Treatment.—There is little danger of dangerous bleeding before the seventh month, and a waiting treatment may be adopted, but the woman should be closely watched and told what the trouble is, so she will be willing to remain quiet. Rest in bed, the avoidance of all muscular exercise and quieting medicines may enable the mother to carry the child until it can live, when pregnancy must be quickly terminated. If the child is dead the womb must be emptied at once. After the seventh month an expectant treatment is no longer allowable, and authorities declare the pregnancy should be terminated without delay. The mother is in great danger from sudden free flow. This treatment must be given by an experienced hand and only a physician can do it. If the pregnancy is allowed to continue to full term the danger to the woman is very great, as the mortality runs from thirty to sixty-five per cent; but under modern treatment it has been brought down to five to ten per cent. The death rate of the child is between fifty and seventy-five per cent.
[528 MOTHERS' REMEDIES]
Labor.—Labor may be defined as the physiological termination of pregnancy whereby the mature foetus (child) and its appendages (after-birth, etc.), are separated from the maternal organism.
Premonitory Signs of Labor.—Premonitory signs of labor, usually observed from one to two weeks before the onset of the labor pains, is a sinking down of the womb in the abdomen, whereby some of the unpleasant features of pregnancy are relieved, and the so-called "lightening" takes place. The waist line becomes small, the breathing is easier and the general well-being of the woman is better, so that her friends are attracted by her feeling of relief. But as a result of the womb descent and the consequent pressure, irritation of the bladder and rectum may occur, and she may have frequent calls to empty these organs. The vagina secretes more actively, the veins enlarge, some dropsy may appear in the extremities, and the womb contractions of pregnancy, which have been painless, begin to cause more and more discomfort.
These false pains recur at regular intervals of hours or even days, and generally at night, last for a varying period and usually disappear in the morning. They often deceive the woman and lead her to the belief that the labor has already begun; but examination of the cervix will reveal that this is not so. It is well to bear in mind that the true labor pains usually begin in the back, extend down to the thighs and often around to the front and they recur at regular intervals, and with increasing intensity.
The beginning of labor is characterized by recurring pains at regular intervals and of increasing severity. There is also a discharge from the vagina of mucus, and this is sometimes tinged with blood, "the show." If an examination is now made, it will be found that the cervix (neck of the womb) is shortened, and that the mouth of the womb is beginning to dilate. At the beginning, the pains are usually in the back and spread to the abdomen and down the thighs; but they may be felt first in the abdomen. They return every half hour or twenty minutes, but as labor goes on the interval is shortened, so that toward the end of the second stage when the child is being born, they appear to be continuous, and the patient feels as if she is encircled by a belt of pain; however, with all this, she will bear the suffering easier and better for she knows that progress is being made, and that she will soon be over the pains and the child born. A pain rarely lasts more than one minute.
[OBSTETRICS OR MIDWIFERY 529]
STAGES OF LABOR.—First stage extends from the beginning of labor until the mouth of the womb is dilated. Second stage, from the complete dilation until the complete birth of the child. Third stage, from the birth of the child until the expulsions of the after-birth—Placenta.
The First Stage.—The first stage varies greatly in different women. The average duration of this stage is from ten to fourteen hours in the woman with the first child, and six to eight hours in the woman who has borne children. During this stage the woman prefers to remain on her feet, sit, stand or walk about. The amount of pain experienced varies greatly, according to the temperament of the patient; in nervous women it may be excessive. The pains now have nothing of that bearing down character which they afterward acquire; they are described as "grinding," are usually felt in the front. The genitals become bathed with secretions, which are sometimes tinged with blood. This is an especially trying period to a young wife, for she cannot see that the pains are doing any good, only making her restless, tired and nervous. Little can be done by the physician in this stage except to encourage and explain what is really being accomplished by these seemingly futile pains and by tact and proper encouragement, a physician tides this stage over and gives great comfort to the needy patient. This stage ends with the opening and dilation of the mouth of the womb and the second or expulsive stage sets in, with pains altered in character.
Second Stage.—The pains now become more frequent and severe and last longer, and the patient now manifests a strong desire to expel the contents of the womb. The woman now feels better in bed and when the pains come she involuntarily bears down, with each contraction she sets her teeth, takes a deep breath, fixes the diaphragm, contracts the muscles of the abdomen and bears down hard if you allow her to do so. The knowledge that she is working to overcome an obstacle gives her some satisfaction and she feels that she is accomplishing something by the efforts she is making. The physician can aid greatly by suggesting to the patient how to use the pains and how much bearing down to do. He can tell her when not to bear down, and so save her strength for the next real pain when bearing down will do good. Although the pains are really harder in this stage, nervous women suffer no more, for their mind is now concentrated upon the work at hand. Sometimes at the beginning of this stage the patient feels chilly or has a severe chill; a hot drink and more covering counteract this. Another phenomena is the escape of the waters and a lull in the pains for a little time, when they come on more effectively than before as the womb contracts down upon the child and is not hindered by the "bag of water." The pains keep on at intervals until the child is born and the physician can now be of help by guiding, directing and assisting the birth of the head. This stage averages about two hours.