Comparisons between the fetal mortality after the use of pituitrin or the forceps are erroneous. Quigley[131] contrasted the fetal mortality in these conditions. In 147 pituitrin cases it was 2.7 per cent., in about five or six times the number of forceps cases it varied from 5.7 to 15.63 per cent.; but wherever there is any real need at all for the forceps, pituitrin at once is contraindicated except in easy low forceps deliveries, where in the hands of a skilled man pituitrin may safely replace the forceps to avoid possible instrumental infection of the uterus. There are contractions of the uterus toward the end of gestation, before labor proper sets in, which cause what are called False Pains, and these must not be mistaken for the beginning of labor, as unnecessary examinations and meddlesome interference may bring on great harm. Uterine atony, or weak pains, may affect the patient in the first stage of labor, in which the cervix of the uterus should be dilated; or the second stage, in which the child is delivered; or the third stage, the post-partum period, when the placenta is thrown off. Contractions of the uterine muscle cause pain, and these contractions themselves are called the Pains. In the first stage weak pains may prolong the dilatation of the cervix for days and expose the mother to sepsis or exhaustion, and the child to consequent danger. [131] _Jour. Amer. Med. Assoc._, April 10, 1915. In the second stage the abdominal muscles, which push the child out of the uterus, fail to work if the pains are weak. Causes of unsuccessful pains in the second stage are: an infantile uterus, fibroids or other tumors in or near the uterus, peritoneal adhesions, a full rectum or bladder, abnormal position of the uterus, a pendulous abdomen, diseases of the uterine wall, scars from past operations, chronic metritis or endometritis, primiparity in relatively advanced age, twins, distention of the bag of waters, gas in the uterus, abnormal position of the child, contracted pelvis, adhesions of the membranes about the os uteri, fatigue of the woman, and tetany or stricture of the uterus. The obstetrician must be able to diagnose the special cause and treat the indications.