LABOUR. 55 



found mixed with the mucus upon the finger, after an examination. 

 This is commonly denominated in the lying-in rooms " a shoiv^'' and 

 it is usually an indication that the os uteri is dilated, or nearly so. 

 The hemorrhage proceeds from the slight vascular twigs extending 

 between the uterus and the membranes, which are ruptured by the 

 increasing dilatation. 



The phenomena which have been described are repeated during 

 every succeeding pain, (the intervals being shorter and the pains 

 longer,) until the dilatation of the os uteri is completed. During the 

 whole period of the first stage, the pains have been acting, not so 

 much for the expulsion of the child, as for preparing it and the pas- 

 sage for that purpose. The more completely the os uteri is oppo- 

 site to the fundus, and the greater the correspondence between the 

 axis of the uterus and that of the superior strait, the more speedily 

 will the dilatation be accomplished. As soon as this has taken place, 

 the first stage is ended. 



Second stage. — The phenomena that present themselves in this 

 stage differ essentially from those of the preceding. The pains suc- 

 ceed each other with greater frequency, and last longer, and the 

 suffering is increased ; but, in consequence of the respiratory muscles 

 being fixed, in order to supply a fulcrum for muscular exertion, the 

 woman rarely cries out during a pain. Hence the character of the 

 cry, as before stated, is a diagnostic sign of this stage. The pains 

 now appear not to be so much confined to the womb ; they acquire 

 a more expulsive character, and are attended with strong bearing- 

 down efforts of the abdominal muscles. Upon the approach of each 

 pain, the woman seizes hold of anything within her reach, and brings 

 the muscles of the extremities, back, and abdomen to aid her in the 

 expulsive effort. These are commonly called hearing-dmjon 'pains. 

 If the membranes have not ruptured previously, they generally give 

 way during one of these pains, and the liquor amnii escapes through 

 the external organs ; the foetus, forced downwards by the same con- 

 traction, immediately fills up the space previously occupied by the bao- 

 of waters, and the uterus condenses itself upon the body of the child. 

 This is therefore folded into a smaller space, and is much more com- 

 pressed than previously. 



Each succeeding contraction pushes on the presenting part ; but, 

 as the pain goes off, it again recedes, not, however, to the point it 

 occupied before, as there generally is more or less advance on that 

 gained by the preceding effort. If it were not for this gradual ad- 

 vance and recession, there would be great danger of laceration of the 

 soft parts, from a continued expulsive effort before the passages were 

 sufficiently dilated to receive the presenting parts. It thus not only 

 takes away the danger of pressure, but is in itself a good sign, inas- 

 much as it proves that the cavity of the pelvis is sufficiently capa- 

 cious. The woman during the second stage is much less irritable 



