THE CHILD

Categories: 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 mout .



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

directions).







THE MOTHER.



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.