THEReadermay easily conceive, by the way, thattheseare neither to be madebiggerorlesserbyArt; notwithstanding which, by using themSkilfully, and treating themJudiciously, many aDifficultBIRTHmay not only be prevented, but also many aLifesaved, as will manifestly appear from what follows.
NOWtheBones, upon which the Success of theBIRTHchiefly depends, are theOs Coccygis, and the Point of theSacrum; which sometimes bend too muchinwards, and thereby obstruct and render thePassagesonarrow, that noBIRTHcan possibly succeed. Andagain, It sometimes happens, that theINFANTfalling down into thePELVIS, and presenting itselfHead foremost, is oppos’d and stopped there by theOs Coccygis: As it also sometimes falls out, that theShouldersstick fast against theEdgeof theseBones; or theButtocksfalling down and offering themselvesfirst, may be so fastened or affixed to them, that they can never beextracted.
THESEMisfortunes may proceed fromEitherof these two differentCauses; viz. Either from theGrossnessor largeSizeof thesePartsof theInfant, or from theNarrownessof thePELVIS, occasion’d by an illPositionof itsBones, particularly of theOs Coccygis; whichBonewhen theHeadcannot make it yield or move, neither can it then possibly reach theOrificeof theWomb, to dilate it sufficiently: And, in short, if theHeadcannot effect thisessential Point, much less can theButtocks, or any otherPartbe supposed capable of doing it.
BUTin all the above-mentionedCases, I am sensible, that mostMIDWIVES(not knowing better) ascribe the wholeDifficultyto theOrificeof theWomband theVagina; upon which they ignorantly fall atearing and dilating both theOneand theOther, (never minding thePointof theSacrum); and findingthese Orificesbut littleopen’d, notwithstanding the frequentRepetitionof very severePAINS, they imagine that their substantialHardnessorThicknessis the onlyCause: So that therefore (without regarding anyadjacent Part) they go on violently dilacerating sometimes theMouthof theWomb, and sometimesThatof thePRIVITIES, (as I have found it by Experience) quite to theRectum. For such is theirStupidityin this Condition ofLife(asDaventerwell observes) that whilst theythustear and rend theWomantoPiecesin a manner, they allow her to sit over and above with thePointof theOs Sacrum, upon herSeatorBed; or in some other wrongPosture, which so presses and confines theOs Coccygisat the same Time, that neither ofthesecan move:Not minding at all that the chiefPressuresandImpulsesof theHead, must first bear upon theOs Coccygisin order to remove it, before it can effect theDilatationof theOrificeorMouthof theWomb. Thus they spend theWoman’sStrengthin vain, break herSpirits, and ruin herConstitutionthro’ Ignorance; whilst a capablePerson, administring seasonable and judiciousHelp, according to the Circumstances of theCase, refreshesNature, renewsStrength, givesCourage, and fills the (otherways languishing and despairing)WOMAN, withHopesandAssurancesof a happyDELIVERY.
INshort, the TrueMethodofDeliveringand helping theWomanconveniently, in the differentConditionscontain’d in thisChapter, depends entirely uponrepellingor thrusting back thePointof theOs Sacrum, together with theOs Coccygis. I say (therefore) the wholePointof theOs Sacrum, and thatFleshy Partlying about it, is to bethrust backanddilated, so that thePassagemay be sufficiently opened for theInfantto pass through; which patentDilatationis to be promoted bypressingalsobacktheOs Coccygis. Now these Things, in short, may be all done cautiously without creating any intensePain, or the least Damage; andthusthe obstructedPassagebeing clear’d and open’d, theBirthadvances regularly of Course, and theCHILDis born with the greatestEase, in the Space of a few Minutes: Whereas otherways (without the Use of theseMeans) both itsOwnand theMother’sDestinymay be precarious or uncertain after someDaysLabour.
THUSit is certain, that by assisting aWomaninLabourseasonably and skilfully, herPAINSare happily excited and encreased; whereas, on the contrary, byimprudent Treatmentthey unhappily cease and vanish, to her great Prejudice. Moreover, dailyExperienceteaches us, that the verydifferentTouchingof Things, occasions differentSensations; and from thence it is, that thedextrous MIDWIFEknows byoneway ofTouching, how to promote thePAINSofLabour;and byanother, how to retard or put them off according as the Necessity of theCaserequires; which hereafter will appear more at large.
BUTthat we may more particularly satisfy suchMIDWIVES, of ourMethodof repressing theseBones, andDeliveringtheWOMANin the abovesaidCases; I must add, that, after placing thePATIENTin the most convenientPosturefor aWOMANinLabour, as before fully enjoin’d[168], I would directHerto besupportedby two Women, and mov’d so far off theBedorCouch, that thePointof theOs Sacrummay be free to yield or give waybackwards, without any the leastImpediment: Then I would pass my wholeHandat once (being first well anointed or dipp’d inOil) into theVAGINA, and from thence (if theHeadwill admit it) into theWOMB, as occasion should require: where, upon opening myHand broad, that it may press equally every where, I turn thePALM upwards, and theBACK downwardsagainst theRECTUM, and theOS SACRUM: Thus I extend myFingersas far as possible to theHead, thrusting it a littlebackwards, rather than hinder myHandfrom being firmly placed against theOs Coccygis: Upon myHandbeing thus properly placed, as soon as thePAINbegins to threaten (which I commonly perceive before theWOMAN) I advise her, to make good Use of the approachingPains, in order toLabourmutually, and depress with all her Power, promising her my most faithfulAssistance: By which Time, as soon as thePainshave seiz’d her, and she doing herPart, I press myHandbackwards, firstsoftly, and by degrees morestrongly, against thePointof theSacrum, bringing it at the same time graduallydownwards, that I may thereby make Room for theHeadsliding the same way; so that the moreseverethePAINSare, the more I depress still, and theharderI press down withEffectual PAIN, the more vigorously and successfully theWOMANis able toLabour.
THUSI enlarge thePassagewith great Moderation, so that theInfant’sHeadsucceeds or follows myHand, as I bring it by little and littlebackagain; and this adviseableMethodI would reiterate as often as theCaseshould require, always encouraging myWOMAN, by the most obliging Words: Upon whichShesuffering noPAINin vain, finds immediateRelief, recovers herStrength, recollects herSpirits, and by jointlylabouringherBestwith all her Force and Might, at last produces herChildwith Comfort and Satisfaction, whilst I congratulate her upon the Success of being ajoyful MOTHER.
BUTsupposing by the way, that theINFANToffers itsButtocksfirst, they being neither soroundnorhardas theHEAD, I would then intrude all myFingersinto theWombmore easily; some of which (or sometimesAll) I would pass into theOrificeof theWombunder theButtocksas before into theVAGINA. Now myHANDbeing placed there, I intently observe thePAINSas they come on; then inviting theWomantoLabour, I gradually pressbackwardsas hard as I can conveniently, drawing myHAND downwardsas before: But if in attracting it so, theHANDshould slide too much out of theWomb, (which however I endeavour to prevent) while thePAINSare yet upon her; then as soon as they are over, I pass it up again, that I may be ready against theirReturn. AndthisI would reiterate upon everyPAIN, so that theChild(guided by myHAND) may slide down at every Turn, until at last thePassageis so dilated, that it may advance gradually witheaseinto the World.
BYthese judiciousMeans; forcing back theOS COCCYGISby thePressureof theHAND, as thePAINScome on, I may not only dilate thePassage, and enlarge theOrificeof theWomb; but also upon retracting theHANDby degrees, I can gradually attract theCHILDout of theWomb, through theNarrownessof thePELVIS: And thus, by this curiousArt, (which I take to be one of the chiefPointsbelonging toMidwifery) I do fairlydelivertheWoman, who by no otherMeanswhatsoever, could be preserved, together with herINFANT, in all Probability.
HOWEVER, tho’ I have candidly laid down thisMethod, (conformable to the Doctrine of the most excellent and ingeniousInstructers) yet I would not advise every coarseClumsy HANDto undertake it, norsuchas are not thoroughly acquainted with thePartsof Generation: For thisPerformancerequiresJudgmentandPrudence, as well asArtandExperience. But however yet inCaseofNecessity, where noExtraordinary Person’s Assistancecan be had, as it often happens in theCountry, theOrdinary MIDWIFEought not to neglect herDuty: nevertheless, before she offers to attempt this piece of extraordinarySkill, she ought to be very certain that theseBONESare the greatImpedimentandDifficultyof the Delivery.