Midwifery and the diseases of women

by Joel Shew

There are three of these membranes, which are found surrounding the fetus. “There is first the outer, or connecting membrane, which is flocculent, spongy, and extremely vascular, completely investing the whole ovum, and lining the uterus; secondly, the middle membrane, which is nearly pellucid, with a very few small blood-vessels scattered over it, and which form a covering to the placenta and funis, but does not pass between the placenta and uterus; thirdly, the inner membrane, which is transparent, of a firmer texture than the others, and lines the whole ovum, making, like the middle membrane, a covering for the placenta and funis. With the two last the ovum is clothed when it passes from the ovarium into the uterus, where the first is provided for its reception. These membranes, in the advanced state of pregnancy, cohere slightly to each other, though in some ova there is a considerable quantity of fluid collected between them, which being discharged when one of the outer membranes is broken, forms one of the circumstances which has been distinguished by the name of by, or false waters.”

It seemed necessary that I should make these preliminary remarks concerning the physiology of the placenta and the membranes, in order that you might the better understand the third process of labor, or that which consists in the expulsion of these growths, the secundines, as they are called.

I have now some practical remarks to make, which I hope you will study faithfully, for it not unfrequently happens that a child is born before you can obtain the assistance of a physician; and after the child has been expelled, what to do in reference to the after-birth; that is a question which, under such circumstances, puzzles your sex more a great deal than it need or ought to do.

Suppose, then, that a child is born suddenly, or at least before the medical man or woman whom you would employ, comes to your aid, and the placenta remains undelivered.

I shall tell you, in another place, not to be in such a flurry, as women too often are, in regard to separating the umbilical cord. So, too, I say in regard to the after-birth; be in no hurry.

Have you not often heard people say that the after-birth has grown fast and sticks? Women sometimes say this, and so do the doctors, some of them; such, for example, as are not honest enough to tell the truth, if they know it, and would make you believe that they are doing a great thing when they get away the after-birth, if it sticks.

Now please remember that it is right that the placenta should grow fast to the womb; that is, to its inner surface. It is always grown fast, and should be; but it is possible for it to adhere more firmly in some cases than in others; and in some cases, too, the uterus seems to be so weak that it has not power sufficient to expel it.

In cases when the womb is very active after the birth of the child, the placenta may be expelled very quickly.

But it is more commonly the case that after the uterine contractions have forced the child into the world, the womb reposes itself for a half hour, less or more. After this, periodical pains begin to occur, so that the after-birth may be completely thrown forth into the world; but far oftener it is either wholly, or in part only, into the vagina, where it remains for a time at least.

At what time, and under what rules, should manual aid be administered in helping away the after-birth? By different practitioners different rules have been instituted. A rule of Dr. Hunter’s was to wait till four hours after the birth of the child. If the placenta come away of itself, before this time have elapsed, it is well; but if, on the other hand, it still remain in the cavity of the uterus, manual aid may become necessary.