The Midwife

by Jennifer Worth

  antenatal: Before birth.

  anterior presentation: The back of the baby’s head in labour will normally be in the front or anterior part of the mother’s pelvis. This anterior presentation is the most favourable for the baby to adopt for a normal delivery.

  asphyxia: Insufficient oxygen supply to the vital organs, particularly the brain, sometimes resulting in death or permanent damage.

  bd: Medical shorthand used as an instruction on prescriptions to mean twice a day.

  BP: Medical shorthand for blood pressure.

  breech: A baby that is positioned bottom down rather than the usual head down.

  breech delivery: The description of the breech delivery has changed little over the decades though breech delivery at home is now a very unusual occurrence. A breech delivery is slower than a head-first delivery as the baby’s body negotiates the pelvis first and the widest diameter, the head, is delivered last. When the baby’s head enters the pelvis it is maintained in a flexed position by the weight of its own body hanging down outside the mother’s body. This ensures that the head is delivered slowly and safely.

  Caesarean section: An operation to deliver a baby through an incision in the mother’s abdomen.

  cervix: The neck of the womb.

  chancre: The initial lesion of a syphilis infection.

  chloral hydrate: A mild sedative and analgesic used in the early stages of labour. The drug was given as a drink with either water and glucose or fruit juice. Chloral hydrate is an irritant to the stomach which often causes vomiting so is no longer used.

  colostrum: The first breast milk. Mature breast milk is produced from the third or fourth day after the birth of the baby.

  contraction: The intermittent tightening of the muscles of the uterus (womb), which are painful during labour.

  cord: The umbilical cord attaches the baby to the placenta before birth.

  crown: The crown refers to the top of the baby’s head, usually the first part of the baby’s head to emerge. When it emerges it is said to “crown”.

  cystitis: Inflammation or infection of the bladder.

  D and C: Dilatation and curettage (D and C) is an operation to remove any pieces of placenta or membrane from the uterus after delivery to prevent further bleeding or infection.

  delivery techniques: Placing the heel of the hand behind the anus is no longer undertaken as part of delivery. It is now considered to be unnecessary and invasive.

  eclampsia: A rare and severe consequence of pre-eclampsia which is characterised by convulsions. Eclampsia is an infrequent cause of death of a mother and unborn baby. The old term used for eclampsia was toxaemia.

  enema: A preparation used to empty the lower bowel. It used to be given to all women at the start of labour, administered in the belief that it would stimulate contractions and make space for the baby to descend. Research has shown that an enema is not a labour stimulant and is no longer used.

  episiotomy: A cut made to enlarge the opening of the vagina during delivery.

  ergometrine: An oxytocic drug which makes the muscle of the uterus contract after delivery. The oxytocic drugs of choice now are either syntometrine or syntocinon.

  Fehlings solution: A chemical used for testing for the presence of sugar in urine. The chemical is now used in a tablet form (clinitest), added to 5 drops urine and 10 of water. The colour of resulting solution is compared to a chart for a result.

  first stage of labour: From the start of regular painful contractions until the cervix (neck of the womb) is fully open.

  forceps delivery: If a baby becomes stuck in the mother’s pelvis during labour then forceps would be used to assist the delivery. Forceps are applied in two halves, one either side of the baby’s head, and the operator pulls gently on the forceps to deliver the baby. A low forceps delivery refers to the baby being low in the mother’s pelvis.

  full term: The duration of a pregnancy is (nine months) forty weeks. Full term is considered to be between thirty-eight and forty-two weeks of pregnancy.

  fundus: The top of the uterus.

  gallipot: A small glass or ceramic bowl for medicines or lotion.

  gas and air machine: Gas and air was a popular form of pain relief for labour. The air has now been exchanged for oxygen but is still usually called “gas and air”. The “gas” in current use is nitrous oxide.

  gestation: The number of weeks of pregnancy.

  gluteus muscle: Gluteus or gluteus maximus muscle is the large muscle in the bottom.

  IM: Intra muscular or into the muscle.

  IV: Intra Venous (IV) or intra venous infusion may be more commonly known as a drip.

  kidney dish: A kidney-shaped bowl available in various sizes to hold medical equipment.

  left side: Positioning women on their left side for delivery was popular for a while. Women are now encouraged to choose the position for delivery that is most comfortable for them; the left side or left lateral position is rarely used.

  lying in: A period of ten to fourteen days when a woman was confined to bed and was not expected to get up for any reason. This enforced bed rest created problems rather than encouraging recovery. Women are now expected to be up and out of bed very soon after the birth of the baby.

  macerated foetus: A baby that has been dead in the womb for a while and the skin has started to break down.

  mastitis: Inflammation or infection of the breast.

  Mauriceau-Smellie-Veit: A series of manoeuvres to deliver a breech baby. This method of breech delivery is still used by some midwives and obstetricians.

  mucus catheter: Mucus is now sucked from the baby’s mouth using gentle electrical suction rather than oral suction to prevent the spread of infection.

  multigravida: A woman who has had more than one pregnancy.

  nephritis: Kidney infection.

  nurse: The title of nurse is now rarely used for or by midwives. Midwifery is an entirely separate profession. Many midwives were trained as nurses but this dual qualification is now less common.

  occipital protuberance (or occiput): The back of the baby’s head.

  oedema: Swelling caused by fluid retained in the tissues.

  oxytocic drugs: See ergometrine.

  paediatrician: A doctor who specialises in the care of babies and children.

  path. or path lab: A shortened term for a pathology laboratory where samples of blood would be sent for confirmation of infection.

  pelvic floor: The layer of muscle that lies across the lower part of the pelvis.

  perineum: The area between the vaginal opening and the anus. The perineum is often damaged in childbirth. A tear or cut (episiotomy) in the perineum may require stitches, but usually heals quickly.

  pinard: A pinard or foetal stethoscope is shaped like a listening trumpet and is placed on the abdomen of the woman so that the midwife can hear the foetal heartbeat.

  pitting oedema: Swollen skin will stay dented if pressure has been applied.

  placenta: Also known as the afterbirth. The placenta is attached to the wall of the uterus during pregnancy and separates after the birth of the baby.

  placenta praevia: When the placenta forms partly or wholly over the opening of the uterus. Severe bleeding can occur. Delivery is usually by Caesarean section.

  post-natal or post-partum: The six weeks following birth.

  post-partum delirium: Is now called puerperal psychosis; the less severe form is called post-natal depression.

  pre-eclampsia: A disease that is peculiar to pregnancy. The symptoms are high blood pressure, protein in the urine and oedema (swelling).

  premature baby (care of): Skin to skin care is now widely used for the care of premature babies. Separation of the mother and baby in modern neonatal intensive care units is kept to a minimum and contact between the mother and her baby is encouraged. Skin to skin care is also known as Kangaroo Care. The modern history of its use goes back to the early 1980s in Bogota, Columbia, where it was developed out of medical need as there were
not enough incubators to keep the premature babies warm. The success of Kangaroo Care has now spread all over the world. Kangaroo Care works because the baby is kept warm so uses fewer calories, needs less oxygen and has a better breathing rate. Babies receiving this form of care have also been found to cry less and sleep better than those cared for in an incubator.

  primigravida: A woman pregnant with her first baby.

  pubic bone: The centre and front part of the pelvis.

  sacro anterior position (left or right): Positions that a breech baby could be in immediately before delivery. The baby’s sacrum (bone at the base of the spine) lies at the front of the mother’s pelvis.

  scrape: Another name for D and C (see above). second stage: The time when the neck of the womb or uterus is fully open until the delivery of the baby.

  shave: The perineum was shaved for labour until the 1980s. It was thought to make the skin cleaner for delivery. Research has shown that shaving does not improve the cleanliness of the perineum either before or after delivery.

  sim’s speculum: An instrument that looks like a double ended shoe horn bent into a gently curved M shape used to stretch the vaginal walls.

  spirochaeta: A type of organism such as treponema pallidum, the cause of syphilis.

  suprapubic: Above the pubic bone.

  third stage: The time from the birth of the baby to the complete delivery of the placenta.

  uterus: Also known as the womb.

  vagina: Birth canal.

  vernix caseosa: The sticky white substance that is on the baby’s skin at birth, usually seen in the skin folds.

  vulva: A woman’s genital organs.

  waters: A protective bag of water surrounds the baby in the womb. The bag breaks during labour and the water drains away.

  References

  Cowell B., and Wainwright D., Behind the Blue Door, Cassells Ltd, London 1981.

  Morton, L. T., A Medical Bibliography (3rd edn, The Trinity Press, London, 1970).

  Myles, Margaret F., Text Book for Midwives. V. Ruth Bennett and L. K. Brown, eds (Churchill Livingstone, Edinburgh, 1999).

  Richardson H., ‘Kangaroo Care: why does it work?’, Midwifery Today, 44 (1997), 50-51.

  Stables D., Physiology in Childbearing with Anatomy and Related Biosciences (Balliere Tindall, Edinburgh, 1999).

  1

  The Midwives of St Raymund Nonnatus is a pseudonym. I have taken the name from St Raymund Nonnatus, the patron saint of midwives, obstetricians, pregnant women, childbirth and newborn babies. He was delivered by Caesarean section (“non natus” is the Latin for “not born”) in Catalonia, Spain, in 1204. His mother, not surprisingly, died at his birth. He became a priest and died in 1240.

  2

  From Behind the Blue Door in A History of the Royal College of Midwives, Hansard, p. 23. This is a quote from the proposed Bill for the Registration of Midwives, 1890, from a speech made by Charles Bradlaugh MP.

  3

  from John Keats, ‘Ode to a Nightingale’.