The Practice and Applied Therapeutics of Osteopathy Charles Hazzard, D. O. 1905      CHAPTER XXV   OBSTETRICS  
 
    It is not the object here to deal with the conduct of a case of childbirth.  That is left to special works upon the subject.  It is sufficient, within the scope of this work, to give the special osteopathic points in connection with obstetrical work.
    It is the common practice, during the early stage of labor after the true pains have commenced, to hasten labor, if desirable, by stimulation at the parturition center at the 2nd lumbar.  This increases circular contractions in the uterus, causes descent of the cervix, and dilatation of the os. It is usually best to rely upon the natural process of labor and very often this treatment is not used.
    Later one may aid the further dilatation of the os by inhibition of the clitoris.  This is accomplished by pressure over the lower part of the pubic symphysis, between the labia.  Inhibition of the round ligaments is also used for this purpose.
    For severe pains in the back, desensitize about the 5th lumbar and relax the neighboring spinal tissues.
    If the bearing down pains do not come regularly and hard enough, one should give occasional firm stimulation in the region of the second lumbar.
    As the head is descending the finger should be used to press back the edges of the os all around the head.  Also, in case of folds in the vaginal walls, they should be kept smoothed out, and the walls should be pressed well up and outward all around.  If these folds occur they cause great pain and headache.
    To prevent laceration of the perineum, both hands should be applied to the pelvis.  One presses the tissues down over the pubic arch and inhibits the clitoris, while the other grasps the two tubers ischii and springs them toward each other, at the same time supporting the perineum.  As the head is born the hand makes pressure against it, as required, to prevent its coming with too great force.
When the afterbirth is ready for delivering, slight stimulation at the upper lumbar will aid it if necessary.  If necessary, a quick pull at the mons veneris will aid in expelling it.  A cough will sometimes be sufficient to start it.
    After it is born the hand should be placed upon the abdominal wall and support the uterus until it is well contracted and hard.
    Desensitize the clitoris to stop after pains.
    It is well to flex and circumduct the limbs carefully, before leaving a case, to see that there are no slips at the hip joints or excessive contractures of muscles, which may lead to milkleg.