Part 19

We have not within the walls of Paris one solitary example of a woman who had survived the Cæsarean section. She who lived the longest was one of those on whom I assisted M. P. Dubois to operate. She died on the seventeenth day of a tetanic affection, when everything promised a most successful result.—(Bull. of the Acad. of Med., t. iii., p. 694; t. v., p. 25.)

When the contraction is such that a living fœtus cannot be brought forth, the accoucheur has then to choose between the Cæsarean section or miscarriage.

During pregnancy, abortion will present an extreme and last resource. And it would seem more humane to sacrifice, before the period of viability, an embryo whose existence is so uncertain, in order to protect the mother from the perilous chances of symphyscotomy and the Cæsarean section.

I must confess that, if such an alternative were presented to me, the diameter of the pelvis being only two inches, I should not hesitate to propose this means.

The abuse and criminal extension of such a resource is reprehensible, but not its proper and authorized employment. This operation should always be undertaken with great care, and all necessary precaution used to satisfy the public mind of its necessity.

LABOR, DELIVERY, ETC.

After seven months of pregnancy the fœtus has all the conditions for breathing and exercising its digestion. It may then be separated from its mother, and change its mode of existence. Child-birth rarely, however, happens at this period: most frequently the fœtus remains two months longer in the uterus, and it does not pass out of this organ till after the revolution of nine months.

Examples are related of children being born after ten full months of gestation; but these cases are very doubtful, for it is extremely difficult to know the exact period of conception. The legislation in France, however, has fixed the principle, that child-birth may take place up to the two hundred and ninety-ninth day of pregnancy.

Nothing is more curious than the mechanism by which the fœtus is expelled; everything happens with wonderful precision; all seems to have been foreseen, and calculated to favor its passage through the pelvis and the genital parts.

The physical causes that determine the exit of the fœtus are the contraction of the uterus and that of the abdominal muscles; by their force the liquor amnii flows out, the head of the fœtus is engaged in the pelvis, it goes through it, and soon passes out by the valve, the folds of which disappear; these different phenomena take place in succession, and continue a certain time; they are accompanied with pains more or less severe; with swelling and softening of the soft parts of the pelvis and external genital parts, and with an abundant mucous secretion in the cavity of the vagina. All these circumstances, each in its own way, favor the passage of the fœtus. To facilitate the study of this action, it may be divided into several periods.

The first period of child-birth.—It is constituted by the precursory signs. Two or three days before child-birth a flow of mucus takes place from the vagina, the external genital parts swell and become softer; it is the same with the ligaments that unite the bones of the pelvis; the mouth of the womb flattens, its opening is enlarged, its edges become thinner; slight pains, known under the name of flying pains, are felt in the loins and abdomen.

Second period.—Pains of a peculiar kind come on; they begin in the lumbar region, and seem to be propagated towards the womb or the rectum; and are renewed only after intervals of a quarter or half an hour each. Each of them is accompanied with an evident contraction of the body of the uterus, with tension of its neck and dilatation of the opening; the finger directed into the vagina discovers that the envelopes of the fœtus are pushed outward, and that there is a considerable tumor, which is called the waters; the pains very soon become stronger, and the contraction of the uterus more powerful; the membranes break, and a part of the liquid escapes; the uterus contracts on itself, and is applied to the surface of the fœtus.

Third period.—The pains and contractions of the uterus increase considerably; they are instinctively accompanied by the contraction of the abdominal muscles. The woman who is aware of their effect is inclined to favour them, by making all the muscular efforts of which she is capable: her pulse then becomes stronger and more frequent; her face is animated, her eyes shine, her whole body is in extreme agitation, and perspiration flows in abundance. The head descends into the lower strait of the pelvis.

Fourth period.—After some moments of repose the pains and expulsive contractions resume all their activity; the head presents itself at the vulva, makes an effort to pass, and succeeds when there happens to be a contraction sufficiently strong to produce this effect. The head being once disengaged, the remaining parts of the body easily follow, on account of their smaller volume. The section of the umbilical cord is then made, and a ligature is put around it at a short distance from the umbilicus or navel.

Fifth period.—If the midwife has not proceeded immediately to the extraction of the placenta after the birth of the child, slight pains are felt in a short time, the uterus contracts freely, but with force enough to throw off the placenta and the membranes of the ovum; this expulsion bears the name of delivery. During the twelve or fifteen days that follow child-birth the uterus contracts by degrees upon itself, the woman suffers abundant perspirations, her breasts are extended by the milk that they secrete; a flow of matter, which takes place from the vagina, called lochia, first sanguiferous, then whitish, indicates that the organs of the woman resume, by degrees, the disposition they had before conception.

MANAGEMENT OF LABOR.

Women in general are ignorant of parturition or delivery. Almost all of them are under the impression that labor is completed more by art than nature; hence the most noted accoucheurs are employed to attend during this interesting period; and professional men, in general, have no wish to undeceive them on this subject, as their interest is too much concerned. It is often astonishing to see the credulity and ignorance manifested on these occasions. Thanks and blessings have been poured forth, under the idea that he had saved their lives in labor, when the accoucheur had merely looked on and admired the perfectly adequate powers of nature, and superintended the efforts of her work; and it is nature that accomplishes all, while the accoucheur gets the credit of it. There is not one case in a thousand in which he can do more than remain a silent spectator, except to calm the fears of the ignorant and timid attendants. The mischief and injury that are done by the untimely interference of art are incalculable.

In pregnancy women are bled till they have not strength enough to accomplish delivery; and, when it takes place, the forceps or other instruments are used, which often prove fatal to the mother or child, or both.

There are various particulars to be avoided, and several things to be done, in the management of women during labor. We have room here to state only a few, and shall begin by pointing out the course to be pursued in

Natural Labor.

When called to a woman supposed to be in labor, ascertain if her pains are true or false, which may be easily known by a little inquiry. If the female complains of flying or unsettled pains about the system, occurring mostly toward evening or during the night, and being slight or irregular, it may be taken for granted that they are spurious or false. If these symptoms prove troublesome, an infusion or tea of hops may be taken; or, if this is not sufficient to relieve them, or procure sleep, an anodyne may be taken; and it may be necessary also to give laxative medicines or an injection, with a little laudanum.

True pains may be known by the pain being more concentrated in the lower part of the belly, through the loins and hips.

The pains now increase in regularity and force, returning every ten or fifteen minutes, and leaving the woman comparatively easy in the intervals.

When the pains become regular and severe, there is a discharge of slimy matter, tinged with blood, known by the name of shows. At this period of labor it will be proper for the person who attends the labor to examine, in order to ascertain what part of the child presents, which may be done by requesting the female to sit in the chair or on the side of the bed, and to extend the legs, when the longest finger, dipped in sweet oil, may be passed up the vagina to the part which presents, and the sense communicated will determine the nature of the presentation. In nineteen cases out of twenty, or in almost every case, the head will be felt. Frequent examinations should be avoided.

Dr. Bard, speaking of examinations, remarks: “What terms shall I use to condemn, as it deserves, the abominable practice of boring, scooping, and stretching the soft parts of the mother, under the preposterous idea of making room for the child to pass. It is impossible to censure this dangerous practice too severely; it is always wrong; nor can there be any one period in labor, the most easy and natural, the most tedious and difficult, the most regular or preternatural in which it can be of the least use; in which it will not unavoidably do great mischief: it will render an easy labor painful; one which would be short, tedious; and one which, if left to nature, would terminate happily, highly dangerous.”

“All that is proper to be done in a case of natural labor, from its commencement to its termination,” says Dr. McNair, “will suggest itself to any person of common understanding; and I have long labored under the conviction, that the office of attending women in their confinement should be intrusted to prudent females. There is not, according to my experience, and the reports of the most eminent surgeons, more than one case in three thousand that requires the least assistance. I am aware, however, that there are crafty physicians who attempt, and often succeed, in causing the distressed and alarmed female to believe that it would be altogether impossible for her to get over her troubles without their assistance; and, for the purpose of making it appear that their services are absolutely necessary, they will be continually interfering, sometimes with their instruments, when there is not the least occasion for it. There is no doubt in my mind but that one-half of the women attended by these men are delivered before their proper period; and this is the reason why we see so many deformed children, and meet with so many females who have incurable complaints.”

It is a very common circumstance for an inexperienced (or he may be an experienced, but ignorant) practitioner to attempt a rupture of the membranes, and in doing so, rupture the bladder, which would render the woman miserable during life. We are acquainted with twenty-five or thirty females who have met with this sad misfortune, and many of them have been attended by those who are termed our most successful, or old experienced physicians.

Dr. Rush, speaking of child-bearing among the Indians, says, “that nature is their only midwife; their labors are short and accompanied with little pain; each woman is delivered in a private cabin, without so much as one of her own sex to attend her: after washing herself in cold water, she returns in a few days to her usual employment; so that she knows nothing of those accidents which proceed from the carelessness or ill management of midwives or doctors, or the weakness which arises from a month’s confinement in a warm room.”