CONDUCT OF A LABOUR. 65 



needlessly repeated ;) first, whether she be really pregnant ; second- 

 ly, if she be in labour; thirdly, whether the membranes have 

 ruptured or not ; fourthly, the nature of the presentation; fifthly, 

 the stage and progress of the labour ; sixthly, the state of the os 

 uteri, vagina, and perineum ; he is also to take the opportunity of 

 estimating the capacity of the pelvis, and other circumstances which 

 may influence the duration of the labour. (Fig. 17.) 



It is scarcely necessary to repeat this examination during the first 

 stage, if all is right ; but in the second, it should be regulated by 

 the rapidity of the advance, and when once the head has reached 

 the perineum, the finger should be kept upon the head during each 

 pain, so as to regulate the amount of support for the perineum. The 

 finger ought always to be introduced during a pain, but the exami- 

 nation should also extend to the interval. 



During the first stage, the patient need not be confined to the bed, 

 but may be allowed to sit up, or even to walk about, if she desire it. 

 Neither is it incumbent upon the medical attendant to remain in the 

 lying-in room during the first stage ; his presence may be a restraint 

 upon the patient. 



The condition of the bowels should always be early attended to, 

 and if they have not been acted upon lately, should be unloaded 

 either by an enema, or an aperient. The bladder should also be 

 emptied, either spontaneously, or by the catheter. The diet of the 

 patient, when the first stage is protracted, should be of a light, un- 

 stimulating character; the object being to sustain nature while under 

 a severe effort, at the same time that we carefully avoid calling that 

 effort in the direction of the dicrestive organs. 



There should always be in readiness several strong ligatures 

 for the cord, a pair of sharp scissors, some strong pins, and a 

 " binder," or broad bandage, for the female. It is likewise the duty 

 of the accoucheur to see that the bed is properly prepared for the 

 patient. This is best done by spreading a piece of oiled cloth upon 

 the mattress to protect it at the point the patient is about to occupy ; 

 over this may be placed several blankets or ooverlets, folded square, 

 to receive the discharges, &c. These latter can be easily removed 

 after the labour is completed, without disturbing the patient, leaving 

 the bed-linen beneath unsoiled. 



The second stage is often announced by the rupture of the mem- 

 branes. As soon as this occurs the patient should retire to her bed, 

 and the practitioner make an examination, in order to determine 

 more accurately the position, and inform himself of the advance of 

 the head. 



In this country and in England, it is usual to place the woman 

 upon her lefi; side, with her hips close to the edge of the bed, and 

 her knees drawn up towards the abdomen. This position enables the 

 practitioner to use his right hand with advantage, and is also sup- 



