About this time the bag of waters usually bursts, and, as a rule, this marks the beginning of the "second stage of labor." The amount of water passed varies in amount. Should the rupture take place before the door is fully open, then labor proceeds with difficulty and the condition is known as "dry labor."
The head after proper rotation now begins the descent; and here the pains begin to change from the sharp, lancinating, cramp-like pains which begin in the back and move around to the front, to those of the "bearing down" variety, while at the same time there begins to appear the bulging at the perineum, which means that the head is about to be born. At this time great stress is brought to bear upon the perineum and often, in spite of anything that can be done to prevent it, the perineum is more or less lacerated.
As soon as the baby is born the "second stage of labor" has passed and within thirty to fifty minutes the close of the third stage of labor is marked by the passage of the placenta or "afterbirth."
FALSE LABOR PAINS
Sometimes, as long as two weeks before the birth of the child, certain irregular, heavy, cramp-like pains occur in the abdomen and back. For a half-dozen pains they may show some signs of regularity; but they usually die down only to start up again at irregular intervals. These are known as "false pains."
When the pains begin to take on regularity and gradually grow heavier and it is near the appointed time for the labor, the patient should prepare to start for the hospital; or, if it is to be a home delivery, the physician should be called. As noted above, the first subjective symptom may be the rupture of the bag of waters, and it is imperative to prepare at once for the labor. It is far better to spend the day at the hospital, or even two days waiting, rather than to run the risk of giving birth to the child in a taxicab or street car; or, in the event of a home labor, to have the child born before the doctor arrives.
WHAT TO DO IN THE ABSENCE OF A DOCTOR
It is often the case that when we need our physician the most, he is busy with another patient and cannot come, or perhaps an automobile accident detains the man of the hour. The hospital delivery always possesses this advantage over the home—physicians are always on hand. We deem it wise to relate in detail the method of procedure during the rapid birth of a child; that the husband or nurse may give intelligent and clean service.
After the patient has been given the enema and has been shaved and the bath has been administered as previously directed, the helper most vigorously "scrubs up." There are three distinct phases to the "scrubbing up": First, the three-minute scrubbing of the hands and forearms with a clean brush and green soap; to be followed by, second, the trimming and cleaning of the finger nails, for it is here, under the nails, that the micro-organism lives and thrives that causes child-bed fever or septicemia; and, third, the final five-minute scrubbing of the fingers, hands, and forearms. An ordinary towel is not used to dry the well-cleansed hands, but they are now dipped in alcohol and allowed to dry in the air.
And now if the pains are returning every three to five minutes or if the bag of waters has broken, the patient should go to bed. She will lie down on her back with the knees drawn up and spread apart. The patient, having had the cleansing bath, is now washed with the disinfectant bath (2 antiseptic tablets to 1½ pints of water), from the breasts to the knees. Another member of the family takes the outer wrappings off the sterilized delivery pad and the "clean" helper places the sterile delivery pad under the expectant mother, who is directed to "bear down" when her pains come. She may be supported during these pains by pulling on a sheet that has been fastened to the foot of the bed.