You may ask why it is that a woman should be made to suffer pain at all in bringing forth a child, and why did not the Creator form the system of woman in such a way that a child could be expelled without causing any of that agony which is well known to be a natural circumstance of childbirth. I answer, it was not possible for God to create woman in such a way. Suppose He had made her pelvis larger, and the soft parts more yielding; she would have been constantly subject to the misfortune of miscarriage; or rather, it would not have been possible for her to carry a child at all.
But see the beautiful, and at the same time wonderful operation of nature in the mechanism of parturition. At first, some days before labor is to come on, the abdomen begins to subside, showing that the uterus, with its contents, is gradually sinking downward in preparation for the greater struggle that is to take place at the birth. Probably, too, the womb at the same time begins to contract itself more firmly upon the child, and, as it were, begins to gather strength for the contest which it is about to engage in, namely, that of forcing the child into the world. After this there appears a greater discharge of mucous than ordinary from the womb and vagina, which serves to soften and lubricate the parts in preparation for the terrible distension which is to take place. Gradually, also, in the first stage of labor, the womb dilates, for too sudden a distention of this important part would be very apt to cause a fatal rupture of the organ. In the second stage, the head of the child is driven through the os uteri into the vagina. As the pains continue, the face of the child is turned into the hollow of the sacrum; that is, toward the back of the mother, the wider part of the head being in the wider part of the pelvis, just as a wise mechanician would naturally place it; but in the beginning of labor, when the child’s head is at the upper part of the pelvis, it lies more to the side of the mother, corresponding to the wider diameter of this upper strait.
Look at a skeleton, I repeat, that bugbear of our childhood, that grim yet beautiful remnant of our mortality; and when you see and understand how admirably adapted the form and shape of the pelvis is to the ends for which it was created, tell me if you do not recognize in this adaptation the most unmistakable evidences of the work of an Almighty hand.
In cases of first children, the first or dilating stage usually occupies from six to thirty or more hours. It is natural to expect that a woman must suffer greater pain, and bear a more tedious labor with her first child than with the subsequent ones. “I have heard a voice as of a woman in travail, and the anguish as of her that bringeth forth her first child,” saith the prophet Jeremiah. The difference in the length of the first and subsequent labors, however, is not usually in proportion to the number of children that have been borne. If a woman be twenty-four or thirty-six hours in labor with her first child, she may be only six or eight with her second, and in the subsequent labors only three or four hours. There will, of course, be many deviations from any calculation of this kind that can be made, but the practitioner will, however, often be able to form a tolerably accurate opinion of the probable duration of a labor, if the woman have had a number of children previously. But even here there will be a good deal of liability to error, since the fifth, sixth, or tenth labor may prove a very tedious and difficult one, because of some mal-position of the child. I had an example of this kind in my own practice some months ago, in which a lady suffered incomparably more with the birth of her third child than with both of the former together, and the labor was protracted to thirty hours, which was a much longer period than either of the former had been. This happened in consequence of the face of the child, that is, the wider part of the head, presenting forward in the narrower part of the outlet of the pelvis, whereas in almost all cases the reverse of this takes place, as I before remarked. Such cases are, however, fortunately very rare, the exception only to the general rule.
You will readily understand why the first labor is apt to be somewhat more difficult than subsequent ones, when you recollect that all the soft parts, such as the womb, vagina, the external organs, etc., are more rigid and unyielding in the first labor than they afterward are. The bones, recollect, are the same at all times; they do not give or separate, as many of you have supposed; they are bound so firmly together that it is not possible for them to be separated, in their natural and healthful state, by any such force as that which is exerted in the birth of a child, although this force is a great one. It is necessary that the bones of the pelvis should be thus strongly bound together, otherwise they would not be sufficiently firm to answer the purposes for which they are intended.
THE AGE AS AFFECTING LABOR.
If the patient be considerably advanced in years at the time of her first pregnancy, the labor is apt to be, or rather, must necessarily be, a more difficult one than would occur earlier in life.
In the life of any woman there is a period at which her system has become, as we say, matured, or, in other words, capable of child-bearing. After the system has become thus matured, it is evidently more natural, and consequently more healthful to bear children than not to do so. We are to suppose, then, that if a woman follows the order of nature, it will be better for her, in regard to the easiness of childbirth, than if she becomes old before this function is brought into action. Nature, however, is not so closely bound down to arbitrary rules as we might at first conclude. Indeed, we could not reasonably suppose that the Creator would form woman’s system in such a way that she could not safely bear children, even if the child-bearing function were not brought into action until some years after puberty. I knew a lady whose marriage took place quite late in life, and whose first child was born when she was forty-two; and although her labor was a severe one, lasting seventy-two hours and upward, yet she recovered remarkably well, as much so as almost any one I ever knew. Her child, too, was a fine, healthy one, and throve well. Another lady, whom I attended about one year since, who was thirty-eight years old at the time, it being her first labor, felt some pains for two days and nights previously to the one on which I was called to visit her. It could hardly be said, however, that labor had fully set in before ten o’clock of the day on which the child was born at four in the afternoon, making the real labor only about six hours. Thus we see that, although the age of the individual has generally more or less influence in regard to the painfulness and length of labor, yet a woman who is far advanced in the child-bearing part of her life, when she bears her first child, has apparently as good a chance for a speedy and favorable recovery as a younger one has. In this circumstance, too, we have still another among the many proofs of the benevolence of the Creator of all things. He, in His wisdom, foreknew that it would not be proper for every woman to marry precisely at that age in which it is most natural for her to become pregnant, and consequently her system was formed with a reference to that circumstance, although it is admitted that labor is somewhat more difficult and protracted if it occur for the first time late in the fruitful period.
It is an unwise procedure to tell a woman, as has been sometimes done, that because she is somewhat advanced in years, and must consequently expect to have a difficult labor, she should be bled frequently toward the close of her period, have purgative medicines given her, etc., with the view of helping nature, as it is said. But it were far better, more honest, as well as more truly philosophic, to tell her that, in order to get along the best that may be under the circumstances, she should do every thing in her power to improve her general health; for always the more strong and vigorous the patient at the time of labor, the better is her prospect in every respect. Suppose, too, it were deemed necessary to reduce her system somewhat toward the close of pregnancy, how much better are abstinence and fasting for that purpose than bleeding and cathartics? It is a foolish practice to bleed or drug the system when we have always at hand so much better means.