The uterus acts as a receptacle providing the home for the growing fetus from conception to the time of delivery. Globally most women deliver vaginally. The mechanism of onset of labour is still a speculation. Current theory is that hormonal change brought about by the hypothalamopituitary axis lowers progesterone, which is a muscle relaxant. This is followed by local changes in the chorioamnion that result in the production of prostaglandins, which cause softening and effacement of the cervix and uterine contractions that are key elements for the onset and progress of labour. Absent mechanical difficulties, uterine contractions bring about the process of cervical dilatation and descent of the head, resulting in spontaneous expulsion of the fetus, placenta and membranes. The main reasons for slow progress are inefficient uterine contractions (P-power), relative disproportion due to malposition, or cephalopelvic disproportion either due to a large baby and head (P-passenger) or a relatively small or non-gynaecoid pelvis (P-passage). These three Ps influence labour outcome.

Labour or parturition is a physiologic process culminating in expulsion of fetus, amniotic fluid, placenta and membranes from the gravid uterus of a pregnant woman involving sequential and integrated changes in the myometrium, decidua and cervix. In a woman with a regular 28-day cycle, labour is said to take place 280 days after the onset of the last menstrual period. However, the length of human gestation varies considerably among healthy pregnancies, even when ovulation is accurately measured in naturally conceiving women. Initiation of labour may be best regarded as a withdrawal of the inhibitory effects of pregnancy on the tissue of the uterus, rather than as an active process mediated by the release of uterine stimulants. Successful labour passes through three stages: the shortening and dilatation of the cervix; descent and birth of the fetus; and the expulsion of the placenta and membranes. Efficient uterine contractions (power), an adequate roomy pelvis (passage) and an appropriate fetal size (passenger) are key factors in this process.

Preterm birth (PTB) is the leading cause of perinatal mortality and morbidity. The long-term health problems associated with PTB are significant. Despite many strategies to identify and treat preterm birth and labour, there remains slow progress in reducing the rates of PTBs. The causes of PTBs are multifactorial. There needs to be a good and coordinated approach to the identification of risk factors, screening strategies and appropriate interventions to have any impact on reducing the rates of PTBs worldwide. Currently, there is no single diagnostic test that should be used exclusively to direct management in the setting of threatened preterm labour. Tests to stratify risks of PTB include biochemical markers such as fetal fibronectin and transvaginal ultrasound of cervical length. Common interventions for preterm labour include tocolysis, antenatal corticosteroids and magnesium sulphate for neuroprotection. This chapter analyses the causes and risk factors for PTB, screening strategies and preventative initiatives to prevent PTB, and reviews the evidence and current guidelines in the screening and prevention of PTB.

Chapter 5 discusses the economic structure of a rational state. Anticipating Marx’s critique of capitalism, Hegel associates the maximization of self-interest promoted by the modern market to an inconsistent and ultimately irrational conception of freedom. He argues that the elevation of freedom to a rational form requires not merely a readjustment of the economic sphere, but a change of paradigm, and this change is entrusted to a system of professional corporations in which competition is replaced by cooperation and trust. Yet although these groups can help mitigate capitalism’s worst excesses, they are not up to the conceptual role Hegel wants them to play. This does not mean, however, that his associative strategy cannot be successfully revived. The chapter’s final section shows that a rational economic sphere implies not only the common ownership of society’s productive resources, but also the democratization of the productive sphere. Drawing on the market socialist tradition, it is suggested that the corporations can be fruitfully reconstructed as worker-directed enterprises, capable of recapturing their communal spirit while avoiding their main limitations.

This chapter describes material and immaterial labour in the context of the industrial production, resource extraction, and global circulation of the silvery-alkali metal known as lithium. It focuses on the different kinds of material labour involved in lithium’s extraction from local sites in and around the Atacama Desert in Latin America, as well as less visible forms of labour underpinning the mining industry, including the labour of social reproduction and colonial dispossession. In this context, it asks: how do narrative arts document the violence of lithium’s extraction as it materialises in damaged and dispossessed bodies and environments, as well as those less visible traces of lithium’s circulation around the world, and the different affective economies it inhabits? I suggest that a contradiction or tension between materiality and immateriality, between what is seen and unseen, defines every level of lithium’s transformation into a commodity, as registered within global networks of labour. These larger systems, I argue, are rendered invisible; just as lithium silently provides the charge for iPhone and Tesla, it is a vanishing mediator to what some thinkers have described as ‘new extractive imperialism’. This, however, becomes visible—precisely as a kind of ideological dissimulation—across a whole range of narrative forms.

Conclusion: The book ends by reflecting on the boundaries of ‘fact’ and ‘fiction’ in the context of maritime writing and the range of texts that render the different forms of lived experience associated with seafaring. It restates the book’s focus on the everyday global sea of the long nineteenth century that shaped the lives, labour practices, and imaginative worlds of working-class individuals and their families.

Marx’s early theory of labour and alienation originates from idealist concepts of spontaneity and formativity. His ideas of socialism and emancipation in the 1840s reprise aspects of Kantian autonomy and heteronomy and follow Fichte in linking labour with spontaneity. Marx formulates the dialectic of the will in a way favourable to the moment of particularity as membership in a social class, and sees one particular class as simultaneously a vehicle of universal interest and revolutionary transformation. Quantitative change is insufficient though necessary: a merely distributive socialism might enhance the living conditions of the workers, but would leave intact structures of exploitation which deprive workers of their agency as well as their happiness. His theory of history and emancipation, recently described as a self-actualisation account, can be more precisely identified as a variant of post-Kantian perfectionism, which, like Feuerbach’s, contains a strong admixture of pre-Kantian elements. This blending of heterogeneous elements has profound theoretical and practical consequences, notably in the absence of a developed concept of right.

This chapter explores the economy of the later Roman Empire, with special emphasis on resource management, economic structures and regional variations. It highlights how land, labour and capital functioned within a largely agrarian system, with agriculture serving as the primary economic driver and tax base. The chapter examines diverse sources, including archaeological surveys, historical texts, coinage and environmental data. It analyses the effects of political instability, regional differentiation and resource distribution on economic trends. Case studies from North Gaul, Iberia, Italy and the Eastern Mediterranean reveal that economic activity was influenced by both local conditions and imperial policies. The study also incorporates ecological data, such as pollen analysis and lead pollution levels, to assess economic fluctuations. A central argument is that the later Roman economy was not a uniform system but a collection of interconnected regional economies. While political fragmentation led to economic contractions in some areas, others adapted through local specialisation and changing trade networks. This study thus challenges the view of economic collapse, instead emphasising resilience and adaptation, and calling for an interdisciplinary approach to better understand the complexities of late Roman economic life and its long-term transformations.

This opening chapter situates O’Casey in the Dublin of his time, describing the existence of O’Casey’s Protestant family in Dublin’s Northside. The chapter contrasts that lower-middle-class existence with the disease and insecurity of the slum areas of Dublin. We encounter the political and cultural sensibilities of the Irish capital’s Catholic working-class population, a population that profoundly affected O’Casey’s life and work. The chapter shows O’Casey to be a writer who moved between and across social and cultural groupings in Dublin, with this part of the volume highlighting the Irish capital’s differing religious and political affiliations in the early twentieth century.

This chapter analyses the place of class in O’Casey’s thinking and focuses in particular on a relatively unknown O’Casey script from 1919, The Harvest Festival, which revolves around a charismatic worker-hero who dies when a strike becomes violent. The chapter also examines the rewritten version of that play, Red Roses for Me (1943), in order to explore how O’Casey’s aestheticizing of class confrontation was developed and refined. The chapter shows how O’Casey wanted class analysis to replace ideologies like religion and nationalism, which he believed to be misdirections of humanity’s important longings.

This chapter examines O’Casey’s plays in the context of Irish historical revisionism, examining whether the cynicism towards nationalism that O’Casey expressed in the 1920s can really be seen as an example of revisionism avant la lettre. The chapter situates O’Casey’s views in relation to the work of Father Francis Shaw and R. F. Foster, and looks at the critique of O’Casey offered in 1926 by Hanna Sheehy Skeffington. But the chapter argues that O’Casey was not seeking to evaluate the historical record in a dispassionate way. Rather, O’Casey sought to endorse a class-conscious socialist republic, and to show in his drama the way that the existing class system might use and abuse individual capability.

Content on the physiology of pregnancy focuses on the commonly examined areas including the cardiovascular, respiratory, endocrine and haematological changes in pregnancy, then the subsequent impact upon conduct of anaesthesia. We include a section on the materno-fetal circulation and the placenta, with an emphasis on the changes that occur at birth.

Obstetric anaesthesia is one of the high-risk areas of anaesthetic practice and is feared by many novices. Physiological differences of the pregnant patient are discussed.

The anaesthetist may have three main functions in the labour ward: provision of support and analgesia for the parturient, care of the patient in the obstetric theatre and care of the patients in the maternity high-dependency unit. Effective labour analgesia requiring the support of an anaesthetist may include the use of Entonox, IV/IM medications, and placement of an epidural or spinal. Remifentanil PCAs may be preferred in patients with contraindications to regional intervention and set-up may follow strict protocols and meticulous monitoring. A caesarean section may be an emergency depending on the threat to the health of the mother or fetus and may require urgent timely intervention. Regional anaesthesia is frequently the first choice, but some cases may require a general anaesthetic. Both types of interventions may carry risks and complications. Failed tracheal intubation in the obstetric patient should follow the OAA and DAS management guidelines.