NUBSma. 283 



Should the pregnancy be further advanced, or the circumstances less 

 favorable, a longer period of rest will be required. Where there has been 

 severe or long-continued flooding, a patient is frequently reduced to a conditiox. 

 of weakness quite equal to that following an ordinary confinement. In such 

 cases it is only reasonable to expect the same care to be exercised as after a 

 labor at full term. 



On no account should a patient leave her bed, after a miscarriage, :o long 

 as any discharge of blood continues, as, while that persists, it is imcertain 

 whether there is not some portion of the after-birth or membranes still remain- 

 ing in the womb, and rendering the patient liable to further attacks of flooding. 



PROCESS OP NATURAL LABOR: Signs of Approaching 

 Labor — Its Division into Stages— Labor-Pains.— The **Bag 

 of Waters " — Description of First Stage— Of Second Stage 

 — Of Third Stage. 



Approach of Labor Pains.— Towards the latter part of the ninth 

 month, certain changes take place which give warning that labor is not far off. 

 One of the earliest of these is sinking of the abdominal swelling; the upper 

 end of the womb, which at the beginning of the ninth month, reaches as high 

 as the pit of the stomach, now falls a little below that point. Great relief to 

 the breathing follows this alteration, as the pressure upon the organs within 

 the chest is thereby greatly lessened. On the other hand, owing to this change 

 in the position of the womb, certain new inconveniences arise from the pressure 

 of its lower portion on the various important parts contained in the pelvis. 

 Thus, walking becomes more diflicult, the bladder requires relieving more fre- 

 quently, and piles are apt to form. 



A sign that makes it probable that labor is actually about to commence is 

 the appearance of a slight discharge of mucus, streaked with a little blood. 

 This is spoken of, in the lying-in room, as the "show." 



Labor is Divided, for the Sake of Description, into Three 

 Stages.— 27;e first of these is called the stage of dilatation of the mouth of 

 the womb; tJie second lasts from the moment when that dilatation is completed 

 up to the birth of the child; while the third, or last stage, includes the time 

 from the birth of the child to the coming away of the after-birth, or placenta. 



The so-called pains of labor are, in reality, contractions of the muscular 

 wall of the womb. At the early part of labor they are slight, occur at long 

 intervals, and are felt mostly in the lower part of the front of the abdomen; 

 as labor advances, they become longer and more energetic, follow one anothei 

 more quickly, though always with a certain regularity, and are generally felt 

 chiefly in the back and loins. Each pain is comparatively feeble at its com- 

 mencement, increases in intensity until it reaches its height, and then gradually 

 passes off. This character, together with the regularity of their recurrence, 

 serves to distinguish pains really due to uterine contraction from colicky and 

 Other pains, for which they are sometimes mistaken. 



