The symptoms of miscarriage are a show of blood, more or less profuse, with intense abdominal pain; on the slightest show of blood the patient should go to bed at once and the physician should be sent for.

CHAPTER XI.

THE CONFINEMENT.

Preparation for the Confinement; Signs of Approaching Labor; Symptoms of Actual Labor; the Confinement-bed; the Process of Labor.

"To my conception one generation of educated mothers would do more for the regeneration of the race than all other human agencies combined; and it is an instruction of the head they need, and not of the heart. The doctrine of responsibility has been ground into Christian mothers above what they are able to bear."

-- ISABELLE BEECHER HOOKER.

Preparations for the Confinement.-- The right time to engage the physician who is to take charge of the woman at her confinement is just so soon as the woman knows that she is pregnant. It used to be argued that, since giving birth to children was a physiologic process, there was no necessity for the woman to consult the physician until he was sent for when the labor pains began. Take the case of the woman who is for the first time pregnant; she is absolutely at sea; she has not the least idea how she ought to feel, what she ought to do or to leave undone; the result is that she often has a miscarriage which is the source of the greatest disappointment to her husband and herself, or she suffers very unnecessarily throughout the entire pregnancy, has a difficult labor, and perhaps gives birth to a sickly child.

The educated physician will explain to her what symptoms are normal and what are pathologic, and often he will be able to entirely cure the latter. It is now a well-established fact that the most serious complications of the pregnancy, and of the labor itself are caused by severe congestion or disease of the kidneys. The condition of the kidneys can only be determined by frequent examinations of the urine; during the early months of pregnancy these examinations are made once a month, and during the last month they are made every week. The amount of urine pa.s.sed in the normal condition is three pints a day.

Nowhere, perhaps, is the constant vigilance of the physician so well rewarded as in the careful oversight of the pregnant woman. She goes through her entire pregnancy feeling well, and often the greatest discomfort that she suffers is due to her size; her labor and her lying-in are normal, and she gives birth to a healthy child.

Engagement of the Nurse.-- This is generally left to the physician in charge of the case, since he is responsible for the safe delivery of the woman; but if the patient has any decided choice in the matter, it is acceded to unless there should be some very valid objections, and the physician always sends the nurse in view for that case to see the patient in order to ascertain if she is personally agreeable to the patient.

Choice of Room for the Confinement and Lying-in.-- The room should be light, sunny, and well ventilated; it should not be too near a water-closet. In the city as quiet a room as possible should be selected, and one that is well removed from the rest of the house, so that if necessary perfect quiet can be maintained. The room should be as cheery as possible.

The dress of the mother during the lying-in consists of a merino undervest, with high neck and long sleeves, and a nightgown, which shall be open all the way down the front. The gowns should be made of light muslin or of cambric; and there should be a sufficient number so that they may be changed every day.

Six abdominal bandages should be provided. These are made of light muslin, and they should be eighteen inches wide and long enough to go once and a third around the patient's hips at the sixth month of pregnancy, or about one yard and a quarter long; they may be made straight or to fit the patient at the sixth month. This bandage is fastened down the front; it is applied directly after the labor, and adds greatly to the patient's comfort during the lying-in.

The v.u.l.v.ar pads used during the lying-in are the antiseptic absorbent pads which can be obtained at any place where surgical dressings are sold; they are made of absorbent cotton, covered with cheesecloth, and sterilized.

There must be a sufficiently generous supply of sheets so that they can be changed every day, and the drawsheet as often as may be required. Nothing is so important to a good lying-in as to have a clean, well-ventilated room, and plenty of fresh bed-linen.

Cleanliness is the first requisite to antisepsis, and this is the secret of avoiding puerperal fever.

Articles to be provided for the confinement are: 1. An oblong douche-pan of agate-ware.

2. An agate bed-pan.

3. A bath thermometer.

4. Two pieces of rubber sheeting; one, one yard square, and the other two yards square.

5. Two sterilized bed-pads, 30 inches square by 3 to 4 inches thick.

6. Three dozen antiseptic absorbent pads.

7. One pound of sterilized absorbent cotton; twelve yards of cheese-cloth.

8. Six abdominal bandages, eighteen inches wide, preferably made to fit the figure at the sixth month of gestation.

9. Two hand-scrubs.

10. Four ounces of the tincture of green soap.

11. Bottle of corrosive sublimate tablets.

12. Four ounces of powdered boric acid.

13. Half a pint of good whisky.

14. Two ounces of aromatic spirits of ammonia.

15. Two ounces of aqua ammonia.

16. One pint of alcohol.

17. Two tubes sterilized white vaselin.

18. Plenty of large and small safety-pins.

19. Hot-water bag.

20. New fountain syringe, to hold four quarts; with gla.s.s nozle.

21. One small basin for vomited matter.

22. Two very large agate basins or wash-bowls for washing doctor's hands and for antiseptic solutions.

23. Vessel for after-birth.

24. Three large pitchers; one for boiling water, one for cold boiled water, and one for antiseptic solution.

25. Tumbler for boric acid solution for washing baby's eyes, with fine old linen sterilized.

26. One dozen freshly laundered sheets, and two dozen towels.

27. Stocking-drawers, muslin.

28. Change of night-clothing warmed for the mother.

29. A warm blanket to receive the baby.

30. An infant bath-tub.

31. A large piece of oil-cloth to protect the floor.*

* Van Horn & Co., Park Avenue and 41st Street, New York, keep an obstetric outfit, containing many of the above articles, cleansed, sterilized, and packed in a box ready for use, so that they remain intact until needed. The price of this outfit is $16.50.

Baby's Outfit.-- Four flannel bandages, to be made of fine, soft flannel, four inches wide, to go once and a third around the body. The edges may be pinked or whipped, but should never be hemmed; a tape is sewed on double, the ends pa.s.sing around the body, and so the bandage is fastened without pinning.

Six merino shirts, with high neck and long sleeves, made to b.u.t.ton down the front.

Cotton diaper napkins, not too large; old soft ones are preferable.

Long merino stockings which can be pinned to the napkin.

Flannel petticoats, not too long; these may be made on muslin bands, which are held up on the shoulders by means of straps. The essential in all the clothing is that it should be sufficiently loose.

Dress-slips should not be so elaborate that they cannot be washed and changed with sufficient frequency; and not so long that the baby's feet will be hampered in their movements by them. All of baby's clothes but the dress should be fastened by safety-pins.

Baby's basket should contain: 1. One outfit of clothes.

2. One tube of sterilized tape.

3. A pair of blunt-pointed scissors.

4. Large and small safety-pins.

5. Pieces of fine old linen; old handkerchiefs are the best.

6. A soft hair-brush.

7. A powder box and puff, with talc.u.m powder.

8. Two tubes of sterilized white vaselin.

9. Two soft towels.

10. Castile soap.

11. Single-bulb syringe; so-called "eye and ear syringe."

12. A woolen shawl or wrap.

If there is no nurse available before the labor sets in, and it is necessary for the patient to see to the sterilizing of the above articles, she should first scrub off all pitchers, basins, and other utensils, as well as the douche-pan, fountain syringe, and rubber sheeting, with a brush and hot soap-suds; the hand-scrubs are to be well washed; then each article should be pinned separately in coa.r.s.e towels, and put to boil for half an hour in an ordinary wash-boiler.

The articles so boiled are then dried without removing the towels, put away, and not opened till the time of the labor.

The abdominal bandages must be laundried and pinned up in separate towels until they are needed. The cheese-cloth must be laundried and then sterilized.

The v.u.l.v.ar pads should be pinned in an old napkin, in packages of half a dozen each; and one package is sterilized at a time by placing it in the oven until the outer covering is scorched. The linen for the baby's eyes and the cheese-cloth are treated in the same way; they are to be cut up into small pieces and sterilized as needed.

Signs of Approaching Labor.-- About two weeks before labor there is a sinking of the womb. At the beginning of the ninth lunar month this was at the end of the breast-bone; it now descends to a point midway between this and the navel; the abdomen becomes smaller, the pressure on the lungs is relieved, and the woman breathes more freely. But at the same time that the woman is relieved of the pressure on the chest, she experiences increase of the troubles in the lower extremities.

There is an increase of the bladder symptoms, with a desire for frequent unrination. Constipation becomes more troublesome, and there may be hemorrhoids; the veins of the lower extremities may become greatly enlarged.