Notes of a complicated case of labour : with remarks on the postural treatment of prolapsus funis and the management of the third stage of labour / by Alexander R. Simpson.

  • Simpson, Alexander Russell, Sir, 1835-1916.
Date:
1864
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Licence: Public Domain Mark

Credit: Notes of a complicated case of labour : with remarks on the postural treatment of prolapsus funis and the management of the third stage of labour / by Alexander R. Simpson. Source: Wellcome Collection.

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    slightest pain * for before the head entered into the pelvic brim, the patient was unconscious of any sensation of suffering when the hand over the abdomen could feel the uterus distinctly contracting; and afterwards, when the head was passing through the pelvic canal, there was no kind of pain, only a feeling of fulness re¬ sulting from the pressure of the head on the soft parts of the pelvis. The histories of such painless labours have from time to time been.related to our Society; Jourdain,1 Chailly,2 3 Mont¬ gomery,8 and many others, have published similar cases ; and their importance in a medico-legal point of view calls for a due notice of them in works on Medical Jurisprudence.4 I had never before met with a case of absolutely painless parturition ; but Dr Yon Eitgen, the venerable professor of midwifery at Giessen, told me some years ago, that in the course of his practice he had seen seven¬ teen women who passed through the parturient process without any pain ; and from his observation of these cases he had been led to form the conclusion that the act of parturition is nor¬ mally and physiologically a painless one, which only becomes painful and pathological in consequence of the abnormal and arti¬ ficial mode of life led by the great mass of civilized womankind. His conclusion I have sometimes advanced as an argument in answer to those who object to the use of anesthetics in midwifery, on the ground of the fancied physiological character of the pain. 4til. Prolapsus Funis, and its Replacement by the Postural Treat¬ ment.—I first saw the woman on going to visit, for my uncle, the patients in his ward in the Infirmary, at one o’clock P.M., about a quarter of an hour after she had been seen by Dr Watson. On making an examination, I found that a complication had occurred, from the falling down of a loop of the umbilical cord, of four or five inches in length, opposite the left sacro-iliac synchondrosis. The umbilical vessels were pulsating vigorously, and the prolapsus must have taken place very shortly before, as there was none to be felt when Dr Watson made the examination. We can easily understand the occurrence of prolapsus of the funis in cases of preternatural presentations and mal-presentations of the head, or where, from contraction of the pelvic brim, the presenting part of the child is prevented from adapting itself closely to the lower segment of the uterus ; but the conditions of its descent in cases of normal head-presentation have not yet been accurately ascertained. In the present instance, we have a concurrence of three of the conditions that have been more especially insisted on as favouring the occurrence of this accident. First, The patient was a multipara, with a very relaxed and dilatable cervix uteri; and, perhaps, there 1 Velpeau, De l1 Art des Accouchemens, vol. i. p. 451, Paris, 1835. 2 Chailly-Iionore, Traite pratique de l’Art des Accoucliemens, p. 244, Paris, 1842. 3 Signs and Symptoms of Pregnancy, p. 607, London, 1856. * e. g., Wharton and Still4, Philadelphia, 1855, p. 307.