Hints to Husbands: A Revelation of the Man-Midwife's Mysteries. George Morant
extended structures from injury, separating the child, and extracting the placenta from the vagina after its total exclusion from the uterine cavity; still, in the fortieth danger may occur, only to be arrested by the promptest, the most decisive, and most judiciously directed help.
“Much knowledge[20] is necessary to discriminate the kind of cases in which assistance is proper, and determine the time at which that assistance ought to be employed, as well as the mode of its application. It is this which distinguishes the scientific from the ignorant obstetrician; it is this important knowledge on which the life, the future health and comfort of many a parturient woman must depend; which, nevertheless, has been held in such low estimation by some members of the profession, as to be thought unworthy of cultivation by the scientific and literary mind; unfit to be possessed by men of respectable station in society; and the adaptation of which knowledge to practice has been characterized, in an official document under the seal of the highest of our medical corporate associations, as ‘an art foreign to the habits of gentlemen of enlarged academical education.’[21] In the same communication it is asserted, ‘that the most successful practice of midwifery requires no such laborious preliminary study as is necessary for the practice of medicine, else discreet matrons, and plain uneducated men in the country, who frequently arrive at great notoriety in this calling, would not acquire that credit which they often attain.’ … nor, perhaps, are we generally expected to regulate the number of individuals to be present, though we may be called upon occasionally to exercise our authority in this respect. The only persons whom I would willingly admit are the nurse and some female married friend, the mother, or other near relation, or an intimate acquaintance, to act as confidante to the sufferer, into whose sympathizing ear she may whisper all her apprehensions and distresses, and from whom she may receive those numberless comforts and sustaining consolations of which she stands so eminently in need. Unmarried females are neither the most fit companions for the patient, nor the most useful assistants to the practitioner.[22]
“On being ushered into her chamber, we may engage her in some general conversation, which will give us an opportunity of observing the frequency, duration, strength, and character of the pains; and our conduct must be framed according. Should they be of trifling importance, we may content ourselves with giving some ordinary directions and retire from the apartment. But if they are returning with frequency and activity, we must not allow much time to elapse before we require to make an examination PER VAGINAM.[23] An objection may be raised by the patient to the necessary examination being then instituted, under the idea that no assistance can be rendered her so early in the labour. As I would regard the feelings of a parturient woman in a degree only secondary to her safety, I would by no means insist on putting her to this inconvenience, unless I thought it quite indispensable. But as much valuable information may be gained by this first examination, and as it is highly desirable to obtain that information during the progress of the first stage, it is right firmly, but gently, to urge its propriety. It is seldom, indeed, that she will not accede to the recommendation of her medical attendant, provided he possesses her confidence, and conveys his request with becoming delicacy.[24]
“Much knowledge must be acquired during the first vaginal examination. It is, first, whether the woman be pregnant;[25] secondly, if she be in labour; thirdly, whether the membranes have ruptured, or are still entire; fourthly, how the child is presenting; fifthly, how far the labour is advanced; and, sixthly, the state of the os uteri, vagina, and perineum, in regard to their distensibility. … She should be also covered by a light counterpane, or a blanket and a sheet. In this position (lying on her left side, with the nates brought to the edge of the bed) the vaginal examination is to be conducted in the following manner:—The attendant, sitting rather behind her, and having anointed the two first fingers of his right hand, with some unctuous substance, mostly in readiness, is to place them on the labia externa; then gently separating these organs, he must introduce the first finger into the vagina,[26] in the direction of its entrance, which is backwards and upwards: or he may take the perineum as his guide, and insinuate his finger within the genital fissure posteriorly, close to the fourchette. Having introduced it as high as he conveniently can, he must pronate his wrist, so that the junction of the first and second finger shall fit in under the symphysis pubis. In this way he will be able usually to reach the os uteri without difficulty. Should that organ, however, be situated so high that he cannot perfectly command it, rather than remain in ignorance of its condition, and of the presentation of the child, he may introduce the first two fingers of his left hand, and as these may be passed higher within the pelvis, they will give a greater facility for inquiry.
“These examinations are commonly made during the urgency of pain; and this has given rise to the phrase of ‘trying a pain.’ It is, however, desirable, on many accounts, that we should not introduce our finger up to the os uteri at the time when the uterus is acting strongly, because then the membranes are protruded into the vagina, and if we press against them at that moment, we may, probably, rupture the cyst, and lose its influence in the after progress of the labour. Besides, it is impossible, under such protrusion, to ascertain the presenting part of the fœtus with precision, because of the quantity of water which is then interposed between our finger and its person.
“Nevertheless, as it is expected that we should examine while the uterus is in action—and, indeed, as in many cases the patient would not allow us to pass our finger at all, were it not for the belief that we can ‘assist’ her—and that only in the time of pain, it is necessary that we should request her to inform us when there is a return, and take that opportunity of introducing our finger within the external parts. Having gained this advantage, we must allow it to remain inactive in the vagina while the pain continues; and upon its cessation, which we have seldom any difficulty in ascertaining, we may direct it up to the os uteri.
“Frequent examinations should not be made during the first stage of labour.
“We can do no good by such a practice after we have once gained the information we require. We cannot facilitate the descent of the child; we cannot dilate the parts; but we may do a great deal of injury, for we denude the vagina of that soft relaxing mucus which is designed by nature to protect it; and we, moreover, run the risk of destroying the integrity of the membranous cyst. We may, therefore, predispose the parts to inflammation, and retard the dilatation of the os uteri itself. As, however, it is a common idea among women that, under each examination, material assistance is rendered,[27] we shall frequently be urged, during the first stage, especially if the labour be rather slower than usual, to remain in close attendance on the patient’s person; and these solicitations are generally advanced with a degree of fervency, that it appears the extreme of cruelty not to accede to.
“Should this be the case, the finger may be introduced from time to time, with the greatest care and gentleness; more to pacify the patient’s mind, and assure her she is not neglected, than with any other view beyond that, and also watching the progress of dilatation. The more rigid the parts are, the more do they require the softening influence of the natural secretion, and the more careful must we be to preserve it. … In about an hour … we may see her again, and we may then, if we think it right, make another examination, to ascertain that the labour is proceeding satisfactorily.
Duties during the Second Stage.
“The second stage of labour having commenced, we are summoned to the patient’s room, if we have been absent, and told that ‘the waters have broken.’ She is most likely found reclining on the bed, and, probably, the pains are more urgent than they were before; or, perhaps, they are somewhat suspended. We now require to make another examination, because it is possible that the head may have fully entered the cavity, and may be soon expelled. Finding it low in the pelvis, finding the os uteri almost entirely dilated, the membranes broken, and the pains strong and coming on frequently, it is right not to leave the room; but unless the perineum is somewhat on the stretch, we need not yet take our post exactly by the bed-side. But as soon as the head has come to press upon the external parts—particularly when it has made its turn, and is beginning to extend the structures at the outlet of the pelvis, it becomes our duty to take our seat by the bed-side, and never to move from our position till the child has passed. This we do to protect the perineum, in order to prevent laceration.[28]
“For the purpose of supporting