In anticipation of the birth of the child, its clothing should be hanging before the fire, a bath, warm water, a clean sponge, and some good soap should be in readiness, also a pair of scissors, and two pieces of linen thread, each piece about a yard long, and twice doubled, with a good knot at each end, for the purpose of tying the cord. Some olive-oil should also be at hand.
As soon as the head is horn, the attendant should pass the fingers up to feel whether the cord is round the neck. If it be, the finger should be able easily to slip it over the shoulder. One hand is then placed over the outside of the belly, and, grasping the womb, as it were, gentle pressnre is to be made, following it downwards as it descends. The body of the child will usually be born within a few seconds of the head without any further aid, though gentle pulling may be made with one hand on each side of the head, if aid seems needed from threatened suffocation of the child or other cause. Rarely the membranes are not ruptured during labour, and the child is born still in closed in them. They must in such a case be quickly torn, else the child will be suffocated. The child is said in such circumstances to be born with a "caul." This, of old, was con sidered a sign of good omen, and seamen used to seek to obtain the canl under the belief that it protected the wearer from death by drown ing.
The average duration of the second stage in primiparee is 2 hours, in mnitiparte 1 hour.
Attention must now be diverted for a little from the mother to the child.
The Immediate Tveatment of the Newly born soon as the child is born it should be placed in a position in which it may breathe easily, bed-clothes being kept off its face, &c., and mucus wiped from the mouth and nostrils with a square of gamgee. Usually the mere contact of its naked body with the air causes a gasping movement., followed by regular breathing and lusty crying. If thi does not at once occur, it is ordinarily readily induced by suddenly bloWing in the child's face, smartly. patting it on the buttocks, rapidly rubbing the fingers up and down the sides of the chest, or dashing a small quantity of cold water on the chest. All these means, by irritating the nerves of the skin, stimulate the movements of breath ing. In the meantime it is proper not to tie the cord or separate the child from its attach•. ment to the mother. For if the fingers be placed on the cord, pulsation will often still be felt, indicating that the circulation in the after birth has not yet ceased, and there is thus the possibility that the child's blood may still be aerated to some extent through the mother.
In ordinary circumstances little effort is needed to excite breathing beyond the slapping, &c., already noted. All that remains to be
done, then, is to tie and cut the cord. This is done in the following way. Two pieces of linen thread, folded twice, each with a large knot at both ends, are used. One piece is tied tightly round the cord, about 2 inches from the belly, and the other piece an inch farther away. The cord is then divided between the two pieces of thread. Care must be taken that, in the act of tying, the cord is not suddenly jerked, lest it be torn from its attachment to the belly, which would occasion bleeding very difficult to stop. Further, while the cord is being divided, care must be taken lest the child, by a sudden twist, brings fingers, toes, or other part between the scissors. As soon as the child is separated from the, mother its eyes are wiped clean with a fresh piece of gamgee; it is wrapped in a square of flannel ready for the purpose, and laid in a safe, warm place, while attention is again given to the mother.
If the pulsation has stopped, and the child's breathing is not yet established, the cord should be tied, and then divided, and the child's body should be quickly plunged into a basin of warm water, the head, of course, being supported, and then as quickly removed from it, and cold water plentifully dashed over the chest, then plunged again into the hot water and again the cold dashed over it, till by the sudden changes the breathing is established. If these methods do not speedily produce the desired effect, artificial respiration must be resorted to. The little finger (quite clean) of the attendant should be introduced into the mouth and passed to the back of the throat to sweep out any mucus there. Then one of two methods may be adopted. Dr. Howard, of New York, advises that the child be supported on the attendant's left hand and arm (as shown in Fig. 211), while the right hand grasps the lower part of the chest. The chest is steadily compressed for three seconds, and then suddenly let go. After waiting for three seconds the pressure is re peated, and so on, ten to twelve times a minute. The second method consists in the attendant, after cleaning the child's mouth, applying his or her own mouth closely to it, and, the child's nostrils being closed, gently and steadily blow ing till the chest is seen to be inflated. On allowing the nostrils to open, the chest will fall again ; they should be again closed, and the blowing repeated. This should be continued for a considerable time, at the rate of ten to fifteen times a minute, and if any effort to breathe be made by the child itself the blow ing should be timed to aid it.