Obstetrician

“ It is at this point that nurses are more and more being given opportunity for immensely gratifying service. A private patient who is in the care of an obstetrician is, of course, supervised and instructed by her doctor. But there are other patients—women who cannot afford this individual care, but who need care none the less. And it is these expectant mothers that nurses are helping the doctors to instruct in the principles of right living, 114and are watching for danger signs, through visiting nurse societies, out-patient departments of hospitals and through prenatal clinics. ”

“ Every physician having to do with the parturient woman, every obstetrician, every midwife, must be frequently and constantly advised of the dangers and possibilities of this disease, the necessity of prevention, and the value of early and correct treatment. ”

“ Dear Cousin,—By the first of July, as soon as I have conquered some miserable little difficulties, such as the acte de naissance, certificate of vaccination, &c., which I cannot produce, I shall enter La Maternité, a world-famous institution, and remain until I have succeeded in my first object—viz. to become an accomplished obstetrician. ”

“ A final class of labours includes the cases where some complication or anomaly arises and becomes a source of danger, independently of disturbances of the mechanism or of any operative interference. These complex labours are due to complications that may be maternal, such as hemorrhage and convulsions; or foetal, such as twins or prolapse of the umbilical cord. To cope with these anomalies an obstetrician requires all the resource of a physician and all the dexterity of a surgeon. ”

“ The treatment and nursing care vary widely because so little is definitely known about the cause, and because of the varieties of theories concerning it which are held by different obstetricians. Some believe that prompt emptying of the uterus is about the only course which is effective, while others feel that because of the probable toxicity of the patient it is advisable also to stimulate all of the excretory organs. Accordingly, they give free purges, colonic irrigations, hot packs and copious amounts of sugar and saline solution by mouth, rectum, intravenously and by infusion. ”

“ An anxious frame of mind also causes real ailments to assume an importance out of all proportion to their actual significance.
Patients who have followed my advice to place themselves in the care of a physician as soon as they clearly recognize the existence of pregnancy will receive his assistance in properly estimating the significance of what they notice. This service is by no means the least the obstetrician renders his patients. His opinion should always be sought when symptoms are not understood ”

“ Obstetrician to the Chicago Lying-in-Hospital and Dispensary, and to Wesley and Mercy Hospitals, etc. W. B. Saunders Co. 1913.
No subject in medicine presents greater difficulties in all its aspects than this one, (treatment of contracted pelves) and none demands such art or practical skill. Science aids little here. P. 709.
Outside factors must also be considered: 1—The environment, whether the parturient is in a squalid tenement, in the country, in a home where every appliance is attainable, or in a well equipped maternity. ”

“ It has been borne in upon me, in the first place, that very often there is something akin to bewilderment among those nurses who have been trained to care for patients according to the teachings of one group of obstetricians and who later find themselves nursing the patients of other doctors who hold different, or even opposite views. ”

“ Although the symptoms of pregnancy have been observed throughout the ages by women who have borne children, and accoucheurs of one sort and another who have attended them, a positive diagnosis at an early stage of this condition is sometimes still baffling to the most experienced obstetricians. ”

“ Obstetricians of the highest eminence stand ready to examine her and counsel her; gynecologists are at hand to perform any necessary operations; trained nurses call at her home, supply and prepare her diet, warn her against a too animated social life, hand her instructive literature, and entertain her with anecdotes suitable to her condition. ”

“ Playfair became one of the foremost obstetricians in this country, and was among the first to decline to hand over obstetric operations to general surgeons, and thus set obstetricians the example of operating on their own patients. ”

“ In order that such a discussion may not seem irrelevant to obstetrical nursing, the nurse must remind herself anew, that the object of obstetrics to-day is not only to carry a woman safely through childbirth, but to give her such care from the beginning of pregnancy that she and the baby shall emerge from this experience, not merely alive, but well and vigorous and with every prospect of continuing to be so.
It is the acknowledged obligation of those engaged in obstetrical work to strive toward improving the health of the race at its source—the health of the mothers and babies. ”

“ It is maintained, viitoo, that say what we may, childbirth is, and must necessarily be, in all civilized societies, a serious thing to enter upon. What woman who has ever passed through this ordeal does not regard it so? and what physician, no matter how old, or experienced, or skillful he may be, does not, every time he enters the lying-in chamber, feel this responsibility to be a great and trying one? Admitting all that can be done by the water-treatment in matters of midwifery, and much, very much, certainly may be—childbirth is yet an agony, and must ever continue so to be. ”

“ EARLY SIGNS OF COMPLICATIONS OF PREGNANCY It is evident that by teaching the principles of personal hygiene to the expectant mother so convincingly that she will adopt them, and sometimes, by employing simple nursing procedures to relieve the various discomforts of pregnancy, much will be accomplished toward promoting the welfare of both the patient 142and the expected baby. But this is not enough. The nurse must also be on the alert to detect and report the early symptoms of complications, for there may be times when she will be the first one to see the patient after a symptom has developed. ”

“ In fact, by virtue of the deep significance of the states of pregnancy and motherhood, and the long period of time through which they continue, it is scarcely possible for them not to produce a mental effect of some sort upon the average woman. Sometimes this effect is a very happy one; but all too often it is quite the reverse. It is safe to say that the majority of maternity patients are passing through deep waters, and the nurse’s usefulness to these charges will be greatly broadened if she has at least some understanding of the cause and character of these mental sufferings. ”

“ It is because so many women fail to appreciate this that abortions and premature births are often followed by ill health and invalidism. Under proper care, an abortion 80or premature labor is not, of itself, any more serious for a woman than a normal delivery.
Bleeding from the vagina, or a sudden increase in the size of the abdomen with perspiration and a sudden feeling of faintness, may be the beginning of severe bleeding, or hemorrhage, from any one of a number of causes, and in such a case the expectant mother should notify her doctor, go to bed at once and keep quiet until he arrives. ”

“ These simple applications of important scientific discoveries 10that relate to the everyday life of her patient—these are things for the maternity nurse to bear in mind. She is nursing a human being who is passing through crucial periods and anything that affects her as a human being affects her as a patient.
Apparently, then, the work of the obstetrical nurse necessitates a training in general nursing and its various branches, in addition to obstetrics, for there seems to be no aspect of nursing which may not, under some condition, have its place in the care of the mother or her baby. ”

“ Conception Soon After a Preceding Pregnancy.—Conception sometimes follows birth (or abortion) with astonishing rapidity, and some women seem for a period of their lives either always pregnant or with infants at their breasts. This prolificity is often alluded to, and is not confined to the lower classes, as often stated, but is common even among the nobility. Illustrative of this, we have examples in some of the reigning families in Europe to-day. A peculiar instance is given by Sparkman in which a woman conceived just forty hours after abortion. ”

“ The intimate relation between the breasts and the uterus manifests itself in such a variety of ways and with such force that no one doubts its existence. Thus, if a nursing mother becomes pregnant her infant is usually deprived of sufficient nourishment or suffers some digestive disturbance; if not, and the mother, ignorant of her condition, continues with the breast feeding, she may jeopardize the newly begun pregnancy. Very likely she will be warned of the fact by the signs of threatened miscarriage. ”

“ Notwithstanding this, in cases of abortion, or where the fœtus is dead, or, in fact, when any difficulty arises in the delivery so as to require manual aid, it is better that the feet should come first; they act as a wedge on the narrow uterine passages. Hence, when we chiefly depend upon the fœtus, as being lively and active, to accomplish delivery, we must do our best that the head escape first; but if the business is to be done by the uterus, it is advisable that the feet come foremost. ”

“ I have not, I trust, heretofore, in my medical lifetime, been wholly unmindful of my duty as a physician, in endeavoring to instruct and to encourage your sex in these matters. But I have never wished to conceal my conviction that I regard pregnancy and childbirth as things of very serious moment in a woman’s life; and he who can trifle with them is almost worse than a very fiend. ”

“ It may be at the end of two weeks, or it may not be until the close of four or five weeks, in the case of the mother who cannot nurse her child; for the nursing of the breast greatly facilitates the shrinking of the uterus. Extensive lacerations may hinder the involution as well as other accidents of childbirth, so it must be left with the physician to decide in each individual case when the mother may enter into the activities of life and assume the responsibilities of the care of the baby and the management of her home. ”

“ Buhl, Gütterbock, and others are of the opinion that the disease may be communicated by the mother to the foetus.
Pregnancy undoubtedly exercises an unfavorable influence on the course of the disease, chiefly from the tendency to uterine hemorrhage. Pregnancy is interrupted in over 50 per cent. of the cases. Premature labor is observed more frequently than abortion. The prognosis with reference to the life of the child is absolutely unfavorable.
In very exceptional cases the evacuation of the uterine cavity has seemed to exercise a favorable influence on the course of the disease. ”

“ Are the plans of medical treatment, such as are usually adopted in childbirth, calculated more and more to undermine the constitution? Are people almost universally in the habit of debilitating themselves by connubial excesses in the married state? These are questions of vital importance to all who expect to be mothers.
After-pains proceed from the contraction of the uterus, caused by the presence of bloody clots, the blood having oozed from the orifices of the torn vessels, and becoming coagulated in its cavity. ”

“ These few examples give some idea of the benefits of prophylaxis in the practice of obstetrics. Prospective mothers should understand not only that there is an advantage in taking such precautions, but that they may be risking their lives, or at least their future well-being, unless they insist upon competent medical attention. It is true, of course, that pregnancy and childbirth are generally normal processes, but they are not always so. ”

“ It is then to be observed, that during a woman’s pregnancy, and before the labor-pains 230come on, one of the principal points of midwifery is, what is called the art of Touching. Thence are derived the surest prognostics for preparation, and especially from the signs it affords of rectitude or obliquity of the Uterus. I have already offered reasons needless to repeat, why the men can never arrive at the excellence of skill in the women in this particular. ”

“ Normal Course.—We have already delineated the normal course of abortion at this period. The death of the embryo has usually preceded, often for weeks, and is characterized by the feeling of pelvic congestion, gastric and vesical irritation, weariness, weakness, and increase of uterine and vaginal secretion; the membranes have developed more or less; expulsion is inaugurated by hemorrhage. If the cause be more violent, the flow of blood is free. Usually there is but a slight oozing, which ceases at times, but gradually increases; the suffering which accompanies uterine contraction is present. ”

“ The use of the menstrual discharge seems to be to prepare the uterine system for conception. For females do not become pregnant before they commence, nor after they cease having turns; nor while they are suppressed by some disease, by cold or by nursing. Some credible women, however, have said that they become pregnant while nursing, without having had any turn since their last lying-in. It is believed that in these oases they had some discharge, colorless, perhaps, which they did not notice, but which answered the purposes of the common one. ”

“ An incomplete abortion is one in which the fetus is expelled but the placenta and membranes remain in the uterine cavity. The treatment is removal of the retained tissues, followed by the same care that is given during the normal puerperium. Prompt action in completing the delivery is important because of the hemorrhage that usually persists until the uterus is entirely emptied of its contents. ”