The only way in which the physician can determine whether labor has begun is by making an internal examination; and this will enable him to decide as to whether it is necessary to remain or not.

The nurse should always wear a wash dress in the confinement and lying-in room.

If the labor is long, nourishment in the form of beef-tea, broths, and milk may be given.  No stimulants should be given without the direction of the physician.  The frequent taking of cold water is permissible.

At the beginning of the labor the family and friends must be excluded from the room, and it must be kept as quiet and as cheerful as possible.

Toilet of the Patient.—­ The newly born child is received in a small blanket, is well wrapped, and laid in a warm place.  The nurse then turns her attention to the mother; the external genitals and soiled parts of the body are cleansed with sterilized cheese-cloth wrung out of an antiseptic solution; if the body-linen has become soiled, it is also changed, and all blood-stained articles are removed from the bed.  The patient is then carefully lifted up on the permanent bed, and the vulvar pad and the abdominal bandage are applied; after which the patient is allowed to rest.

CHAPTER XII.

 Lying-in.

Management of the Lying-in; Lactation; Nursing.

  “’Tis is ourselves that we are thus or thus.  Our bodies are our
  gardens; to the which, our wills are gardeners.”—­ “Othello.”

Management of the Lying-in.—­ Immediately after the delivery the first essential for the patient is absolute quiet and rest; the room must be kept quiet and darkened, and ordinarily the patient is allowed to fall into a light sleep.  During the first few hours after labor the best position for the mother is flat on the back, with only a small pillow under the head.  After the first twenty-four hours the patient may be allowed to turn on the side as she prefers.  Since absolute rest is the first requisite for the patient, she must be left alone with the nurse, who must see that she does not fall into too deep a sleep.  If the child’s cries disturb the mother, it must be taken into another room.

The lying-in room must be kept free from all odors, all soiled clothing must be at once removed from the room, and good ventilation must be insured, being careful to prevent any drafts.

While the patient is asleep, and after the baby has been attended to, the nurse should place all blood-stained articles in cold water to soak.  If in the city, the after-birth may be burned in the furnace or range; it should be well covered with coal.  In the country the after-birth can be buried in a deep hole.