Delivery or Labor
(The Natural Process)

Remember that delivery is a natural process and that it ought to terminate without assistance. Three factors are involved in the delivery-mechanism: (a) the power, supplied by the contracting muscles of the uterus; (b) the passage formed by the vagina and uterine cavity being merged into each other forming ode ellipse; and (c) the passenger or the outcoming child. For purposes of effecting delivery, the power has to come at less frequent intervals; the more advanced the stage of delivery is, the passage has to become soft, yielding and moistened with mucus; and the passenger has to adapt itself to the varying shapes and contours of the birth-canal. The power of the uterus is exerted chiefly through the bag of waters which forms an excellent dilator of the passage; the passage is helped by certain muscles lying about it; these muscles have the invariable tendency to move forward everything coming in contact with them; and the eminently flexible body of the child and the extremely loose and gliding skull-bones lend themselves to the necessary adaptability and moulding.

Delivery is said to be normal, if the back of the head comes out first and the delivery occurs within 18 hours of commencement of pain. A normal delivery requires little help from anybody. But those factors which convert a normal delivery into one of troubles are: — (1) Uncleanliness, (2) meddlesomeness, and (3) artificial mode of life. The woman who is going to deliver should have the best room in the house—that which is dry, well-lighted, thoroughly ventilated without being draughty, free from smoke or effluvia; she should have the cleanest dress, cleanest bed and bed linen, cleanest utensils and every person entering and lying in the room should be clean in person, clean in dress and clean in habits, If these are not done, septic poisoning, tetanus and pelvic cellulitis, etc. result inevitably.

Every person should know the importance of the bag of water, but the meddlesome midwife knows it not. She is too often responsible for delayed Labor, caused by her prematurely puncturing the bag of waters. She has been known to cause prolapse of uterus by pulling at the umbilical cord she has been known to tear away the placenta by similar ignorant manipulation. Everyone should beware of a meddlesome midwife. She has little power for doing good but has immense power of causing irreparable mischief. She is at best a specialized maid-servant and nothing more.

The indolent indoor-life that most indian women lead; lightly lacing the loin-cloth, irregular habits of visiting the closet, carelessness as to dietary and several other factors contribute to delivery being of the nature of something unnatural.

Delivery starts with pain; the following table shows at a glance the difference between real and false pain: —

Onset of Labor

The abdomen, suddenly ceases to enlarge and on the contrary feels slightly emptied, in its upper part; the patient has to make water rather frequently and feels urging for going water-closet. The private parts feel moist and relaxed and as if stuffed up. The pains slowly start from the loins, she gets anxious, sometimes she shivers and there is a sudden gush of water— “Show”—or secretion of large quantity of mucus, more or less blood-tinged.

Medically speaking, delivery or Labor is divided into three distinct stages:

First stage—is that which is concerned in the dilatation of the cervix. In a primipara (i.e. one who is going to deliver for the first time) it occupies about 16 hours, in a multipara (who has had several issues), 11 hours.

Second stage—is that occupied by the extrusion of the child; it occupies in a primipara, 2 hours; in a multipara, 1 hour.

Third stage—is that occupied in the expulsion of the placenta; it is usually done in 20 minutes.

During the first stage let the patient be alone. Let her have her usual meal if she can take it; if not, let her have milk or soup. She can and ought to be up and about as much as she can. Encourage her to visit the closet as often as she likes and secure a thorough evacuation of the bowels. Let no anxious or pessimistic or fearsome faces be about her. Keep up the spirits by encouraging and cheering talks. Summon the midwife; and just as the pains are getting very frequent and painful, put her into the lying-in-room.

During the second stage (usually but not invariably ushered in with a gush of water)—let her lie at ease and give her something to pull upon, when the pains are very strong. If for any reason the pains get dull, let her rest a while, the pains will start again. It is not advisable to get her sick. The wisest midwife will at this stage try to save the perinaeum from rupture.

As soon as the child is born, quickly wipe mucus out from its mouth and see that the umbilical cord does not strangle it or that the cord is not pressed upon or strained over much. Lay the child by the mother if it has already cried lustily. If it has not cried, slap it, dash cold water on to its face or chest and alternately dip it in cold and hot waters. Do not be in a hurry to cut the navel cord, until pulsation in the cord has ceased.

To tie the cord, use clean thread or silk—neither too fine nor too thick. Tie the cord first at one-inch distance from the child’s abdomen and another at 3 inches from the abdomen. Cut the cord by means of a clean pair of scissors, between these legatures. Having cut the navel cord, put over it the dust of burnt rag if no boric wool is available. Never put dust or unclean rag on to it. Then anoint the body with mustard, coconut or olive-oil and finally sponge the body with a rag wrung out of cold water (in summer) or warm water (in winter). Then wrap it up in warm clothes and put it by. It requires no food for 48 hours but all the same it should be put to the breast 3 or 4 times in slops. The mother may take, if desired, heating substances in 24 hours. Examine all the natural orifices of the newborn to see if they are all right.

During the third stage, it is well to gently massage the top of the uterus from the abdomen. This causes its firm contraction and helps to expel the placenta.

When the placenta is out, wipe out the genitals with clean rags (previously boiled and dried) and let her put a napkin over the genitals, to catch the blood (Lochia) that comes out of the uterus. The mother should on no account be allowed to get up within 12 hours. The napkin may be changed as often as necessary and a binder applied over the abdomen if she wants it. She should be encouraged to sleep as much as she can and take slops, milk, barley or sago- gruel, sharbet, soups, fruit-juices. Warm fomentations or taking hot things with extra dose of ghee are not often wanted but may be allowed. A dose of Arnica 3x, four times a day put her right.

We must point out again that it is very important to secure proper ventilation in the natal chamber, in day and at night, in summer as in winter; but let it never be draughty. We repeat, it is not necessary to foment the body of mother or child but there can be no harm if it is done, Never, however, foment the child’s navel or mother’s genitals or lower abdomen or loins. Custom and religious sentiments apart, it is neccesary for the mother and child to be in bed for 10 continuous days. During all this time, the mother should sit up as little as possible. Cleanliness of room, of surroundings, of person and of beddings and clothes of mother and child and their attendants is an absolute necessity for all times—atleast for one month from the date of delivery, Mouth breathing on the part of the child should he discouraged, as it opens the door to tuberculosis and mental weakness. A mother should avoid coitus for a year at least from the date of her last delivery,

Treatment of complications of Labor: —If Labor is delayed owing to rigid Os: Gels 3. Pains are mild, irregular, do not come on with vigour after first show, nausea present: Puls. 30. But if cramps in thigh are present with these symptoms (in a multipara) Secale Cor. 30. Headache, restlessness, flushed face and eyes, delirium, restlessness Bell. 30. Unbearable pain: Chamomilla 6, Coffea 6, Gels. 6. After severe pain, all pains suddenly disappear, eyes and face get flushed, breathing is hurried and stertorous, loss of consciousness Opium 6-30. Severe convulsions, patient crying out Hyoscyamus 6. Other parts of child than head may be bom first—to prevent it, Puls. 30. Rigid Os: Bell. 30. Difficult Labor: Arnica 3. Fits of unconsciousness during or after Labor, body cold, pulse feeble: Camphor Ө. Placenta not expelled or detached within an hour of delivery: Puls. 30 or Secale 30 every 15 minutes. If this fails, with left hand keep up pressure on fundus and with the clean right hand, introduced into uterus, gently scrape out the placenta. [In cases of rigid Os (according to some authorities) 2 grains of Pulv. Ipecac cause the Os to dilate, pains to be strong, placenta to be easily delivered and bleeding to be small.