As the two hundred and seventy-three days come to a close, our expectant mother approaches the day of labor with joy and gladness. The long, long waiting days so full of varied experiences, so full of the consciousness that she, the waiting mother, is to bring into the world a being which may have so many possibilities—well, even the anticipated pangs of approaching labor are welcomed as marking the close of the long vigil. These days have brought many unpleasant symptoms, they have been days of tears and smiles, of clouds and sunshine.

THE TIME OF WAITING

The prospective mother has thought many times, "Will my baby ever come?" But nature is very faithful, prompt, and resourceful. She ushers in this harvest time under great stress and strain, for actual labor is before us—downright, hard labor—just about the hardest work that womankind ever experiences—and, as a rule, she needs but little help—good direction as to the proper method of work and the economical expenditure of energy. In the case of the average mother this is about all that is needed, and if these suggestions come from a wise and sympathetic physician—one who understands and appreciates asepsis—she may count herself as fortunately situated for the oncoming ordeal.

In the days of our grandmothers it was almost the exception rather than the rule to escape "child-bed fever," "milk leg," etc.; but in these enlightened days of asepsis, rubber gloves, and the various antiseptics, puerperal infection is the exception, while a normal puerperium is the rule; and this work of prevention lies in the scrupulous care taken by anyone and everyone concerned in any way with the events of the day of labor.

On this day of labor, the mother, who has gone through the long tedious days of waiting, should see to it that nothing unclean—hands, sponges, forcep, water, cloth—is allowed to touch her. Above all things do not employ a physician who has earned the reputation of being a "dirty doctor." Puerperal infection is almost wholly a preventable disease and every patient has a right to insist upon protection against it.

In a former chapter will be found a detailed description of the "delivery bed." Beside this bed, or near by, are to be found the rack on which are airing the necessary garments for the baby's reception—the receiving blanket and other requisites for the first bath—together with numerous other articles essential to safety and comfort.

There should be an easy chair in the room for the mother to rest in between her walking excursions during the first stages of labor. The sterilized pads and necessary articles mentioned in an earlier chapter are, of course, close at hand.

FIRST SYMPTOMS OF LABOR

Regular, cramp-like pains in the lower portion of the abdomen which are frequently mistaken for intestinal colic, often beginning in the lower part of the back, and extending to the front and down the thigh, are often the first symptoms of the approaching event. With each cramp or pain the abdomen gets very hard and as the pain passes away the abdomen again assumes its normal condition. These regular cramp-like pains are the result of the early dilation of the cervix—the first opening of the door to the uterine room which has housed our little citizen through the developmental stages of embryonic life—and as a result of this stretching and dilating there soon appears that special blood-tinged mucus flow commonly known as "the show."

THE PRELIMINARY BATH

At this time a very thorough-going colonic flushing should be administered. The patient takes the "knee-chest" position, or the "lying-down" position, and there should flow into the lower bowel three pints of soapy water; this should be retained for a few moments; and after its expulsion, a short, plain water injection should be given. Now follows the preliminary general bath.

Just prior to the bath, the pubic hair should be clipped closely, or better shaved. Then should follow a thorough soap wash, with patient standing up in the tub, using plenty of soap, applied with a shampoo brush or rough turkish mit. The rinsing now takes place by either a shower or pail pour. Do not sit down in the tub. This is a rule that must not be broken, because of the danger of infection in those cases where the bag of waters may have broken early in the labor.

A weak antiseptic solution, prepared by putting two small antiseptic tablets into one pint and a half of warm water, is now applied to the body from the breasts to the knee. Put on a freshly laundered gown, clean stockings and wrapper. The head should be cleansed and hair braided in two braids.

THE PROGRESS OF LABOR

If all the mothers who read this volume could bear children with the comfort Mrs. C. does, I should be happy, indeed.

At four o'clock one morning a very much excited father telephoned me, "Hurry, quick, Doctor, it's almost here." It was well that we did hurry, for the first sign the little mother had was the deluge of the waters—at this point the husband ran to telephone for the doctor—no more pains for thirty-eight minutes (just as we entered the door) and the baby was there. But such is not usually the case, nor will it be, as labor usually progresses along the lines of conscious dilating pains, occurring at intervals twenty minutes apart at first, later drawing nearer together until they are three to five minutes apart. This "first stage of labor" lasts from one to fifteen hours—during which time the tiny door to the uterine room which was originally about one-eighth of an inch open—dilates sufficiently to allow the passage of the head, shoulders and body of the fully developed child.

About this time the bag of waters usually bursts, and, as a rule, this marks the beginning of the "second stage of labor." The amount of water passed varies in amount. Should the rupture take place before the door is fully open, then labor proceeds with difficulty and the condition is known as "dry labor."

The head after proper rotation now begins the descent; and here the pains begin to change from the sharp, lancinating, cramp-like pains which begin in the back and move around to the front, to those of the "bearing down" variety, while at the same time there begins to appear the bulging at the perineum, which means that the head is about to be born. At this time great stress is brought to bear upon the perineum and often, in spite of anything that can be done to prevent it, the perineum is more or less lacerated.

As soon as the baby is born the "second stage of labor" has passed and within thirty to fifty minutes the close of the third stage of labor is marked by the passage of the placenta or "afterbirth."

FALSE LABOR PAINS

Sometimes, as long as two weeks before the birth of the child, certain irregular, heavy, cramp-like pains occur in the abdomen and back. For a half-dozen pains they may show some signs of regularity; but they usually die down only to start up again at irregular intervals. These are known as "false pains."

When the pains begin to take on regularity and gradually grow heavier and it is near the appointed time for the labor, the patient should prepare to start for the hospital; or, if it is to be a home delivery, the physician should be called. As noted above, the first subjective symptom may be the rupture of the bag of waters, and it is imperative to prepare at once for the labor. It is far better to spend the day at the hospital, or even two days waiting, rather than to run the risk of giving birth to the child in a taxicab or street car; or, in the event of a home labor, to have the child born before the doctor arrives.

WHAT TO DO IN THE ABSENCE OF A DOCTOR

It is often the case that when we need our physician the most, he is busy with another patient and cannot come, or perhaps an automobile accident detains the man of the hour. The hospital delivery always possesses this advantage over the home—physicians are always on hand. We deem it wise to relate in detail the method of procedure during the rapid birth of a child; that the husband or nurse may give intelligent and clean service.

After the patient has been given the enema and has been shaved and the bath has been administered as previously directed, the helper most vigorously "scrubs up." There are three distinct phases to the "scrubbing up": First, the three-minute scrubbing of the hands and forearms with a clean brush and green soap; to be followed by, second, the trimming and cleaning of the finger nails, for it is here, under the nails, that the micro-organism lives and thrives that causes child-bed fever or septicemia; and, third, the final five-minute scrubbing of the fingers, hands, and forearms. An ordinary towel is not used to dry the well-cleansed hands, but they are now dipped in alcohol and allowed to dry in the air.

And now if the pains are returning every three to five minutes or if the bag of waters has broken, the patient should go to bed. She will lie down on her back with the knees drawn up and spread apart. The patient, having had the cleansing bath, is now washed with the disinfectant bath (2 antiseptic tablets to 1½ pints of water), from the breasts to the knees. Another member of the family takes the outer wrappings off the sterilized delivery pad and the "clean" helper places the sterile delivery pad under the expectant mother, who is directed to "bear down" when her pains come. She may be supported during these pains by pulling on a sheet that has been fastened to the foot of the bed.

The clean, helper then sits by her constantly until the baby is born but under no circumstances should touch her until after the head appears. Immediately after the birth of the head, the shoulders usually follow with the next pain, which ought to occur within two or three minutes. Occasionally the face turns blue, in such an instance, the mother is directed to strain vigorously and presses down heavily on the abdomen with both her hands, this usually hurries matters materially, and the body of the child follows quickly. The baby should cry at once. If the child does not show signs of life, quick, brisk slapping on the back usually brings relief. During the birth of the head it is imperative that, in the event of liquid passing at the same time, no water or blood be sucked into the mouth by the baby. Great care must be exercised in this matter. Should the baby remain blue, lay it quickly upon its right side near the mother, and after the pulse of the cord has stopped beating the clean helper ties the cord twice, two inches from the child and again two inches from this tying toward the mother, and then the cord is cut between the two tyings with scissors that have been boiled twenty minutes.

Should there be more difficulty with the breathing of the new born child, if slapping it on the back brings no relief, its back (with face well protected) may be dipped first in good warm water, then cold, again in the warm, again in the cold—this seldom fails. The child should then be kept very warm, lying on its right side.

CARE OF THE MOTHER

All this time, a member of the family has been firmly grasping the mother's abdomen, and within an hour the afterbirth passes out through the birth canal. If the physician has not yet arrived, all dressings, the pad, the afterbirth, must all be saved for his inspection.

The inside of the thighs and the region about the vagina is now washed with bichloride solution, the soiled delivery pad removed, a clean delivery pad is placed under her; an abdominal binder is applied and two sterile vulva pads are placed between the legs, and hot water bottles are put to her feet, as usually at this stage there is a slight tendency toward chilliness. She should now settle down for rest. Fresh air should be admitted into the room. There may be some hemorrhage, and if it is excessive, grasp the lower abdomen and begin to knead it until you distinctly feel a change in the uterus from the soft mass to a hard ball about the size of a large grape fruit; thus contraction has been brought about which causes the hemorrhage to decrease. If the doctor has not yet arrived put the baby to the breast, and place an ice bag for ten or fifteen minutes on the abdomen just over the uterus. Should there be lacerations, the doctor will attend to their repair when he comes. One teaspoonful of the fluid extract of ergot is usually given at this time, if possible get in touch with the physician before it is administered.

CARE OF THE BABY

After the mother is comfortable, your attention is directed to the baby; the condition of the cord is noted; should it be bleeding, do not disturb the tying, but tie again, more tightly just below the former tying, and with the long ends of the tape, tie on a sterile gauze sponge or a piece of clean untouched medicated cotton, thus efficiently protecting the severed end of the cord. No further dressing is needed until the doctor arrives.

Grave disorders have arisen from infection through the freshly cut umbilical cord.

Should the doctor be longer delayed, one drop of twenty per cent argyrol should be dropped in each of the infant's eyes and separate pieces of cotton should be used for each eye to wipe the surplus medicine away.

This application must not be long neglected, for a very large per cent of all the blindness in this world might have been avoided had this medicine been placed in each eye soon after birth.

The warmed albolene is now swabbed over the entire body of the infant (this is done with a piece of cotton), the arm pits, the groins, behind the ears, between the thighs, the bend of the elbow, etc, must all receive the albolene swabbing. In a few minutes, this is gently rubbed off with a piece of gauze or an old soft towel, and the baby comes forth as clean and as smooth as a lily and as sweet as a rose.

The garments are now placed on the child—first the band, then shirt, diaper, stockings, flannel skirt, and outing flannel gown—and it is put to rest after the administration of one teaspoonful of cooled, boiled water. In six to eight hours it will be put to the breast.