Examination of the Patient

Categories: 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. T e 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.