[Obstetrics or midwifery 529]

Stages of labor.—­First stage extends from the beginning of labor until the mouth of the womb is dilated.  Second stage, from the complete dilation until the complete birth of the child.  Third stage, from the birth of the child until the expulsions of the after-birth—­Placenta.

The First Stage.—­The first stage varies greatly in different women.  The average duration of this stage is from ten to fourteen hours in the woman with the first child, and six to eight hours in the woman who has borne children.  During this stage the woman prefers to remain on her feet, sit, stand or walk about.  The amount of pain experienced varies greatly, according to the temperament of the patient; in nervous women it may be excessive.  The pains now have nothing of that bearing down character which they afterward acquire; they are described as “grinding,” are usually felt in the front.  The genitals become bathed with secretions, which are sometimes tinged with blood.  This is an especially trying period to a young wife, for she cannot see that the pains are doing any good, only making her restless, tired and nervous.  Little can be done by the physician in this stage except to encourage and explain what is really being accomplished by these seemingly futile pains and by tact and proper encouragement, a physician tides this stage over and gives great comfort to the needy patient.  This stage ends with the opening and dilation of the mouth of the womb and the second or expulsive stage sets in, with pains altered in character.

Second Stage.—­The pains now become more frequent and severe and last longer, and the patient now manifests a strong desire to expel the contents of the womb.  The woman now feels better in bed and when the pains come she involuntarily bears down, with each contraction she sets her teeth, takes a deep breath, fixes the diaphragm, contracts the muscles of the abdomen and bears down hard if you allow her to do so.  The knowledge that she is working to overcome an obstacle gives her some satisfaction and she feels that she is accomplishing something by the efforts she is making.  The physician can aid greatly by suggesting to the patient how to use the pains and how much bearing down to do.  He can tell her when not to bear down, and so save her strength for the next real pain when bearing down will do good.  Although the pains are really harder in this stage, nervous women suffer no more, for their mind is now concentrated upon the work at hand.  Sometimes at the beginning of this stage the patient feels chilly or has a severe chill; a hot drink and more covering counteract this.  Another phenomena is the escape of the waters and a lull in the pains for a little time, when they come on more effectively than before as the womb contracts down upon the child and is not hindered by the “bag of water.”  The pains keep on at intervals until the child is born and the physician can now be of help by guiding, directing and assisting the birth of the head.  This stage averages about two hours.