Labor

Suggestion in Labor.--When the subjects are normal, expectancy has

much to do with the severity of labor pains. In recent years so much

fuss has been made and so much said and written about woman's burden

and travail in the pains of childbirth, that preliminary dread and

anxious attention have wrought young women up to such a poignancy of

expectation as to make these pains worse than they really are. In the

old days ch ld-bearing was as much a matter of course as the husband

going out to his daily work, and the taking of the dangers and

fatigues of it was a simple matter of duty. Labor was then

comparatively easy and, while never pleasant, was also never an

over-uncomfortable process. The effect of unfortunate suggestion has

been to make it seem ever so much worse than it really is. Multiparae

furnish the best proof of this. A healthy woman who has already had

more than one child does not dread labor pains very much, or only to a

slight degree, because the previous maternities have lessened the

physical pain to be experienced, though a healthy woman's tissues are

so thoroughly resilient that nature is able to bring about a return to

normal conditions so complete that it is not always easy to decide

whether a woman has given birth to a child or not. Of course, there

are many cases in which tears reveal the former labor, but there are

others in which it is not so, and the renewal of the birth process

must, therefore, be nearly if not quite as painful as before,

especially if it is recalled that succeeding children are usually

larger. In spite of this in multiparae, labor has lost most of its

terrors because real knowledge of its comparative ease has replaced

the previous unfavorable suggestion, and instead there has come a

proper appreciation of what will have to be borne, and of the positive

pleasure of the relief when it has been borne successfully.



Healthy women of the lower classes have so little difficulty in labor

that they are quite frank to confess that it means scarcely more than

a few severe muscular pains during an hour or so. Some of them mind it

so little that up to within half an hour of the birth of the baby they

occupy themselves with other things and succeed effectually in

distracting their pains away.



In their article on "Hypnotism and Suggestion in Obstetrics" Drs.

Auvard and Secheron [Footnote 37] suggest that hypnotism can be

employed with advantage during labor, but it is more difficult to

produce it then than in the normal condition. Its only advantage is

anesthesia, and this can be obtained during the preliminary pains in

many cases. It is frequently impossible to produce complete

anesthesia, however. To replace hypnotism they advise that suggestion

in the waking state be used and they even suggest the employment of

pseudo-choloroform or other like means. This method they consider more

advisable than hypnotism, for there are no inconveniences and many

real advantages. The nervous condition of the patient after hypnotism

during labor is sometimes far from satisfactory.



[Footnote 37: "L'Hypnotisme et la Suggestion en Obstetrique,"

Paris, 1888.]





Nature's Methods.--In obstetrics and labor we have been finding in

recent years that we have not trusted nature enough, have not looked

sufficiently to the woman herself for assistance in its difficulties,

and have made her too much a passive rather than an active factor.

Practically all of the dangers that have accrued to the woman in

childbirth, certainly many times more than have come from any other

factor, have been due to well-meant but unfortunate attempts to help

her while preventing her from helping herself. Before the middle of

the nineteenth century most of the puerperal fever was due to

infection from over-zealous but unclean attendants. Now men are

proudly reporting hundreds of cases of delivery without even a vaginal

examination. Above all, we have failed to take advantage of the

occupation of mind that could be used to save women much of the

anxiety and suffering of labor. If the parturient woman were allowed

to change her position, as she does so naturally and frequently in a

state of unsophistication, and to help actively, as she can in

many postures, in the delivery of her child, it would mean much in

diverting her mind from pain which is emphasized by inactivity. The



rule of having the woman lie on her back has been unfortunate in many

ways and has required much more external interference than if other

positions were adopted, while the pains have been more unbearable

because that is actually the position in which the woman suffers most

and in which she can do least to lessen them.



I was once told by an Irish grandmother the story of nearly one

hundred deliveries without accident of any kind, in which the only

rule had been not to touch the woman, but to allow her to change her

position and, above all, to facilitate her in getting on her knees in

a stooping bent-over posture so as to help herself. The upper mattress

was doubled over completely and the woman was encouraged to kneel on

the lower straw mattress, which was so arranged that it could be

changed completely, or destroyed immediately after labor. This seemed

old-fashioned and unscientific twenty years ago, when I heard the

story, but I have been interested recently in reading Professor King's

address on "The Significance of Posture in Obstetrics." [Footnote

38]



[Footnote 38: Bulletin of the Lying-in Hospital, Vol. V, No. IV.]





Professor King is sure that there are many advantages in following

certain natural inclinations of the mother to change her position and

that this helps her in many ways. Above all, as the psychotherapist

sees at once, it will occupy her mind, keep down anxiety and lessen

pain in many natural ways, besides encouraging concentration of

attention on muscular effort instead of on painful sensation. The

whole article is well worth reading, for in it he suggests that

certain obstetrical operations, even version, would not be so often

necessary, if the woman were sometimes allowed to assume the squatting

position in the course of birth. His illustrations make very clear the

help that changes of position are in the mechanics of many

difficulties of labor. The pressure of the patient's thigh on the

abdomen, when she was allowed to assume a squatting position, enabled

him, in a case in which the woman had been in labor twenty-eight

hours, in which ergot had been given by the midwife, in which the

waters had been discharged and the uterus was tetanically contracted

around its contents, to deliver the child without instrumentation and

without further delay. In five minutes the arm (for it was an arm

presentation) began to recede, and in twenty minutes the child was

delivered, head first, and mother and infant both did well. Other

cases with similar results have been reported by obstetricians quite

as distinguished as Professor King. Many other experienced obstetrical

teachers have expressed themselves to the same purpose in recent

years.





Postures after Labor.--Allowing changes of position after labor also

has its advantages. There is often retention of urine and this can be

relieved by allowing the woman to assume the usual position. It may be

impossible owing to the swelling and hyperemia in the neighborhood of

her urethra for the woman to pass water, and yet if she is allowed to

sit in the usual position upon a commode, she will in most cases pass

her water in a few minutes without difficulty and the risks attending

catheterization will be obviated. The power to urinate is due in these

cases partly to the pressure of the thighs upon the abdomen which

helps the bladder to contract and undoubtedly also to the suggestive

influence that the position has.