Philosophy of Osteopathy by Andrew Taylor Still (android e book reader .TXT) 📕

You are there to assist it to get out of the place it has occupied so long. You must begin first to rotate or roll the placenta first one way and then another, up, down and across the vagina, by gently pulling the cord. Look out or you will pull the cord loose from the placenta; then you will have made your first blunder,—no cord to pull placenta with, and the mother bleeding and faint from loss of blood. Now is the time and place to save life. Pass your hand forward into the soft parts to get your fingers behind the placenta; now give a rolling pull and bring it out with the hand. You will find it an easy matter to get your hand into the vagina and womb after the birth of the child. Get all the placenta out, then take a wad of cloth or rags as large as the child's head, and press it under the cross bone of the pelvis; push the cloth under and up, so as to completely plug the pelvis. Now pull the hair gently over the symphesis, which will cause the womb to contract by irritation.

All is now done but to provide for the mother's comfort, which is your next duty. Draw her chemise down her back and legs until it is straight, then with safety pins, pin the chemise on inner side of thighs so that the chemise will go around both thighs separately. Now you have the shirt fast to keep it from sliding upwards, and you are ready to make a band of the chemise to support the womb and abdomen. Bring the chemise tightly together for two or three inches above the pelvis to form a band. Previous to pinning, draw the lump (womb) you feel above symphesis, up, then pin, and the belt you have made of the chemise will support the womb. All is safe now, but you must not leave for two hours. You may have delivered a feeble woman, who may flood to death after delivery of the child, if you do not leave her safe. I have in mind one case who flooded all of two quarts at a single dash. The first symptom was a pain in the head.

I know of only two causes that would produce hemorrhage or bleeding after the child is delivered. One is when the afterbirth (placenta), is separated from its attachment to the womb and still retained in the womb or vagina, or when a part is separated and still lies in the womb, that retention of placenta prevents the natural circular contraction of the womb, to close on itself and retain it, with force enough to prevent the further discharge of blood, would give a chance for a continued stream. Then should the patient bleed profusely after the placenta has been removed, another cause would be in pulling away the afterbirth, as part of the upper portion of the womb may be pulled to an inverted position, which would be like a hat if you press the top down with the hand. Then there is a chance for leakage because of this unnatural fold made in the womb.

My method of relief is to insert the hand, and with back of fingers smooth out all folds. Before you draw the right hand from the womb place left hand on abdomen, catch the womb between the thumb and finger and withdraw hand. With the left hand pull the hair above symphesis or scratch the flesh just above across the region of the symphesis, just enough to make an irritation. After the hand is out of vagina pass a small bundle of cloths as far under the symphesis as would be necessary to hold everything up, then fasten chemise; beginning at symphesis draw it tight for about two inches above symphesis and with strong pins fasten it. Be sure you keep garment tight by pulling down between limbs. The coarser the chemise the better, as you want to make a strong bandage at that point so as not to push the womb down into the pelvis. If the patient's general health is fairly good let her tell you what she wants to eat, and go and get it. Let her diet be after her usual custom. You must remember she has just left the condition of a full abdomen. Lace her up, fill her up and make her comfortable for six hours; then change her bedding.

Remember this, if you stop digestion on her for some hours with teas, soups and shadows to eat, you carry her to the condition where it would be dangerous to give her a hearty meal. My experience and custom for forty years has been crowned with good success. I never lost a case in confinement. I have universally told the cook to give her plenty to eat.

If she begins to have fever followed by chilly sensations, with swelling of one or both breasts, I relieve that by laying her arm ranging with her body. Let some one hold the arm down to the bed, then I place both of my hands under the arm, pull it up with considerable force till I get it as high or higher than normal position of the shoulder. Then pull her shoulder straight out from the body a fairly good pull, then pull the arm up on a straight line with the face, and be sure that you have let loose the axillary and mammary veins, nerve and artery, which have been cramped by pulling the arm down during delivery. No breast should become caked in the hands of an Osteopath. Do not bother about the bowels for two or three days. It may be necessary to use the catheter if the water should fail to pass off after inhibiting the pubic system. This is straight mid-wifery and will guide you through at least in ninety per cent of the cases you will meet in normally formed women.

Right here I wish to say one word: I think it is very wrong to teach, talk and spend so much time with pictures, cuts, talks and lectures, and hold up constantly to the view of the student, births coming from the worst imaginable deformities and call that a knowledge of mid-wifery. It is normal mid-wifery you want to know and be well-skilled in. The abnormal formations are few and far between, and when a case of that kind does appear, it is your knowledge of the normal that guides you through the variations. You will very likely never find two abnormals presenting the same form of bone. As this is intended to only present to the student natural delivery I will let the subject drop with one word about the sore tongue of the mother. Adjust her neck, relieve constrictor and all other muscles that would impede any blood vessel that should drain the mouth and tongue. Remember this, that a horse that is always hunting bugars never finds a smooth road.