BY dystocia is meant unnatural, “laborious, morbid, or difficult labor. Labors do not always take place in what may be regarded as a truly natural, normal manner. They may become, by a combination of circumstances, difficult, dangerous, or even impossible. It is here the intervention of art is called for. These circumstances are exceedingly various and numerous, and they give rise to three distinct groups or classes of labor, viz: 1. “Those rendered difficult, dangerous, or impossible by a defect or an excess in the action of the expulsive forces. 2. Those rendered difficult, dangerous, or impossible by obstacles to the expulsion of the foetus. 3. Those complicated by accidents liable to endanger the life or health of the mother and child.
*Cazeaux.
In respect to the first of these cases, it should be observed that the pelvis, as well as the organs of generation, may be perfectly natural, and the child in harmony with the passage, and yet the expulsive force may be wonderfully deficient, and at length may cease to act entirely. In deciding on the duration of labor, it may be adopted as a general rule, that where more than twenty-four hours have elapsed since its commencement, serious accidents may be feared, either to the mother or child; and these should be anticipated by removing the cause of the excessive slowness. The fact which requires particular attention in the prognosis is, that the period of dilatation of the cervix is to that of the expulsion as two or three to one. Now, the delay may occur either in the first or the second of these stages. The first stage may be prolonged without danger, either to the mother or the child; but when the second stage, or the period of expulsion, is extended beyond ten or twelve hours, the uterine pains may become irregular in their return and intensity, and the foetus seem to retrograde rather than advance there is no expulsion. The condition of the patient at this crisis is thus described by Cazeaux:
“The local disorder is accompanied, or at least soon followed, by a violent trembling; the patient has an inclination to vomit, and even throws up bilious matters; she is uneasy, excited, and changes her position every moments; the skin is hot and dry; the pulse runs up to a hundred or a hundred and fifty per minute; the tongue is dry, and both it and the teeth are covered with a dark coating. The vagina and cervix are hot, and sensitive to the touch, and a yellowish liquid escapes from them, which occasionally has a fetid odor; the pressure of the child’s head on the cervix vesicae prevents the emission of urine; and the parts that line the superior strait and the pelvic excavation, being compressed for a long time by the head, may become inflamed, or even gangrenous; which complications may subsequently prove a source of the most serious accidents.
“If the woman still remains undelivered, these symptoms increase in intensity in a frightful manner; the vomitings become more frequent, and the abdomen more distended; the excitability of the patient knows no bounds; the pulse is more and more feeble and frequent, and she falls into a half-stupid, or a semi-delirious condition, which is soon terminated by death. It is scarcely necessary to remark that, in the latter case, the life of the child is also most seriously compromised.
There are numerous causes which may operate to bring about this condition, some of which are vital; others mechanical, as, for example, the over-distention of the uterus by an excess of the liquor amnii, or the too early rupture of the membranes. When the cause appears to be a vital one, the pains having been too weak from the first, grow weaker, cease entirely, are irregular, or in any way abnormal, study the following remedies:
TREATMENT FOR FAILURE OF THE VITAL FORCES, IN ANY WAY TO PRODUCE SPONTANEOUS DELIVERY IN A REASONABLY PROMPT AND EASY MANNER.
Pains too weak: Study particularly, 1st. Belladonna, Chamomilla Kali carb., Natrum m., Nux v., Opium, Pulsatilla, Ruta, Secale c., Sepia.
2nd. Arnica, Borax, Camphor, Carbo vegetabilis, China, Cocculus, Graphites, Ignatia, Lycopodium, Magnesia m., Natrum c., Nux moschata, Platina, Sulphur, Thuya.
Pains ceasing: 1st. Belladonna, Chamomilla, Kali carb., Natrum m., Nux v., Opium, Pulsatilla, Ruta, Secale c., Sepia.
2nd. Arnica, Borax, Camphor, Carbo vegetabilis, China, Cocculus, Graphites, Ignatia, Lycopodium, Magnesia m., Natrum c., Nux moschata, Platina, Sulphur, Thuya, Veratrum.
Pains distressing: 1st. Aconitum, Arnica, Belladonna, Chamomilla, Coffea, Gelsemium, Hyoscyamus, Ipecacuanha, Nux v., Pulsatilla, Sepia.
2nd. Aurum, Causticum, Conium, Cuprum, Ignatia, Kali carb., Lycopodium, Opium, Phosphorus, Secale c., Strontiana, Veratrum.
Aconitum There is much distress, restlessness, and moaning during every pain. On examination, per vaginam, the parts are found dry, tender, and undilatable.
Arnica The pains are so violent as to make her almost crazy, yet but little good effect is accomplished. She wishes to change her position very frequently. The pains are sometimes very weak and feeble with a desire to change the position frequently. She feels unusually sore and bruised in every position.
Aurum The pains make her desperate, so that she would like to jump out of the window, or to dash herself down, often with congestions to the head and chest, and palpitations of the heart.
Belladonna The pains come on suddenly and disappear, after a time, as suddenly as they came. Spasmodic contractions of the neck, which is hot, dry, and tender. Very red face and injected eyeballs, with pain; labor slow and tedious. Throbbing headache, with great sensibility to light and noise.
Borax The pains are accompanied by violent and frequent eructations. She fears a downward motion. She is very sensitive to the slightest noise, as the rumpling of paper, fall of the door- latch, &c.
Chamomilla Her pains are spasmodic and distressing. She can hardly bear them, she wishes to get away from them. She is very fretful peevish and cross, can’t return a civil answer. Tearing pains down the legs.
Camphor Her pains have ceased, and her skin is cold, dry and shrunken; she does not like to be covered, and is restless. Camphor 200, or higher, will now warm the patient, restore the pains, and other things being equal, produce spontaneous delivery.
Causticum.
She complains mostly in her back of a sore, distressing pain. Her suffering is principally in the back.
Carbo veg.
The pains are too weak or ceasing with great debility. Particularly indicated where there is a varicose condition of the vulva, or when there has been a great loss of animal fluids or the debilitating effects of acute disease.
China Where much blood has been lost, fainting fits, convulsions, &c. Cessation of pains from the loss of blood; her skin may even be cold and blue. She can’t bear to be touched during the pains, not even her hands.
Cocculus Her pains are of a spasmodic, irregular, and paralytic character. She will have one hard one, and then, after a longer interval, several light ones, &c. Much headache.
Coffea Labor pains insupportable to her feelings; she feels them intensely, weeps and laments fearfully.
Conium If there are scirrhosities in either the breasts or uterus and labor does not progress normally. Pains spasmodic; vertigo, particularly on turning in bed; rigidity of os uteri.
Cuprum Violent spasmodic pains appearing at irregular intervals, often with violent cramps in the lower extremities.
Gelsemium Cutting in the abdomen from before backward and upwards, rendering the labor-pains useless; these come on with every pain.
Graphites In females of large, corpulent, venous constitution, tettery spots here and there on the surface, which itch much and ooze a glutinous fluid; her pains are weak or have ceased.
Hyoscyamus. There is delirium, startings and jerks in various parts of the body, in the face, eyelids and sometimes all over.
Ignatia. Deep sighs and sadness, she must take a deep breath in order to breathe at all. The labor does not progress.
Ipecacuanha. One constant sense of nausea, not a moment’s relief. The pains are distressing by reason of a sharp cutting about the umbilicus which darts off towards the uterus, or even the sharp cutting about the umbilicus; this distress hinders the proper action of uterus.
Kali carb. The pains begin in the back and instead of coming round in front like a regular pain, pass off down the buttocks or the glutaei muscles or they are sharp and cutting across the lumbar region arresting contractions.
Lycopodium. During the paroxysms of her pains she is obliged to keep in constant motion, with weeping and lamenting; there may be even spasmodic contraction of the neck with the above symptom.
Magnesia m. The labor pains are interrupted by hysterical spasms See. Hysteria, same remedy.
Natrum c. Anguish, tremor, and perspiration with every pain, during which she desires to be gently rubbed.
Natrum m. Very, very sad and forboding so much so as that labor goes on very slowly, from feeble pains.
