NURSING 289 



eum in the hope of facilitating the escape of the head. Contrary to the popular 

 belief, the attendant's duty is rather to keep back the head by gentle pressure, 

 than to hasten its expulsion. Above all things there should be no pulling; 

 Nature is to be allowed to do her own work. 



If the medical attendant be still absent when the head is born, the nurse 

 must spread the flannel receiver close up to the vaginal orifice, and receive the 

 head of the child upon her right hand, still keeping up the gentle pressure 

 upon the stretched perineum until the shoulders have passed out. Even then 

 the body and legs must be left to follow of themselves, the nurse meanwhile hold- 

 ing up the parts which are already born. The upper bed-clothes should be 

 now turned back sufficiently to allow the child to breathe, without causing any 

 exposure of the patient herself. If the navel-string is found coiled around the 

 child's neck, it must be slipped over its head as quickly as possible, lest the 

 life of the child should be sacrificed owing to a stoppage in the circulation of 

 the blood through the cord. Very occasionally it happens that the child is 

 born with the membranes unbroken ; they will in such cases be found drawn 

 tightly over the little face, and will cause death from suffocation, unless quickly 

 torn open and the mouth freed. Amongst some people this occurrence is 

 known as being born with a veil or caul. 



The cry which a child usually utters as soon as it is bom, helps to fill the 

 lungs with air, and is on that account rather to be encouraged than checked. 

 If the child does not cry, the nurse must examine the mouth to ascertain 

 whether there is anything either over it or within it, preventing the breathing. 

 Sometimes there is some frothy mucus in the mouth which can be clewed away 

 with the finger. It is often useful, also, when breathing is delayed to turn 

 the child on its face, and give it a few gentle slaps on the back with the flat 

 hand. 



The navel-string must not be tied imtil the breathing is established, tinlefle 

 it is quite evident that the child is still-born. The first ligature must be 

 tied an inch and a half from the navel, and the knot must be pulled tightly two 

 or three times so as to squeeze out of the way the jelly-like material which 

 surrounds the blood-vessels of the cord; otherwise the vessels may not be closed 

 by the ligature, and bleeding from the stump may occur to a fatal extent while 

 the nurse is attending to the mother. The second ligature is placed an inch 

 further from the child than the first one, and the cord is then divided with scis- 

 sors mid-way between the two. All this must be done outside of the bed-clothea, 

 lest some other part than the cord be cut in mistake. 



Now and then it happens that a nurse has to take the temporary charge of 

 cases where not the head, but the breech, passes out first. Delivery with th« 

 child in this position is full of danger to the life of the child. The nurse must 

 not hasten matters by pulling, even when the legs are already born ; but, when 

 the whole of the child's body has passed except the head and arms, and when 

 these parts appear to be arrested, she may endeavor to assist Nature by bringing 

 down the arms from the sides of the child's head in the following manner: — 

 Pasaing her forefinger up the child's back, and over its shoulder, she draws tke 

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