LABOUR. 57 



Strait, the coccyx is pushed backwards, and the external orifice is 

 dilated ,- the anus projects, and the whole perineum is elongated ; the 

 labia majora, and even the mons veneris, are put greatly upon the 

 stretch, and the former disappear entirely ; this is not the case, how- 

 ever, with the labia minora, which can be felt even at the moment 

 of the exit, and greatest distension. The sufferings of the patient 

 are now at their height, and the pains are frequently " double^'' a 

 new one commencing before the former has quite terminated. The 

 force is at length so great, that all resistance is overcome, and with 

 a cry of anguish the exit is effected. There generally succeeds an 

 interval of rest for a few seconds or more, then the pains again re- 

 turn, and the remainder of the child is expelled. 



The second stage is now completed, and the woman is entirely 

 free from pain. If the hand be placed upon the abdomen, it will be 

 found flabby and relaxed, and the uterus can be felt through the 

 abdominal parietes, large, and moderately contracted. 



The third stage is occupied by the detachment and expulsion of 

 the placenta ; the period occupied in effecting this varies much in 

 duration. Sometimes it is expelled with the body of the child, at 

 others, it is retained for some time after. Usually, after an interval 

 of ten or fifteen minutes, pains of a different character follow ; by 

 these the detachment of the placenta is effected, and it is extruded 

 into the vagina. By the voluntary efforts of the woman, assisted by 

 the contraction of the vagina, it is entirely expelled, and the labour 

 is completed. Its expulsion is commonly accompanied by a gush of 

 blood, from which circumstance these pains have been called dolores 

 cruenti. 



The placenta generally enters the vagina inverted, that is, with its 

 foetal face looking outwards, and the bag of membranes is also turned 

 inside out. Especially is this the case, if traction has been employed 

 upon the cord. After the expulsion, the uterus, now emptied of its 

 contents, contracts into a firm hard ball, which can usually be de- 

 tected for some days above the symphysis pubis. In this state of 

 condensation it is about the size of a foetal head. 



PRESENTATIONS AND POSITIONS. 



By the term 'presentation^ we understand that part of the child 

 which offers itself at the superior strait. By position^ the relative 

 situation of the presenting part to some point of the superior strait. 



It will at once be seen that there may be a presentation lor every 

 square inch of the child's body. This, however, would lead to end- 

 less confusion ; hence obstetrical writer? have diminished the num- 

 ber greatly. Some make only ttvo great presentations, viz. : of the 

 head and breech^ looking upon ail others as deviations from one of 

 these. Others include the above with their deviations, viz. : 



