In the first place, the services of a competent attendant should be secured. The attendant should, if possible, be a thoroughly trained physician. This is a field in which woman as a physician can fill a very useful sphere. Under no circumstances, except in emergencies, should the important process of parturition be placed wholly in the hands of a midwife whose qualifications, such as she may possess, are wholly derived from experience at the bedside, no matter how large may be the number of cases she may have attended. No one person could by practical experience alone in a life-time acquire all the knowledge necessary to meet the urgent emergencies which are liable to arise at any time in childbirth. The science and art of obstetrics have been developed by a very slow process, and as they exist at the present day, are the result of the combined experience of physicians during the last two thousand years. Thorough theoretical knowledge is indispensable as a foundation for practical skill. This; of course, must be supplemented by actual experience.

As soon as the first labor pains make their appearance, the physician should be promptly notified, and also the nurse, if the latter is not already in readiness. The room in which the patient is to be confined should be a large, light, airy, and pleasant one. But few persons should be allowed to be present, and these should be such as are desired by the patient, and no others.

So far as consistent, all her wishes should be complied with, so that she may be in as pleasant a state of mind as possible, and that no mental influence may present an obstacle to prevent the completion of the process in which her physical and nervous powers will be taxed to the uttermost. No remark of a discouraging nature should be uttered in the presence of the patient, but hope and confidence should be inspired.

During the first stage the patient need not go to bed. In fact, it is better that she should sit up, as the sitting posture favors the progress of labor. This need not be required, however, if the patient prefers to be in bed. During this stage the patient should quietly allow nature to carry on the work without any attempt to hasten matters by "bearing down," as she may often be encouraged to do by ignorant friends. These voluntary efforts are of no consequence until the neck of the womb is fully dilated. The patient should be allowed to drink cold water, or weak lemonade, as freely as desired; but stimulants should not be given, as they will produce a feverish state of the system without giving any real strength. Hot teas are also better withheld. If the bowels have not moved freely, they should be relieved by a full enema.

During the first stage, the bed should be made in readiness. The feather bed, if in use, should be removed and replaced by a moderately hard mattress. Over this should be placed a large rubber cloth three or four feet wide and six feet long. This should be covered with a comfortable, and a sheet placed over all.

At the beginning of the second stage the patient should go to bed, and her clothing should be drawn up under her arms so that it will not be soiled, the lower portion of the body being protected by a sheet or petticoat. The patient may lie on the left side or on the back. If the fetus is strongly inclined toward the right side, it is better for the patient to lie upon the left side. During the severe pains which characterize the second stage of labor, the back of the patient should be supported by firm pressure with the hand. The knees should be drawn up, and fixed in such a position as to give them support during the pains. The nurse should take hold of the hand or wrist of the patient to give her an opportunity to make firm traction during the pain. In the intervals between the pains, if the patient is exhausted, she should be allowed to sleep, if possible, in order to recuperate her strength. When the face becomes hot and flushed, it should be bathed with cool water. As the termination of labor approaches, as indicated by the increasing severity and frequency of the pains which at this time often become almost continuous, a supply of hot water should be got in readiness, a large pailful being brought to the bedside, together with a large pan, to be ready for any emergency. A syphon syringe should also be filled with hot water and held ready for use. A bottle of camphor should also be at hand, and a strong cord, made of silk or linen thread twisted and well waxed, with a pair of scissors, should be in readiness for prompt use.

As the head of the child presses severely upon the perinaeum, the efforts of the patient should be restrained, to avoid rupture by giving the tissues time to dilate. As soon as the head passes out, the cord should be felt for, as it is sometimes wound around the neck in such a way as to interrupt the circulation as the strain is brought to bear upon it. It also sometimes happens that knots are tied in it, which being tightened by the strain may cut off the supply of blood from the child too soon. If the body is not speedily expelled, the child may be withdrawn by making traction with the finger placed in the armpit

As soon as the child is born, the hand of the nurse should be placed upon the abdomen of the mother in such a way as to grasp the upper part of the womb, firm pressure being made for the purpose of securing contraction of the organ. This pressure should be kept up until the after-birth is expelled and the bandage applied.

The child should be brought to the edge of the bed as soon as it is born and examined. Generally it at once utters a cry, which indicates that its lungs are filled with air. In case it does not cry and breathes feebly, or only gasps, the hand should be dipped in cold water and placed upon its chest, or the chest may be slapped with the hand. This will generally be sufficient to start the respiration. If the child is limp and pale, and makes no efforts whatever at respiration, it should be immediately inverted, being held with the head downward, and hot flannels should be wrapped about it. Efforts should be made to excite respiration by compressing the chest at intervals of a few seconds Care should also be taken to see that the mouth is cleared of mucus, though this is not likely to be necessary unless the child has begun to breathe just as the head is being bom and has drawn mucus into the throat If the face has a purplish appearance, the child should be placed at once in a warm bath of a temperature of 105, or as hot as can be safely used without injury to the skin, and cold water should be dashed upon the chest. Artificial respiration may also be employed at the same time. These measures should be continued for some time and should not be abandoned so long as any evidence whatever of the action of the heart can be obtained. Some cases are recorded in which infants have been resuscitated after apparent death had continued for fully an hour.

As soon as it breathes freely the cord should be tied in two places; the first about two inches from the body, the other about three inches. The child should then be laid upon its side, not on the back, as the side position favors the escape of mucus from the throat. If there should be much rattling in the throat, indicating the presence of considerable mucus, the infant should be laid with its head downward and to one side, so as to allow the mucus to escape.