments are sterilized by boiling twenty minutes in a four per cent of bicarbonate of soda solution. The instru- ments should be wrapped in a towel before placing them on to boil and kept wrapped until needed. The needles should be run through a piece of gauze or cloth, and then rolled up, and should remain so un- til needed.
Bed pans are sterilized by boiling twenty minutes in a wash boiler or washing them thoroughly in a one to one-thousand bichloride solution.
The basins should be filled two thirds full of water, place one basin over the other, covering in the steam, place them on the stove and boil twenty minutes.
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When sterilization of the sheets or labor pads is impossible, boil one dozen towels in a one to a thousands bichloride solution twenty minutes, and with surgically clean hands, according to directions given below, wring the towels out as needed and place them immediately under the buttocks of the patient over the pad. Remove the towels when soiled and replace with a fresh one. This insures safety for your patient and renders the sterilization of the sheets unnecessary. Allow the towels to remain folded when placing them on to boil and only unfold as each is used. For vulva pads for the first hve days use first a thin pad of absorbent cotton boiled in a one to live thousand bichloride of mercury solution, or a one per cent of lysol solution. Have the pad large enough to entirelv cover the birth canal and hairy re- gion so as to prevent any germs entering the genitals. Over this a large pad of dry sterilized absorbent cot- ton, or use absorbent cotton wrapped in sterile gauze.
Sterilization Of The Hands. — Scrupulously clear) the hands. Scrub the hands and forearms Avell with a soft brush, soap and water, paying special attention to the linger nails, which should be cut short, and between the fingers, then wash off with plain sterile water. Afterwards immerge them for several minutes in a solution of bichloride of mercury in the strength of one in two thousand. Use all precaution to pre- vent puerperal sepsis.
OTHER DIRECTIONS.
Other directions than these must come from the phvsician in charge of the case.
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