MIDWIFERY. 
>ng the progress of expulsion the uterus 
contracts around the remaining parts of the 
child, and at the time the placenta only 
remains, the uterus is only sutficiently large 
to contain it. The next effort of the ute- 
rus, therefore, by contracting its internal 
surface, not only assists in pressing out the 
placenta, but becomes the cause of the 
separation ; while the same power, which 
separates the placenta and throws it off, 
prevents the occur rence of any serious he- 
morrhage. This is a most beautiful ilhts- 
tration of the mercy and power, as well as 
wisdom of the Almighty. 
At the commencement of this pi'ocess 
there is almost always a discharge of mucus 
tinged with blood, from the vagina, and 
the blood is sometimes intermixed in consi- 
derable quantity, a fact, however, which is 
of no consequence. Tliere is at this time 
also, very generally an uneasy oppression 
about the prascordia ; and as the pains in- 
crease in violence, vomiting will often arise 
from the extreme distention of the os 
uteri, white the pulse generally augments in 
strength and frequency. At the same time 
the progressive pressure of the child’s head, 
expels almost involuntarily both the urine 
and feces ; while from the vicinity of the 
sciatic nerve, cramp, and paralysis, occasi- 
onally take place from the same cause. 
■ In labours of every kind there are 
many things to be attended to, which, 
tliough seemingly frivolous, are yet of great 
importance, and,- in general, are only ma- 
nageable by practice : first, then, the bed 
should be so made, that the woman may 
lay comfortably both in labour and after 
labour, and that she may lay in the best 
way with regard to our convenience. If 
she be used to a mattress she may lie on one, 
it being the best sort of bed ; but if she be 
afraid of a mattress, she may be allowed to 
lay on a feather bed, first making it as 
nearly as possible a mattress by beating the 
feathers all away to the other side of the 
bed. Upon the feather bed a blanket 
should be laid and a sheet, and upon these 
a common red sheep skin, or instead of it a 
piece of oil-skin or oil-cloth ; over this a 
blanket doubled to four thicknesses; and 
lastly, a sheet upon this four times doubled, 
only lengthwise : this last sheet is to be 
laid across, and secured to the bedstead by 
tapes. When tlie os uteri is so far dilated, 
that in the event of the membranes break- 
ing it would receive the apex of the head, 
the patient should be put to bed, but not 
before : for, with some women who have 
VOL. IV. 
had cliildren, it is astonishing hoW fast the 
os uteri will dilate itself ; it sometimes takes 
place with such prodigious rapidity, that 
there is only time to get tlie woman on the 
bed before the child is born. 
The woman should be undressed before 
getting into bed ; her shift had better be 
tucked up round her ; and, instead of a 
shift below, a petticoat will do much better, 
as it saves the linen. When placed on the 
bed she must lay as near as possible to the 
edge, and in the posture before described. 
Tliis is equally proper in the easiest and 
most difficult labours. The lying-in loom 
should be as airy as possible ; and upon this 
principle it is that the poor people in the 
country get about sooner after lying-in, 
than the same class of inhabitants of this 
metropolis: in the generality ofcottagesitis 
not necessary to be very anxious about tliis 
there are few of them so air tight but that 
they will do without a ventilator. If food 
be proposed during labour, we should gene- 
rally speak rather against than in favour of 
it; for if food betaken, it must be either 
digested or undigested, in either case it is 
productive of mischief; if digested it be- 
comes the fuel of fever ; if it remain un- 
digested, the stomach and bowels are all the 
worse for it ; the proper refreshment is tea 
with dry toast, as this will do no harm. 
The urine should frequently be evacu- 
ated, and the perinaeum supported with 
tlie practitioner’s left hand as soon as the 
child’s head rests upon it. 
The reason why the perinasum needs this 
support, is simply this ; a wmman bears down 
with a force equal to tliree, one of which is 
voluntary; the natural structure of the 
perinmum has enabled it to support, with- 
out danger, the contraction of the uterus • 
it has therefore, of itself, a^tower superior 
to two, whicli is the force of uterine con- 
traction ; but, in consequence of the pati- 
ent’s voluntary efforts being added to the 
involuntary efforts of the uterus, a force 
equal to three is acting against a power 
equal to only two. By pressing against this 
part, we do not say the head shall not come 
out ; we only say it shall not come through 
a hole wliicli is too small to receive it. In 
supporting the perinmum, it may be done 
througli the medium of a folded cloth, 
which is held in the hand upon the peri- 
naeum, and keeps the hand clean from occa- 
sional discharges of meconium or feces, 
waters, &c. and the perineum should not 
be left unsupported till the shoulders are 
born; indeed laceration more frequently 
(7 ? Ik' 
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