350 EUTOCIA. 



827. The accoucheur places himself to the right of the bed; he 

 is there most commodiously situated to touch, to follow the progress 

 of the labor, and support the perineum; all of which may be done 

 under the bed clothes, for it is with the finger or hand, and not with, 

 the eye, that he must here act and ascertain the state of the parts. 

 As the will and the courage of the patient exert a great influence on 

 the progress of parturition, it imports him to know how to direct 

 their powers. We daily meet, in practice, with women who hear 

 down, and endeavor to make the most of their pains, as soon as 

 they become somewhat strong; the old women, the midwife, and 

 sometimes the accoucheur himself encourage them to act in this 

 way, by persuading them that they will be the sooner delivered. 

 Such conduct is extremely blameable, and can only be the fruit of 

 ignorance or want of reflection. Where the os uteri is not dilated, 

 the membranes unbroken, or at least, where the head is not as yet 

 engaged in the superior strait, efforts to hasten the delivery only 

 serve to exhaust the woman to no purpose whatever; until the end 

 of the first stage, the action of the muscles is not solicited, the womb 

 does not demand their aid, and they can be of no use. 



But as soon as the foetus penetrates into the excavation, the os 

 uteri being dilated, and the membranes ruptured, and the sense of 

 weight about the fundament, tenesmus, and strainings are felt, they 

 occasion a desire to bear down, and compel the muscular contrac- 

 tions to come on stronger and stronger in aid of the womb, in pro- 

 portion as the child is nearer the moment of expulsion. The womb 

 now compels the eflTorts to take place, independently of the woman's 

 will; the thing is, to know how to make the best use of them, and 

 there are many women who do not know how to do it — who do not 

 know how to deliver themselves; who, with the expense of a con- 

 siderable degree of power, cause the labor to advance but very little; 

 the accoucheur should teach them their apprenticeship, if I may- 

 use such an expression, should teach them that when the pains are 

 regular, they should not employ their voluntary efli'orts until the con- 

 traction is fairly begun, or until the muscular action is positively- 

 solicited; then, by pressing the pelvis, feet, and hands upon the bed 

 or upon the persons stationed to support them, they should bear down 

 with all their might, as if at the stool; as soon as the womb itself 

 ceases to act, all efl!brt ought to be suspended, and the woman 

 should be strictly directed to rest, and be as still as possible, never 

 losing sight of the fact, that the muscles are not intended to force the 

 foetus downwards, but only to aid and support the contractions of 

 the uterus. 



828. The pains are sometimes so acute, so intolerable, when the 



