A System of Midwifery

by Edward Rigby

We also observe, that organs, the various conditions and derangements of which have exerted little or no influence upon the uterus in its state of quiescence during pregnancy, now affect it powerfully, and are capable of modifying its action very considerably. The stomach, the intestinal canal, and the skin, are remarkable instances of this, and seldom fail to disturb or pervert the natural efforts of the uterus, whenever these organs deviate from a healthy condition. It will be, therefore, of the highest importance to watch their functions narrowly, in order that we may form a correct estimate of their effects upon the uterus.

Derangements in the contractile power of the uterus may arise from a variety of causes, which may be chiefly brought under two heads, viz. functional and mechanical.

The functional derangements may arise from insufficient activity, the result of general or local debility; from a deranged condition of the digestive organs; from passions or affections of the mind; from hereditary temperament, constitution, or peculiarity; from the patient’s age, being either very young or considerably advanced in years, and pregnant for the first time; from plethora, general or local; from rheumatic affection of the uterus; and from uterine inflammation.

The contractions of the uterus may be mechanically impeded, by tumours imbedded in its substance; by organic diseases, as schirrus, cephaloma, and hæmatoma; cicatrices from former ulcerations or rupture, or by any other circumstances which interrupt the action of the longitudinal fibres upon the os uteri.

From debility. Where uterine action is insufficient from debility, the pains are feeble, and do not appear to act in the right direction; they are frequently attended with much greater suffering than might be expected from their inefficiency; the intervals between the pains are unusually long, the pains themselves are very short, or, after a while, cease altogether.

This condition, when depending on general debility, may be the result of previous disease, loss of blood, or other debilitating evacuations, poverty, with its attendant miseries, depressing passions of the mind, and health broken down by intemperance.

The contractile power of the uterus itself may be injured by previous leucorrhœa or menorrhagia, by abortions, or by attacks of hæmorrhage during the latter part of pregnancy; it may be weakened by over-distention of the uterus, either from plurality of children or too much liquor amnii, by the patient exerting herself improperly at the commencement of labour, straining violently, and endeavouring to bear down before she is involuntarily compelled to do so by the presence of the head in the vagina. It may also be produced by the membranes giving way too soon, as is so frequently observed in first labours.

From derangement of the digestive organs. We have already described the change which takes place in the relation between the uterus and other organs, as soon as it passes into a state of action. The intestinal canal stands foremost in the influence which it exerts upon the uterus; whether it be from constipation or diarrhœa, irritation from acrid contents, &c., it will greatly modify, and even derange, its contractile power; the pains cease to be genuine uterine contractions, and assume a spasmodic character, producing much painful griping and pinching about the front and lower part of the abdomen, without any of that regularity of interval and duration, and gradual accession and recession, which mark the presence of real labour pains, and, we need scarcely add, with little or no effect upon the progress of the labour itself. These griping colicky pains appear to supersede the true process of parturition, and either to prevent the uterus acting with due regularity and effect so long as they last, or so to pervert its action as to produce a species of metastasis towards other organs. The pains lose their peculiar character as the expelling powers of the uterus; they cease entirely, and the patient is suddenly attacked with dyspnœa, cramps in the extremities, violent shivering, great restlessness, intense headach, delirium, convulsions, or even mania.

Wherever the action of the uterus is deranged by gastric or intestinal irritation, the abdomen is generally more or less tender in front, particularly over the symphysis pubis; the os uteri is thin, tense, and rigid; the vagina is hotter than natural; the secretion of mucus is sparing; and both os uteri and vagina are more than usually tender to the touch.

From mental affections. The mind is capable of influencing the action of the uterus during labour in a remarkable manner, not only where it is suffering from depressing emotions, as grief, great anxiety, or painful anticipations as to the result, but from causes of a much slighter character, which are nevertheless well worthy the attention of the practitioner: his sudden appearance in the room, without the patient having been properly warned of his arrival: the dread of an examination; or annoyances of a much slighter character, as regards his manner, or that of the nurse, &c., will not unfrequently be quite sufficient to stop the progress of the pains.