If these measures fail to make the child breathe, the child will often be caused to do so by grasping it with both ankles in the right hand, and gently lifting it so till it haugs head downwards. This manoeuvre will produce a gasp. The child is thee lowered on to its back and again lifted in the same way, and this movement is repeated till breathing is estab lished. Because the child does not at once breathe, no hasty conclusion that it is still-born should be reached. Prolonged and patient per sistence will often be rewarded.
Management of the Thihl Stage of Labour.--The first thing requiring attention after the removal of the child is the removal of the after-birth. This is the third stage of labour (see p. 638).
If the nurse's hand has been pressing down on the womb from the outside during the birth of the child, this will probably have aided the separation of the after-birth. The hand is to be again applied on the belly over the womb, which ought to be felt as a firm, roundish mass, and if the womb be grasped, and gently but firmly pressed downwards and back wards, a slight rubbing movement being at the same time practised, the womb will usually be found to grow smaller and firmer, and to de scend. The hand must follow it, the firm pres sure being continued, when the after-birth will be readily expelled. The after-birth is not to be removed by pulling on the cord, only a gentle pull is to be exerted on it, if the womb is con tracted, and merely to aid its expulsion, not forcibly to draw it out. When it appears at the external opening it is to be taken into the grasp of the hand and twisted round and round a considerable number of times. This coils the membranes, expelled with it, into a sort of rope, and prevents any part of them being retained in the womb, to give rise to severe after-pains. After th6 removal of the after-birth the patient may roll round on to her back. The nurse's hand, meantime, should be kept pressing on the womb, and if it show signs of relaxing to any extent, by growing larger and rising up into the belly again, slight rubbing and gentle kneading will cause renewed contraction, and in a short time it will remain firmly con tracted.
The after-birth usually comes away in from 20 to 30 minutes after the birth of the child, but it may immediately follow the child, or it may be delayed two hours. In ordinary cir cumstances, therefore, even though a nurse be without help, she may safely leave the mother, as soon as the child is born, to attend to it, if any delay has occurred in its breathing.
On the other hand, if the child breathes and cries lustily, the nurse, having laid it in a safe place, should return at once to the mother, turn her on to her back, and by the hand over the belly assist to keep the womb con tracted, and thereby assist to limit the loss of blood till the after-birth is expelled. If
this is delayed she should sit down at the bed side, being assured of the safety of the child, and keep her hand over the womb, gently kneading and pressing it, and now and again trying by a gentle strain on the cord to see whether the after-birth be not actually out of the womb, and merely lying in the passage.
So long as the womb feels hard under the hand, and is not becoming soft and again be coming distended, there is no need for hurry. The patient may be directed to cough and to press down, and this may be enough to expel it. After fully half an hour's delay the nurse may gently insinuate the whole hand into the passage, and, finding the placenta there, sweep it wholly out, but it must not be torn. Before doing this, however, the nurse must thoroughly wash and scrub her hand, and soak it in lysol solution, as directed on p. 636.
If it is not found lying in the passage, the cord must on no account be pulled on. Medi cal aid must be summoned, and meantime the nurse must sit, maintaining pressure over the womb and the gentle kneading to keep it firmly contracted. If she does not do so, serious bleeding may occur. This is called postpartum hmmorrhage, and may be due to irregular contraction of the womb—hour glass contraction—imprisoning the after-birth, or to adhesions between the after-birth and the wall of the womb.
The Treatment of the Mother after the Completion of Labour.—The having been removed, the petticoat guarding the bed-clothes from staining should be un done, the draw-sheet or accouchment sheet unpinned, and so rolled up under the mother and withdrawn as to enclose all discharge. It is well at this point, if possible, to slip a warm bath-towel under the mother, and with fresh squares of gamgee and fresh lysol solution to sponge thoroughly clean the mother's person, removing all clots and blood-stains. Oppor tunity must be taken to see to what extent, if any, the parts have been torn, and if any tear is found in the perinreum, medical assist ance must be got to stitch it. Meantime the parts are thoroughly cleansed and dried with squares of gamgee, and a perfectly clean band age or folded napkin is used to tie round both legs and keep them together till the stitching is done. The towel is then removed, the fresh, warm, folded blanket or sheet of absorbent wool or gamgee is spread under the patient, a clean, warn' napkin or diaper of gamgee placed close up between the legs and fixed by attachment to the binder.