The Second Stage of Labour begins when the mouth of the womb is sufficiently widened to permit each contraction of the womb—each pain — to urge the child through the opening and down the passage to the outside, and it ends with the birth of the child.
• During this stage the bag of fluid is no longer a help, but rather a hindrance, and, therefore, it is proper for the attendant to introduce a finger into the passage, and when a pain occurs to press the point against the bulg ing and stretched part so as to burst through it. This permits the escape of the water and allows the advancing part of the child to come directly into contact with the walls of the pas sage, which it is best able to stretch.
The upper and inner end of the passage is formed of the bony rim of the pelvis, and is practically unyielding, so that the child in advancing through it must have its body com pressed and moulded to permit of its passage. Were the pains constant the continued com pression might be injurious to the child, and so the, intervals of rest, though brief, are beneficial. The remainder of the canal is formed of soft and yielding structures, which the advancing part of the child stretches with more or less ease. But here again the periods of contrac tion, followed by intervals of rest, permit the parts to be stretched to some extent and then to be released from pressure. Thus the widen ing of the passage is accomplished gradually, and without risk of injury.
During the second stage the patient naturally fixes her body, bends the knees up towards the body and the head towards the chest, grasps something fixed with the hands, and, holding her breath, presses down. The pressure thus exerted by the walls of the belly greatly aids the process of delivery. During this period, therefore, the patient remains in bed, and the more quietly she lies, the more firmly she holds her breath while the pain lasts, and the more vigorously she presses down, the • more speedy will be the termination of her suffering.
In a few cases, when the child is advancing with great rapidity, and the parts are being stretched too quickly and forcibly for safety, one does not permit the patient to have any thing to grasp, and, instead of urging her to hold her breath and press down, one asks her to cry out, to refrain as much as possible from pressing down, and thereby to prevent the pressure by the walls of the belly.
The pains during the second stage are felt at the back, and the patient is much aided by someone pressing the back firmly with the palm of one or both hands.
Towards the termination the mother feels something pressing low down, and the bulging and opening out of the external parts indicate the near approach of delivery. The advancing part of the child appears at the external open ing, which it widens as the pain occurs. With
the interval of rest it retreats. When another pain occurs it advances further, stretches the opening still more, and with another interval again retreats. The child may seem just about to be born, when the pain ceases for a minute or two and it goes back again. This some times disheartens a mother somewhat, but it is desirable, for it permits the gradual widen ing of the opening, and diminishes the risk of tearing. Finally, with a great effort, the first part of the child is horn, the rest of its body quickly follows, and the delivery of the child is accomplished.
The Third Stage of Labour, however, re mains. It consists in the expulsion of the after birth, with which the cord passing from the child's navel is connected. It is not usually accompanied by much pain, and occurs within from five to thirty minutes of the birth of the child. It is often expelled from the womb when the child is born, and lies in the passage for a little time, till it is removed by gentle pulling on the cord by the attendant, or ejected by contractions of the walls of the passage itself.
The after-birth is separated from the wall of the womb by its contractions. But with its separation blood - vessels of the mother are opened and a raw surface is left. From this, for an instant, blood escapes in considerable quantity, but is speedily checked by the con traction of the womb, which now becomes per manent, squeezing the mouths of the bleeding vessels together and thus closing them. Some blood remains in the cavity of the womb, which is reduced by the contraction to very small dimensions. It gradually oozes away as dis charge. Any clots that remain do not escape so readily, and excite small contractions to get rid of them. These are the occasion of the after-pains. So that the more thoroughly the womb is emptied of all clots, after the separa tion of the after-birth, the fewer will be the afterpains; and they will be severe and trouble some for a day or two if any quantity of clots has remained behind. Osually after-pains are absent in a first labour.
Tho Duration of Labour varies naturally with the size of the child and the width and capacity of the canal through which it must pass, as well as with the age, vigour, and build of the patient. It is longer in first labours than in those subsequent, on an average twice the length. The average for first labours is roughly twelve hours, and for others six. The first stage occupies generally two-thirds of the whole time. At the same time it is not possible to gauge what is likely to be the time occupied during the later stages from that occupied by the first. For a labour which has begun quickly and gone on quickly for some time may become much slower as its termination approaches, or the reverse may occur.