A healthy and natural birth usually takes place after the fifteenth day of the ninth month of pregnancy. It may be delayed until the end of the month, but is seldom so protracted. Shortly before labor is to commence, the belly sinks, and the hitherto snug-fitting dress will become loose. This is caused by the descent of the womb into the bottom of the belly. The motions and weight of the child are also felt to be lower than usual, and if in a natural position, the head will fall down to the orifice of the womb, Labor is caused by involuntary contractions of the uterus and abdominal muscles. By their force the liquor amnii flows out, the head of the foetus is engaged in the pelvis, it goes through it, and soon passes out by the valve, the folds of which disappear. These different phenomena take place in succession, and continue a certain time: they are accompanied with pains more or less severe, with swelling and softening of the soft parts of the pelvis and external genital parts, and with an abundant mucous secretion in the cavity of the vagina. All these circumstances, each in its own way, favor the passage of the foetus. The precursory signs of labor are as follows: Two or three days before it is to commence, a flow of mucus takes place from the vagina, and the external genital parts swell and become softer: it is the same with the ligaments that unite the bones of the pelvis; the mouth of the womb flattens, its opening is enlarged, its edges become thinner, and slight pains, known under the name of flying pains, are felt in the loins and abdomen. At the next stage pains begin to be felt in the lower part of the back, or lumbar region, and tend towards the womb, or the rectum: these occur at intervals of fifteen to thirty minutes, and each is accompanied with contraction of the womb, and tension of its neck, which begins to open. If a finger is now introduced into the vagina, a considerable tumor may be felt, which is a protrusion of the membrane coverings of the foetus, containing the first waters. The pains gradually become stronger up to the time when the membranes break, and labor actually begins. The uterus now contracts on itself, and is applied to the surface of the foetus. Soon the pains and contractions of the uterus increase considerably, and are accompanied by the contraction of the abdominal muscles. The woman At this stage there is a discharge of whitish matter from the vagina, and pains occur which extend from the small of the back, or loins, and the groins, down towards the front, or private parts; and sometimes the membranes will even protrude through the external opening. Presently a strong pain comes on, crack go the membranes, the liquor amnii gushes out with a rush, deluging the bed. After this there are longer intervals between the pains, and on the midwife’s introducing her finger, she can feel the head of the child. As the pains increase in intensity, the patient is apt to scream, though some women of firmness will suppress their feelings: she lays hold of a towel, which is commonly fastened to the bed-post for this purpose, and bears down with all her might: her pulse now is rapid, and her skin is hot; the process still goes bravely on; the pains are now more frequent, stronger and lasting. The head of the child now gradually descends lower and lower in the vagina until it presses on the perinoeum, or outer edge of the private part adjoining the anus. In this stage of the labor an inexperienced midwife would think that a few pains more would expel the child, but although the head rests upon the perinoeum, and shows itself at the external orifice, yet it may be some hours before it is expelled, more especially if it is a first child; but if the second or third, half-a-dozen more pains will generally be sufficient to complete the process. During this time the woman usually suffers some from head-ache, looks intensely red in the face, and often experiences a trembling of the lower limbs. The outer passage will now begin to enlarge gradually, and the head appears. When it is advanced as far as its ears, it is said to be “in the passage.” When the birth has advanced one-third, the midwife may assist the expulsion if she chooses, though Nature alone would accomplish it. When the child is born, the midwife should lay it upon her knees, with its face down, so as to give exit to the mucus, waters, &c., from the mouth, if any has been imbibed, which is most generally the case. Now that the child is born, there is a freedom from pain and the mother feels rejoiced at the sudden transition from severe suffering to comparative ease. In about ten minutes she again begins to experience pains, which are, however, slight, or less violent than before, in the region of the uterus, coming and going about every five minutes. On examination, the accoucheuse will find a quantity of clotted blood expelled, and on passing up the finger along the cord, she will discover the after-birth, or placenta, as it is called, forced into the upper part of the vagina. If not attached to the womb, which is easily known by carefully pulling at the cord, the midwife will separate it gently, by introducing her hand. The navel-string must be divided as soon as the child is born; which may be done with a pair of scissors, having first tied a string as well on the child’s side of the cord as the mother’s, to prevent hemorrhage. The placenta being taken away, the labor is now over. An hour after, let the mother take a little oil of sweet almonds, to ease the after pains; and let a poultice of oil of sweet almonds, and two or three new-laid eggs, be boiled together, and laid to the parts, renewing at every six hours for two days. Fifteen days after the birth, the parts may be bathed with an astringent decoction of red roses, alum, or nut-galls in red wine, in order to brace them. The following is the formula I usually employ: Red-rose-leaves, 1 ounce; Alum, 2 drams; Ordinary Claret, half a The above is a brief description of a healthy delivery; and such are the usual ones. In some cases, however, the labor may be tedious and difficult, when the lower part of the belly must be covered with a flannel cloth dipped in a hot decoction of bitter herbs, as tanzy, hops, wormwood and catnep, of each a small handful, to which put three pints of equal parts vinegar and water; boil for half an hour in a covered vessel. Wring the flannel out and apply warm over the region of the womb, which will relieve the tension and ease the pain, besides gently stimulating the uterus to contract more forcibly on its contents, whereby the labor is facilitated. Stimulating injections by the bowels, may now and then be administered—especially if the woman be at all costive. The midwife should also push back with her longest finger the os coxygis, which tends to excite the labor and ease the pain. If the parts are in a stiff, straitened condition, as in the first child, especially if the woman is not young, emollient liniments are to be used, and the parts must be anointed with fresh butter or oil, and to be dilated gently with the hand. If there is a tumor, carbuncle, or membrane opposing the birth, the assistance of an experienced surgeon is required. Always in difficult labors, the patient should be made as cheerful as possible by her friends, by the recital of lively and amusing anecdotes, and by every species of encouragement in their power; as a depressed and melancholy state of mind invariably retards the labor. Women in labor, who have a languid circulation and a weak constitution, are benefited by cordials and good nourishment. Let half a glass of wine be given every two hours, which will invigorate the system, and render the action of the uterus more powerful. If the feet present first, the midwife must be very cautious lest there be twins, and lest she should take a foot of each. The feet must be wrapped in a dry napkin, and the child must be drawn gently, till the waist is in the orifice of the uterus. Then the infant’s hands must be drawn down close to the sides; and if the nose be turned towards the pubic bone in front, it should be placed in an opposite direction to prevent any obstacle. If the chin is embarrassed, the midwife must disengage it, by putting her finger into the mouth, in order to turn to advantage. In case the infant’s head presents across the passage, or laterally, it must be gently thrust back, and carefully turned to its natural situation. If the shoulder presents, the same tact and talent must be employed, although the difficulty is greater. If the belly, hip, or thigh appears first, the child must be extricated by gentle traction made at the feet, and the mother must lie flat on her back. If one or both hands are directed upward, above the head, and lie close to it, the case is not so bad as some would apprehend; for they will keep the orifice equally dilated till the head passes, and thus prevent strangling. When the foetus dies before the time of birth, and the membranes are not yet ruptured, it will not putrefy; therefore the work must be left to Nature, for the pains of labor will at length come on spontaneously. Baudelocque says, if the navel-cord first appears, and is compressed soon after by the head of the infant, its life is in danger; and the remedy is to return the infant, and reduce the cord, till the head fills the opening. But if this cannot be done, the woman must be put in a suitable posture, and the child must be extracted by the feet. When the placenta first presents itself, which is known by its spongy, soft texture, and the great quantity of blood flowing at the same time, it requires speedy assistance. If the membranes are entire, they should be broken, the placenta and membranes should be returned into the I would caution all how they use the instruments when the mouth of the womb is not fully opened, and never to resort to them unless actually compelled to do so by some serious danger which is to be apprehended from delay. Many cases of this kind do occur, it is true, in large cities, if one happens to have a large practice in this branch of the Healing Art. |