Under all conditions the nurse must remember that no matter what anesthetic is given, nor by whom it is administered, she must guard against the very prevalent tendency to talk freely while the patient is going under, in the belief that she is unaware of what is going on about her. Many patients suffer great mental distress because of hearing, or partly hearing conversation not intended for their ears, which takes place in their hearing while they are incompletely anesthetized. CHAPTER XIII OBSTETRICAL OPERATIONS AND COMPLICATED LABORS Unhappily, not all labors run the smooth and uncomplicated course which was described in the last chapter. Certain abnormalities sometimes arise to complicate delivery, occasionally necessitating operative interference or relief. There is little that a nurse can do alone, in the presence of complicated labor, but her preparations and assistance will be more effective if she understands the purpose of the operations, and she will better appreciate the gravity of certain symptoms, which she is required to watch for and report, if she realizes the extreme seriousness of their import. The principal conditions which give rise to, or follow complications, prevent spontaneous delivery or necessitate operations at the time of labor are perineal lacerations; contracted or malformed pelves; marked disproportion between the diameters of the child’s head and mother’s pelvis; ruptured uterus; exhaustion of the mother; poor muscle tone or certain chronic and acute diseases of the mother; death of the fetus; prolapsed cord; certain presentations of the fetus in which spontaneous delivery is doubtful or impossible. The preparations for operations in hospitals are all so carefully planned and systematized that in the presence of such emergencies the nurse will merely have to carry out the customary routine, but in a patient’s home she may have to exercise a good deal of originality in attempting to meet the needs of the occasion and imitate hospital provisions.