Nux moschata She is very drowsy, sleepy and disposed to fainting spells the pains being correspondingly slow and feeble or quite suppressed.
Nux v. Every pain causes an inclination to go to stool or to urinate. The more urgently she is disposed to stool the more Nux v. is indicated. Every pain causes fainting and thereby interrupts the progress of labor. Retarded and painful labors in women accustomed to a sedentary life and to those accustomed to high living and an inactive, indolent life.
Opium. The pains have been suppressed from fear or fright. She is in a soporous state, with red face and eyes, and stertorous breathing twitching and jerking muscles.
Phosphorus. Tall and slim ladies of phthisical habit, the pains being distressing and of but little use. She feels so weak and empty across the abdomen, and sometimes cutting pains.
Platina. The contractions are interrupted by the very painful sensitiveness of the vagina and the external genital organs. Very painful though ineffectual spasmodic labor pains.
Pulsatilla In mild, tearful, women, apparently in a healthy condition, but the uterus seems inactive. The pains excite palpitations, suffocating and fainting spells, unless the doors and windows are wide open; she feels that she must have them open. Pulsatilla will allow them to be shut, and labor will transpire very soon.
Ruta. General lameness and soreness all over, with weak, feeble pains.
Secale c. Particularly in weak cachectic women, or in women debilitated from venous hemorrhages. In such cases it is particularly efficacious for weak, suppressed, or distressing pains. By far the best is the 200, or higher. Fainting fits in such cases, small or suppressed pulse.
Sepia. Shuddering attends the pains, and she rather wants to be covered up more, because she can bear the pains easier. Indurations are felt upon the neck of the uterus. Shooting pains in the neck extending upwards. Spasmodic contractions of the neck in these cases.
Stannum. The pains seen to exhaust her very much and make her speech difficult from weakness in the chest. She cannot answer questions; she is all out of breath; the labor does not progress.
Sulphur. She has flushes of heat, frequent weak and fainty spells, wants more air. Cold feet, heat on top of head.
Thuya. In some cases of complication with syphilis, which hinders the proper contractility, this remedy will do much good immediately.
Veratrum. The pains are accompanied with cold sweat, particularly in the forehead fainting on the least motion the pains exhaust her much, and she feels completely done over after every pain.
MECHANICAL CAUSE Of DYSTOCIA. (a) Over distention of the Uterus from Excess of the Liquor Amnii. Cases of this kind can be recognized from the fact that the membranes do not bulge into the mouth of the uterus as it dilates: during the contractions the membranes are felt to be tense and to retain the globular form of the uterus. In this case, the only plan of relief and of rendering the pains efficacious is to rupture the membranes, which may readily be done by plunging the finger through them during a uterine contraction.
(b) Premature Rupture. In cases of this kind, the early escape of a small portion of water allows the head to descend upon the undilated mouth of the uterus, so as to hinder the escape of any more water, and, of course, it is all retained in the fundus, above the child. The contractions gain nothing by forcing out more water, either through the ruptured membranes, or by causing the bulging of a pouch, consequently, the pains are liable to become more and more feeble. The mode of action now to be adopted, is to introduce a finger and, in the absence of a pain, raise the head and hold it up during a pain, when the water will escape in torrents. Repeat this process, if necessary, again and again, and the pains will strengthen rapidly.
Sometimes the child’s head becomes engaged in the lower segment of the membranes and they fit close to it, and there is no opportunity for the membranes to bulge through the os, the consequence of which is, that the water is all retained above the body of the child and in the fundus of the uterus. In this case, the membranes must be scratched through, as described on page 488, and the head elevated in the absence of a pain, and held there until the next pain, when water will gush out and the pains will gain strength. This process may be repeated again and again, if necessary, and the pains will become more and more effective.
The pains may be rendered inefficacious from an over distended bladder, the reflex from which painful condition will cause the uterine contractions to cease. This may be determined by the history of the patient case, and by great sensitiveness of the bladder when pressed or by a dulness on percussion if she has not voided urine for a long time. In this case, a catheter must be used, the male being preferred, for obvious reasons. A loaded rectum may have the same effect as the bladder in the state above described, in which case it must be washed out with injections.
In above which are too rapid, the chief danger lies in a liability to the rupture of the uterus from too powerful contractions, or of the vagina, or yet the perineum. The umbilical cord may be torn asunder by the child falling on the floor, or the child may receive other injuries consequent on sudden and violent action. Some women are always troubled with too rapid labors, and, knowing from experience what to expect, should adapt themselves to this condition by preserving a recumbent posture from the first pain and restraining themselves as much as possible., In some cases the disposition to too slow or to too rapid labor seems to descend hereditary from mother to daughter.
When the pains seem too strong, study the following remedies, viz.: Aurum, Belladonna, Chamomilla, Coffea, Conium, Gelsemium, Lycopodium, Nux v., Phosphorus, Secale c., Sepia, as above described.
We next come to the second group of causes which render labors difficult, dangerous or impossible. These causes are mechanical and refer themselves to the mother or to the child, We shall first treat of those which depend on the mother, and the first of these which we shall notice are the malformations of the pelvis. A pelvis is malformed, in the sense in which we here use the word, when it too greatly exceeds, or falls short of the average size. Excess of amplitude or of retraction, too great size or narrowness, are productive of notable obstacles in the exercise of the child bearing functions. If the amplitude is too great the woman is exposed to serious accidents, in all the three states, the non gravid, the pregnant and the parturient.
In the non gravid, because the uterus, being free and movable in an overspacious cavity, is much more liable to the various displacements of descent, anteversion, and retroversion.
In the pregnant, because during gestation the womb, finding more space than usual in the pelvic cavity, remains there until a much more advanced period of pregnancy, and the volume of the organ, by compressing the rectum and the bladder, often occasions an excessive tenesmus in these parts, which proves very distressing to the patient; sometimes, even the discharge of the urine and fecal matters is impeded, besides which varices, hemorrhoidal tumor, or a considerable infiltration of the lower parts are found to be developed, in consequence of the mechanical obstacle to the circulation of the inferior extremities. Cazeaux.
In the parturient state, because, during labor, the too great amplitude of the pelvis, exposes the patient to all the dangers resulting from a too rapid delivery, which we do not propose to treat of here. A woman subject it this malformation should be kept in the recumbent posture during labor, and she should be instructed not to aid the pains in any way and not to bear down until the os uteri is fully dilated; and even then as little voluntary effort should be made as possible.
But the most terrible accidents which can occur in the obstetric art, are those arising from the retractions of the pelvis. For it must at once be obvious that a just proportion must exist between the dimensions of the canal and those of the body which is to traverse it; and that where this relation does not hold, either through the retraction of the pelvis, or the abnormal size of the child, the delivery becomes impossible.
The contractions of the pelvis, according to Velpeau, are either absolute or relative: absolute, when although greatly retracted in all its dimensions, it notwithstanding is properly formed, and presents no irregularity in its exterior aspect; relative, when only one or more of its diameters are affected by the contraction (the others preserving or very nearly so, their normal length,) and the form is completely changed by this partial alteration. The last group of contracted pelves, viz., the relative, is the only one which will engage our attention in this place. This deformity is referred by M. Dubois to one of three principal types, viz., either to a flattening from before backwards to a compression on the sides, or to the depression of the anterior and lateral parts.
