The urine should frequently be evacu ated, and the perineum supported with the practitioner's left hand as soon as the child's head rests upon it.
The reason why the perineum needs this support is simply this ; a woman bears down with a force equal to three, one of which is voluntary ; the natural structure of the perineum has enabled it to support, without danger, the contrac tion of the uterus ; it has therefore, of itself, a power superior to two, which is the force of uterine contraction ; but in consequence of the patient's voluntary efforts being added to the involuntary efforts of the uterus, a force equal to three is acting against a power equal to only two. By pressing against this part, we do not say the head shall not come out ; we only say it shall riot come through a hole which is too small to receive it. In supporting the perineum, it may be done through the medium of a folded cloth, which is held in the hand upon the peri neum, and keeps the hand clean from occasional discharges of meconium or feces, waters, &c. and the perineum should not be left unsupported till the shoulders are born ; indeed laceration more frequently happens while the shoul ders are passing, than when the head is, The great art is, to give support close to the edge, against which the greatest force is acting, for the parts give way first at the edge. The perineum is to be sup. ported from the time that it is stretched by the pressure of the head, and we roust take care that we apply sufficient force to counteract the voluntary efforts of the patient.
As soon as the child is born, breathes, and cries, we should tie the navel string. To do this, about ten threads must be joined in the ligature ; the first made about two inches from the body, and the second the same distance from that again, or towards the placenta. The division is made between the two ligatures, the se.
cond being only intended to prevent the blood escaping from the divided cord, and staining the bed. The next step to the separation of the child is the placing -dry clothes under the patient, and to the perineum. Midwives apply them warm ; this should only be done in winter, for warmth increases the discharge from the uterus. We should then lay the hand on the abdomen, to ascertain whether there is another child in the uterus ; being ea. ,tisfied of that, we are to proceed to the extraction of the placenta.
The uterus contracts after the birth of the child, so as to contain only this sub stance ; and its contractions being conti nued, the surface naturally must first loosen and then separate itself from that of the placenta ; and the same contrac tion which separates, expels it. It is ge. nerally necessary to pass the fingers up upon the cord which is held in the other hand, and if we be able to feel the root of the placenta, the separation is complete, and we have only to get it gently out from the os uteri. If the root of the placen ta cannot be felt, it is dangerous to pull the cord with any degree of force ; it is still attached to the uterus, and may pro. duce inversion of the womb. When, by gently drawing the cord, we have got the placenta and membranes down to the os externum, we should have a basin ready to slip it under the bed clothes ; and in drawing the placenta out, the cleanest way to bring the membranes with it is, to turn it round, by which means, after a few turns, we separate them neatly ; after which it will be venient not only to lay under the patient the end of the folded sheet which hung over the bed side, but also to make some degree of pressure upon the abdomen by bandage; after which she may be entrust. ed to the care of the nurse.