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Inflammation Parotid Gland

womb, child, head, pressure, usually, birth and placenta

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PARTURITION.—The process of bringing forth a child. Childbirth usually takes place about 280 days after conception, and is accomplished by contractions of the womb, by the opening of the uterus, and by muscular pressure of the abdomen. The contractions of the womb, which are present during the entire period of pregnancy, become stronger toward the end, and lead to a loosening and gradual distension of the lower portion of the womb. These so-called labour pains widen the mouth of the womb, and force the presenting part of the foetus (usually the head) into it. As soon as the mouth of the womb (cervix) is fully dilated—that is, as soon as it will allow the passage of the head—the amniotic sac containing the waters usually ruptures, and the woman feels their discharge.

After the discharge of the waters the woman must be prepared for birth to take place at any time. In first pregnancies the rupture of the sac may take place too early, and a dry, tedious labour ensue. The rupture of the waters is a usual sign that the initial stage of childbirth is passed. Following this event, the labour-pains generally become more and more severe, and involuntarily the mother seeks to aid in the expulsion of the child by " bearing down." In her endeavour to do this she supports hands and feet firmly against the sides of the bed, drawing her breath deeply and at long intervals. This hearing down is usually a bad practice. It is true that it often aids in the birth of the child, but it is apt to rupture the vagina or other important parts.

As soon as the head of the foetus begins to exert pressure upon the intestine and the perineum, the patient feels a strong inclination to defcate. This inclination should not be gratified. Following the severe pains accompanying the pressure of the foetus, the child's head is forced into the cleft of the vulva, gradually distending the latter, and finally passing through the external opening and beyond the receding perineum. The head is followed by the shoulders of the child, and the remaining parts of the body slide out easily. The birth of the head is usually the most difficult part of the labour. In the passage of the head it frequently happens that the

perineum (that part of the body situated between the vagina and the anus is more or less torn. The narrower the vagina, and the more resistant the perineum, the more readily do these tears occur. Such ruptures should at once be sutured by the attending physician, in order to prevent infection, which may result in inflammation or even in blood-poisoning. Furthermore, experience has taught that the loss of perinea] support may cause the descent and prolapse of the internal genital organs. If the patient be sensible, and heeds the advice of her physician, it may often be possible to prevent such a tearing.

In case of premature birth, when the parturient is delivered without assistance, she should wait quietly until help arrives. She should place the infant between her thighs in such a manner that it is well covered, and able to breathe freely. Some time after the expulsion of the foetus the labour pains recur, causing the expulsion of the afterbirth (the placenta). This is accompanied with a moderate hemorrhage. The placenta should be preserved, even after the ligature of the umbilical cord, so that the physician may determine whether the uterus is empty or not. It sometimes occurs that a child is born in an unopened decidua (born with a caul). In such a case the caul should he opened at once, or otherwise the infant \ vill suffocate. If the afterbirth does not follow spontaneously upon the expulsion of the child, and, no haemorrhage takes place, the patient should wait quietly. After about half an hour, slight labour-pains recommence, gradually increasing in severity until the placenta is expelled. Pressure on the abdominal walls is sometimes practised in order to aid in the expulsion of the placenta. Even after the passage of the afterbirth, strong pressure on the uterus is helpful in preventing hmmorrhage. The placenta and the decidua should be examined very minutely as to completeness, and pressure on the womb should be maintained for at least two hours after birth.

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