A manual of obstetrics . permitted to stand erect, walkaround the room, or sit down as she chooses and on noaccount should she endeavor to assist the labor-pains ; suchefforts are valueless and exhausting. (2) TJie Stage of Expiilsion.—This stage covers the periodfrom the time of full dilatation of the os until the birth ofthe child; its average duration is, in primiparse, two orthree hours, and in multiparae from one to two hours. Thepains now are completely altered in character; they aremuch more intense, have assumed a bearing-down quality,and are associated with voluntary efforts on the pa
A manual of obstetrics . permitted to stand erect, walkaround the room, or sit down as she chooses and on noaccount should she endeavor to assist the labor-pains ; suchefforts are valueless and exhausting. (2) TJie Stage of Expiilsion.—This stage covers the periodfrom the time of full dilatation of the os until the birth ofthe child; its average duration is, in primiparse, two orthree hours, and in multiparae from one to two hours. Thepains now are completely altered in character; they aremuch more intense, have assumed a bearing-down quality,and are associated with voluntary efforts on the part of thepatient, the abdominal muscles and the diaphragm being Jour, lie Mht. de Paris, \\>x\\ 9, 1895. EUTOCIA, OR NORMAL LABOR. 123 brought into play. As the pain comes on the woman takesa long breath, grasps whatever object may be within reach,and strains as in difficult defecation. This is often ac-companfcd by a grunting sound as a quick inspiration istaken and the bearing-down efforts are renewed. The effect. Fig. 54.—Bulging of the perineum. of the pains is very apparent. Passing through the fully-dilated cervix, with each pain the presenting part is drivendown the vagina, which dilates to receive it. Finally thepelvic floor is reached, and the firm but elastic perinealstructures direct the advancing part upward and forward 124 ^ MANUAL OF OBSTETRICS. toward the vulvar orifice. The passage through the vaginais facilitated by a profuse secretion of glairy mucus thatthoroughly anoints the presenting part and the vaginal the intervals between the pains the resisting soft struc-tures press back the fetus, so that there is a marked reces-sion until the head becomes too firmly fixed under the sym-physis pubis for this phenomenon to occur. The perineunnow bulges during the pains (Fig. 54); the anus opens andthe bowel protrudes; the vulvar orifice dilates, and the pre-senting part may be seen as the woman bears down, againdisappearing as the pain dies away. This
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectobstetrics, bookyear1
