STAGES OF LABOR.
Labor may be appropriately divided into three stages, which are the following:
1. That which includes “all the circumstances which occur, and all the changes made, from the commencement of the labor to the complete dilatation of the os uteri (mouth of the uterus), the rupture of the membranes, and the discharge of the waters.”
2. This stage includes those circumstances which occur between the first stage and the expulsion of the child.
3. The third stage includes all that relates to the separation and expulsion of the placenta or after-birth.
As labor is about to come on, and even for some days previously to it, an increased mucous discharge takes place from the vagina, which for a day or two at the last is apt to become streaked with blood, forming what is termed the show. This arises from a partial detachment of the placenta, at which time it might perhaps with propriety be considered that labor had actually commenced, although in a slight degree.
This show, however, does not always appear, for, as Dr. Denman observes, “in many cases there is no colored discharge in any period of the labor, and then the dilatation proceeds more slowly; for the discharge is not only a sign that the parts are in a state disposed to dilate, but it also improves that state.”
If the bladder is at all irritable, the woman at this time suffers from strangury, more or less. This is in consequence of the pressure of the womb upon the neck of the bladder, or upon the urethra. If the rectum is in a similar condition, there is apt to be tenesmus, or a bearing-down feeling at the lower bowel, as if something should be discharged, but which the woman is not able to accomplish. All these are common symptoms; but in some cases labor begins, as it were, suddenly, without any warning whatever.
Not unfrequently, in the beginning of a labor, the woman experiences one or several rigors, which may be in connection with or without a sense of cold. These are supposed to arise in consequence of the system rallying its energies to concentrate them upon one important object, namely, that of effecting the dilatation of the uterus and the expulsion of the fetus. They are evidently not attended with any danger, and should therefore give the patient no alarm.
State of the Bowels.—It is not uncommon for patients to have one or more loose discharges from the bowels at the beginning of or during labor. This symptom occurs in consequence of the sympathy that exists between the womb and the lower part of the alimentary tract. There appears to be in the minds of most women a great prejudice against bowel complaints through the different stages of pregnancy, and at the time of labor, and, as a consequence, there is a willingness, and often anxiety, on their part to use such means as are supposed to have an effect in suppressing them. But in most cases of diarrhea under these circumstances, the patient is relieved by it rather than made worse, and should therefore take no special means of counteracting it, unless, indeed, under the guidance of a medical attendant who should deem such a course necessary.
Nature of the Pains.—It is an object to know how you may distinguish between the true pains of labor and those which are false.
The true pains of labor usually begin in the back and loins, and shoot round to the upper part of the thighs; or they may commence first in the lower part of the abdomen, as if in the region of the bladder, passing backward toward the spine. Some women commence being sick, as if they had eaten something that disagreed with them; and I have repeatedly known them to attribute the pains of the commencement of labor to this cause. A little time in such cases is sufficient to convince them of their error.
Periodicity is, in most cases, a symptom showing that the pains are not false. The interval between them may vary in different cases from one minute to thirty, forty, or more, according to the action of the uterus, on which they depend. The more the pains are multiplied the better it is to be regarded for the patient, and for the reason, that if an effort of great importance to the constitution is to be produced, the more slowly and gradually it is done the better, if the slowness is not the effect of disease. A sudden and violent labor is never to be looked upon as being so safe as one which happens in a more gradual manner. “It is an old observation,” says Dr. Denman, “confirmed by daily experience, that after the completion of slow or lingering labors, patients usually recover better than after those which are quick; not to mention that they are less liable to the untoward accidents which precipitation may immediately produce.”
A considerable difference exists in the character of the pains, according to the stage of labor in which they occur. The earlier pains are termed cutting or grinding, from the fact that uterine fibers alone are principally concerned in them. Afterward the pains get to be lower down, and are of a more bearing-down nature. When these pains exist, the woman is instinctively led to bring her abdominal muscles into powerful action, causing her, at the same time, to hold in her breath, so that after the pain has ceased, or partially so, she utters a deep groan. In the earlier part of the labor, the cries are more shrill, so that an experienced observer will often be able to judge of the stage of the labor merely by hearing the manifestations made. In some cases, however, the patient does not exhibit any of the aforementioned signs of distress, until the moment when the child is about to pass into the world. She is then obliged to put forth an expression of agony, which proves but too well how much it is her lot to endure.