The patient herself, as \veil as her family, may do much in advance to assist in the normal course of childbirth and of the lying-in period. In a broader sense of the word, this preparation should begin before marriage. Some women are incapable of maturing the fcetus, and others are unable to bring forth the viable fcetus without endangering their lives. A careful examination by the family physician should, therefore, be made in due time. Among some of the conditions particularly prejudicial to health may be mentioned severe anaemia, general weakness, consumption, sinister affections of the lungs, heart, or kidneys, tumours of the genital organs, and marked narrowing of the pelvis, caused either by a dwarfed growth or by rickets.
The dangers threatening a pregnant woman who suffers from any of these diseases may be obviated by exercising proper foresight, and by securing careful treatment after conception has taken place. In cases of moderate narrowing of the pelvis, it is often advisable to induce artificial delivery as soon as the fcetus is viable ; that is, during the seventh or eight month of pregnancy. In the absence of adverse conditions a chemical examination of the urine should be made from time to time, so that the physician may keep himself informed as to the functional capacity of the kidneys. In this way he will be able to detect severe disorders in these organs, and especially to avoid eclampsia, a convulsive, and often fatal, disease of parturient women.
The premonitory signs enabling a woman to recognise the oncoming of labour in time to call for assistance become manifest about ten days before the time of birth. One of the first signs is the falling or sinking of the womb, usually known as " regaining the figure." This is clue to the settling down of the uterus and the pelvis preparatory to labour. In this later period the woman often experiences a slight change in disposition, a certain unrest, often of a cheerful nature. This may be followed by pressure and slight dragging in the small of the hack and in both sides of the lower abdomen. A pregnant woman, especially one who is to deliver for the first time, usually experiences frequent inclinations to urinate during the last two weeks before delivery. She also experiences greater freedom of the abdominal region, and consequently of respiration. The fatal movements also become less pronounced. At this time the presenting part of the foetus (usually the head) descends into the pelvis. These signs, however, as well as the calculation of the day of delivery, arc often quite uncertain ; and a pregnant woman should, therefore, observe certain precautionary measures during the last month of pregnancy. She should not leave the house un necessarily, and should never be without a companion if she does. All objects required during the term of childbirth should be within easy reach. It has frequently happened that pregnant women have suffered severe injuries, even death, by falling from step-ladders or chairs which they had used in order to reach things that had been put on the upper shelves of closets.
It is wise to engage one's doctor and nurse several months in advance.
The duration of the various stages of birth varies greatly in the individual cases. Owing to the firmness of the genital passages, they invariably last longer in women who are pregnant for the first time than in those who have had several deliveries. In first labours the initial stage lasts, on an average, ten to twenty hours, as against one to twelve hours in subsequent deliveries ; and the expulsion stage from an hour and a half to eight hours, as against fifteen minutes to an hour and a half in subsequent cases. Dis turbances of labour-pains may be incurred by exposure to draughts, by eating irritating or indigestible food, by the accumulation of excrements and gases in the bowels, and by distension of the bladder. In case of irregularity and feebleness of labour-pains, it is possible to regulate them by stimulating the activity of the skin (inducing sweating), by the application of hot towels to the abdomen, and by warm body-baths. Instead of baths moist packs may be used, especially in attacks of eclamptic convulsions.
If labour is seriously delayed it becomes necessary to determine the cause of the retardation ; and if labour is going on without medical assistance it is imperative that a physician be summoned. As midwives are not always regularly educated, it is advisable in all cases to have a physician in attendance. It is absolutely essential in every case of labour, whether it terminates without accident, or whether the physician is obliged to interfere, that every object and every person coining in contact with the parturient woman be absolutely clean and free from disease-germs. For details as to preventive preparations see PUERPERAL FEVER. A patient who has a narrow pelvis, or one who is conspicuously narrow-hipped, dwarfed, or deformed, should submit to an early physical examination. Even a woman who appears well built may have a narrow pelvis. This is particularly the case with women who have suffered from rickets during childhood. It is imperative, therefore, that women who have suffered from retardation of bone-development, or who have deformed limbs or other abnormalities, should tell the physician of these defects, so that he may palpate and measure the pelvis to learn if it is large enough to permit the birth of a child. Severe interference with labour may be caused also by scars and tumours obstructing the genital passages, and also by defective development, or excessive relaxation of the womb or of the abdominal walls. In patients with pendulous abdomen, which is generally present in a special form of narrow pelvis, the womb, with the fretus, falls so far forward that the child cannot be made to enter the opening of the pelvis. In such cases it is feasible, by timely professional assistance, to bring about a correct position of the foetus.