MANAGEMENT OF LABOR. 349 . 



permit. Again, she should be persuaded to lie down early if her 

 pelvis be a very large one, and the membranes do not give way, 

 though the os uteri be dilated, when the labor progresses too rapidly, 

 and when there is a threatening prospect of hemorrhage, or when 

 there is an obliquity of the womb. Women affected with curva- 

 ture of the spine, asthma, hydrothorax, ascites, or some other ab- 

 normal disposition, are sometimes constrained not to lie down at all, 

 and are oWiged to be delivered while standing up, or seated, or on 

 their knees, (fee, while there are others wl^o could not leave their 

 beds before the termination of the labor without difficulty. But 

 these are cases of exceptions Avhich do not belong to the class of 

 eutocia. 



826. When the woman is on the bed, she should, during the pains, 

 be on her back with the legs and thighs half flexed, and the feet 

 resting on the mattrass or sacking. This posture, which is so natural 

 that women assume it of their own accord, and if they have changed 

 it for a moment, always return to it as soon as the pain returns, is 

 particularly necessary where the womb is strongly inclined forwards. 

 But in the intervals of the contractions it would be as ridiculous as 

 it would be cruel to exact any determinate attitude; the woman 

 ought then to be left free to choose a position that is most agree- 

 able to herself, on either side; a being, when suffering unavoidable 

 pain, at least hopes by changing*its situation and trying various 

 positions, for some alleviation of its distress; to deprive it of such 

 a resource, would be a real act of barbarity. Moreover, the atti- 

 tude on the back is very rarely necessary except in cases of very 

 decided obliquity. Most of the English and American women lie 

 on the left side, with the breech near the right edge of their com- 

 mon bed, which is properly prepared, the legs and thighs flexed, the 

 knees separated by pillows or cushions, and nol\%ithstanding; we do 

 not find that childbirth is much more dangerous in England than in 

 France. However, it is evident that such an attitude must be very 

 uncomfortable and unfavorable to the muscular contractions that 

 occur during the pains. The British accoucheurs who recommend 

 it, think it admits of their supporting the perineum more effectually, 

 of employing the touch more freely, and, which I cannot understand, 

 of operating more readily with the forceps, the hand, or any instru- 

 ment whatever; but when we remember to what extent the modesty 

 of the English ladies is carried, and reflect on their extreme delicacy, 

 and the reserved character of their manners and customs, we are 

 rather led to think that the lateral position, which prevents them 

 from looking the accoucheur in the face, has been chosen to gratify 

 and save them from unpleasant feelings. 

 31 



