Sometimes also an excess of waters, by over distending the womb, causes ineffective pains. Rupture of the membranes is the remedy for this condition, but no midwife or nurse should lightly adopt this procedure. It has been pointed out (p. 841) that frequently the womb sinks down on to the pelvis even three weeks before the due end of pregnancy, and this fall ing down, by the pressure exerted on soft parts, often sets agoing pains quite like labour pains. False pains they are called. In many caeca a single dose of a sedative will allay them. But they frequently go on, intermittently, for many hours. A hasty nurse, mistaking these for real pains, getting impatient at the failure to pro gress, and deciding to rupture the membranes, would commit a grave error of judgment, which might be paid for by the child's life. For so long as the membranes are entire, and the waters surround the child, it is safe.
Whatever may be the cause of delay in the first stage, drugs for increasing the vigour of the uterine contractions must never be used by any non medical person. In particular, ergot must never be employed.
Delay in the Second Stage may also be due to failure in the contractions of the'womb to force the child on, or to narrowness or loss of elasticity of the passages, or to blocking of the passages by some obstruction, or to the size or position of the child. This is the stage begin ning when the mouth of the womb is fully dilated and ending with the birth of the Now, when the mouth of the womb is fully dilated, it is possible for the trained person to determine by finger examination the part of the child which is coming first, and also what rela tion that part bears to the canal through which it must pass. Thus the finger can not only ascertain whether the child is advancing head first, but also in which of the four positions noted on p. 639 the head is placed. But at
this time the child is not yet engaged in the birth-canal, it is only about to enter the canal. If there is anything irregular in the presenta tion—the part of the child that is in ad van ce,—if, for instance, the child is lying across the mouth of the womb and a shoulder is presenting, this is the time when a little manipulation can easily rectify it. By this time, also, a competent medical man would have ascertained that there was no undue narrowing of the passage and no obstacle to the gradual pogress of the child along it. These circumstances make it clear that, if possible, nothing should be permitted to stand in the way of a woman having, at the very least, the advice of a medical man early in her labour.
When the mouth of the womb has been fully dilated, the bag of waters ceases to be of any further value. If the membranes remain un ruptured, the retained waters only hinder the advancing part of the child coming into contact with the walls of the canal, and so hinder pro gress. In the second stage of labour, therefore, unruptured membranes are as much a hindrance as in the first stage they are a help. Some times, therefore, iu the second stage of labour rupturing the membranes is all that is required to hasten delivery.
It would be quite profitless to consider here causes of delay due to narrowness of the passages of the mother or exceptional size of the child. The remedy for the most of these conditions is some form or another of operative interference.
Allusion must, however, be made to two conditions, the subjects of the immediately following paragraphs.