Muscular contractions may be inefficient or the os slow to dilate from rigidity. Caustic treatment, so prevalent for ulceration, destroys the natural elasticity of the cervix. Severe and prolonged suffering without dilatation is often the consequence. (See Chap. XXI.) Few women realize the injury done by the prevalent use of caustic treatment. One lady told me that she had been treated by eleven physicians, every one using similar measures. At last in despair she “gave up doctoring,” and by hygienic methods had attained to a comfortable degree of health. The time must come when people will protest against the burning of mucous surfaces as they now protest against blistering and bleeding, which only a few years since were universal.
The head advancing may meet with resistance from dryness, heat, and rigidity of external parts.
The hot sitz-bath is the best temporary means to overcome rigidity of both os and vulva, and to relieve pains that are neuralgic in character. Seat the patient in a sitz-bath tub, containing very hot water, her feet also in a hot foot bath. Envelop her with blankets and increase the temperature of the water by pouring in hot water as she can bear it. Let her remain until profuse perspiration is induced. Dry her under the blankets and let her lie down without removing them. Sometimes she can remain in the bath an hour with advantage, though a shorter time is usually sufficient. The pains entirely or partially subside, and she seldom fails to fall into a refreshing sleep. Local relaxation will be accomplished, the pains assume an effective character, and a speedy termination of the case can be expected. To accomplish the desired result, the bath must be hot, not warm, and continued until perspiration is induced. When prolonged labor is caused by rigidity of the soft parts, good and speedy results are sure to follow. The following cases prove the value of the hot bath:
Mrs. N—— engaged my services for her seventh confinement, stating that I might expect a tedious case, as in all previous labors the skill of physicians had been baffled. She had lingered in labor from 48 to 96 hours, attended with convulsions and other distressing symptoms; several times had been delivered with instruments. Summons came for me on a bright June morning at 5 o’clock. She had had irregular pains all night, was very nervous and had great dread of her sufferings, having no hope of relief for at least two days. I found no dilatation, and no real contractions were taking place.
I gave her remedies, hoping to arrest the suffering until relaxation could be produced, and left her. At 10 o’clock I returned, armed with one of Dickens’ novels, for a two days’ pastime. Found the pains increased in severity, attended with rigidity of os, still no dilatation, but pressure of the uterus upward. Although a woman of great self-control, she could not repress the most piercing screams with each pain. A hot sitz-bath was administered, increasing the temperature until most copious perspiration was induced, after which, enveloping her in blankets, I bade her sleep, while I sat down to Dickens.
She obeyed orders, slept soundly, having contractions every fifteen minutes, when she would rouse and exclaim, “What relief!” “Heaven surely can be no sweeter than this rest!” “What a blissful change!” I would say, “Don’t talk, don’t bear down, sleep all you can,” and still read Dickens. About one o’clock expulsive pains came on. Examination revealed full dilatation of cervix, and head advancing. At 3:30 P. M. the child was born, no spasms, no instruments, and no medicine had been required. This is only one of many that I have seen relieved in the same way, and always find the bath effectual where there is no deformity of the pelvis. I am confident that this hot bath, if generally used, would save thousands of instrumental deliveries.
Mrs. N. was a very grateful patient, and believes that the same means would have given relief in former labors, as the first symptoms were the same. The only unpleasant sequel in the case was, the novel remained unfinished.
Mrs. L——, primapara, aged thirty-three, a severe, tedious labor, with slow dilatation. Gave the hot bath with the happiest effect; patient, nurse, and all but the husband went to sleep. Contractions continued, accompanied by profuse perspiration, but for two hours did not awaken the patient. Expulsive efforts finally setting in, labor was completed in one hour. It was, however, almost immediately followed by violent hemorrhage inducing fainting. Examination revealed the placenta attached, the fibers so closely adhering to the uterus that the least attempt at removal caused the greatest suffering. The placenta was grasped and partially brought down into the cervix. By this interference the hemorrhage was arrested, and the placenta allowed to remain for about twelve hours, when it was expelled without any assistance. The patient made a rapid recovery.
At first I feared that the excessive relaxation from the bath caused the flowing, but became convinced that it was only exposure of the bloodvessels from the partial adhesion of the placenta. Its removal from the body of the womb allowed the organ to contract upon the exposed bloodvessels, and consequently the hemorrhage ceased.
The hot bath is also effectual for flagging pains that are annoying and worrying, and “seem to do no good.” In such cases the patient takes a long rest after the bath, and real contractions and expulsive efforts may not occur for hours or even days. This gives nature time to overcome all obstacles, and the final termination is more satisfactory.