MIDWIFERY. 
not a formiJable evil. Tn early examina- 
tion we shall, instead of feeling the month 
of the uterus, come to the neck ot the dis- 
tended bladder ; bnt in the progress of la- 
bour the child’s head presses upon the neck 
of the bladder, which pressure causes the 
suppression. This will never happen i 
the bladder be frequently emptied in the 
early part of labour, because the time e- 
tween the head's being at the upper aper- 
ture of the pelvis, and delivery, is in gene- 
ral of a moderate duration, in which no 
sprious accuimiliition can take place in t le 
bladder, unless the labour is very long. 
When it is necessary to draw off the uiine, 
the catheter will enter the meatus urinarms 
with greater ease if its curve be a little in- 
creased. With regard to a woman in this 
situation, we should never rest satisfied that 
her bladder is not dangerously full, because 
we see a little water which has passed with- 
out the instrument. We must never allow 
the w'oman’s delicacy, or dislike, to prevent 
our examining ; we must represent to her 
the importance of it ; for if she die from a 
burst bladder, it will be a very deplora- 
ble circumstance, as it is so easily pre- 
vented. 
Contraction of the Vagina forms another 
impediment to labour. It this be the con- 
secpience of a cicatrix it will sometimes be 
proper to divide it by a knife, in order to 
allow the child’s head to pass through; when 
we attempt to divide it high up, we are in 
a very delicate situation on account of the 
bladder and rectum f and if the head have 
passed so far forward as to come into view', 
it will be adviseable to leave it to nature. 
Excrescences arising from the os uteri or 
vagina may impede labour, though these 
causes in general only produce slight diffi- 
culty ; the os uteri has been known to be 
in such a state from a tumor on its side, 
’ that only two-thirds of the circle have di- 
lated for the passage of the child’s head. 
In most cases the tumor is pushed aside, so 
that it occupies a protected situation during 
labour, and the head passes very w ell. 
An unfavourable state of the Ofitw may 
protract labour. It is said, that the na- 
vel string may be tied round the neck of the 
child in its passage through ; by which the 
effect of each pain is lost, being held on 
each side bv the string, it is forced a little 
forward iu each pain, retiring again as soon 
as the pain goes off. It does not appear 
likely, however, that this ever happens, 
because the effect attributed to Ihe elasti- 
city of the cord, may be seen in every la- 
bour from the elasticity of the soft parts, 
and more particularly where the head is 
larger than the cavity of the pelvis. So that 
there is no reason to believe this to be 
a cause of difficult labour. Yet we may 
now speak of its treatment, when it doe.s 
occur. The cord is frequently turned round 
the neck of the child when the circulation 
is not in the least interrupted ; iu this case 
we have only to turn it off the neck, and 
if the circulation be felt, leave it. Where 
the loop round the neck is tight, so as to 
interrupt the pulse, we may loosen it by 
passing the finger between it and the skin 
of the neck, so as to feel the pulse again. 
It has been said to be sometimes so tight 
as not to admit of its being slackened at 
all. This is just possible, and the most im- 
probable thing in the world. It is then to 
be divided between two ligatures. 
Rigidity of the Membranes has been stated 
to produce difficult labour. It has been 
observed, labour was quicker when the 
membranes were ruptured early; but though 
the labour is slower, it is safer where the 
membranes are unruptured. Where the 
membranes are to be opened, there have 
been a great number of pretty looking in- 
struments invented for doing it. Long 
tubes, at the end of which blades or points 
were projected. But it requires more skill 
in telling where they should be let alone, 
than w’here they should be meddled with. 
With the first child they must never be 
broken : the inferior parts of the passage 
dilate but slowly, and require the assi.stance 
which the membranes are capable of giving. 
But in subsequent labours, perhaps, it may 
be admissible, where the pelvis and soft 
parts are known to be capacious and yield- 
ing. The time when they should be broken 
is when the head may be received into the 
os uteri upon their breaking. Never must 
they be broken before the os uteri is of the 
proper size ; if they be, we cause a conti- 
nual drivelling of the waters, which in itself 
is productive of great delay. It will often 
protract the labour two days: it has been 
known to protract it three weeks. 
A frequent cause of the Rupture of the 
Membranes is the using too violent exercise 
fo)- the parts to bear. The riding in a coach 
over the rough stones will bring it on, as 
the weaker part will always give way first. 
Another cause of the membranes giving 
way may be the death of the child, for dead 
members w ill give way when a living mem- 
ber will uot give way. 
The next cause of difficult labour is iu the 
