DELIVERY

This subject is best discussed under three heads: (1) Signs of Recent Delivery in the Living. (2) Signs of Recent Delivery in the Dead. (3) Signs of Previous Delivery.

1. Signs of Recent Delivery in the Living

(a) Transitory Signs; (b) Persistent Signs of Delivery

(a) Transitory Signs of Delivery

1. General Indisposition.—The face is pale or flushed; the eyes sunken, and surrounded by a dark areola; there is considerable debility, and a tendency to faint; the skin is warm and moist, and the pulse quick. It must be borne in mind that a woman who is anxious to conceal her recent delivery may, by an effort of the will, to a great extent hide her real condition.

2. The Breasts.—The breasts feel firm and “knotty,” and on pressure yield a small quantity of colostrum or milk, which may be distinguished by the aid of a microscope.

3. The Abdomen.—The skin of the abdomen shows signs of recent distension; it is relaxed, and more or less thrown into folds, the lower part marked by irregular broken streaks of a pinkish tint, becoming white and silvery as time goes on.

4. The Lochia, or the “Cleansings.”—These consist in a discharge from the uterus, which, for the first three or four days after delivery, is more or less bloody. During the succeeding four or five days it acquires a dirty-greenish colour—“green waters,” with a peculiar sour, rancid odour. In a few days this is succeeded by a yellowish, milky-looking mucous discharge, which may continue for four or five weeks.

5. External Parts of Generation.—The labia and vagina bear distinct marks of injury and distension.

6. The Uterus.—The uterus is enlarged, and may be felt by the hand for two or three days after delivery, as a round ball, just above the pubes. The orifice of the uterus, if examined a few hours after delivery, appears as a continuation of the vagina. This condition completely disappears in about a week after delivery.

7. After-pains.—These are of no use from a diagnostic point of view, as we have no means of testing their presence or absence.

(b) Persistent Signs of Delivery

1. Entire obliteration of the hymen.—This is no proof of actual delivery.

2. Destruction of the fourchette.

3. The vagina dilated, and free from rugæ.

4. Dark colour of the areola round the nipples.—This varies among women; and cases are known where there was no areola either during pregnancy or after delivery.

5. Skin of Abdomen.—Due to the great distension of the abdomen, the skin appears streaked with silvery lines varying in breadth. These markings in some cases may be scarcely perceptible, especially if the female has worn a tight abdominal belt during her pregnancy. The same appearance may be produced by dropsy, or the prolonged distension of the abdominal walls, the result of other causes. Attention to the other signs present will assist the diagnosis. After the lapse of seven to ten days the recent delivery of a woman cannot be certainly proved by an examination of the living woman, especially if it be known that she had previously borne children. In primiparæ the pink-coloured streaks on the abdomen, and the transverse condition of the os uteri, may strongly point to recent delivery.

2. Signs of Recent Delivery in the Dead

Should the woman die immediately after delivery, the external parts will present the same appearance as just described in the living. On opening the abdomen, the uterus will be found fat and flabby, between nine and twelve inches long, and with the os uteri wide open. The cavity of the uterus may contain large bloody coagula, and its inner surface be lined by the decidua. The attachment of the placenta is easily detected by its dark colour, and by the semi-lunar openings of the arteries and veins on the surface of the uterus.

Of course all the appearances just described will be greatly modified by the time that has elapsed between delivery and death.

Delivery after Death.—The fœtus has been known to have been expelled from the uterus by the force of the gases generated by putrefaction. Dr. Aveling, in a paper published in the Obstetric Transactions, 1873, arrives at the conclusion that post-mortem delivery is possible even where no symptoms of parturition were noticed before death. He also thinks that the child may live in utero for some hours after the death of the mother.

Table showing the Size of the Uterus at
Different Periods after Delivery

Two to Three Days.—7 inches long and 4 inches wide.

Seven Days.—Between 5 and 6 inches long and 2 inches wide.

Fourteen Days.—From 4 to 5 inches long and 1½ inches wide.

End of Second Month.—Normal size. 2½ inches long and about 2 inches broad at the fundus.

Table giving Weight of the Uterus
after Delivery

Immediately after Delivery22 to 24ounces.
Within a Week18 to 21“
End of Second Week10 to 11“
End of Third Week5 to 7“
End of Second Monthnormal, 9 to 10drachms.
(Heschl.)

3. Signs of a Previous Delivery

1. Marks on the abdomen, consisting in shining silvery lines, due to the distension of the skin. These may result from distension other than that the result of pregnancy—tumours, dropsy, &c.

2. Marks on the breasts, similar to those appearing on the abdomen. These, in conjunction with the above, are important.

3. Peculiar jagged condition of the os uteri, felt by the finger. The condition may be the result of disease.

4. Marks of rupture of the fourchette or perinæum.

5. Dark colour of the areola round the nipple.

6. Negative evidence, from absence of any of the above.

Can a Woman be delivered unconsciously?—This question may arise in cases of infanticide. Setting aside cases of epilepsy (in a fit of which disease Husband once attended a woman who was confined during the fit without being aware that she had been delivered), cases of apoplexy, coma, and narcosis from chloroform, opium, &c., it may be stated that delivery is possible during profound sleep. Husband once attended a woman who informed him that “she always had her pains during her sleep,” and only woke up just as the head came into the world. When it is borne in mind how easily some women pass through labour, it is quite possible that, after a busy day, sleep may be so profound as not to be disturbed by the pains of labour. In primiparæ the occurrence is more problematical. Women have often declared that they have been unconsciously delivered whilst at stool. This is also possible, but the circumstances of the case must be severely sifted.

CHAPTER XIII
FŒTICIDE, OR CRIMINAL ABORTION

[“Every woman, being with child, who, with intent to procure her own miscarriage, shall unlawfully administer to herself any poison or other noxious thing, or shall unlawfully use any instrument, or other means whatsoever, with the like intent: and whosoever, with intent to procure the miscarriage of any woman, whether she be or be not with child, shall unlawfully administer to her, or cause to be taken by her, any poison or other noxious thing, or shall unlawfully use any instrument, or other means whatsoever, with the like intent, shall be guilty of felony, and being convicted thereof shall be liable, at the discretion of the Court, to be kept in penal servitude for life, or for any term not less than five years, or to be imprisoned for any term not exceeding two years, with or without hard labour, and with or without solitary confinement.”—Statute 24 and 25 Vict. c. 100, sec. 58.]

The 59th section of the same Statute also takes into consideration the unlawfully supplying or procuring any poison, or other noxious thing, or instrument, or thing whatsoever for a woman, for the purpose of inducing abortion. The person so doing shall be guilty of a misdemeanour, and be kept in penal servitude for a term of five years, or be imprisoned for any term not exceeding two years, with or without hard labour.

It will be seen from the passages above quoted that there is no distinction between a woman quick or not quick with child. “The offence is to procure the miscarriage of any woman, whether she be or be not with child” (R. v. Goodhall, 1 Din. 187; 2 C. & K. 293). But although the law does not regard “quickening” in cases of abortion, yet the fact of having “quickened” may be pleaded as a bar to immediate capital punishment.

Fig. 23.—Abortion at fourth week.
(Glaister.)

It has been decided in Scotland that drugging or operating to procure abortion is criminal, though unsuccessful, but it is not certain whether the woman alone can be charged with taking drugs to procure abortion. Both in England and in Scotland, to make the procuring of abortion criminal, “there must be felonious intent,” for it may be necessary to cause abortion. It must be borne in mind that the law allows no discretionary power on the part of medical practitioners who, to save the life of the mother, may deem it advisable to induce premature delivery. This being the case, no medical man should attempt to induce premature labour without the consent of the relatives of the woman, and the sanction of a medical colleague after consultation. This precaution is the more necessary as several medical men have been prosecuted, an event which would not have taken place had the precaution above suggested been observed. A medical man should also be very careful never to give any medicine “to bring on the courses” if he has the slightest suspicion of pregnancy, even as a “placebo” to satisfy an importunate patient, for should abortion be otherwise procured, his really harmless medicine may be accused with the result, and a grave suspicion be raised against him, to say the least.

The term abortion is understood in medicine to mean the expulsion of the contents of the fœcundated uterus before the sixth month of pregnancy, that is, before the child is considered viable. After this period it is said to be a premature labour.

In law, however, no distinction is made and the expulsion of the contents of the uterus at any period before the full time of pregnancy is considered an abortion; in popular language, a miscarriage.

Fig. 24.—Abortion between
sixth and eighth week.
(Glaister.)

Fig. 25.—Abortion at tenth week.
(Glaister.)

Abortion, when not produced by criminal means, generally occurs at or a little before the third month of utero-gestation, and then usually in first pregnancies, or during the latter part of the period of child-bearing. It is also more frequent among the rich than among the poor. Of the two thousand cases of pregnant women examined by Dr. Whitehead of Manchester, the sum of whose pregnancies was 8681, or 4.38 for each, rather less than 1 in 7 had aborted.

When abortion is criminally induced, it generally takes place between the fourth and fifth months, that is, about the time the woman becomes certain of her condition.

The Causes of Abortion are—