CHAPTER I.
PRELIMINARY INSTRUCTION TO THE NURSE MIDWIFE.
It is my design in giving the following instructions to prepare the student of this work to be a skilled or skillful nurse, not to be simply a midwife; to act in conjunction with, not in opposition to, physicians; to conform to, and not to violate laws which regulate the practice of medicine; to officiate in cases of easy, natural labor sometimes, but never in cases requiring the use of instruments; to be prepared to act in emergencies until the doctor can come and take the case; not to treat the case when the services of a physician can be obtained and is desired or needed; in short to act intelligently in all cases in which women now act perhaps blindly, hurriedly and ignorantly.
The present state of feeling among our people, and especially among the medical profession in this country, would not sanction an effort to educate women solely as midwives.
But there is a general feeling or sentiment that every young lady ought to have that kind of education which may render her useful; that she should be prepared in some way to minister to the desires, wants and needs of her fellow creatures, and that some part of that knowledge or skill should be of that kind which would be available if these persons were thrown on their own resources; hence I would have some of you to be, not only nurses of the sick, but skilled nurses of lying-in women. And should some young lady after studying this work, decide to pursue the study of medicine thoroughly and become a physician, the knowledge here obtained would be available.
PRELIMINARY INSTRUCTIONS.
1. Do not stop short of a thorough knowledge of this book, every part of it.
2. Endeavor here to get a knowledge of midwifery that will qualify you to attend ordinary cases of _natural_ labor, and enable you sometimes to give medicine when needed, and when there are no physicians in attendance; but understand that there are many times when the only proper thing for you to do is to send for a physician or experienced accoucheur.
3. Do not hesitate to seek knowledge and experience and instruction from any source where you think that you can obtain it. Physicians will be willing to aid you, and I think the time is coming when he will regard the educated nurse as his friend, and not as his natural enemy.
4. I do not think it best that you should call yourself a midwife, because if you do it will excite misapprehension and prejudice. Seek in every way to be skillful as a nurse, and seek to have a corresponding reputation.
5. Do not undervalue your position, if you have the wisdom and courage and perseverance necessary to prepare you to minister to your sex in their time of greatest suffering and trial. Do not doubt that your mission is an honorable one. And even if you do not minister very often to the sick in labor, except as the right arm of the medical man, you may help to raise the standard qualifications of the nurses of our land. Do not suppose that I am complaining harshly of our present supply of nurses. Women have shown a wonderful adaptability to the needs and exigencies of their suffering friends in nursing and caring for them. And it is because they are so ready to receive instruction that I endeavor here to furnish good instruction for them.
6. Do not suppose that your knowledge obtained by study is sufficient to enable you to act as midwife (except in an emergency), unless your studies are supplemented by observation, as mother nurse, &c.
7. Do not be unwilling to minister to women who are poor. The young physician is willing to do something in this way to gain experience and for the sake of humanity, and this will be your opportunity to gain experience without coming in competition with rivals.
8. The nurse as well as the medical man, must study the phenomena of labor at the bedside of the patient. No one can be qualified by mere reading for the duties of a midwife, and no woman that is diligent and observing can attend a case of labor without some addition to her knowledge.
INSTRUCTION TO THE NURSE MIDWIFE.
When I use the term nurse midwife I mean a nurse that has some knowledge of midwifery, that can be called to attend to women near the time that she expects to be confined, and that can remain in attendance for two weeks or more if it is desired or necessary. Sometimes a woman would, if possible, have a skilled nurse with her a week or more before confinement, especially because she would thereby avoid sending for the physician unnecessarily, and because she would be less likely to detain him for a long period of time.
If the nurse midwife understands her business she will in some cases do better for the woman than a physician in the commencement of labor. For instance, suppose that a doctor is called a distance of five miles and away from his home and his other patients, and when he examines the case the pains seem to be of the character of false labor pains. He knows that the real good of the patient might require that she should take an opiate, but the doctor would be unwilling to give it lest it might protract a real labor, and subject all parties to the inconveniences of a prolonged labor including unnecessary visits of the doctor. The nurse who can remain with the patient, if the labor should not be concluded in several days, would be more likely to do just what the good of the woman requires. And in such a case a skilled nurse would be peculiarly acceptable to a physician if he chanced to be called, because he would be much more at liberty to leave his patient if it seemed necessary to do so.
When a nurse midwife is called to attend a case, she should carry with her besides disinfectants, a male catheter, some laudanum or other opiate, quinine, and extract ergot, in order to be prepared for emergencies. Ordinary cases may require no medicine, but some cases do.