Prospective Mother — 13 - Chapter 10, part 1 - The Birth of the Child

THE BIRTH OF THE CHILD

The Cause of Labor--The Course of Labor--The Stage of Dilatation--The Stage of Expulsion--The Placental Stage--The Effect of Labor upon the Child--Meddling--Justifiable Intervention--Management of Birth without the Doctor--Methods of Reviving the Child.

The birth of a child is an act of nature, an act generally performed as satisfactorily as any other bodily function.

Birth has, however, so deep a meaning for the mother, as well as for her family and her friends, and is, above all, so vital to the future of the race, that it has naturally become the subject of many impressive superstitions.

Primitive peoples have invariably embodied in their religion their views of the origin of life and the phenomena of its inception.

With these mysteries Greek and Roman mythology dealt extensively, as did also the myths of the Phoenicians, the Egyptians, the Chinese, and the people of ancient India.

No race, indeed, has lacked its own interpretation of childbirth, and no phase of the process has failed to have attributed to it a supernatural significance.

A number of these superstitions still distress women on the eve of motherhood.

To correct exaggerations and to deny many utterly false impressions of childbirth there is no better way than to give a frank account of what does actually occur.

I shall adhere to a purely physiological description of the event, for, although I appreciate fully the fact that its sociological and sentimental aspects are perhaps equally important, these are not, in my opinion, pertinent to a medical discussion.

In a scientific sense the act of birth may be described as a series of muscular contractions which widen the birth-canal and expel the contents of the pregnant womb.

Since the process requires an expenditure of energy, it has come to be called labor.

Intrinsically, labor does not differ from many other physiological acts.

The heart drives blood into the arteries; the bladder empties itself; the intestine moves its contents and finally expels the undigested residue.

All these acts strongly resemble that of birth; but they also differ from it, for the head of the fetus is a hard body which resists being molded to the shape of the passageway through which it enters the world.

To this resistance the pain which accompanies delivery is largely due.

And yet even in this respect the act of birth is not unique; certain circumstances lead to painful contractions of the muscle fibers in the intestine and less frequently of those in other organs.

It is natural to ask what purpose is served by the pain associated with labor; and a moment's reflection will make it clear that one reason for the discomfort is the warning which it gives of the approach of birth.

If the mother were not thus cautioned, she might be delivered under very awkward circumstances, and even under such conditions that occasionally the infant would perish the instant it was born.

All mammals suffer in giving birth to their young, though with quadrupeds the period of suffering is shorter, for the upright posture of man has changed the shape of the pelvis, rendering birth somewhat more difficult.

Anyone who observes the lower animals preparing for delivery will be convinced that they also are responding to pain, the most compelling call of nature.

That the suffering is at all essential to the mother's love for her child I cannot believe.

Under certain circumstances, as for example when the Cesarean operation is performed before the onset of labor, the delivery is painless; yet I have never known a mother less devoted to her child on that account.

Biology throws no light upon the relation of the "curse of Eve" to present-day confinements.

THE CAUSE OF LABOR.

--It is evident that, in a general way, the muscular contractions of the womb cause the birth of the child; but before we thoroughly understand the act, science must discover what stimulates the muscle to contract.

Although careful research has thus far failed to disclose the source and character of the stimulus, it has taught many properties of the contractions themselves.

Their force has been measured and found to increase as the end of labor is approached; the pressure they exert varies between nine and twenty- seven pounds.

We also know that the patient can neither hasten nor delay the contractions voluntarily.

Strong emotions are believed to accelerate them at times, and we find a very extraordinary illustration of this effect recorded in I Samuel, IV, 19, where we read: "Phineas' wife was with child, near to be delivered; and when she heard the tidings that the ark of God was taken, and that her father-in-law and her husband were dead, she bowed herself and travailed; for her pains came upon her."

On the other hand, and much more familiarly, excitement checks the contractions after they have begun.

Every obstetrician has heard patients say that with his arrival the pains died down.

Yet such an influence is never permanent; the contractions soon reappear, and labor advances as though no interruption had occurred.

For the artificial induction of labor, the physician has at his disposal means that resemble the method sometimes employed by nature.

Suitable appliances introduced into the womb provoke contractions, and labor proceeds step by step as if the stimulus were a normal one.

Nature does not, however, ordinarily employ mechanical irritation to start the uterine contractions.

The initial factor is more remote and, as I have said, is not yet well understood.

Since, as everyone admits, delivery occurs with conspicuous regularity about the end of the fortieth week of pregnancy, and pregnancy corresponds, therefore, to ten menstrual cycles, some have been led to believe that labor and menstruation have a common basis.

The truth of this supposition, however, must be doubtful until we know the cause of menstruation.

Yet it is a matter of common observation that the uterus becomes unusually irritable about the time when the tenth menstrual period would be due.

Strong purgatives administered with other drugs on or after the calculated date frequently bring about delivery, whereas previous attempts of this kind prove unsuccessful.

To account for this peculiar irritability of the uterus about the fortieth-week of pregnancy, microscopical changes in its tissues have been suggested but sought in vain.

Nor will the distention of the organ explain it.

A great many theories have been offered to explain the causation of labor, but they have now only an historical interest.

To-day we are just beginning to learn the correct methods of studying the problem.

The experience of ages has firmly established the fact that the fetus is expelled when ready to enter the world, or as we say, when it has become mature.

But how does the fetus assert its maturity?

There is the kernel of the matter; that is the real problem, a problem for the solution of which, happily, we possess better facilities than have heretofore existed.

One solution that has been suggested assumes that the fetus loses ultimately its power to assimilate the nourishment provided through the mother's blood.

In consequence, it is argued, the material which previously enabled the fetus to grow now collects-- in the maternal circulation, stimulating the womb to contract.

A part of this explanation, namely, that the material which stimulates the muscle fibers, whatever it may be, is a chemical substance and that it circulates in the mother's blood, is almost certainly true.

There are, however, very weighty reasons for believing that this substance has not the character of food.

A more plausible supposition is that the fetus produces this material in the course of its natural living processes, and the substance would accordingly be a waste-product.

THE COURSE OF LABOR.

--The current view that labor begins in the early evening and generally ends during the night is incorrect.

This impression has grown out of the fact that the whole process frequently consumes twelve hours and must in such an event include some part of the night.

Statistical evidence indicates that almost as many births occur at one hour of the twenty-four as another; to be precise, only five per cent.

more children are born between 6 P. M.

and 6 A. M.

than between 6 A. M.

and 6 P. M.

As already pointed out, labor commonly begins with transient discomfort in the lower part of the back.

At first the uterine contractions are far apart; they last but a moment and cause only twinges of pain.

Gradually, the preliminary contractions give place to others of more definite character, which appear at intervals of five to ten minutes.

Estimates of the total length of labor will vary according as one counts from the first warning or from the advent of typical contractions which we hear called "pains of the right kind."

These generally continue for about four hours, and this period represents the average length of time the physician remains constantly with his patient.

Estimates which include the initial symptoms are longer, varying from ten to eighteen hours.

Prolonged labors are rare; and extremely short labors are also infrequent, though now and again it will be only an hour or two from the very first pain until the child is born.

To predict absolutely the length of labor for any particular patient is impossible.

The averages calculated from large groups of cases have no more than a broad scientific interest; when applied to any individual they are apt to be very misleading.

Thus, from statistics we should expect the first labor to be longer than subsequent ones, but we are often surprised by an unusually rapid delivery.

To facilitate description, labor is divided into stages which are conveniently designated the first, the second, and the third.

During the first stage the way is prepared for the expulsion of the child;

at the end of the second stage the child is born; the third stage is occupied with the separation and the expulsion of the after-birth.

The progress of labor may be ascertained from time to time by means of suitable examinations.

Whereas formerly vaginal examination was the only method which served this purpose, we are now acquainted with several.

For example much of the information necessary for the proper management of delivery may be gained from examination of the patient's abdomen; and this may be supplemented by observations too technical to consider here.

Occasionally I have heard doctors accused of negligence because they failed to make numerous vaginal examinations.

Censure of this kind generally is unjust, for discretion in limiting the number of vaginal examinations provides against infection a guarantee which cannot be overestimated.

In many cases, of course, they are still invaluable toward determining what treatment should be pursued, yet they are never employed to the extent once customary.

Moreover, physicians have learned to take extraordinary precautions whenever vaginal examinations must be made.

Anyone who practices obstetrics in these days appreciates how careful he must be, especially of the cleanliness of his hands.

Energetic scrubbing with soap and water and the free use of antiseptics, as physicians now employ both these measures, appear ridiculous to some women who have witnessed deliveries under a less stringent regime.

They may be bold enough to express their disapproval.

They may remind us that many women have been successfully delivered without such care.

And in this they are correct; we know that nine of every ten mothers passed through childbirth uneventfully before modern precautions were dreamed of.

Such precautions as are now taken, however, are necessary to secure the safety of the tenth patient.

And it is because they are anxious that all their patients shall enjoy the greatest possible security that physicians dare not omit any precaution.

Disinfection of the physician's hands does not entirely exclude the danger of infection through vaginal examinations.

Although he may have been most conscientious, there is some risk of carrying contaminating material into the birth-canal from the region about the opening of the vagina.

Unless that region has been satisfactorily disinfected, sterilizing the dressings and cleansing the hands may become a waste of time.

Sensible patients, therefore, will never object to the preparations which the nurse is instructed to make.

THE STAGE OF DILATATION.

--For reasons which are sufficiently clear, the womb must remain closed while fetal development is in progress;

but under normal conditions, when this development is complete, the mouth of the womb dilates and the infant is expelled.

The infant never takes an active part in its birth, although physicians once thought it did and attributed tedious labors to stubbornness on its part.

The error has been corrected in medical teaching, but many persons unacquainted with the facts cling to the idea that the infant forces its own way out of the womb.

At the end of pregnancy the mouth of the womb is small, too small, often, to admit an instrument as broad as a lead pencil.

It is obvious, therefore, that very radical changes must be wrought before the infant can pass.

The door, as it were, must be widely opened.

This phenomenon, which we call dilatation of the womb, is brought about by involuntary contractions of the muscle fibers in its wall, every point of which they draw upward.

Now, the top of the womb is directly opposite its mouth, consequently the contractions inevitably pull its lips wider and wider apart.

Ordinarily another factor is concerned in this mechanism.

To understand the whole process we must recall that a fluid surrounds the fetus, and that this fluid is contained within elastic membranes.

The uterine contractions compress the fluid, drive the membranes, like a wedge, into the mouth of the womb and spread its lips apart.

Thus, to the pulling effect just mentioned, a pushing force is added.

After full dilatation has been accomplished and the membranes can serve no further purpose, they rupture; as the midwife puts it, "the bag of waters breaks."

The quantity of fluid which escapes will vary.

Occasionally, a huge gush will drench the patient's clothing; but more often what is lost at first amounts to only a few teaspoonfuls, though small quantities of fluid often dribble away with subsequent contractions.

Although not the rule, it is by no means unusual for the membrane to rupture at the onset of labor, or at least before the mouth of the womb is fully dilated.

Exceptionally, rupture occurs a few days before labor begins; and still longer intervals, though extremely rare, have been recorded.

Whenever the membranes rupture prematurely, the pushing force of the uterine contractions becomes less effective, though the pulling force is never impaired.

Under these circumstances, which occasion what is called a "dry labor," delivery is apt to proceed slowly, yet that does not follow necessarily, for the part of the fetus which happens to lie over the mouth of the womb may act as efficiently as the unruptured membrane would.

During the first stage, the longest of the three, the patient is comfortable between the contractions and generally interests herself in some diverting occupation.

The presence of the physician can be of no assistance then, and patients rarely demand it.

Usually, they are satisfied to know he is ready to come when called.

It is wrong to deceive patients with various recommendations from which they will vainly expect help during this stage; their welfare is best served when they are left alone.

Generally the advice of well-meaning friends will be as harmless as it is futile, yet I must emphasize that during the first stage straining to expel the fetus is ill advised.

Such effort will surely be ineffective then and may exhaust the patient; in that event it becomes harmful, for she will be fatigued when she most needs strength.

Since, during the first stage, the progress of delivery is not influenced by what the patient may choose to do, she may follow her own inclinations.

The average patient will be restless and will keep on her feet most of the time; alternately she will walk or stand still as one or the other happens to make her more comfortable.

As a contraction begins she often seeks support, leaning upon a chair or bending over the foot of the bed, and presses with her hands against the lower part of her back.

Patients may sit down or lie down whenever they wish; if so inclined they may even go to sleep.

Most patients take no food during the whole course of labor, but, if nourishment is desired, there is no reason for abstaining from it.

They may always drink water as freely as they like, and may also have milk, weak tea or coffee, or broth; but alcoholic beverages should never be taken without the specific consent of the physician.

This same caution applies to strong coffee and tea.

If desired, crackers or toast and rice or other cereals may be eaten in reasonable quantity.

For fear of vomiting a patient will occasionally be told not to partake of any food.

This advice is given, not because the symptom is alarming, but to save her needless annoyance.

Indeed, vomiting frequently indicates that dilatation is well advanced, and, therefore, may generally be regarded as an encouraging sign.

Ordinarily a persistent inclination to have the bowels move has the same significance.

On the other hand, a constant desire to empty the bladder is more prominent at the onset of labor than later.

To know the moment which marks the transition from the first to the second stage of labor can be of no benefit to the patient; but for the medical attendant the greatest interest centers about this point.

Casual observation sometimes enables the physician to recognize it, for characteristically at the close of the first stage the whole picture changes.

In a typical case the membranes will rupture at this instant, expulsive efforts will begin, and, as we have just learned, there may be symptoms referable to pressure.

Moreover, a blood-tinged discharge, spoken of as the "show," usually makes its appearance about the same time.

Since slight bleeding frequently occurs at the beginning of labor, or a little later, this manifestation, like all others, may not be implicitly trusted to indicate the end of the first stage.

Such uncertainty, however, is a matter of no great consequence, for in the absence of all these symptoms the physician may, if necessary, accurately determine the degree of dilatation by an internal examination.

THE STAGE OF EXPULSION.

--The term delivery has been broadly applied to include the whole of labor.

More strictly, its use should be limited to the second stage, for this period alone is concerned with the actual birth of the child.

Although dilatation has been completed, the uterine contractions continue, devoting their force to emptying the womb.

In this they now receive assistance from the voluntary contractions of the abdominal muscles.

The second stage is very much shorter than the first; for this reason and others, too, it proves much less trying.

As the child is moved downward through the birth-canal, the mother usually appreciates for herself that she is making headway; whereas in the first stage she may know of progress only through what she is told.

Moreover, it is possible in this stage for the physician, by means of inhalations of chloroform, to relieve her of the pain attending the expulsion of the child.

Since the anesthetic properties of chloroform were discovered by an obstetrician who was searching for a drug with which to lessen the pain of childbirth, the facts connected with the discovery have a peculiar interest for mothers.

Sir James Y. Simpson had always been anxious for some means to prevent the suffering endured during surgical operations "without interfering with the free and healthy play of the natural functions."

He, therefore, welcomed the introduction of ether anesthesia from America; and in January, 1847, at the Edinburgh Medical School, administered ether to an obstetrical patient.

This was the first instance in which an anesthetic was employed at the time of childbirth.

Since ether, to his mind, had certain shortcomings, Simpson set about finding another anesthetic, and devoted all his spare time to testing the effect of numerous drugs upon himself.

How he came to try chloroform has been vividly told by one of his neighbors.

[Footnote: "Late one evening, it was the 4th of November, 1847, Dr. Simpson, with his two friends and assistants, Drs.

Keith and Duncan, sat down to their somewhat hazardous work in Dr. Simpson's dining room.

Having inhaled several substances, but without much effect, it occurred to Dr. Simpson to try a ponderous material which he had formerly set aside on a lumber- table, and which, on account of its great weight, he had hitherto regarded as of no likelihood whatever; that happened to be a small bottle of chloroform.

It was searched for and recovered from beneath a heap of waste paper.

And with each tumbler newly changed, the inhalers resumed their vocation.

Immediately an unwonted hilarity seized the party--they became bright-eyed, very happy, and very loquacious--expatiating upon the delicious aroma of the new fluid.

But suddenly there was talk of sounds being heard like those of a cotton mill, louder and louder; a moment more, and then all was quiet--and then a crash!

On awakening, Dr. Simpson's first perception was mental--'This is far stronger and better than ether,' said he to himself.

Hearing a noise, he turned round and saw Dr. Duncan beneath a chair, quite unconscious, and snoring in a most determined manner.

More noise still and much motion.

And then his eyes overtook Dr. Keith's feet and legs making valorous attempts to overturn the supper table.

By and by Dr. Simpson having regained his seat, Dr. Duncan having finished his uncomfortable and unrefreshing slumber, Dr. Keith having come to an arrangement with the table and its contents, the _sederunt_ was resumed.

Each expressed himself delighted with this new agent, and its inhalation was repeated many times that night.

Miss Petrie, a niece of Mrs. Simpson, gallantly took her place and turn at the table, and fell asleep, crying: 'I'm an angel!

Oh, I'm an angel!'

"--Quoted from "The Life of Sir James Young Simpson," by H. Laing Gordon; Masters of Medicine Series.

] The introduction of chloroform met with violent opposition, not upon medical grounds alone, but also for moral and religious reasons.

"To check the sensation of pain in connection with the visitations of God," zealous theologians announced, "was to contravene the decrees of an all-wise Creator."

Simpson reminded them "that the Creator, during the process of extracting the rib from Adam, must necessarily have adopted a somewhat similar artifice--for did not God throw Adam in a deep sleep?"

Nevertheless, a number of years passed before the prejudice against artificial sleep was overcome.

Chloroform only became popular after Queen Victoria consented to its use at the birth of her seventh child, Prince Leopold, in 1853. There is still some difference of opinion regarding the routine employment of chloroform in obstetrical practice, though the weight of authority favors its use during the contractions at the end of the second stage, providing always that no preexisting organic derangement renders the drug dangerous.

Under no circumstances, however, should chloroform be given in the first stage, and seldom at the beginning of the second.

Prolonged administration will exert an injurious influence upon both mother and child; under these conditions it ultimately weakens the uterine contractions and delays the delivery.

Such an effect must be avoided, since it would endanger the life of the child by asphyxiation as well as exhaust the mother.

On the other hand, a few drops of chloroform inhaled with each pain toward the end of the second stage will dull sensibility, although consciousness remains unaffected.

When the drug is thus administered, the uterine contractions are scarcely, if at all, altered, and the assistance which the patient is willing to give herself generally becomes more powerful.

Should the anesthetic have the opposite effect, it must be withheld; but that is seldom necessary.

As the head advances the anesthesia is deepened, and the mother sleeps soundly while the child is being born.

As long as dilatation is in progress, the patient may sit up or walk about; but with the advent of the second stage she should go to bed, for there she will be able to make the best use of the expulsive pains.

The appropriate posture for delivery is still the subject of dispute, though modern views in no instance advocate the unnatural absurdities formerly supported by custom or superstition.

Students of ethnology relate that among savage tribes almost every conceivable position was advocated for women in labor.

Subsequently it became customary to have delivery take place in specially constructed chairs which are still used in semi-enlightened countries.

With civilized nations at present women are always delivered in bed; yet national peculiarities still prevail.

Some physicians favor what is known as the English position, in which the patient lies on her left side with her face inclined toward the chest, the trunk bent toward the knees, and the legs drawn up toward the abdomen.

The majority of obstetricians, however, prefer that the patient should lie flat on her back.

With the average case, and from the standpoint of facility in delivery, which of these postures happens to be chosen is a matter of indifference.

But it is so much less awkward for the physician when the patient is on her back that this position has been widely adopted in America.

During the expulsion of the child the mother intuitively desires to help herself; generally she cannot resist straining, and rarely needs encouragement.

Assisting the uterine contractions with voluntary muscular effort, the act commonly described as "bearing down," may be performed most effectively when the patient is lying on her back.

The knees are drawn up and spread apart; the feet are braced against some firm object; the hands grasp straps fastened at the foot of the bed;

and the head is slightly raised so as to bring the chin near the chest.

When the contraction begins the patient takes a deep breath and holds it while she strains vigorously, as if to make her bowels move.

All voluntary effort should cease as the contraction wears away, for straining between the contractions can accomplish nothing.

Her own inclination to "bear down" will clearly indicate to the patient when she ought to act.

In the second stage patients regularly experience a feeling of pressure against the rectum, and this sensation, since it depends upon a low position of the child's head, is a welcome sign.

Cramps in the legs also indicate progress, for they result from similar pressure against nerves adjacent to the lower part of the birth- canal.

The cramps disappear immediately after the child is born, and are consequently never dangerous.

Straightening out the legs or rubbing them usually gives relief.

Most women, however, complain during the expulsive period only of pain in the back, and find nothing so grateful as firm pressure over this region.

Energetic efforts quickly bring the head to the outlet of the birth- canal, where it may be seen, at first only during the contractions, but later during the pauses as well.

The crown of the child's head is generally directed upward and becomes fixed against the pubic bones of the mother, which lie just in front of the bladder.

Around this firm pivot the child's head rotates upward, and, as a result of the movement, forehead, eyes, nose, mouth, and chin successively emerge from the birth-canal.

Following the birth of the head, natural forces turn the body upon one side, the better to accommodate the shoulders to the passageway.

After these are born, the rest of the body slips easily into the world, and the second stage ends.

THE PLACENTAL STAGE.

--Although the third stage is chiefly concerned with the separation and the delivery of the after-birth, on which account it is known as the placental period, the description of other no less remarkable events belongs here.

Even after the infant is born the umbilical cord extends from its navel to the placenta, just as it has done throughout pregnancy.

Among larger mammals separation of the new-born from the mother is brought about in one of two ways;

sometimes the activity of the young breaks the navel-string, though more frequently the mother bites it in two.

Both these methods, we are told, have been employed by savages; but at the beginning of civilization it became customary to sever the cord with a cutting tool, and the tie thrown round it represents the first attempt of man to ligate blood-vessels.

Ordinarily there is no need for haste in this operation.

On the contrary, some delay is often of advantage, since an appreciable quantity of blood that otherwise would remain in the placenta is thus given opportunity to enter the infant's body.

According to present ideas, as long as the heart-beat can be felt in the cord it should not be tied.

The sleep induced toward the close of the previous stage lasts for a few minutes, so that most patients are unconscious through the greater part of the brief placental stage.

Before the influence of the anesthetic has worn off, the physician has an excellent opportunity to sew up any laceration which may have occurred in the course of delivery.

Slight injuries are not uncommon, especially if the confinement be the first, for the most skillful treatment often fails to prevent them.

Since superficial tears are never serious if promptly closed, it is not their occurrence, but the failure to recognize them, or to sew them up when they are recognized, that deserves condemnation.

After the birth of the child the womb becomes smaller, its walls grow thicker, and the cavity within is narrowed.

This series of changes partly detaches the placenta, but the separation depends chiefly upon the uterine contractions.

These contractions also force the after- birth into the vagina, whence it may ultimately be dislodged by the patient if she bears down again.

Usually, however, it is preferable to save her further efforts of this kind, and, as a routine, the physician places one hand upon the abdominal wall, grasps the womb, and, during the contraction, makes firm pressure downward.

The maneuver expels the after-birth, which consists of the placenta, the membranes, and the umbilical cord.

Then the empty womb will form a hard, spherical mass about the size of the child's head, lying just above or to one side of the bladder.

Slight bleeding also occurs during the third stage, and further loss of blood follows the removal of the after-birth.

The total loss varies between a half pint and a pint, though larger amounts may be noted occasionally without appreciable effect upon the mother.

Naturally, large, robust women can spare much more blood than those who are anemic.

And yet pregnancy invariably prepares the mother for a loss of blood that would alarm anyone unfamiliar with obstetrical practice.

Often the woman just delivered is not harmed by a hemorrhage that would endanger the life of a healthy man.

This may seem paradoxical, but it is not; for the surplus blood, which formerly performed important duties in connection with the nutrition of the fetus, must now be removed to readjust the mother's circulation.

In a very small number of cases an unduly large loss of blood follows the expulsion of the placenta.

Fortunately, by treatment which consists usually in spurring Nature to more vigorous action we are well equipped to deal with this emergency.

A wonderful mechanism has been provided by Nature to control excessive bleeding after delivery.

If the forces upon which this mechanism depends are sluggish, the physician stimulates them.

As in the preceding stages, the muscle fibers of the uterus supply the power in question, and because of this role an observant obstetrician once called them, "living ligatures."

Certain of these fibers encircle the mouths of the blood- vessels which have been left open through the detachment of the placenta.

When they contract the vessels are squeezed, impeding the escape of blood.

The necessity of this action explains the contractions which continue even after the placenta has been expelled, when they are vigorous enough to cause discomfort they are spoken of as "after-pains."

After-pains seldom follow the birth of the first child, but they regularly follow later confinements.

In any case, such contractions do not persist very long, for tiny clots form within the blood vessels and effectually close them.

As soon as the lining of the womb has been restored the clots are absorbed, leaving the organ in much the same condition as before conception took place.