A pair of blunt-pointed scissors.

Large and small safety pins.

Several small squares of soft linen, about four inches square, for dressing the cord, and two inches square, for washing the eyes and mouth.

A soft hairbrush.

A powder-box and puff, with lycopodium or fine starch powder. (The scented powders are often irritating.)

A small jar of cold cream.

Two soft towels.

A full suit of clothes, as described above, for the baby.

A woolen shawl or wrap.

CHAPTER VIII.

SIGNS OF APPROACHING LABOR-THE PROCESS OF

LABOR.

Certain changes take place during the latter part of the ninth month which indicate that labor is approaching. One of these is the sinking of the abdominal enlargement. The upper part of the womb, which has at the beginning of the ninth month been high enough to reach the pit of the stomach, comes down gradually to a point about midway between the extremity of the breast bone and the navel. This sinking of the womb is known as "descent" or "settling" of the child, and indicates that the head of the child, which is ordinarily the part to be born first, has stretched the lower part of the womb and is finding its way into the cavity of the pelvis, through which it must pass in the birth. Great relief to the mother results from this descent of the womb, as the lungs are no longer pressed upon to the same extent as before. The change in the position of the womb produces, however, an increased amount of pressure on the lower portions of the body. Swelling of the lower limbs is apt to result in consequence of this, and walking is rendered difficult. Piles, or hemorrhoids, are apt to form, and irritability of the bladder to exist.

During the last two weeks of pregnancy patients are apt to suffer from what is known as "false pains." These are cramp-like pains, so much like labor pains that patients are often deceived by them, and led to imagine that the labor is really coming on. They are called 'false pains" to distinguish them from the pains of labor, which are known as "true pains." The way to distinguish between the two kinds of pains is to observe whether there is any regularity as to the time of their occurrence; also, whether the interval grows shorter, and whether, with this shortening of the interval, the pains grow stronger. "False pains" are irregular in their occurrence, while "true pains," though starting perhaps at quite long intervals, as three-quarters of an hour or a half-hour apart, gradually come nearer together and grow stronger. "False pains," also, are generally located in the abdomen. "True pains" more frequently start in the back, coming forward to the abdomen and extending down the thighs. A strong "pain" is apt to be followed by one or two weaker pains. A nurse, if in doubt as to whether the pains are real labor pains or not, should have the physician sent for, who will make an examination to learn what the condition of the parts may be. A sign that makes it probable that the labor is really coming on is the appearance of what is known as the "show," a discharge of mucus, tinged with blood, which comes from the mouth of the womb, and indicates that the stretching of the mouth of the womb is taking place.

The whole process of labor is divided into three stages. The first is the stage of dilatation, when the mouth of the womb is stretching so as to allow the child to pass through it. With women who have never borne children this stage lasts on an average fifteen hours, while it is a very variable period for those who have previously borne children-sometimes lasting but three or four hours; the average time given is from seven to eleven hours.

The second stage of labor begins after the completion of the stretching of the mouth of the womb and ends with the birth of the child. For women with their first birth, this period lasts from an hour to an hour and a half; with others, from twenty minutes to an hour.

The third stage of labor includes the interval between the expulsion of the child and the coming away of the afterbirth on an average a half an hour or twenty minutes.

The time for the entire labor, in a case where it is the first birth, is about seventeen hours. In cases where other children have previously been born, the average is from eight to twelve hours.

The "bag of waters" is a sac of membranes in which the child is enclosed. Within this bag is found a liquid in which the child floats. The presence of this liquid between the child and the walls of the womb serves to protect it from the effect of falls or blows to which the mother may be subjected, and favors the regular development of the child. When labor begins with the

stretching of the mouth of the womb, a small portion of this sac is pushed out like a wedge beyond the rim of the dilating orifice, and helps thus in the dilatation. When the waters break early, labor is much more tedious because the even pressure of the bag of waters on the mouth of the womb is lost, and the stretching cannot, therefore, go on so rapidly and easily. As the mouth. of the womb opens, the pouch formed by the bag of waters is pushed further and further out into the vagina, the pains become stronger, and the pouch at last bursts, letting the water escape. This is "the breaking of the waters," called by physicians the "rupture of the membranes," and it should not take place before the mouth of the womb is fully open.

Labor, however, sometimes begins with this loss of water, as has been said in the chapter on the Accidents of Pregnancy.

The pains of the first stage of labor are cutting, grinding pains, very hard for the patient to bear, and causing her to be nervous and irritable.

The cries made by the patient during the first stage of labor are very different from those of the second stage. They are cries of complaint and suffering, while during the second stage they are rather groans accompanying a bearing-down effort on the part of the patient. The pains of the second stage are called "forcing" or "bearing-down pains." An experienced woman will know, as soon as these pains begin, that the doctor should be