CARE OF THE MOTHER AND INFANT DURING LABOR.
Care of the Mother.
attentions which the accoucheur has to give to a woman in labor are so intimate in their nature, so delicate, that the first duty which the attendant must impose upon himself is, to respect as much as possible the sense of shame, and the sensibility of his patient, hence to proceed always with patience and gentleness, to spare the woman all unnecessary examination, not to expose her person except when forced to da so, that is is say, at the end of labor, when the perineum must be watched. However great the repugnance of the woman, he must not hesitate then; and though in multipane delivery under cover is strictly possible in cer tain cases, we proscribe it positively in primipane [The better rule is never to allow the presenting part to emerge, except under the eye—Ed.] It is utterly impossible to watch the perineum with the necessary care unless it is fully uncovered, and women must be made to understand the importance of this supervision, which they yield to without opposition after a certain time. During the course of labor, however, we must abstain from every unnecessary examination, and repetitions should be avoided is much as possible.
Along with patience and gentleness, the accoucheur must possess cool ness and decision. His coolness, his calmness, will permit him to resist the pressure brought to bear upon him by the surroundings of his patients; his calmness will make him accept patiently all those more or less odd demands to which he is obliged to respond; and his decision must be absolute with him. Indeed, in certain cases, he must know how to combat the resistance of the patient or her family, and to assume the responsibility of an intervention which the surrounding friends may stupidly dispute, but which may occasionally save the mother and the child.
There is one point upon which we cannot lay too much stress, and that is cleanliness; not the ordinary cleanliness which consists in having clean hands, but one which extends to all the details, even to the linen and the instruments. Modern research has clearly demonstrated that, although auto-infection occurs in lying-in women, the accidents to which they are subject are much oftener the result of communicated infection, of contagion. It is not enough that the hands
or instruments are washed and brushed with warm water and soap; the hands must possess a special cleanliness, and both they and the instru ments must be washed with disinfectant solutions, such as carbolic acid, permanganate of potassium, boric acid, salicylic acid, or others. Instru ments must be washed with water and alcohol, and kept submerged in antiseptic solutions. Nickel-plated instruments should be given the pref erence over others.
The accoucheur must sedulously avoid all contact with other patients, especially those suffering with contagious or organic diseases (eruptiVe fevers, cancer). The nurses should be chosen from among those who at tend only lying-in women, and be attentively watched with reference to their cleanliness and their regular habits.
Physicians in charge of hospital service must take still stricter precau tions than others. Indeed, the sanitary condition of maternity institu tions is rarely absolutely perfect, and therefore, since such physicians are more exposed than others to contact with sick women, they must be still more scrupulous and painstaking. We absolutely prohibit visiting a parturient, and more particularly a lying-in woman, after leaving a hospi tal, especially if the physician has been obliged to perform or even assist at an autopsy. But there is one condition under which the physician must absolutely abstain from attending a woman in labor, and that is, when he has been called upon to examine patients with fetid lochia (puer peral infections, retained placenta, etc.). In fact, in such cases, no mat ter what attention the physician bestows upon his hands, they retain for twenty-four, and even forty-eight hours, a special odor, which clearly proves that organic particles, morbid germs, still adhere, and we believe that in such cases the physician must substitute in his stead an experienced con frere, so as to avoid grave consequences. Although this can be done in cities, it is otherwise in country practice. In the latter case, the physi cian must make free use of antiseptic solutions, and avoid examinations unless their necessity is absolute.