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Category: Obstetrics or Midwifery

The eyes should be washed soon and normal respiration established. If the
child does not breathe well, cold water may be sprinkled in the face and
chest and if this fails, immersions in hot water at 106 degrees F., and
sprinkling with cold water must be resorted to. If necessary, artificial
respiration must be given. Slap the child on the back and move the arms up
and down by the side a few times, or breathing into the child's mouth.

Another method. Face the child's back, put an index finger in each
arm-pit and the thumbs over the shoulders, so that their ends over-lap the
collar-bone and rest on the front of the chest, the rest of the fingers
going obliquely over the back of the chest. The child is suspended
perpendicularly between the operator's knees. Its whole weight now hangs
on the first fingers in the arm-pit; by these means the ribs are lifted,
the chest is expanded and inspiration is mechanically produced. The infant
is now swung upward till the operative's hands are just above the
horizontal line, when the motion is abruptly, but carefully, arrested. The
momentum causes the lower limbs and pelvis of the infant to topple over
toward the operator. The greater part of the weight now rests on the
thumbs, which press on the front of the chest, while the abdominal organs
press upon the diaphragm. By these two factors, the chest is compressed
and we get expiration, mechanically. After five seconds the first position
is resumed again, and the lungs expand and fill with air. This process may
be repeated several times until the breathing seems to be going naturally,
and with delicate infants it should be the last resort.

After the breathing has been established the child should be wrapped in a
warm flannel with hot water bags or cans near it, and left until the
mother has been cared for. Infants at birth are covered with a white
greasy substance, vernix caseosa, or cheesy varnish; it is removed by
applying olive oil, vaselin or fresh lard, and afterward rubbing the skin
gently with a soft cloth. The eyes and mouth should be washed out with
pure warm water--or a saturated solution of boric acid, used. Separate
squares of soft linen being used for this purpose. If the baby is born too
soon or is very small, weak and undeveloped, it should be given an oil
bath, only, and then wrapped in cotton wool and kept at a temperature of
not less than 80 degrees F., for ten days or two weeks.

To a fully developed child the first bath may be given at once. Have
everything ready before beginning, a foot tub, warm soft towels, warm
water, castile soap, olive oil or vaselin, small squares of muslin or
linen, dusting powder, a dressing for the navel and clothing, the latter
consisting of a diaper, a flannel band, a shirt, long woolen stockings, a
loose long sleeved flannel petticoat and a simple soft white outside
garment, the two last, long enough to more than cover the feet. The infant
should be wrapped in flannel and only the part which is being bathed at
the moment should be exposed. The eyes are first bathed separately and
with different cloths, and afterward the face, no soap being used; the
head is then washed with warm water; very little soap should be used with
infants as it is more or less irritating, and it is likely to injure the
fine texture of the skin. Next, one should carefully clean the parts
behind the ears and the crevices of the neck, arm-pits and joints and
those between the buttocks and the thighs, and it is well to notice if all
the natural openings are perfect; finally the baby is put down into the
tub of warm water at about 96 degrees F., and washed off, with the head
and back firmly supported with the left arm and hand during the bath. The
baby is lifted out in a minute of two, held face downward for a moment and
rinsed off with clean warm water. It is then wrapped in a warm towel and
flannel and dried by patting, not rubbing. It is best to do all this on a
table, instead of on the lap, and it should be large enough to hold a bath
tub, every thing necessary for the bath and a pillow upon which to place
the baby. Everything then can be done without stooping and with greater
comfort to the child. Powder should not be used except where there are
signs of chafing, when stearate of zinc is the best to use.

The navel is then dressed. A hole is cut in the center of a square of
sterilized lint or linen which is slipped over the cord and folded about
it; the cord is then laid toward the left side, and over it is put a small
sterilized cotton pad which is held in place by the flannel bandage and
just tight enough to hold. The binder may be kept on by sewing it smoothly
with half a dozen large stitches, thus doing away with any danger of being
injured from the pins. A binder should only be tight enough to hold the
dressing for the navel. After the cord drops off the looser knitted band
should be used. The infant is not bathed in the tub again until after the
cord has been dried up and ready to drop off, which usually occurs on the
fifth or sixth day, although it may not drop off for nine days. The cord
should not be redressed in the meantime. (See Baby Department for further


The first duty of the physician, following the third stage of labor, is to
see that the womb is well contracted and control of this organ should be
continued for at least one hour after delivery. This generally prevents
excessive loss of blood. If necessary to promote womb contraction one
teaspoonful of ergot can be given. After the womb has been kept in a state
of contraction, the room should be rid of all evidences of labor and the
woman made comfortable. The buttocks and thighs which have been soiled
during the labor should be bathed with warm water and soap and the
external genitals sprayed with an antiseptic solution, then dried with
sterile gauze or cotton, the dressing applied to the vulva and the
temporary bed removed, her night dress pulled down and the patient thus
lying in a clean, comfortable bedding. The woman may then have a cup of
weak tea, hot milk or broth and be left to rest; but during the first
sleep the womb should be carefully watched lest it relax and serious, if
not fatal, bleeding occur. In a normal confinement the dressings need not
be changed, as a rule, oftener than six times in twenty-four hours, for
the first few days. As soon as convenient after the first toilet is
finished the physician sterilizes his hands and with the patient on her
left side introduces one finger into the rectum and the thumb into the
vagina to discover the condition of the perineum. Washing out of the
vagina is not necessary as a rule.

The binder is considered indispensable, and should be made of unbleached
muslin and wide enough to extend from the pubic (bone) to the breast-bone,
and long enough to go around the patient's body and slightly lap. The
binder should be pinned or sewed tightest in the middle, but it should not
be so tight as to press upon the womb and crowd it backward or to either
side. It acts as a splint to the muscles and assists in resting them to
their natural condition.

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Previous: Management of the Second Stage

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