The os uteri may also become a cause of difficult labour by its being rigid. This state is natural to some women, and especially those who are somewhat ad vanced in life when they begin to bear ; also with the first child the parts dilate more slowly than in subsequent labours. Rigidity may arise from repeated and use less examinations; and where the os nte ri is rigid, it forms one of the most pain ful labours, accompanied with excruciat ing pains in the back. This state is at tended with inclination to vomit and to sleep, both which things are in them selves useful : for sleep restores the strength of the body, while the vomiting strengthens the bearing down.
The os uteri, when in this rigid state, resembles inflammation, it being tender to the touch ; its hardness almost reminds us of a board, which is bored through the middle with an augur. This is one of two kinds of rigid os uteri, the other description of which gives a very differ ent feel : it is more apt to give way under the finger, is of a pulpy substance, and in some measure resembles the intestine of an animal filled with water and drawn ; into a circle and though this is nut so rigid to the finger as the other, yet it is longer in giving way. This sort of swell ing, or thickening, is sometimes occa sioned by edema, or ecchymosis, as it has been known to arise in a quarter of an hour ; at the same time it lies between the os pubis and the child's head. It ge nerally happens, that from the pain there is a degree of fever present. But when once one part of the enlarged circle re tires behind the head, the whole of it slips up, and the child is sometimes born in five minutes, if there be no resistance from the soft parts.
We must here be very cautious not to allow the woman to exhaust herself in fruitless efforts ; for which reason we should explain to her that it will be of no avail, that the mouth of the womb is not large enough to admit of the child's pass. ing, and that it must be a work of time, and will be a work of time, notwithstand ing all the ehdeavours she may make to shorten it. We should, in the meanwhile, fill up our time, and keep up her atten tion, by ordering.,an injection, or making some other preparation; and if the last be a six or eight ounce mixture, in case the os uteri is very irritable, and by fre quent examination has been rendered more so by being deprived of its mucus, twenty drops oflaudanum may be added to the mixture. Where the os uteri is rigid and unyielding, the vagina hot and dry, and accompanied with a feverish state of the system, the most effectual remedy is blood-letting.
In difficult labours it will now and then happen that the vagina is very rigid, mak ing considerable resistance; this very ge nerally depends on irritation, by the in terference of the midwife. The conse
"pence is, that inflammation of the peri osteum and membranes covering the bones very often arises. In such cases, patience and horizontal posture are both grand remedies : besides which, why not use fomentation, as in whitlow, or any other case where relaxation is wanted The next cause that impedes labour, from resistance of the soft parts, is a full bladder and suppression of urine. This is not a formidable evil In early examina tion we shall, instead of feeling the mouth of the uterus, come to the neck of the distended bladder; but in the progress of labour the child's head presses upon the neck of the bladder, which pressure cau ses the suppression. This will never happen if the bladder be frequently emp tied in the early part of labour, because the time between the head's being at the upper aperture of the pelvis, and deli very, is in general of a moderate duration, in. which no serious accumulation can take place in the bladder, unless the la bour is very long. When it is necessary to draw off the urine, the catheter will enter the meatus urinarius with greater ease if its curve be a little increased. With regard to a woman in this situation, we should never rest satisfied that her bladder is not dangerously full, because we see a little water which has passed without the instrument. We must never allow the woman's delicacy or dislike, to prevent our examining : we must repre sent to her the importance of it ; for if she die from a burst bladder, it will be a very deplorable circumstance, as it is so easily prevented.
Contraction of the vagina forms another impediment to labour. If this be the consequence of a cicatrix, it will some times be proper to divide it by a knife, in order to allow the child's head to pass through : when we attempt to divide it high up, we are in a very delicate situa tion on account of the bladder and rec tum : and if the bead have passed so far forward as to come into view, it will be advisable to leave it to nature. Excre scences arising from the os uteri or vagi. na may impede labour, though these cau ses in general only produce slight diffi culty: the os uteri has been known to be in such a state from a tumour on its side, that only two-thirds of the circle have di lated for the passage of the child's head. In most cases the tumour is pushed aside, so that it occupies a projected situation during labour, and the head passes very well.