Under the term labor includes the physiological process of childbirth. The nurse should position the patient with their elbow to avoid soiling them. Wash the patient's genitals, lower abdomen, perineum, and thighs using a one-to-two-thousand bichloride of mercury solution. After cleaning, apply an antiseptic vulva pad made from dry sterilized cotton held in place by a T-71 bandage. This protects the parts and absorbs any discharge. The patient should be warned not to touch or sit on the water closet after this preparation. Dry other areas with a clean towel. Dress the patient in nightgown, stockings, slippers, and a bathrobe or kimono of light material. Encourage walking until severe pains start or amniotic sack ruptures. If pains are severe and change from back to front, put the patient to bed before membranes rupture.
Second stage labor begins with full dilation of the cervix and ends with expulsion of the child. Pains become more intense and frequent as labor progresses. After amniotic fluid escapes, the uterus contracts down on the child, causing a desire to strain and bear down. Each pain increases cervical dilation until the child descends into the pelvis and is expelled. The first pains are described as grinding; later they feel like cutting and bearing down.
After rupture of the amniotic sack, if membranes have not ruptured and fetus descends to vulva, gently rupture with finger-nail but never before presenting part is visible at vulva. If ruptured while child is in cervix, labor will be slow and tedious. In rare cases, entire ovum may be expelled without rupturing coverings; such a case requires immediate rupture of sack.
Patient should remain in bed after rupture of amniotic sack and severe pains begin. Use sterile slop jar or chamber for evacuation needs. When patient remains in bed, use bichloride pad to cover genitals until head is visible at vulva. Change pad as often as it becomes soiled; hands must be disinfected before changing.
When doctor arrives, prepare the bed with a flat hair mattress covered by sheets and rubber sheet or enamel oil cloth. Place labor pad on right side of bed midway between head and foot. Prepare table with necessary items for doctor: fluid extract of ergot, chloroform mask, bichloride tablets, sterile douche bag, liquid soap, hypodermic syringe, sterile vinegar, basins, hand brushes, vaseline, boric acid powder, nitrate of silver solution, olive oil, safety pins, absorbent cotton, towels, abdominal binder, nail file, obstetrical gown, slop jar, vessel for placenta, foot tub.
Prepare baby's cradle or bed with woolen blanket and folded napkin to receive child. If infant's bowels move, protect the blanket as well as for baby's comfort.
Key Takeaways
- Sanitize and prepare the patient before labor begins to prevent infection.
- Encourage walking until severe pains start or amniotic sack ruptures, as this helps in child's descent.
- Use sterile slop jars for evacuation needs after rupture of membranes.
Practical Tips
- Prepare a bichloride pad and T-71 bandage to cover the birth canal during labor.
- Ensure that all linens and bedclothes are freshly laundered before use.
- Encourage the patient to walk around until severe pains start or amniotic sack ruptures.
Warnings & Risks
- Never replace a vulva pad once removed, even if it is clean.
- Avoid using pointed instruments when rupturing membranes as they may injure the child.
Modern Application
While many of these sanitation practices are outdated due to modern antiseptic techniques and medical advancements, understanding historical methods can provide valuable insights into early obstetrical care. The emphasis on cleanliness and preparation remains crucial in any childbirth scenario.
Frequently Asked Questions
Q: What is the purpose of using a bichloride pad during labor?
The bichloride pad, made from dry sterilized cotton held in place by a T-71 bandage, protects the birth canal and absorbs any discharge that may escape from the vagina. It should be kept on until the head of the child is visible at the vulva.
Q: Why should patients not leave their bed after rupture of membranes?
Patients should remain in bed to prevent further escape of amniotic fluid and to avoid any potential complications that could arise from moving around during this stage of labor. This also helps maintain hygiene and prevents infection.
Q: What is the significance of rupturing the membranes at the right time?
Rupturing the membranes too early can slow down labor, making it tedious and painful. It should only be done when the presenting part is visible at the vulva to avoid removing the dilating factor and causing complications.