LABOR seems
completed with the expulsion of the child, the one act upon which the
efforts of the accoucheur and the expectations of the patient have
centred, the culmination of hours of suffering and anxiety; both feel as
if their work were completed, and but little thought is given by either
to the remaining afterbirth which is usually expelled without much
suffering to the mother, and if nature be not interfered with, rarely
calls for any exertion on the part of the attendant.
Accidents occurring during the birth of the child are immediately
followed by alarming results, while those happening
during the delivery of the placenta can be ignored at the time,
although the consequences are often disastrous. The third
stage of labor accordingly excites but little interest, and is, I
may almost say, unduly neglected; some radical changes have
of late years been made in its treatment, but, although advocated
by able obstetricians, they have by no means met with
the hearty concurrence of the profession at large, of which
they deserve and which their importance justifies.
My attention has been recently directed to what I may call
the natural management of labor, or the customs observed during
childbirth by such people as are not yet governed by
modern obstetric law, and who follow the dictates of instinct in
this purely mechanical function of our animal existence; my
researches in regard to the position of women in labor have
shown me the correctness of the course adopted by those
untutored people with whom methods have been traditionary
for ages which have not until now reached us, in this advanced
nineteenth century, as the teachings of our most scientific
obstetricians; and I deem it of interest, if not of some little
practical importance, to study the management of the placenta,
indeed the treatment of the patient during the third stage of
labor, among uncivilized people who are as yet forced to rely
upon their instinct for their obstetric practice, and upon whom
the obstetric laws, and I may say obstetric fashions, of to-day
have not yet encroached. It is only of late that ethnological
studies have developed and have brought to light the innermost
life and most private and secret customs of those interesting
children of nature; but very little attention has, however, been
paid to their obstetric practices, and above all to this very
uninteresting and unimportant detail.
The management of the third stage of labor has received so
little attention that I shall be obliged to confine myself, by reason
of the scanty data at my command, to the leading points; I
nevertheless hope to be able to develop the more important features
sufficiently to show that these untutored people, following
the guidance of instinct, have, as a rule, pursued a much more
correct practice than can be attributed to the followers of scientific
midwifery; above all they have fully appreciated, in resorting
to abdominal expression, the dangers of the vis a fronte,
and the importance of the vis a tergo as their main reliance for
the speedy and successful removal of the placenta. Nor are
the data as broad as I should like to see them; I can gather
but little from the records of travellers or from the pages of
history; the information I have been able to obtain is almost
altogether in regard to the customs now observed among the
North American Indians, and for this I am indebted to the
kindly interest shown by the surgeons of the United States
Army, and the physicians of the Indian Agencies who have
freely responded to the questions I have put in the circular
sent out through the Smithsonian Institution by the generous
offices of Major J. W. Powell, the director, and others of the
gentlemen connected with the Bureau of Ethnology, above all
Dr. H. C. Yarrow.
I shall discuss, first, the management of the third stage of
labor in simple cases, as it is customary among the various
tribes, and this will be best understood by describing, I., those
methods which are adopted for the purpose of expelling the
placenta, in which the patient retains the same position which
she occupied in the delivery of the child, and, of these, the
one ordinarily practiced is by the employment of a
vis a tergo,
most commonly by a force applied externally from above downwards,
by manual expression; and secondly, by action of the
diaphragm, by the use of emetics. Much less frequent is the
employment of the
vis a fronte, that fatal traction upon the
cord, which forms the third group. Somewhat different from
these methods is a fourth, which I have classified under II.,
comprising the customs of all those tribes who look upon a
change of posture as the important element for the purpose of
accomplishing the expulsion of the after-birth; a change of
position is made immediately after the birth of the child, and
the patient assumes a different posture from the one occupied
during the earlier stages of labor. This is not frequent in ordinary
cases, but is a usual resort in case that some difficulty is
experienced in the removal of the placenta. I have then considered
under different heads the treatment of simple and difficult
cases, and will next review the management of the cord,
as it may be of interest to note the usual time of cutting the
cord and the methods of cutting and tying it; finally I will
briefly indicate some of the more peculiar customs, and the, to
us, strange views entertained with regard to this stage of labor.
