THE AGE AS AFFECTING LABOR.
If the patient be considerably advanced in years at the time of her first pregnancy, the labor is apt to be, or rather, must necessarily be, a more difficult one than would occur earlier in life.
In the life of any woman there is a period at which her system has become, as we say, matured, or, in other words, capable of child-bearing. After the system has become thus matured, it is evidently more natural, and consequently more healthful to bear children than not to do so. We are to suppose, then, that if a woman follows the order of nature, it will be better for her, in regard to the easiness of childbirth, than if she becomes old before this function is brought into action. Nature, however, is not so closely bound down to arbitrary rules as we might at first conclude. Indeed, we could not reasonably suppose that the Creator would form woman’s system in such a way that she could not safely bear children, even if the child-bearing function were not brought into action until some years after puberty. I knew a lady whose marriage took place quite late in life, and whose first child was born when she was forty-two; and although her labor was a severe one, lasting seventy-two hours and upward, yet she recovered remarkably well, as much so as almost any one I ever knew. Her child, too, was a fine, healthy one, and throve well. Another lady, whom I attended about one year since, who was thirty-eight years old at the time, it being her first labor, felt some pains for two days and nights previously to the one on which I was called to visit her. It could hardly be said, however, that labor had fully set in before ten o’clock of the day on which the child was born at four in the afternoon, making the real labor only about six hours. Thus we see that, although the age of the individual has generally more or less influence in regard to the painfulness and length of labor, yet a woman who is far advanced in the child-bearing part of her life, when she bears her first child, has apparently as good a chance for a speedy and favorable recovery as a younger one has. In this circumstance, too, we have still another among the many proofs of the benevolence of the Creator of all things. He, in His wisdom, foreknew that it would not be proper for every woman to marry precisely at that age in which it is most natural for her to become pregnant, and consequently her system was formed with a reference to that circumstance, although it is admitted that labor is somewhat more difficult and protracted if it occur for the first time late in the fruitful period.
It is an unwise procedure to tell a woman, as has been sometimes done, that because she is somewhat advanced in years, and must consequently expect to have a difficult labor, she should be bled frequently toward the close of her period, have purgative medicines given her, etc., with the view of helping nature, as it is said. But it were far better, more honest, as well as more truly philosophic, to tell her that, in order to get along the best that may be under the circumstances, she should do every thing in her power to improve her general health; for always the more strong and vigorous the patient at the time of labor, the better is her prospect in every respect. Suppose, too, it were deemed necessary to reduce her system somewhat toward the close of pregnancy, how much better are abstinence and fasting for that purpose than bleeding and cathartics? It is a foolish practice to bleed or drug the system when we have always at hand so much better means.
LETTER XXVI.
MANAGEMENT OF LABOR.
The Placenta, or After-Birth—The Membranes—Management of the After-Birth—Rules for Extracting it—Of Flooding after Delivery.
In the preceding letter, I spoke of the first two stages of labor. The last, which refers to the birth, or expulsion of the placenta and membranes, I now propose considering.
First, I must say something of the nature and office of what is termed the after-birth.
THE PLACENTA AND UMBILICAL CORD.
The placenta, or after-birth, is of different forms in different animals. In the human subject, “it is a flat, circular body, about six inches in diameter, and about one inch and a half in thickness at the center, becoming thinner toward the circumference. Usually in the center, but sometimes at or near the edge, we find the insertion of the funis, or umbilical cord, the vessels of which immediately ramify in a divergent manner upon the surface of the organ.”
From Dr. Maunsel, of Dublin, I make the following quotation, in regard to the office of this viscus:
“The uses of the placenta appear to be in some degree analogous to those of the lungs and stomach of the breathing animal. The blood passes into it from the hypogastric arteries, and after a very free circulation through it, returns by the umbilical vein directly to the heart. The circulation continues until respiration is established, when it ceases spontaneously, and any interruption of it, before the latter process has commenced, is immediately fatal. From these facts we are warranted in inferring that a change necessary to life (probably oxygenation) is produced in the placenta, although the nature of that change is obscure, and the relative properties of the blood in the umbilical arteries and veins not at all known. That the organ in question not only revivifies the blood, but also elaborates new vital fluid, thus performing a function analogous to that of the stomach, can only be inferred from the absence of any other source from whence the fetus could obtain materials for growth and support.”