CAUSES CONNECTED WITH THE MOTHER WHICH MAY IMPEDE LABOR, OR MAKE IT DIFFICULT.
INERTIA, OR WANT OF SUFFICIENTLY POWERFUL CONTRACTION IN THE WOMB.
This is most likely to occur in delicate females, and in those who are debilitated by disease. The contractions are very feeble, and, as the nurses say do not tell; the mouth of the womb dilates but slowly, and the head descends with difficulty into the passage.
In many cases in fact the labor is so tedious, from this cause, that the female becomes completely worn out, and finally sinks, while the child is exposed to the greatest hazard from the delay.
It is in these cases that the patient's strength needs supporting, and that stimulants may be useful. A little wine, or brandy and water, will often rouse the failing energies, and bring on a series of strong contractions that will end the labor at once.
The most usual resort however is to the drug called Ergot, or Secale Cornutum, a fungus growth which is sometimes found on ears of rye. This possesses the peculiar property of exciting the womb to contract, the same as an emetic excites the stomach to vomit, and it seldom fails in its effect; but still there are many objections to its use. It not unfrequently causes delirium, great restlessness, and anxiety, sickness, headache, and convulsions, or complete prostration, from which the female may be long in recovering. It is also supposed by some to be not altogether free from danger to the child. If however no other means were known of making the womb contract, in such cases, all the probable evils should be risked, because the labor must be completed at all hazards; but other means are known, which succeed even more certainly than ergot, and without any danger. The application of Galvanism, explained in my "Neuropathy," and "Practical Facts," will almost invariably cause the womb to contract, and speedily bring the labor to a safe termination, without the slightest risk or inconvenience, to either mother or child. Simple friction over the abdomen will also succeed in many cases, and gently rubbing the mouth of the womb with the finger in others. These simple means should therefore always be used in preference to the ergot, but in case they cannot be resorted to, or fail, the drug must be administered, and I will therefore explain the manner in which this is done. When gathered the ergot is in large irregular lumps, and should be so kept. When wanted for use a single drachm should be finely powdered, and divided into three parts; one of these parts to be taken first in a glass of sugar and water, and the others at intervals of ten minutes, unless the effects of the first are very powerful. It is often thrown from the stomach however even in still smaller quantities, and is then given, by some, as an injection by the rectum, in which mode it seems more powerful, so that a smaller dose is sufficient.
Great caution should always be observed in using this powerful drug, as it will sometimes act so energetically as to burst the womb; or expel the child so suddenly as to lacerate the perineum and other parts. The contractions produced by it are different from the natural ones, being almost constant, without any interval, and gradually increasing in force. They usually come on in about ten or fifteen minutes after the last dose, and continue about an hour and a half. Some practitioners depend almost altogether on the ergot, in every protracted case, and even use it to bring on premature labor, when that is required. Thus M. P. Dubois was once called to a dwarf, whom he delivered with instruments, the first time, but with great difficulty and risk. The next time she became pregnant he determined to bring on premature labor, and accordingly he administered ergot, when she was about eight months gone. This brought on natural labor, and she was delivered without difficulty. M. Chailly says he believes it will bring on uterine contraction at any time, and that he has never known it to fail. I consider however that there is always more or less risk in its use, and I should certainly prefer any of the other means, particularly Galvanism.
It is of the first importance however to be certain, before using any forcing means whatever, that there is no physical impediment. If the pelvis should be deformed or small, if the child's head should be unusually large, or dropsical, or if the soft parts of the mother should be undilated and rigid, the most serious consequences must ensue from violent uterine contractions. In like manner if the presentation be unfavorable, particularly if it be one of the trunk, the danger is equally great. In every case the passage of the child must be physically possible, before it is attempted to force it away. A neglect of this rule has frequently led to fatal results. The ergot has been given and the uterus forced to contract, while the pelvis was too small for the child to pass through; and the consequence has been rupture of the uterus, or complete exhaustion, with death to both mother and infant. In other cases the delivery has resulted so suddenly, from the violence of the expulsive efforts, that the vagina and perineum have been lacerated in the most shocking manner.
The ergot is also especially dangerous to very nervous women, or to those who are disposed to congestion, apoplexy, or inflammation.
Among the special causes which often paralyze the action of the womb, may be mentioned a full habit of body, great distention of the uterus from accumulations of fluid, and extreme thickness of the membranes. In some cases in fact, the membranes will be so strong that the most violent contractions fail to break them, and the uterus completely exhausts itself to no purpose. It is in such cases as these, when the mouth of the womb is fully dilated, that the accoucheur should rupture the membranes artificially. This is usually done with the finger nail by pinching them. Some practitioners however use a pointed instrument, or a sharp quill; but there is always more or less danger of injuring the child or the mother by such means. The best time for breaking them is during a strong pain, when they are fully distended. The mere scratching, or pushing on them will frequently suffice. I have known cases however in which they were so strong that an instrument was actually necessary to open them.