284 DB. CHASE'S RECIPES. 



The bag of waters consists of the membranous coverings of the foetus, 

 enclosing within them what the doctors call, the liquor amnii, in which the child 

 floats. During pregnancy this fluid serves to preserve the child from injury; 

 during labor it forms a pouch at the mouth of the womb, which it acts upon 

 like a wedge, and so assists in dilating. Experience tells us that, when the 

 waters escape early, labor is rendered more tedious. The explanation of this 

 is to be found in the fact that the bag of waters, being round and even, and 

 pressing on the mouth of the womb {ps uteri) equally all around, the mouth of 

 the womb is opened out more rapidly and easily by this even pressure than by 

 the uneven surface of the presenting part of the child. 



As the OS utet-i opens, and the end of the first stage draws near, the pouch 

 formed by the protruding membranes is pushed further into the front passage, 

 or vagina, and, the pains becoming more violent, the membranes at last give 

 way during a pain more severe than the rest, and so the waters escape. In 

 natural labors this usually happens as soon as the mouth of the womb is fully 

 opened and thus th.& first stage of labor is ended. 



The head of the child now begins to pass through the oa uteri. After a 

 certain time, usually much shorter than that occupied by the first stage, it 

 reaches the vaginal opening, through which it gradually escapes, and thus the 

 child is born, and the second stage is completed. 



The pains of the first stage are called " grinding pains," and are different in 

 character from those of the second stage, which are known as "forcing" or "bear- 

 ing pains." The cry which is called forth by the pains during the first stage is 

 also different from the groan which escapes from the patient when the pains of 

 the second stage commence. An experienced nurse knows from this circum- 

 stance alone that the first stage is over, and as the sending for the doctor ought 

 on no consideration whatever to be delayed beyond this period, it is a point of 

 great practical importance. 



The pains now become stronger and more frequent; the patient, holding 

 her breath and bearing down at each return of the pain, becomes hot and 

 flushed, and breaks out into a profuse perspiration. At the end of each pain 

 the head of the child goes back a little, which prevents the strain from being 

 so continuous as to be hurtful and exhausting. Nevertheless, almost every 

 pain marks an advance upon the one preceding. This slight withdrawal of 

 the head is frequently perceived by the patient herself, and unless explained 

 to be natural and necessary, is apt to make her think she is not making any 

 progress. There eventually comes a point, however, when the head is so far 

 expelled that it no longer recedes between the pains. The intervals become 

 shorter, and the pains more severe, until at last the head slips out altogether, 

 and then the most painful part of the labor is over. The uterus usually now 

 rests for a moment. Then the face of the child mak^ a little turn towards one, 

 of the patient's thighs, generally the right, in order that the shoulders may be 

 brought into such a position that they may pass with the least diflBculty. With 

 another strong pain the shoulders are expelled. The rest of the body gives 

 little trouble, for no part of it is as broad sis those which have already passed. 



