It has been pointed out that labour is a I natural process, and thtft in the vast majority of cases it pursues a regular course, with which interference is undesirable and often harmful.
Delay, causing protracted labour, may be due in general to one of these causes : (1) to lack of expulsive effort on the part of the womb; (2) to excessive narrowness or rigidity of the canal through which the child has to pass; or (3) to an abnormally large child, or an unusual posi tion of the child. Some of these causes may come into play earlier in the labour than others. Thus, at the outset the expulsive effort may be sufficient, but it may give out in the later stages ; and, again, everything may go on normally till the child's head is at the outlet, and there it may, by excessive smallness of the outlet or rigidity of the parts, be arrested for a long time, till the woman becomes utterly tired out with her efforts.
It would be profitless to discuss, in a book such as this, all the various causes of protracted labour, the means of distinguishing them, and the measures taken to overcome them, for all these require the attention of a trained medical person, and ought not to be dealt with by a mere nurse or midwife. But it may neverthe less be prudent to give some indication of what a nurse or midwife might do, supposing medical assistance to be far off or long delayed.
The various stages of labour have been de scribed on pp. 637-642, and we shall note some of the more frequent causes of delay operating during the various stages.
Delay during the First Stage. — This is the stage in which the mouth of the womb is opening —dfiating. It has been pointed out that a main agent in the dilating of the mouth of the womb is the pressure of the bag of mem branes insinuating itself between the lips of the womb with each pain. If the membranes have ruptured early in labour, this agent is lost or greatly diminished. If, therefore, a free escape of water occurs when labour should be begin ning, or soon after it has begun, the woman should take to bed to avoid, in the horizontal position, the loss of water as much as possible.
Delay at this stage is sometimes due to rigidity of the mouth and neck of the womb. This is more likely to occur in women who are pregnant for the first time after thirty years of age. It may be also due to irregular contractions of the womb, and to a spasmodic contraction of the mouth, simultaneous with the expulsive effort of the rest of the organ. This cause is easily overcome by the patient being put under the influence of chloroform. This, of course, can only be done by a qualified person, but a dose of chloral hydrate is also very useful, and 10 grains in water might be given, and repeated every half-hour till a total of 30 grains had been given. This should only be given, however, if a long time of ineffective severe pains had elapsed, and an examination with the finger had shown the lips of the womb to be hard, dry, hot, and unyielding.
Delay in this stage by lack of power of the contractions of the womb is generally recognized by the shortness of the pains, the little evidence of suffering on the part of the patient, and the lack of firmness of the womb when the hand is laid on the belly during a pain. Such uterine inertia, as it is called, is frequently due to the nervous state of the patient, and is not in frequently caused by the presence in the lying in room of some person whom the patient would rather not have there. In such cases it would be better that only the nurse should be in the room. A very hot drink often sets the con tractions going more vigorously, and a mild stimulant like a glass of sherry sipped slowly, along with a biscuit, is frequently of great value.
Delay from this cause is sometimes due to a pendulous belly, hindering the pains pressing the contents directly on to the mouth of the womb. This will be overcome by the pressure of a well-adjusted binder.