Process Of Natural Labor
( Originally Published Early 1900's )
Signs of Approaching Labor — Its Division into Stages—Labor-Pains,— The "Bag of Waters"—Description of First Stage-Of Second Stage — Of Third Stage.
Approach of Labor Pains.—Towards the latter part of the ninth month, certain changed take place which give warning that labor is not far off. One of the earliest of these is sinking of the abdominal swelling; the upper end of the womb, which at the beginning of the ninth month, reaches as high as the pit of the stomach, now falls a little below that point. Great relief to the breathing follows this alteration, as the pressure upon the organs within the chest is thereby greatly lessened. On the other hand, owing to this change in the position of the womb, certain new inconveniences arise from the pressure of its lower portion on the various important parts contained in the pelvis. Thus, walking becomes more difficult, the bladder requires relieving more frequently, and piles are apt to form.
A sign that makes it probable-that labor is actually about to commence is the appearance of a slight discharge of mucus, streaked with a little blood. This is spoken of, in the lying-in room, as the "show:"
Labor is Divided, for the Sake of Description, into Three Stages.—The first of these is called the stage of dilatation of the mouth of the womb; the second lasts from the moment when that dilatation is completed up to the birth of the child; while the third, or last stage, includes the time from the birth of the child to the coming away of the after-birth, or placenta.
The so-called pains of labor are, in reality, contractions of the muscular wall of the womb. At the early part of labor they are slight, occur at long intervals, and are felt mostly in the lower part of the front of the abdomen; as labor advances, they become longer and more energetic, follow one another more quickly, though always with a certain regularity, and are generally felt chiefly in the back and loins. Each pain is comparatively feeble at its commencement, increases in intensity until it reaches its height, and then gradually passes off. This character, together with the regularity of their recurrence, serves to distinguish pains really due to uterine contraction from colicky and other pains, for which they are sometimes mistaken.
The bag of waters consists of the membranous coverings of the foetus, enclosing within them what the doctors call, the liquor amnii, in which the child floats. During pregnancy this fluid serves to preserve the child from injury; during labor it forms a pouch at the mouth of the womb, which it acts upon like a wedge, and so assists in dilating. Experience tells us that, when the waters escape early, labor is rendered more tedious. The explanation of this is to be found in the fact that the bag of waters, being round and even, and pressing on the mouth of the womb (os uteri) equally all around, the mouth of the womb is opened out more rapidly and easily by this even pressure than by the uneven surface of the presenting part of the child.
As the os uteri opens, and the end of the first stage draws near, the pouch formed by the protruding membranes is pushed further into the front passage, or vagina, and, the pains becoming more violent, the membranes at last give way during a pain more severe than the rest, and so the waters escape. In natural labors this usually happens as soon as the mouth of the womb is fully opened and thus the first stage of labor is cnded. -
The head of the child now begins to pass through the os utcri. After a certain time, usually much shorter than that occupied by the first stage, it reaches the vaginal opening, through which it gradually escapes, and thus the child is born, and the second stage is completed.
The pains of the first stage are called " grinding pains," and are different in character from those of the second stage, which are known as "forcing" or "bearing pains." The cry which is called forth by the pains during the first stage is also different from the groan which escapes from the patient when the pains of the second stage commence. An experienced nurse knows from this circumstance alone that the first stage is over, and as the sending for the doctor ought on no consideration whatever to be delayed beyond this period, it is a point of great practical importance.
The pains now become stronger and more frequent; the patient, holding her breath and bearing down at each return of the pain, becomes hot and flushed, and breaks out into a profuse perspiration. At the end of each pain the head of the child goes back a little, which prevents the strain from being so continuous as to be hurtful and exhausting. Nevertheless, almost every pain marks an advance upon the one preceding. This slight withdrawal of the head is frequently perceived by the patient herself, and unless explained to be natural and necessary, is apt to make her think she is not making any progress. There eventually comes a point, however, when the head is so far expelled that it no longer recedes between the pains. The intervals become shorter, and the pains more severe, until at last the head slips out altogether, and then the most painful part of the labor is over. The uterus usually now rests for a moment. Then the face of the child makes a little turn towards one of the patient's thighs, generally the right, in order that the shoulders may be brought into such a position that they may pass with the least difficulty. With another strong pain the shoulders are expelled. The rest of the body gives little trouble, for no part of it is as broad as those which have already passed.
The contractions of the womb now cease for a short time, varying from five to ten or twenty minutes, when a little pain is again felt, and the after-birth and membranes are discharged, along with a small quantity of blood, with which a few clots are generally mixed.
Such is a brief account of the order of events in a perfectly natural labor.