he First Stage.--The first stage varies greatly in different women. The
average duration of this stage is from ten to fourteen hours in the woman
with the first child, and six to eight hours in the woman who has borne
children. During this stage the woman prefers to remain on her feet, sit,
stand or walk about. The amount of pain experienced varies greatly,
according to the temperament of the patient; in nervous women it may be
excessive. The pains now have nothing of that bearing down character which
they afterward acquire; they are described as "grinding," are usually felt
in the front. The genitals become bathed with secretions, which are
sometimes tinged with blood. This is an especially trying period to a
young wife, for she cannot see that the pains are doing any good, only
making her restless, tired and nervous. Little can be done by the
physician in this stage except to encourage and explain what is really
being accomplished by these seemingly futile pains and by tact and proper
encouragement, a physician tides this stage over and gives great comfort
to the needy patient. This stage ends with the opening and dilation of the
mouth of the womb and the second or expulsive stage sets in, with pains
altered in character.

Second Stage.--The pains now become more frequent and severe and last
longer, and the patient now manifests a strong desire to expel the
contents of the womb. The woman now feels better in bed and when the pains
come she involuntarily bears down, with each contraction she sets her
teeth, takes a deep breath, fixes the diaphragm, contracts the muscles of
the abdomen and bears down hard if you allow her to do so. The knowledge
that she is working to overcome an obstacle gives her some satisfaction
and she feels that she is accomplishing something by the efforts she is
making. The physician can aid greatly by suggesting to the patient how to
use the pains and how much bearing down to do. He can tell her when not to
bear down, and so save her strength for the next real pain when bearing
down will do good. Although the pains are really harder in this stage,
nervous women suffer no more, for their mind is now concentrated upon the
work at hand. Sometimes at the beginning of this stage the patient feels
chilly or has a severe chill; a hot drink and more covering counteract
this. Another phenomena is the escape of the waters and a lull in the
pains for a little time, when they come on more effectively than be