672 
PARTURITION. 
differs very materially in its nature and in its influence 
on the uterus. Paroxyfms of intc.Jlinal 'pain, or fuch as 
are termed falfe or fpurious pains, may be diftinguiftied 
from genuine labour-pains, by being unconnefited with 
uterine contraction ; by attacking different parts of the 
abdomen ; and liy recurring irregularly. Thefe pains 
ufually originate in fome fource of inteftinal irritation, 
and may almoft always be removed by emptying the 
bowels, and fubfequently exhibiting an opiate. They 
can hardly be confounded with enteritis by an obfervant 
praCtitioner, The uterine pains are either dilating or ex- 
pulfive. Dilating; pains, or, as they are popularly termed, 
grinding pains, refult from uterine contraction. They 
are principally confined to the back, and occur in the 
earlieft ftage of labour, and are often peculiarly diftrefling 
to the patient, who expreffes her fuffering by reftlefinefs, 
defpondency, and moaning. They often continue a long 
time without the intermiflions being free from uneafinefs, 
and.appear almoft exclufively to dilate the os uteri, hav¬ 
ing little or no influence over the fundus of the uterus. 
It is during the exigence of thefe dilating pains that 
rigors moft commonly occur, and may be relieved by 
avoiding fpiced or fermented fluids, and by giving any 
Ample warm diluents. When the mouth of the womb is 
confiderably dilated, expuljive pains, fometimes termed 
forcing or bearing-down pains, commence on the loins, 
and gradually proceed round the abdomen, till they meet 
at the region of the pubes, and dart down the labia pu- 
dendi and thighs. 
Vomiting is a common attendant on uterine pain, and 
is beneficial by rejecting food, which from its quantity or 
quality may be a fource of inconvenience to the ftomach. 
It principally occurs during the dilating pains, and un- 
queftionably a (Tilts in the relaxation and dilatation of the 
os uteri. 
Belides thefe attendants on parturition, the pulfe 
ufually becomes quickened and full; the countenance 
florid; the whole furface of the body covered with pro- 
fufe perfpiration ; and the lower extremities cramped. 
The premonitory fymptoms having continued for an 
indefinite time, pains in the loins darting through the 
pelvis, with an appearance of Jhoiu, indicate the approach 
of lefs unequivocal evidences of the commencement of 
parturition. For fome time thefe pains are of the dila¬ 
ting kind ; and, on an examination per vaginam, will be 
found rather to be diminifhing the thicknefs of the cer¬ 
vix uteri than to be opening the mouth of the womb. 
When the cervix uteri becomes reduced to the thicknefs 
of the other parts of that organ, it begins to open ; and, 
as foon as it can admit the extrufion of any portion of 
the membranes diftended with liquor amnii, the pains 
become rather of the expuljive character, and there will 
be a fenfible bearing-down of the whole uterine tumour. 
Succelfive paroxyfms of pain dilate the os uteri more and 
more, whilft the protruded membranes, diftended like a 
tenfe bladder, fill up the opening, and perform the office 
of an inimitable wedge, till the uterus and vagina form 
one continuous paffage. 
When the wedge begins to aft, the grinding or cutting 
pains diminifli, and, as a larger quantity of the waters in- 
creafes the bulk of the protruding bag or wedge, the 
bearing-pains begin to be felt; and, in proportion as the 
pains grow ftronger, there is a greater freedom from un¬ 
eafinefs during the intermiflions; commonly too the pains 
are rather longerapart. The irritable ftate of the os uteri, 
during the firft ftage of labour, very often produces, from 
fympathy, thofe (hiverings and vomitings already fpoken 
of; and, when the cutting-pains are very frequent and fe- 
vere, defpondency and lownefs of fpirits generally pre¬ 
vail. 
The firft ftage of labour may be confidered as termi¬ 
nated, when the os uteri is dilated to the full extent of 
two inches in diameter, provided that the head of the 
faius has defcended fo much as to occupy the fuperior 
aperture or brim of the pelvis. This is the pofition 
which is fliown on the annexed Plate I. where A, A, A, 
denote the left fide of the vagina, relaxed by labour, 
and diftended in fome meafure by the defcending 
child. B, B, the left labium pudendi. C, the cut fur- 
face of the integuments of the abdomen. D, the nymphre. 
E, the clitoris. F, the urethra. G, the meatus urina- 
rius. H, the bladder pulhed forwards by the uterus. 
I, the os pubis. K, the redtum. L, the anus. M, the 
left thigh. N, the external furface of the uterus. P, P, 
the cut edge of the coats of the uterus. Q, the divided 
edges of the os uteri. R, R, R, the inteftines. S,S,S,the 
canal containing the medulla fpinalis. T, the perineum. 
b, h, b, os coccygis. c, c, c, facrum. d, d, d, lumbar ver¬ 
tebrae. 
Second Stage. —When the firft ftage of labour has 
terminated favourably, the fecond feldom offers much 
difficulty or delay ; the pains become move forcing, and 
of longer duration, and a new power is called in, to afiift 
in propelling the child through the pelvis. This afliftance 
is afforded by the diaphragm and abdominal mufcles, 
which are brought into aCtion during the pains. 
It is no uncommon thing, during the earlier period of 
the labour, to hear the poor patient advifed by hernurfe 
and female friends to afiift herfelfand bear down with all 
her might; and the chidings that (lie undergoes, for not 
making her pains ufeful, tend greatly to produce difmay 
and deprefiion of fpirits ; whenever the accoucheur ob- 
ferves this, he fliould endeavour to reprefs fuch abfurd 
and improper behaviour. The fail is, that, during the 
firft ftage of labour, the voluntary efforts of the patient 
are neither called for, nor can be beneficial. They may 
exhauft her ftrength, but cannot advance the labour. 
The aCtion of the diaphragm and abdominal mufcles is 
almoft, if not altogether, ufelefs, till the os uteri is getting 
well dilated ; then, indeed, it becomes a powerful auxili¬ 
ary in producing greater dilatation, and in propelling the 
child through the pelvis. 
But now the woman cannot withhold her exertions ; it 
is no longer a matter of choice, but of neceffity ; (he is 
compelled to drive in forwarding the birth ; (lie eagerly 
grafps in her hands udiatever is within her reach, and 
endeavours to fix her feet againft fome firm body ; (lie 
holds in her breath, and bears down, with all her force. 
By thefe powers united, file is enabled to get through the 
fecond ftage of labour, which maybe confidered as finiflied, 
as foon as the os uteri is fully dilated, and the head of the 
foetus is fo placed as for the forehead to occupy the hol¬ 
low of the facrum. A violent draining to vomit occa- 
fionally accompanies the pain, which completely dilates 
the os uteri. 
Sometimes, however, the fecond ftage of labour takes 
up a longer time, depending, perhaps, upon the want of 
a due proportion between the pelvic cavity and the fcetal 
head. And delay is fometimes occafioned by the prema¬ 
ture rupture of the membranes, and the difcharge of the 
liquor amnii. Whether this arifes fpontaneoufiy, acci¬ 
dentally, or by defign, it has the effeCt of interrupting 
the progrefs of the labour; for the dilating power fo adr 
mirably poflefled by the foft, lleady, equable, preflure of 
the bag of waiters, is now removed, and the dilatation 
muft be effected by the head of the child (lowly moulded 
into a conical ftiape ; the liardnefs and inequalities of 
which little adapt it for fuch a purpofe. If the Jhow has 
not already appeared, it will be difcovered during this 
ftage, and may be confidered as a very favourable occur¬ 
rence; for the difcharge of this intermixture of blood 
and glairy matter tends very much to produce relaxation 
in the foft parts of the mother. 
In the progrefs of this fecond ftage, the phenomenon 
which peculiarly ftrikes us, is that change in the pofition 
of the head, by which the face is turned into the hollow 
of the facrum. Although the advantage, and even ne- 
cefiity, of this change in the pofition of the head,, has 
been 
