Mother, Nurse and Infant / A Manual Especially Adapted for the Guidance of Mothers and Monthly Nurses, Comprising Full Instruction in Regard To Pregnancy, Preparation for Child-birth, and the Care of Mother and Child, and Designed to Impart so Much Knowledge of Anatomy, Physiology, Midwifery, and the Proper Use of Medicines as Will Serve Intelligently to Direct the Wife, Mother and Nurse in All Emergencies.

by S. P. Sackett

5. The uterus may be greatly distended and its expulsory power thereby weakened. In such cases there may be a suspension of the action of the uterus for several hours although the labor before that had made considerable progress. If pains of labor are feeble or slow or suspended, no harm can come to the mother or child (in such cases) except that the mother is compelled to bear them for a longer time. The only remedy that I would suggest is that the distention be relieved by the rupture of the membranes and discharge of water. If more efficient pains did not come on, then I would give a dose of morphine, which would either increase the pains, or give a period of rest.

6. Sometimes there are vehement and cramp-like pains in the abdomen producing no effect that is good and adequate, caused by partial irregular or spasmodic contractions of the uterus—usually what are called hour-glass contractions. If the bowels have been evacuated and there is no improvement, I would give one-fourth grain of morphine which will enable the woman to go through her labor more easily, and perhaps quite as quickly.

7. It is generally believed that a cord being very short and being around the neck of the child may protract a labor. I do not deny that this may possibly occur, and when the child’s head is born, and I find that there is a coil of the funis on its neck I loosen it.

8. Weakness of the constitution when the general health of the woman is below the natural proper standard may be a cause why the uterine contractions are not severe. But in such cases the parts are not rigid, and nothing more than a dose of four or five grains of quinine is needed to make the pains effectual.

9. A want of irritability in the constitution frequently observed in fat and inactive women, or in those who are exceedingly timid, will sometimes be a cause of slow and lingering labor. Fear often lessens the energy of all the powers of the constitution, and diminishes or wholly suppresses for a time the action of all the parts concerned in parturition. Attendants should endeavor to inspire such patients with activity and resolution, and remove all fear from their minds. These cases are not dangerous but I have often found it necessary in this kind of cases to apply forceps. The skilled nurse might perhaps give eight or ten grains of quinine, if no physician has charge of the case.

10. Every woman is expected to suffer greater pain and to have a more tedious labor with her first child, and if a woman be advanced in age at the time of having her first child the difficulty attending her labor may be somewhat greater. A longer time may be required for the completion of the labor than in ordinary cases, but I do not advise giving any medicine unless it is perhaps a dose of quinine. There may be a little more need of assistance by instruments, &c.

11. An oblique position of the os uteri, it being projected on one side or the other of the center of the superior strait, or so far backwards that it cannot be felt for several hours after labor has begun, is a cause of delay. The presenting part may be found pressing against the walls of the pelvis at one point, instead of keeping its course in the center of the pelvic cavity. You should endeavor to place the patient so as to remedy this condition. When the presenting part is found to one side, it will be found that the fundus of the womb is lying to the opposite side; this should be remedied by a proper support of the abdominal tumor or by holding it up by the hands. For example, if the os uteri be projected to the left side, she ought to rest on the right side and have a pillow placed under her body; some physicians would prefer that she lay on the left side, but without the pillow under her.

12. Extreme rigidity of the os uteri is a cause of tedious and very painful labors. It sometimes happens that the os is dilatable, but the pains are not sufficiently expulsive. Perhaps at the same time the os is found far back towards the promontory of the sacrum, and the head appears not to be driven directly into the os so as to aid in its dilatation, but rather presses against the anterior wall of the cervix. In such a case the end of the finger can be hooked into the anterior lip of the os uteri so as to aid in the dilatation, and also to help correct the displacement of the os. In other cases we may help dilate the os by a firm and gentle sweep of the finger around the advancing part of the child’s head within the os. But we cannot always do this, because we may be afraid of rupturing the membranes prematurely. If the membranes have been already ruptured, we may act more boldly, but we must never make any great efforts to dilate it artificially lest we excite inflammation. In many cases it is best to give ¼ gr. of morphine, and inform the suffering woman that she cannot possibly get through her labor in a short time, but if you can give her an hours’ rest, the os, which is rigid, will be more relaxed and pains more effectual.

13. In first labors there is sometimes unusual rigidity of the soft parts, which are external. Where the perineum is rigid it may require several hours continuance of the pains before it is sufficiently stretched to allow the head of the child to pass. But the difficulty can hardly be relieved by our interposition. We should generally wait the due time, as we must also if the os coccygis is anchylosed with the sacrum.

14. The head of the child may be comparatively large when the pelvis is of the ordinary form and size. This may be a cause of delay though it may perhaps cause nothing more than prolonged, tedious labor. In such cases you have time to send for a doctor, even if he lives at a distance. After the woman has been a long time in labor he will think it best to apply the forceps.