Should women be confined in their, own bed, or is it better to sub stitute another one (a lying-in couch, an iron bedstead, etc) ? For our part, we much prefer to deliver the woman on a separate bed, and trans port her subsequently to her own, except in cases where the woman is very tall, very stout, very fat, or where it is impossible on account of pecu liarities of the dwelling.
Thereby we have the advantage of being able to place the patient in a fresh, clean, white bed (we proscribe the use of a warming pan, a bottle of hot water suffices), one which has not been soiled during the efforts of the woman, and the feeling of comfort it gives rise to in the patient com pensates largely for the inconvenience caused by transporting her from one bed to another, after her delivery. If the chemise is not stained we do not change it, but if it is soiled in the least, a clean one must be sub stituted. It is the accoucheur's duty to make this change with all duo precautions and with a view to the convenience of the patient, and, as a matter of course, the toilet must be made most carefully after delivery. (Vide of the Woman after Delivery.") The lying-in couch should be high rather than low; it should be pro tected with wax cloth or a sheet of rubber cloth, and made like an ordi nary bed; one or two mattresses, two sheets, and one or two blankets, according to the season. One pillow, with bolster, generally suffices; the under sheet is covered with one or two draw-sheets, to be changed if necessary. The Alsatians are in the habit of placing upon the mattress a large sac filled with bran, which absorbs the liquids and thus saves the woman contact with fluids escaping from the genitals.
Tis is the most common method, where the women are delivered re clining on a bed. But in Germany and Holland, obstetrical chairs, so called, are also often made use of. Schroeder has reproduced from Boss lein (1328) a cut of one of his obstetrical chairs, and of the position of the woman while being examined by the midwife.
Position of the Woman.
As to the position the woman ought to occupy on the bed, there is no absolute rule; usage varies in different countries. Thus, while in France the dorsal decubitus is customary, in England and America women are delivered on the side, generally the left, the buttocks at the edge of the bed, limbs and thighs flexed, and the knees separated by pillows. In
certain eases, this position presents incontestable advantages, besides per mitting a more thorough supervision of the perineum. Moreover, certain authors advise, not only the lateral decubitus, but even a crouching posi tion, or the knee-elbow position; but the latter in particular should be reserved for quite exceptional cases. But whatever be the position of the woman, the bed should be neither too high nor too low, and must offer a sufficiently resistant surface not to be too far depressed by the buttocks of the patient. In some cases it is advisable to slide between the two mattresses a board or a leaf from a table which will prevent excessive sink ing in of the bed.
During the whole duration of labor, the woman should take only liquid nourishment, soups, bouillon, etc.; for we have frequently observed vom iting; of beverages, syrups and teas may be permitted. We prefer grog, weak tea, and coffee largely diluted with water.
Whenever the accoucheur has to make an internal examination, he must first anoint his fingers with some greasy substance,cerate,cold cream, sweet oil, or oil of sweet almonds. We commonly employ carbolated oil or carbolated vaseline. It is self-evident that the hands must be carefully washed after each examination.
Another question is, Should the aecoucheur remain constantly near his patient ? No absolute rule can be laid down in this respect; the physician must be exclusively governed by the wish of his patient with reference thereto; but in a general way we may say that in primiparse the presence of the accoucheur is really of little use until after the membranes have ruptured, and when the cervix has dilated to the diameter of a silver dollar. In multiparx it is not prudent to wait so long; at all events, if the physician leaves, he must return to his patient at least every two hours; but if the diagnosis is not yet complete, or the presentation is not regular, he must not leave his patient on any pretext.