MIDWIFERY. 
to provoke contraction of the uterus ; when 
stimuli are given, it is not recollected that 
they jirodtice fever. Opiates are not quite 
so exceptionable ; they save time to the 
practitioner, but in their effects we. cannot 
govern them, else they occasionally save 
the woman’s strength. 
Another cause of difficult labour is the 
irregular contraction of the fibres of the 
uterus ; where the longitudinal set, and the 
circular set, do not contract as they should 
do relatively to each other. This alway 
arises from irritation of the os uteri, in 
needless examinations. The patient has 
strong labour pains without the delivery 
being forwarded. We may here recom- 
mend a dose of opium ; after which it is 
probable, that, upon their action recom- 
mencing, it will be in tlie natural man- 
ner. 
Passions of the Mind are the next set of 
causes of difficult labour. The effect of 
them is to diminish the strength and fre- 
quency of the pains, till they at last sub- 
side altogether j and this will all occur in 
constitutions where the powers of action 
were originally very good. These things 
shew the necessity of keeping up the hopes 
of the patient to the pitch of security and 
confidence, for from the moment that her 
confidence fails her, from that moment the 
pains are protracted, and that merely from 
the state of doubt and arising anxiety. This 
points out the necessity of never forming 
a prognosis of duration ; we may form, and 
declare our opinion as to the event, but 
never the length of time which the labour 
shall last ; for if we were to speak the. 
truth, our prognosis would be in general 
very unsatisfactory. If we only tell a pa- 
tient it will be to-morrow before the child is 
born, it will depress her resolution, and 
damp her perseverance ; the pains will di- 
minish, and she will be all the worse for 
what has been said. 
The os uteri may also become a cause of 
difficult labour by its being rigid. This 
state is natural to some women, and espe- 
cially those who are somewhat advanced in 
life when they begin to bear ; also with the 
first child the parts dilate more slowly than 
in subsequent labours. Rigidity may arise 
from repeated and useless examinations ; 
and where the os uteri is rigid, it forms one 
of the most jKvinful labours, accompanied 
witli excruciating pains in the back. This 
state is attended with inclination to vomit 
and to sleep, both which things are in 
themselves useful ; for sleep restores the 
strength of the body, while the vomiting 
strengthens the bearing down. 
The os uteri, when in this rigid state, re- 
sembles inflammation, in being tender to 
the touch ; its hardness almost reminds us 
of a board, which is bored through the 
middle with an auger. This is one of two 
kinds of rigid os uteri, the other description 
of which gives a vei-y different feel : it is more 
apt to give way under the finger, is of a 
pulpy substance, and in some measure re- 
rembles the intestine of an animal filled with 
water and drawn into a circle; and though 
this is not so rigid to the finger as the other, 
yet it is longer in giving way. This sort of 
swelling, or thickening, is sometimes occa- 
sioned by oedema, or ecchymosis, as it has 
been known to arise in a quarter of an 
hour ; at the same time it lies between the 
os pubis and the child’s head. It generally 
happens, that from the pain there is a de- 
gree of fever present. But when once one 
part of the enlarged circle retires behind 
the head, the whole of it slips up, and the 
child is sometimes born in five minutes if 
there be no resistance from the soft parts. 
We must here be very cautious not to 
allow the woman to exhaust herself in fi uit- 
less efforts ; for which reason we should ex- 
plain to her that it will be of no avail that 
the mouth of the womb is not large enough 
to admit of the child’s pa-ssing, and that^it 
must be a work of time, and will be. a work 
of tune, notwithstanding all the endeavours 
she may make to shorten it. We should, in 
the meanwhile, fill up our time and keep 
up her attention by ordering an injection, 
01- making some other preparation ; and if 
the last be a si.x or eight ounce mixture, 
in case the os uteri is very iiritable, and by 
frequent examination has been rendered 
more so by being deprived of its mucus, 
twenty drops of laudanum may be added to 
the mixture. 
Ill difficult labours it will now and then 
happen that the vagina is very rigid, making 
considerable resistance ; this very generally 
depends on irritation, by the interference 
of the midwife. The consequence is, that 
inflammation of the periostemii and mem- 
branes covering the bones very often arises. 
In such cases, patience and horizontal pos- 
ture are both grand remedies : besides 
which, why not iiije" fomentations, as in 
whitlow, or any other case vvheio rela.xation 
is wanted. 
The next cause that impedes labour 
from resistance of the soft parts, is a full 
bladder and suppression of urine. This is 
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