-that, you may
recall, was the more or less painless stage, or as it has been termed, the
"getting-ready" stage. Inasmuch as it is an unimportant and practically
painless stage, most patients do not mind it. They continue to be up and
around and work as usual.

The first stage of labor is utilized by nature in opening the mouth of the
womb.

The second stage of labor is utilized by nature in expelling the child into
the outer world.

LENGTH OF THE SECOND STAGE OF LABOR.--After the second stage has begun, the
length of time necessary to end the labor, assuming everything is normal,
depends upon the strength and frequency of the pains. The stronger and more
frequent the pains, the quicker it will be over. First confinements
necessarily take longer, because the parts take more time to open up, or
dilate, to a degree sufficient to allow the child to be born. In subsequent
confinements, these parts having once been dilated yield much easier, thus
shortening the time and the pains of this, the most painful, stage of
labor. The average duration of labor is eighteen hours in the case of the
first child, and about twelve hours with women who have already borne
children. The time, however, is subject to considerable variation, in
individual cases, as has been pointed out.

CONDUCT OF THE PATIENT DURING THE SECOND STAGE OF LABOR.--She should remain
up, out of bed, as long as she possibly can. The object of this is because
experience shows that the labor pains are stronger, and more frequent, when
in the upright position. Even though this procedure would seem to invite
more constant suffering, it must be remember that labor is a physiological,
natural process, that there is nothing to fear or dread; and if the patient
is in good health, it is to her advantage to have it over soon, rather than
to encourage a long drawn out, exhausting labor. When the pains come [97]
she should be told to hold on to something, to hold her breath as long as
possible, and to bear down. A good plan is to roll up a sheet lengthwise,
and throw it over the top of an open door and let her grasp both ends
tightly and bear down; or she can put her arms over the shoulders of the
nurse and bear down. Instruct her to hold her breath as long as she can,
bearing down all the time, and when she can't hold it any longer, tell her
to let up, and then take a quick deep breath and bear down again, repeating
this programme until the pain ceases. Tell her specifical