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The Management of Labour

patient, pains, time, confinement, indeed and interference

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Parturition is the term applied to the pro cess by which the offspring, brought to a certain degree of maturity within the body of the mother, is expelled therefrom, and enters upon a separate existence. A shorter and more familiar word for the same thing is labour.

It is a natural process, and in the vast ma jority of cases is best accomplished by nature's own unaided efforts, without any necessity of meddlesome interference. It is only now and again that interference is necessary or desirable.

As, however, in nearly every case where inter ference is necessary, there is a particular period when it may be more easily and successfully employed than at another, a woman in labour ought to have from the beginning the services of a skilled attendant. If on examination he finds everything going on properly and natu rally, it is a great comfort and encouragement to the patient to be told so; and if, on the other hand, he finds something that requires active interference, he can choose the best time for it, and is ready for the emergency. It cannot, however, be too strongly stated that the cases where interference is really necessary are not so common as is supposed, are indeed rare in proportion to the natural and unaided births.

Symptoms of Labour. — Several things concur to indicate that confinement is near at hand. By the calculation shown on p. 626 the patient should know approximately the date at which confinement should occur.

That the time is near is usually :ndicated by the fact that the enlargement of the abdomen is not carried so high. The patient one day becomes aware that it is much lower down; she walks, also, with leas ease; her joints seem slacker, as indeed they are. As a matter of fact the enlarged womb, with the child, does settle down, and this often happens three weeks before the confinement occurs. As a result of the weight pressing down more on to the pelvis there may be some discomfort about the bladder, more frequent need to pass water; and the bowel also may suffer from the pressure. In

some cases piles form and cause a good deal of annoyance.

False Pains.—The weight of the womb rest ing on the pelvic organs is also likely to occasion irregular pains, which may be mistaken for the commencement of labour, and are called "false pains," and they may indeed lead on to this. As a rule they pass off if the bowels be un loaded, and if the patient takes a good deal of rest.

While these symptoms suggest the approach of confinement, there is no means of definitely fixing the day or hour of its actual onset.

True Pains.—The real process sets in, as a rule, quite suddenly with the true pains. These are distinguished by their regularity in character and in recurrence. A woman in her first labour—a primipara, as she is called—may think, at first, the pains are those of colic, but she will soon notice that they come at regular intervals, perhaps every half-hour, and as time goes on the intervals gradually lessen. Each pain is also of a definite character ; it has its period of gradul increase to a height, it lasts a certain time, and then it rapidly diminishes. The duration is from half a minute to a minute and a half, and during the interval it com pletely disappears, so that even when the interval is only a few minutes the patient may have snatches of sleep.

The Management of the First Stage of labour implies little. As has been already stated (p. 637), what is happening during this period is that the mouth of the womb is slowly dilating in consequence of the insinuation be tween its lips of the bag of membranes. Unless, therefore, the pains from the outset are coming rapidity and violence, the patient may go'- about, and occupy herself, if she pleases, setting things in order. It will be well, indeed, if she can do so.

As the dilatation progresses there will be a little oozing of blood, and much mucus is secreted by the glands of the vagina, so that a stained glairy discharge issues from the passage, vulgarly called the show.

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