What Women Should Know/Chapter 12

Duration of Pregnancy.—The full time for pregnancy is from two hundred and seventy to two hundred and eighty days, though delivery may sometimes take place a few days earlier or a few days later. In rare cases it is sometimes delayed for weeks after the proper period.

The "Show."—When the time for parturition is actually drawing near, the woman is apprised of the fact by a mucus-like discharge usually tinged with blood. When this discharge, or "show," as it is called, appears, it is a sign that labor has actually commenced, though it may be several hours or even several days before the pains are felt with any regularity.

First Stage of Labor.—This is the first stage of labor. The mouth of the womb is open and the parts gradually relaxing preparatory to the second stage.

Preparations for Confinement.—It is now time for the woman to set her house in order, get all things in readiness, and send for her nurse, if one is engaged, but not yet time to think of a doctor.

The Bed Prepared for Delivery.—Let the ​bed be made up with fresh. clean, well-aired clothes These must all be lifted from the foot and folded back over the upper half of the bed. Over the bare mattress or bed should be spread a piece of oil-cloth a yard and a half square. Over this again is folded and spread an old comfort. This should be covered with a sheet, which, if desirable, to save extra washing, may be the one which has already been in use upon the bed. The bed-clothing to cover the patient must be in quantity suited to the weather, and of a material easily washed. The curtains and valances should be removed.

What Kind of a Bed should be used in Confinement?—I believe it immaterial, in a hygienic point of view, whether a straw bed, a mattress or a feather bed is used during confinement. The patient should consult her own feelings entirely in the matter.

Feather Beds.—There is a great deal of what I consider unfounded prejudice against the use of feather beds. Some object to them on the score of their enervating influence, others on that of a supposed general unhealthfulness. If one feels weakened from the use of a feather bed, he or she had better give it up, but that is no reason why another who experiences no such bad effects should practice a similar denial. I know its use is absolutely beneficial to some persons. As to its unhealthfulness, when it is profusely. shaken, aired and cleansed, I think that is all a mistake.

​Proper Bedstead.—The bedstead used in a lying-in chamber should be strong and well made, and without a foot-board. The old-fashioned four-poster is the very best kind that can be obtained, as it is capable of enduring all the strain that may be put upon it.

Necessities of the Lying-in Room.—In a place where they will be found without difficulty by those in attendance must be extra bed-clothes, underclothing for the sick woman, bandages and napkins, or cloths. There must be water in the room, towels, soap and a saucer of lard. On a stand, table or dressing-bureau should be a pair of sharp scissors and a piece of cord or string, either cotton or linen, strong, round, soft and elastic, and a cushion filled with pins. Either in or convenient to the room should be the means of heating water quickly.

Infant's First Clothing.—The infant's clothing needed for immediate use should be placed all together in a basket, so that when it is required there will be no time lost in searching out the separate articles. The contents of the basket should be: a soft, long-sleeved night-gown, a flannel petticoat, a soft linen shirt, a flannel or elastic cotton band, socks, a piece of soft linen rag (an old handkerchief is the best), some equally soft cotton rags, a pin-cushion containing pins of two sizes, a piece of white castile soap, a little bag of thin muslin containing powdered potter's clay, a flannel blanket, soft towels and a wash-rag. On top of all should be laid some old garment of soft ​flannel large enough to receive the babe when it is first born, and to wrap it entirely up until some one is ready to take charge of it.

Personal Preparations for Delivery.—When it is time for her to take to her bed, let the woman put on a clean undergarment, with a short nightgown over it. These must both be folded up around her shoulders and waist, and around the latter must be pinned the soiled undergarment taken off, a cotton or flannel petticoat or a folded sheet.

The Hair during Confinement.—Part the hair evenly in a number of divisions, and tightly braid each division. The style is not at all becoming, but it allows of the braids being taken down and combed separately, at intervals that will not fatigue the sick woman.

Condition of the Bowels at the Commencement of Labor.—It is of the utmost importance that previous to the actual progression of labor the bowels should be freely opened. Nature will generally do this; but if she fails, it must be done by artificial means. An injection will probably accomplish the desired end; but if that also fails, a mild purgative, such as magnesia, should be administered without delay. Bear in mind, however, that medicine is only to be resorted to when other means fail.

Ventilation of the Lying-in Room.—The sick-room should be well ventilated without exposing the woman to draughts. An open fireplace or pipe-hole is one of the best and safest means of ​ventilation. Of course, whether windows and doors are to be open, will depend upon the season.

Number of Attendants desirable.—There should not be too many attendants in the sick-room. The midwife, with the nurse, and perhaps a second woman for assistant, are all that are needed. The assistant may be dispensed with, though there should be a third person within call ready to respond to any summons for warm water or whatever may possibly be required.

Second Stage of Labor—Grinding Pains.—When the first regular pains are felt, then the second stage of labor is reached. These pains, which are called grinding pains, may be felt almost immediately after the "show," or may not appear for several hours or days. Some women who have easy deliveries suffer very little from these pains, and do not count them as pains at all. In others they are very severe and almost unendurable. During these pains the mouth of the womb gradually dilates until the opening is sufficiently large to allow the child to force its way through. One of these pains is first felt low down in the back: the pain extends across to the front of the abdomen, then the woman becomes sensible of a contraction of the whole womb without any bearing-down feeling. This contraction is not without pain, though its effect is more that of suspending the breath and making motion impossible for a moment even after the pain has subsided.

Blunders of Medical Authorities.—Writers ​on this subject not infrequently confound the two classes of pains. One medical writer describes the grinding pains as being "attended with a bearing. down sensation." Another authority, also a physician, copies from a medical work a description which he gives as that of bearing-down pains, which occur in the third stage of labor, though it is a correct description of the grinding or dilating pains of the second stage. The description is as follows: "The true labor pains are situated in the back and loins; they come on at regular intervals, rise gradually up to a certain pitch of intensity, and abate as gradually; it is a dull, heavy, deep sort of pain, producing occasionally a low moan from the patient, not sharp or twingeing, which would elicit a very different expression of suffering from her." These pains commence feebly and irregularly at first, but gradually increase in strength and regularity, until they will probably come on at regular intervals of five minutes. They may come on with regularity and severity for a time, leading to a hope of a speedy delivery. Then they will relax and disappear altogether. This may be repeated again and again. There is nothing more discouraging to the patient. If she has summoned doctor and attendants, she feels as though she had been practicing deception upon them, when, after a period of pain, she finds herself perfectly free from suffering, and apparently as far from actual labor as she was before her "show." Besides, her strength is after a time exhausted by this lengthened and repeated ​suffering, and the little courage she may have been able to summon to meet the ordeal before her is very likely to ooze away as time passes.

To Hasten a Tedious Labor.—When there is this discouraging commencement to labor, it will be found beneficial to bathe the feet in warm water and drink some warm herb tea. Thyme tea is excellent in this case, though, if this cannot be obtained, a tea made of hops or of any of the aromatic or medicinal herbs will do. It might also be well to try a tepid sitz-bath. Drinking abundantly of cold water, and applications of cold water upon the abdomen, are recommended by some physicians to accomplish the same purpose.

Time to send for a Doctor.—When the pains seem fairly established in regularity and severity, then it is time to send for a midwife, either professional or non-professional.

Are Doctors Necessary in Delivery?—I have always maintained that in ordinary confinements there is no need whatever of the aid of a physician. In many cases the nurse or attendant woman performs all his duties before he arrives, and all that is left for him to do is to inspect affairs and see if everything is right. There are exceptional cases, of course, when the presence of a doctor is desirable and even necessary.

Female Physicians.—I think, when a woman physician can be obtained, she is to be preferred to a man. She is, as a rule, just as capable, more reliable, ​more sympathizing and more helpful, not to say that her presence does not wound the delicate sensibilities of the patient.

Male Physicians in the Lying-in Chamber.—Do not let the reader understand me to mean that a male physician cannot enter the parturient chamber without violating propriety or shocking modesty: There are many noble men in the profession whose desire is solely to relieve suffering, and their attendance upon the sick-beds of women is characterized by the utmost delicacy.

Reputation of Medical Students.—Still, when one bears in mind the general character of medical students and their deportment on certain special occasions yet well remembered, it is not strange if one should question the probability of these young men ever acquiring that modesty and that respect and consideration for the other sex which should be considered the imperative adjuncts of the male midwife. As the boy is the father of the man, so is the student the father of the physician; and the rudeness, the indelicacy and insulting demeanor which a large number of medical students have proved themselves capable of—as those who read the newspapers but a very few years since will remember—seem sufficient to disqualify them for ever from certain important branches of their profession. For certainly the man who cannot maintain a proper demeanor during the discussion of certain subjects when he meets women as fellow-students in the lecture-room is also incapable of ob​serving propriety when the same subjects are discussed between himself and one of the other sex, the one as physician and the other as patient or nurse.

No Doctor absolutely Necessary.—If the patient has followed the rules I have given her in the previous pages of this book, and if she feels well and strong, there is every reason to look forward to an easy confinement, during which the attendance of a woman of ordinary experience, common sense and presence of mind, is all that is necessary.

Right and Wrong Presentations.—There is, reasonably speaking, only one risk to be run-that of a wrong presentation; and whether the presentation is right or wrong can be ascertained by the attendant, or by the patient herself, if she have resolution sufficient for it, in time to send for professional assistance if necessary. The examination should be made early in labor. The attendant must lubricate her hand with lard or oil, and passing her finger up the vaginal passage, press it upon the mouth of the womb, which will be found lying toward the back. If a hard, unyielding substance is encountered, the presentation is right—it is the head. If, on the contrary, the contents of the womb feel soft and yielding like flesh, a physician should be sent for without delay, as it may be necessary to turn the child before it can be born.

"Taking a Pain."—I have frequently heard women talking about the doctor "taking a pain." For some time I was greatly puzzled what they ​meant by it, but would not subject myself to their ridicule by confessing my ignorance. I at last discovered that they believed that a doctor in making vaginal examinations was able to give them relief from pain and hasten the conclusion of the labor. An occasional examination is necessary, when the labor is prolonged, to note its progress and judge of the probable time of its ending. But these examinations, if so frequently made, irritate the passages, give the woman unnecessary pain and actually retard the progress of the labor.

Requisites of a Competent Midwife.—Although any woman of ordinary ability is perfectly competent to act as midwife, still, it is supposed that no one will undertake the responsibility of such a position without some preparation either of study or observation. Every woman should possess the requisite knowledge to act in this capacity, for every woman is liable to be called without warning to assume this part. If by any combination of circumstances, a woman finds herself forced to act without this due preparation, she must allow herself neither tremors nor fears, but must rely upon her common sense and presence of mind, constantly remembering that nature wants waiting on, but not assistance.

Patient's Position on the Bed.—While the grinding pains continue the patient may sit, stand, walk or lie, as she prefers. It is well to encourage her to be upon her feet as much as possible, as that position helps to strengthen the pains. When she ​takes her final position upon the bed, she must lie diagonally across the lower portion of it.

Voiding of Urine during Labor.—The patient should frequently make water during the entire progress of labor. By so doing she will be saved much pain and possible trouble.

No Bearing Down during the Grinding Pains.—Ignorant attendants will sometimes tell the woman to strain or bear down during the continuance of the grinding pains. This is worse than useless. It exhausts the patient's strength to no purpose; and if this forced bearing down were productive of any result whatever, it would be that of rupturing the womb and causing the woman's immediate death.

Third Stage of Labor.—When the mouth of the uterus is sufficiently dilated, the third stage of labor commences, indicated by a change to "bearing-down pains," by the means of which the child is expelled.

In the bearing-down pains the sensation is exactly like straining at stool. The bearing down is partly an involuntary action of the womb, but it is greatly facilitated by the patient herself straining with all her might. There is no pain, strictly speaking, in the bearing down. What suffering there is at this period of the labor comes from the head of the child tearing the edges of the mouth of the womb as it passes through, and from the excessive stretching and possible tearing of the outer organs as the child is born. If everything is in its most favorable condition, there ​will be no pains whatever at this stage of labor. The severe effort required is, however, exhaustive.

There is no gradual transition from one class of pains into the other. The change is sudden and complete. It may be that one pain is both bearing down and grinding, but seldom more than one. And this is the hardest, most unendurable pain of labor.

In the third stage of labor her bed is the only place for the woman. She must lie on her left side, and it is usual to place her in such a position that she can brace her feet against the bed-post at the recurrence of each pain, at the same time giving her a towel made fast to the same post to pull upon. The patient does not always desire these aids, and it is absurd to insist that she must use them, as I have seen done, when she feels no need for them.

Support to the Back during Labor.—Sometimes it is a relief to the patient to support her back during each pain. This support should be given by a pillow or bundle pressed against the back, rather than by the hands.

Duration of the Third Stage of Labor.—The third stage of labor is generally of short duration, though in a first confinement or in cases of difficult delivery it may be hours before the suffering is at an end. As these pains are only for the purpose of expulsion, if the mouth of the womb is sufficiently dilated, the muscles of the passage relaxed, the child not too large and the bones of the head soft and yielding, three or four pains ought to accomplish the delivery.

​Support for the Right Knee.—When the woman feels the head of the child in the passage, it is customary to place a pillow or bundle between her knees, or for an attendant to support the right knee in an elevated position. These aids, though better than nothing, are not, after all, as perfect as they should be. If this stage of the labor is prolonged, the position becomes very fatiguing to the woman, for after all she only half depends upon the aids furnished her, and is obliged to make much exertion herself, so that days afterward she may suffer from the pain and weariness resulting from it. A better plan is to place a stool, about the height of an ordinary chair, in the bed in such a position as not to be in the way of the attendants who must assist in the delivery of the child. On this let the woman rest her knee. The height of the stool and the consequent elevated position of the knee will force open the bones of the hips to a wider extent, thus allowing a freer passage for the child, and consequently ensuring an easier delivery.

Breaking of the Waters.—The child, while it exists in the womb, floats in a liquid called the amniotic fluid or liquor amnii, the whole being enclosed in a sac. Besides other important purposes which it serves, this amniotic liquor, by gushing out of the ruptured bag a few moments preceding birth, moistens and softens the passages and renders the progress of the child easier. Sometimes the sac of waters breaks in the early stages of labor. This is ​unfortunate, as the labor is retarded in consequence. Sometimes, again, the child is born with the sac unbroken, or, if broken, with the membrane still over its head. This membrane is called a caul, and superstitious people attach a certain significance to it. The proper time for the "breaking of the waters," as it is called, is when the head of the child is in the vaginal passage. At each pain there will be a flow of liquor. If the water does not break of itself, then the attendant ought to rupture the bag with her finger, taking care not to injure the child's head in so doing.

Precaution against Piles.—During the progress of the bearing-down pains it is of the utmost importance that some one—the patient can do it herself as well as any one—should take a soft napkin or rag and press with her finger upon the anus; otherwise, in the severe straining the rectum will be forced outward and piles may be developed. Each succeeding confinement will increase this tendency to piles, and the woman may become a lifelong sufferer.

Protection of the Perineum.—When the head descends in the passage, it is equally necessary that the perineum, or muscle which separates the anus from the vaginal passage, should be protected. In severe delivery, especially in a first confinement, this muscle is sometimes ruptured for want of proper precautions, and the two passages become one. Scarcely a more serious disaster could occur.

Foot Presentation.—It is possible, with a foot presentation, for the labor to advance naturally and ​terminate favorably. A woman of nerve and self-confidence need have little hesitation in conducting a labor with such a presentation. If she lacks confidence and resolution, a physician ought to be sent for. The greatest difficulty in such a delivery is that the hands may not come with the body, but remain clasped over the bead. It is imperatively necessary that the arms be drawn down before the expulsion of the head. The attendant should, with the utmost care and deliberation, slip her forefinger around one arm of the child close to the shoulder, and draw it gently downward, observing the natural movements of the joints. One arm being freed, the other should be treated in the same manner. The body of the child should be supported until the head is born, so that it will meet no injury by unnecessary strain. When the expulsive pains come on, there should be a slight aiding, but no hastening, of nature. An attempt to a forced withdrawal of the child may result in a premature rupture of membranes, a breaking of the navel cord, introversion of the womb or breaking the child's neck. Still, it is actually necessary when the head is born last, if the expulsion of this part is prolonged, to aid nature in a gentle manner. If there is any long delay, the continued pressure upon the umbilical cord, and the consequent interruption of communication between mother and child, may result in the death of the latter, as it is not yet able to breathe. Until it breathes it is necessary for its life that the constant flow of blood through the cord should be unchecked.

​Cases where a Physician is Necessary.—When the labor is exceptionally severe, or when the patient early shows signs of weakness and exhaustion, it is advisable to send for a doctor. Also, when the head of the child has progressed so that it may be seen, and there remains stationary for a length of time, unable through the narrowness of the passage or the rigidity of the muscles to make a further descent. In this case the use of instruments may be required.

There are other cases detailed in medical books in which the presence of a professional is absolutely demanded. It is not necessary, however, to describe these cases here, as probably such a description would cause unnecessary alarm to timid and nervous women, and invest parturition with a host of imaginary evils which do not properly belong to it. These cases are exceptional, and a prudent and judicious attendant, without being positively informed of their varied and exact natures, will always be able to detect them by the abnormal symptoms which they present. When such cases are suspected, without waiting to ascertain their exact nature, there should not be a moment's delay in sending for professional assistance.

Proper Presentation in Labor.—When labor progresses properly and naturally, the back of the head will appear at the opening, the face of the child being turned to the woman's back.

Face Presentation.—Children are sometimes born with what is called a face presentation—that is, ​with the face turned front and presented at the opening. Such delivery is more tedious to the mother and dangerous to the child.

To Avoid Suffocation by the Navel Cord.—As soon as the head is born, the hand should be passed around the infant's neck in order to see if it is encircled by the navel cord. Such cases are rare, yet not impossible; and if the cord is allowed to remain, the child may be suffocated before its birth is completed. The cord must be loosened gently and slipped over the child's head.

Attention to the Child upon Birth.—Three or four pains after the first appearance of the head will generally complete the delivery; and then the mother, utterly exhausted, is allowed a breathing-spell. Now the first object of attention is the child. It ought to cry immediately upon entering the breathing world. All is well if it gives ever so feeble a cry. It is a sign that air has entered its lungs and its communication with the outer world established. It is not uncommon, however, that there is some difficulty in obtaining this first breath. The nose and mouth should be cleansed of all blood and mucus. A smart blow upon the buttocks will sometimes startle the child into breathing. If it still struggles, breathless, blow into the child's mouth in order to inflate the lungs. If this also fails, procure a quill, and closing the mouth and one nostril, blow into the other nostril in order to fill the lungs with air; and then, taking away the hand from mouth and nose. ​press gently on the breast to expel the air, thus imitating natural breathing. This can be done, though not so well, without a quill, if one is not at hand. This failing, immerse the child in water at a temperature of 98° Fahrenheit, or at blood heat. Continue these trials until the child breathes unaided, or until life is extinct. There is little danger of a healthy, maturely born child dying if the proper means are resorted to and persevered in to introduce it to life. I have never known a single instance.

Cutting the Navel Cord.—When the child has fully established itself in the breathing world—not before—the umbilical cord should be cut. This should be tied about an inch and a half—some say two inches—from the body of the child, with a soft, strong cord or string. It should be tied again a short distance from the first place, and then cut between the two tyings by a pair of sharp scissors. The second tying is to prevent the blood, which is still circulating in the cord, from running out and soiling the bedclothes unnecessarily.

Care Necessary in Tying the Navel Cord.—The utmost care should be taken that the string is tied sufficiently tight to prevent any possible bleeding of the child. Doctors are not always careful as they should be in this particular, and it is well for nurses to look after even their work. An overlooked and bleeding navel will soon bring death to the healthiest child. After the navel is attended to, the infant may be wrapped up warmly and stowed away in some safe ​place until its turn for attention comes, unless there is some one ready to wash and dress it.

After-Pains.—In twenty minutes or half an hour after delivery the patient is seized with another class of pains called after-pains. These pains are caused by the contraction of the womb. Their effect is first the expulsion of the placenta or after-birth, then of the clots of blood which have accumulated in the uterus, and finally of the discharges which continue for some time after delivery.

Duration of After-Pains.—A woman with the first child suffers little or not at all with after-pains, but in each successive delivery her sufferings from them are longer and more severe.

Remedy for After-Pains.—Opium in some form is usually prescribed to alleviate the sufferings caused by after-pains. Those who can take opium with impunity will find their sufferings relieved by its use. But I should recommend a person of nervous temperament and with a deranged nervous system to endure the suffering rather than to accept the remedy. Once or twice in my own experience I was persuaded to make use of this drug for this purpose, but its after effects were so bad that I resolved to let it alone in future. I felt many of the symptoms experienced by a confirmed opium-eater when he attempts to break himself from the habit. I scarcely expect to be believed when I state that under certain circumstances I still feel the effects of these two trials, though the first was made five years ago.

​Expulsion of the After-Birth.—In ordinary cases the after-pains will shortly come on. If they do not appear, it is well to wait a reasonable time rather than to hurry nature. I once knew a woman to lie eight hours without any pains and with the placenta unexpelled, without any inconvenience to herself, except the discomfort of not being able to be placed in a clean bed. If the pains are felt, but the after-birth does not come away, that is another thing. In that case a woman may shortly be brought to the verge of death.

Aids in the Expulsion of the After-Birth.—If after the lapse of the usual time of twenty minutes or half an hour the pains begin, but the afterbirth gives no signs of coming, it will be well to pull gently at the cord, with not sufficient force, however, to run any risk of breaking it. At the same time gently yet firmly knead the bowels in order to assist in the detachment of the placenta from the walls of the womb. The woman may also blow in the palms of her hands. The effort put forth by this act is sometimes available. If time goes on and all attempts prove useless, then a doctor should be sent for, all the sooner if the patient is suffering from the severity of her pains, threatened with flooding and showing signs of fainting.

Flooding.—If flooding sets in or is apprehended after delivery is safely accomplished, lower the patient's head and raise her hips, and apply a compress wrung out of cold water to the lower regions of the ​bowels. Continue this until the flooding is checked. If the woman has a desire for ice-water, or even ice, it can do her no harm, and may even be beneficial.

Fainting.—If the patient faints or shows signs of fainting, the windows of the room should be opened, and as much air given her as possible. Her head should be lowered, if it is not already low; hartshorn should be applied to her nose, and water sprinkled in her face. If the fainting is prolonged or repeated, it may be well to put a little wine or brandy in her mouth. A doctor should be sent for at once.

Contraction of the Womb.—The bowels of the patient should be pressed with the hand in order to help in the expulsion of the clots and in the proper contraction of the womb. If the womb is contracting as rapidly as it ought after the expulsion of the afterbirth it should feel hard and rough to the hand, instead of soft and yielding.

Bandage for a Lying-in Woman.—As soon as the after-birth has come away, and the more soiled of the bed-clothing under her has been removed, the bandage must be put on. This bandage may be, and usually is, a yard of strong muslin folded lengthwise and sewed at the ends, or a long and strong towel. Neither of these is as good as a regular bandage cut to suit its especial purpose. The accompanying diagram shows the form I would recommend.

This bandage should be thirty inches around the top, and twenty-five inches from the top of the back to the bottom of the long narrow end. It is ​made double, of strong unbleached muslin. It is fastened in front as tightly as can be borne with comfort. The narrow end is brought down the back, passed between the legs and pinned to the front. This prevents the bandage from slipping up, and at the same time furnishes something by which the cloths needed by the patient can be kept in place, so that they will not fall away at every change of position. The bandage should be tightened from time to time.

There is real comfort in this bandage. In the old-fashioned straight bandages there is nothing but discomfort. Every movement of the patient causes them to slip up, and then by great effort they must be pulled down again; for if allowed to remain out of place, they do harm instead of good.

I think the bandage which I have described might be improved by being made to lace up in front in​stead of being pinned, and then it could be tightened without trouble as often as desirable.

Correct Manner of Putting on a Bandage.—In putting on the bandage, be careful and put it well down around the hips and lower part of the abdomen, in order to give the latter its needed support, while in its present weak condition. The bandage is not used to give shape to the waist, as is the common belief. We do not care one straw about the waist, whether it turns out small or large. If it remains larger than before, it is tolerably good evidence that it was smaller than it ought to have been. Non-professionals usually make the mistake of putting on the bandage too high up. A bandage properly applied will prevent the abdomen from hanging down after convalescence.

Permanent Disposition of the Patient in Bed.—If the delivery has concluded favorably, and no troubles of any sort occur, as soon as the after-birth is disposed of and the bandage adjusted, it is well to place the patient more comfortably in bed. I know the usual advice is for her to remain an hour or more undisturbed. But, no matter how weak she is, she will feel better and gain strength quicker if the soiled clothes surrounding her be removed, and she is made clean and comfortable. Besides, any delay is really retarding the period of actual rest.

Raise her sufficiently to remove all the soiled clothes from under her. Draw down her clean nightgown and chemise, which have been folded around her waist. Bring down the bed-clothes on the side of the ​bed on which she is to lie, and help her to move into the proper place, not allowing her to raise up, but drawing her gently into position. If she is weak and exhausted, she should be lifted at once to the proper place, and not be allowed to make any exertion. Cover her so that she shall feel comfortable, and then finish the arrangement of the bed. When the child is dressed, it should be brought to her and placed to the breast.

Admission of the Husband to the Sick-Chamber.—When all this is done and the traces of delivery removed, then the husband should be admitted to see his sick wife. It will be considerate to leave him alone with her for a short time; but the interview must not be too prolonged.

Need of Quiet.—Sleep is what the mother now needs more than anything else. There must not be a word uttered either to her, or in her presence, until she has had a quiet, refreshing sleep. I know too well how generally this is disregarded. The attendants linger about and fill the sick-room with the confusion of their talk, until the woman becomes nervous and feverish, and sleep becomes impossible. Not even the nurse should remain in the room, though she should be within call.

Food Unnecessary during Labor.—It is a common practice to give a woman in labor hearty, stimulating food, under the impression that she needs it to keep up her strength. If the labor is vigorous and rapid, she should on no account eat anything, as ​all the energies of her body are given to the one effort. If, however, the labor is slow, and the woman feels weakness for want of nourishment, a little cold broth or warm tea or gruel may be administered, but nothing more solid or stimulating. If there are actual pauses in the labor-pains for any lengthened period, she may partake sparingly of any light, nutritious, easily-digested food, as during the pauses the stomach will probably be enabled to resume its functions long enough for digestion.

Food after Delivery.—Even after delivery is accomplished do not press the woman to eat. If she feels the need of food, it may be given her, sparing in quantity and exceedingly light in character; but she is better without it for a time, until the organs have had opportunity to rest.

Stimulants.—Wine, brandy and stimulants of every character should be avoided, and only given, by the advice of a doctor, in cases of extreme prostration. It is best to avoid all temptation by having none of these articles in the house.

Anæsthetics in Midwifery.—I have said nothing about the use of anæsthetics, as chloroform or ether, to mitigate the pains of childbed, because their use comes properly within the province of a physician, and no unprofessional midwife should meddle with them. This silence does not signify disapprobation. On the contrary, I consider them one of the greatest blessings science has vouchsafed to us, and I wish in obstetrical practice their use was far more common.