CHAPTER VIII

THE PREPARATION OF ROOM, DRESSINGS AND EQUIPMENT FOR HOME DELIVERY

It sometimes devolves upon the nurse to give advice in selecting and preparing the room to be used for a home confinement, and very often to help the prospective mother in preparing and assembling adequate equipments for the delivery and for the care of herself and the baby afterwards.

Under such circumstances the nurse must feel under compulsion to do all in her power to make the home delivery satisfactory, from the standpoint of the patient’s happiness and contentment and from the standpoint of surgical cleanliness and efficiency as well, so that normal cases, at least, may be attended with reasonable safety at home.

We know that the deaths, incident to childbirth, throughout this country at large, have not declined during the past decade, in spite of improved obstetrical methods and skill and the large percentage of recoveries in hospitals where they are applied. In the homes, in general, young mothers continue to die in distressingly large numbers, chiefly from infection, which we know is largely preventable. Apparently, then, in some important particulars the conditions surrounding the majority of home deliveries are still such as to be almost a menace to life and health. And as it is manifestly impossible for all obstetrical patients to be cared for in hospitals, home deliveries need to be made safer, which virtually means, made _cleaner_.

This grave need cannot be dismissed by the nurse as something outside of her province. She may aid greatly, and therefore is under obligation to do so, in making home confinements surgically clean, by being conscientious and thoughtful and thorough in her preparations and assistance.

A relatively small percentage of obstetrical patients require operative assistance, but without a single exception they all require cleanliness; cleanliness of appliances and cleanliness of methods.

As the first labor is usually longer and more difficult than later ones, and the percentage of lacerations and operative interference is higher, primiparæ should be delivered in hospitals when possible, as well as all cases presenting any complication or abnormality. But women who are normal, particularly multiparæ, and these constitute the vast majority of obstetrical patients, should be able to remain at home in safety.

In most instances the patient who is to be delivered at home will have to occupy her accustomed room and there is no alternative. Should there be a choice of rooms, however, one should be selected that is cool and shady, if the confinement takes place during the summer, but bright and sunny for occupancy during most of the year; it should be conveniently near a bathroom if possible, and have an adjoining room for the nurse and baby to occupy.

The arrangement and furnishings of the room will not of necessity vary greatly from those of a room which is to be occupied by any patient. Carpets, upholstered furniture, heavy draperies and curtains are no more suitable in this than in any patient’s room.

The ideal is: A room with a washable floor with small, light rugs; freshly laundered curtains at the windows; a single, brass or iron bedstead, about 30 inches high, with a firm mattress, and so placed as to be accessible from both sides and with the foot in a good light, either by day or by night; a bedside table and two others (folding card tables are a great convenience); a bureau; a washstand, unless there is a bathroom on the same floor; one or two comfortable chairs, two or three straight chairs and a couch or _chaise longue_, all of which should be of wood or wicker or covered with freshly laundered chintzes.

Barrenness is not only unnecessary but is to be avoided, for the room should be as cheerful and pretty as is compatible with cleanliness. There is usually no objection to pictures on the wall, but the room should be free from useless, small articles which are dust catchers, give the nurse unnecessary work, and occupy space needed for other things. Between such a room as this and the one which the nurse finds must be used, there may be a dismaying difference, and so once more she must exercise her ingenuity and resourcefulness; change and improve where it is possible and make the best of conditions that cannot be altered, for the baby is coming and the mother must be safeguarded from infection and other disaster, no matter what the room is like.

Much as we should like ideally to equip and prepare every room to be used for a home confinement, we cannot overlook the importance of having preparations made with as little disturbance as possible to the patient and her household. Preparations made with bustle and ostentation are suggestive of inefficiency; are bad for the patient, frequently causing her great alarm, and in the main had better be omitted. The nurse who is able to go into a home quietly and unobtrusively and accept what she finds, even carpets and draperies, and still do clean work, is doing better nursing than the one who arranges a faultless room but upsets her patient and disrupts the household in the process.

Common sense, judgment and tact, then, will sometimes be as important in preparing a room for home delivery as are washable floors, curtains and furniture.

While we do not advise nor elect to have carpets, draperies and upholstery in a delivery room, we know that they need not menace the patient’s welfare if all details of the work about the patient, herself, are scrupulously clean. That is the one point which the nurse must bear constantly in mind, the paramount importance of clean work about the patient.

The room should be given a thorough housecleaning about two weeks before the expected date of delivery. If there is carpet on the floor, there should be a large canvas or rubber, or an abundance of newspapers available to protect it, about, and under the bed; and if the bed is of wood, the sideboards and foot should be covered to protect them from injury by soap, water and solutions which may be spattered or spilled during labor. If the bed is low, there should be four solid blocks of wood prepared, upon which to elevate it, after removing the casters, and it is also a good plan to have a large board, or table leaves, in readiness to slip under the mattress to make it firm, particularly if the bed is soft or sinks in the middle.

So much for the room.

In preparing the dressings and assembling the various articles to be used the nurse will do well to remember that, although it is possible to use a number of things during labor, it is also possible to do excellent work with a meagre equipment supplemented with a cool head and ingenuity and training and above all, an exacting conscience. The average nurse will wish, usually, to follow a median course in her preparations, having everything at hand that will facilitate the work; be adequately equipped for emergencies but not burdened with non-essentials.

As the wishes and methods of different doctors vary, the articles needed in assisting them must of necessity vary also. But in addition to the instruments which will be used, the following articles will meet the ordinary requirements during a home confinement, and many of them, or adequate substitutes, are to be found in the average household.

=For the Mother and the Delivery=:

Plenty of sheets, pillow cases, towels and night gowns. 4 or 6 T. binders or sanitary belts. 1 piece rubber sheeting or oilcloth, 1 × 1½ yards. 1 piece rubber sheeting or oilcloth, 2 × 1½ yards. Two or three dozen safety pins. Hot water bag with flannel cover. 1 two-quart fountain syringe. 1 douche pan. 1 bed pan. 2 covered slop jars or covered pails. 3 basins, about 16, 14 and 12 inches in diameter. 2 stiff nail brushes, nail scissors and file or orange stick. 3 agate or enamel pitchers, holding at least one quart each. Medicine glass. Medicine dropper. 2 bent glass drinking tubes. 100 bichloride tablets. 4 oz. chloroform. 4 oz. boric acid powder. 4 oz. green soap. 1 pint grain alcohol. Small jar of vaseline to be sterilized. Lard, olive oil, vaseline or albolene to oil baby. Roll adhesive plaster 1 inch wide. 1 pkg. absorbent cotton. 1 thermometer.

In addition to these, a certain supply of sterile dressings will be needed. Complete outfits of such dressings, sterilized and ready for use, may be obtained from any one of a number of firms, or the following may be prepared by the nurse or by the patient, under the nurse’s direction:

=Dressings=:

1 doz. sterile towels. 5 or 6 doz. perineal pads. 2 or 4 delivery pads, made of gauze and common cotton with top layer of absorbent cotton, or newspapers covered with muslin. 5 or 6 doz. gauze sponges. 2 or 3 doz. gauze squares, 4 inches square. 4 or 5 doz. cotton pledgets. 1 pr. leggings, made of canton or outing flannel, either loose fitting hose or a yard square folded diagonally and stitched. (See Fig. 110.) 3 sheets. 6 pieces cord-tie of bobbin or narrow tape, 9 inches long.

These may be put up into packages in the usual manner, using muslin for wrapping, and sterilized in the patient’s home as follows: Fill a wash boiler about ¼ full of water and fashion a hammock from a towel or strong piece of muslin, tied securely with strings at each end and hung from the handles so that the bottom of the hammock in about half way down in the boiler. As the weight of the dressings makes the hammock sag low, in the middle, it is usually necessary to place a rack, or support of some kind, in the bottom of the boiler to hold the dressings well above the bubbling water, at the point where they hang lowest. Pile the dressings into the hammock, cover the boiler tightly and keep the water boiling vigorously for one hour; dry the packages in the sun or by placing them in the oven for a few moments, and at the end of twenty-four hours repeat the steaming and drying process, wrap the packages in a clean sheet or paper and put them away in a drawer or covered box where they should remain until time to prepare for the delivery. The brushes, douche pan, irrigation-bag, and other articles which must be surgically clean may be sterilized in the same way. The gloves may be sterilized in this way or boiled immediately before delivery. If sterilized by steam, the gloves should be thoroughly dried, dusted with talcum inside and out to prevent them from sticking together, and may be wrapped in packages or placed in individual cases (Fig. 42). A small towel or piece of soft muslin and a ball of gauze containing talcum powder, if placed in the case and sterilized with the gloves, are often a convenience to the doctor in putting on the gloves.

The newspaper delivery pads offer excellent protection and are made of six thicknesses of paper covered with a piece of freshly laundered muslin, which is folded over the edges and basted in place. (Fig. 43). These pads may be made virtually sterile by ironing them on the muslin side with a very hot iron, folding the ironed surface inside without touching it; again ironing on the outside and wrapping in a clean muslin or sheet, also recently ironed, and putting away in a place protected from dust.

The nurse herself should have:

A hypodermic syringe and 4 or 6 needles. 1 pr. long forceps to use as dressing forceps. 1 pr. short forceps. 1 pr. blunt pointed scissors. 2 artery clamps.

The doctor will usually supply himself with any articles needed beyond those which have been enumerated, but the nurse should be sure about the following in order that she may prepare whatever he may lack:

Instruments and sutures. Hypodermic tablets. Pituitrin and ergot, or ergotole. Gauze packs. Gloves and sterile gown. Rubber apron. Filtered, sterilized salt solution and infusion needles. Chloroform inhaler.

In planning the baby clothes, there are a few important factors to bear in mind. The clothes should be simple; not more than twenty-seven inches long; warm, but light in weight, and large enough to fit loosely. Like the dressings, complete layettes may be bought outright, but if the mother wishes to make the little garments herself, the following list will be found to provide an adequate supply of clothing for the new baby. (See also Fig. 159.)

=For the Baby, Layette=:

2 to 4 doz. diapers, preferably 18 in. square. 3 flannel bands, 6 or 8 inches wide and 27 in. long unhemmed. 3 shirts, size No. 2, of cotton and wool, silk and wool but not all wool. 4 flannel petticoats, Gertrude style. 4 flannel nightgowns or slips. 6 white slips. 3 knitted bands with shoulder straps, to use after the cord separates. Flannel kimono or square, one yard, to be used as extra wrap in cool room. Cloak and cap or other wrap for out-door use.

=Additional Articles Which Are Needed or Useful in the Care of the Baby=:

Bath tub, tin, enamel, agate or rubber. Drying frames for shirts and stockings. Rubber bath apron. Flannel, or Turkish toweling bath apron. Low chair without arms. Low table. Screen to protect baby during bath. Rack upon which to hang clothes to warm during bath. Scales, with beam and basket and scoop, not the spring variety. Hot water bag and cover. Crib, basket or box, to be used as bed. Folded felt pad, blanket or hair pillow for mattress. Rubber or oilcloth to cover mattress. 6 crib sheets. 1 thermometer. 2 crib blankets. Soft towels and wash cloths. An old blanket to be used for bath blanket. 3 or 4 dozen safety pins, assorted sizes. Castile soap. Boric acid powder. Olive oil or albolene. Absorbent cotton pledgets, preferably sterile. Enamel pail and cover.

The above lists of dressings and articles for the baby can be considerably modified and still be satisfactory. The leaflet of “Advice for Mothers” issued by the Maternity Centre Association, New York City (see p. 429), gives a somewhat curtailed list of equipment which proves to be adequate and within the means of most of the patients with whom the Association works.

It is usually a good plan for the nurse to advise the patient to have her dressings ready by about the end of the seventh calendar month, and the layette by the end of the eighth month. A baby born before this time would probably be so frail that it would be wrapped in cotton and not require the clothes ordinarily prepared for a full-term baby.