Under such conditions, the doctor should be called at once if the symptoms develop between 7 A. M. and 11 P. M. If the pains begin in the night, say from 11 P. M. to 7 A. M., the doctor need not be called unless he has requested it, or, unless in the judgment of the nurse or the anxiety of the patient, it is desirable for him to see her.
[Illustration: Fig. 51.—Points of greatest intensity of fœtal heart tones. _V_, vertex presentations; _B_, breech presentations. (Eden.)]
When the doctor is notified he will want to know, and the well trained nurse will be able to inform him, when the pains began, their strength, duration and frequency. He will want to know whether or not the membranes have ruptured. Many doctors also require, and a well trained nurse who specializes in obstetrics should be able to say by external examination, whether the head seems high or low, as well as the position and frequency of the fœtal heart tones.
In the hospital the following rules for summoning the resident physician may be found useful:
1. For multipara, when pains are regular and five minutes apart.
2. For primipara, when pains are regular and two minutes apart, or when head is visible if pains are less frequent.
3. If a precipitate is imminent, delivery must be delayed until arrival of attending man by—
(a) Turning patient on side with legs straight;
(b) Instructing patient to breathe deeply or to cry out with mouth wide open; then
(c) Place sterile towel over vulva, and at time of pain prevent expulsion by compressing the head by means of locking the hands over a towel on the vulva.
It is possible thus to delay delivery two hours, or until the doctor arrives. _Do not permit a precipitate._
After the nurse has completed her preliminary observation, she starts her history, notes the character of the pains, the pulse, temperature and respiration. All unusual phenomena should be recorded; and after the visit of her attending man, his examination, if any, and the conditions found, are put down. Then she prepares the patient and sets up the room for the delivery.
=Preparation.=—As soon as the patient is known to be in labor, the bowels are thoroughly cleansed with a soapsuds enema. A toilet jar should be used and not the water closet. The bladder must be emptied at the time of preparation and at frequent intervals throughout the labor. As soon as the bowels and bladder are emptied, the patient is given a bath and thoroughly soaped. The shower is preferred lest the water, contaminated by bacteria from the skin and external genitals, should enter and pollute the vagina.