THE CARE OF THE PATIENT IMMEDIATELY AFTER LABOR.
If the third stage of labor has been conducted after the manner we have outlined, the accoucheur has, on the one hand, assured himself that the uterus does not contain a second foetus, and, on the other hand, that this organ has thoroughly contracted, and that he need not fear uterine inertia, or hemorrhage, or inversion. His duty now is to see that this contraction is being maintained, and, for this purpose, it suf fices to palpate the abdomen from time to time. If the uterus be at the level of the umbilicus, if it be hard, spherical, and resisting, if no blood flows from the vagina, all is right; if on the other hand, the uterus be soft and relaxed, gentle friction over the fundus may suffice to expel clots, and to obtain the contraction which is a necessity. Of course, we are sup posedly speaking of a normal case. For the complications of delivery we refer the reader to this heading. Usually, at the end of a few min utes, the woman has a chill, which is of a1_____o__n import, depending purely_ on change in vascular tension. It is only necessary to slip a dry sheet under her, to cover her a little more, keeping her on the back, the legs together, and amidst perfect quiet. The administration of a little stimulant, in addition, soon dispels the chilly sensation. At the end of about,one half hour, according to circumstances, we proceed to the toilette, and careful examination of the genital organs. This toilette should be attended to with the greatest possible care, the genitals being washed with lukewarm water, to which is added a little alcohol, or' tinctureof arnica. We pre , fer a dilute pheuic acid solution. Now, if the night dress be soiled, let it be replaced, as quietly as possible, by a dry and warm one. Over the abdo men a folded towel should be placed, and this we prefer to the binder. We thus obtain equable compression, and we prefer the compress to the binder, for the reason that the patient must lie quietly on her back, else the compress will slip off. [Nothing adds so much to the comfort of the puerpera, as a neatly applied and gently compressing abdominal binder. No wonder, when we remember that for months the abdomen has been enormously distended, that the patient feels the need of a certain amount of compressive force. Undue compression is of course to be avoided, else the tendency will be to force the uterus back towards the sacrum, placing the suspensory ligaments of the organ under great strain, and making it likely the patient will, at the end of convalesence, have a retroversion.—
Ed.] The puerpera should now be left alone with the nurse, and abso lute quiet should be enjoined, in order that sleep may be uninterrupted. When she awakens, a little bouillon may be given to her. The physician should remain with his patient at least one hour after delivery, where the labor has been normal. In case there has occurred hemorrhage during the third stage, then the woman should not be disturbed for a number of hours, even for the purpose of cleansing her or the bed, and the physician should remain by her until he feels absolutely certain that danger of uterine inertia no longer exists. Certain accoucheurs are in the habit of admin istering, routinely, about fifteen grains of ergot by the mouth, or by the rectum. We believe this to be an unnecessary precaution. If there be no tendency to inertia, the administration of ergot is useless, and only excites after-pains and therefore disturbs the rest which the woman needs; if inertia has existed, ergot is useless, for, as we will see, it is at the outset necessary to empty the uterus of clots, and ergot should never be given until the uterine cavity contains neither clots nor blood. There is one role, which, for us, is absolute: the accoucheur should always revisit his patient in from five to six hours after delivery.
[The practice of administering ergot immediately after the delivery of the placenta, as a routine measure, we believe to be a wise one. Not only does ergot tend to keep up firm and equable contraction, but by so doing it also assists the process of involution. In no given case can the accou chenr feel that the uterus will not relax, and we may efficiently guard against this by giving from one to two drachms of the fluid extract of ergot before we leave our patient. Where the stomach is irritable, the drug may be given by rectal suppository, as the aqueous extract (five to ten grains.) Further still, we believe it good practice to continue the ergot for ten days after delivery, giving fifteen to thirty drops three times a day. The object of this is to assist involution. If the drug seems to cause after-pains, these pains are salutary, usually, since they may mean that the uterus is endeavoring to expel clot. These pains are rapidly quieted by a small dose of chloral hydrate (fifteen grains by mouth, or thirty'grains by rectum.)—Ed.]