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Examination of the Patient





Category: Obstetrics or Midwifery

The physician needs to satisfy himself as to
the position of the child, etc. This can be done by an examination of the
abdomen and also of the vagina. He must determine whether the child is
alive, its position, the condition of the cervix and mouth of the womb. In
making such examination a routine plan should be adopted. The coat must be
removed, the shirt sleeves turned up and the hands and arms washed with
soap and water. The abdomen should be thoroughly palpated (felt) and
listened to with the ear or stethoscope to determine the character of the
child's heart beat, whether it be very slow, one hundred and twenty or
less, or a very rapid one, one hundred and fifty or more. It may indicate
danger to the child and necessitate a hurried delivery. After these things
have been done, the hands and arms must again be thoroughly washed and
sterilized, the fingers anointed with carbolated vaselin and the
examination of the vagina made.

This cleanliness is necessary, and if this plan were carried out by
everyone connected with the patient during the whole confinement, there
would be fewer cases of "child-bed" fever, with its resultant diseases.
The patient should lie on her back with the knees drawn up. There is no
need for any exposure now, for the covering can be held up by an attendant
so that it will not touch the physician's hands. The soft parts are now
separated by the fingers of one hand while the examining fingers are
introduced into the vagina. These fingers should never touch any external
part and especially the parts near the anus. If the cervix is found to be
long and the canal still undilated, or only slightly so, and especially if
it is the first child (primipara), the physician's presence is not needed
and he may safely leave for an hour or two. But if the mouth (os) of the
womb is dilated to the size of a silver dollar he should on no account
leave the house.

Frequent examination of the vagina should not be made. In ordinary cases
during the first stage, the woman should be up and encouraged to walk
about the room, to sit or assume any comfortable position. During a pain
she may stand beside the bed resting her hands upon something or kneel in
front of the bed or chair. The standing position assists in the birth. The
bladder should be emptied frequently, as a distended bladder retards labor
and may even stop the womb contractions. The pains become more frequent
and severe as the end of this stage approaches and each contraction is now
accompanied by straining or a bearing down effort on the part of the
woman, and as a rule the membranes rupture spontaneously about this time.
An examination of the vagina should now be made with the woman in bed, and
if the membranes have not broken and the womb is completely dilated as
shown during the pain, they may be ruptured by pressing against them with
a finger-nail during a pain. Sometimes we use every means to retain the
membranes intact, but that is when protection for the child is needed for
sometime longer. If the suffering is very severe, during this stage,
fifteen grains of chloral hydrate, well diluted with water, may be given
every fifteen or thirty minutes until sixty grains have been given. (This
medicine should never be given to a person with heart trouble). I find one
drop doses of the tincture of Gelsemium every fifteen to thirty minutes of
benefit, especially if the womb does not dilate well, or the patient is
very nervous. The patient may receive and can receive light nourishment
during this stage.





Next: Management of the Second Stage

Previous: MANAGEMENT OF LABOR



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