LETTER XXVII.. Advice Concerning Labor.

ADVICE CONCERNING LABOR.

The Medical Attendant—State of Mind—The Room—State of the Bowels—The Dress—The Bed—The Position, Exercise, Food, and Drink.

It will be inferred, from what I have already said in these letters, that I am in favor of employing a physician, male or female, in all cases of parturition. Most cases, I admit, will get along well without any medical aid whatever; but, as you are well aware, there are exceptions to all rules; and it is for these exceptions that a physician is needed.

In the first place, then, it is always advisable in labor that you call your medical attendant early. If it is worth your while to have aid at all, it is best to have it in good season. The physician himself always prefers to be called early.

Once you have fixed upon your medical attendant, resolve to be guided by him in every particular, and follow his directions faithfully. If you have, from necessity or otherwise, chosen a man-midwife, you need have none of those foolish whims which some among the so-called reformers of the present day would have you to believe.

It is always an unpleasant duty for one to attend a woman in childbed; and be assured that, of all places in the world, a delivery is the last one in which lascivious or lustful excitement is experienced. I wish you, then, one and all, to remember that if it is unpleasant for you to be attended by a man under such circumstances, it is equally so to him. If he is a conscientious and benevolent physician, he will cheerfully do that which he considers his duty to do; but as far as his own personal self is concerned, he would much rather be at home, enjoying its quiet and its sleep, if need be.

In regard to your preparation for labor, I will suppose that you have done all in your power to maintain an equable and healthful state of both mind and body, and that you are resigned to encounter whatever God in His mercy may see fit to bring upon you. If you have done all that you could for yourself, and are still willing and determined to do so, surely you should feel contented; you can do no more.

The Room.—As to the apartment in which you are to be confined, you should take the best one in the house. If possible, you should have one which is well lighted and aired, and which can be readily warmed, if there is need of raising the temperature. If it is in a city, a back room should be preferred in preference to one in front, on account of the noise of the street.

If the labor is to be a tedious one, it is particularly necessary that the air of the apartment be kept as pure as possible. Not only should the strictest attention be paid to ventilation, but all odors and perfumes should be dispensed with. These do no good, for mere hiding the bad air is not destroying it, and they always do more or less harm.

There should not be too many persons in the room when the woman is to be confined. In the country it is by far too much the fashion for a large company of women to get together on such occasions. This always renders the air of the apartment more foul than it otherwise would be, and for other reasons it ought not to be permitted.

I have many a time pitied the condition of women whom I have attended, who had but one room to live in, cook, wash, iron, and at last to be confined in; and yet those women have in general got along better than such as live in a more sumptuous way. Such women are, in fact, workers, and employment, as I have before remarked, is a most blessed thing in regard to preparing the system for the important function of labor.

The Bowels.—If the bowels should be constipated at the time when labor is about to come on—and such is likely to be the case—the woman should use clysters freely. This practice is, in fact, advisable in all cases, inasmuch as it can do no harm. If there is fecal matter in the colon, it is better that it be removed before the birth is about to take place. Hardened excrementitious matters in the lower bowel are always a hindrance to labor.

The Dress.—Formerly it was considered a matter of importance as to how a woman was dressed in labor. Different countries and provinces had their particular forms of gowns, jackets, chemises, and head-dresses. The great thing, however, to be observed, is simplicity; that is, nothing should be worn which at all interferes with the body in any of its functions or parts. If the dress is such as causes no constriction of the abdomen, the chest, or the neck, such as gives free motion to the limbs, and is of such material that it makes the body neither too hot nor too cold, it is all that is required. Generally too much clothing is worn at the time of labor. It is safer to be on the side of too great coolness than of the opposite extreme.

The Bed.—This has been called by different names; the lying-in bed, bed of labor, bed of pain, bed of misery, little bed, etc.

Some women will not make use of any sort of couch whatever. I know a lady in this city who has borne a pretty large family of children, who affirms that she gets along much better upon her hands and knees on the floor than in any other way. Some are delivered standing up, the elbows resting on some object, as the mantle-piece, bureau, the back of a chair, or some other piece of furniture, or perhaps upon the shoulders of a friend. “A strong and well-formed woman,” says Velpeau, “may be delivered in any posture, on a chair, on the floor, a bundle of straw, on foot, and on all the kinds of beds that have been proposed; so that it is only in the cases where nothing interferes with the accoucheur’s doing just what he thinks best, that he ought to attach some value to the composition of the lying-in bed; further, the only essential matter is, that the woman should lie as comfortable as possible, that she should not be incommoded, neither during the pains nor the intervals between them, and that the perineum may have room to dilate.”

Oftener than otherwise in this country, the woman is delivered on the same bed on which she sleeps. Sometimes, also, a cot is used, which also is a very convenient contrivance, since it allows of the free passing of the physician and others about it. It is, likewise, a healthful plan to move from one bed to another after labor; but this is by no means strictly necessary. Cleanliness, comfort, and good air—these are the great requisites in regard to the bed.

The Position.—If the patient is to lie upon a bed, which is doubtless the preferable plan in the majority of cases, what shall be her position?

This, like many other things, is a matter somewhat of fashion. In Great Britain the woman is always placed upon the left side, with the thighs flexed, that is drawn up toward the body, and the hips brought close to the right side of the bed. The same position is usually adopted in this country; but on the Continent, the woman is placed on her back to be delivered. This, I am inclined to think, is the most favorable, as well as most agreeable position, although perhaps not the most convenient for the medical attendant.

Exercise.—During a considerable portion of an ordinary labor, it is doubtless better for the patient, especially if she feel inclined to it, to sit up, and walk about a little from time to time. This not only affords some relief, but likewise aids in causing more efficient contraction of the uterus.

Food and Drink.—It would always be better, so far as food is concerned, for the patient to fast a meal or two before labor comes on. She should, however, be allowed all the drink she desires, pure soft water being the best she can have. If she drink pretty freely, it will be of essential service to her in keeping off feverishness, and in helping the renal organs to act properly. If the pains are tardy, taking now and then a drink of cold water, even against the inclination, will help on the pains. Even ice is used with good effect for this purpose.