LETTER XXIV.. Phenomena of Labor.

PHENOMENA OF LABOR.

Meaning of the Term—Its Divisions—Duration—Is Pain a Natural Condition of Labor?—Ether and Chloroform.

Having, in the preceding letters, spoken of the various conditions of pregnancy, I propose now making some remarks on the subject of labor.

I use the term labor in the medical sense, which means the same thing as delivery, or that process of nature by which the fetus, the secundinus or membranes, and the placenta or after-birth, are brought into the world.

In order to give you clearer ideas respecting labors, it is proper that I should say something in regard to the different kinds that may occur. On this subject authors have varied somewhat; some having divided labors into few classes, while others have designated many. But first, a few remarks on the cause of labor.

I have remarked in another place, that among women the natural term of utero-gestation is forty weeks, or nine calendar months. Occasionally, it is true, the expulsory process commences within this period, or in other cases extends beyond it; but on the whole, it happens so nearly at this period, that we are compelled to conclude that it must be under the influence of some particular agency, the nature of which we can in no wise comprehend.

Some have maintained that it is the weight of the child, forcing it downward at this precise period, which causes it to be expelled. Others have supposed that the uterus contracts at the end of the forty weeks, merely because it has no power of further expansion.

Others again have ascribed labor to the increasing activity of the child and the uneasiness caused by its movements. But all of these hypotheses are proved fallacious by the facts, that a large or small child is born at the same period even with the same woman, and that a dead child, unless the death took place at a very early part of the pregnancy, is born in the same manner, and with the same punctuality as to period, as a live one. “No fact,” says Dr. Denman, “is more incontestibly proved, than that a dead child, even though it may have become putrid, is commonly born after a labor as regular and natural in every part of the process, as a living one.” We can, therefore, only state, that parturition comes on at a stated period, in consequence of a law of nature, or, in other words, as Avicenna remarks, “at the appointed time labor comes on by the command of God.”

DIVISIONS OF LABOR.

Dr. Conquest has disposed of labors in the following manner:

“The division of labors originally made by Hippocrates into: 1st. Natural; 2d. Preternatural, is sufficiently comprehensive, while it forcibly recommends itself by its simplicity and perspicuity. Natural labor supposes four things: 1st. That the vertex presents; 2d. That there is sufficient room in the pelvis to admit of the ready descent of the head of the child in that direction which permits the occiput to emerge under the arch of the pubis; 3d. That there is parturient energy adequate to the expulsion of the contents of the uterus without manual interference, and without danger either to the mother or child; and, 4th. That the process of parturition is completed within a moderate time.

“Preternatural labor embraces all the varieties not comprehended in the class of natural labor, whether they respect difficulty, duration, or danger, and may be included in the following six orders: 1st. Protracted labors; 2d. Those labors in which any other part than the head may present; such as the breech, feet, hands, penis, etc.; 3d. Labors with a plurality of children; 4th. Labors attended with convulsions; 5th. Labors with uterine hemorrhage; 6th. Labors in which laceration of the uterus or contiguous parts may occur.”

Dr. Denman’s division of labors is probably as good as any one, and has the recommendation of being simple and easy to comprehend. It consists of the following classes: 1. Natural; 2. Difficult; 3. Preternatural; 4. Anomalous.

Under one or other of these distinctions, every kind of labor which can occur, is to be placed.

Natural labor “is that which consists in a gradual enlargement of the mouth of the womb, and the diametus of the vagina, so as to suffer the child to pass away when urged from above by a repetition of expulsatory contractions of the uterus and all the surrounding muscles.” This kind of labor is by far the most frequent, and indeed takes its name from its frequency; and in the great majority of labors there is no danger however painful and distressing they may be. Natural labor lasts usually from two to twelve hours, seldom happening sooner than the first or later than the last. Dr. Good places the average at about six hours. If I were to speak of the average duration of labor from memory, in regard to the cases which I have attended, I should consider that six hours was too low a number, and should think that eight or ten would be a nearer approximation to it.

Dr. Maunsel, of Dublin, has given the records of 839 cases of labor which occurred in the Wellesley Institution. In these,

347 terminated in 6 hours. 300 „ 12 „ 87 „ 18 „ 59 „ 24 „ 37 „ 48 „ 3 „ 56 „ 5 „ 60 „ 1 „ 72 „

IS PAIN A NATURAL CONDITION OF LABOR?

I am here led to make a digression on the subject of pain. There are some nowadays who contend that labor is naturally a painless process, and that through the voluntary habits of the individual it is possible to make it so even at the present day.

I must humbly dissent from this doctrine. I am willing to admit, or, rather, I do emphatically affirm, that the safety of parturition, the ability to pass with comparative comfort through the period of pregnancy, and the recovery from childbirth, are very much under the influence of the voluntary habits of the individual, and may be modified to an almost indefinite extent. If I did not believe all this most fully, I would never have written these letters, and probably not have practiced the healing art. But all this is a very different thing from that of bringing forth a child without pain.

I do not care even if some of your sex who have borne children, too, should themselves tell me that they passed through labor without experiencing any suffering whatever. I could hardly trust their word if they should tell me so, because I know too well that they may deceive themselves, and that it is a matter of striking benevolence in the Creator, who has formed woman’s nature in such a way that she soon forgets the agony after it has passed. How many of you all to whom I address myself would ever consent to bring forth a second child, if there should always be present in your minds the consciousness of the agony, not to say the pain, the real agony, which labor actually cost you?

See, too, the animals which we hear so much about. Some will tell you that they do not suffer when they bring forth their young. But I say to you these pretended philosophers do not know of what they affirm. Take the healthiest animals—not the sickly, stall-fed ones of our cities, but those of the country—and such as never manifested any signs of sickness whatever; do they not suffer pain when they bring forth? I speak from a knowledge of the facts when I tell you they do. They sometimes even die in the process, and they always manifest signs of distress, even as a premonitory symptom when labor is about to come on. How, indeed, could there be such a displacement of living, vital parts as occurs in a labor without there being pain? As to danger, that is another thing.

I would, therefore, not have you carried away with that foolish notion, which some would instill into your minds, that labor can be without pain. I trust I have said and shall say some things in these pages which will go to encourage you somewhat in reference to childbirth; but all along my desire is to tell you the truth. It is better for you that you should know it, and for me that I should speak it. We ought never to be afraid of the truth.

But perhaps some of you are ready to ask, what is the meaning of that passage of Scripture which reads:

“Unto the woman God said, I will greatly multiply thy sorrow and thy conception; in sorrow shalt thou bring forth children; and thy desire shall be to thy husband, and he shall rule over thee.”

I can tell you what I think it does not mean, which is, that the Almighty did not order that human beings should have no agency in regard to the pains and perils of childbirth. He did not say, that if a woman chooses, when pregnant, to go to balls, parties, theaters, and the like places, become excited, and, for example, dance, that she could not thus, of her own voluntary acts, bring on abortion or some worse ailment. He did not order, that if she will persist in drinking tea and coffee, that her nerves will not be injured thereby. And so of all other rules of health. If we obey God’s physiological laws, health will be better in proportion to the extent of that obedience; if we disobey them, we must inevitably suffer in consequence thereof. Nor is there any thing in the Word of God, when rightly understood, which at all conflicts with this doctrine.

ETHER AND CHLOROFORM.

Holding, as I do, that pain is a natural condition of the puerperal state, you can understand why it is that I am opposed to the use of ether and chloroform under such circumstances. We ought never to counteract a law of nature. If we do, we are certain of being injured to a greater or less degree; and it is no wonder at all to me that people sometimes lose their lives in the use of these anesthetic agents. The only wonder is that they do not oftener sink under them. I am not now saying that I would never recommend even the risk of using chloroform, but only that I would not recommend it in labor, because that is a natural process, and one which should not be unnecessarily interfered with by art.