Chapter I: Preface

It might seem that an apology was necessary for presenting a new textbook on obstetrics for nurses when so many are to be had for the asking. But when a teacher is rarely or never satisfied with his own work it is too much to expect that he will ever fully endorse the product of another. It may be therefore largely a personal matter that none of the existent books seem to exhibit the fullness of information, the conciseness of expression, and the emphasis due to certain subjects that the present writer would hope to find.

The necessities apparently demand such an arrangement of our obstetrical doctrine that the book may serve for class instruction and at the same time be complete enough for post-graduate reference.

To secure this much discrimination is necessary. The confusion attendant upon overabundance must be avoided as well as the discouragement that is not infrequently produced by a large book or a periphrastic style.

Hitherto there has been a tendency to teach the nurse too little rather than too much but conditions have changed. Vocational instruction is not only more methodical and far reaching but it is developmental. The present day nurse expects not merely to assist the physician and earn a stipulated reward, but she is constantly alert to attain her own maturity as a professional woman.

To be a capable and intelligent assistant it is not sufficient to have a clear comprehension of her particular duties, but she must have a defined and critical conception of what the doctor is aiming to accomplish.

This is especially true in obstetrics where the nurse has the additional responsibility of giving support and counsel to her patient in the various emergencies that arise. Moreover, to attain her intellectual maturity the nurse must strive unremittingly to understand the complicated processes that take place under her observation.

She must cooperate with her doctor whose associate she is and secure the confidence of her patient who relies upon her for guidance in the perils she is facing. For childbirth is a peril. It is no longer the normal process it once was. Civilization has changed the shape of the pelvic bones, altered the muscles of parturition and weakened the nerve centers that control the event.

The birth of a child is equal in severity and seriousness to many of the major operations. It is not an affair to be entered upon lightly nor managed without the utmost foresight and care.

The dangers that are recognized and prepared for in this book by what may seem to some to be an extravagant technic, are very real dangers, extremely subtle, and against them at times every precaution and every defense proves unavailing.

Nevertheless, skill, thoughtfulness, and above all, cleanliness, will avert the worst, as well as unhappily the most common of these disasters. If our nurses could be convinced of this, the difficulties and apprehensions of childbirth would be greatly diminished.

The nurse should see to it that her patient is surrounded by all the precautions and safeguards against infection that she would demand for a member of her own family. This means of course that her work will be far more exacting and onerous but also it will save many nights of anxiety and not infrequently a life.

This book represents the obstetric ideas and technic which the writer has endeavored for years to impress upon his students and nurses with such emendations and changes as experience and scientific progress have suggested. It is a selective essence distilled from the recurrent harvests that workers in this field have brought forth during centuries of consecrated effort. To all these forerunners the writer acknowledges a deep personal indebtedness.

In the preparation of the book thanks are due particularly to Charlotte Gregory, Head Nurse of the Wesley Maternity, whose rare ability as teacher, technician and executive and whose untiring vigilance has been a leading factor in securing and maintaining the high state of efficiency in this department. She has kindly contributed Chapters XXIII and XXIV, together with valuable suggestions and criticisms in other portions of the text.

The author also takes pleasure in acknowledging his obligations to Florence Olmstead, Head Nurse of the Dispensary of the Northwestern University Medical School, whose long experience in feeding babies gives to her words an unquestioned authority. Chapter XXII is almost entirely her work.

To the various publishers who have courteously allowed the reproduction of valuable illustrations from the books of other writers thanks are also extended, and to his own publishers especially for their cordial and sympathetic cooperation the author wishes to express his warmest gratitude.

C. B. R.

Chicago, 1917.

CONTENTS

CHAPTER I
PAGE

ANATOMY 17

CHAPTER II

PHYSIOLOGY 33

CHAPTER III

NORMAL PREGNANCY 51

CHAPTER IV

HYGIENE OF NORMAL PREGNANCY 66

CHAPTER V

ABNORMAL PREGNANCY 74

CHAPTER VI

ABNORMAL PREGNANCY (CONTINUED) 89

CHAPTER VII

PREPARATIONS FOR LABOR AND THE NORMAL COURSE OF LABOR 98

CHAPTER VIII

THE MECHANISM OF NORMAL LABOR 120

CHAPTER IX

THE CARE OF THE PATIENT DURING NORMAL LABOR 129

CHAPTER X

THE NORMAL PUERPERIUM 151

CHAPTER XI

UNUSUAL PRESENTATIONS AND POSITIONS 165

CHAPTER XII

OPERATIONS 179

CHAPTER XIII

MINOR OPERATIONS 200

CHAPTER XIV

COMPLICATIONS IN LABOR 214

CHAPTER XV

COMPLICATIONS IN LABOR (CONTINUED) 228

CHAPTER XVI

THE ABNORMAL PUERPERIUM 242

CHAPTER XVII

INFECTION 255

CHAPTER XVIII

THE CARE OF THE CHILD 265

CHAPTER XIX

THE CARE OF THE CHILD (CONTINUED) 278

CHAPTER XX

THE CARE OF THE CHILD (CONTINUED) 287

CHAPTER XXI

THE CARE OF THE CHILD (CONTINUED) 298

CHAPTER XXII

INFANT FEEDING 310

CHAPTER XXIII

CLEANLINESS AND STERILIZATION 323

CHAPTER XXIV

DIETS AND FORMULÆ 330