Professional Documents
Culture Documents
Full Download PDF of (Ebook PDF) Adolescence Canadian Edition by Ian McMahan All Chapter
Full Download PDF of (Ebook PDF) Adolescence Canadian Edition by Ian McMahan All Chapter
http://ebooksecure.com/product/software-engineering-10th-edition-
by-ian-sommerville-ebook-pdf/
http://ebooksecure.com/product/ebook-pdf-adolescence-15th-
edition-by-santrock/
http://ebooksecure.com/product/ebook-pdf-adolescence-16th-
edition-by-john-santrock/
http://ebooksecure.com/product/ebook-pdf-adolescence-11th-
edition-by-laurence-steinberg/
(eBook PDF) Adolescence 17th Edition by John Santrock
http://ebooksecure.com/product/ebook-pdf-adolescence-17th-
edition-by-john-santrock/
http://ebooksecure.com/product/ebook-pdf-mathematics-for-
economics-and-business-9th-by-ian-jacques/
http://ebooksecure.com/product/adolescence-16th-edition-ebook-
pdf/
http://ebooksecure.com/product/adolescence-11th-edition-ebook-
pdf/
https://ebooksecure.com/download/progress-in-heterocyclic-
chemistry-ebook-pdf/
Another random document with
no related content on Scribd:
or without a sense of cold. These are supposed to arise in
consequence of the system rallying its energies to concentrate them
upon one important object, namely, that of effecting the dilatation of
the uterus and the expulsion of the fetus. They are evidently not
attended with any danger, and should therefore give the patient no
alarm.
State of the Bowels.—It is not uncommon for patients to have one
or more loose discharges from the bowels at the beginning of or
during labor. This symptom occurs in consequence of the sympathy
that exists between the womb and the lower part of the alimentary
tract. There appears to be in the minds of most women a great
prejudice against bowel complaints through the different stages of
pregnancy, and at the time of labor, and, as a consequence, there is a
willingness, and often anxiety, on their part to use such means as are
supposed to have an effect in suppressing them. But in most cases of
diarrhea under these circumstances, the patient is relieved by it
rather than made worse, and should therefore take no special means
of counteracting it, unless, indeed, under the guidance of a medical
attendant who should deem such a course necessary.
Nature of the Pains.—It is an object to know how you may
distinguish between the true pains of labor and those which are false.
The true pains of labor usually begin in the back and loins, and
shoot round to the upper part of the thighs; or they may commence
first in the lower part of the abdomen, as if in the region of the
bladder, passing backward toward the spine. Some women
commence being sick, as if they had eaten something that disagreed
with them; and I have repeatedly known them to attribute the pains
of the commencement of labor to this cause. A little time in such
cases is sufficient to convince them of their error.
Periodicity is, in most cases, a symptom showing that the pains are
not false. The interval between them may vary in different cases from
one minute to thirty, forty, or more, according to the action of the
uterus, on which they depend. The more the pains are multiplied the
better it is to be regarded for the patient, and for the reason, that if
an effort of great importance to the constitution is to be produced,
the more slowly and gradually it is done the better, if the slowness is
not the effect of disease. A sudden and violent labor is never to be
looked upon as being so safe as one which happens in a more gradual
manner. “It is an old observation,” says Dr. Denman, “confirmed by
daily experience, that after the completion of slow or lingering
labors, patients usually recover better than after those which are
quick; not to mention that they are less liable to the untoward
accidents which precipitation may immediately produce.”
A considerable difference exists in the character of the pains,
according to the stage of labor in which they occur. The earlier pains
are termed cutting or grinding, from the fact that uterine fibers alone
are principally concerned in them. Afterward the pains get to be
lower down, and are of a more bearing-down nature. When these
pains exist, the woman is instinctively led to bring her abdominal
muscles into powerful action, causing her, at the same time, to hold
in her breath, so that after the pain has ceased, or partially so, she
utters a deep groan. In the earlier part of the labor, the cries are more
shrill, so that an experienced observer will often be able to judge of
the stage of the labor merely by hearing the manifestations made. In
some cases, however, the patient does not exhibit any of the
aforementioned signs of distress, until the moment when the child is
about to pass into the world. She is then obliged to put forth an
expression of agony, which proves but too well how much it is her lot
to endure.
THE LIQUOR AMNII, OR WATERS.
In order that you may the better understand the first stage of
labor, I will here make some remarks on the nature and office of the
fluid above-named. By liquor amnii, or waters, is meant that fluid
which is contained within the membranes surrounding the child.
The quantity of the waters, when compared with the size of the
child, is greater in the earlier parts of pregnancy. At the time of labor
it is found to vary a good deal in different cases, amounting in some
to four or five pints, and in others to scarcely as many ounces. It is
thought to be largest in case the child has been for some time dead,
as also when it is very feeble.
In regard to the office of this fluid, some have imagined that the
fetus is nourished by it, the liquor being swallowed into the stomach.
But in answer to this doctrine, it is to be remarked, that there are
many examples of children having been born without any passage to
this organ. There have also been born children of a full size and well-
formed shape, all except the head, which was wanting. These facts
make it clear that the child must be nourished in some other way
than by the waters surrounding it.
Some also have supposed this fluid to be an excrementitious
substance; but this belief is not now generally adopted, or rather, no
physiologist of any eminence regards it as such at the present day.
The liquor amnii “is generally transparent, often milky, and
sometimes of a yellow or light-brown color, and very different in
consistence; and these alterations seem to depend upon the state of
the constitution of the parent. It does not coagulate with heat, like
the serum of the blood; and chemically examined, it is found to be
composed of phlegm, earthy matter, and sea-salt, in different
proportions in different subjects, by which the varieties in its
appearance and consistence are produced.”
It has been supposed that the liquor amnii may, all of it, be
discharged as early as the sixth month of pregnancy, without
producing injury to either mother or child; but this cannot be true, it
would appear, since it is well known, that when the membranes are
broken intentionally, so that all of the waters are discharged, the
uterus never fails to contract itself until abortion or the birth comes
on. A discharge from the vagina, somewhat resembling the waters,
however, may appear for weeks, and even months, before the
delivery takes place; but in such cases it has been observed, that no
diminution in the size of the abdomen occurs, from which
circumstance it is known that the real liquor amnii does not pass off.
The normal purposes of this fluid in the system appear to be to
afford the fetus a safe and easy lodgment in the uterus. If it were not
there to protect the embryo, it would constantly be in danger of being
destroyed by mechanical violence; besides which, it would be almost
certain of adhering to the inner surface of the womb in such a way
that the birth could not possibly take place. At the time of labor, too,
we see the advantages of the “bag of waters,” for as it is protruded in
advance of the child, it forms a soft, yielding wedge, as it were, which
gradually dilates the soft parts, without overstretching or tearing
them, which would not be the case if the comparatively hard head of
the child was the first to present itself.
The rupture of the membranes, which ends the first stage of labor,
may take place a very short time before the expulsion of the child, or
it may happen prematurely, as it were; that is, many hours, or even
days or weeks before the child is born. In such cases the occurrence
is to be considered as an accident or exception to the general rule. It
does happen, however, every now and then, and in many cases it
seems to make no difference whatever in regard to the future
progress and safety of the delivery.
The greatest agony, as I have remarked, is experienced at the time
the child is brought into the world; but if I could make plain to you
the mechanism of labor, you would be struck with admiration, I am
sure, at the wonderful marks of benevolence and design which are
exhibited in the manner in which a child is expelled from the uterine
cavity.
You may ask why it is that a woman should be made to suffer pain
at all in bringing forth a child, and why did not the Creator form the
system of woman in such a way that a child could be expelled without
causing any of that agony which is well known to be a natural
circumstance of childbirth. I answer, it was not possible for God to
create woman in such a way. Suppose He had made her pelvis larger,
and the soft parts more yielding; she would have been constantly
subject to the misfortune of miscarriage; or rather, it would not have
been possible for her to carry a child at all.
But see the beautiful, and at the same time wonderful operation of
nature in the mechanism of parturition. At first, some days before
labor is to come on, the abdomen begins to subside, showing that the
uterus, with its contents, is gradually sinking downward in
preparation for the greater struggle that is to take place at the birth.
Probably, too, the womb at the same time begins to contract itself
more firmly upon the child, and, as it were, begins to gather strength
for the contest which it is about to engage in, namely, that of forcing
the child into the world. After this there appears a greater discharge
of mucous than ordinary from the womb and vagina, which serves to
soften and lubricate the parts in preparation for the terrible
distension which is to take place. Gradually, also, in the first stage of
labor, the womb dilates, for too sudden a distention of this important
part would be very apt to cause a fatal rupture of the organ. In the
second stage, the head of the child is driven through the os uteri into
the vagina. As the pains continue, the face of the child is turned into
the hollow of the sacrum; that is, toward the back of the mother, the
wider part of the head being in the wider part of the pelvis, just as a
wise mechanician would naturally place it; but in the beginning of
labor, when the child’s head is at the upper part of the pelvis, it lies
more to the side of the mother, corresponding to the wider diameter
of this upper strait.
Look at a skeleton, I repeat, that bugbear of our childhood, that
grim yet beautiful remnant of our mortality; and when you see and
understand how admirably adapted the form and shape of the pelvis
is to the ends for which it was created, tell me if you do not recognize
in this adaptation the most unmistakable evidences of the work of an
Almighty hand.
In the preceding letter, I spoke of the first two stages of labor. The
last, which refers to the birth, or expulsion of the placenta and
membranes, I now propose considering.
First, I must say something of the nature and office of what is
termed the after-birth.
THE PLACENTA AND UMBILICAL CORD.