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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 child-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

[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

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.

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