[530 Mothers’ remedies]

Third Stage.—­The birth of the head is very soon followed by the shoulders and the rest of the body, and the woman is now at comparative rest.  The cord is now tied and cut and the child laid away, if all right, in a warm place until it can be washed and dressed.  Following the birth of the child there is a short resting period, the contractions of the womb cease and it becomes smaller through retraction.  After a few minutes the pains begin again, the after-birth separates from its attachment in the womb, and together with the membranes is extruded into the vaginal canal and vulvar opening; whence it can be easily delivered by pressing upon the abdomen over the lump (womb) and by guiding the after-birth with the cord.  This should be done slowly so that the membranes will all come away with the after-birth.

This should always be examined to be certain that everything has come away.  A greater or less amount of clots of blood come with the after-birth.  The contraction of the womb stops the bleeding, one hand should be kept on the abdomen over the womb, to see that it remains hard and retracted.  The womb moves under the hand.  If it softens, gentle rubbing should be kept up and the womb will soon remain contracted.  This stage averages about fifteen minutes.

Management of labor.—­Preparation of the Bed.—­The bed should be high, springs not soft, with a firm and smooth mattress.  It should be placed so that both sides are accessible.  The bed should be made up on the right side as a rule, as the woman usually lies on her left side when delivered.  Place a rubber, or an oil cloth sheet, over the mattress, and over this an ordinary muslin sheet and secure this with safety pins to the corners of the mattress.  This is the permanent bed; on top of this is the second rubber sheet and this is covered with another muslin sheet and both held by safety pins.  This is the temporary bed.  Plenty of hot and cold boiled water should also be at hand.  Frequently only a temporary bed is made with rubber or oil cloth underneath, blanket and sheet above this.  They should be fastened so that the movements of the woman will not disorder them.  These can be removed after the confinement and new, clean warm clothes put in their place.  The objection to this is the woman may be too tired to be moved, while, with the permanent and temporary bed arrangement she need not be moved at all, only lifted, while the temporary bed is being removed and she is then let down easily upon clean bedding.

Preparation of the Patient.—­The patient, if she desires, can take a full bath.  The bowels should be moved thoroughly with a soap and water injection so that the rectum will be fully emptied.  This makes labor not only easier, but pleasanter, as no feces will be discharged during labor.  The bladder should also be emptied.  The external organs should be scrupulously cleansed and bathed with some antiseptic solution, like glycothymoline, listerine, borolyptol, etc.  A fresh suit of underwear may then be put on and over this a loose wrapper.