M I D W I F E R Y. 



251 



i- at once render it dilatable and soft. In this de*irable 

 state of the mouth of the womb, if its aperture be equal 

 *" to half-a-crown, the membranes may be ruptured with 

 advantage it' they have not already given way ; and the 

 principle on which this advice is given has been ex- 

 plained above. On the other hand, when the cs uteri 

 is rigid, the membranes ought to b. ! cmiiv un- 



til relaxation take place. Opening them is also im- 

 proper, if the os uteri be vry irritable. The writer 

 M well aware that these directions may i"' i: 1 -repre- 

 sented, and, perhaps, by some ignorant pe< 

 derstood, and supposed to encourage r i irri- 



tation, and improper interference with natural labour. 

 He is little accustn :>ceal hU senti.nents, from 



the whh totcrcen responsibility ;ai ,' that these 



opinions are of great importn; Cement of 



tedious labour, he deems it a duty to support and 

 recommend them. When the pain* are deficient from 

 debility, excited by previous fatigue, it is generally pro- 

 per to procure a suspension by an opiate, more especial- 

 ly it' the water have been discharged. In state of fa- 

 tigue, when we wish to procure rest, or when the os 

 uteri reni . and, in a vhere 



we dare not use the lancet * ith safety, a full dose 

 to be given, and it it mo*t sat > tercd M . 



iff. On the other hand, wl. 



Use pains rather than to suspend them, a small dose, 20 

 or 25 drops for instance, may be given, and often has 

 the effect of re : >c action ' It is useful 



previously to leam, if we can, how the medicine agrees 

 with the patient. The strength is to be support 

 light and mild nourishment, and sometimes z 

 wine. 



Irregular action of the uterine fibres is another cause 

 of tedious labour, and which, amongst other sources, very 

 often arises from the spontaneous discharge of the 

 urnnii before, or in the commencement of labour, 

 pain* produce little effect, and, when thejr go of, leare 

 behind them a distressing uneasiness in the back. A 

 saline clyster, and preasing up the head of the child gea- 

 ring a pain, to procure the more perfect evuc-., 

 of the liquor amnii, are useful lilo. 

 the o* uteri be rigid or tumid, which i* often t'le case, 

 especially if the water* have been prematurely discharg- 

 ed. If these means foil, or have not been proper, a* for 

 instance in consequence of previous debility, an ano- 

 dyne dyster, or opium suppository, is of benefit. 1 f 

 this state should exist, without evacuation of the water, 

 it i* useful, if the o* uteri be sofi, thin, an 

 ably dilated, to rupture the membrane*. In all these 

 case*, the advice already given, not to allow the o* uteri 

 to remain too long undilated, ought to be acted on. Af- 

 ter a time the child is expelled, but spasmodic contrac- 

 tion and hemorrhage are apt to follow, When labour 

 is rendered tedious, by the accession of fever, or local 

 inflammation, the lancet and cool air, with a laxative 

 clyster, arc the m mean* of relief, whilst 



timely recourse should be had to the forcep* if neces- 

 sary. 



Order Second. 



When there exists a disproportion between the sue 

 at" the child and the capacity of the pelvis, labour must 

 be more or less tedious and severe. In such cases, our 

 i ought to be .j the regulation of the 



. evacuation of the urine, the preservation of 

 strength, particularly by avoiding all unnecessary ex- 

 ertion, the procuring of sleep, and a respite from suf- 

 fering, if that can be s*fely done by an opiate, tod, 



above all, to the prevention of dangerous exhaustion, Of Pariurl. 

 by not ptrnsitting the first stage of labour, or the com- t tion - 

 plete dilatation of the os uteri to be too long protracted, W "Y"^"' 

 and afterwards having timely recourse to artificial de- 

 livery. 



THAP. VI. 

 Of Instrumental Labour. 

 Order First. 



When the head of the child, and the cavity of the Of intiru- 

 pelvis, do not bear a just proportion to each other, the mental la- 

 resittance to the passage of the head may be so great as bour ' 

 to prevent the safe delivery of the child. The increas- 

 ed obstacle cither for a time cheeks the full expulsive 

 action of the womb, and ultimately unfits it for accom- 

 plishing its purpose, or affords such resistance as not to 

 be safely overcome by the most severe efforts which are 

 ultimately excited. It is, however, a great error to sup- 

 pose, that this is the only case requiring the aid of in- 

 struments; for the resistance afforded by the soft parts, 

 .irioua other causes influencing the action of the 

 uterus, and producing tedious labour, may render them 

 necessary. Many females require the forceps fur the 

 delivery of their first child, who afterward* are naturally 

 red both with facility and celerity. These two 

 cases have been noticed by practical writers under the 

 distinction of impact ion and arrest, the first being gup- 

 posed, and justly, to require more prompt interference 

 than the second. It i* however much to be fear- 

 til, that, in both there is an undue backwardness to in- 

 terfere, and an overwcaning confidence placed in the 

 power* of nature. It is indeed true, that, in many of 

 these cases, the child may be at last expelled without 

 artificial aid ; but in no small proportion of instances . 

 there is good ground to fear that it shall be still born, 

 and that the mother shall sink from hemorrhage or ex- 

 >n, or have fatal inflammation excited. The d:ui- 

 ijer in protracted labour is greater to the child than 

 ther ; that is, the hes sooner than the 



other. From the table* of Dr. Breen, exhibiting the 

 result of the practice in the Dublin lying-in hospital, it 

 appear* that, out of I<X> women who hud tedious la- 

 bour of their first child, but were delivered by the ef- 

 forts of nati >re dead children; that is, thrce- 

 ti-ntiis of the children were lost. If we come to parti- 

 cular*, we find, that when the labour lasted from 30 to 

 40 hour*, rather more than one-fifth of the children 

 was lost, and 1 woman in 34 died. Whc n it lasted 

 from 40 to 60 hour*, three-tenth* of the children 

 were lost, and one woman in 15. When it continued 

 from 5O to (JO hours, 1 woman in 1 1 died, and not quite 

 one-third of the children were still born. It is impos- 

 sible to form a comparison of these results with those 

 instruments were employed, because they were 

 always delayed long, or, when employed early, were re- 

 sorted to under dangerous circumstances. In little more 

 than half a century ,780,001 women were delivered in the 

 Dublin hospital, and at an average 1 child in 18 was 

 still born. The death among women was a* 1 to 92. 

 It is impossible to draw all the important conclusions 

 here which might be done from thc.-c documents ; but 

 the following facts cannot fail to strike the reader. In 

 women who were between 30 and 40 hour* in labour 

 of their first child, and delivered without aid, 1 woman 

 in 34, instead of 92, the average of the whole, died ; and 

 1 child in 5, instead of 18. If the woman have previ- 

 ously born children, protracted labour becomes more 

 dangerous, as it must generally hare arisen from the 



