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The Stages of Natural Labour

womb, mouth, stage, child, walls, muscular, membranes and time

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THE STAGES OF NATURAL LABOUR. The First Stage of Labour. — Natural labour is the process by which the child is ex pelled from the womb and born into the world, It occurs at the end of the ninth calendar month of pregnancy, or, as has been already mentioned, about 280 days after conception. It probably begins at the time when a monthly illness would have been due, counting such illness as recurring every twenty-eight days, that is to say, at the time when the tenth monthly illness from the time of conception would have become due.

As we have seen, the womb is composed largely of muscle. As pregnancy advances it becomes greatly enlarged to make room for the growing child. Its walls also become greatly increased in thickness, and the muscular fibres become increased not only in number but also in size. The chief force in labour is the con traction of these muscular fibres. The fibres are so arranged in the walls that when they contract and shorten the" tend to diminish the size of the womb and of its cavity, and thus act in the direction of squeezing out of the womb its contents. The walls are so strong that when they contract in this way they exert a very great force, and are thus able to overcome very great resistance to the expulsion of what ever the womb contains. The amount of resis tance will depend on the bulk of the contents —on the size of the child--and on the width of the passage through which the child has to pass before reaching the outside. The first resistance, however, occurs at the mouth of the womb, which is closed, or at least not much wider than to admit the passage of anything thicker than an adult's finger. The child can, therefore, make little advance along the pas sage till the mouth of the womb has been sufficiently dilated or stretched, and this open ing up or dilatation of the mouth of the womb is, accordingly, the first thing to be accomplished in the labour process. It forms the first stage of labour.

It has been already mentioned (p. 625) that the child is inclosed in a bag of membranes, floating in a liquid (the waters), having a cord attached at the navel by which it is connected with a mass called the placenta or after-birth (p. 6247attached to the inner wall of the womb, by means of which union with the mother is maintained. By the contraction of the muscular walls the bag of membranes, with its contents of waters and child, is pressed on and forced in the direction of least resistance, that is, against the mouth of the womb. The mouth being slightly open, the membranes and their con tained fluid bulge into the slight opening, and are a very active agent in widening it. Some

times the mouth of the womb is rather rigid, and the force pressing the membranes into it is so great that the pressure of the fluid bursts them, and a gush of water takes place—" the waters are broken," as the phrase is. The part of the child's body that is directed downwards — usually the head — is then pressed directly against the mouth of the womb, but it being larger, and not able to insinuate itself into the small opening as the bulging membranes did, dilates it much more slowly, and the labour is all the more tedious. During the first stage of labour, then, it is desirable that the mem branes should remain unruptured, and that the "waters" should not escape.

It is the contractions of the muscular walls of the womb that occasion the pain characteristic of labour. They are not continuous, but last only a brief period, so that there are periods of pain followed by periods of freedom from it. The intervals of rest prevent exhaustion of the muscular walls, and also of the mother, and at the same time permit the mouth of the womb to be gradually and gently opened up without risk of injury, while the child also is allowed an interval to recover from the compression which, in the later stage of tabour, each contraction exerts on it. The pains during this first stage are of a cutting or grinding character, and are usually trying to the mother, because she feels as if no progress were being made by them. She is often on this account irritable and rest less under them, frequently changing her posi tion and uttering complaints. A considerable interval elapses between each pain in this stage, perhaps twenty or thirty minutes at first, but the interval gradually lessens as the opening up of the womb becomes more nearly sufficient, till towards the end of this stage they may be returning every five minutes or oftener. The pain is usually felt more in front. While this stage lasts, efforts of straining or pressing down wards do not render any assistance in opening up the mouth of the womb, and they ought not to be mom-aged, since they throw away the patient's strength, which ought rather to be reserved for the second stage, when they are of great value. It is of advantage, however, for the patient to move about her room, and interest herself in some gentle occupation dur ing the intervals of rest, rather than confine herself to bed.

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