Chapter IX. COMPLICATIONS DURING LABOR. (Part 2)

late, but send for the nearest physician. Prolapse of the Cord. — This is a very rare occur- rence, yet one of great consequence, and one that every nurse should be familiar with, the presentation of the umbilicus cord. It is a very serious condition for the child. When the cord presents at the vulva, the nurse will easily recognize the cord and she should Fig. 43 — Knee-chest position. send for a physician immediately. While waiting his arrival place the patient in the knee chest position, or elevate the hips by placing several pillows under them and with a large pad of sterilized absorbent cotton the nurse closes the vaginal opening and holds the pad in place by firm pressure against the vulva with the hand being careful not to press on the cord. There is no ad- vantage gained by putting the cord back in the va- gina. To be of any consequence the cord must be put back beyond the crevical os. This is impossible. 143 So should a nurse have a case of prolapse of the cord, send for the physician at once, and while awaiting Fig-. 44 — The elevated Sims' position. his arrival keep the patient in the knee chest position, If the patient complains of dyspnea or much dis- tress the elevated Sims position is preferable. HEMORRHAGES. General Direction. — One of the greates dangers at- tending child-birth is hemorrhage. This may take place either before, during or after the birth of the child. Where hemorrhage occurs keep in mind, in such a case, there are two things to do, to con- trol the hemorrhage and revive the patient. To revive the patient before stopping the flow of blood would aid her in pumping out her heart's blood. So the first thing to do is to stop the flow of blood and then revive her. To stop the flow of blood from an artery, pressure should be applied above the wound. An important fact to remember is where the blood is coming from and the course of the blood vessels, to know where to apply this pressure. The uterus is supplied with blood vessels that come through the broad ligament from each side, and it is difficult to bring pressure to bear directly upon these vessels. But we can stimulate the uterus so it will contract down on and compress 144 these arteries by kneading the uterus in circular movements through the abdominal wall : knead firm- ly and if the uterus will not respond to stimulation. ice sometimes applied to the abdomen will stimulate contractions. The pillow should be removed from under the head of the patient and the foot of the bed elevated about two feet, by placing a chair or box or table under it. this is to get the blood back to the brain. Open the window and let the patient have plenty of fresh air. being careful not to allow draughts, and keep her covered. If bleeding has ceased or has been controlled, the patient should now be given a stimulant to revive her. Give whiskey, aromatic spirits of ammonia, hy- podermic injection of one-thirtieth of a grain of strychnine and a cup of black coffee. If all efforts to secure contraction of the uterus fail give a douche of one pint of sterilized vinegar. This will usually cause contractions when all the other methods fail. It is usually the last we resort to. as it is best to avoid manipulation of the birth canal if possible, be- cause of the danger of carrying germs and infection into it from without. Placenta Praevia Hemmorrhage. — One occuring during labor sometimes and which is very serious is the placenta praevia hemorrhage, it is the most dangerous one of all hemorrhage? of the child- bearing period. It is usually caused by the wrong attachment of the placenta and is often fatal. The blood simply gushes forth. The best way. if any, to control this kind of a hemorrhage is to have someone make firm, continuous pressure on the ab- dominal artery while the nurse packs the vagina as tight as possible and send for the physician imme- 10: 145 diately. The contiuous pressure on the blood ves- sel will prevent the further escape of blood. To ac- complish this the nurse should kneel on the bed by the side of the patient so as to be in a position where she can use the pressure to the best advantage possi- ble, she should rest her arm against her side so as to use all the force she can bring to bear on this large blood vessel. This treatment must be contin- ued continuously until the arrival of the physician. This treatment has saved many lives. Post Portum Hemmorrhage. — One immediately after labor or delivery is known as post portum hemorrhage. It is not an uncommon event ; it may follow the easiest normal labor, and in a few minutes carry the patient to death's door. It is caused by failure of the uterus to contract down properly and lacerations of the blood vessels in the cervix of the uterus. The danger does not end with the ex- pulsion of the placenta. The nurse should watch her patient closely for several hours. Should the uterus become lax, knead it until it contracts down firmly, and hold it, and do not let it soften again. If it be- gins to soften or relax, stimulate it by kneading through the abdominal wall. If the uterus is so soft it cannot be felt, knead it very vigorously and it will usually contract down. The uterus is very sensitive to massage and it usually responds to this treatment. Should this treatment fail to control the hemorrhage and the uterus, in spite of kneading, remain lax and soft, put your hand up in the uterus and with a piece of sterile gauze wet in sterilized vinegar swab the uterus well. Carry the gauze saturated with vinegar up into the cavity of the uterus with the right hand and with the left hand press very hard 146 down upon the uterus and try and make it contract. If you cannot get sterilized vinegar, use unsterilized vinegar and follow by a hot bichloride douche in the strength of one in four thousand, and the tempera- ture of the water should be from one hundred and ten degrees to one hundred and fifteen degrees F. Hot water acts as an astringent, contracting the blood vessels. It, of itself, will often stop bleeding. This is an emergency, when in order to save the woman's life, you must act quickly. Life depends on the rapid action of the nurse. If the physician is not there she should keep her presence of mind and observe all an- tiseptic precaution as far as she is able. Give, as soon as contractions are secured, a hypodermic in- jection of 15 m. of ergotole. Ergot, by mouth, acts too slowly to prove of service in an emergence}", it is nauseating to some patients and may not be absorbed by the stomach. If the hemorrhage is large and the patient seems w^eak ; after the uterus has contracted well down, give a hypodermic injection of one-fiftieth of a grain of digitaline and one-thirtieth of a grain of strychnine and watch the patient carefully until the physician arrives. Recurring Hemorrhage. — Hemorrhage occuring dur- ing puerpurium is termed recurring hemorrhage It is caused either by the separation of a thombi from the placental site, or a congested condition of the endometrium, the mucus membrane that lines the cavity of the uterus. The treatment consists in quiet rest in bed and hot -vaginal douches. Ergot is usually given three times a day, a half a dram, for several days as a security against reccurrence. Should it continue the uterus should be packed with sterile 147 Hemorrhage of Abortion. — For hemorrhage fol- lowing abortion, the only treatment is to pack the vagina tight with sterile gauze and give one dram of fluid extract of ergot. This usually is all that is neces- sary. Secondary Hemmorrhage. — A hemorrhage occuring several days after a previous one has been controlled, is known as a secondary hemorrhage. It is usually controlled by giving a teaspoonful of fluid extract of erp-ot and stimulating the uterus bv massasre. Symptoms of Hemorrhage. — Besides the external bleeding the face and lips of the patient are pale, the brow is usually covered with a cold sweat, a rapid running- pulse, the face is palid and wears an anxious expression. The pupils are dilated. The patient com- plains of feeling very faint and weak, and if not con- trolled is a reasonable length of time the patient be- comes unconscious and may die. The nurse must keep cool and not lose her presence of mind as life depends upon it. Eclampsia. — The next most serious emergency like- ly to arise is eclampsia. It is the occurrence of convul- sion followed by coma, and like hemorrhage, it is very dangerous. It may take place during- pregnancy, labor or the puerperium period. The cause of eclampsia is not exactly known, but is supposed to be due to the improper action of the kidneys ; toxemia or blood in- toxication. The cardinal symptoms are uncontrol- lable headache, symptoms of imperfect vision, verti- go, an unusual desire to go to sleep, eye symptoms, flashes of light before the eyes, odema of the face and extremities ; disturbance of memory ; anomali- ties of the senses ; scanty secretion of urine and the 148 presence of albumen and cast in the urine. The pa- tient suddenly becomes unconscious and goes into a convulsion. The mouth is drawn to the side and facial contortions are hidious, and the whole body is shaken by a strong- muscular spasm which seldom lasts longer than one minute. On awakening from an attack the patient complains of headache and pains in the muscles. The body is often covered with a cold, clammy sweat. During the spasm there is great danger of the patient biting her tongue severe- ly. To prevent this a firm object should be placed be- tween the teeth at the beginning of the spasm. A clean clothespin or the handle of a tooth brush is use- ful for this purpose. Place the prong end of the clothespin or the handle of a tooth brush in the mouth between the teeth. Often the patient dies in the first attack or convulsion follows convulsion with lightning rapidity until death occurs from exhaus- tion. The, fetus is usually still born. Treatment. — The first thing to do is to send for the physician nearest at hand and while awaiting his com- ing give a saline laxative. If it is possible, while the patient is able to swallow, give a large dose of epsom salts, at least one ounce, if it is impossible for the patient to take this medicine because she is unable to swallow the large dose, give four drops of croton oil on a little sugar. This can be given even if swallowing is hard. The bowels must be made to move freely. A saline enema should also be g-iven. The nurse may administer ether to counteract the convulsion. 149