C73 
P A 11 T U 
been long known to pra&itioners, yet Dr. Ofborn is, per¬ 
haps, the firft author who has clearly explained the effi¬ 
cient caufle of this. His remarks are thefe: “ As it (viz. 
the head) delcends obliquely through the pelvis, the 
preflure of the two converging ifchia will not beexaftly 
oppofite to each other on the two parietal bones; but, 
one ifchium afling or preffing on the part of that bone 
contiguous to the occiput, and the other on the oppofite 
fide next to the face, the head being made up of different 
bones, united by membranes, and forming various futures 
and fontanels, which permit the fhape to be changed, 
and the volume to be leffened, it neceffarily follows, that 
the head, thus compreffed, will take a fhape nearly refem- 
bling the cavity through which it pafles; and as, from 
the convergency of the ifchia, the cavity of the pelvis 
fomewhat approaches the form of a cone, the child’s 
head is moulded into that fhape, the fhape of all others 
heft adapted to open the foft parts, and make its way 
through the os externum. This unequal preflure of the 
two ifchia upon the head, will, in the firft inftance, direft 
the occiput, or apex of the cone, to turn under the arch 
of the pubis, where there is little or no refiftance ; while 
the preflure of the other ifchium, in its further defcent, 
will have the fame efteCt on the other fide, and direCl or 
compel the face to turn into the hollow of the facrum.” 
This change of pcfition is productive of three advan¬ 
tages. ift, The largeft part of the head is again adapted 
to the wideft part of the pelvis. 2dly. The fmalleft pof- 
flble furface of the head is applied to the furface of the 
bones of the pubes. 3dly. As Dr. Ofborn, in the pafiage 
quoted, very juftly obferves, the head is moulded into 
that fhape which is beft calculated to pafs, without doing 
harm, through the loft parts. This is the pofition exhi¬ 
bited on Plate II. 
Third Stage. —The ftrength of the pains now in- 
creafes ; but generally there is a longer interval between 
them; and during this the patient fometimes gets a 
few minutes’ deep, and always is refrefhed. After each 
period of quietude, when the pain returns, ftrong pref- 
fure is made to force forwards the head of the child and 
to expand the external orifice : the perinasum is ftretched, 
the anus opens, the anterior part of the reCtum is pufhed 
outwards ; the woman imagines that fhe is going to part 
with a ftool, and, if any faeces are contained in the reCtum, 
they are a&ually expelled. The pain now ceafes, the 
head is retraced, the bag of waters, if ftill entire, be¬ 
comes flaccid, the woman is again at reft. After a while, 
another pain comes on ; it would feem, as if the force 
was fufficient to make the head break down every thing 
that oppofed it; but again the pain abates, and again the 
head is retraded. Thus the patient muft continue to 
fuffer, till the external outlet is diffidently dilated to al¬ 
low the child’s head to pafs. 
During the fecond and third ftages of labour, the pulfe 
will have been gradually increafing in quicknefs and 
force; the fkin grows hot; the face becomes intenfely 
red ; drops of fweat ftand upon the forehead ; and a per- 
fpiration, fometimes profufe, breaks out all over the 
body ; frequent violent tremblings accompany the laft 
pain ; and, at the moment that the head pafles into the 
world, the extremity of differing feems to be beyond 
endurance. 
The head of the child being born, the poor woman ex¬ 
periences a temporary relief from pain : and this is the 
moment to afcertain whether there be any portion of the 
navel-ftring round the neck of the infant; and, if there 
be, it mud be flackened or drawn over the head, other- 
wife the infant will be loft. Time fliould be allowed for 
the accommodation of the fhoulders, and the expulfion 
of the body of the infant; and the utmoft attention 
fhould be paid to fupporting the perinaeum during that 
part of the procefs ; for now the throes return for the 
purpofe of expelling the fhoulders; which is effeded thus: 
When the head pafles into the world, the chin of the foe¬ 
tus refts againft the perinaeum ; but, while the head con- 
Vol. XVIII. No. 1273. 
RITION. 
tinues in this pofition, the fhoulders are in a wrong di¬ 
rection for paffing through the inferior bony aperture; 
for the long diameter of the fhoulders is oppofed to the 
fliort diameter of the pelvis. The firft effect of the pain, 
then, is to turn the chin of the child towards the thigh 
of the mother ; this alters the direction of the fhoulders, 
and firft one and then the other pafles through the ex¬ 
ternal parts; this is often effected by the fame pain, and 
not unfrequently the whole body is at the fame time 
protruded; but fometimes two ar three pains are required 
to accomplifh the entire expulfion. 
The child is now born into the world, and parturition 
may be faid to be accomplifhed ; but, as the management 
of the after-birth is a very important part of natural la¬ 
bour, this is now denominated the 
Fourth Stage. —After the parts are cleaned and 
dried, the patient has a little refpite till the placenta be¬ 
gins to feparate. This procefs was fome time fince, under 
the direction of Dr. Hunter, entrufted wholly to nature ; 
nor was art fuff’ered to interfere, though a day or two 
elapfed before the feparation took place. This was an 
error in many refpeCts. The mind was kept in anxiety; 
for the patient was not completely a mother till reftored 
to her former (late ; nor, till the circulation in the uterus 
was free, was there any probability of the flow taking 
place to the breads. Modern practitioners have, there¬ 
fore, neither hurried on the feparation, nor delayed it 
many hours, fhould not nature complete the bufinefs. It 
is ufually an operation of nature without afliftance ; and, 
after about ten minutes from delivery, pains begin ; the 
cord, if kept tenfe, is elongated, the abdominal tumor 
fubfides into a rounded ball, finking gradually lower, and 
the placenta, with little difficulty, is brought through 
the vagina. If the labour has been long and tedious, or 
the patient previoufly debilitated, the contraction of the 
uterus, which produces the feparation, takes place flowly. 
We muft then wait; and, if in five or fix hours, gently 
pulling in the interval by the cord, it does not advance, 
the hand, guided by the funis, muft be introduced into 
the uterus, and the edges of the placenta feparated 
around. It then foon comes forward, for the centre is 
firft naturally loofe. The cake is diftingui(lied from the 
clots which ufually furround it, by its being in the centre 
of the funis, by its firmer confiftence, and by its convex 
puckered feel. When flooding is violent, the feparation 
nuift be quickly accomplifhed ; and when the contraction 
of the uterus is irregular, reducing its form to that of an 
hour-glafs, the ftriCture muft be ffeadily'dilated ; a work 
of no little difficulty. In general, the feparation fhould 
be left to nature ; but, fhould haemorrhage and convul- 
fions occur; fhould the feparation, notwithftandingevery 
effort, be delayed for more than twelve hours ; the molt 
fteady but determined mode of feparation fliould be 
adopted. 
From what has been faid it will be feen, that natural 
labour requires but little afliftance on the part of the ac¬ 
coucheur. During the whole of the firft ftage, indeed, 
and great part of the fecond, if he attempts to give aflift¬ 
ance, he will do mifchief. The dilatation of the foft 
parts will be eff'eCIed by the natural pains, affifted by the 
bag of waters gradually infinuating itfelf through the 
os uteri and vagina, much more eafily and more fafely 
than by any artificial means that he can employ ; of courfe 
no attempts ought to be made by him to produce artifi¬ 
cial dilatation. 
During the firft and fecond ftages, the patient may be 
allowed to fit, ftand, kneel, or walk about, as her incli¬ 
nation may prompt her; if fatigued, fhe fhould repofe 
occafionally upon the bed, or a couch ; but it is not ex¬ 
pedient, during thefe two ftages, that (lie fhould remain 
very long at a time in a recumbent pofture. She fliould 
be fupplied, from time to time, with mild bland nourifh- 
ment in moderate quantities. Tea, coffee, gruel, barley- 
water, milk and water, broths, See. may fafely be allowed. 
Beer, wine, or fpirits, undiluted or diluted, fhould be 
8 I forbidden ; 
