Labour, baby-birth, delivery and its management :-
Calculation of the time of labour
The period of pregnancy, from conception till confinement, is calculated at ten lunar months, or forty weeks, which amount to 280 days. It is sometimes reckoned at nine calendar months, that is, 273 days, or thirty-nine weeks; forty weeks, however, is the safer reckoning. When the date of conception is known, the reckoning begins from that day. If that be not known, the calculation must commence from the last monthly appearance. If the period of the last monthly course cannot be remembered, then the time of quickening, or when the motions of the child are first perceived (usually about four and a half month after conception), may be made use of, but this is not a very reliable basis for calculation.
Since it is highly important that the period of labour be known, we add a calendar, showing 280 days from any given date.
Its service will be especially appreciated by the newly-married lady, who, through delicacy, might hesitate to seek advice on this important point. Much time might often be saved, and great anxiety avoided, by being able to reckon approximately the hour of solicitude and hope. In point of economy, too, the advantage of bespeaking medical and other assistance at the proper time, is self-evident.
Those, however, who make use of the calendar should bear in mind that the period of pregnancy is slightly altered by the age of the parties concerned; the fact being fully proved that the younger the husband and wife the shorter the period of utero-gestation; and, vice versâ, as age increases, the term of gestation is proportionably lengthened (Clay).
In reference to this subject, Dr. Clay adduces a curious experiment on the eggs of domestic fowls. Poult eggs can be easily distinguished from those of hens of three or more years old. A certain number of the former were placed under a young hen, and an equal number of eggs from older fowls under an old hen. The result was, that every chick had escaped from its shell under the young hen at least twenty-four hours, some even as much as thirty-six, sooner than those of the old hen. The difference is very remarkable in so short a period of incubation. He infers from this and other circumstances, that the duration of the gestative period is far more definite than has hitherto been supposed, and that where the circumstances are similar, the result as to the length of term is very nearly the same. Maintaining that utero-gestation is definite and regulated by age, we do not calculate by that of the mother alone, but by the combined ages of both parents.
Symptoms of labour
The earliest is a diminution in the size of the waist, from the child’s sinking lower in the abdomen. The more immediate indications are agitation, lowness of spirits, flying-pains, frequent desire to pass water, etc. A slight discharge of mucus tinged red, technically called the “show”, is the most certain sign that labour has commenced.
Our sole intention I this manual is so describe the general course of a perfectly natural labour that, in the unavoidable absence of a medical man, any intelligent person may be enabled to act with some degree of correctness, and to modify any distressing symptoms which may arise, by means of suitable remedies. I
Towards the close of gestation, ladies are apt to suffer from pains which may be mistaken for those of labour, but which the following table will aid in distinguishing :
(1) Come on and go off regularly, gradually increasing in frequency and severity.
(2) Are situated in the back and loins.
(3) Are grinding or bearing-down, according to the stage of labour.
(4) Arise from the contraction of the uterus, and the resistance made to its efforts, and produce dilatation of the mouth of the womb.
(5) Are usually attended with a “show”.
(1) Are irregular in their recurrence, or, in some instances, are unremitting.
(2) Are chiefly confined to the abdomen.
(3) Are of a colicky nature.
(4) Are caused by cold, flatulence, indigestion, spasm, fatigue, etc., and have no effect upon the mouth of the womb, which is found closed.
(5) Are unattended with a “show”.
If the character of the pains points to true labour, although the proper time has not arrived, Pulsatilla will generally quiet the abnormal tendency. If, after a few doses at intervals of forty or sixty minutes, the symptoms continue, Cimicifuga may be given in like manner. If yet the pains increase, then the Section on Miscarriage should be consulted.
Assuming the proper time for childbirth to have arrived, and the symptoms of labour to have set in, an occasional dose of one of the forementioned remedies may be administered with advantage, unless some other be indicated.
To produce relaxation of a rigid, unyielding os uteri in labour, this remedy, in from one to five drops of the strong tincture, every half-hour, is probably superior to every other.
Excessive painfulness in highly sensitive, irritable patients.
Irregularity, uncertain and fitful pains, chiefly in the back.
Pains that are too weak and seem to be declining.
Violent, spasmodic pains, cramps in the limbs, a tendency to convulsions, nervous irritability and dejection.
Flushed face, throbbing headache, confusion of ideas; a tendency to wander; convulsive movements, sensitiveness to noise, light, etc. Bell. is also sometimes useful when the pains are strong and normal, but an apparent resistance in the womb itself impedes progress.
Feverishness, palpitation, think she is gonna die etc.
Is preferable to Ergot as a uterine excitant.
A dose every fifteen, twenty, or thirty minutes, as the case may require. If no relief follows the third or fourth dose, another remedy should be selected.
No rugs, stimulants, spirituous liquors, etc., should be taken, as they often increase the difficulties and dangers of parturition. A calm assured manner in attendant, and in all persons concerned, is necessary to dissipate alarm and anxiety. All whispering or signs should be avoided, as the patient is very susceptible at this period, and is ready to apprehend every kind of evil. Friction over the abdomen, with moderate pressure, especially during the pains in the latter stages of labour, is often of much service, by exciting the action of the womb. This should be continued till the placenta is detached. Protracted labour should always be expected to terminate favourably. Patience is most important on the part of both the mother and attendant.
After the birth, all being otherwise satisfactory, a dose of Arnica may be given every forty minutes for three or four times; this remedy will help to prevent soreness and After-pains. When the after-birth has expelled, lotion of the same remedy, – twenty drops of the tincture in a tumbler of water, – may be applied by means of a saturated napkin, and renewed as often as necessary.
The child should be applied to the breast as soon as possible; it needs nourishment, and the breasts need to be relieved if distended with milk, or excited and stimulated, if the milk be not yet ready. Moreover, the child’s sucking at the breasts, by reflex action, causes a contraction of the womb, which is absolutely necessary to the mother’s welfare. When the application of the child to the breast is duly attended to, Flooding is an unlikely occurrence. Should the milk be delayed for a day or two, the child should still be occasionally applied to the breast, and fed meantime with pure cow’s milk made sufficiently warm and thin by the addition of an equal quantity of hot (but not boiling) water. Nothing else whatever ought to be given to the infant.
The patient having been made comfortable, and the child applied to the breast, the first few hours should be essentially hours of repose. The patient should not be disturbed, except to remove the soiled napkins, apply the blinder, and otherwise to render her as comfortable as possible. If after good management she be left to herself, one or two hours refreshing sleep will have a wonderfully beneficial effect. After this, should no untoward circumstances forbid, she may be changed and placed in bed, preserving the horizontal posture, and not making the slightest effort herself.
After-pains, if not prevented by Arnica, may require Chamomilla or Coffea, if the patient is sensitive and irritable, or Gelsemium if the pains are the only indication present. Other remedies are, Puls., Sec., Ign., Zanth., etc.
Coffea – Sleeplessness, nervous excitement, and restlessness. Two pilules, or a drop of the tincture, may be administered in a teaspoonful of water, every hour until sleep ensues.
Aconitum may be substituted for Coffea, and given in the same manner, should there be any symptoms of fever.
The diet should be simple and nourishing, and given not at regular intervals, but it should not be restricted to gruel even the first day.