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, and press upon it. This drives forward the membranes which restrain the water at the orifice, and at the proper moment they break, and labor then commences.
Labor is caused by involuntary contractions of the uterus and abdominal muscles. By their force the liquor amnii flows out, the head of the fœtus 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 fœtus.
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 fœtus, 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 fœtus. Soon the pains and contractions of the uterus increase considerably, and are accompanied by the contraction of the abdominal muscles. The woman should favor this state of things by making all the muscular efforts in her power, (straining.) As the labor progresses, her pulse will become stronger and more frequent; her face becomes animated; her eyes grow brighter; her whole body is in extreme agitation; perspiration flows in abundance; until the head of the child descends into the lower strait of the pelvis.
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 perinœum, 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 perinœum, 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.