The patient is entirely comfortable, as a rule, between pains and until they become very frequent will usually feel able, in fact prefer, to be up and about, but if she is on her feet when a contraction begins she will usually seek relief by assuming a characteristic leaning position (Fig. 67) or by sitting down, until the pain subsides. As dilatation advances, the patient has an increasing, sometimes persistent, desire to empty the bowels and bladder because of encroachment upon these two organs by the descending head. She may vomit, also, when the cervix becomes nearly or quite dilated. [Illustration: FIG. 63. ] [Illustration: FIG. 64. ] [Illustration: FIG. 65. ] [Illustration: FIG. 66. ] FIGS. 63, 64, 65, AND 66 are diagrams showing stages of dilatation and obliteration of cervix during labor. In the course of this stretching process, the cervix sustains many tiny lesions, from which blood oozes and tinges the vaginal discharge. This blood-stained secretion is often called the “show” and usually appears toward the end of the first stage. [Illustration: FIG. 67.—Characteristic position which patient often assumes during pains in first stage. ] As a rule, when the cervix is fully dilated the membranes rupture and there is a sudden gush of that part of the fluid which was below the fetus in the amniotic sac, but the rupture of the membranes does not necessarily mark the end of the first stage. In some instances they rupture before the cervix is fully dilated; in others, though not often, before the patient goes into labor, thus producing what is known as a “dry” labor. The abdominal muscles do not contract very forcibly during the first stage, the expulsive force in this period coming almost entirely from the uterine contractions. The patient’s cries at this time are sharp and complaining in contrast to the groans and grunts which accompany the second stage. Complete dilatation of the cervix marks the termination of the first stage. [Illustration: FIG. 68.—Diagram indicating the rotation and pivoting of baby’s head during birth. ] =Second Stage.= The second stage is sometimes called the stage of descent, or expulsion, of the fetus. The patient should and is usually quite willing to be in bed throughout the second stage, during which she should not be left alone. The pains are now regular, occurring at intervals of about two minutes from the beginning of one to the beginning of the pain following, and as the contractions last about one minute and are excruciatingly painful, the patient has very little respite from her suffering. Her face is flushed and she may perspire freely.