MIDWIFERY. 
happens while the shoulders are passing, 
than when the head is. The great art is, 
to give support close to the edge, against 
which the greatest force is acting, for the 
parts give tvay first at the edge. The peri- 
naeum is to be supported front the time 
that it is stretched by the pressure of the 
head, and we must take care that we apply 
sufficient force to counteract the voluntary 
efforts of the patient. 
As soon as the child is born, breathes 
and cries, we should tie the navel string. 
To do this, about ten threads must be joined 
in the ligature ; the first made about two 
inches from the body, and the second, the 
same distance from that again, or towards 
the placenta. The division is- made be- 
tween the two ligatures, the second being 
only intended to prevent the blood escap- 
ing from the divided cord, and staining the 
bed. The next step to the separation of 
the child is the placing dry clothes under 
the patient, and to the perinajum. Mid- 
wives apply them warm; this should only 
be done in winter, for warmth increases 
the discharge from the uterus. We should 
then lay the hand on the abdomen to ascer- 
tain whether there is another child in the 
uterus ; being satisfied of that, we are to 
proceed to the extraction of the pla- 
centa. 
The uterus contracts after the birth of 
the child, so as to contain only this sub- 
stance ; and its contractions being conti- 
nued, the surface naturally must first loosen 
and then separate itself from that of the 
placenta ; and the sante contraction which 
separates, expels it. It is generally neces- 
sary to pass the fingers up upon the cord 
which is held in the other hand, and if we 
be able to feel the root of the placenta, the 
separation is complete, and we have only 
to get it gently out from the os uteri. If 
the root of the placenta cannot be felt, it is 
dangerous to pull the cord with any degree 
offoice; it is still attached to the uterus, 
and may produce inversion of the womb. 
When, by gently drawing the cord, we 
have, got the placenta and membranes down 
to the os externum, we should have a ba- 
son ready to slip it under the bed clothes ; 
and in drawing the placenta ortt, the clean- 
est way to bring the membranes with if, is 
to turn it round, by which means, after a 
few turns, we separate them neatly; after 
which it will be convenient not only to lay 
under the patient the end of the folded 
sheet which bung over tlie bed side, but 
also to make some degree of pressure upon 
the abdomen by bandage ; after which she 
may be entrusted to the care of the nurse. 
DIFFICULT LABOUR. 
Of difficult labour there are three spe- 
cies ; First, those labours which, though 
protracted, are ultimately accomplished by 
the powers of nature unassisted by art. Se- 
condly, those which, although requiring the 
assistance of art, yet are compatible with 
tlie life both of the mother and the child. 
Thirdly, those which, besides being accom- 
plished by artificial means, require that 
either the life of the child must give way 
to save the parent, or that of the parent to 
preserve the child. 
The first source of difficulty is weakness. 
We know that labour requires a certain 
quantity of force or power, therefore labour 
is more likely to be difficult in weak than in 
strong women. We have many proofs to the 
contrary ; but, generally speaking, it is so. 
Fatness is another predisposing cause of 
difficult labour: fatness offers resistance, 
and generally occurs in women of weak con- 
stitutions ; so that here we have both resis- 
tance and want of power. AH asthmatic and 
pulmonary complaints generally will cause 
difficult labour. We know that to assist 
the contractions of the uterus it is necessa- 
ry to take and keep a full inspiration ; and 
where the chest is not equal to the task im- 
posed upon it, the labour will be more pro- 
bably protracted. 
Deformity of Body, attended with consti- 
tutional weakues.s, will generally produce 
difficulty in labour ; it is most likely that in 
these cases the pelvis is not formed as it 
should be, pai taking of the state in which 
most of the other bones are. If a woman 
be too young, the pelvis will not be per- 
fectly formed ; and if too old, the parts will 
be rigid. The best time for a woman to 
commence child-bearing is between the 
ages of eighteen and twenty-five. For 
though a woman may be in perfect health 
at thirty-six, yet we know that the parts 
were designed to be used at eighteen ; and 
have been inactive for the rest of the time, 
and cannot then be so fit to act. 
The next kind of difficulty in regard to 
labour is Debility of theUterus, not disposing 
it to contract. This may happen in a wo- 
man otherwise strong, as a man may have 
a weak arm, while the rest of his body may 
be strong. Such a woman may have no 
character of weakness about her but this, 
so that we may not be able very readily to 
guess at the cause when it exists. It is not 
proper to give stimulants and opiates here, 
