She is less agitated after the pain subsides, though it does not cease entirely. During the interval the margins of the os again become supple, the membrane that was tense while the pain lasted becomes flaccid, and the child’s head can be more plainly felt. As the contractions are repeated the os uteri dilates more and more until it is completely opened and no part of its margin can be touched; though very frequently from some obliquity of the uterus, the margin on one side can be observed pushed down before the head of the child, while that on the other side cannot be reached. In ordinary cases the membranes are ruptured and the waters escape at the commencement of the second stage, and the time occupied by the first stage is nearly three-fourths that for the whole labor. But the duration of the stages as well as the time occupied by the parturition is exceedingly variable, and the same may be said in regard to the duration and character of the pain. We may observe here that pain is nearly inseparable from the contractions of the uterus, so that in common language the two expressions are used indifferently; but using the word in its ordinary sense the pain in the first stage of labor is different from that in the second. What are called grinding pains characterize the first part of labor, and although they differ in different individuals, they are pretty generally so severe as to cause the patient to cry out. As soon as the labor advances to _the second stage_ there is a change in the character of the pains. They are more frequent and longer and the intervals shorter; but though the suffering may be greater the cry is more suppressed, the bearing down is carried to a greater degree, and each pain is succeeded by a calm more perfect than that in the first stage. Should the interval be rather long some patients get a little sleep between the pains, but if there has not been a bursting of the waters previously there is generally now a pain sufficiently hard to break the membrane. Either in the first or last part, or during the whole of the labor, the woman says that the pain is in her back, it being in the lumber and dorsal region; the grinding pain she speaks of as being forward, they seem however to go through from the umbilicus to the sacrum. In cases where there is rigidity of the uterine orifice, there is I believe pain especially in the back; and when the os becomes fully dilated, the pains are bearing down; the patient at the accession of a pain holds her breath, and seizing hold of something with her hands, brings the muscles of the back and abdomen and extremities to aid the expulsive efforts of the uterus. I do not doubt that this straining of the mother at this time is advantageous; these efforts of the mother should not be encouraged, however, at the first part of the labor, because then they do no good, nor at the very last, as combined efforts then may rupture the perineum.