Pictorial midwifery : an atlas of midwifery for pupil midwives / by Sir Comyns Berkeley.

  • Berkeley, Comyns, Sir, 1865-1946.
Date:
1941
Catalogue details

Licence: In copyright

Credit: Pictorial midwifery : an atlas of midwifery for pupil midwives / by Sir Comyns Berkeley. Source: Wellcome Collection.

    49/186 (page 31)
    In this position the patient is placed, either on a table or across the bed, on her back. Her thighs and legs are flexed, and are kept in this position by a Clover’s crutch or by special iron uprights on the operating table. In fixing a Clover’s crutch the nurse must be sure that the ends of the bar, to be attached to the legs, are strapped below the knees, and the strap that holds the bar passes over one shoulder and below the other. It is an extraordinary thing that the \ majority of sisters and nurses away from hospitals always, if they are allowed, fix the ends of the bar above the knees and the strap round the neck. Doctors have been known to do the same. If a Clover’s crutch is not available, a stick, suitably padded, can be placed across and under the knees, and a bandage then affixed to each end as is the strap. This position is the correct one when any operation has to be performed upon the patient by the vaginal route. Thus induction of premature labour, craniotomy, cephalo- tripsy, and the induction of abortion are carried out with the patient in this position. It is the best position for packing the vagina in cases of ante-partum haemorrhage. FIG. 52.—LITHOT¬ OMY POSITION. FIG. 53.—MODIFIED LITHOTOMY POSITION. This is the position during the 3rd stage of labour and when the perineum has to be sutured. The four sterilized towels are fixed with safety pins. Many doctors place the patient in this position when delivering her by the forceps, and some during a normal 2nd stage. This is also the best position in which to measure the diagonal conjugate diameter and the antero-posterior and transverse diameters at the outlet. For the treatment of post-partum haemorrhage, for manual removal of the placenta and for douching, the modified lithotomy position is the correct one. The patient is placed across the bed with the legs drawn up and held in position, the feet resting on the edge of the bed and the buttocks being brought as near the edge as possible. If a Clover’s crutch is available, the true lithotomy position can be used with better advantage when performing the operations mentioned above, especially when there is not sufficient assistance to hold up the two legs in position. When a Clover’s crutch is used the nurse, or some assistant, must hold the patient steady; otherwise she may fall off the table and be seriously injured. This has occurred.