Midwifery and the diseases of women

by Joel Shew

Another rule is, to judge by the pains, without any regard to the length of time that has elapsed since the delivery of the child; pains, it is said, accompany the contractions; the contractions expel the placenta; the pains, therefore, indicate the time at which artificial assistance should be interposed.

Another rule is, first to determine the situation of the womb before any manual attempt is made for helping away the after-birth. If, on examination, the placenta is found lying in the upper part of the vagina, and through the os uteri, and more especially if the union of the umbilical cord with the placenta can be felt, it is considered proper to remove it. But if the umbilical cord ascend high into the womb, and no part of the placenta can be felt, it is considered best to wait.

Still another rule is, to act according to the feeling and condition of the uterus, without any regard to the length of time after the birth, the pains, or the situation of the placenta. If, on examination externally, it is found that the womb is yet large, uncontracted, and pulpy, the placenta should not, according to this rule, be interfered with. But if, on the other hand, there is an opposite state of things—that is, if the uterus is found hard and contracted, feeling like a child’s head in the abdomen, and if it remain so for some time permanently, it is considered safe and best at once, in a proper manner, to remove the viscus. A skillful practitioner will bear in mind all these circumstances, and form a rule out of all of them, as it were, to guide him in each individual case; and I wish you to remember, that although you may consider the principal part of delivery is accomplished at the time when the child comes into the world, it is to be remembered that its real danger has not yet commenced, and that the birth of the placenta is a most important part of the process.

Into all the niceties and difficulties of this part of the accoucheur’s art, I do not, you will remember, attempt to induct you. It is my object to give you some general ideas of the matter, such as may be of use to you in an emergency, and prevent a great deal of unnecessary anxiety and alarm in some cases. My remarks will also, I trust, go to impress upon your minds how very necessary it is, under such circumstances, to have the aid of a physician—a man or woman, I care not which—who understands well the art. You may say that nature is sufficient in most cases to perform her own tasks unaided and alone. That, I admit, may all be true, especially with those who have good constitutions, and who observe well the laws of life. But remember that these circumstances do not always exist. Any one of you would rather incur the expense of having a physician a thousand times, when he is not needed, than to suffer danger for his want in a single instance.

OF FLOODING AFTER DELIVERY.

Hemorrhage is one of the most dangerous of all circumstances connected with labor. Fortunately, however, this does not often happen; and in those cases when it does occur, it may generally be very soon arrested, provided the proper means are adopted.

This form of uterine hemorrhage not unfrequently occurs when the physician is absent. For this reason, it is necessary that I should make some remarks on the subject.

Flooding may be either external or internal. When the blood passes from the vagina, we call it external; when it does not thus pass off, but remains within the cavity of the uterus, causing the abdomen to swell and the patient to faint, we call it internal.

Here is a remarkable fact in nature. Women, in consequence of possessing the menstrual function, and being exposed to the accidents of childbirth, are more subject to hemorrhage than men. In striking accordance with this fact, it appears to have been a benevolent intention of the Creator to form the female system in such a manner that it more readily recovers from profuse loss of blood than that of the opposite sex. Under the effects of severe loss of blood, the system of a man remains pale and enfeebled for months, perhaps, while that of a woman regains its strength and color in half the time. Many a time, before I was aware of these facts, I have been fearful, and sometimes greatly alarmed at the amount of blood lost at the birth of a child, and when, to my great surprise, in a day or two the patient was up, and apparently almost as well as ever. This, then, is an important practical fact, and one well worth remembering.

In regard to the treatment of flooding after delivery, I refer you to what I have already said under the head of uterine hemorrhage. Cold, remember, is the great agent here, as all acknowledge.