461. If, at the commencement of the labor, the “waters should break,” even if there be no pain, the medical man ought immediately to be sent for; as, in such a case, it is necessary that he should know the exact presentation of the child.
462. After an uncertain length of time, the character of the pains alters. From being “grinding,” they become “bearing down,” and are now more regular and frequent, and the skin becomes both hot and perspiring. These may be considered the true labor pains. The patient ought to bear in mind then that “the true labor pains are situated in the back and loins; they come on at regular intervals, rise gradually up to a certain pitch of intensity, and abate as gradually; it is a dull, heavy, deep sort of pain, producing occasionally a low moan from the patient; not sharp or twinging, which would elicit a very different expression of suffering from her.”[[86]]
463. As soon as the pains assume a “bearing down” character, the medical man ought to be in attendance; if he be sent for during the early stage, when the pains are of a “grinding” character, and when they come on “few and far between,” and at uncertain intervals (unless, as before stated, “the waters should break” early), he can do no good; for if he attempt in the early stage to force on the labor, he might do irreparable mischief.
464. Cramps of the legs and of the thighs are a frequent, although not a constant, attendant on labor. These cramps come on more especially if the patient be kept for a lengthened period in one position; hence the importance of allowing her, during the first and the second stages of labor, to move about the room.
465. Cramps are generally worse during the third or last stage of labor, and then, if they occur at all, they usually accompany each pain. The poor patient, in such a case, has not only to bear the labor pains but the cramp pains! Now, there is no danger in these cramps; it is rather a sign that the child is making rapid progress, as he is pressing upon the nerves which supply the thighs.
466. The nurse ought to well rub, with her warm hand, the cramped parts; and, if the labor be not too far advanced, it would be well for the patient to change her position, and to sit on a chair, or, if she feel inclined, to walk about the room; there being of course an attendant, one on each side, to support her the while. If either a pain or a cramp should come on while she is thus moving about, let her instantly take hold of the bedpost for support.
467. I observe, in a subsequent paragraph, that in a case of labor, a four-post mahogany bedstead without a foot-board is preferable to either a brass or an iron bedstead. It will now be seen that this was one of my reasons for advising the old-fashioned bedstead; as the support of a bedpost is oftentimes a relief and a comfort. The new-fashioned mahogany bedsteads made with fixed foot-board, and both the iron and brass bedsteads with railings at the foot, are each and all, during the progress of labor, very inconvenient; as the patient, with either of these kinds of bedsteads, is not able to plant her feet firmly against the bedpost—the foot-board of the former and the railings of the latter being in the way of her doing so. The man who invented these new-fangled bedsteads was an ignoramus in such matters.
468. Labor—and truly it may be called “labor”[[87]]—is a natural process, and therefore ought not unnecessarily to be interfered with, or woe betide the unfortunate patient.
469. I firmly believe that a woman would stand a much better chance of getting well over her confinement without assistance, than if she had been hurried with assistance.
470. In a natural labor very little assistance is needed, and the doctor is only required in the room occasionally, to ascertain that things are going on rightly. Those ladies do best, both at the time and afterward, whose labors are the least interfered with. Bear this in mind, and let it be legibly written on your memory. This advice, of course, only holds good in natural confinements.