IfUBSmG. 991 



ta-acted. If, instead of this being the case, it is felt to be large, soft, and 

 uncontracted, firm pressure should be continued, so as to excite contraction and 

 prevent flooding, which, in such circumstances, is greatly to be feared. 



Should a gush of blood make its appearance in spite of the pressure, the 

 hand must still be kept over the uterus and the pressure increased, cold wet 

 cloths being in the meantime repeatedly applied with suddenness to the external 

 genitals. Of course, if the medical attendant has left the house, he must be 

 again summoned at once. 



The uterus being firmly contracted, and the flow of blood having ceased, 

 the thighs and surrounding parts are to be gently sponged with warm water 

 and dried by means of a soft warm napkin. 



If there has been no flooding, the soiled chemise and night-dress may now 

 be drawn down, and, along with the folded sheet, blanket, and upper rubber, 

 removed from beneath the patient, who must not be permitted to make the 

 slightest effort while this is being done. Then she may be slowly rolled over 

 on to her back, to allow of the application of the binder. The binder, well 

 aired, must be rolled up to half its length, and the roll passed underneath the 

 lower part of the patient's back. Being caught on the other side, it is then 

 unrolled, and having been smoothed out free from wrinkles, it is so applied as 

 to encircle the hips tightly, and the overlapping end is then secured by means of 

 three or four good safety-pins. All this is to be done with as little exposure of 

 the patient as possible. The pillows having been duly replaced, the patient 

 may now be carefully lifted into her usual position in bed; a fresh warm napkin 

 being applied against the vulva, and the clean chemise drawn down Into its 

 place. 



If, however, there has been any flooding, the patient, must still remain 

 undisturbed for some time after the discharge has ceased, the nurse from time 

 to time examining the napkins to make sure that tliere is no return of the 

 bleeding. 



When the medical attendant is present, he will probably prefer to under- 

 take many of these duties himself; at any rate he, being the responsible person, 

 will give instructions according to the requirements of each individual case, 

 which instructions it will be the nurse's simple duty to obey. 



During the passage of the child's head, it facilitates matters if the patient's 

 knees are separated. This is sometimes effected by placing a pillow between 

 them, but the pillow is apt to be in the way, and a better plan is for the 

 nurse to pass her hand beneath the right knee, and keep it well raised during 

 each pain. 



Sometimes the medical attendant desires the nurse to make pressure upon 

 the womb during the third stage of labor, to assist it in expelling the after- 

 birth. To do this she should stand behind the patient at the doctor's left hand, 

 and passing the hand under the bedclothes, she should place it on the abdomen, 

 where she will feel the round, firm body of the uterus above the pubes. 

 Spreading out her hand over this organ, she should keep up a steady pressure 

 downwards and backwards as long as the attendant desires it. 



