Obstetrics for Nurses

By Charles B. Reed

"Obstetrics for Nurses" by Charles B. Reed is one of the first leading medical texts in the obstetrics field, one that has undergone many changes over the years. Meant to be an educational tool for nurses in order to allow them to be able to provide the best possible care to expecting mothers, this book covers everything from breathing to sanitary practices. While it's no longer considered the gold-standard for obstetric nursing education, it's still an insightful text with surprisingly relevant information.

• Language: English
• Publisher: Good Press
• Release date: Nov 5, 2021
• ISBN: 4066338073419

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Charles B. Reed

Obstetrics for Nurses

Published by Good Press, 2022

[e-mail]

EAN 4066338073419

Table of Contents

PREFACE

ILLUSTRATIONS

CHAPTER I ANATOMY

THE SOFT PARTS

THE EXTERNAL GENITALS

CHAPTER II PHYSIOLOGY

CHAPTER III NORMAL PREGNANCY

DIAGNOSIS OF PREGNANCY

CHAPTER IV HYGIENE OF NORMAL PREGNANCY

CHAPTER V ABNORMAL PREGNANCY

CHAPTER VI ABNORMAL PREGNANCY (Cont’d)

CHRONIC INFECTIONS

CHAPTER VII PREPARATIONS FOR LABOR AND THE NORMAL COURSE OF LABOR

CHAPTER VIII THE MECHANISM OF NORMAL LABOR

CHAPTER IX THE CARE OF THE PATIENT DURING NORMAL LABOR

IMMEDIATELY AFTER LABOR

CHAPTER X THE NORMAL PUERPERIUM

CHAPTER XI UNUSUAL PRESENTATIONS AND POSITIONS

CHAPTER XII OPERATIONS

CHAPTER XIII MINOR OPERATIONS

CHAPTER XIV COMPLICATIONS IN LABOR

CHAPTER XV COMPLICATIONS IN LABOR (Cont’d)

CHAPTER XVI THE ABNORMAL PUERPERIUM

CHAPTER XVII INFECTION

CHAPTER XVIII THE CARE OF THE CHILD

CHAPTER XIX THE CARE OF THE CHILD (Cont’d)

CHAPTER XX THE CARE OF THE CHILD (Cont’d)

CHAPTER XXI THE CARE OF THE CHILD (Cont’d)

CHAPTER XXII INFANT FEEDING

FOOD PREPARATION

PUTTING FOODS TOGETHER

CHAPTER XXIII CLEANLINESS AND STERILIZATION

BATHS

STERILE DRESSINGS—ANTISEPTIC SOLUTIONS—STERILIZATION OF INSTRUMENTS

CHAPTER XXIV DIETS AND FORMULÆ

RECTAL FEEDING

ELIMINATIVE ENEMAS

DIET LIST

CHAPTER XXV SOLUTIONS AND THERAPEUTIC INDEX

THERAPEUTIC INDEX

GLOSSARY

INDEX

PREFACE

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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.

ILLUSTRATIONS

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OBSTETRICS FOR NURSES

CHAPTER I

ANATOMY

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The study of obstetrics is an investigation of the passage, the passenger, and the driving powers of labor, as well as of the various complications and anomalies that may attend the process of reproduction.

The passage is composed of a bony canal, called the pelvis, and the soft tissues which line and almost close its outlet.

The pelvis is made up of four bones; the sacrum, the coccyx, and two other large structures of irregular shape, called the hip, or innominate bones. Joined by cartilage and held in place by ligaments, they form a cavity or basin which, in the male is deep, narrow, small and funnel-shaped, while in the female, slighter bones, expanded openings and wider arches make a broad, shallow channel, through which the child is born.

The bony pelvis is divided for description into two parts, the upper or false pelvis, and the lower or true pelvis. The upper pelvis is formed by the wings of the innominate bones and has but two functions of importance to child-bearing. It acts as a guide to direct the child into the true passage, and when measured by the pelvimeter, it gives information as to the shape and size of the inlet to the true pelvis. The true pelvis is of most concern to the obstetrician, because anomalies in its size or shape may impede the progress of labor or render it impossible. The pelvis is divided conveniently into three parts: the brim, the outlet, and the cavity.

The brim, inlet, or upper pelvic strait, is the boundary line between the false and true pelvis. It is traced from the upper border of the symphysis along the iliopectineal line on both sides to the promontory of the sacrum. The shape and size of this opening varies much in different races and individuals, both normally and through disease; and when pathologically altered, both shape and size may exercise a marked influence on the course of labor. In American women, the outline of the brim is roughly heart-shaped, like an ovoid with an indentation where the promontory of the sacrum impinges upon the opening.

Fig. 1.—The normal female pelvis. (Eden.) The lines ab and cd divide the pelvis into the right and left anterior and the right and left posterior quadrants. ab indicates the anteroposterior diameter of the brim, cd shows the transverse diameter while gh and ef represent, respectively, the right and left oblique diameters.

The brim or inlet has four important diameters to be remembered; important because the hard, round head of the child must pass through them by accommodating its diameters as favorably as possible to those of this opening. These diameters are named respectively the anteroposterior or conjugate diameter, the transverse, and the right and left oblique diameters. The two oblique diameters attain their greatest importance when the pelvis is irregularly distorted, but the others are essential in every case where labor impends. It is to secure an estimate of these latter diameters that the bony prominences are measured. This upper opening lies not horizontally, but in oblique relation to the body in standing position, and the weight of the abdominal viscera rests largely upon the bones and in consequence does not crowd into the inlet unless forced in by corsets or faulty habits.

Fig. 2.—The planes of (a) the brim, (b) the cavity and (c) the outlet. (Eden.)

Passing through the brim, a cavity is found below it, midway between the inlet and outlet, which is nearly round in shape. This is the excavation, or the true pelvis. Then comes the outlet, bounded in front by the pubic arch and soft parts, and behind by the coccyx pushed back as far as it can go. It is ovoid in shape, but the long axis of this ovoid lies at right angles with the axis of the ovoid inlet.

We find, therefore, a succession of three geometric figures or planes through which the head must pass by means of a spiral motion called rotation. These figures are inclined to one another so markedly in front that a line drawn through the center of each will curve forward at both ends, one end passing out near the umbilicus, the other through the vulva. This is known as the axis of the pelvis or the curve of Carus.

Fig. 3.—Visceral relations. (Redrawn from Gray.)

THE SOFT PARTS

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Inside the pelvis are the organs of generation with their accessory structures and supporting tissues.

Of first importance are the ovaries, tubes and uterus, together with the vagina. These special structures are the true genital organs. They are bounded in front by the bladder, behind by the rectum, above by the abdominal viscera, and surrounded everywhere by muscular, mucous and fatty tissues, which support them and aid their function.

The Vagina.—The vagina is a hollow organ, about four inches long, attached to the cervix above and the vulva below. It is an elastic sheath bounded in front by the bladder and behind by the rectum. Under normal conditions, this tube easily admits one or two fingers, but during labor it dilates enormously to allow the head to pass. The vagina is lined with a thick mucous membrane, ridged and roughened by folds, which are called rugæ. Thus a continuous channel connects the ovary with the outside and through it pass, at appropriate times, the ovule, the menstrual blood, the uterine secretions, the child, the placenta, and the lochia.

The Uterus.—The uterus (womb) is a pear-shaped organ, flattened from before backward, and composed of unstriped or involuntary muscle cells and connective tissue. Normally the virgin uterus measures from two and one-half to three inches in length, and weighs about two ounces. It is suspended in the middle of the pelvis by strong ligaments, so that the fundus inclines gently forward against the bladder. When the bladder fills, the uterus is pushed backward. Most of the organ is internal, but a small part of the lower pole is grasped by the vagina, in which the lower end with its invaluable aperture, the os, dips and swings. The part above the vagina is called the body or fundus, and is covered with the serous membrane (peritoneum) that lines the abdominal cavity. Below the fundus is the cervix or neck, which lies partly above and partly within the vagina. The cavity of the uterus is usually closed by the apposition of the walls. The inner surface is covered with a peculiar kind of membrane called the endometrium, which is highly vascular. The uterine cavity opens into the vagina through the os, which is small and round in the nulliparous woman, and slit-shaped or gaping in the woman who has borne a child.

Fig. 4.—Uterus and appendages. On either side of the uterus will be seen the ovary, the fimbriated extremity of the tube, the tube, and the round ligament. The vagina lies open below. (Lenoir and Tarnier.)

Fallopian Tubes.—On either side of the upper end of the uterus are the orifices of the Fallopian tubes, through which the egg, escaping from the ovary, finds access to the uterine cavity. These tubes extend outward from the uterus about four inches, and terminate in a bell-shaped opening with long, ragged fingers which hang loosely down toward the ovary. The tubes are lined by epithelial cells having hair-like projections, (ciliæ) which wave automatically toward the uterus. Thus impelled by a gentle current, the egg moves definitely along the tube toward the uterus and against this current the spermatozoa force their way to meet and fertilize the egg.

The Ovaries.—On either side of the pelvis, close to the fringed end of the Fallopian tube and attached to it, lies a small, hard, almond-shaped organ, called the ovary. This is the intrinsic sexual gland of the female. It contains the small cells which are to ripen and become eggs. Each ovary is said to contain about thirty-six thousand eggs, or ovules.

The Bladder.—The bladder lies between the pubic bone and the uterus. It is a reservoir for urine, filled by means of two little tubes called ureters, that run down from the kidneys. It drains through the urethra which opens just below the pubic bone in front of, and just above, the vaginal opening. The bladder should be emptied frequently during labor.

The Anus.—The large bowel (colon) terminates in an opening near the middle of the genital crease. This opening is called the anus. It is closed by a contracting muscle, the sphincter, which acts like a puckering string. Just inside of the opening is a group of large veins which may become enlarged, inflamed, and bleed during pregnancy. They are then called hæmorrhoids.

The Rectum.—Upward from the anus and to the left of the uterus extends the rectum. This is the end of the intestinal canal and is supplied with an abundance of nerves. When the head presses upon it, it gives the sensation of a bowel movement, and warns the observer of the low position of the head. The anus pouts as the head comes down and the anterior walls become visible. In severe cases of labor, the sphincter is sometimes torn. The bowels should be emptied by an enema as early as possible in the first stage of labor.

The Peritoneum.—The peritoneum is a thin, glistening, serous membrane, which lines the abdominal cavity and drops down from above over the uprising tops of the bladder and uterus. Folding together at the sides and extending to the walls of the pelvis, it encloses the tubes and round ligaments in deep, flat masses, called the broad ligaments. This is the structure that becomes so perilously inflamed (peritonitis) when infected by germs that find entrance through the genital passage.

Fig. 5.—Normal position of pelvic organs, seen from above and in front. They are enveloped in peritoneum. (Bougery and Jacob, in American Text Book.)

THE EXTERNAL GENITALS

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The external genitals form the vulva. Under this name are included the mons veneris, the labia majora, the labia minora, the clitoris, the vestibule, the hymen and the glands of Bartholin.

The entire groove from the mons veneris to a point well up on the sacrum forms a deep fold or crevice, which is known as the genital crease. That part of the genital crease lying between the anus and vulva is technically known as the perineum (q.v.)

Fig. 6.—The external genitals. (Redrawn from Gray.)

The Mons Veneris.—The mons veneris is a gently rounded pad of fat lying just above the junction of the pubic bones (the symphysis). The overlying integument is filled with sebaceous glands and covered with hair at puberty.

The Labia Majora.—The labia majora are the large lips of the vulva. They are loose, double folds of skin extending downward from the mons veneris to the anterior boundary of the perineum and covered externally with hair. Normally they lie in apposition and conceal the vaginal opening. They correspond to the male scrotum.

The Labia Minora.—The labia minora, or nymphæ, are two small folds of skin and mucous membrane, that extend from the clitoris obliquely downward and outward for an inch and a half on each side of the entrance to the vagina. On the upper side, where they meet and invest the clitoris, the fold is called the prepuce, but on the under side they constitute the frænum.

The labia minora are sometimes enormously enlarged in the black races and are then called the Hottentot apron.

The Clitoris.—The clitoris is an erectile structure analogous to the erectile tissue of the penis. The free extremity is a small, rounded, extremely sensitive tubercle, called the glans of the clitoris.