Obstetrical Nursing by Carolyn Conant Van Blarcom

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Title: Obstetrical Nursing
A Text-Book On The Nursing Care Of The Expectant Mother,
The Woman In Labor, The Young Mother And Her Baby

Author: Carolyn Conant Van Blarcom

Release Date: April 9, 2019 [EBook #59234]

Language: English

Character set encoding: UTF-8

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OBSTETRICAL NURSING

THE MACMILLAN COMPANY

NEW YORK · BOSTON · CHICAGO · DALLAS · ATLANTA · SAN FRANCISCO

MACMILLAN & CO., Limited

LONDON · BOMBAY · CALCUTTA · MELBOURNE

THE MACMILLAN CO. OF CANADA, Ltd.

TORONTO

THE CARESS

From the painting by Gari Melchers

I hold you close: and I could cry
Because you seem so new and dear;
And such a helpless warder I
To keep your candle burning clear:

The curious candle of your breath,
Body’s and spirit’s throbbing breath.

Fanny Stearns Gifford.

OBSTETRICAL NURSING

A TEXT-BOOK ON THE NURSING CARE OF THE EXPECTANT MOTHER, THE

WOMAN IN LABOR, THE YOUNG MOTHER AND HER BABY

BY

CAROLYN CONANT VAN BLARCOM, R.N.

FORMERLY, ASSISTANT SUPERINTENDENT AND INSTRUCTOR IN OBSTETRICAL NURSING AND THE CARE OF INFANTS AND CHILDREN AT THE JOHNS HOPKINS HOSPITAL TRAINING SCHOOL FOR NURSES

Author of

“The Midwife in England”

WITH 200 ILLUSTRATIONS AND 8 CHARTS

New York

THE MACMILLAN COMPANY

1922

All rights reserved

PRINTED IN THE UNITED STATES OF AMERICA

Copyright, 1922,

By THE MACMILLAN COMPANY.

Set up and electrotyped. Published May, 1922.

Press of

J. J. Little & Ives Company

New York, U. S. A.

THIS BOOK IS DEDICATED

TO THE

SPIRIT OF HELPFULNESS

WHICH HAS MADE ITS PREPARATION
POSSIBLE WITH THE HOPE THAT IT
MAY BE OF HELP TO THOSE NURSES

WHO TAKE YOUNG MOTHERS AND BABIES

INTO THEIR CARE.

PREFACE

In writing this book on obstetrical nursing I have been influenced by certain steadily deepening

impressions which have been received in the course of my contact with maternity work in this country,
Canada and England during the past twenty years. It has been borne in upon me, in the first place, that
very often there is something akin to bewilderment among those nurses who have been trained to care
for patients according to the teachings of one group of obstetricians and who later find themselves
nursing the patients of other doctors who hold different, or even opposite views. And not infrequently I
have found in the nurses a degree of loyalty to their training which made them sceptical, or even
intolerant, of nursing methods which differed from those which they had been taught.

I have become convinced, therefore, that a book on obstetrical nursing which would be helpful to and

widen the outlook of all nurses, no matter where nor by whom trained, must of necessity describe the
underlying principles of obstetrical nursing and offer a survey of the nursing methods which are
employed in maternity wards and hospitals of recognized excellence and in the practice of acknowledged
authorities upon obstetrics.

This is, I am aware, a unique attitude, for the present text books on obstetrics for nurses reflect, in

each instance, the wishes of one doctor, almost entirely, or advocate the methods employed in one
hospital. My experience in teaching obstetrical nursing makes me feel that a parallel description of
dissimilar nursing procedures serves to broaden the nurse’s attitude toward her work and her grasp of
the entire subject, both because she becomes aware of the fact that methods, other than those with
which she is familiar, are employed in hospitals of high standing and because she appreciates the fact
that these unfamiliar methods may be as efficacious as those in which she has become expert.

Accordingly I have devoted the better part of the past year and a half to a study of the scope and

methods of the present training in maternity nursing in several hospitals, in this country and Canada, in
which the obstetrical work is of a conspicuously high character, and have presented a composite of this
teaching in the succeeding pages.

But that there might not be apparent inconsistencies in the different methods of maternity care

described, I have given an explanation of the purposes and general principles of the care, including
nursing, which the nurse is likely to find is given to all obstetrical patients, the country over.

For the sake of simplicity and clarity I have divided the book into seven parts, following an

introduction which describes the requisites and opportunities of obstetrical nursing and the importance
of the nurse’s own attitude toward her work and her patient. The first two parts, dealing with the normal
anatomy and physiology of the female generative tract and the development of the fetus, are designed to
supply the nurse with enough technical information to make her ministrations intelligent and effective.
In this respect, I have doubtless given less than some nurses will wish and possibly more than others will
think necessary, but I have given about the average amount of instruction that is found satisfactory in
the training schools of high standing. Four of the succeeding parts are devoted respectively to a
description of the nurse’s duties during pregnancy, labor, the puerperium and early infancy. In each of
these I have explained, first, the normal physiological processes which take place; then, the nurse’s
duties under average conditions and finally, her responsibilities in the event of complications or
abnormalities. A separate part is devoted to a description of the organized care and instruction of the
maternity patient, by public health nurses, both before and after delivery, which have proved to be
satisfactory.

While describing various hospital procedures, I have deemed it of practical importance to explain, in

each instance, how similar results might be obtained, with improvised appliances, in a patient’s home
whether in a city or a rural community. In short, I have endeavored to make clear the essentials of
obstetrical nursing without regard to the status or location of the patient.

Since the patient’s state of nutrition and her frame of mind are of vital importance throughout

pregnancy, labor and the puerperium, I have not only dwelt upon them in all descriptions of the nurse’s
duties during these periods but have devoted an entire chapter to a simple explanation of the principles
of each of these two important subjects.

My varied contact with obstetrical nurses has convinced me that those nurses who appreciate the

never ending wonder and beauty of this miracle of the beginning of a new life, derive peculiar satisfaction
from the care of the maternity patient. At the same time, in many hospitals, even where the patients are
given the most conscientious care, the nurses are often so nearly overwhelmed by the long, irregular
hours and the insistent demands of routine duties, that they do not grasp the significance of the event in
which they are participants. Accordingly, I have made a sustained effort throughout the following pages
to give the young nurse something of a feeling of reverence for this great mystery of birth.

In the course of my survey of the present training in obstetrical nursing, I have met the warmest

generosity on the part of the obstetrical and nursing staffs in all of the hospitals which I have visited.
Accordingly, I find it very difficult to find adequate expression for my sense of gratitude to the doctors
and nurses of the Montreal Maternity Hospital; the Burnside Obstetrical Department of the Toronto
General Hospital; The Hospital of the University of Pennsylvania; Bellevue Hospital; The Long Island
College Hospital; The Brooklyn Hospital; The Cleveland Maternity Hospital and to Dr. J. Whitridge
Williams and Miss Elsie Lawler for making available the entire resources of the wards, clinics,
laboratories and class and lecture rooms at Johns Hopkins Hospital.

I wish to offer an expression of deepest possible appreciation to Dr. John W. Harris for the generosity

with which he has given of his time, thought and wide experience in an effort to provide accurate and
practical information, and to set a high standard of work and ideals for those nurses who would be

xi

xii

xiii

xiv

influenced by this book. Having taught and lectured to nurses, as well as medical students, for years, Dr.
Harris is in a position to give counsel and criticism of peculiar value to a book on obstetrical nursing and
he has given these throughout the entire preparation of this book.

Because of their concern with any effort to better the state of mothers and babies, I have been given

suggestions, assistance and inspiration with the most selfless generosity by The Reverend Father John J.
Burke; Dr. J. Clifton Edgar; Dr. Frederic W. Rice; Dr. J. P. Crozer Griffith; Dr. Caroline F. J. Rickards; Dr.
Esther Loring Richards; Dr. E. V. McCollum; Miss Nina Simmonds and Dr. John R. Fraser. Among the
many nurses with whom I have conferred, I have met a characteristic spirit of helpfulness which has
expressed itself in their eager readiness to pass on to other nurses the benefits of their own training and
experience. Those to whom I am especially indebted, for aid and suggestions, are Miss Calvin
MacDonald; Mrs. Bessie Amerman Haasis; Miss Robina Stewart; Miss Caroline V. Barrett; Miss
Katherine de Long; Miss Jean Gunn; Miss Mary E. Robinson; Miss Sara Cooper; Miss Laura F. Keesey;
Miss Chelly Wasserberg; Miss Kate Madden; Mrs. Minnie S. Brown; Miss Anne Stevens; Miss Madge
Allison and Miss Katherine Tucker.

To Mrs. Elizabeth Porter Wyckoff I am under heavy obligation for most discriminating editorial

assistance and for her farsighted criticisms toward increasing the clarity of the text. And I feel sure that
the tender little poem on the miracle of motherhood, which Mrs. Elizabeth Newport Hepburn wrote
expressly for this book, will be as warmly appreciated by my readers as it is by me.

I wish to express my deep gratitude to Mr. Max Brodel for his invaluable counsel and guidance in

planning and assembling the illustrations to elucidate the text. And I am very grateful to Mr. Gari
Melchers for the spirit which I believe is infused into this book through the reproduction of two of his
lovely paintings of a mother and baby, and to Mr. Russell Drake for his valuable drawings. I wish further
to thank Mr. J. Norris Myers, of The Macmillan Company, for unfailing courtesy and helpfulness in
facilitating all matters relating to the publication of this book.

For statistical information I am indebted to Dr. Louis I. Dublin and for authority in offering the

scientific background of the teaching I have drawn from “The Practice of Obstetrics” by J. Clifton Edgar;
“Obstetrics” by J. Whitridge Williams; “The Diseases of Infants and Children” by J. P. Crozer Griffith
and “The Prospective Mother” by J. Morris Slemons.

Carolyn Conant Van Blarcom.

New York City, 149 East 40th Street

xv

TABLE OF CONTENTS

PAGE

Preface
xi

Introduction
3

PART I.

ANATOMY AND PHYSIOLOGY

CHAPTER

I.
Anatomy of the Female Pelvis and Generative Organs
19

II.
Physiology
45

PART II.

THE DEVELOPMENT OF THE BABY

III.
Development of the Ovum, Embryo, Fetus, Placenta, Cord and Membranes
61

IV.
Physiology of the Fetus
84

V.
Signs, Symptoms, and Physiology of Pregnancy
93

PART III.

THE EXPECTANT MOTHER

VI.
Prenatal Care
111

VII.
Mental Hygiene of the Expectant Mother
145

VIII.
Preparation of Room, Dressings, and Equipment for Home Delivery
155

IX.
Complications and Accidents of Pregnancy
164

PART IV.

THE BIRTH OF THE BABY

X.
Presentation and Position of the Fetus
217

XI.
Symptoms, Course, and Mechanism of Normal Labor
232

XII.
Nurse’s Duties During Labor
243

XIII.
Obstetrical Operations and Complicated Labors
295

PART V.

THE YOUNG MOTHER

xvii

xviii

XIV.
Physiology of the Puerperium
317

XV.
Nursing Care During the Normal Puerperium
323

XVII.
The Nursing Mother
357

XVII.
Nutrition of the Mother and Her Baby
368

XVIII.
Complications of the Puerperium
391

PART VI.

THE MATERNITY PATIENT IN THE COMMUNITY

XIX.
Organized Prenatal Work
405

XX.
Care of the Mother and Baby by Visiting Nurses
437

PART VII.

THE CARE OF THE BABY

XXI.
Characteristics and Development of the Average New-born Baby
451

XXII.
Nursing Care of the Average New-born Baby
461

XXIII.
Common Disorders and Abnormalities of Early Infancy
518

XXIV.
A Final Word
544

LIST OF ILLUSTRATIONS AND CHARTS

ILLUSTRATIONS

Anatomy and Physiology.

FIG.

PAGE

1 a.
Normal female pelvis
21

b.
Normal male pelvis
21

2.
Diagram of pelvic inlet seen from above
22

3.
Diagram of pelvic outlet seen from below
23

4.
Sagittal section of the pelvis
24

5.
Two types of pelvimeters
25

6.
Diagram showing method of measuring distance between crests, spines and

trochanters
26

7.
Diagram showing method of measuring Baudelocque’s diameter
27

8.
Diagram showing method of estimating true conjugate
28

9.
Diagram showing method of measuring intertuberous diameter
29

10.
Anterior view of external and internal female generative organs
31

11.
Diagrams of sections of virgin and multiparous uteri
32

12.
Sagittal section of female generative tract
35

13.
Diagram of external female genitalia
39

14.
Sagittal section of breast
42

15.
Front view of breast
43

16.
Diagram of human ovum
47

Development of the Baby

17.
Diagram of human spermatozoa
61

18.
Diagram of segmenting rabbit’s ovum
65

19.
Ovum about 13 days old embedded in the decidua
66

20.
Diagram of developing fetus, cord, membranes and placenta in utero
69

21.
Diagram of structure of placenta
71

22.
Photograph of placental vessels
72

23.
Maternal surface of the placenta
74

24.
Fetal surface of the placenta
75

xix

25.
Embryo about 5.5 cm. long in amniotic sac
77

26.
Outlines of fetus at different stages
78

27.
Full term fetus in utero
81

28.
Diagram of fetal circulation
85

29.
Diagram of circulation after birth
87

30.
Side and top view of fetal skull
90

The Expectant Mother.

31.
Height of fundus at different stages of pregnancy
94

32.
Contour of abdomen at ninth month
95

33.
Contour of abdomen at tenth month
95

34.
Front view of home-made abdominal binder
123

35.
Side view of same
123

36.
Back view of same
123

37.
Abdominal binder used in above
124

38.
Front view of home-made stocking supporters
124

39.
Back view of same
124

40.
Patient in right-angled position to relieve varicose veins
138

41.
Elevated Sims position
139

42.
Gloves, ready for dry sterilization
160

43.
Delivery pad of newspapers and old muslin
161

44.
Diagram of centrally implanted placenta prævia
174

45.
Partial placenta prævia
175

46.
Diagram of marginal placenta prævia
176

47.
Champetier de Ribes’ bag inserted in uterus
177

48.
Patient in hot pack given with dry blankets
197

49.
Method of giving infusion
202

The Birth of the Baby.

50.
Attitude of fetus in uterus at term
217

51.
Illustration from first text-book on obstetrics
218

xx

52.
Attitude of fetus in breach presentation
219

53.
Attitude of fetus in vertex presentation
220

54.
Diagram of six positions in a vertex presentation
222

55.
Diagram of six positions in a face presentation
223

56.
Diagram of six positions in a breech presentation
223

57.
First maneuver in abdominal palpation
225

58.
Second maneuver in abdominal palpation
226

59.
Third maneuver in abdominal palpation
227

60.
Fourth maneuver in abdominal palpation
228

61.
Diagrams showing positions of nurse’s hands in four maneuvers of abdominal

palpation
229

62.
Ascertaining position of fetus by rectal examination
230

63, 64, 65,

66.

Diagrams showing stages of dilatation and obliteration of cervix

234

67.
Characteristic position of patient during first stage pains
235

68.
Diagram indicating rotation and pivoting of head during birth
236

69.
Anterior shoulder being slipped from under symphysis
237

70.
Birth of posterior shoulder
238

71.
Diagrams of Duncan and Schultze mechanisms of placental separation
239

72.
Section showing thinness of uterine wall before birth of fetus
240

73.
Section showing thickness of uterine wall immediately after labor
241

74.
Preparing patient for vaginal examination or delivery
250

75.
Patient draped for vaginal examination
251

76.
Wrong and right methods of boiling gloves
253

77.
Powdering hands before putting on dry gloves
254

78.
Successive steps in proper method of putting on gloves
255

79.
Bed and simple equipment ready for normal delivery
258

80.
Instruments shown in Fig. 79
260

81.
Old prints showing early methods of delivery
261

82.
Patient draped with sterile dressings for delivery
262

83.
Patient pulling on straps while bearing down during second stage
264

84.
Palpating baby’s head through perineum
265

xxi

85.
Baby’s head appearing at vulva
266

86.
Head farther advanced
267

87.
Holding back head at the height of a pain
268

88.
External rotation following birth of head
269

89.
Wiping mucus from baby’s mouth
270

90.
Stroking baby’s back to stimulate respirations
271

91.
Two clamps on cord after pulsation has ceased
272

92.
Wrong and right method in tying knot in cord ligature
272

93.
Stimulating baby’s respirations
274

94, 95.
Stimulating baby’s respirations
275, 276

96, 97.
Resuscitating baby by holding under warm water
277, 278

98.
Resuscitation by means of direct insufflation
279

99.
Delivery of the placenta
280

100.
Twisting membranes while withdrawing placenta
281

101.
Massaging fundus through abdominal wall
282

102.
Showing prolapsed cord between head and pelvic brim
285

103.
Giving chloroform for obstetrical anæsthesia
287

104, 105.
Giving ether for obstetrical anæsthesia

289, 290

106.
Giving ether for complete anæsthesia
293

107.
a. Tarnier forceps, b. Simpson forceps
301

108.
Patient in position and draped for forceps operation
302

109.
Forceps sheet used in Fig. 108
303

110.
Two types of leggings for obstetrical use
304

111.
Rubber bougie
311

112.
Champetier de Ribes’ bag
311

113.
Voorhees’ bag
312

114.
Bag held in forceps for introduction into uterus
312

115.
Syringe for filling above bags after insertion
312

The Young Mother.

116.
Height of fundus on each of first ten days after delivery
327

xxii

117.
Patient draped for postpartum dressing
336

118.
Equipment in rack used in Fig. 117
337

119.
Method of covering nipples with sterile gauze
339

120.
Baby nursing through a nipple shield
341

121.
Nipple shield used in Fig. 120
342

122.
Supporting heavy breasts by means of folded towels
343

123.
Ice caps applied to engorged breasts
344

124.
Y binder before application
345

125.
Y binder applied
346

126.
The same seen from the other side
347

127.
Indian binder
347

128.
Method of stripping
348

129, 130,
131, 132,
133, 134,

135.

Bed exercises taken during the puerperium

350 to 353

136.
Knee-chest position
354

137.
Exercising by walking on all fours
354

138.
Position of mother and baby for nursing in bed
359

139.
The Nursing Mother (from a painting by Gari Melchers)
361

140.
Baby partially blind as a result of a faulty diet
378

141.
Rachitic and normal babies of the same age
381

142.
Chest walls of normal and rachitic rats of the same age
383

143.
Interior of specimens in Fig. 142
384

The Maternity Patient in the Community.

144.
Baby’s bed improvised from a market basket
415

145.
Layette recommended to expectant mothers by Maternity Centre Association
416

146.
Breast tray recommended to expectant mothers by Maternity Centre Association
417

147.
Baby’s toilet tray recommended to expectant mothers by Maternity Centre

Association
417

The Baby.

148.
Diagram of first teeth
456

xxiii

149.
Umbilical cord immediately after birth
457

150.
The same four days later
457

151.
Umbilicus immediately after separation of cord
458

152.
Well healed umbilicus
458

153.
Nursery at Manhattan Maternity Hospital
465

154.
Bathing the baby
467

155.
Preparation for circumcision
468

156.
Baby draped with sterile sheet, in above
469

157.
Cord dressed with dry sterile gauze
470

158.
Abdominal binder applied over cord dressing
471

159.
Satisfactory baby clothes
473

160.
Diagonally folded diaper applied
474

161.
Longitudinally folded diaper applied
474

162.
Sutton poncho to protect baby for outdoor sleeping
479

163.
Training the baby to use a chamber
481

164.
Stiff cuffs to prevent thumb sucking
483

165.
Hammer cap to prevent ruminating
484

166.
Ruminating cap applied
485

167.
Proper method of carrying baby
487

168.
Preparing the baby’s milk
493

169.
Giving the baby his bottle
496

170.
Holding baby upright after feeding
497

171.
Dr. Griffith’s table of fat percentages
500

172.
Reverse side of above card
501

173.
Baby in a basket ready to travel
507

174.
Quilted robe with hood for the premature baby
509

175.
Premature baby in lined basket, being fed with Boston feeder
510

176.
Bed for premature baby improvised from small clothes basket
511

177.
Putting the baby in a wet pack
521

178.
Baby in wet pack
522

179.
Diagrams showing successive steps in giving the baby a pack
522