Sect. II.Of the Cutting of the Child’s Navel-String.
Though this is accounted by many but a trifle, yet great care is to be taken about it; and it shows none of the least art and skill of a midwife to do it as it should be; and that it may be so done, the midwife ought to observe, 1. The time. 2. The place. 3. The manner. 4. The event.
1. The time is, as soon as ever the infant comes out of the womb, whether it brings part of the after-burden with it or not; for sometimes the child brings into the world a piece of the amnios upon its head, and is what midwives call thecaul, and ignorantly, attribute some extraordinary virtue to the child that is so born: but this opinion is only the effect of their ignorance; for when the child is born with such a crown (as some call it) upon its brows, it generally betokens weakness, and denotes a short life. But to proceed to the matter in hand. As soon as the child is come into the world, it should be considered whether it is weak or strong; and if it be weak, let the midwife gently put back part of the vital and natural blood into the body of the child by its navel; for that recruits a weak child (the vital and natural spirits being communicated by the mother to the child by its navel-string); but if the child be strong, the operation is needless. Only let me advise you, that many children that are born seemingly dead, may be soon brought to life again, if you squeeze six or seven drops of blood out of that part of the navel-string which is cut off, and give it to the child inwardly.
2. As to the place in which it should be cut,that is, whether it should be cut long or short, it is that which authors can scarcely agree in, and which many midwives quarrel about; some prescribing it to be cut at four fingers’ breadth, which is, at best, but an uncertain rule, unless all fingers were of one size.
3. As to the manner in which it must be cut, let the midwife take a brown thread, four or five times double, of an ell long or thereabouts, tied with a single knot at each of the ends, to prevent their entangling; and with this thread so accommodated (which the midwife must have in readiness before the woman’s labour, as also a good pair of scissors, that no time may be lost) let her tie the string within an inch of the abdomen with a double knot, and, turning about the end of the thread, let her tie two more on the other side of the string, reiterating it again, if it be necessary; then let her cut off the navel another inch below the ligatures, towards the after-birth, so that there only remains but two inches of the string, in the midst of which will be the knot we speak of, which must be so close knit as not to suffer a drop of blood to squeeze out of the vessels; but care must be taken, not to knit it so strait as to cut it in two, and therefore, the thread must be pretty thick, and pretty strait cut, it being better too strait than too loose; for some children have miserably lost their lives, with all their blood, before it was discovered, because the navel-string was not well tied; therefore great care must be taken that no blood squeeze through; for if there do, a new knot must be made with the rest of the string. You need not fear to bind the navel-string very hard, because it is void of sense, andthat part which you leave falls off in a very few days, sometimes in six or seven, or sooner, but never tarries longer than eight or nine.
4. The last thing I mentioned was the event or consequence, or what follows cutting the navel-string. As soon as the navel-string is cut off, apply a little cotton or lint to the place to keep it warm, lest the cold enter into the body of the child, which it most certainly will do, if you have not bound it hard enough. If the lint or cotton you apply to it be dipped in the oil of roses, it will be the better; and then put another small rag three or four times double upon the abdomen: upon the top of all, put another small bolster; and then swathe it with a linen swathe, four fingers broad, to keep it steady, lest by moving too much, or by being continually stirred from side to side, it comes to fall off before the navel-string which you left remaining is falling off. It is the usual custom of midwives to put a piece of burnt rag to it, which we commonly call tinder; but I would advise them to put a little ammoniac to it, because of its drying quality.
A woman cannot be said to be fairly delivered, though the child be born, till the after-burden be also taken from her; herein differing from most animals, who, when they have brought forth their young cast forth nothing else but some water, and the membranes which contained them. But women have an after-labour, which sometimes proves more dangerous thanthe first: and how to bring it safely away, without prejudice to her, shall be my business to show in this section.
As soon as the child is born, before the midwife either ties or cuts the navel-string, lest the womb should close, let her take the string and wind it once or twice about one or two of the fingers of her left hand joined together, the better to hold it, with which she may draw it moderately, and with the right hand she may only take a single hold of it above the left near the privities, drawing likewise with that very gently, resting the while the fore-finger of the string towards the same hand, extended and stretched forth along the entrance of the vagina, always observing, for greater facility, to draw it from the side where the burden cleaves least; for, in so doing, the rest will separate the better: and special care must be taken that it be not drawn forth with too much violence, lest by breaking the string near the burden the midwife be obliged to put the whole hand into the womb to deliver the woman; and she need to be a very skilful person that undertakes it, lest the womb, to which this burden is sometimes very strongly fastened, be drawn away with it, as it has sometimes happened. It is, therefore, best to use such remedies as may assist nature. And here take notice, that what brings away the birth, will also bring away the after-birth. And therefore, for affecting this work, I will lay down the following rules.
1. Use the same means in bringing away the after-birth that you made use of to bring away the birth; for the same care and circumspection are needful now that were then.
2. Considering the labouring woman cannotbut be much spent by what she has already undergone in bringing forth the infant; be therefore sure to give her something to comfort her. And in this case good jelly broths, also a little wine and toast in it, and other comforting things, will be very necessary.
3. A little hellebore in powder, to make her sneeze, is in this case very proper.
4. Tansey and the stone ætites, applied as before directed, are also of good use in this case.
5. If you take the herb vervain, and either boil it in wine, or make a syrup with the juice of it, which you may do by adding to it double its weight of sugar, (having clarified the juice before you boil it), a spoonful of that given to the woman is very efficacious to bring away the secundine; and featherfew and mugwort have the same operation, taken as the former.
6. Alexander boiled in wine, and the wine drank, also sweet servile, sweet cicily, angelica roots, and muster-wort, are excellent remedies in this case.
7. Or, if this fail, the smoke of marigolds, received up a woman’s privities by a funnel, has been known to bring away the after-birth, even when the midwife let go her hand.
8. Boil mugwort in water till it be very soft; then take it out, and apply it in the manner of a poultice to the navel of the labouring woman, and it instantly brings away the birth and after-birth. But special care must be taken to remove it as soon as they come away, lest by its longer tarrying it should draw away the womb also.
Sect. IV.Of Laborious and Difficult Labours, and how the Midwife is to proceed therein.
There are three sorts of bad labours, all painful and difficult, but not all properly unnatural. It will be necessary therefore to distinguish these.
Thefirstof these labours is that wherein the mother and child suffer very much by extreme pain and difficulty, even though the child come right; and this is distinguishably called the laborious labour.
Thesecondis that which is difficult, and differs not much from the former, except that, besides those extraordinary pains, it is generally attended with some unhappy accident, which by retarding the birth, causes the difficulty: but these difficulties being removed, it accelerates the birth, and hastens the delivery.
Some have asked, what is the reason that women bring forth their children with so much pain? I answer, the sense of feeling is distributed to the whole body by the nerves; and the mouth of the womb being so strait that it must of necessity be dilated at the time of the woman’s delivery, the dilating thereof stretches the nerves, and from thence comes the pain. And therefore the reason why some women have more pain in their labour than others, proceeds from their having the mouth of the matrix more full of nerves than others. The best way to remove those difficulties that occasion hard pains and labour, is to show first from whence they proceed. Now the difficulty of labour proceeds either from the mother, or child, or both.
From the mother, by reason of the indisposition of the body, or from some particular part only, and chiefly the womb, as when the woman is weak, and the mother is not active to expel the burden, or from weakness or disease, or want of spirits; or it may be from some strong passion of the mind with which she was once possessed; she may be too young, and so may have the passage too strait; or too old, and then, if it be her first child, because her pains are too dry and hard, and cannot easily be dilated, as happens also to them which are too lean; likewise those who are either small, short or deformed, as crooked women, who have not breath enough to help their pains, and to bear them down, and persons that are crooked having sometimes the bones of the passage not well shaped. The cholic also hinders labour, by preventing the true pains; and all great and active pains, as when the woman is taken with a violent fever, a great flooding, frequent convulsions, bloody flux, or any other great distemper. Also, excrements retained cause much difficulty, and so does a stone in the bladder or when the bladder is full of urine, without being able to void it; or when the woman is troubled with great and painful piles. It may also be from the passages, when the membranes are thick, the orifice too strait, and the neck of the womb not sufficiently open, the passages pressed and strained by tumours in the adjacent parts, or when the bones are too firm, and will not open, which very much endangers the mother and child; or when the passages are not slippery, by reason of the waters being broke too soon, or the membranes being too thin. The womb may also beout of order with respect to its bad situation, or conformation, having its neck too strait, hard, and callous, which may easily be so naturally, or may come by accident, being many times caused by a tumor, an imposthume, ulcer, or superfluous flesh.
As to hard labour occasioned by the child it is when the child happens to stick to a mole, or when it is so weak it cannot break the membranes; or if it be too big all over, or at the head only, or if the natural vessels are twisted about its neck; when the belly is hydropical; or when it is monstrous, having two heads, or joined to another child; also, when the child is dead, or so weak that it can contribute nothing to its birth; likewise when it comes wrong; or when there are two or more. And to all these various difficulties there is oftentimes one more, and that is, the ignorance of the midwife, who, for want of understanding in her business, hinders nature in her work instead of helping her.
Having thus looked into the cases of hard labour, I will now show the industrious midwife how she may minister some relief to the labouring woman under these difficult circumstances. But it will require judgment and understanding in the midwife, when she finds a woman in difficult labour, to know the particular obstruction, or cause thereof, that so a suitable remedy may be applied; as, for instance, when it happens by the mother’s being too young or too strait, she must be gently treated, and the passages anointed with oil, hog’s lard, or fresh butter, to relax and dilate them the easier, lest there should happen a rupture of any part when the child is born;for sometimes the peritoneum breaks, with the skin from the privities of the fundament.
But if the woman be in years with her first child, let her lower parts be anointed to mollify the inward orifice, which, in such a case being more hard and callous, does not easily yield to the distention of labour, which is the true cause why such women are longer in labour, and also why their children, being forced against the inward orifice of the womb (which, as I have said, is a little callous) are born with great humps and bruises on their heads.
Those women that are very small and misshapen, should not be put to bed, at least, till their waters are broke, but rather kept upright, and assisted to walk about the chamber, by being supported under the arms; for, by that means, they will breathe more freely, and mend their pains better than on the bed, because there they lie on a heap. As for those that are very lean, and have hard labour from that cause, let them moisten the parts with oil and ointments, to make them more smooth and slippery, that the head of the infant and the womb be not so compressed and bruised by the hardness of the mother’s bones which forms the passage. If the cause be weakness, she ought to be strengthened, the better to support her pains; to which end give her good jelly broths, and a little wine with a toast in it. If she fears her pains, let her be comforted, assuring her that she will not endure many more, but be delivered in a little time. But if her pains be slow and small, or none at all, they must be provoked by frequent and pretty strong clysters; let her walk about the chamber, that so the weight ofchild may help them forwards. If she flood, or have strong convulsions, she must be then helped by a speedy delivery; the operation I shall relate in the section of unnatural labours. If she be costive, let her use clysters which may also help to dispel the cholic, at those times very injurious, because attended with useless pains, and because such bear not downward, and so help not to forward the birth. If she find an obstruction or stoppage of the urine, by reason the womb bears too much on the bladder, let her lift up her abdomen a little with her hand, and try if she receives any benefit; if she finds she does not, it will be necessary to introduce a catheter into her bladder, and thereby draw forth her urine. If the difficulty be from the ill posture of the woman, let her be placed otherwise, in a posture more suitable and convenient for her; also if it proceed from the indisposition of the womb, as from its oblique situation, &c. it must be remedied, as well as it can, by placing her body accordingly; or, if it be a vicious conformation, having the neck too hard, too callous, and too strait, it must be anointed with oils and ointments, as before directed. If the membranes be so strong as that the waters do not break in due time, they may be broken with the fingers, if the midwife be first well assured that the child is forward in the passage, or else, by breaking the waters too soon, the child may remain in danger of remaining dry a long time; to supply which defect, you may moisten the parts with fomentations, decoctions, and emollient oils: which yet is not half so well as when nature does her work in her own time, with the ordinary slime and water. These membranes sometimes do press forth with thewaters three or four fingers’ breadth out of the body before the child, resembling a bladder full of water; but there is then no great danger to break them, if they be not already broken; for when the case is so, the child is always in readiness to follow, being in the passage; but let the midwife be very careful not to pull it with her hand, lest the after-burden be thereby loosened before its time, for it adheres thereto very strongly. If the navel-string happen to come first, it must presently be put in again, and kept so, if possible, or otherwise the woman must be immediately delivered. But if the after-burden should come first, it must not be put up again by any means; for the infant having no further occasion for it, it would be but an obstacle if it were put up; in this case it must be cut off, having tied the navel-string, and afterwards draw forth the child with all the speed that may be, lest it be suffocated.
When the difficulty of labour arises from a dead child, it is a case of great danger to the mother, and great care ought to be taken therein; but before any thing be done, the midwife ought to be well assured the child is dead indeed, which may be known by these signs.
1. The breast suddenly slacks, or falls flat, or bags down. 2. A great coldness, possesses the abdomen of the mother, especially about the navel. 3. Her urine is thick, and a filthy stinking settles at the bottom. 4. No motion of the child can be perceived; for the trial whereof, let themidwife put her hand in warm water, and lay it upon the abdomen; for that, if it is alive, will make it stir. 5. She is very subject to dream of dead men, and be affrighted therewith. 6. She has extravagant longings to eat such things as are contrary to nature. 7. Her breath stinks, though not used so to do. 8. When she turns herself in bed, the child sways that way like a lump of lead.
These things being carefully observed, the midwife may make a judgment whether the child be alive or dead, especially if the woman take the following prescription: “Take half a pint of white wine and burn it, and add thereto half an ounce of cinnamon, but no other spice whatever; and when she has drank it, if her travailing pains come upon her the child is certainly dead; but if not, the child may possibly be either weak or sick, but not dead; this will bring her pains upon her, if it be dead, and will refresh the child, if it be living; for cinnamon refresheth and strengtheneth the child.”
Now, if upon trial, it be found that the child is dead, let the mother do all she can to forward the delivery, because a dead child can be nowise helpful therein. It will be necessary, therefore, that she make some comfortable things to prevent her fainting, by reason of the putrid vapours ascending from the dead child. And in order to her delivery, let her take the following herbs boiled in white wine, (or at least as many of them as you can get), viz. dittany, betony, pennyroyal, sage, featherfew, centuary, ivy leaves, and berries. Let her also take sweet basil, in powder, and half a drachm at a time, in white wine; let her privities be also anointed with the juice of thegarden-tansey. Or take the tansey in the summer, when it can be most plentifully had, and before it runs up to the flower, and having bruised it well, boil it in oil till the juice of it be consumed. If you set it in the sun, after you have mixed it with oil, it will be more effectual. This an industrious midwife, who would be prepared against all events, ought to have always by her. As to the manner of her delivery, the same methods must be used as are mentioned in the section of natural labour. And here again I cannot but commend the stone ætites, held near the privities, whose magnetic virtue renders it exceedingly necessary on this occasion, for it draws the child any way, with the same facility that the loadstone draws iron.
Let the midwife also make a strong decoction of hyssop with water, and let the woman drink it very hot, and it will in a little time bring away the dead child.
If, as soon as she is delivered of the dead child, you are in doubt that part of the after-birth is left behind in the body (for in such cases as these, many times, it rots, and comes away piecemeal), let her continue drinking the same decoction till her body be cleansed.
A decoction made of the herb muster-wort, used as you did the decoction of hyssop, works the same effect. Let the midwife also take roots of pollodum, and stamp them well; warm them a little, and bind them on the soles of her feet, and it will soon bring away the child, either dead or alive.
The following medicines likewise are such as stir up the expulsive faculty; but in this casethey must be stronger, because the motion of the child ceaseth.
Take savin, round birthwort, trochisks of myrrh, afaran roots, cinnamon, saffron, each half a drachm; make a powder, give a drachm.
Or she may purge first, and then apply an emollient, anointing her about the womb with oil of lilies, sweet almonds, camomile, hen and goose grease. Also foment, to get out the child with a decoction of mercury, orris, wild cucumbers, sæcus, broom flowers. Then anoint the privities and loins with ointment of sowbread. Or, take coloquintida, birthwort, of each a drachm; make a powder; add ammoniacum dissolved in wine, ox-gall, each two drachms; with oil of keir make an ointment. Or this pessary:
Take birthwort, orris, black hellebore, coloquintida, myrrh, each a drachm; powdered ammoniacum dissolved in wine, ox-gall, each two drachms. Or make a fume with an ass’s hoof burnt, or gallianum, or castor, and let it be taken in with a funnel.
To take away pains, and strengthen the parts, foment with the decoction of mugwort, mallows, rosemary, with wood myrtle, St. John’s wort, each half an ounce, spermatic two drachms; deer’s suet an ounce; with wax make anointment. Or,
Take wax six ounces, spermaceti an ounce; melt them, dip flax therein, and lay it all over her abdomen.
If none of these things will do, the last remedy is to use surgery, and then the midwife ought without delay to send for an expert and able man-midwife, to deliver her by manual operation; of which I shall treat more in the next chapter.
CHAPTER VI.Of unnatural Labour.
In showing the duty of a midwife, when the child-bearing woman’s labour is unnatural, it will be requisite to show, in the first place, what I mean by unnatural labour; for that women do bring forth children in pain and sorrow is natural and common to all. Therefore that which I call unnatural is, when the child comes to the birth in a contrary posture to that which nature ordained, and in which the generality of children come into the world.
The right and natural birth is, when the child comes with its head first; and yet this is too short a definition of a natural birth: for if any part of the head but the crown comes first, so that the body follows not in a straight line, it is a wrong and difficult birth, even though the head comes first. Therefore, if the child comes with its feet first, or with the side across, it is quite contrary to nature, or, to speak more plainly, that which I call unnatural.
Now, there are four general ways a child may come wrong. 1. When any of the fore parts of the body first present themselves. 2. When, by an unhappy transportation, any of the hinder parts of the body first present themselves. 3. When either of the sides, or, 4. the feet present themselves first. To these the different wrong postures that a child can present itself may be reduced.
Sect. I.How to deliver a Woman of a Dead Child, by Manual Operation.
When manual operation is necessary, let the operator acquaint the woman of the absolute necessity there is for such an operation; and that, as the child has already lost its life, there is no other way left for the saving of hers. Let him also inform her, for her encouragement, that he doubts not, with the divine blessing, to deliver her safely; and that the pain arising thereby will not to be so great as she fears. Then let him stir up the woman’s pains by giving her some sharp clyster, to excite her throes to bear down and bring forth the child. And if this prevail not, let him proceed with the manual operation.
First, therefore, let her be placed across the bed that he may operate the easier, and let her lie on her back, with her hips a little higher than her head, or at least the body equally placed, when it is necessary to put back or turn the infant to give it a better posture. Being thus situated, she must fold her legs so as her heels be towards her body, and her thighs spread, and held so by a couple of strong persons: there must be others also to support her under her arms, that the body may not slide down when the child is drawn forth; for which, sometimes, a great strength is required. Let the sheets and blankets cover her thighs, for decency’s sake, and with respect to the assistance, and also to prevent her catching cold; the operator herein governing himself as well with respect to his convenience, and the facility and surety of the operation,as to other things. Then let him anoint the entrance of the womb with oil or fresh butter, if necessary, that so with more ease he may introduce his hand, which must also be anointed; and having, by the signs before-mentioned, received satisfaction that the child is dead, he must do his endeavours to fetch it away as soon as he possibly can. If the child offer the head first, he must gently put it back, until he hath liberty to introduce his hand quite into the womb; then sliding it along to find the feet, let him draw it forth by them, being very careful to keep the head from being locked into the passage, and that it be not separated from the body; which may be effected the more easily, because the child being very rotten and putrefied, the operator needs not be so mindful to keep the breast and face downwards as he is in living births. But if, notwithstanding all these precautions, by reason of the child’s putrefaction, the head should be separated and left behind in the womb, it must be drawn forth according to the directions which have been given in the third section of this chapter. But when the head, coming first, is so far advanced that it cannot well be put back, it is better to draw it forth so, than to torment the woman too much by putting it back to turn it and bring it by the feet: but the head being a part round and slippery, it may so happen that the operator cannot take hold of it by reason of its moisture, nor put them up to the side of it, because of its bigness; he must therefore take a proper instrument, and put it up as far as he can, without violence, between the womb and the child’s head, observing to keep the point of it towards the head (for thechild being dead before, there can be no danger in the operation,) and let him fasten it there, giving it hold of the bones of the skull, that it may not slide; and after it is well fixed in the head, he may therewith draw it forth, keeping the ends of his left hand flat upon the opposite side, the better to help to disengage it, and by wagging it a little, to conduct it directly out of the passage, until the head be quite born; and then taking hold of it with the hands only, the shoulders may be drawn into the passage, and so sliding the fingers of both hands under the arm-pits, the child may be quite delivered; and then the after-burden fetched, to finish the operation, being careful not to pluck the navel-string too hard, lest it break, as often happens, when it is corrupt.
If the dead child comes with the arms up to the shoulder so extremely swelled that the woman must suffer too great violence to have it put back, it is then (being first well assured that the child is dead) best to take it off by the shoulder points, by twisting three or four times about, which is very easily done by reason of the softness and tenderness of the body. After the arm is so separated, and no longer possesses the passage, the operator will have more room to put up his hand into the womb, to fetch the child by the feet and bring it away.
But although the operator be sure the child is dead in the womb, yet he must not therefore presently use instruments, because they are never to be used but when hands are not sufficient, and there is no other remedy to prevent the woman’s danger, or to bring forth the child any other way; and the judicious operator willchoose that way which is the least hazardous and most safe.
There is nothing more obvious to those whose business it is to assist labouring women, than that the several unnatural postures in which children present themselves at their birth, are the occasion of most of the bad labour and ill accidents that happen unto them in that condition.
And since midwives are very often obliged, because of the unnatural situations, to draw the children forth by the feet, I conceive it to be most proper first to show how a child must be brought forth that presents itself in that posture, because it will be a guide to several of the rest.
I know indeed in this case it is the advice of several authors to change the figure, and place the head so that it may present to the birth; and this counsel I should be very inclinable to follow, could they but also show how it may be done. But it will appear very difficult, if not impossible, to be performed, if we would avoid the danger that by such violent agitations both the mother and the child must be put into; and therefore my opinion is, that it is better to draw forth by the feet, when it presents itself in that posture, than to venture a worse accident by turning it.
As soon, therefore, as the waters are broken, and it is known that the child comes thus, and that the womb is open enough to admit the midwife’sor operator’s hand into it, or else by anointing the passage with oil or hog’s grease, to endeavour to dilate it by degrees, using her fingers to this purpose, spreading them one from the other, after they are together entered, and continuing to do so till they be sufficiently dilated, then, taking care that her nails be well pared, no rings on her fingers, and her hands well anointed with oil or fresh butter, and the woman placed in the manner directed in the former section, let her gently introduce her hand into the entrance of the womb, where, finding the child’s feet, let her draw it forth in the manner I shall presently direct; only let her first see whether it presents one foot or both; and if but one foot, she ought to consider whether it be the right foot or left, and also in what fashion it comes: for, by that means, she will soon come to know where to find the other, which, as soon as she knows and finds, let her gently draw it forth with the other; but of this she must be especially careful, viz. that the second be not the foot of another child; for, if so, it may be of the utmost consequence, for she may sooner split both mother and child, than draw them forth: but this may be easily prevented, if she but slide the hand up by the first leg and thigh to the twist, and there find both thighs joined together, and descending from one and the same body. And this is also the best means to find the other foot, when it comes but with one.
As soon as the midwife has found both the child’s feet, she may draw them forth, and holding them together, may bring them by little in this manner; taking afterwards hold of the arms and thighs, as soon as she can come atthem, drawing them so till the hips come forth. While this is doing, let her observe to wrap the parts in a single cloth, that so her hands, being always greasy, slide not on the infant’s body, which is very slippery, because of the vicious humours which are all over it; which being done, she may take hold under the hips, so as to draw it forth to the beginning of the breast; and let her on both sides with her hand bring down the child’s hand along its body, which she may easily find; and then let her take care that the belly and face of the child be downwards: for, if they should be upwards, there would be some danger of its being stopped by the chin, over the share-bone; and therefore, if it be not so, she must turn it to the posture; which may easily be done, if she takes proper hold of the body when the breast and arms are forth, in the manner as we have said, and draws it, turning it in proportion on that side which it most inclines to, till it be turned with the face downwards; and so, having brought it to the shoulders, let her lose no time, desiring the woman at the same time to bear down, that so drawing the head at that instant may take its place, and not be stopped in the passage. Some children there are whose heads are so big, that when the whole body is born, yet that stops the passage, though the midwife takes all possible care to prevent it. And when this happens, she must endeavour to draw forth the child by the shoulders, taking care that she separate not the body from the head, (as I have known it done by the midwife,) discharging it by little and little from the bones in the passage with the fingers of each hand, sliding them on each side opposite theother, sometimes above and sometimes under, till the work be ended; endeavouring to despatch it as soon as possible, lest the child be suffocated, as it will unavoidably be, if it remain long in that posture; and this being well and carefully effected, she may soon after fetch away the after-birth, as I have before directed.
Though the utmost care be taken in bringing away the child by the feet, yet if it happen to be dead, it is sometimes so putrefied and corrupt, that with the least pull the head separates from the body, and remains alone in the womb, and cannot be brought away but with a manual operation and great difficulty, it being extremely slippery, by reason of the place where it is, and from the roundness of its figure, on which no hold can be taken; and so very great is the difficulty in this case, that sometimes two or three able practitioners of midwifery have, one after the other, left the operation unfinished, as not able to effect it, after the utmost industry, skill and strength; so that the woman, not being able to be delivered, perished. To prevent which fatal accident, let the following operation be observed.
When the infant’s head separates from the body, and is left alone behind, whether through putrefaction or otherwise, let the operator immediately, without any delay, whilst the womb is still open, direct up his right hand to the mouth of the head (for no other hole can therebe had), and having found it, let him put one or two of his fingers into it, and the thumb under its chin; then let him draw it by little and little, holding it by the jaws: but if that fails, as sometimes it will, when putrefied, then let him pull out the right hand, and slide up his left with which he must support the head, and with the right let him take a narrow instrument called acrotchet, but let it be strong, and with a single branch, which he must guide along the inside of his hand, with the point of it towards it, for fear of hurting the womb; and having thus introduced it, let him turn it towards the head, to strike either in an eye-hole, or the hole of an ear, or behind the head, or else between the sutures, as he finds it most convenient and easy; and then draw forth the head so fastened with the said instrument, still helping to conduct it with his left hand; but when he hath it brought near the passage, being strongly fastened to the instrument, let him remember to draw forth his hand, that the passage, not being filled with it, may be larger and easier, keeping still a finger or two on the side of the head, the better to disengage it.
There is also another method, with more ease and less hardship than the former: let the operator take a soft fillet or linen slip, of about four fingers’ breadth, and the length of three quarters of an ell, or thereabouts, taking the two ends with the left hand, and the middle with the right, and let him so put it up with his right as that it may be beyond the head, to embrace it as a sling doth a stone, and afterwards draw forth the fillet by the two ends together; it will thus be easily drawn forth, the fillet nothindering the least passage, because it takes up little or no space.
When the head is fetched out of the womb, care must be taken that not the least part of it be left behind, and likewise to cleanse the womb of the after-burden, if yet remaining. If the burden be wholly separated from the side of the womb, that ought to be first brought away, because it may also hinder the taking hold of the head. But if it still adheres to the womb, it must not be meddled with till the head be brought away; for if one should endeavour to separate it from the womb, it might then cause a flooding, which would be augmented by the violence of the operation; the vessels to which it is joined remaining for the most part open as long as the womb is distended, which the head causeth while it is retained in it, and cannot be closed till this strange body be voided, and this it doth by contracting and compressing itself together, as has been more fully before explained. Besides, the after-birth remaining thus cleaving to the womb during the operation prevents it from receiving easily either bruise or hurt.
Though some may think it a natural labour, when the child’s head comes first; yet, if the child’s head present not the right way, even that is an unnatural labour; and therefore, though the head comes first, yet if it be the side of the head instead of the crown, it is very dangerous both to the mother and child, for the child’s neck would be broken, if born inthat manner; and by how much the mother’s pains continue to bear the child, which is impossible unless the head be rightly placed, the more the passages are stopped. Therefore, as soon as the position of the child is known, the woman must be laid with all speed, lest the child should advance further into this vicious posture, and thereby render it more difficult to thrust it back, which must be done, in order to place the head right in the passage, as it ought to be.
To this purpose, therefore, place the woman so that her thighs may be a little higher than her head and shoulders, causing her to lean a little upon the opposite side to the child’s ill posture; then let the operator slide up his hand, well anointed with oil, by the side of the child’s head, to bring it right gently with his fingers between the head and the womb; but if the head be so engaged that it cannot be done that way, he must put his hand up to the shoulders, that so by thrusting them back a little into the womb, sometimes on the one side and sometimes on the other, he may, by little and little, give a natural position. I confess it would be better, if the operator could put back the child by its shoulders with both hands: but the head takes up so much room, that he can only make use of his fingers, with which he must perform this operation, and with the help of the finger ends of the other hand put forward the child’s birth, as in natural labour.
Some children present their face first, having their hands turned back, in which posture it is extremely difficult for a child to be born; and if it continues so long, the face will be swelled,and become black and blue, so that it will at first appear monstrous, which is occasioned as well by the compression of it in that place, as by the midwife’s fingers in handling it, in order to place it in a better posture. But this blackness will wear away in three or four days’ time, by anointing it often with oil of sweet almonds. To deliver the birth, the same operation must be used as in the former, when the child comes first with the side of the head; only let the midwife or operator work very gently, to avoid as much as possible the bruising the face.
Sometimes the infant will present some other part together with its head; which if it does, it is usually with one or both its hands; and this hinders the birth, because the hands take up part of that passage which is little enough for the head alone: besides when this happens, they generally cause the head to lean on one side; and therefore this position may be well styled unnatural. When the child presents thus, the first thing to be done, after it is perceived, must be to prevent it from coming down more, or engaging further in the passage; and therefore the operator having placed the woman on the bed, with her head lower than her thighs, must guide and put back the infant’s hand with his own as much as may be, or both of them, if they both come down, to give way to the child’s head; and this being done, if the head be on one side, it must be brought into its natural posture,in the middle of the passage, that it may come in a straight line, and then proceed as directed in the foregoing section.
There are none but will readily grant, that when the hands and feet of an infant present together, the labour must be unnatural; because it is possible a child can be born in that manner. In this case therefore, when the midwife guides her hand to the orifice of the womb, she will perceive only many fingers close together; and if it be not sufficiently dilated, it will be a good while before the hands and feet be sufficiently distinguished; for they are sometimes so shut and pressed together, that they seem to be all of one and the same shape: but where the womb is open enough to introduce the hand into it, she will easily know which are the hands and which are the feet; and having taken particular notice thereof, let her slide up her hand, and presently direct it towards the infant’s breast, which she will find very near, and then let her very gently thrust back the body towards the bottom of the womb leaving the feet in the same place where she found them: and then, having placed the woman in a convenient posture, that is to say, her thighs a little raised above her breast, and (which situation ought also to be observed when the child is to be put back into the womb), let the midwife afterwards take hold of the childby the feet, and draw it forth, as is directed in the second section.
This labour, though somewhat troublesome, yet is much better than when the child presents only its hands; for then the child must be quite turned round before it can be drawn forth; but in this they are ready, presenting themselves, and there is little to do but to lift and thrust back the upper part of the body, which is almost done of itself, by drawing by the feet alone.
I confess there are many authors that have written of labours, who would have all wrong births reduced to a natural figure; which is, to turn it that it may come with the head first. But those that have written thus are such as never understood the practical part; for if they had the least experience therein, they would know that it is impossible; at least, if it were to be done, that violence must necessarily be used in doing it, that would very probably be the death of both mother and child in the operation.
I would therefore lay down, as a general rule, that whensoever a child presents itself wrong to the birth, in what posture soever, from the shoulders to the feet, it is the best way, and the soonest done, to draw it out by the feet; and that it is better to search for them, if they do not present themselves, than to try to put them into their natural posture, and place the head foremost; for the great endeavours necessary to be used in turning the child in the womb, do so much weaken both the mother and the child, that there remains not afterwards strength enough to commit the operation to the work of nature; for, usually, the woman hath no more throes or pains fit for labour after she has beenso wrought upon: for which reason it would be difficult, and tedious at best; and the child by such an operation made very weak, would be in extreme danger of perishing before it could be born. It is therefore much better in these cases to bring it away immediately by the feet; searching for them, as I have already directed, when they do not present themselves; by which the mother will be prevented a tedious labour, and the child be often brought alive into the world, who otherwise could hardly escape death.
We have already spoken something of the birth of twins in the chapter of natural labour; for it is not an unnatural labour barely to have twins, provided they come in a right position to the birth. But when they present themselves in different postures, they come properly under the denomination of unnatural labours; and if when one child presents itself in a wrong figure, it makes the labour dangerous and unnatural, it must needs make it much more so when there are several, and render it not only more painful to the mother and children, but to the operator also; for they often trouble each other, and hinder both their births. Besides which, the womb is so filled with them, that the operator can hardly introduce his hand without much violence, which he must do, if they are to be turned or thrust back to give them a better position.
When a woman is pregnant with two children,they rarely present to the birth together, the one generally being more forward than the other; and that is the reason that but one is felt, and that many times the midwife knows not that there are twins till the first is born, and that she is going to fetch away the after-birth. In the first chapter, wherein I treated of natural labour, I have showed how a woman should be delivered of twins, presenting themselves both right; and therefore, before I close the chapter of unnatural labour, it only remains that I show what ought to be done when they either both come wrong, or one of them only, as for the most part it happens; the first generally coming right, and the second with the feet forward, or in some worse posture. In such a case, the birth of the first must be hastened as much as possible, to make way for the second, which is best brought away by the feet, without endeavouring to place it right, because it has been, as well as its mother, already tired and weakened by the birth of the first, and there would be greater danger of its death than likelihood of its coming out of the womb that way.
But if, when the first is born naturally, the second should likewise offer its head to the birth, it would be then best to leave nature to finish what she has so well begun; and if nature should be too slow in her work, some of those things mentioned in the fourth chapter, to accelerate the birth, may be properly enough applied: and if, after that, the second birth should be yet delayed, let a manual operation be deferred no longer; but the woman being properly placed, as has been before directed, let the operator direct his hand gently into thewomb to find the feet, and so draw forth the second child, which will be the more easily effected, because there is a way made sufficiently by the birth of the first; and if the waters of this second child be not broke, as it often happens, yet, intending to bring it by the feet, he need not scruple to break the membranes with his fingers; for though, when the birth of a child is left to the operation of nature, it is necessary that the waters should break of themselves, yet when the child is brought out of the womb by art, there is no danger of breaking them; nay, on the contrary, it becomes necessary; for without the waters are broken, it would be impossible to turn the child.
But herein principally lies the cares of the operator, that he be not deceived, when either the hands or feet of both children offer themselves together to the birth; in this case he ought well to consider the operation, as, whether they be not joined together, or any way monstrous; and which part belongs to one child, and which to the other; that so they may be fetched one after the other, and not both together, as may be, if it were not duly considered; taking the right foot of the one and the left of the other, and so drawing them together, as if they belonged to one body, because there is a left and a right, by which means it would be impossible ever to deliver them. But a skilful operator will easily prevent this, if, having found two or three of several children presenting together in the passage, and taking aside two of the forwardest, a right and a left, and sliding his arm along the legs and thighs up to the wrist, he finds they both belong to one body; of whichbeing thus assured, he may begin to draw forth the nearest, without regarding which is the strongest or weakest, bigger or less, living or dead, having first put aside that part of the other child which offers to have the more way, and so dispatch the first as soon as may be, observing the same rules as if there were but one, that is keeping the breast and face downwards, with every circumstance directed in that section where the child comes with its feet first, and not fetch the burden till the second child is born. And therefore, when the operator hath drawn forth one child, he must separate it from the burden, having tied and cut the navel-string, and then fetch the other by the feet in the same manner, and afterwards bring away the after-burden with the two strings as hath been before showed. If the children present any other part but the feet, the operator may follow the same method as directed in the foregoing section where the several unnatural positions are fully treated of.