Lectures on obstetric operations : including the treatment of hæmorrhage, and forming a guide to the management of difficult labour / by Robert Barnes.
- Robert Barnes
- Date:
- 1886
Licence: Public Domain Mark
Credit: Lectures on obstetric operations : including the treatment of hæmorrhage, and forming a guide to the management of difficult labour / by Robert Barnes. Source: Wellcome Collection.
Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.
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![cervix and os externum uteri, acquiring power as the head de- scends and rotates in the pelvis. The pains become expulsive or *'bearing-down; evoldng powerful reflex action, they call forth the stored-up nervous energy, and excite the semi-voluntary, semi- reflex contractions of the diaphragm, abdominal, and other expiratory muscles. The uterus must be supported by the diaphragm and abdominal muscles. The diaphragm is not a direct agent; it acts by supplying a ;point cVapimi to the abdominal muscles; the chest expands, the lungs fill, the glottis closes. The diaphragm then contracting gives to the base of the thorax, supported by the lungs distended with air, the solidity required for the effective action of the muscular forces. The uterus, in its turn, supported and compressed by the diaphragm and abdominal muscles, is excited to further exertion. The body is arched forward, the thighs are flexed upon the belly, the pelvis is tilted up so as to bring its axis more nearly into coincidence with the axis of the trunk. Everything conspires to aid extrusion. The uterine contractions become more frequent; and when the head comes down upon the perinaeum, pressing, upon the anal and vulvar sphincters, reflex action is irresistibly exerted, and new vigour is added to the expulsive efforts. At this critical moment the nervous, vascular, and muscular systems are at the highest pitch of tension. Unless the various forces are exactly balanced, or unless provision is at hand to moderate the resisting force on the one hand, or the driving force on the other, danger is imminent. Thus the vascular tension may issue in apoplexy, or the muscular tension may issue in bursting of the uterus or laceration of the perinseum. These evils are averted by the yielding of the vulva before the advancing head, and often by the opening of the glottis under the sense of pain; when, the ijoint cVap])ui being lost, the abdominal muscles quickly relax, and the dangerous strain is taken off. The conditions ascertained on examination are: the regular succes- sion and progress of dilatation of the cervix uteri, the rupture of the membranes, discharge of liquor amnii, and propulsion of the foetus. Now, if any cause of obstruction intervene, the progress or order of the labour is interrupted, and the characters of the '' pains change. The characters that mark an unpropitious labour are : irritability of mind, anxiety, bodily restlessness ; continuous pain, exacerbated* on return of the uterine contractions ; tenderness on pressure upon the uterus; the uterine contractions assuming a peculiar abortive or ineffectual character—that is, having a wearying, irritating effect upon the system, and leaving a sense of having been of no use in advancing the labour. This is expressed in the utterances of the woman in a way easily interpreted by the skilled observer. If,](https://iiif.wellcomecollection.org/image/b21039902_0033.jp2/full/800%2C/0/default.jpg)
