MIDWIFE* Y. 



247 



Of Parturl- ing; but although a tew pains may distend the peri- 



tion. ncum, it may yet be some hours before this takes 



'*~~<~* m/ place, the pains for all that time appearing to produce 



little effect, although the pelvis be well formed. 



!d the perineum become stretched, and the anus 



be carried forward a little during the pain, we may 



expect that delivery is at hand. If the patient have 



already born children, the child is sometimes delivered 



within a few minutes after the perineum is first felt 



to become full. 



It is immaterial in what posture the patient place 

 herself during the first stage of labour ; but in the se- 

 cond stage, when delivery is approaching, it is pro- 

 per that she be placed on her side, and it is usual for 

 her to lie on the left side, as this enables the practi- 

 tioner to use his right hand The knees are a little 

 drawn up, and generally at this time kept separate by 

 means of a small pillow placed between them. Many 

 women with to have their feet supported, or pr*sed 

 against by an assistant, and it is customary to give her 

 towel to grasp in her hand. This is either held by 

 the nurse, or fastened to the bed-post. We must 

 however be careful that these contrivances do not en- 

 courage the woman to make too strong efforts to bear 

 down. When the patient ii i n 1*<I. it it proper to 

 have a soft warm cloth applied to the external parts, 

 in order to absorb any mucus or water that may be 

 discharged and this is to be removed when it is wet. 

 Attempts to dilate the os uteri or the vagina in natu- 

 ral labour, and the application of unctuous substance* 

 to lubricate the parts, are now very properly abandon- 

 ed by well-instructed practitioners. Tne membrane* 

 ought generally to be allowed to burst by the efforts 

 of the uterus alone, for this is the regular course of 

 nature, and a premature evacuation of the water either 

 disorders the process and retards the labour, or, if it 

 accelerate the labour, it renders it more painful. We 

 cannot, however, go the length of some, who say, 

 that the artificial evacuation of the water is always 

 hurtful ; for there are circumstances in which it may 

 be allowable and beneficial. 



Examination ought, in the first stage of labour, to 

 be practised seldom ; but, in the second stagr, w< 

 have recourse to it more frequently ; and when the 

 pains are becoming stronger, and the head advancing, 

 we mutt not leave the bedside. 



A* the fxces are generally passed at this time in- 

 voluntarily, a soft cloth is to be laid on the perineum ; 

 and when the second stage of labour is drawing t<> n 

 conclusion, the hand it to be placed on this, in order 

 to prevent the rapid delivery of the bead, and the con- 

 sequent laceration of the perineum '['hit is a point 

 of very great importance, and which require* to be 

 carefully considered by the practitioner. 



The last advice to be given respecting this stage of 

 labour is, that at we retard rather than encoura. 

 expulsion of the head, so we are not to accelerati- the 

 delivery of the body. 



The child being born, a ligature is to be applied 

 on the cord very near the navel, and another about 



nches nearer the placenta. It is then to !>e < 

 betwixt them, and the child removed I i.c h.u.d i. 

 next to be placed on the belly, to ascertain that there 

 be not a second child, and the finger may, for the same 

 piirjxne, be slid gently along the n.r in the os uteri. 

 i a*ii*taiit lintilil )> ..|.|,l,.il nn the ab- 

 domen, and gently prc-w.i ,, the uit-ruv winch may 

 exrile it to action, and prrvmt torpor. It the pla- 

 centa be not expelJed soon, the uterine region may be 



7 



rubbed with the hand, to excite the contraction of the Of Parturi- 

 womb. Immediately after the expulsion of the child, ^ 



there is often a copious evacuation of water, which is *"Y~" 

 sometimes mistaken by the woman for a discharge of 

 blood. But hemorrhage never takes place so instanta- 

 neously, in such quantity. It is generally a minute or 

 two, sometimes much longer, before flooding come on. 

 Against the occurrence of this, we are to be on our 

 guard. 



Soon after the birth of the child, the placenta is ex- 

 pelled, and this process is accompanied by trifling dis- 

 charge of blood, and a little pain. However, it some- 

 times happens that it is retained, and the retention 

 may or may not be complicated with Hooding. 1 1' 

 it be, all are agreed on the propriety of introducing 

 the hand first to excite the uterus, and then to extract 

 the placenta. But if there be no flooding, many, from 

 a fanciful conceit of the powers of nature, are for do- 

 ing nothing. It is warrantable and proper to extract 

 it entirely at* the end of an hour, if it be still re- 

 tained. 



In every instance, but more particularly of tedi- 

 ous labour, and in those cases where there has been 

 the smallest indication of irregular or spasmodic ac- 

 tion of the womb, it is indispensable that we repeated- 

 ly ascertain that no hemorrhage has taken place ; and 

 this ought not to be neglected, even after the placenta 

 has been naturally expelled. W lift her the placenta be 

 retained or thrown off, the treatment is the same, 

 namely, to excite the regular contraction of the ute- 

 rine fibres. This is without loss of time to be done, by 

 introducing the hand into the uterus, when, in almost 

 every instance, it will be found that a circular or 

 spasmodic contraction has taken place. This is to be 

 gently dilated with the hand, which is to be moved 

 constantly or pressed lightly against the interior sur- 

 face, so as to excite universal action ; nor is it to be 

 withdrawn till that be accomplished. If the placenta 

 be still retained, it is to be carefully brought down 

 through the contraction into the inferior part of the 

 womb, when it may be left so long as the spasm re- 

 mains. Pressing on the abdomen, particularly over 

 the uterus, and gentle grasping of the womb, though 

 the abdominal position tends to excite action, whilst 

 the exhibition of a full dose of laudanum contributes 

 to allay the spasm. The strength is in the mean time 

 to be supported by stimulants ; and when the att.ick 

 has been severe, by the sedulous use of light nourish- 

 ment. We must not, however, carry the cordial plan 

 too far, as there is in such cases a propensity to inflam- 

 mation of the womb afterwards. 



CHAP. III. 

 Of Premature Labour. 



WHEN labour is established, it it to l>e conducted or prnai. 

 much in the same way with parturition at the full ture labour. 

 time ; but the following observations will not be im- 

 proper. I lie patient must avoid much motion, levt 

 hemorrhage be excited. Frequent examination and 

 every irritation are hurtful, by n t irdin^ the process, 

 and tending to produce spasmodic contraction. If 

 thu contraction take place, marked by paroxysms of 

 pain, referred to the belly or pubis, little or no effect 

 pro- lured on the os utt-ri, a full dose of tincture 

 ol opum should be given, after the administration of 

 a clyster. Severe p. mi-, with premature efforts to l>ear 

 down, and a rigid tati- of the os uteri, require vene- 

 section, and afterwards an opiate. The delivery ot' 



