The patient must rest and maintain her self-restraint.

A large box of shiny new text books arrived yesterday courtesy of Sugar Daddy. Last night before bed as I wandered about the house looking for something to read I grabbed my new copy of Oxorn-Foote's Human Labor and Birth. You might think this is a curious choice of bed-time reading but I think perhaps it's a bit indicative of just how excited I am to get started at this stuff. I mentioned to Husband who's eyebrows went up as I pottered in to bed clutching this pretty hefty book that I thought this phase will soon pass. I'm aware that a time will come when I can't stand to look at these books. But for now they interest me wildly. So much so that I'd rather take a book about women's reproductive organs to bed, than him. :)

I opened the book to the very first page. There I found a description of the inominate bones of the pelvis and the points of note in the ilium:

"1. The anterior superior iliac spine gives attachment to the inguinal ligament.
2. The posterior superior iliac spine marks the level of the second sacral vertebra..."

You get the picture. Oh boy, am I glad I really studied my anatomy. To my surprise I understand this crazy language. Fun reading but a bit boring. But it got better. Or at least more interesting.

Within a few chapters I found myself reading the how to of abdominal inspection and palpation. Cool. I then discovered that rectal exams can be performed instead of vaginal exams to determine things like station (position of baby in the pelvis). I'd NEVER heard of that before. I quickly checked the publication date: 1980. This is OLD. Not old-as-your-granny old, but old. Old enough to be decidedly unfriendly to women, the 'patients' the authors refer to so clinically. Old enough that some of the the attitudes in it I find pretty disturbing. Almost laughably so. I thought I'd share.

Greatest hits from Oxorn-Foote so far:

"p. 125 Management of the First Stage of Labor
8. The patient must rest and maintain her self restraint. (this was clearly written by a man) This is important for lost control is difficult to regain. The attendants can help by continual reassurance, frequent enouragement and judicious sedation. ... (It has been said that the best sedative for a woman in labor is to see the doctor at the side of the bed.) (If she gets crazy, knock her out.)

10. Measures to improve the character and efficiency of the contractions:
a. Hot soapsuds enema (You gotta be kidding me!)
b. Artifical rupture of membranes.
c. Oxytocin (pitocin)
d. Ambulation" (walking)

Ok, ignore the first THREE, the last one's where you really should start OR you could: Put her in some water, give her some privacy and have her love-up with her partner... A soapy enema??? That'd be enough to stop labor cold for me.

And then there was the discussion of the "(popular and effective) Brandt-Andrews maneuver for cord traction" to deliver the placenta. I have a feeling that I'll be taught that this is a bad, bad idea. And yet it appears in one of the big obstetrics texts. Interesting. I've always percieved this as a time saving technique. OB's don't like sitting around for placentas to detach on their own and plop out. So they will frequently employ a technique which can get them to their next delivery faster but (as I understand it) risks tearing the cord and/or placenta and potentially causing big time bleeding. Perhaps there's a time and a place for cord traction and I haven't learned it yet.

I should note that I don't know for sure that this book is requred reading for my course. The further into it I get the more I think it probably won't be. Or perhaps it'll be a matter of ignore the stuff that's too totally rediculous. I only know that it is a major educational text for this subject and in any case it's good stuff to know. Even if it's from the perspective of what not to do. There's a lot of really interesting technical and anatomical detail which at any rate will make good counterpoint as what not to do if it turns out to be something I won't actually be learning from.

But seriously people, rectal exams and soapy enemas!? I wonder what obstetrical miracles Harry Oxorn has planned for me next?