During this stage the nurse is giving the finishing touches to her preparations. She has sent for the medical attendant ; for at this stage a finger examination will show the position of the child, and enable him to decide whether the labour is likely to pursue a normal course. It will, perhaps, also enable him to decide whether interference may be necessary.
In anticipation of his arrival, the nurse should make the preparations noted on p. 636.
This stage lasts longer in the case of patients bearing the first child — pri mi parrs -- than in those who have borne several—multiparm. In the latter it may be as short as two hours; in the former it may go slowly on for several days, and it not uncommonly lasts for 24 hours; and the average is 15. The older the patient the slower is it likely to be.
Voluntary expulsive effort during this stage is valueless, and not to be encouraged.
Whatever nourishment the patient has during this period should be of a simple character: hot milk, hot tea, hot soup in small quantities —a tea-cupful—at the patient's own pleasure.
If the bowels have not been freely opened that day, the lower bowel should be cleared out by an enema, and the patient should make sure that the bladder is emptied.
Visitors should not be encouraged in the room. Apart from the fact that one has no control of their movements, and no guarantee of their being free of infective possibilities, their conversation is very often entirely unsuited to the mental state of the patient Management of the Second Stage. —Th is stage is often indicated by the "escape of the waters", but not necessarily so, as the mem branes may rupture before labour seta in, mak ing it very slow, and they may remain untorn till the head is born.
The occurrence of the second stage is best known by the altered character of the pains. They are less irritating to the patient, who now instinctively settles down, holding her breath, fixing her body by grasping something with the hands, and aiding the expulsive effort by pressing against some support 'with her feet.
At this stage, therefore, the patient should go to bed, having removed everything except her night-clothing, which should be well rolled up as high as the armpits, out of the way of discharge. To protect the bed-clothes, a gar
ment should be put on, lightly fastened round the waist, and quite open behind, a kind of apron. A flannel petticoat, split right down behind, is very suitable, but it must be perfectly clean and fresh, having been thoroughly washed for the purpose.
The powerful expulsive effort the patient can produce by voluntary contraction of the abdominal walls is of great value at this stage, and is much helped by giving the patient some thing with which to fix her arms, a towel fixed to the head of the bed, for instance, and by placing a firm support, a stool, for instance, at the foot of the bed. These must be scrupulously clean, and ought to be arranged beforehand (see p. 633).
The pain has changed from the front and thighs, where it is mostly felt during the first stage, and is now chiefly in the back, low down, and much comfort is given by the nurse sitting in front of the bed, applying both hands over this region and pressing firmly during each pain.
The pains are also recurring with increasing frequency, and the intervals become very brief.
When the head gets down on to the floor of the pelvis the bulging of the external parts shows its presence, and the patient now begins to feel something pressing on the perinteum. It is at this time that a pillow should be placed between the knees to separate the thighs. Now also the external parts may be again cleansed with a piece of gamgee soaked with lysol solution. This may be repeatedly needful be cause of matter forced out of the bowel.
During the labour, drink, cold water, &c., is not to be refused, but, of course, ought to be partaken of only in moderate quantities. A warm cup of tea may be refreshing, but stimu lants are to be given only by medical orders, and without such advice no drugs should he taken with the idea of terminating the confine ment more quickly.
Just when the child is being born the patient should refrain as much as possible from severe pressing down, that the risk of tearing the parts may be diminished. It appears also that the common custom of placing the hand over the external parts to hold against the advan cing head is more likely to lead to rupture than to prevent it.