CHAP. I.
Of BIRTH.
MAN’s appointed Time may as reasonably allude to his BIRTH, as to his DEATH: His Days and his Months (mentioned by holy Job[158]) being as much determin’d, naturally speaking, in the One, as in the other Case.
THE INFANT thus being thoroughly ripen’d, and arrived to full Perfection of Maturity, the Hour approaches, in which it scorns any longer Confinement to such narrow Bounds. For the Animal Spirits being discontented, for want of due Liberty and free Motion; the Vitals, for want of Refrigeration and Refreshment; and the Natural Spirits, for want of sufficient Respiration and Nutrition: They all concur to make a Commotion, and (as it were) a victorious Revolt or an Effort pushing for CONQUEST.
THE INFANT being thus irritated, immediately shakes off its Fetters, breaks the Ligaments, rents the Membranes, thrusts through the Enclosures, and makes its most vigorous Attempts to enlarge itself from the Prison of the Womb, into that of the World.
WHICH Enlargement depends very much indeed upon NATURE, but more particularly on the Strength and Vigour of the INFANT, seconded by a peculiar Faculty of the Womb, that by degrees is drawn-in to Consent, and Endeavour to dislodge and expel its troublesome and obstreperous GUEST.
NOW the INFANT, during the whole Time of Gestation, adhering to the WOMB, by the Umbilicals, as the Fruit does to the Tree by the Stalks, upon this Occasion distends the WOMB, and having valiantly turn’d itself, breaks the Membranes, and dissolves the Acetabula: When also the Orifice of the WOMB is competently open’d; and That (in Avicenna’s memorable Words[159]) at the Command of the great God. Upon This the Waters flow; the Umbilicals parting from the WOMB and their proper Vessels, and the Veins and Arteries of the SECUNDINE severing themselves, in like manner; As ripe Fruit, or the Leaves of Trees in Autumn fall-off naturally, or break from their proper Stalks.
THUS the WOMB, exerting its extensive and expulsive Faculties, excludes the Legitimate INFANT: To which great Work also, the Painful Labours, and Labouring Pangs of the MOTHER (in the manner they happen with the contracted Spirits, depress’d Midriff, and compress’d Muscles of the Abdomen) contribute not a little Help. And, in short, this stupendous Work or Action is called BIRTH; and is nothing else, but an Exclusion of the mature CHILD.
WHICH BIRTH proceeds either from Causes of the INFANT, or from Causes of the WOMB: Of the INFANT, because through the strict Confinement of a narrow Place, and Defect[160] of Aliment, and Refrigeration, It kicks and spurns for its Exit: Of the WOMB, because about that Time, being overloaded and aggrieved by the Bulk and Weight of the Child, it endeavours, by its own expulsive Faculty, to disburthen itself, and propel or drive it forth to the utmost of its Power. For——
AS it is the proper Function of the Stomach, to eject the noxious Humours by Vomit, and deject the Natural Excrements into the INTESTINES; as it is also the Office of the RECTUM to evacuate the FÆces; as likewise the Profusion of the Urine is the Action of the Bladder; as again the Extrusion of all fuliginous Matters is the Work of the Heart and Lungs; and as, at last, the Effusion of the Genital Seed (in Venery) is the Operation of the Virile Testicles: So the Exclusion of the Mature FOETUS is the Eighth[161] and last proper Action of the WOMB; which is justly deem’d the only Primary Agent and Active Cause of BIRTH, as the excluded FOETUS is the Passive.
BUT this BIRTH is not always Uniform; for as it differs in Time, so it does also in Manner: From hence we have with respect to the Time, Legitimate and Illegitimate BIRTHS, which being already discuss’d[162], I shall resume nothing by way of Repetition in this Place: And with respect to the Manner, we have also two general Sorts, namely, Natural and Preternatural BIRTHS; which together with their particular Branches, I am now to enter upon, without any farther Digression.
BY a Natural BIRTH, I mean nothing else, but that which is perform’d without any ART or Artificial Means; which BIRTH (of itself) strictly observes the Order and Appointment of Nature: That is, in the INFANT’s coming Head foremost, Face downwards, Arms following, extended (along the Sides) strait upwards, towards the Thighs.
HIPPOCRATES’s Reason[163], in short, for the CHILD’s thus turning and presenting itself, is very good; viz. Because of all the Parts, the Head is the Heaviest about the Time of BIRTH, as appears more at large from Sect. I. Chap. 10.
BUT besides this Argument, I believe Wise Nature has also order’d it thus; because This indubitably is the most safe and easy Manner of EXITION both for the Mother and Infant: Insomuch that by all other Methods of EXTRACTION, One or the Other, and sometimes Both Lives are, or may be, endanger’d, if not very dextrously perform’d, according to the best Laws of Art and Judgment, as by and by will more manifestly appear.
BUT because I have generally observ’d most Authors to treat promiscuously of BIRTHS, not only accounting some, which are really Natural, to be Preternatural; but also both handling and writing of them as such, only because attended with some difficult Circumstances: I shall (in this place) take Leave to make an agreeable Distinction betwixt the different Sorts of Natural BIRTHS, in order to make every thing the more clear and obvious to the Conception of the Reader. Upon which Account therefore, I shall reduce These to two Heads, and that under the Titles of Natural Easy, and Natural Difficult BIRTHS.
THE FIRST of which I include in this Chapter; but because in this Case (which I call a Natural Easy BIRTH), Nature alone always performs the Work, without any Help of ART or Artful Means; and because also the Midwife (upon this Occasion) has but little or nothing to do, save only to observe the concluding Chapters of the last preceding Section; and upon receiving the Child, immediately to manage and provide both for the Mother and the Infant according to their several Necessities, as hereafter shall be inculcated in the respective Chapters of the next following Section: I say, for these Reasons, I have no Room here to insist farther on this present Head; wherefore I proceed in course to the SECOND Sort of these BIRTHS. Namely——
THO’ indeed every difficult Expulsion of the INFANT, from whatsoever Cause it may proceed, is verily a Difficult BIRTH; yet I shall here distinguish a difficult One from a preternatural BIRTH; not only that I may thereby, the better avoid the Confusion which others have led themselves into, by treating of Both promiscuously, but also that my Method may tend the more to the peculiar Benefit and Advantage of the Ingenious Reader.
WHEREFORE I call that a Difficult BIRTH; where, notwithstanding the Figure and Dimensions of the CHILD, answer in all respects to its proper natural Posture, in a Perpendicular Womb, duly situated, yet the Exclusion of the INFANT, is retarded, by some certain Opposition or Difficulty. From hence proceeds the real Difference between This and the Natural Easy BIRTH, forasmuch as This always requires less or more skilful Assistance, according to various Circumstances, and That but Little or none at all.
NOW the Causes of Difficult BIRTHS are very various, and according to the Nature of them, This sometimes proves equally as dangerous as the Preternatural; but when so it happens, I have commonly observed the Fault to be, for the most Part wholly owing to the arrogant MIDWIFE, who either knew not how to remove the Cause and facilitate the BIRTH herself, or delay’d applying betimes to some Abler Person, for the Relief and Safety of her Labouring WOMAN.
HENCE arises a Fundamental Maxim, which I would lay down for a memorable Rule to all such Ignorants; that no MIDWIFE ought to keep a Woman in this Condition under her Hands (especially in a Place where extraordinary Help is to be had) any longer, than she finds the Advances of BIRTH answer to the Proportion of Time spent about it: But forthwith she ought to deliver her up to the Care of the more Skilful and Judicious Practiser in this Art. In which Case, of Compliance and Condescension, she is to be highly commended for her tender Care, and cautious Concern; whereas upon acting contrary to this good Rule out of Pride or Obstinacy, and the fatal Accident ensuing, I have known the MIDWIFE to have been try’d for her Life in the City of Venice.
BUT that I may render every thing Plain and Easy to the Apprehension of the weakest Reader, by reason that the Causes of Difficult BIRTHS are both different and numerous, I shall again reduce them to Two Classes; namely, External and Internal: The External, I shall include in the next following Chapter; but the Internal Causes, requiring a more Curious and Extensive Dilucidation, may (I hope) be pertinently divided into a Three-fold Difference; viz. Causes of the Mother, of the Infant, and of the Passages; which I propose to handle particularly, all in their due Order. But First,
IN all difficult Cases, the Cure or Remedy chiefly depends upon the certain Knowledge of the Nature of the Case, and the Cause of the Difficulty: Since (according to Celsus[164], that noble Roman Physician) it is not to be suppos’d that He should know how to remedy Diseases, who knows not their Original Causes.
FOR as in other Cases, so also in MIDWIFERY, the Cause being known, the Difficulty is easily remov’d; but especially when it only proceeds from External Causes, it requires no great Art, save only the MIDWIFE’S particular Notice and discreet Animadversion.
AS, FIRST, for Instance, in Case of any Difficulty, occasion’d by an Intemperature, or inclement Constitution of Weather and Air; the more adverse or inclement the Weather is, the more tender Care ought to be taken of the Labouring Woman: Namely, in Summer, when the Heat scorches so much as to dissipate the Woman’s Strength, she ought to Labour in a Ground-Chamber backwards, which may be strewed (for the Purpose) with Vine or Willow-Leaves, Rose-Water, and a little Vinegar; as it is customary in hot Countries.
IN Winter, when the Cold pinches so as to condense and astringe the Womb and the Passages, she ought to Labour in an Upper-Room, kept moderately warm with one continued Fire; the MIDWIFE rubbing gently the Hypogastrick and Ischiatick Regions every now and then with hot Cloathes.
IN Spring and Fall, when parching dry Weather, with North and East Winds most abound, the MIDWIFE ought not only to rub these Inferiour Regions with hot Cloaths; but also to qualify the Influences of the Siccid AIR, by anointing the Passages with proper Unguents.
A Second External Cause may proceed from the Passions of the Will or Mind, as it often does from Fear and Despair, Dejection and Pusillanimity: In which Case, it is the MIDWIFE’s Duty to encourage her Woman by the Hopes of a Speedy DELIVERY, and doing well under God’s Blessing. When the Cause arises from Anger or Sorrow, these are to be assuaged by the repeated Christian Exhortations, and Friendly Admonitions of the Midwife and Gossips. When it comes from Pride and Obstinacy, as has been the Case of some Lofty Women; who (deeming themselves too good, to be treated after the common Course of Mankind) have refused to undergo or permit the proper Means, absolutely necessary for their own Relief; This ought to be severely check’d by the Company, especially by the nearest Friends; the Midwife (by proper Remonstrances) convincing her to her Shame of her obstinate Sin. When it proceeds, in fine, from Bashfulness or too strict a Modesty, she may be justly reprehended of Folly; for no Woman of good Sense (how Modest and Virtuous soever) will expose her own Life or her Infant’s to Danger, for the trifling Fancies or Caprices of her own vain Imagination, especially in a Case where like things happen to All equally of Flesh and Blood.
BUT when it happens to proceed from the Woman’s being ill-affected, or owing a private Grudge or Hatred to any in the Company, (as I once knew it to be the Cause of a difficult and lingring BIRTH) She ought to speak her Mind freely, at least to her MIDWIFE; who ought to give the Person civil Notice to retire forthwith, for certain Reasons, &c.
A Third External Cause of a difficult BIRTH may proceed from a wrong Position, or other sinistrous Methods taken to assist the Woman: In which Case, such Inconveniencies are to be alter’d, and better Measures practis’d; for thus the Cause being removed, the BIRTH differs in Nothing from That of the Natural Easy Case.
WHENCE I come, in the next Place, to speak of Difficult BIRTHS, proceeding from Internal Causes; and because they are Three-fold, as has been before observed, I shall assign them as many respective Chapters, treating of Each in their due Order, as mentioned.
IN this (as in the former Case) the Midwife must use her most acute and nicest Judgment, to find out the particular Cause of the Difficulty. Which being done,
I. IF She finds it arises from the Woman’s being too Young, or too Old, of her first Child, or too Lean at last; she is to anoint the Passages with proper Unguents, which ought to be done some time before, as well as in the Hour of LABOUR: When she is likewise to employ her subtile Hand, in assisting and augmenting the Dilatation of the Orifice; as is requisite also in Case of the Woman being too Fat or Gross.
II. IF the Woman be too small, short, crooked, or misshaped, not having a Breast strong enough to forward and bear down her PAINS; or if she be over tender, sensible, and apprehensive of PAIN; or too weak, and not able to contribute or assist by her own forcing Endeavours; or short-winded, and not capable to constrain her Spirits downwards: In all these Cases she is to be kept upright, for the more free Respiration, as well as for encreasing her PAINS, standing or walking about the Room, according to her Strength, being supported under her Arms, and not put to Bed until at least the WATERS are broke. But, in the mean Time, the weak and tender Woman ought to be now and then comforted and refreshed with fresh soft Eggs, good Broths, Jellies, a little Wine and Toast, a little Wine and Water, or such like convenient Things, as well as with the Hopes of a speedy Delivery.
III. WHEN the PAINS are not Natural or Genuine; but Spurious, Faint and Languid; or Shifting and Tergiversant; such are to be assuaged by proper Lenitives and Anodynes; which being regularly done, the Genuine Pains may be excited by proper Clysters, and divers other Means. But I would advise none to a Profuse Use of MEDICINES in such Cases, since I well know that many a Woman has lost her Life by using dolorifick Medicines, prescribed by imprudent MIDWIVES, without considering, or so much as knowing the true Circumstances of the Condition: Whereas in most Cases, by the ingenious Motion of an Experienc’d Hand only, the Pains may be sufficiently awaken’d, and the Birth safely promoted.
IV. WHEN the Difficulty proceeds from the Debility of the Womb, or its Expulsive Faculty, not being able or capable to Exclude the INFANT, because of a more strong and valid Retentive Power: In this Condition, if there be no evident External Cause to be obviated, it depends chiefly upon the Subtile Hand of the MIDWIFE, to assist the Womb in its Function; and otherways the PATIENT is only to be treated as in the Case of the weak and tender Woman above-mentioned.
V. WHEN the Woman is taken with any Acute Disease, the BIRTH is to be prompted by all safe Means; and if a Natural DELIVERY does not presently succeed, an Artificial one must (without Loss of Time) be undertaken. As in the Case of immoderate and continual Floodings, with concomitant Convulsions, which always proceed from the Separation of the SECUNDINE (either in whole or in part) from the Womb, and happen many different ways, as already mentioned at large[165].
IN these Cases, especially if the Secundine is found (by the Touch) at the Orifice, there is no Hope of Stopping them by any other Means, than by delivering the Woman; which now the sooner done, the better (for saving two Lives) and that whether at full time of Reckoning or not. But this Operation, I conceive, is to be most discreetly Undertaken in the manner following, viz.
THE Woman is to be placed in Bed, with the Upper and Lower Part of her Body almost equal, then the Midwife is gently and gradually to introduce her Fingers into the Orifice, dilating it cautiously with one or two, until she can enter them All; when opening the Matrix by Degrees, she gets in her Whole Hand, and thereby first carefully tears the Membrane with her Nails, if the WATERS are not previously broke: Then she puts her Hand in the same Membrane to the Infant’s Feet, seeking them in their Place, where they are to be found, when they don’t present themselves at First: Because, the Hold by the FEET being Better, it is more easy to deliver by Them, in this Case, than by the HEAD, or any other Part. After this the FEET being found, the Child is easily turn’d, as long as the Womb is loose and slippery, and the Humours not quite flown off; which being nicely done, the FEET are to be drawn out both together, if possible; but if otherways, they must be drawn down separately, with great Caution: And so being conjoin’d or held fast together, they are to be drawn forward with one Hand, whilst the other is circumspectly thrust towards the Knees or Buttocks of the Child, in order thereby to turn also the whole Body of the Infant, so that its Face, Belly, and Toes may tend downwards towards the RECTUM.
IN this Posture the Child may be gently and gradually extracted with Ease; next the SECUNDINE must be fetch’d away in its Turn, and lastly the Womb is to be thoroughly cleans’d of all heterogeneous Bodies, as formerly directed[166]. And thus the Womb (having yielded up its Contents) immediately contracts, by which MEANS of divine Appointment, the Vessels close and shut firmly, and consequently the FLUX ceases, together with all the concomitant SYMPTOMS.
BUT it is to be well remembred, that this Operation ought to be timely perform’d; that is, before the Woman has lost too much Blood, or is too much spent; in which Condition such a painful Attempt would but accelerate her Death. As to her Regimen next, upon this melancholy Occasion, She must be duly provided for beforehand, that she may be able to undergo and stand out such an extream difficult DELIVERY; and afterwards, that she may recruit her Spirits, and retrieve her exhausted Strength: For which Purposes, she ought to be supplied from time to time with some good Broths, Jellys, and a little generous Wine, smelling continually Rose-Vinegar, and applying repeated warm Toasts dipt in Wine (in which Cinnamon has been infus’d or boil’d) to the Region of her Heart, as also Napkins dipt in a Mixture of Water and Vinegar about her Reins, in order for turning the Course of the Flux.
THESE Things being all duly and artfully perform’d, the Patient (under God) will soon recover and be in Statu quo. Now These, in short, are all the principal and most common Causes of difficult Births proceeding from the part of the Mother; which being thus discussed with all Brevity, I go on to——
IT sometimes also happens, that the Difficulty in Labour arises from the Infant: And that FIRST when Two or More strive for Priority in BIRTH.
NOW this Condition the Midwife can no otherways distinguish or discover, but by the Touch; and when the one is more forward than the other, ’tis not to be done or known, until she has even touch’d the very Fund of the Womb: Because sometimes it so happens, that One Child has its Hands and Feet so intermix’d, that whatever way She turns her Hand, she finds Legs or Arms, Hands or Feet, which often deceives Midwives, believing there are TWINS. But in this perplex’d Case the most sure and only certain Sign, is, when she feels two Heads or two Backs; for then she cannot be Mistaken, since one Body cannot have two Heads, unless it be a Monster, which may be soon discover’d by feeling if the double Head be fix’d to one and the same Body.
BUT in the Case of TWINS or more Children (as long as they come right) the Delivery is perform’d, as if the Woman had but One, in the Natural Case already Stated; so that I shall repeat or recapitulate Nothing of what I have said, only that the After-Birth, or Births are not to be touch’d, until all the CHILDREN are Born: Upon which drawing gently the Navel Strings (in their Turns) with the One Hand, the Other brings them forth easily and orderly; as is set forth more fully in Sect. IV. Chap. 18.
A SECOND difficult LABOUR may proceed from the Weakness and Debility of the Infant, or from its being too Small-grown; in which Case, both the Woman and the Midwife are to use their best mutual Endeavours to promote the BIRTH, since the CHILD can do little or nothing for itself, and the Less it is, the less it is affected with the THROWS of the Mother, and the less Impression her Impulses make upon it: Whereupon Nature is to be assisted in this weak Condition by all convenient Means, whereof THAT of the Agile or Nimble Hand is the most effectual.
A THIRD difficult BIRTH may proceed from the Infant’s being too Big; In which Place I must previously apprize the READER, that I no ways mean a MONSTER or Hydropical CHILD, but only One full, well, or Big-grown, which is only reckoned too Big in regard of the Maternal Passages, which may be too Small in Proportion.
IN this Case, there is an absolute Necessity for Manual Assistance, since the PAINS (however penetrating or forcible) cannot effect the Work. But and if the INFANT is fallen down (well turn’d) into the Pelvis, the Midwife using her best and most skilful Endeavours to dilate the Passages below near the Os Coccygis, the Child may be easily brought forth (without any dangerous Instrument) by her dextrous Hand only accomplishing the Work. In the mean Time, however, it is to be minded always, that This is still more safely and commodiously done by the Feet, than by the Head, after carefully dilating the Os Coccygis, taking this Opportunity in the beginning of the Labour, before the INFANT is too much press’d down into the Pelvis.
NOW these are, in fine, the most common Causes on the Part of the INFANT, whence I come to touch upon difficult BIRTHS, proceeding from Causes of the Passages; which, because they are various, I subdivide into a Fivefold Diversity; viz. Difficult BIRTHS, proceeding from Causes of the Membranes, from Causes of the Pelvis, from Causes of the Bones of the Pelvis, from Causes of the Bladder and Rectum, and from Causes of the Vagina: And because all these require to be singularly explain’d, and particularly insisted upon, I shall assign them as many respective Chapters. And First——
SUCH Difficulties as These, in BIRTH, may arise, FIRST from the Strength and Firmness of the Membranes; when they happen to be so gross, callous, or thick, that the INFANT cannot easily break through them.
In this Case, when the MIDWIFE finds the Orifice of the Womb sufficiently dilated, for the Circumference of the Head, and the Child so forward in the Passage, that it is ready for BIRTH, and only impeded by the rigid or stiff Membrane; then she has just Authority to break it gently with her Nails and Fingers; taking Care in the Act not to draw the Membrane towards her, because thereby the Secundine (of which the Membrane, tho’ distinguish’d from the Placenta, is in Effect, but the Thinner Part) would be untimely separated from the Womb, and the INFANT undone, unless presently Born.
BUT the MIDWIFE, after All, must always remember, not to attempt This, before these mentioned Signs are obvious to her Touch; otherways the Waters being too soon discharged, the CHILD is left behind, the Passages grow dry, and that which might have been an Easy and Speedy, proves a Difficult and Lingring BIRTH.
AND the self-same Consequences arise from the Weakness and Tenuity of the MEMBRANES; when they are so thin and soft, that they break, and the Waters (which are destin’d to lubricate and moisten the Passages) flow before their Time: In both which Cases, the Office of the Waters must be supply’d by proper Fomentations, and Oils, which (however costly) falls far short of the Effect of what is so Natural. However, in short, neither of these Conditions, under the diligent Hand of the expert Midwife, can differ far from the Case of an Easy BIRTH, as already defin’d; wherefore I proceed regularly to——
DIFFICULT BIRTHS on part of the Passages, happen frequently, because of some perverse Form of the PELVIS, in these Respects; as by its being either too Large, too Narrow, or too Smooth. But that I may be the better understood in this Matter: FIRST, by a PELVIS too large, I mean such an One, as is so in comparison with the Womb or Infant; in which Condition, as the Womb can neither be firmly fix’d, compactly inclos’d, or duly supported, so neither can the Head of the Infant and the WATERS be exactly depressed upon the Orifice: Hence it often happens, that (besides the Midwife’s careful Hand) the Privities are the best, if not the only Defence, against both the Womb and the Child’s falling out of the Body.
SECONDLY, By a PELVIS too small, I mean, such an One as is so, in Consideration of the Size of the whole Body; in which Condition, the INFANT commonly answering to that Proportion, its Head can by no Possibility pass thro’ the PELVIS, in a Womb well seated, without great Force, by which Means the Womb may be easily turn’d obliquely: And thus consequently the Smallness of the PELVIS, may sometimes prove the Cause of a Preternatural, as well as of a Difficult BIRTH; and not only so, but also the Death of both the MOTHER and CHILD may ensue thereupon, unless timely deliver’d by an Artful Hand.
THIRDLY, By a PELVIS too smooth, I mean such an One, whose Distance betwixt the OSSA PUBIS and the prominent Part of the OS SACRUM is too narrow; in which Condition, tho’ the Womb be well placed, it cannot admit the Head (especially if large and well-grown) without great Difficulty: And this smooth PELVIS may also very easily turn the Womb (either way) obliquely, and consequently prove of the same dangerous consequential Effect with the preceeding Case.
HENCE (I think) it evidently appears, how necessary it is that all MIDWIVES should not only know the Form and Size of the PELVIS, but also the Situation and Connexion of its Bones, as already describ’d at large[167], that she may thereby the better distinguish the Circumstances by plainly discerning the Causes, and judge accurately of the Position of both the WOMB and the INFANT; so that in the beginning of the Labour, she may immediately discover how the Pelvis and its Entrance is form’d, whether Large or Narrow, Smooth or Round.
FOR this Reason, the first Thing that the MIDWIFE ought to do, when she comes to a Woman in Labour, is to try by the Touch, how all is circumstantiated, with respect to these Things; and This is to be done before the WOMB and the CHILD are fallen down into the Pelvis, that she may contrive her Work accordingly. Because sometimes the Exclusion of the INFANT, is to be hoped for, from the Pains only; sometimes Nature is to be prudently assisted; sometimes there is an absolute Necessity for extracting the Child (without loss of Time) by an Artful Hand, as will hereafter more clearly appear; and sometimes again the same Necessity obliges us to protract the BIRTH, than we may save One or Both Lives: As in the Case of a smooth Pelvis, the Os Pubis and the VertebrÆ of the Sacrum being but little distant, the Child’s Head is stopped; when if the Mother should labour much, or endeavour to force an expeditious BIRTH, its tender Head (of course) must suffer in proportion; Or perhaps the Brain may break, by so hard a Pressure against the Bones; or, finally (which is worse) it may be so closely squeez’d between the Bones, that both the MOTHER and the INFANT may peradventure die, before any BIRTH can possibly succeed or come happily into the World.
BUT in this critical Condition, the Woman is to labour gently, and bear her PAINS (how violent soever) patiently; the MIDWIFE always directing the Head, at the same time by her safe Hand, into the larger Space; by which Means at last, it passes gradually through that narrow Passage without the least Danger.
THE same also is the Condition when the PELVIS is too small or narrow; for by the Woman’s labouring gently and deliberately, the Head is depressed softly into an oblique Figure, and passes easily by Degrees: Whereas, on the other hand, if it is forced by Violence, it becomes flat and broad, and consequently incapable of Passing, if not also dash’d to Pieces, as aforesaid.
HENCE we clearly see, how easily Ignorance in this Point, may lead common Midwives into the grossest of Mistakes; For what is more ordinary with them, even in all Cases, than to advise the Woman to strong Labour, and to force her to violent Depressions: Insomuch that Some have Arrogance enough to carry their Bottles or Powders about them, of which they neither know the Quality nor Virtue; taking them only as they are told (by the confident Quacks or Mercenary Hands which vend them) that they may encrease and promote the Pains of Labour, and This without having any regard to the Form of the Pelvis, or the Position of either the WOMB, or the INFANT.
IN short, the mature Consideration of this very Case, was not the least Motive which induced me to the Work in Hand; since I cannot but heartily commiserate so many fine delicate Women, as are thus every day miserably handled, tormented, and exhausted, by the preposterous Management of such indiscreet and imprudent MIDWIVES. I may well say exhausted, or worn-out; This being too evident, from the vast Number of most beautiful Women, who, by this ill-manag’d Condition, (notwithstanding they have all along heretofore, enjoy’d a good State of Health, together with the Affluence of other Worldly Blessings) have been more dejected and broken both in Complexion and Constitution, after one or two BIRTHS, than some others (judiciously and expertly delivered) have been after Twenty: Such is the great Difference betwixt the unskilful Hands or Conduct of common Midwives, and those Dextrous Touches or ingenious Operations of the more judicious Andro-Boethogynists. Whence I come in Course to——
THE Reader may easily conceive, by the way, that these are neither to be made bigger or lesser by Art; notwithstanding which, by using them Skilfully, and treating them Judiciously, many a Difficult BIRTH may not only be prevented, but also many a Life saved, as will manifestly appear from what follows.
NOW the Bones, upon which the Success of the BIRTH chiefly depends, are the Os Coccygis, and the Point of the Sacrum; which sometimes bend too much inwards, and thereby obstruct and render the Passage so narrow, that no BIRTH can possibly succeed. And again, It sometimes happens, that the INFANT falling down into the PELVIS, and presenting itself Head foremost, is oppos’d and stopped there by the Os Coccygis: As it also sometimes falls out, that the Shoulders stick fast against the Edge of these Bones; or the Buttocks falling down and offering themselves first, may be so fastened or affixed to them, that they can never be extracted.
THESE Misfortunes may proceed from Either of these two different Causes; viz. Either from the Grossness or large Size of these Parts of the Infant, or from the Narrowness of the PELVIS, occasion’d by an ill Position of its Bones, particularly of the Os Coccygis; which Bone when the Head cannot make it yield or move, neither can it then possibly reach the Orifice of the Womb, to dilate it sufficiently: And, in short, if the Head cannot effect this essential Point, much less can the Buttocks, or any other Part be supposed capable of doing it.
BUT in all the above-mentioned Cases, I am sensible, that most MIDWIVES (not knowing better) ascribe the whole Difficulty to the Orifice of the Womb and the Vagina; upon which they ignorantly fall atearing and dilating both the One and the Other, (never minding the Point of the Sacrum); and finding these Orifices but little open’d, notwithstanding the frequent Repetition of very severe PAINS, they imagine that their substantial Hardness or Thickness is the only Cause: So that therefore (without regarding any adjacent Part) they go on violently dilacerating sometimes the Mouth of the Womb, and sometimes That of the PRIVITIES, (as I have found it by Experience) quite to the Rectum. For such is their Stupidity in this Condition of Life (as Daventer well observes) that whilst they thus tear and rend the Woman to Pieces in a manner, they allow her to sit over and above with the Point of the Os Sacrum, upon her Seat or Bed; or in some other wrong Posture, which so presses and confines the Os Coccygis at the same Time, that neither of these can move: Not minding at all that the chief Pressures and Impulses of the Head, must first bear upon the Os Coccygis in order to remove it, before it can effect the Dilatation of the Orifice or Mouth of the Womb. Thus they spend the Woman’s Strength in vain, break her Spirits, and ruin her Constitution thro’ Ignorance; whilst a capable Person, administring seasonable and judicious Help, according to the Circumstances of the Case, refreshes Nature, renews Strength, gives Courage, and fills the (otherways languishing and despairing) WOMAN, with Hopes and Assurances of a happy DELIVERY.
IN short, the True Method of Delivering and helping the Woman conveniently, in the different Conditions contain’d in this Chapter, depends entirely upon repelling or thrusting back the Point of the Os Sacrum, together with the Os Coccygis. I say (therefore) the whole Point of the Os Sacrum, and that Fleshy Part lying about it, is to be thrust back and dilated, so that the Passage may be sufficiently opened for the Infant to pass through; which patent Dilatation is to be promoted by pressing also back the Os Coccygis. Now these Things, in short, may be all done cautiously without creating any intense Pain, or the least Damage; and thus the obstructed Passage being clear’d and open’d, the Birth advances regularly of Course, and the CHILD is born with the greatest Ease, in the Space of a few Minutes: Whereas otherways (without the Use of these Means) both its Own and the Mother’s Destiny may be precarious or uncertain after some Days Labour.
THUS it is certain, that by assisting a Woman in Labour seasonably and skilfully, her PAINS are happily excited and encreased; whereas, on the contrary, by imprudent Treatment they unhappily cease and vanish, to her great Prejudice. Moreover, daily Experience teaches us, that the very different Touching of Things, occasions different Sensations; and from thence it is, that the dextrous MIDWIFE knows by one way of Touching, how to promote the PAINS of Labour; and by another, how to retard or put them off according as the Necessity of the Case requires; which hereafter will appear more at large.
BUT that we may more particularly satisfy such MIDWIVES, of our Method of repressing these Bones, and Delivering the WOMAN in the abovesaid Cases; I must add, that, after placing the PATIENT in the most convenient Posture for a WOMAN in Labour, as before fully enjoin’d[168], I would direct Her to be supported by two Women, and mov’d so far off the Bed or Couch, that the Point of the Os Sacrum may be free to yield or give way backwards, without any the least Impediment: Then I would pass my whole Hand at once (being first well anointed or dipp’d in Oil) into the VAGINA, and from thence (if the Head will admit it) into the WOMB, as occasion should require: where, upon opening my Hand broad, that it may press equally every where, I turn the PALM upwards, and the BACK downwards against the RECTUM, and the OS SACRUM: Thus I extend my Fingers as far as possible to the Head, thrusting it a little backwards, rather than hinder my Hand from being firmly placed against the Os Coccygis: Upon my Hand being thus properly placed, as soon as the PAIN begins to threaten (which I commonly perceive before the WOMAN) I advise her, to make good Use of the approaching Pains, in order to Labour mutually, and depress with all her Power, promising her my most faithful Assistance: By which Time, as soon as the Pains have seiz’d her, and she doing her Part, I press my Hand backwards, first softly, and by degrees more strongly, against the Point of the Sacrum, bringing it at the same time gradually downwards, that I may thereby make Room for the Head sliding the same way; so that the more severe the PAINS are, the more I depress still, and the harder I press down with Effectual PAIN, the more vigorously and successfully the WOMAN is able to Labour.
THUS I enlarge the Passage with great Moderation, so that the Infant’s Head succeeds or follows my Hand, as I bring it by little and little back again; and this adviseable Method I would reiterate as often as the Case should require, always encouraging my WOMAN, by the most obliging Words: Upon which She suffering no PAIN in vain, finds immediate Relief, recovers her Strength, recollects her Spirits, and by jointly labouring her Best with all her Force and Might, at last produces her Child with Comfort and Satisfaction, whilst I congratulate her upon the Success of being a joyful MOTHER.
BUT supposing by the way, that the INFANT offers its Buttocks first, they being neither so round nor hard as the HEAD, I would then intrude all my Fingers into the Womb more easily; some of which (or sometimes All) I would pass into the Orifice of the Womb under the Buttocks as before into the VAGINA. Now my HAND being placed there, I intently observe the PAINS as they come on; then inviting the Woman to Labour, I gradually press backwards as hard as I can conveniently, drawing my HAND downwards as before: But if in attracting it so, the HAND should slide too much out of the Womb, (which however I endeavour to prevent) while the PAINS are yet upon her; then as soon as they are over, I pass it up again, that I may be ready against their Return. And this I would reiterate upon every PAIN, so that the Child (guided by my HAND) may slide down at every Turn, until at last the Passage is so dilated, that it may advance gradually with ease into the World.
BY these judicious Means; forcing back the OS COCCYGIS by the Pressure of the HAND, as the PAINS come on, I may not only dilate the Passage, and enlarge the Orifice of the Womb; but also upon retracting the HAND by degrees, I can gradually attract the CHILD out of the Womb, through the Narrowness of the PELVIS: And thus, by this curious Art, (which I take to be one of the chief Points belonging to Midwifery) I do fairly deliver the Woman, who by no other Means whatsoever, could be preserved, together with her INFANT, in all Probability.
HOWEVER, tho’ I have candidly laid down this Method, (conformable to the Doctrine of the most excellent and ingenious Instructers) yet I would not advise every coarse Clumsy HAND to undertake it, nor such as are not thoroughly acquainted with the Parts of Generation: For this Performance requires Judgment and Prudence, as well as Art and Experience. But however yet in Case of Necessity, where no Extraordinary Person’s Assistance can be had, as it often happens in the Country, the Ordinary MIDWIFE ought not to neglect her Duty: nevertheless, before she offers to attempt this piece of extraordinary Skill, she ought to be very certain that these BONES are the great Impediment and Difficulty of the Delivery.
DIFFICULTY in BIRTH may also proceed from the BLADDER, as (in like manner) it may from the RECTUM or Strait Gut.
I. FROM the BLADDER, when affected with Tumours, Ulcers, or Glands, obstructing the Passages; which however is more frequently occasioned by Stones lodged in the BLADDER, or in its Neck: In either of which Conditions, the Midwife, by dilating the Passage with a subtile HAND, must repel the OS COCCYGIS according to Art (as taught in the preceeding Chapter) that the HEAD in falling down, may the less offend the BLADDER.
II. THE same Difficulty may arise from the RECTUM, when it happens in the same Manner, to be affected with such obdurated Glands, Tumours, &c. for the Consequence is the same in shutting up the Passages: In which Case the MIDWIFE is to depress gently such Excrescences, of what kind soever, with her cautious HAND, and consequently to dilate the Passages by degrees (how much soever obstructed) for receiving the Head of the INFANT; always having a respect to the affected Parts, and bearing no harder upon them than Necessity requires.
MOREOVER sometimes it happens, that the only Difficulty in LABOUR proceeds from hardened Excrements in this Gut, which may as effectually stop or shut up the Passage, as any thing else, until duly voided and evacuated by one or more proper CLYSTERS, as Occasion directs.
BUT sometimes it also happens, that such Difficulties arise from the falling out of the Fundament by the strong and violent THROWS that the Woman Suffers in Labour: In which Condition, if the CHILD is very forward in the Passage, before it happens, it may be prevented by dissuading or hindering the Woman from Labouring so vehemently; but if it happen’d before that time, it must be left so until the BIRTH be accomplished; after which time, it is to be put up exactly, and reduced to its proper Place, in the same manner as the Womb might be (in Case of its Prolapse, as mentioned in the following Chapter) after duly fomenting and bathing it with proper Applicatives: advertising always to use no CLYSTERS, in time of Child-Bed; because such Means would readily excite it again to a slippery Relapse.
DIFFICULTY likewise in LABOUR may also arise from the VAGINA, or Neck of the Womb; this Part being no less liable to the Affection of Tumours, Glands, Ulcers, &c. than any Other before-mentioned: In Either of which Cases, my above-mentioned Method in the foregoing Chapter, shall suffice for the MIDWIFE’s Instruction; as also in Case of an Inflation or Inflammation of the Pudendum.
BUT sometimes also this Difficulty happens from the falling down of the VAGINA; which Accident may as well precede as follow after the Birth, and that by the Orifice of the Womb pressing hard into that of the Privities: So that sometimes, when the MEMBRANE is broke, the Head of the INFANT, as well as the Orifice of the Womb, slides down so far, as to hang out of the Body; whereby the stressed Ligaments (being too much relaxed) give way to the falling down not only of the VAGINA, but also of the Womb it self.
IN this sad Condition the Woman must keep her Bed, and her Body equally situated, that either the fallen VAGINA or WOMB, may recover and be immediately restored to its proper Place; which being done, other Matters may be easily prevented by the Care and Diligence of the prudent MIDWIFE, stopping and restraining the Orifice of the Womb before it comes so far to that Extremity: Wherefore she ought to keep it up in the VAGINA (as much as possible) with her Hands, until the Woman has happily extruded both the CHILD and the AFTER-BIRTH.
UPON This afterwards, she is to use her best Endeavours, to restore both the Womb and VAGINA to their due Situation; laying the Wrinkles Smooth in their proper Order, not one upon another, then placing the Woman conveniently in Bed, with her Head and Shoulders declining, Exsiccant or drying MEDICINES are to be judiciously applied, and Strengthening or Astringent Fomentations often used; whereby (in good Time) both may be again confirmed in their proper Natural Places.
NOW having thus, in fine, candidly explained the Different Causes of all Difficult BIRTHS, and carefully laid down the genuine Methods of correcting and removing them, and consequently of Delivering the good Woman successfully in all such nice Cases, it remains now in Course that I proceed to——
SUCH BIRTHS, (properly speaking) are only Preternatural, which degenerate from the Natural, in respect either to the Situation of the Infant, or the Womb, or of both these jointly: Such (I say) may be well call’d Preternatural, because of the imminent Danger that (in these Conditions) threatens both the Mother and the Child.
HENCE we find the Difference between This and the Natural BIRTH; in as much as the One depends entirely upon Art, and the Other merely upon Nature: In That the INFANT is artificially extracted by the Hand, but in this it is naturally extruded by the PAINS.
HIPPOCRATES gives[169] us a Two-fold-Cause or Reason of a Preternatural BIRTH; to wit, the Amplitude of the Womb, and the inordinate Motion of the Woman about the Time of LABOUR: Who, because of her afflicting PAINS and great Ailments, keeps her Body in a restless and unsteady Posture, throwing herself sometimes here, and sometimes there, sometimes on One side, and sometimes on Another through Uneasiness. By which means it cannot be otherways, but that the INFANT may be easily turn’d into some Preternatural Situation.
AND to These Causes, Senertus, Rodericus À Castro, &c. add the Two following; namely, the Solidity of the MEMBRANES, and the Debility of the Head of the CHILD: Because (as they well observe) when This is not strong enough to break through Those, the INFANT endeavouring it otherways, (with Feet or Hands) may readily fall into some Preternatural Position.
BUT because I find, that Preternatural BIRTHS deviate in different Degrees, and vary in many respects from the Natural, and that also according to a great Variety of CAUSES (no ways known to those most Learned Authors) but only of late discovered; I shall now again reduce the different Species of Preternatural BIRTHS to four Classes; namely, Preternatural BIRTHS on Part of the INFANT, on Part of the Womb, on Part of Both those jointly, and lastly on Part of some intervening Accidents.
IN treating of which, I shall according to my best Judgment, state these respective HEADS in due Order, and assign each its proper Branches; which I shall particularly discuss in brief Terms, for the Facility and Benefit of the Candid READER, whether MAN or Woman-Midwife; That they may (by this plain and easy Method) be enabled the more readily to judge of, and distinguish the several Circumstances, and consequently the better discharge their Duties (upon Occasion) to the Comfort and Satisfaction of those PATIENTS concerned, and the Honour of their own ingenious Profession.
BUT before I enter upon These, I would willingly in this place, previously subjoin a Word or two of Advice (by way of Precaution) to the Young Andro-Boethogynist: Which, in short, consists in this Point, that as it is the too common Practice here in England, for an obstinate Set of Women to keep their Labouring PATIENTS so long under their own Hands only, until the very last Extremity; so I would not counsel him at that Time, when sent for, upon such a ticklish Occasion, to go Head-long to such a Work, nor to undertake the Delivery of such a Woman, before He makes some requisite Observations: And that I mean no ways because of any Danger of the Preternatural BIRTH which she labours under, how difficult soever it may be; but merely, on account of the Woman’s exhausted Strength and Ability, to undergo the respective Operation in her weaken’d Condition; which I would very much question in most Women, after One, Two, or Three Hours strong Labour, and that in Some far sooner, notwithstanding that others have been known to stand it out, and struggle a much longer Time.
HOWEVER, be this as it will, I commonly guess at the Woman’s State of Ability, not only by her Pulse, if strong or weak, unequal or intermitting; by her Eyes, if dejected; by her Speech, if faint; by touching the Extremities of her Body, if frigid: but also by some other Symptoms, which infallibly appear, if the Woman be too far spent, such as Cold Sweats, Swoonings, Convulsions, Loss of Sense, &c. Whereupon I say in these Cases, it is more adviseable to let alone or decline the Office, than to undertake such a precarious uncertain Piece of Work; because if the Woman happens to die under his Hand, He may perhaps be (however unjustly) blam’d for the errant Midwife’s Faults, or at least He will scarce avoid the Censure of the Ignorant and Malevolous.
YET this Advice (however wholesome and prudent) is, I confess, what I would but seldom have Recourse to, or follow myself, notwithstanding the worst Consequences of the Case; since as long as there is Life, there is Hope with me, by the Blessing of God: Which tho’ never so little, I should think myself obliged in Conscience to do what both Art and Nature command, and rather in all Conditions of Life to attempt an uncertain Cure[170], than abandon the Distressed to certain Death, as some Politicians in Physical Affairs commonly do, who prize their vain Reputation above the Life of their Neighbour. But thus, in short, (for my own Part) I would chuse to act, because I have often seen, and known NATURE to have perform’d, and recover’d a weak spent parturient Patient, even beyond all human Probability.
NOT but that I would take the proper Precautions along with me, before putting my Hand to the critical Work, upon any such desperate or dangerous Occasion, by giving my ingenuous Prognostick to the nearest Friends and By-standers of the extreme Danger that both Lives may be in: Whereupon after thoroughly examining all Circumstances, with respect to the Child, whether One or More, Dead or Alive, &c. I would chearfully begin my Endeavours to relieve the afflicted Woman, encouraging and exhorting her in the first Place, for God’s-sake, as well as her own, and the tender Infant’s Life, to put herself entirely into my Hands, to undergo her Labour patiently, and contribute what she can to the Delivery.
BUT to return from this pardonable Digression to what is here proposed; as I come first to speak of Preternatural BIRTHS on the part of the Infant, I would observe that all ill Postures of the Child, in a Womb well situated, are the only Causes (meant in this place) of Preternatural BIRTHS on its own Part: Which Postures being very various and different, and each requiring a different peculiar Operation; I shall state them particularly (as above-mentioned) and that in their respective Chapters, after the manner following: viz.—
AMONG the many various Preternatural Positions of the INFANT, I cannot but reckon This One: First when, tho’ the CHILD offers itself Head foremost, yet the Face is turn’d upwards; and that because the INFANT in such a Posture can never be commodiously bent and adapted to the Form of the Pelvis.
IN this Case, the MIDWIFE ought to take special Care, that the Head fall down directly and safely, without being hurt, whilst she endeavours to bring it forward: For this Purpose, she is to enlarge the Passage as much as possible, dilating the Privities, and depressing the Os Coccygis; which however must be done, without lifting the Head with her Hand, for fear of bruising the Face against the Os Pubis. By this Method the BIRTH (how Preternatural soever) may be pretty well and easily perform’d.
BUT because the CHILD can only be said to be well turn’d, when it comes with its Chin leaning upon its Breast, and its Top or Crown of the Head tending directly to the Orifice; I reckon This another Preternatural Position, when the INFANT presents itself with the Crown bent backwards, and consequently with the Face forwards: By reason that in this Case, the Orifice itself and all the rest of the Passage must be much more dilated, than in the natural Condition; and the Head (being thus bent backwards) requires more severe Pains and hard Labour, to make it slide through the Passages.
IN which Case, the MIDWIFE, having timely discover’d this Situation by the Touch, ought immediately (upon the flowing of the Waters) to bend the Head gently forwards to the Breast, all the while adverting to handle the Face, especially the Nose and Eyes, very tenderly: And to this End, the Woman may be laid down on her Back, with her Head low; by no means labouring with the PAINS, before the Head of the CHILD is so conveniently turned: which may be thus most properly perform’d; viz. By laying the Palm of the Hand on the INFANT’s Breast, near its Throat, pressing it entirely back towards the Fund of the Womb; by which means the Head falls forwards of its own Accord upon the MIDWIFE’s Arm, and she with-drawing her Hand, will find the Head well turn’d.
BUT supposing the Head to be very strictly bent or pressed back, then the MIDWIFE is to attract it gently forwards by her Thumb, or Fore-Finger thrust into its Mouth; or by the Points of all Four thrust betwixt the Womb and the back Part of the Head. And thus, in fine, the Head being well Turned, and dextrously brought into the Passage; the Woman is then to be placed commodiously for BIRTH, and to labour her Best as in other Cases.
HOWEVER to this Case, I must add, by way of Remark for the MIDWIFE’s farther Information and better Government, that, if the Head is not brought into the Passage, as soon as the Waters have flow’d, it commonly happens, that the Hands offer themselves first; which if she do not instantly repel, the Head is turn’d up forwards with the Face, near the Chin, upon the Os Pubis; in which Condition, by reason of the Siccity and Contraction of the Womb, the only Expedient is to thrust back the Arms, and so passing the Hand under the CHILD’S Breast, to take hold of, and extract it by the Feet.
THE CHILD also sometimes offers itself preternaturally to the Orifice, with its Hand, Elbow, Shoulder, Knees, or Buttocks first: In which Condition, the Hand always gives an easier BIRTH than the Elbow, the Elbow than the Shoulder, the Shoulder than the Knees, and the Knees than the Buttocks: For the Hand being commonly placed near the Head, it is no great Wonder, if it presents itself before, or along with it; as sometimes (after Flooding) the Hand may slide together with the Head obliquely to either Side, and thereby either Elbow or Shoulder unfortunately fall into the Passage.
THIS is one great Reason, why I have before inculcated, that the MIDWIFE ought to be diligent and accurate in Touching her Woman, even before the Membrane breaks, that she may thereby discover and prevent this Case: Which is easily perform’d, either by repelling the Hands, or by pinching the INFANT sensibly by the Fingers, and then it soon retracts them; for thus, in short, by moving my own Hand seasonably, the Head (of its own accord) slips of course down into the Passage. But and if it happens otherways, ’tis no difficult Matter to turn and bring it down, by directing my Fingers beyond the Face to the CHILD’s Forehead; which however must be done immediately after Flooding: Whereas, if This be neglected until the dry Womb is contracted, Then, and in that Condition, the FEET may be looked for, which (in such a Posture) are soon found, with the KNEES next the Belly; and the INFANT may be readily drawn out by them. But
WHEN it so happens, that the CHILD comes with its KNEES foremost, it commonly has its LEGS folded towards the BUTTOCKS; by which means many a MIDWIFE has been deceiv’d, especially when she feels but one KNEE, mistaking it for the HEAD, because of its Hardness and Roundness.
IN this preternatural Condition, the INFANT must be stopped and hindered from advancing farther; wherefore having placed the Woman aright, I would gently repel the KNEES, that I may the more commodiously unfold the complicated LEGS, one after another; which I commonly do by directing one or more Fingers under the Ham, gradually along behind the LEG, until I come to the Foot; drawing always a little obliquely, that I may come the easier to its Extremity: And thus, in short, having disengaged the One, I accordingly manage the Other after the same manner; and by bringing both FEET at last together, I finish my Work, as if the Child had come FEET foremost, of which in course.
MOREOVER again it also happens sometimes, that the CHILD falls with its BUTTOCKS forwards; in which preternatural Condition, the Midwife must industriously prevent it from coming too low in the Passage, before it be duly corrected or rectify’d; since the Infant cannot possibly come, after this manner, into the World; unless it be very small, and the PASSAGE, on the other hand, very large. Wherefore in this Case, after the Woman is decently laid upon her Back, with her Head declining, I would advise to thrust back the BUTTOCKS as well as possible; then passing up my Hand along the THIGHS to the Legs, I would take hold of the FEET, and bring them gently, and one by one, forth gradually; which being done, I would attract them by the HEELS towards the Side as far as the Length of the BUTTOCKS; and then at last taking good Hold under the HIPS, I would easily and softly with the greatest Deliberation, draw out the whole Body successively.
SOMETIMES likewise the CHILD offers its Breast or Belly first, along with the Navel-string; which Preternatural Figure is most dangerous for the BIRTH, because of the Body’s bending backwards.
IN this difficult Case, the attentive MIDWIFE places her Woman conveniently, as soon as the Waters have flow’d, and sliding her Hand into the Womb, removes the String, and endeavours to bring the HEAD forwards into the PASSAGE; which she easily performs, as long as the Infant is suspended on high, and its Back not too much bent, by putting-in her Hand gently up to the hinder Part of the CHILD’S Head, attracting it gradually downwards. But if in this Condition the BIRTH be fallen too far down, it is more adviseable first to attract the FEET considerately.
I say considerately, because it is not sufficient to penetrate with the Hand to the FEET; which however yet, in this Posture is pretty difficult: But also to know exactly in what manner they are to be drawn down; since it is no indifferent Matter to understand how that is to be rightly perform’d with Success. Wherefore I shall in this place take upon me to set forth two different Ways of Turning the INFANT in this Condition; viz.
I. I would either First pass my Right Hand to the Left Thigh of the CHILD, and taking hold of it near the KNEE, push it upwards with my Thumb, drawing it at the same time downwards with my Fingers placed behind: Thus I would bring down one KNEE to the Passage, leaving the Foot yet above, and then the other KNEE in its Turn; which being done, I would change my Hand, and put the Left up to the INFANT’s Belly or Breast; where, as I thrust back its Body upwards, there is presently Room enough: then I would take hold again of one or both KNEES, to move the CHILD higher, that so the FEET may be more conveniently brought into the Passage one by one, if not Both at once: Or, upon the LEGS being bent with the Right Hand, and the KNEES brought into the Passage (as above) I would take hold of them below the Ham, and bring them past the Orifice of the Womb, till the FEET are before the Passage; whereupon I would then readily endeavour to extract the Infant by the FEET. Or, Secondly,
II. I would put my Right Hand up along the Belly to either Thigh, or Knee, having at the same time a thin Bandage doubled and dipp’d in Oil, upon my Fingers’ Ends, in order to be put about the Knee, that I may attract it gently thereby; which I would draw out again by the Right Hand, whilst my Left holds the Ends of the Bandage, that they may not move out of their Place: Then I would take the Extremities of the Bandage in my Right Hand, attracting it softly thereby, whilst I pass up my Left into the Womb, to thrust the CHILD’s Belly upwards. By which ingenious and regular Means, I think, Dr. Daventer first moved the upper Part of the Body upwards, and the Feet downwards, because the Knees are thereby brought nearer to the Orifice. Now these, in short, are the only safe, and proper Methods to be taken in this present Case, or nice Conjuncture; because, by all other inconsiderate and temerarious Means, the INFANT’s Loins may be twisted, its Hips or Knees disjointed, its Feet lamed, and itself at last quite lost or destroy’d.
IN like manner it happens not very seldom, that the INFANT comes with its Back forwards into the Passage; and in this Posture the Navel-String falls commonly down there, so that besides itself, nothing else is to be felt by the Touch: In this Case, the Midwife is to observe well the Flooding; immediately upon which, she is to seek for the Feet, which are more easily come at than the HEAD, tho’ the same is even also a very difficult Task, by reason that the CHILD’s Back takes up the whole Space of Room; which, notwithstanding, must be cautiously done, and the INFANT discreetly extracted by them.
BUT again sometimes, the BIRTH lies also Transverse, or a-cross the Womb; in which dangerous Case, I confess the MIDWIFE cannot well perceive, so as to distinguish Matters by the Touch, before Flooding: Because the INFANT (swimming in the Waters) is as yet seated high, and then moving its Hands and Feet variously, she sometimes feels one, and sometimes another Member at the Orifice; or, one Moment she finds Something, and another Nothing at all there. However, in fine, she may perceive the Humours most commonly compressed into an acuminated or oblong Form.
WHEREFORE in this difficult Preternatural Condition, the MIDWIFE ought primarily and chiefly to consider and discover the Posture of the Womb, whether it be direct or oblique; since according to That she must proceed in assisting her Woman with true Discretion. As for Example, if she finds it in a streight or natural State, and the Waters sufficiently exuberant, extended length-ways, &c. as aforesaid, She must, without Loss of Time, break the MEMBRANE, and presently, removing all Impediments of HAND, FOOT, or NAVEL-STRING, judiciously direct the HEAD into the Passage; which may be very easily and safely done immediately upon the Flooding. Whereas if this Method be delay’d, or not taken in due Time, and consequently the HANDS (as the readiest) present themselves to the Orifice first: In this Condition, I would lay the Woman discreetly upon her Back, with the upper Part of her Body lowest; after which, I would move the INFANT’s Hands back with my own; whereby at the same time bringing its FEET into the Passage, I would in the next Place gently extract the whole Body with all possible Conduct and Success.
IN like manner again, it often happens, that the CHILD offers its FEET foremost; which next to a Natural BIRTH is the most easy and safe Position, however I have been oblig’d to postpone it to the rest, for Method’s sake: In this Case, the MIDWIFE, observing one FOOT presenting itself in the Passage after FLOODING, ought to stop and retain it there, that it may not slide through, until she meets with the other. In order to which Performance, she must immediately seek for it, with either Hand, according as she perceives the INFANT’s great Toe situated, since it is only to be sought for along its Side; and being found, it is to be gently drawn down, and placed near its Fellow in the Passage.
BUT it falls out sometimes, that the MIDWIFE comes too late, and finds one LEG so far through, that the Buttocks are strictly confin’d: In this Condition, I would advise to lay the Woman conveniently upon her Back, with her Head low, that both the Womb and the Child may retreat a little; then taking hold of the right LEG with my Right Hand, I would thrust the INFANT back, till the whole Foot (or at least the Knee) is brought back into the Orifice of the Womb, in order that I may have the more Room for passing my Hand along the LEG: By which means I get hold of the other Foot; and bringing it also into the Passage, I place it along with the other, that both may come forth successfully together.
WHICH Thing, happening so when it will, that both FEET are excluded, whether done spontaneously or by Art, they are never to be repell’d or thrust back again; but, on the contrary, the way is to be duly cleared for their Passage; This being a very commodious Situation, provided the Child be well turned, I mean, with HEELS and BUTTOCKS upwards, and TOES and BELLY downwards: Whereas, if otherways, the CHIN may be easily hooked upon the OSSA PUBIS; which (if not so happily turned at first) I commonly prevent in the most adviseable manner following; viz.
UPON attracting the INFANT, I turn it cautiously at the same time, using both Hands in the ensuing Method; namely, The One I put up under its Body as far as possible, whilst with the Other I hold both FEET together: Insomuch that by this Means I gradually turn, not only the FEET and the LEGS, but also the whole Body; bringing it always forwards in the Interim, till at last it lies with its BELLY downwards, and is out above half way: Upon this I then give my Woman the Motion, to begin her Labour and endeavour her Best; because the HEAD and ARMS must necessarily pass through All at once. For notwithstanding the contrary Opinion of most Authors, who teach us to draw down the Arms one by one, and place them upon the Body, I cannot but agree with Daventer, and positively advise in this and all such other like Cases, to leave the Arms about the HEAD, that they may be excluded along with it: Because, as he says, tho’ the Woman in so doing, is obliged to force her INFANT forwards with all possible Endeavours, yet like a small transient Cloud, it is soon over.
WHEREFORE I commonly make it my Business to prevent the Woman’s PAINS, until I have brought the CHILD this Length; when allowing her a little Time to rest, I heartily encourage and positively promise Her, that, she performing her Part effectually, (by using all her Strength, and behaving herself as if the PAINS were most really pressing upon her, whether so or not) the BIRTH will immediately succeed: And upon this Promise, with the PATIENT’s mutual Assistances concurring, I never yet fail’d; neither will any Persons who faithfully and ingeniously follow this Method, in comfortably helping the Woman upon such an Occasion, by drawing the CHILD cautiously downwards, with whatsoever judicious Force: I mean not downwards, according to the Woman’s Length, but downwards towards the strait Gut. And as I every Moment insinuate to the MOTHER, that her BABE’s Life depends entirely upon her vigorous confederate Labour; so she mutually concurring with me, in endeavouring to do our Best, the Agrippa INFANT is presently brought forth to the great Satisfaction of Both.
BY these Means and Methods, we prevent the Tragical Consequences, which Mr. Portal and many others confess they have often met with in their Practice; viz. That the HEAD has been sometimes pulled-off from the SHOULDERS, or that the CHILD has been frequently stifled, by the Womb’s contracting and shutting-up about the NECK: Which was altogether owing to the injudicious Method of their Practice, in drawing down the Arms awkwardly (as mentioned above) along the Sides of the Body.
THIS Case also happens sometimes remarkably; upon which, if Both or All are contain’d in one and the same SECUNDINE, or when the MEMBRANES are broken, then the right Version is very difficult; not so much for want of Room, as because their HANDS and FEET are commonly interwoven and twisted together: In which preternatural Condition, when so complicated and entangled, they are to be unfolded and cleared off one another with the nicest Circumspection and Judgment.
BUT besides, farther, they are otherways, only to be treated in this difficult Point, as if there was but one CHILD; for turning them always One by One duly, I would bring all their Feet into the Passage, and consequently handle them, as if they had offer’d themselves so at first. The first CHILD being born, I would give it to the next capable Person to tie and cut its String; whilst I directly repass up my Hand, to seek for the other’s Feet, by which I would also draw it forth, after breaking its proper MEMBRANES, in Case the second Flooding is not yet over, and that notwithstanding the Head should present itself First.
BUT and if it happens, that each CHILD has its own proper and distinct SECUNDINE, and That of the INFANT already brought forth chance to be loose and separated from the Womb; In that Case, I would presently fetch it away, and then extract the other INFANT, as long as there is any yet left behind, and that also by the Feet, as aforesaid: Whereas otherwise, the BIRTHS, together with the Constriction of their UMBILICALS, are to be previously accomplished.
IN fine, having thus accounted for all the Preternatural BIRTHS whatsoever, which may or can occur on the Part of the INFANT, and that conformable to the most nice and polite Rules of Art; It remains now in the next place, that I acquit myself in a consonant manner, with respect to Those proceeding from the Part of the Womb. Of which First in general——
MOST, if not all, Authors having hitherto imagin’d, that all Preternatural BIRTHS took their sole Rise and Origin from the wrong Positions of the INFANTS only; I come in this place, with all due Submission, not only to affirm a quite contrary Opinion, but also to lay down a directly opposite Maxim: Namely, that the most difficult and dangerous Preternatural BIRTHS proceed merely from the ill Situation of the Womb; which I take to be the most common Cause of the Child’s wrong Posture. The Truth of which I hope to make evidently appear, to all such, who know and will consider, that this Noble Part is no less subject to various Accidents and different Diseases, than the Rest of the Body; which springing from divers Sources, may rationally be suppos’d to occasion Preternatural BIRTHS, and those more or less dangerous, according to the Nature of the Efficient: as for Instance,
IN Case of an Inflammation, Exulceration, Putrefaction, or the Womb’s being Schirrous, Callous, or Hard; affected with a Carcinoma or Cancer; an obdurated Gland, Cicatrix, or any carnous Excrescence; or in Case of the Womb’s being Dry and Rigid, and the Orifice’s being Hard and Thick, as commonly happens to Women in Years, especially of their First CHILD; I say, from either of these, or any such like Causes, a Preternatural BIRTH may ensue, and that even tho’ the Pelvis and Passage be larger, but much more if those be narrower, and the Point of the Os Sacrum bent Inwards.
I. IN the Larger Pelvis, the greatest Difficulty of this BIRTH proceeds from too great a Descent of the Womb; which relaxes the Ligaments and Fibres of the Vagina, and so much depresses the Bladder, that an Incontinency of Urine presently follows, which in this Case is commonly succeeded by a Falling Down of the Womb or Vagina, as already observ’d in Chap. XI. where the Diligent Midwife will find the due Method of preventing such growing Mischiefs, and of opening the Orifice of the Womb both safely and readily, and consequently Delivering her Woman more easily and expeditiously, with good Success as well as Security.
II. IN the narrower Pelvis, the MIDWIFE needs no ways fear the above-named Accident, and therefore is not to be at so much Pains in retaining the Orifice in its proper Place, whatever Trouble she may have in opening it; which would be no easy Task, was not the Os Coccygis to be thrust back, (as set forth, Chap. IX.) And which I must (for this Reason) recommend once more to all Careful MIDWIVES, as the best and most effectual Method of performing this happy Apertion.
FROM what is said here therefore, we may now conclude, that a great Variety of Causes may subject the Womb to a Diversity of Accidents, and those of sundry Degrees, which may more or less affect its Motion and Situation, as already set forth[171].
AND hence it is that we have so many Degrees of Preternatural BIRTHS on Part of the Womb, All which to enumerate particularly in this Place, would be a Work as Superfluous as Tedious: wherefore, to be brief, I shall here also reduce them to the Four following, (as before mentioned, Sect. IV. Chap. 13.) viz. Preternatural BIRTHS, proceeding from an oblique Situation of the Womb inclining Forwards, or Backwards, or to (either Side) Right or Left: which fourfold Situation of the Womb may be rightly and properly compar’d to the Four Cardinal Points of the Compass, as the rest of its oblique Positions may be analogously adequated to the Collateral and Middle Points: For because, as they decline from the Meridian, and derive themselves from East, West, North, and South, as formerly observ’d[172]; so those are less difficult BIRTHS, and branch out from the Four mentioned Extremities: since the Womb, like a Magnetick Needle, may run quite round, and be ill-seated every way, or on every side. In all which Cases, the INFANT must absolutely be Turned; which Performance in any oblique Womb, requires a competent solid Knowledge and sound Judgment, as well as the best adapted and experienced Hands. But of those, more particularly hereafter; and First, accordingly——
IN speaking to this critical Point, I shall first give the Reason of such a BIRTH, occasion’d by this Position; to wit, The WOMB hanging much forwards, especially in Women carrying it too low in the Abdomen, the INFANT (betwixt the Pains) must needs be forced upon the Os Sacrum, or the VertebrÆ bending inwards; which stops the Head that it cannot conveniently or without Obstruction fall into the Pelvis.
HOWEVER, in this Condition we suppose the INFANT to be well turn’d, I mean (both here and elsewhere) well turn’d in respect of the WOMB, with the Crown of the Head lying against the Orifice; than which nothing can be more Right or Natural in regard of the WOMB itself, nor more Wrong and Preternatural in respect of the PELVIS and Vagina of the WOMB, in this forward Situation: Because by reason of this Posture, the INFANT falls transverse upon the Ossa Pelvis, especially upon the Os Sacrum or hindmost VertebrÆ; upon which it commonly offers itself with the Face prone or turn’d Downwards, tho’ it is not brought forth, but with the Face Supine or Upwards. For as it passes, it must be turn’d round, partly in a Circle, with its Head prone, and Feet drawn up under it; which happens not in the WOMB, but only as it passes the Orifice into the PELVIS or VAGINA.
NOW what I mean is more plainly This, that as soon as the Infant comes into the Turning (which it must pass) it necessarily bends and crooks itself, as it finds its Passage bent or crooked; by which means the Face is sometimes turn’d down, and sometimes upwards: And This proceeds from That, in short, as soon as the Head begins to enter the Orifice, it presently fixes upon (and sticks fast to) the last VertebrÆ of the Loins standing forwards, or to the Os Sacrum; so that it cannot naturally or possibly go forwards, except the Head is bent downwards, and the Neck and whole Body be accommodated to that Bending.
HENCE it is, that THAT which just now was situated prone upon its Belly in the WOMB, now passing through the VAGINA, is bent upwards supine upon its BACK; and from thence it’s evident, that That Inversion is not properly in the WOMB, but in the VAGINA, or (if you please) in the Confines of Both: And, in fine, this forward Inversion (as it happens) occasions a most difficult Preternatural BIRTH.
BUT this, in short, happens to the Woman with CHILD, because her WOMB hangs forward, or is resupin’d, according to the Depression made on the WOMB by the Intestines, forcing it this or that way; or to either Side, as will by and by more fully appear[173]. But——
SINCE it is most requisite to know presently in the Beginning of LABOUR, whether the WOMB be placed forwards, in order that the Means of Help may be taken accordingly; I shall in the second place add the SIGNS, or Tokens, by which the MIDWIFE may know this Position of the WOMB, and what she has best to do in such a nice ticklish STATE of Affairs.
FIRST then, She may know it, principally, by the Hanging forwards and Thickness of the Belly, or perhaps by the good Woman’s Information of the Place, where she chiefly feels the INFANT stirring; for it cannot move but where ’tis placed.
HOWEVER yet a prudent MIDWIFE will have no great regard to such Uncertainties, but betake herself immediately to that which cannot fail her, the Touch; which (in this Case) affords her the following certain SIGNS; viz.
I. THE Orifice of the Womb is suspended higher than usual; which she cannot Touch, by reaching, without a great deal of Difficulty.
II. SHE can only Touch the lower Border of the Orifice, and that only as the Womb hangs more or less forwards; and by no means the upper Edge, except the Orifice has begun to fall down.
III. SHE cannot at all, or very hardly, get her Finger into the opening of the Orifice, and because of that Difficulty, it must then also be crooked or bent.
IV. SHE will find the Orifice opposite to the bending of the last VertebrÆ or the Os Sacrum, and feel it so strongly pressed against the said VertebrÆ, when the Pains come on, that it cannot fall down: and lastly, she’ll feel the Waters (if they hang over the Passage) in a thin slender Form.
UPON This the Skilfull MIDWIFE finding these concurring SIGNS, she may be assur’d that the Womb hangs too much forwards; which Condition requires the immediate Help of Ingenuity and ART to correct this ill untoward Position, and to promote the BIRTH expeditiously. But then these Things are to be carefully perceived and distinguished in the Beginning of Labour, before the Pains have either closed up, or too much depressed the Orifice; yea, in short, even before it sensibly opens: since afterwards all those SIGNS are variously chang’d and alter’d, till at last they entirely vanish.
WHEREFORE let it be deem’d as a certain Rule, that the true Posture of the WOMB is always best discover’d by the Touch in the Beginning of the Labour: At which time may the Orifice be suspended never so high, the MIDWIFE ought to penetrate so far, until she reaches it; if not sufficiently with her Fingers, the whole Hand is to be judiciously used, and passed up that Length, because this particular Touch is absolutely Necessary for that good End: Insomuch that if any Labouring Woman be against this manual Operation or opposes it, she thereby debars her MIDWIFE of an infallible Method, of discovering the true Posture of her Womb, and consequently of taking the most immediate proper Means for Her own as well as her Infant’s Relief.
BUT now supposing, after all, the MIDWIFE to be certain that the Womb hanging too much forwards, in a prominent Belly bearing pretty much out, is deeper depressed than it ought to be; She is obliged then in this Circumstance to consider accordingly how to correct this Preternatural Situation, and assist both the Mother and Infant for the best: To which End, She ought First to endeavour that the Head may fall down into the Pelvis, even to the bending of the Os Coccygis; and then, Secondly, She is thence to advance the Head gradually, that the Exclusion of the CHILD may be expedited and intirely perfected at last.
NOW in order that the Head, together with the Orifice of the Womb, may be so discreetly brought forwards into the Pelvis, the Woman is to be placed with the upper part of her Body lower than the inferiour; I mean, with Head and Shoulders bending downwards, and the Buttocks upwards; by which Means, the Bottom of the Womb is elevated, and gives the Orifice an Opportunity of being brought more easily into the Pelvis.
THEN the parturient Woman being so placed, the MIDWIFE (using both Hands) ought to clear the Womb, together with the Head of the Infant, by putting the one up, as far as there’s occasion, into the Vagina, and laying the other upon the Woman’s Belly, in manner following: viz.——
THE Hand in the Vagina is (by having two or three of its Fingers Ends extended to the upper Border of the Orifice of the Womb) to move it a little beyond the Head of the CHILD, and to direct it into the Mouth of the Pelvis, so that it may fall the more readily down into the design’d Place. But in this critical Juncture the MIDWIFE must always take special Care not to squeeze or press the Top of the Head too much, nor to handle it too hard, lest She should thereby wound, if not also kill the Infant.
AGAIN the Business of the other Hand, used externally, is to drive back the Womb, by pressing the Abdomen; which must be perform’d also with great Caution and Judgement, not by drawing the Hand from above downwards, but pressing as much as the Woman can bear it, from below upwards; so that (if possible) the Womb may be thereby resupin’d or turn’d backwards. Minding always, by the way, that
THIS Pressure of the Womb is not to be attempted, before the one Hand is first conveniently placed within. But if all This Menage should not yet succeed the first time according to Wish, then it may be safely repeated again by turns so often, until the MIDWIFE feels the Crown of the Head; that is to say, till She feels the Borders of the Orifice quite round about hanging over the Entrance of the Pelvis. Upon which happy Discovery, she may with reason rejoice in her Labour, and be heartily glad of her good Success: Because now the Force of good depressing Pains only will effectually perfect the Work.
BUT before Matters are happily brought this prepared Length, the bearing Woman is upon no account to begin her LABOUR; since That would not only be in vain, and otherways debilitate the Strength of her Body; but also be of great Hindrance to the Midwife (to whom all the LABOUR hitherto belongs) who, as she feels the PAINS growing and rushing in upon the Woman, before their proper Time, ought to charge her strictly, to forbear working along with them, and as much as possible to abstain from any co-operating Depression. And in fine, as the MIDWIFE by having her Hand diligently apply’d to the Orifice of the Womb, by strict Attention, may most commonly observe, and previously discern the approaching PAINS, before the Patient Woman herself can be sensible of them: So she ought also for her own helping Part, ex Officio, to be quiet and attempt nothing till Then, but take her convenient Opportunities, always as soon as the PAINS are over.
THUS by seasonably lending Nature an artificial helping Hand, Both jointly may easily effect, what neither can do separately: For as it sometimes happens, that the MIDWIFE ought to cease, while she perceives (by the Pains) that Nature is a working, and therefore ought to work only when the PAINS are past; so it also falls out often, upon other Occasions, that she is to work along with the PAINS, and when those are past, to cease. And thus, in fine, according to different Circumstances, the discreet MIDWIFE knows always the Needfull, what’s to be done, or let alone.
BUT in this Place, I doubt not, many MIDWIVES will object, and say, How is it possible for Us to perceive the PAINS coming on before the parturient Woman herself? To which I ingenuously answer, that This also is one of the many Advantages of the Touch; since by That, I can presently feel a kind of subtile Motion, Contraction, or Compression beginning in the Orifice of the Womb; which is only observable as the Muscles are affected with a New Sense, excited by a New Influx of the Spirits; occasioning a New Force or Impression upon the Womb, which we commonly call a Pang: So that, in short, by distinguishing this Motion from others, I am always able to foretell or advise the Woman of what is a-coming, and to admonish her accordingly of her bounden Duty, as the Case requires.
MATTERS now being fairly brought thus far, that the Orifice and the Head begin to slide down into the PELVIS; the MIDWIFE is at this Time to study how to succour and assist the CHILD, by rendring its Passage easy. In order to which, she must first observe to raise the upper Part of the Woman’s Body a little, and give her some short Respite, before she offers to bring the Orifice into the PELVIS; because the Posture above-directed, occasions considerable Pain as well as great Inconveniency: Which being done, the Woman for the future is to sympathize with every PAIN, and Labour as much as possible, co-operating mutually with them; since now the Pains (by the Assistance of the Head) begin to open the Orifice, and gradually force the Infant forward to its Birth.
HOWEVER yet the MIDWIFE ought in this Case, to be very careful in sustaining, and nice in keeping up the Orifice of the Womb, lest it should fall down together with the Vertex or Crown of the HEAD into the Sinus Sacri; which is a Point so curious and critical, tho’ an Accident too common, that I dare well say, not one in Fifty Practitioners in MIDWIFERY understands it thoroughly; otherways I am confident, and morally certain, that many fine Women would have been living Monuments of their Ingenuity, who are at this day only the Dead Remains of their Ignorance.
THIS I think is past all Contradiction, when we consider, how some Practisers sacrifice the Infant, first by opening, and (as they call it) braining the HEAD, and then by drawing it forth with their Instrument call’d FORCEPS: How others also esteem themselves Masters of the greatest ARCANUM, boasting that they can, without so much as braining the HEAD, extract the INFANT by their Tool call’d an EDUCTOR: How a Third Set again pretending themselves to be the only genuine Sons of Apollo, come slily to correct the Rest, by fixing only a couple of Hooks in the Eyes, Ears, or somewhere else in the Child’s HEAD; by which means they as wretchedly produce the innocent dead Babe as any of the others: For it can no more be suppos’d to survive this cruel Treatment, than the other mentioned Barbarities; not to speak of the Anguish and Perplexity over and above, besides the real Danger all the while brought upon the distressed Mother.
UPON this grand Affair of Life and Death, the Desidious and Capricious MIDWIFE cries at length, God knows I have taken all the Pains and Care I could, but to no Purpose, for this or that trifling Reason, falsely alledged. The SURGEON (if he don’t pretend the CHILD to be already Dead) says, Come, it is better to dispense with one Life than Two; One must go, &c. In consequence of which, he prepares his FORCEPS, EDUCTOR, KNIVES, HOOKS, &c. to draw out the INFANT Dead, or Alive, Whole or in Pieces, by such disingenuous and barbarous Means to save the MOTHER. Thus behold the excellent Art of MIDWIFERY ignorantly perverted! O Deplorable Woman! O Miserable Babe! How much abused! when there is no other Mean left to rescue the tender Life of the poor Mother, but by the massacrous Death of her dearest CHILD! This Case indeed would be very Melancholy, but Glory be to GOD who has neither left the One nor the Other to perish at this untimely or inhuman Rate, excepting it be by Ignorance, or Wilfulness, &c. as aforesaid: No, on the contrary he has provided an EXPEDIENT for every Extremity, and a REMEDY for every Malady, as in the present Case will appear farther by what follows, Viz.——
THAT such Tragical Events may be prudently prevented, I use my constant and unwearied Endeavours to sustain the Orifice, that it may not come below its proper Place; and that having clear’d the HEAD of the WOMB, I may only bring it alone down; which I can much more easily do, than if it was cover’d about with the Womb, sticking fast (as above) in the SINUS SACRI. And supposing the MEMBRANE to press strongly instead of the Head, I treat it all one as if it was the Head, taking always Care not to break it, tho’ the forming of the WATERS is not to be obstructed; for which Cause, I upon all Occasions stretch out my Fingers wide, applying them only to the Edges of the Orifice, not to the Membrane: And this I continue doing, until the MEMBRANE spontaneously breaks; upon which I manage the Head as aforesaid.
THUS the Infant’s HEAD being excluded with the Crown foremost, there is no more Occasion to be at any Pains in keeping up the Orifice; wherefore I now suffer it, together with the HEAD, to fall down past the Bending of the OS SACRUM; which now also, the major Part of it being bare, more easily happens, than it possibly could whilst it was cover’d with the Orifice. Upon this, that the Child may be farther relieved and brought out, I now again make use of both Hands, the one inwardly, the other outwardly, as before: But as the Condition is now much alter’d from what it was at that time, I at present proceed after a quite different Manner, and work along with the Pains, resting only as their Force ceases: For thus I not only observe the Pains my self, but also at the same time encourage my Woman to Labour, and to persist in her LABOUR with all her Strength; and by Turns, as the PAINS come on, to conjoin their Force with her own and my mutual Endeavours, in the manner following: namely,
HAVING One Hand in the Vagina, with its Back turn’d towards the Rectum, I thrust very cautiously the Points of my Fingers as far as I can under the HEAD, where I hold that Hand constantly, until the PAIN comes on; laying the other Hand upon the Belly, about that Part where the Bottom of the Womb lies: Then as I perceive the PAINS come on, I begin to work with both Hands; to wit, by pressing the internal Hand gently downwards, against the Point of the Sacrum to remove it back out of the way; whilst by the external Hand, I gently raise the Womb into a resupine Posture, pressing it also softly downwards: I mean softly in Proportion (howsoever) to the Force of the PAIN: for as it gradually encreases, and more and more excites strong Labour; so I also by degrees press down more strongly.
HOWEVER yet the External Depression ought always to be Moderate, as the Internal ought to be Strong and Vigorous: Whereupon Matters being carefully well observ’d, (as laid down in Chap. 9.) no MIDWIFE needs be afraid of hurting her Patient Woman in the least; no rather, on the contrary, the more Strength I use now, the more grateful and agreeable I prove to Her being thus circumstantiated. And, in fine, the upper Part of the CHILD’s Body being once past that Sinuous Bending above, it presently breaks out all together, and comes away so happily into the World. After which the MIDWIFE is only farther to behave herself with respect to both the Mother and the Child, as in the Natural Case[174], carefully cleansing, restoring, contracting, and shutting the Womb as Before. In a Word, with so great Success at last the BIRTH is accomplished, provided these Precepts be carefully and timely observed.
BUT that the Ingenious may be at no Loss in this momentous Affair upon any Occasion, we shall now particularly state the Case, in which the ordinary Midwife has thro’ Ignorance or Negligence, let Matters come so far, that the acuminated or lower Part of the Womb is fallen into the Pelvis; and the Orifice, together with the Head, is broken thro’ into the crooked Sinus of the Os Sacrum, and is fixed-up there; that the Membrane is broke; that the Infant’s Head is but a little bare; that the poor Woman (after the Fatigues of a strong or long Travail) is quite spent and tired; and finally, that all these Things have happen’d before the extraordinary MIDWIFE is perhaps sent for, or at least before He can conveniently be with the Woman.
IN this Pitiful Case, the Head being yet but a little bared, and sticking fast in the Sinus of the Os Coccygis (as abovesaid) the CHILD cannot possibly make any Impression upon the Orifice, so as to open it; and therefore the Situation of the Womb is to be alter’d: In order to which, I first place the Woman on a commodious Seat adapted to the Purpose, such as upon a Pallet, or Low Bed, or some Pillows laid on the Ground; that she may lie with her Face downwards upon her Knees, with her Head low; her Arms being supported with so many Pillows as are requisite to sustain her Body (leaning upon them) without moving.
NOW I doubt not but some People will think this a strange helpless Posture; but as strange as it is, it is certainly the most effectual, and the absolute best One, which can be devis’d for the Woman’s desir’d Relief in this desperate Condition: For by the Help and Means of it, the Womb is carried down into the lowest Part of the Belly, through its own Weight only; and consequently releases itself out of the foremention’d crooked Sinus; which that it may the sooner and more commodiously do, I put my Fingers into the VAGINA behind, betwixt the Rectum and the Head of the Infant, where I press down the Womb, till the Orifice is so far forced back, that there is Room enough to hold it up, in order that it may not relapse; and also that there may be Room for the Head to be depressed into, and open the Orifice. Thus the Womb and the CHILD being at last forced so far back, by an expert Hand, the BIRTH may be successfully perfected by the above-prescrib’d Means and Method; provided always that the Woman has sufficient Strength and PAINS to carry her through the fatiguing Tryal.
BUT we will how suppose, for better Instruction-sake, her Strength to be quite spent, and the PAINS to be deficient; in this Case the happy Issue of the BIRTH is most dubious; but however, then I place the Woman again as before, and depress the Womb as much as I can, until I reduce the Orifice farther up into the larger Space of the PELVIS, that I may the more conveniently open it by the Help of an inward Hand; and by that also moving aside the Child’s Head, I then seek for, until I find, the Feet; which, upon the Infant’s being right turn’d, with its Toes downwards towards the Mother’s Rectum, I bring into the Passage. Now the Feet being thus in the Passage, the Woman needs not lie any longer in the abovesaid Posture; but, turning herself, may now lie with her Face upwards: When I also give her previous Notice to prepare herself to depress vigorously; I mean as much as she can possibly, when occasion requires.
IN the Interim, holding the Feet all the while with my internal Hand, I attract them gently outwards, until the Buttocks and the Belly are excluded: Then taking fast hold of the CHILD by one Hand under the Belly, and the other upon its Back; I advise the good Woman, in Case she feels no PAIN, to behave herself as if the PAINS were most pressing upon Her, and to contribute by forcing downwards what lies in her Power; whilst I continually attract, and gently draw the Infant towards me, until by this discreet Management the Head is totally excluded, together with the Arms into the World. And thus at length the Distressed Woman may be happily delivered in all these different Cases, and difficult Conditions of Life. Whence I come to——
Experience teaches us, that the Womb may be also too much resupin’d; or tending with its Bottom backwards, may be pressed too much towards the Spine: So that its Orifice is not only raised too high in the Belly, but is also so obliquely seated, that it no more answers to the VAGINA in a right Line, varying more or less, according to the Proportion of this Tendency to the Back-Bone.
FROM this Posture of the Womb now, it necessarily follows, that the Head (tho’ never so well turned) falls upon, and is violently forced against the Ossa Pubis; where the tender Head sticking, often happens by its own Struggles and the Mother’s PAINS, to be grievously squeez’d and gradually crush’d, so that, until it is removed and brought into the PELVIS, the Woman can by no means bring forth her INFANT. Wherefore the diligent and careful MIDWIFE must (by due Attention) make it her Business to discern at the first Touch this ill Position of the Womb, and presently upon the first Pang of Labour, try to help both the MOTHER and the CHILD.
WHEREAS otherwise the slothful and ignorant MIDWIFE, may continue the poor Woman in an irregular Labour perhaps some Days, without perceiving the Head to be fixed upon these Bones, always erroneously imagining the INFANT only to be situated too high, (because it lies out of the reach of her shallow Touch) and that it must in due Time fall down lower within her Ken. Or peradventure otherwise, when by the Touch, she feels a kind of Roundness or Hardness, thro’ the Womb, mistaking This for the Head, she thinks the INFANT is well turned, and wants only strong PAINS to drive it forwards with Success.
THIS Ignorance is chiefly owing to her own Stupidity, in that she cannot clearly distinguish between the Womb and the Vagina by the Touch; nor the Orifice of the Womb from the Parts of the CHILD, or MEMBRANE; which (in this Case) frequently occasions the Death of many a Dear MOTHER and INFANT.
BUT here it is to be moreover noted of this difficult Situation of the Womb, that the MIDWIFE (how skilful soever) perhaps can either not touch the Orifice at all, or but very little, except it lies wide open, when she may touch at least some Part of the Circle of the Border: For the Head being fixed upon the Pubis above, the whole upper Part of the Edges of the Orifice can no ways peradventure be touched with the Fingers, which may only reach the lower Part that is Open.
UPON which, these Fingers are cautiously and prudently to be thrust in farther betwixt the Neck of the Bladder, and the Orifice of the Womb: Then being so near the Neck of the Bladder, a discerning MIDWIFE will feel a sort of a Circular Border, namely, that of the Orifice of the Womb; which if she penetrates with her Fingers, she will also find the hard Part of the Head, which is Smooth and Globular, or the opening of the Vertex; whence she may be certain, that the INFANT, as well as the WOMB, is too close to the Spine of the Back. Whereupon she ought, without loss of Time, to assist and help the CHILD in the following Manner; viz.
SHE is to hinder the Woman from labouring all this while, advising her to bear and put by her PAINS, until this Posture of the INFANT can be duly corrected: In order to which, I would First order the Woman to make Water, if she can, that the Bladder being thereby emptied, may not be hurt by the Pressure of the MIDWIFE’s Hand, or the CHILD’s Head: Secondly, if the MEMBRANE is not yet broken, and the Pains but few and faint, I would prescribe a gentle Clyster, not only to awaken These, but also to remove all Inconveniencies of the RECTUM: Thirdly, I would then advise to lay the Woman in a convenient manner, upon her Back with the superior Part of her Body lower than the inferiour, that both the Womb and the Infant may the more easily recede or give way back.
THEN taking cautiously Hold of the Border of the ORIFICE with the Fingers of either Hand, I would press and draw it back towards the RECTUM, whilst I employ’d my other Hand outwardly upon the ABDOMEN, a little above the OS PUBIS: I mean, that the Child’s HEAD ought to be thrust back a little with the Hand on the outside, pressing it discreetly down; as the ORIFICE is to be drawn back towards the RECTUM, and at the same time also downwards, with the internal Hand.
IN the next Place, as I feel the Head and the Womb mov’d a little downwards, so I would also advise the good Woman to raise the upper Part of her Body, yet so as not to stir the Lower, and to bend herself as much as possible Forwards, sitting as if she was going to Stool: Because by this Posture, she raises both the Infant and the Womb behind, and consequently drives them BOTH Forwards, whilst I would in the Interim keep my HANDS very fast placed as aforesaid, ready to depress the HEAD before, that it may fall directly into the Pelvis. In short, the HEAD being thus disengag’d, I would now advise the Woman to observe her PAINS, and mutually labour with them what she can, with her Body mostly still in a Sitting Posture, or kneeling with her Arms conveniently supported.
BUT supposing the INFANT to stick very fast upon the Pubis (which commonly happens by Loss of Time, or by misimproving a critical Minute;) and that the capable Midwife finds both the Mother and the Child in this miserable Condition, thro’ the Neglect and Ignorance of Another: In this Case I would lay the Woman altogether upon her BACK, with her HEAD low, and her BODY a little elevated; then by the abovesaid Method I would try to depress the Infant’s HEAD, observing however yet not only to press it down from above, but also first to thrust it back, and depressing it at the same Time: By thus repelling it, I would save the tender HEAD from being hurt by the Depression; since otherways these Bones would leave a Dent or an Impression upon it, if not also wound it over and above.
MOREOVER, supposing that the MEMBRANE should break by Chance, and that by enlarging the Orifice, the HEAD should be much bared: Then I would let the Border of the Womb alone, and endeavour to thrust my FINGERS betwixt the HEAD (towards its Upper Part) and the OSSA PUBIS; by which means One may most probably draw the HEAD downwards, along with the Orifice. However, in fine, this Case, (as well as all other preternatural BIRTHS) absolutely requires a sound Judgment, a quick Comprehension, a good Conduct, an easy soft Hand, and a dextrous gentle Method of treating the parturient and patient WOMAN. But, farther——
WE will again in the next Place state the CASE thus, that suppose the HEAD is too Big, and the Child so much compressed, that it cannot be brought into the PELVIS without great Trouble and Difficulty: In this Condition, before Matters come to an Extremity, I would (without Loss of Time) find out the Feet; in order to which, the Orifice (which is now commonly less open) ought to be cautiously open’d with a gentle Force, by thrusting first one, and then more Fingers upwards, which are to be gradually distended, until at last the whole HAND is entered up to the Wrist: Whereby (after prudently breaking the MEMBRANE) I would now and then thrust back the Head, and put it upon one Side, as much as possible by Art.
BUT upon This here it must be carefully observ’d by the way, that I would pass my Hand close up along the INFANT’s Body from the Orifice to the Fund of the Womb, or to the Feet, that it may not come between the SECUNDINE and the Womb, but betwixt the MEMBRANE and the CHILD: By this Method I shall neither hurt the Womb, nor the INFANT; but the HAND distinguishing clearly all the Parts of the CHILD, I cannot miss finding the Feet with the greatest Certainty. Tho’ I must acknowledge by the By, this to be the Work of a very strong and agile HAND, as well as of a sound and ready Judgment; because of the immense Labour and Difficulty, first in opening the narrow ORIFICE, and then in penetrating through it to the Bottom of the Womb, as the INFANT obstructs the Way: not to mention the great Inconveniencies also besides, which arise from the Turnings and Windings, as well as from the Length and Constriction of the Passage. However yet——
THUS having found one or both FEET, I would draw them down both together, if possible, always turning the TOES towards the FACE. Whereas if only ONE can be found to be conveniently attracted, as it often happens, I make it fast by a running Knot on a broad Ribband, or by a certain Bandage, called MITRA, or with a soft Linnen Rag about four Inches broad; which I twist together, and hold in the Hand without the Body, as I pass the other up along this LEG, duly observing whether it is the Right or the Left, that I may know which of my HANDS will most commodiously find out the other LEG; and that HAND having reached the CHILD’s Belly or Buttocks, I slide it along the THIGH to the other LEG: So that the FOOT being thus found, I bring it also down into the PASSAGE, according to the POSTURE of the INFANT.
BOTH FEET being now thus brought down, if they chance to be ill-turned, that is, with TOES up and HEELS downwards, I discreetly turn the CHILD, whilst I gradually draw forth the FEET. These, together with the BELLY, being fairly excluded, I hold the FEET with one Hand, whilst I put the other under the BELLY and BREAST, as far as possible: Or, resting the FEET in my Lap, with one Hand above, and another below, I take good hold of the BODY, attracting it gently. Upon this I advise and encourage my Woman now to labour her best, and that whether she feels any PAINS or not, since they are now no longer to be waited for with the Impatience of a happy Delivery.
BY this regular Method, in fine, the HEAD and both ARMS pass thro’ the Orifice at once, and that without the least Danger; because the Smoothness of the TEMPLES affords always sufficient Room for the ARMS, as the Orifice relaxes and dilates, as has been already observed[175]. Now this, in short, I take, with Submission, to be the only genuine METHOD of perfecting a successful DELIVERY in the present preternatural Condition, whether the BIRTH be Dead or Alive: So that hence I proceed in course to——
THO’ the WOMB may be obliquated (as has been said) either to the right or left Side; yet, to abbreviate this Work, I shall contract both Situations into one; and because the ingenious Reader may easily apply what is said of the one to the other, I shall only treat of that inclining to the right Side.
THE most difficult Posture of this kind is, when the Bottom of the WOMB is placed deeper in the right Side towards the Loins, tending more to the Back than the Forepart. Which the Midwife may know to distinguish by the following Signs; namely, 1. By the Place where the Woman feels the INFANT move most. 2. By that part of the Belly which is most pointed and hard on the Outside. 3. By trying the Woman in the beginning of the Labour, before the Pains have moved the WOMB out of its Place, she will find the Orifice of the WOMB suspended higher, compressed to the Spine of the left OS PUBIS or COXENDICIS; by which means the said Orifice cannot be touched without Difficulty; and by no means the whole of it, but only the lower Border. 4. She will find the INFANT’s Head thro’ the WOMB and VAGINA (tho’ not bare) laid a-cross the PELVIS, but cannot come at the lower Part of it; only with one or more Fingers, she may sometimes penetrate betwixt the Spine of the said Bones, and touch the VERTEX.
BY these Signs the MIDWIFE soon finds her Task most heavy and perplexed; for from thence proceeds the following Difficulties.
I. IN this Posture the INFANT’s Head (as soon as it makes the lead Apertion of the Orifice) is fixed upon the Spine of the left OS PUBIS or COXENDICIS; and the Head thus fixed cannot pass forwards, because those Bones cannot give way: From hence arise the AquÆ FurtivÆ, or a flowing of the Waters by Stealth, or as it were, by Distillation; the Orifice as well as the INFANT’s Head being shut up by the said Bones, so that neither the Head nor the Humours can open it; save only a little on the lower Side: Where the Waters, by pressing the Membranes downwards in an acute Form, break thro’ that acuminated Part as they also force the Head upwards, near to the Border of the said Bones.
II. IT often happens, by these means, that the right Arm is excluded, and falls down to the Shoulder in the PASSAGE, the INFANT being left dry by the unseasonable flowing of the Waters: And the Arm being thus thrust forwards into the PASSAGE, the Head is more and more forced-back upwards, so that the Neck of Consequence is so bent, that it may easily break; and the Crown of the HEAD (falling against the Spine of the PUBIS or COXENDICIS) is so pressed upon it by the violent Pains, that the BRAIN may be readily affringed, and consequently the INFANT die before BIRTH.
III. THE most deplorable Condition of all is when, after all Pains and Labours suffered in vain, the Mother herself expires, without bringing forth her Child; as it too often happens, that after a long continued and miserable Torment, the Birth is not a Jot advanced, whereby of course the wretched Woman must undoubtedly yield up the Ghost for want of effectual Help. I say for want of Help, because the Help of such Midwives as are ignorant of the various Postures of the Womb, and the Method of correcting them; and of such as do not thorowly understand the Touch, but place all their Hopes in Nature and Divine Mercy; is as nothing, and of no Effect upon this critical Occasion: Since the audacious Ignorance of such Creatures serves only to tempt God and his Providence.
HAVING thus defin’d and laid down the fatal Inconveniences of this Preternatural Situation, I come now to shew People concern’d how to correct it and dispatch a happy BIRTH: In order to which, the prÆliminary Articles are the MIDWIFE’S indefatigable Industry, and accurate Attention to the Circumstances of Things.
THEN supposing an INFANT to be brought forth HEAD foremost; the Woman is to be placed with the upper part of her Body a little elevated, the MIDWIFE then finding (by the Touch) the Orifice to be but moderately press’d upon the Left OS PUBIS, or COXENDICIS; in this Case, she is to be laid down full upon the right Side a little obliquely, that the Womb may fall back by its own Weight, and not relapse against those Bones.
NEXT after this I would endeavour to get my right Hand-Fingers above the upper Border of the Orifice, and thereby remove it a little, and bring it down nearer the Cavity of the Pelvis. To facilitate which Work, I would order some of the By-Standing Women to raise her right Side a little, which of Consequence raises the Womb itself; and thus I would, by raising and letting it down by Degrees, move it forwards into the PELVIS: However, always taking special Care, that the Womb, together with the Head, do not slip down too far into the crooked Sinus of the OS SACRUM, so as to stick there, (as has been already precaution’d in the preceding Chapter:) to prevent which unlucky Accident, I would advise to apply all possible Care and Pains in the Beginning, to sustain and keep up the Orifice, and to bare the HEAD sufficiently before its Descent; observing also the same Management in point of the Humours, until the Membrane breaks; which being broken, I would treat the Head in Manner as aforesaid.
NOW tho’ the HEAD in this Posture offers itself as if it were bent aside, because of the lateral Distorsion of the Womb, I would first bring it to a right Position, and then manage it as if it had presented itself directly: And besides, the HEAD being thus directed into the Pelvis, I would always take care that the Woman’s Body be bent a little towards the left Side, that the Child may the more readily be carried down by its own Weight into the PELVIS. But, in short, as to the farther Exclusion of the Infant, and After-Birth, as well as the Cleansing and Contraction of the Womb; These Things are to be perform’d, as directed by the foregoing Chapter.
HOWEVER, we will now state the Case, and suppose that the Woman is spent and tired out with continual hard Labour, before the capable MIDWIFE is sent for: Upon this Condition the BIRTH is to be hastened by all possible prudent Means. In order to which, I would (without Loss of Time) endeavour to turn the INFANT, and extract it by the Feet; Because to direct it otherways into the Pelvis, would be too tedious upon this Juncture. For to bring it Head foremost, would create vehement Pains, which infallibly would expose both Lives to extream Danger. But now, in fine, having thus at large insisted upon the various Cases of Preternatural Births, arising from the four extream oblique Situations of the Womb; It remains yet still, that I also subjoin a few Words, upon such Preternatural Cases, as may proceed from the less oblique Positions of the same Body; and that briefly in manner following——
AS the three preceeding Chapters concern only the Extremities of an obliquated Womb, so they necessarily lead me in this Place to offer a short Hint Upon the Median or Less oblique Uterine Positions. Which notwithstanding their great Variety, according to the just Comparison formerly made[176], I shall for Brevity-sake comprehend in One, and treat of in general Terms as subsequently follows.
I. I observe that however conspicuous and remarkable the Difference of these Preternatural Postures may be, especially That betwixt the Four mention’d Extremes and the Natural Situation of the Womb; yet I fear, that there is too much Reason to suspect, that this Difference is but little known to the generality of Practitioners in MIDWIFERY, otherways I am sure Patience would not be so much cry’d up, or at least Time would not be so much trifled away, (at every difficult LABOUR) by the Ordinary Boethogynists, neither would the Use of SHARPS be so much practis’d by the Extraordinary MIDWIFE.
II. I observe, that tho’ a Womb less oblique, occasions a less Difficult, or more easy BIRTH, than any of the Extremes, yet the least Degree of an oblique uterine Posture, may be of great Hindrance, and imminent Danger to the Woman, whose attending MIDWIFE is ignorant of it, as well as of the exact Method of restoring it to its Natural State.
III. I would observe by the way, that as the fatal Consequences of such Ignorance, have already been sufficiently precaution’d in the preceeding Chapters; so it would be supervacaneous, and altogether needless to re-assume or repeat them in This: Wherefore I shall only farther, once for all, exhort and adjure such MIDWIVES, as have any regard for their own Consciences, and the Lives of their Neighbours, that they would qualify themselves duly in these excellent Points of Knowledge. And This I have the more Reason to inculcate, because I never yet knew an assiduous MIDWIFE, who was thus perfectly well endued with the essential Qualifications of her Profession, but the great GOD rather (to whom the Glory of all Things is due) perpetually compleated his own Gifts, and crown’d the Labour of her Hands with desirable Success.
FOR as the Husband-Man, who never sowed, can never expect to reap; or as the Gardener, who never planted, can never hope to gather; so neither can the MIDWIFE who was never regularly qualified, ever justly hope or expect to effect a happy DELIVERY; especially not in Cases of Difficult and Preternatural BIRTHS: Neither can the Consequences of her Mistakes or Ignorance on the other Hand, ever detract from, or lessen, the Divine Power, which is still the Same, and can always do all Things that it will, but will not always do all that it can. Besides HE, who has been pleased to lay such Burthens upon us, to try the Patience and Constancy of One, and to exercise the Industry and Charity of another; HE, I say, often executes his Judgments upon some, for the Sins of both Offenders, that all Things may the more manifestly tend to his own eternal Glory.
IV. I come now in the fourth Place by certain Demonstration, to explain the Nature of a Womb less obliquated, and to lay down the genuine Method of correcting any Preternatural Situation whatsoever of the disorder’d or distorted Womb.
IN order to which, I would previously observe, that all such Postures of the Womb, whether more or less, either tending aside, or prone, or supine, are only best discover’d by the TOUCH: Because the Orifice always answering in a strait Line to the opposite Situation of the Bottom of the Womb, can never fail to shew its Posture to the judicious MIDWIFE.
HENCE if the MIDWIFE does but know exactly the Natural Position of the ORIFICE, she may thence easily conceive by how much it differs in an obliquated Womb, and accordingly thereby readily judge whereabouts the Bottom is seated: Which Situations of Bottom and Orifice being known, she can consequently be at no loss to comprehend the Disposition of the whole Uterine Body. And if she now remembers or recollects what has been said of restoring and replacing the most extream, or most oblique Womb, she will have no Difficulty in restoring any Womb less oblique to its Natural Posture; This depending entirely upon that Method, to which I refer[177], for Brevity’s sake.
IN short, I shall here only add, that if the INFANT offers itself well turn’d, in this less oblique Womb; the MIDWIFE, having restored the Womb to its right Place and natural Posture, will find nothing more to do, but to take Care to facilitate and enlarge the Passage, and receive the CHILD tenderly with the Head foremost. Whereas in Case the INFANT presents itself ill-turn’d in this Womb, it is to be very circumspectly extracted by the Feet; as by and by will more amply appear from what ensues, Viz.——
BY this sort of BIRTHS, I mean such as are Preternatural, both in respect of the Situation of the CHILD, and of the Womb. Which complicated Preternatural BIRTH is (of all others) the most dangerous; because of an Indefinity of Accidents and Difficulties with which it is always attended, according to the many various Postures in which both the INFANT and the Womb are found: All which to enumerate here, and to guard particularly against them, as I have done in the preceeding Cases, would not only augment the Bulk and Charge of this WORK, but also be in some respect altogether Needless: Because if I was to content my self to treat this Chapter in general (without descending to particular) TERMS, I would not doubt but that the ingenious Reader would even thence readily form a clear IDEA of all such BIRTHS, from the many different Cases already stated and discussed; which if thoroughly well understood, the Rest cannot but be easily comprehended.
HOWEVER, that I may not leave the weaker Capacity, or the doubtful MIDWIFE to the Uncertainties of her own scrupulous Judgement, I shall propose and resolve some of the most difficult and dangerous Cases belonging to this preternatural Subject, and that as far as is really requisite, in manner following; viz.——
I. WE Shall suppose that the INFANT is ill-turned, and presents itself preternaturally, with Face, Chin, Hand, Elbow, Shoulder, Breast, Back, Belly, Side, Buttock, Knee, Foot, or any other Part or Member first, in a Womb tending obliquely forwards. In this Condition, I shall first show the MIDWIFE how, and by what Signs, she may know and discover such perverse Postures; and secondly how, and by what Means, These may be rectify’d, the CHILD extricated, and the MOTHER reliev’d in Life.
THEN as to the First Point, I would have it minded, that the Touch is the only Expedient, by which the Situation of the INFANT in any Womb, whether Oblique or Direct, is to be discover’d and perfectly known. Which when the MIDWIFE finds to be preternatural, she needs not much trouble herself about what precise Part offers or comes first in the PASSAGE: Because of this short Rule, which I would not have her to forget; namely, That, when the Head does not present itself first in this complicated Case, the CHILD is to be drawn out by the FEET. For in this ill Position of both the INFANT and the WOMB, the Version of the CHILD succeeds more easily than if the Head was foremost: Wherefore I would lose no Time, but as Soon as I had discover’d all Circumstances aright, I would commence my Business upon this Occasion, before either the MOTHER or the INFANT are much spent, that I may perform my Work, while they both can mutually concur with me towards their own Relief; That is, while the Womb is yet suspended in the upper Part of the Pelvis, and the Membrane not yet broken.
IN order to this Second Point, the Woman being commodiously placed, the MIDWIFE is to pass up her Hand into the VAGINA, and dispose the Orifice of the Womb to open, which is now sooner done than if the Head came first: This being done dextrously, she is to put first one or two Fingers, then all of them successively into the Aperture; and when that is sufficiently enlarged, she is to penetrate into the Womb, and either break the MEMBRANE, or wait its spontaneous Breaking, as she judges best by occurring Circumstances. In the next place, she is to look for and find the FEET; and, the TOES being always turn’d towards the Rectum, they are to be forthwith brought into the Passage: proceeding still farther in the due and regular Method of extracting the Child, as already taught[178] and dilucidated.
II. WE will suppose moreover, that the Infant is ill-seated, and presents itself preternaturally with any of the aforementioned Members first, in a Womb hanging obliquely to either Side. In this Case, I would sincerely advise the MIDWIFE, to lose no Time in opening the Womb, breaking the Membrane, turning the Child, and extracting it by the Feet: Because in this Posture of both the BIRTH and the WOMB, Experience has taught me that nothing can be safer and less dangerous than this Method, when ingeniously and presently perform’d with Dexterity.
IT is true indeed it may be objected, that I dissent in this Matter, from most (if not from all) Authors: To which I answer, in short, that Those from whom I do differ, were never acquainted with this complicated preternatural Condition, but always supposed the WOMB to continue in its proper Place, never dreaming of its various Motion, nor suspecting its oblique Situation; erroneously imagining all preternatural BIRTHS to proceed merely from the ill Version of the Infant: In which Circumstance however, when it happens so, I confess they are so far in the right, that the Head is to be first brought into the Passage, and the Child excluded by it with all possible Expedition.
BUT that I may farther elucidate the true State of this Case, as it becomes me to speak the Truth ingenuously, it is my candid Opinion that, in any oblique Posture of the WOMB, it is the safest, quickest, and most convenient Method to extract the Infant by the Feet, and that presently in the Beginning of the Labour, either before or at least presently after Flooding, as occasion requires. For this very Reason, and to this Purpose, I hope, I may farther justly lay down one certain Rule; namely, that all BIRTHS ill-turn’d, in a WOMB ill-seated, are to be rightly turn’d again, and drawn out by the Feet. Which Rule, if duly observed, will, I am positive, save a World of Women and Children, that otherwise must inevitably perish; since as for my part, I know no Situation of the Infant in an oblique WOMB, more difficult or dangerous than the Head’s offering itself first; and that because the BIRTH cannot be then turned without the greatest Difficulty and most extreme Pains.
THIS, in short, will be readily granted by All, who do consider or conceive that the WOMB (being fixed by Ligaments on both sides) is always more inclinable to fall Forwards or Backwards, than to either Side, and first most commonly bends back before it comes to any lateral Posture; and that from hence of consequence, the WOMB is distorted as well as obliquely situated. By reason of which Distortion, if the CHILD comes Head foremost, it falls down in the Pelvis obliquely; and tho’ a judicious MIDWIFE may bring the Head directly into the Pelvis, yet the Shoulders following, must needs fall upon the Pelvis a-cross, in its narrower Part; whereby of reasonable Consequence the Infant must be distorted in the Passage.
NOW in this Case, no Pains, how violent soever, can avail to force forwards the BIRTH so fixed upon these Bones; wherefore (I say) when the WOMB is thus seated, it is most safe in the Beginning of the LABOUR, to open its Orifice, break the Membrane, turn the CHILD, and take it out by the FEET; since by the Head’s coming now foremost, both Lives are at Stake and in great Jeopardy.
HOWEVER yet it may be again objected, that I have already prescribed another Method in Chap. 21; viz. of bringing the Orifice together with the Head into the Pelvis, and promoting the BIRTH in that Manner: To this I answer, that my Reason for so doing, was not only to convince some People, that I know their Method as well as my own; but also to whet or assist the Judgment of such good MIDWIVES as cannot forsake their own old By-Paths; Not that I ever design’d to recommend it to any, tho’ I must however acknowledge, that sometimes it may effect the desirable Ends; but according to the Rules of irrefragable Truth, and sound Judgment, we find that, in this Position of the Womb, let the BIRTH offer itself as it will, the only laudable Method is without Loss of Time to extract the Infant, and deliver the Woman as above-directed.
III. I observe upon the whole, that as the immediate present Case is applicable to either (right or left) Side; so what is said of the foregoing Condition, with respect to the Womb’s inclining forwards, may be easily apply’d to the Case of its tending backwards: Only with this considerable Difference, that the oblique forward Posture of the Womb, is the most commodious of the Four mentioned Extremes, and consequently admits of a more easy Exclusion of the BIRTH by the Head, than any of the rest mentioned.
NOT but that either of these grand or complicated preternatural BIRTHS imply and prognosticate imminent Danger to the MOTHER, or the CHILD, or Both; as well as incredible Labour and Fatigue to the faithful MIDWIFE; who, in such Cases, can less distinctly feel, less commodiously handle, and more difficultly come at the Matter, so as to dispose the INFANT’S Members for Attraction, than in any other Condition of BIRTH: Hence it is, in short, that so many MIDWIVES are liable to the most egregious Mistakes, and unaccountable Deceptions upon these unlucky Occasions. But——
AGAIN farther, I hope I may freely speak my Mind, and openly avow, that the most of these Births proceed merely from want of seasonable and skilful Assistance in the beginning of the Labour: Because the BIRTH (however well seated then) by reason of the bad Situation of the Womb, cannot possibly pass thro’ the Pelvis of itself; and not being judiciously assisted at that nice Juncture, behold, from a Natural, it falls on a sudden also into a Preternatural Posture. From hence we have this extreme difficult and most dangerous sort of Preternatural BIRTHS, as will more conspicuously appear from a deliberate Reflection upon the preceding Chapters. And This much (I hope) may finally suffice any intelligent Reader, to conceive the different Circumstances of all complicated Preternatural BIRTHS whatsoever. Whence I go on to the Fourth and last Sort of Preternatural BIRTHS proposed; namely, Those proceeding from intervening accidental Causes; which because they are also different, I shall handle briefly and separately in the ensuing Manner; viz.——
AMONG the various unhappy Accidents, which may happen in or about the Time of Labour, the present Case is none of the most auspicious; in as much as it may, in sundry Respects, occasion a very difficult Preternatural BIRTH, according to the Difference of Circumstances: For the Navel-String having fallen down and come first in the Passage, may be variously turn’d, and consequently cause several and sundry Inconveniences, as follow, viz.——
I. WHEN the Umbilical Vessel falls down alone into the Passage, without any other Part, the BIRTH is then commonly situated a-cross in the Womb; and in this Condition, BACK or BELLY, HAND or FOOT, may be probably expected to come first: Wherefore the active MIDWIFE ought to discover the real Posture by the Touch, and that at least before all the Waters are yet flow’d off and evacuated; and then betimes to fetch away the CHILD by the FEET, unless the Head be more convenient or pat for the Purpose. But these Cases being already particularly discussed[179], I shall add nothing farther upon them in this Place.
II. THE String may fall down double, and so swell with Cold, as to obstruct the Passage, which however is but the smallest Consideration in this Condition, because by its hanging down double, it may be so shortned, that the CHILD may be detain’d, appending by it in the Orifice, until the Blood of the Umbilicals coagulating either by Cold, or by Compression in the Passage, the due Circulation is obstructed, and the Infant expos’d to the greatest of Dangers, if a very speedy DELIVERY does not prevent the fatal Accident.
THE Prudent MIDWIFE ought always to be very sollicitous about this Case, making it her particular Care from the beginning of the Labour, as soon as perceiv’d by the Touch, and before the Waters break, to avert or hinder its either coming before, or along with the Head, by removing it judiciously according to Art. But supposing she comes too late to prevent the Mischief, and that the String is already in the Passage; then it is to be put back behind the Head immediately, and kept there until the Head be fully directed into and lodg’d in the Passage. However it sometimes happens that it cannot be kept-up so long, and that the MIDWIFE, whatever Pains she may take, cannot hinder it from extruding itself at every Pang: In this Condition, I would advise her (without delay) to extract the Birth by the Feet, and that notwithstanding the Head should be foremost.
III. IT also happens sometimes, that the String without hanging down, is variously compress’d betwixt the Head and the Bones of the Pelvis, which (stopping or impeding the Motion of the Blood) soon occasions the Infant’s inevitable Death.
IN which Case, if pressed against the Ossa Pubis, having laid the Woman on her Back with her Head low, and the lower Part of her Body raised, I would press back the Infant’s Head, and put the STRING as much as possible behind it; upon which, then I would bring the Head forthwith into the Pelvis, unless it be more convenient to turn and extract it by the FEET.
AS also, tho’ seldom, it may happen, that the Umbilical may be pressed back by the Head against the Os Sacrum: In which State of Affairs, I would turn the Woman, if Strength may permit, upon her Knees, whilst I employ either Hand on the Back Part, in order to remove the Head, how firmly soever fixed: Whereas if the Patient be weak, I would lay her upon either Side, drawing up one Foot to her Belly, for the Advantage of obtaining more Room, in order to effect the same Thing; which, tho’ difficult, is no impossible Task for the expert MIDWIFE.
BUT if it chances to be pressed against either of the Ossa Ilia, having laid the Woman on the contrary Side, with the lower Part of her Body elevated, I would remove the HEAD with the opposite Hand, and free the STRING; proceeding otherways as in the former Cases, with HEAD or FEET, as I should find most convenient.
IV. AGAIN, it also sometimes comes to pass, that the STRING is found lying upon the Forehead, which is indeed most dangerous; but it is easily removed with good Judgement to the Temples of the Head, which I take to be a safe Position, because there the Pressure is much less aggravated.
V. MOREOVER it likewise sometimes happens, that the STRING comes along with the Shoulder, Elbow, Hand, Foot, &c. without touching the HEAD: Upon this then as soon as the Humours have flow’d, I would pass my Hand quickly up, and bring the CHILD, Head or Feet foremost into the Passage, according to its Situation, always detaining or stopping the STRING from coming out before the BIRTH: Whereas if the STRING be already excluded along with the Foot or the Arm, it is to be repelled with all necessary Speed, Conduct, and Caution, and then the INFANT ought to be dextrously drawn out by the Feet.
VI. I have also seen the CHILD brought forth by the HEAD, with the Umbilical circumvolv’d, or turn’d twice or thrice round the NECK; by which means of the STRING’s being so much shortned, the BIRTH was stopped or retained in the Passage: Upon this Occasion, I endeavour’d to slacken the STRING, and so bring it over the HEAD, but finding it too strait and short to be so ordered, I tied it in two places (at about two or three Inches distance) and then cut it in two betwixt the Ligatures: That being done, it was my Business to lose no Time in attracting the INFANT and delivering the WOMAN; otherways in this Condition, it would have soon expired.
ANOTHER Preternatural Accident to which the BIRTH is also sometimes liable, is the Falling down of the Placenta into the Orifice of the Womb; which of course must needs obstruct the Passage, and prevent the timely Egress of the INFANT.
NOW tho’ the ignorant Midwife often occasions this untoward Accident by her own unskilful and imprudent Treatment, or rough and indecent Usage; yet the Ingenious MIDWIFE discovers this Case in time by two certain different Ways: Namely, First, by the Touch, when she can neither feel the MEMBRANE, nor the naked HEAD; but (on the contrary) perceives a thick, soft, fleshy, boneless Substance: Secondly, by a Bloody Flooding, which constantly attends this Condition; whereby both the MOTHER and the CHILD are imminently endangered, as is already more abundantly set forth[180]: Unless the skilful MIDWIFE can prevent the fatal Consequence, by accelerating the BIRTH; which, however yet, is not to be rashly attempted without due Circumspection.
BUT notwithstanding the daring Difficulties, and time-serving Precautions, mentioned by most Authors of my reading and revolving, in this Case; I can conceive no extraordinary Perplexity which can attend it, if the DELIVERY be but timely or seasonably undertaken, before the Woman’s Strength and Blood be too much exhausted. I know Daventer, Peu, and some others, make long Ambages or Circumlocutions upon this Head; for some are at great Pains to teach us how to perforate the SECUNDINE with a Hair-Needle instead of our Fingers, and others how to keep it back, until the INFANT be first born: But for my part, as I already foresee sundry Difficulties that will arise in these Practices, so I shall be loth to come into them, and that because——
FIRST, in penetrating the Placenta with any acute Instrument, the CHILD (if not the MOTHER also) may be easily wounded: Secondly, supposing it to be done with the Fingers, the Hole must be dilated in proportion to the Aperture of the Mouth of the Womb, and then this mangled Mass must be dispersed to all Sides of the Orifice; by which Means, Daventer himself acknowledges, that it often perfectly congeals with Blood, and sticks so fast to the Womb or Vagina, that the Ignorant would not only take them to be grown together, but also believe them rather to be one and the same Body: Which consequently must require both great Pains and Difficulty to be separated, and at last a very diligent Scrutiny must be made, that no Fragment be left any where Behind, since in this Condition no just Conjecture can be made by the Eye: Thirdly, by retaining the SECUNDINE in the Womb, when its heaviest and most bulky Part (the Placenta) is fallen down into the Entrance, let it be never so judiciously managed and moved, it possesses a considerable deal of Room, and consequently obstructs the Operation of the MIDWIFE’s Hand, lying as a cross thwarting Impediment in her way, which at the same Time blockades or totally shuts up the Passage of the CHILD.
WHEREFORE, and considering that this Body, when so loosened and separated from the Womb, can never possibly be any more serviceable; but, on the contrary, highly detrimental to both the MOTHER and the INFANT, as aforesaid; I cannot but be of Opinion, that it is both the safest and shortest Way, to extract the SECUNDINE first; by which expeditious Step, the MIDWIFE not only gains more Room to turn the Child, but also (this being done) she can much more commodiously draw it out by the Heels: Animadverting always by the way, that in this critical Condition, the BIRTH must immediately follow the SECUNDINE, without the Loss of one Moment’s Time, and that especially for stopping the Floodings, which would otherways not only soon suffocate the weak Infant, but also in a short Space of Time effect the certain Death of the tender Mother.
AMONG the many Preternatural BIRTHS mentioned, I think that of a Dead CHILD, may now at last justly take place.
BUT because this Case is too commonly mistaken, and that the Live INFANT is too often taken for Dead, and consequently the wretched innocent Creature treated accordingly; I think it may not be amiss, before I enter upon this Delivery, that I make a few previous requisite Remarks; by which the extraordinary MIDWIFE, who is commonly sent for too late, may perfectly know whether the BIRTH be dead or alive; to the End that, so also in Case of Necessity, it may be accordingly managed: Since in this fatal Condition I have known several Persons to have been grossly deceiv’d, who have depended upon the Relation of the sick Woman, or taken it upon the Credit of the ignorant attending MIDWIFE.
FIRST then I know it to be Alive, if, by laying my Hand on the Mother’s Belly, I find it stir or move: Or, Secondly, If I have not full Satisfaction this way, I would convey my Hand into the Womb, as soon as the Waters break, to feel the Pulsation of the Navel-String; which the nearer I feel to the CHILD’s Belly, the stronger I find it beat, if Alive: Or, Thirdly, I would put my Finger into the INFANT’s Mouth to feel its Tongue, which (if Alive) I should perceive it to stir, as if it would suck.
WHEREAS, on the contrary, we may know it to be Dead, when a certain nauseous and cadaverous Humour flows from the Womb: Or, when the Woman feels a great ponderous Weight in her BELLY, tumbling always towards that Side, which she inclines to, or lies upon: As also when we find the CHILD cold in the Womb; or the Umbilical Vessel without Pulse; or the Tongue immoveable: Or lastly, when I perceive the Dissolution of the Cuticle on the Top of the Head, I am then positive that the Foetus is Dead; because, as this is not easily dissolved, neither does it happen immediately, but some Space of time after Death.
IN this Case then of a dead CHILD, the Labour is commonly lingring and dangerous, because of the few, faint, and slow PAINS which seize the Woman; so that Nature, being half overthrown by the Death of the INFANT, which now can no ways help itself, absolutely requires to be assisted by the most expeditious Art: And that best, in my humble Opinion, by the Means and Method following, viz.——
FIRST I would endeavour to awaken and promote the PAINS, by one or more sharp and strong Clysters: But Secondly, if these do not succeed so expeditiously as necessary, I would introduce my Hand into the Womb, sliding it all along under the Belly towards the Feet; and so, with Face and Breast downwards, I would gently extract it by them; in the same manner, as if it was Alive. Only, in this Case, great Care must be taken, that the Head may not unhappily sever itself from the Body, and consequently stay behind in the Womb; which Accident may easily happen in the Passage, especially if the BIRTH is any ways putrefy’d.
HOWEVER, after all, in Case of such an untoward Occurrence, I would still excuse myself from the Use of an Eductor, and debar myself from the Practice of any Instrument whatsoever, save only that of my own natural Hand; which, I think, in all Conditions of BIRTHS, whether Natural or Preternatural, Dead or Alive, is solely obliged, and only best serves, according to the Rules of my Profession, to discharge the Duty of all the INSTRUMENTS in the Surgeon’s Shop; excepting only in the Case of a MONSTER or a very Hydropical CHILD.
BUT in the present Circumstance of the Head’s being separated from the Body, as soon as I have extracted the CARCASE, as above; I would instantly convey back my Hand into the WOMB, and put one or two of its Fingers into the Mouth of the HEAD, placing my Thumb under the Chin: For by thus taking Hold of it by the Jaw, I would extract it gently, and that with the greatest Ease and Safety to the PATIENT Woman.
NOW having thus, in fine, both particularly and at large, treated of the several Sorts of Natural, Difficult, and Preternatural BIRTHS: And having also for the common Good of Mankind, without any Affectation, Hesitation, or Reservation, candidly laid down, and ingenuously set forth the most certain, brief, plain, easy, and unprejudiced INSTRUCTIONS, which perhaps have ever yet been committed to Print, upon the excellent Subject of MIDWIFERY: And having likewise, in a Word lastly, for the true Direction and good Government of all MIDWIVES, fairly laid (as it were) and faithfully delivered the big-belly’d Woman, in every relative Case or Condition of BIRTH, which may or can happen to her: It now only remains, I would modestly think, that I should (in the next place) come to take all the necessary Care, and make the most requisite Provision possible for the perfect Recovery of my Child-Bed-Woman; and that in the ensuing Method.
