Delayed labor is defined as one in which the frequency, strength, duration and expulsive character of the uterine pain has been so changed as to prolong the second stage of labor, so that either the life of the mother or that of the child is endangered. The cause of uterine inertia may be local and general.
An condition causing, a disturbance of the uterine muscle would tend to produce this condition, such as multiple pregnancies, uterine tumors, excess of liquor amnii as well as an overdistended bladder. Among the general causes are mentioned, (1) general lowered condition of the system; (2) certain psychic and emotional disturbances; (3) fatty changes and atrophy of the abdominal muscles or separation of the recti.
As to the treatment, the author says that he believes in conservation in all things, particularly in obstetrics, and of the great need of giving Nature a chance; however, in selected cases, he believes in the early application of forceps in the second stage of labor. In conclusion he remarks that the woman about to become a mother has the right to demand every alleviation from suffering which medical science has provided, such as anesthesia, asepsis and rapid delivery.
Given a case of labor with the os uteri fully dilated and obliterated, ruptured membranes, empty bladder and rectum, and asepsis, no abuse is possible. The time at which forceps should be applied depends upon the conditions that arise in each case. It is the author's rule to make use of the forceps after no progress has been made for two hours. The old idea, and one rather common among, general practitioners, to wait until danger signs to mother or child were present, was decidedly erroneous.
—Phila. Med. Jour.