25. CALCULATION OF THE TIME OF LABOUR
THE following table will be especially valuable to the newly married lady, who, through delicacy, might hesitate to seek advice on this important and interesting subject. Much time may be saved, often great anxiety avoided, and timely medical nd other attendants secured, by ability to approximate in reckoning to the hour of solicitude and hope.
The period of pregnancy, from conception to confinement, is calculated at ten lunar months, or forty weeks, which amount to 280 days. 1A very clear case, confirming this statement, occurred at University College Hospital. A maternity patient recorded the day of intercourse, distinctly remembering that she ceased menstruating the the day before. She quickened on 7th March, 196 days from the time of intercourse, and was delivered on 30th August, after a labour of 40 hours. The period of gestation was just 280 days. Similarly clear ceases have been reported in the Lancet, showing the period to be 272 and 286 days. The period of gestation cannot therefore be stated with certainty. it is sometimes reckoned at nine calendar months, that is 273 to 275 days, or 39 week; probably, however, forty weeks is the safer reckoning. Gestation is occasionally protracted beyond 280 days. Cases are recorded in which labour has been delayed 10, 20, or even 30 days beyond the usual period, but such cases are very rare. When the date of conception is known, the reckoning begins from that day. If that be not known, then the calculation must commence from the last monthly period. If the time of the last monthly course cannot be remembered, then that of quickening, or when the movements of the child are first perceived must be made use of. Although sexual connection may not be confined to any period of the month, yet it is an old observation, confirmed by the experience of moder accoucheurs, that conception is more likely to occur within a few days before or after the menstrual flux than at other times.
Patients who make use of the annexed table should remember that the period of pregnancy is slightly altered by the age of the parties concerned; the fact being clearly proved, that the younger the husband and wife, the shorter the term of utero gestation; and vice versa, as are increases, the term of gestation is proportionally lengthened.
Dr. Clay states that he once witnessed a curious experiment bearing on this subject, on the eggs of domestic fowls. Poult eggs can be easily distinguished from those of hens of three or more years old. A certain number of them where placed under a young hen, and on equal number of eggs from older fowls under an old hen. The result was, that every chick and escaped its shell from under the young hen at least twenty-four hours, some even as much as thirty-six, sooner than those of the old hen. This difference is very remarkable in so short a period of incubation. He infers from this and other circumstances that the duration of the gestative period is far more definite than has hitherto been supposed, and that where the circumstances, that the duration of the gestative period is far more definite than has hitherto been supposed, and that where the circumstances are similar, the result as to the length of term is very nearly the same. In maintaining that utero-gestation is definite and regulated by age, the age is not to be calculated by that the mother alone, but by the combined of both parents.
53. DIFFICULT LABOUR
Influence of Artificial Habits. Many of the sufferings attendant upon parturition arise from those habits of life which is the object of this Manual to expose and to guard against, such as- diet of an improper quality or quantity; the use of stimulating beverages; want of sufficient pure air and healthy exercise; tight lacing; late hours; and other injurious habits. Amongst savage tribes childbearing is comparatively free from the sufferings which too frequently attend it in an artificial state of society. Catlin tells us that an Indian woman on the march will often deliver herself, and safely rejoin her companions with her newly-born child on her back before night has set in. What a contrast to the physical disabilities which follow in the train of civilization. 1 (In a note in the American Edition of this Manual, the Editor, Dr. Ludlam, remarks: “The popular idea that the wild lies of Indian women exempts them altogether from the dangers and sufferings contingent upon childbirth is fallacious. The truth is, they often die in labour for lack of proper treatment. Cases of preternatural to the hardships of frontier life than with those who belong to the better classes in our cities and towns.”
Oviparous animals have been known to lose their lives when in labour, striving to be delivered of the egg. This is true of the ostrich, tortoise, and other creatures.) Even in our country, healthy women, of regular habits, accustomed to out-of-door exercise, and whose general mode of life is natural, are freed from the long train of miseries which are the too frequent concomitants of child bearing.
Obstructive Causes.-At the same time, causes, of difficult labour may exist of a more remote nature, the patient. Such are- contraction and deformity of the bones of the pelvis, fro Rickets, or from a similar diseases in adult life; anchylosis of the coccygeal vertebrae to each other and to the sacrum, diminishing nearly an inch the antero-posterior diameter of the outlet of the pelvis; 1 (The condition (described in the text is most frequent in women bearing a first child in life, in women who have been accustomed to sit during the greater part of the day. Anchylosis is loss not infrequent in women who ride too much on horseback.) obstruction from tumours, dropsy, the large size of the child, or from a hydrocephalic head; wrong presentation, etc. The management of these cases requires professional knowledge and skill.
Simpler causes of difficult or tedious labours are a distended bladder; accumulation in the lower bowel; or in digestion from a too full meal, or from food that disagrees, taken just before labour sets in. Prompt treatment suffices at once to remove these obstacles of the progress of labour.
Powerless Labour. Powerless labour is generally due to constitutional feebleness, as from previous of course, preventive treatment is indicated. This includes nourishing diet, pure air, suitable exercise, and the administration of one or more of the remedies which our now rich Materia Medica offers.
Preventive Treatment. This seems a proper place to make a remark on treatment preparatory to labour in cases about which any difficulty is apprehended. Our pharmacopoeia contains remedies which, selected according to the requirements of each case, and administered once or twice a day for some time prior to parturition, tend to facilitate that process, and event correct conditions that would otherwise operate as causes of difficulty. Patients for whom we have prescribed during gestation have often told us of the comparative absence of pains and difficulty which they had experienced in previous labours; and these instances are now altogether too numerous to allow of their being regarded as mere coincidences. As far as our observations extend, the difficulties and dangers of parturition are far less under homoeopathic than under allopathic treatment; to say the least, they are then reduced to a minimum, and especially when preparatory treatment has been adopted.
54. PREPARATIONS FOR LABOUR
The Monthly Nurse. She should be a middle-aged married woman, or a widow; temperate, kind, and cleanly habits; and free from any defect of sight of hearing. In every respect she should be subordinate to the medical attendant, and faithfully carry out his directions, both as to the mother and the infant, as he alone is responsible. Under no pretext should she interfere with the medical treatment, or employ remedies or applications not prescribed by the doctor. If such an arrangement were convenient, the nurse should be selected by the medical man, be engaged early, and as the whole of her time and the best of her energies are to be devoted to the lady and the infant, she should be liberally remunerated.
The Lying-in Room. It practicable, a spacious, well-ventilated room, having a southern aspect, should be selected. Provision should exist both for the admission of fresh air is generally best secured by occasionally leaving the door ajar, having the fireplace open, and the
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top sash of the window more or less down, according to the season. Fresh air wonderfully helps a lady to go through the process of parturition. In cold weather a fire may be kept in the room, but neither the mother nor infant should be exposed to its direct influence.
Who should be in the Lying-in Room. In addition to the medical man and the nurse, one female friend-not the mother of the patient-may likewise be present in the chamber; the should be a prudent, cheerful person, and in herself the mother of children, so much the better. Remarks calculated to depress the patient, especially any referring to unfavorable labours, are strictly improper. If convenient, the mother of the patient may be in the house, or within a short distance, the knowledge of such fact tending to comfort the patient. Bus she should not be in the lying-in chamber, as maternal anxiety is occasionally very embarrassing there. There are, however, occasional exceptions to this rule.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."