An unfavourable stale of the Ovum may protract labour. It is said, that the na vel-string may be tied round the neck of the child in its passage through, by which the effect of each pain is lost ; be ing held on each side by the string, it is forced a little forward in each pain, retir ing again as soon as the pain goes off. It does not appear likely, however, that this ever happens, because the effect attribut ed to the elasticity of the cord may be seen in every labour, from the elasticity of the soft parts, and more particularly where the head is larger than the cavity of the pelvis. So that there is no reason to believe this to be a cause of difficult labour. Yet we may now speak of its treatment, when it does occur. The cord is frequently turned round the neck of the child, when the circulation is not in the least interrupted; in this case we have only to turn it off the neck, and if ' the circulation be felt, leave it. Where the loop round the neck is tight, so as to interrupt the pulse, we may loosen it by passing the finger between it and the skin of the neck, so as to feel the pulse again. It has been said to be sometimes so tight as not to admit of its being slackened at all. This is just possible, and the most improbable thing in the world. It is then to be divided between two ligatures.
Rigidity of the Membranes has been stated to produce difficult labour. It has been observed, labour was quicker when the membranes were ruptured early ; but though the labour is slower, it is safer where the membranes are unruptured. Where the membranes are to be opened, there have been a great number of pret ty looking instruments invented for do ing it. Long tubes, at the end of which blades or points were projected. But it requires more skill in telling where they should be let alone, than where they should be meddled with. With the first child they must never be broken : the in ferior parts of the passage dilate but slowly, and require the assistance which the membranes are capable of giving. But in subsequent labours, perhaps, it may be admissible, where the pelvis and soft parts are known to be capacious and yielding. The time when they should be broken is when the head may be receiv ed into the os uteri upon their breaking. Never must they be broken before the os uteri is of the proper size ; if they be, we cause a continual drivelling of the wa ters, which in itself is productive of great delay. It will often protract the labour two days : it has been known to protract it three weeks.
A frequent cause of the Rupture of the Membrane* is the using too violent exer cise for the parts to bear. The riding in a coach over the rough stones will bring it on, as the weaker part will always give way first. Another cause of the mem branes giving way may be the death of the child, for dead members will give way when a living member will not give way.
The next cause of difficult labour is in the dirdenate size of the Child's Head, compared with the cavity of the pelvis. This is not mollities ossium ; but a disease, which, independent of that, is capable of producing considerable difficulty. The
different size of the head will regulate the progress of the labour. The bead may be so large as not to pass, and this increased size of the head may be com bined with a state of pelvis, which in shape resembles a man's ; which pelvis would not admit of a head of an ordinary size. The head may also be accidentally larger than it should be, for two heads of the same absolute size shall in labour prove to be of different sizes : that is, the first shall give way, aud allow of com pression by the soft parts ; while the se cond, by being more perfectly ossified, will not allow the bones to slip one over the other, as in the first instance; for which reason one of these two heads will, in effect, be larger than the other. The volume of the head may be also increas ed by a descent of one or both the hands; or it may occupy undue space by a wrong position. In all these cues, instead of trusting to time, or using instruments, we may generally afford relief by introducing the fingers and turning the head aright.
Independently of these difficulties, there are others of a totally different class; and which produce difficulty chiefly by rendering a labour more complex. The first which we shall notice is the presen tation of the umbilical flung.
We have already explained that the fetal life is that of a fish ; that it is furnish ed with an apparatus resembling gills ; that the Ennis is analogous to the pulmo nary artery and vein ; and that the circu lation through it, if stopped, produces death, upon the same principle that suf focation doesto an animal which breathes. Hence the importance of the funis pre senting. Let what part will present, arms, legs, shoulders, or breech, it is of conse quence from this circumstance chiefly. It is of no consequence in regard to the woman's safety, and all treatment is ap plicable merely upon the simple ground of oreservine the child's life while labour goes forward. From whatever cause the Tunis has presented, the effect is the same, and the treatment must be directed by the circumstances of the case. Suppose the membranes lately broken, and the os uteri pretty fully dilated, he funis down. The best practice here will be, to turn the child, and bring down the feet, as this affords the best chance for saving the child's life; though, where this happens with the first child, it is as well to let it remain, for the operation of turning will then of itself produce the death of the child. Suppose the head in the pelvis, and the navel string pulsating in the va gina; the best way is, to return the navel string, and follow it up with a long strip of cloth, or handkerchief, artfully pushed up, so as effectually to prevent its coming down again ; and as this is the only chance that we have of keeping it above the pel vis, it should never be undone ; and at last the head will get so far down, that it can be delivered by the forceps imme diately. In all cases we should recollect, that the woman's safety never must be hazarded by doing that which will only obtain a precarious chance for saving the life of the child.