In difficult labor a physician’s skill and knowledge is imperatively demanded. Yet a few practical hints for emergencies may be advantageous.

Presence of mind, with the knowledge given in the preceding chapter, will enable even an inexperienced person, in the chance absence of the doctor, to conduct a case of natural labor satisfactorily.

Prolonged and difficult labor may occur when one has not had the benefit of the “fruit diet” and other hygienic measures herein recommended, or who on account of disease and deformity, has not been able to accomplish desired results. In malformations of the pelvis, in face or shoulder presentations, placenta previa, etc., surgical interference will be required.

Muscular contractions may be inefficient or the os slow to dilate from rigidity. Caustic treatment, so prevalent for ulceration, destroys the natural elasticity of the cervix. Severe and prolonged suffering without dilatation is often the consequence. (See Chap. XXI.) Few women realize the injury done by the prevalent use of caustic treatment. One lady told me that she had been treated by eleven physicians, every one using similar measures. At last in despair she “gave up doctoring,” and by hygienic methods had attained to a comfortable degree of health. The time must come when people will protest against the burning of mucous surfaces as they now protest against blistering and bleeding, which only a few years since were universal.

The head advancing may meet with resistance from dryness, heat, and rigidity of external parts.

The hot sitz-bath is the best temporary means to overcome rigidity of both os and vulva, and to relieve pains that are neuralgic in character. Seat the patient in a sitz-bath tub, containing very hot water, her feet also in a hot foot bath. Envelop her with blankets and increase the temperature of the water by pouring in hot water as she can bear it. Let her remain until profuse perspiration is induced. Dry her under the blankets and let her lie down without removing them. Sometimes she can remain in the bath an hour with advantage, though a shorter time is usually sufficient. The pains entirely or partially subside, and she seldom fails to fall into a refreshing sleep. Local relaxation will be accomplished, the pains assume an effective character, and a speedy termination of the case can be expected. To accomplish the desired result, the bath must be hot, not warm, and continued until perspiration is induced. When prolonged labor is caused by rigidity of the soft parts, good and speedy results are sure to follow. The following cases prove the value of the hot bath:

Mrs. N—— engaged my services for her seventh confinement, stating that I might expect a tedious case, as in all previous labors the skill of physicians had been baffled. She had lingered in labor from 48 to 96 hours, attended with convulsions and other distressing symptoms; several times had been delivered with instruments. Summons came for me on a bright June morning at 5 o’clock. She had had irregular pains all night, was very nervous and had great dread of her sufferings, having no hope of relief for at least two days. I found no dilatation, and no real contractions were taking place.

I gave her remedies, hoping to arrest the suffering until relaxation could be produced, and left her. At 10 o’clock I returned, armed with one of Dickens’ novels, for a two days’ pastime. Found the pains increased in severity, attended with rigidity of os, still no dilatation, but pressure of the uterus upward. Although a woman of great self-control, she could not repress the most piercing screams with each pain. A hot sitz-bath was administered, increasing the temperature until most copious perspiration was induced, after which, enveloping her in blankets, I bade her sleep, while I sat down to Dickens.

She obeyed orders, slept soundly, having contractions every fifteen minutes, when she would rouse and exclaim, “What relief!” “Heaven surely can be no sweeter than this rest!” “What a blissful change!” I would say, “Don’t talk, don’t bear down, sleep all you can,” and still read Dickens. About one o’clock expulsive pains came on. Examination revealed full dilatation of cervix, and head advancing. At 3:30 P. M. the child was born, no spasms, no instruments, and no medicine had been required. This is only one of many that I have seen relieved in the same way, and always find the bath effectual where there is no deformity of the pelvis. I am confident that this hot bath, if generally used, would save thousands of instrumental deliveries.

Mrs. N. was a very grateful patient, and believes that the same means would have given relief in former labors, as the first symptoms were the same. The only unpleasant sequel in the case was, the novel remained unfinished.

Mrs. L——, primapara, aged thirty-three, a severe, tedious labor, with slow dilatation. Gave the hot bath with the happiest effect; patient, nurse, and all but the husband went to sleep. Contractions continued, accompanied by profuse perspiration, but for two hours did not awaken the patient. Expulsive efforts finally setting in, labor was completed in one hour. It was, however, almost immediately followed by violent hemorrhage inducing fainting. Examination revealed the placenta attached, the fibers so closely adhering to the uterus that the least attempt at removal caused the greatest suffering. The placenta was grasped and partially brought down into the cervix. By this interference the hemorrhage was arrested, and the placenta allowed to remain for about twelve hours, when it was expelled without any assistance. The patient made a rapid recovery.

At first I feared that the excessive relaxation from the bath caused the flowing, but became convinced that it was only exposure of the bloodvessels from the partial adhesion of the placenta. Its removal from the body of the womb allowed the organ to contract upon the exposed bloodvessels, and consequently the hemorrhage ceased.

The hot bath is also effectual for flagging pains that are annoying and worrying, and “seem to do no good.” In such cases the patient takes a long rest after the bath, and real contractions and expulsive efforts may not occur for hours or even days. This gives nature time to overcome all obstacles, and the final termination is more satisfactory.

Ergot and cohosh are administered by physicians of all schools for insufficient contractions. These cause violent uterine contractions and great expulsive efforts. If the soft parts are relaxed, labor will be facilitated. If not, great injury may be done. Rupture of the uterus and laceration of the perineum are frequently the consequence. The effects after confinement are liable to be even more disastrous. Among these are violent hemorrhage, puerperal peritonitis which runs a rapid course, cellulitis, milk leg, nervous chills, gathered breasts, etc. These drugs are well understood to be poisonous to any one in a normal state. Surely no reason can be given why a parturient woman may hope to escape their dire effects. Without doubt they lay the foundation for many chronic uterine ailments. Please mark the following, which are only a few of the toxicological symptoms of these drugs taken by a person in health.

Ergot induces rigors, pinched, pale countenance, extreme anxiety, great fear of death, violent headache, stupor, loss of voluntary motion, spasmodic jerking, sudden paralysis, debility and fainting, cold, dry, shriveled skin, knotted veins, tongue cold, livid and pale, vomiting violent, enlargement and pain in the liver, watery diarrhea, swelling of the limbs with cold surface, violent, cramp-like, intermittent pains in the pelvis and groin, hemorrhage, congestion of the womb, local gangrene.

Macrotis, or black cohosh, causes weak but rapid pulse, pains in the back with debility, rheumatic pains in the muscles, limbs seem powerless, drawing pains with trembling, great restlessness, headache with soreness of the eyes and of the base of the brain, heat and pain in the top of the head, dimness of vision with objects floating before the eyes, prickling of the skin, cold extremities, bruised feeling all over, dizziness, loss of memory, great nervousness resulting in hysteria, vomiting, leucorrhea, hemorrhage, etc. Both of these drugs are violent in their action and poisonous in the doses usually administered in labor.

It is rare that one recovers entirely from their effects. They cause uterine inflammation, ulceration, displacement, etc., that are accompanied by amaurosis, loss of memory, headache and many nervous symptoms which are ignorantly attributed to the “last confinement.” Rupture of the cervix, for which ladies so often must be treated in these days, is frequently the result of rapid forced labor by the use of these drugs. As you value good health, never take these remedies in poisonous doses. If uterine contractions can not be increased by the hot bath or cold compresses placed on the abdomen, an attenuated dose of the drug will be followed with as speedy results as a cup full of the infusion or a drachm of fluid extract, and the toxicological effect will be avoided.

Protest positively and persistently against taking a poisonous dose of ergot or black cohosh. Better wait for nature than suffer the effects that are sure to follow.

Instruments will rarely be called in use if women learn the laws of life and obey them. Malformed and diseased as women are, instruments are resorted to far more frequently than necessary. There is a feeling in the profession that dextrous instrumental delivery often saves women suffering, and consequent nervous prostrations. Most women, on the contrary, have a horror of forceps, and this, with the temporarily increased suffering aggravates rather than lessens the prostration. Remember, the physician has selfish temptations for instrumental interference. It entitles him to an extra fee, it saves him time, and possibly gives him eclat as an accoucheur.

In most cases where instruments are now used, speedy results could be obtained from the hot sitz-bath, without danger of subsequent difficulties. Occasionally a case may require instruments, but the experience of many successful physicians, especially the women in the profession, proves that if there is careful preparatory treatment, artificial delivery need seldom be called in requisition. In several hundred obstetric cases in my own practice, instruments were never required where the previous preparation of the patient had been under my own direction.

Women have it in their power to produce such healthful conditions that obstetrical instruments shall be known only in tradition.