Rigidity of the pelvic floor may be due to inadequate elasticity of the tissues as in old primiparas or in young women who have ridden horseback for many years in the cross-saddle position.
The head may come down to the pelvic floor but will not advance further. If the tissues of the vulva do not, or can not yield sufficiently after appropriate time has been allowed, episiotomy may be done. (See Minor Operations, p. [211].)
The uterus itself may functionate abnormally.
Precipitate labor is an over rapid advance of the child wherein the stages of labor are merged into one another and the child expelled in two or three pains.
It may be due to unusual capacity of the pelvis, or to strong contractions which the patient is not aware of, or both. These cases predispose to post partum hæmorrhage and to serious lacerations of cervix and perineum.
The child is usually delivered in an undesirable place, such as a toilet basin or a street car, and perishes from the fall, from cold, from umbilical hæmorrhage, or lack of facilities for revival.
The nurse who is watching a case is responsible for the prevention of a precipitate. If the event impends, the woman must be placed upon her side with legs straight, and she should be instructed to cry out with every pain. Chloroform may be given and the head forcibly held back.
Uterine Inertia.—A sluggish state of the uterus may characterize the labor and the contractions will be slow, shallow and inefficient. The intervals may be prolonged, although the patient complains bitterly of pain.
The condition is seen most frequently in multiparas and is due to defective innervation of the uterus or to imperfect reflexes, and in primiparas also it may be due to the newness of the function that is suddenly called into play, or to contracted pelvis. Many times the trouble results from overfatigue and want of sleep. If this is the case, the remedy may be found in the administration of morphine sulphate ⅙ gr. and scopolamine 1/150 gr. The pains are diminished or abrogated while the contractions continue. The scopolamine may be repeated if necessary. Under proper indications and conditions this treatment is harmless, both to mother and child, but requires supervision on the part of the nurse or physician.
If the patient is not overly fatigued, the introduction of a Vorhees bag, as described under the head of Induction of Labor (p. [208]) will dynamically increase the strength and frequency of the contractions, mechanically aid the effacement of the cervix and the dilatation of the os, and shorten the first stage anywhere from six to twelve hours.