DIFFICULT LADOUIL Of difficult labour there are three ape. cies : First, those labours which, though protracted, are ultimately accomplished by the powers of nature unassisted by art. Secondly, those which, although requir ing the assistance of art, yet are compati-% ble with the life both of the mother and the child, Thirdly, those which, besides being accomplished by artificial means, require that either the life of the child must give way to save the parent, or that of the parent to preserve the child.
The first source of difficulty is weak ness. We know that labour requires a certain quantity of force or power, there fore labour is more likely to be difficult in weak than in strong women. We have many proofs to the contrary ; but, generally speaking,it is so.
Fatness is another predisposing cause of difficult labour; fatness offers resist me, and generally occurs in women of weak constitutions : so that here we have both resistance and want of power. All asthmatic and pulmonary oomplaints generally will cause difficult labour. We know that to resist the contractions of the it is necessary to take and keep a full inspiration ; and where the cheat is not equal to the task imposed upon it, the labour will be more probably pro. tracted.
Deformity of Body, attended with con stitutional weakness, will generally pro duce difficulty in labour ; it is most like ly that in these cases the pelvis is not formed as it should be, partaking of the state in which most of the other bones are. If a woman be too young, the pel vis will not be perfectly formed ; and if too old, the parts will be rigid. The best time for a woman to commence child bearing is between the ages of eighteen and twenty-five. For though a woman may be in perfect health at thirty-six, yet we know that the parts were design ed to be used at eighteen, and have been inactive for the rest of the time, and can not then be so fit to act.
The next kind of difficulty in regard to labour is Debility of the Uterus, not disposing it to contract. This may hap.
pen in a woman otherwise strong, as a man may have a weak arm, while the rest of his body may be strong. Such a wo
man may have no character of weakness about her but this, so that we may not be able very readily to guess at the cause when it exists. It is not proper to give stimulants and opiates here, to provoke contraction of the uterus; when stimuli are given, it is not recollected that they produce fever. Opiates are not quite so exceptionable ; they save time to the practitioner, but in their effects we can not govern them, else they occasionally save the woman's strength.
Another cause of difficult labour is the irregular contraction of the fibres of the uterus ; where the longitudinal set, and the circular set, do not contract as they should do relatively to each other. This always arises from irritation of the os ute ri, in needless examinations. The patient has strong labour pains without the d very being forwarded. We may here re commend a dose of opium ; after which, it is probable that, upon their action recom mencing, it will be in the natural manner.
Passions af the Mind are the next set of causes of difficult labour. The effect of them is to diminish the strength and fre quency of the pains, till they at last sub ale altogether; and this will also occuritt constitutions where the powers of action were originally very good. These things 'hew the necessity of keeping up the hopes of the patient to the pitch of secu rity and confidence; for from the moment that her confidence fails her, from that moment the pains are protracted, and that merely from the state of doubt and arising anxiety. This points out the ne cessity of never forming a prognosis of duration ; we may form and declare our opinion as to the event, but never the length of lime which the labour shall last; for if we.were to speak the truth, our prognosis would be in general very unsa tisfactory. If we only tell a patient it will be to-morrow before the child is born, it will depress her resolution, and damp her perseverance ; the pains will diminish, and she will be all the worse for what has been said.