Preparations for Confinement

water, solution, hands, set, ready, hand, lysol and examination

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It is well also to cut short the hair around the parts concerned in labour.

The bowels should also be specially attended to. A full dose of any opening medicine is liable to bring on labour prematurely, or bring on an attack of false pains. It is better, there fore, for the patient to take daily just such small doses of opening medicine as she finds sufficient gently to aid the daily movement. For this purpose nothing is better than a nightly dose of castor-oil; from a half to one tea-spoonful will usually be sufficient for the purpose. It' may be found better to take it in Alm morning, or to take an even smaller dose morning and night. If the mother begins to do this two weeks or so before the expected date, she will find it add enormously to her comfort during her confinement. Instead of castor-oil, a small morning dose, half to one wine-glassful, of Hunyadi Janos or similar aperient water may do well.

As soon as the mother becomes aware that labour is about to begin, having seen that everything is ready in the room, she should do any sponging, arranging of hair, &c., neces sary, and put on her bed garments; but she need not yet go to bed. With stockings, slippers, and a gown over her night-clothes she may await further progress before going to bed.

The Nurse's the advice given in preceding paragraphs has been followed, everything will be in order and at hand. The fire will be lighted in the lying-in room, the bed prepared, and, if necessary, warmed. The table and wash-stand covered with a fresh white cover or towel. The wash-hand basins will be washed again and scrubbed, dried, and set ready, covered from dust with a clean towel. Plenty of water will be boiled. The bed-room jug will also be scrubbed anew, thoroughly rinsed, and filled with boiling water, then covered with a towel and left to cool. More water will be set to boil. Utensils will be set in their proper place. Material for diapers, binder, pins, thread, dusting-powder, antiseptics, will all be placed at hand, but kept covered. Any extra clothing will be got ready, the child's clothing set out before the fire on a screen, and so on. When at length the patient goes to bed, the nurse should without further delay secure that the mother's external parts are free of any septic material, by washing first with soap and water and then with car bolic acid (1 to 20) or lysol (a tea-spoonful to the pint). In doing this she uses the squares

of gamgee, already noted, both to bathe with and to dry (see p. 634).

By the time the medical attendant arrives, everything should be in order, and the nurse should be ready with hot water and soap for his hands, and with a basin of lysol solution for the same purpose.

Unless she is specially ordered by the medical attendant, the nurse should never make what is called a vaginal examination or a digital examination, that is, an examination with the forefinger of the right hand in the patient's genital passage to determine the position of the oncoming child. If she ever does so without orders she assumes a grave responsibility.

If she ever does so without thoroughly aseptic hands the risks of infecting the mother are immense. There is no possible doubt this is the cause of many of the cases of child-bed fever. No emergency whatever ever justifies such an examination without the hands being first thoroughly cleansed and soaked with anti septic solution. If such an examination has to be made, the routine that must be followed has been already noted (p. 635), but the matter is so important it may be again referred to.

1. The sleeves are to be rolled up.

2. The nails are to be trimmed and cleaned under the edge.

3. Hands and forearms up to elbows are to be washed with soap and hot water, and scrubbed with a nail-brush.

4. Fresh hot water is then to be used to remove the soiled soapy water.

5. Hands are then to be steeped, and arms laved, in a hot solution of lysol (a tea spoonful to a pint) for several minutes.

6. The hands are not dried. The basin con taining the lysol solution should be set at the bed-side on a chair, a clean towel being laid on the chair and the basin set, on it. The clothes over the mother are then arranged, and when all is ready the nurse once more steeps the hand to be used in the lysol solution and then carries it straight from the solution to the mother's external parts, which have also been bathed with antiseptic solu tion as described.

NOTE.—The nurse will note that it is in vain one washes the hands and soaks them in an antiseptic solution, if on the way to the bedside something is touched which is not aseptic, a door handle, for instance, or a chair back. Between the lifting of the hand out of the antiseptic solution and the contact with the mother nothing should intervene.

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