INthis(as in theformer Case) theMidwifemust use her most acute and nicestJudgment, to find out the particularCauseof theDifficulty. Which being done,
I.IFShefinds it arises from theWoman’s being tooYoung, or tooOld, of herfirst Child, or tooLeanat last;sheis to anoint thePassageswith properUnguents, which ought to be done some timebefore, as well as in theHourofLABOUR: Whensheis likewise to employ hersubtile Hand, in assisting and augmenting theDilatationof theOrifice; as is requisite also inCaseof theWomanbeing tooFatorGross.
II.IFtheWomanbe toosmall,short,crooked, ormisshaped, not having aBreaststrong enough to forward and bear down herPAINS; or if she be overtender,sensible, andapprehensiveofPAIN; or tooweak, and notableto contribute or assist by her own forcingEndeavours; orshort-winded, and not capable to constrain herSpiritsdownwards: In all theseCasesshe is to be keptupright,for the more freeRespiration, as well as for encreasing herPAINS,standingorwalkingabout the Room, according to herStrength, being supported under herArms, and not put toBeduntil at least theWATERSare broke. But, in the mean Time, theweakandtenderWomanought to be now and then comforted and refreshed withfresh soft Eggs, goodBroths,Jellies, a littleWineandToast, a littleWineandWater, or such like convenientThings, as well as with theHopesof aspeedyDelivery.
III.WHENthePAINSare notNaturalorGenuine; butSpurious,FaintandLanguid; orShiftingandTergiversant; such are to be assuaged by properLenitivesandAnodynes; which being regularly done, theGenuine Painsmay be excited by properClysters, and divers other Means. But I would advise none to aProfuse UseofMEDICINESin suchCases, since I well know that many aWomanhas lost herLifeby usingdolorifick Medicines, prescribed by imprudentMIDWIVES, without considering, or so much as knowing the true Circumstances of theCondition: Whereas in mostCases, by the ingeniousMotionof anExperienc’d Handonly, thePainsmay be sufficiently awaken’d, and theBirthsafely promoted.
IV.WHENtheDifficultyproceeds from theDebilityof theWomb, or itsExpulsive Faculty, not being able or capable toExcludetheINFANT, because of a more strong and validRetentive Power: In thisCondition, if there be no evidentExternal Causeto be obviated, it depends chiefly upon theSubtile Handof theMIDWIFE, to assist theWombin itsFunction; and otherways thePATIENTis only to be treated as in theCaseof theweakandtenderWomanabove-mentioned.
V.WHENtheWomanis taken with anyAcute Disease, theBIRTHis to be prompted by all safeMeans; and if aNatural DELIVERYdoes not presently succeed, anArtificialone must (without Loss ofTime) be undertaken. As in theCaseof immoderate and continualFloodings, with concomitantConvulsions, which alwaysproceed from the Separation of theSECUNDINE(either in whole or in part) from theWomb, and happen many different ways, as already mentioned at large[165].
INtheseCases, especially if theSecundineis found (by theTouch) at theOrifice, there is no Hope ofStoppingthem by any otherMeans, than bydeliveringtheWoman; which now thesoonerdone, thebetter(for saving twoLives) andthatwhether at full time ofReckoningor not. But thisOperation, I conceive, is to be most discreetlyUndertakenin the manner following,viz.
THEWomanis to be placed inBed, with theUpperandLowerPart of her Body almostequal, then theMidwifeis gently and gradually to introduce herFingersinto theOrifice, dilating it cautiously withoneortwo, until she can enter themAll; when opening theMatrixby Degrees, she gets in herWhole Hand, and therebyfirstcarefully tears theMembranewith herNails, if theWATERSare not previously broke: Then she puts herHandin the sameMembraneto theInfant’sFeet, seeking them in theirPlace, where they are to be found, when they don’t present themselves atFirst: Because, theHoldby theFEETbeingBetter, it is more easy todeliverbyThem, in this Case, than by theHEAD, or anyother Part. AfterthistheFEETbeing found, theChildis easilyturn’d, as long as theWombis loose and slippery, and theHumoursnot quite flown off; which being nicely done, theFEETare to be drawn outboth together, if possible; but if otherways,theymust be drawn downseparately, withgreatCaution: And so being conjoin’d or held fast together, they are to be drawn forward withone Hand, whilst theotheris circumspectly thrust towards theKneesorButtocksof theChild, in order thereby to turn also the whole Body of theInfant, so that itsFace,Belly, andToesmay tend downwards towards theRECTUM.
INthisPosturetheChildmay be gently and gradually extracted with Ease; next theSECUNDINEmust befetch’d away in its Turn, and lastly theWombis to be thoroughly cleans’d of allheterogeneousBodies, as formerly directed[166]. And thus theWomb(having yielded up itsContents) immediately contracts, by whichMEANSof divine Appointment, the Vessels close and shut firmly, and consequently theFLUXceases, together with all the concomitantSYMPTOMS.
BUTit is to be well remembred, that thisOperationought to betimelyperform’d; that is, before theWomanhas lost too muchBlood, or is too much spent; in whichConditionsuch a painful Attempt would but accelerate herDeath. As to herRegimennext, upon this melancholy Occasion,Shemust be duly provided forbeforehand, that she may be able to undergo and stand out such an extream difficultDELIVERY; and afterwards, that she may recruit herSpirits, and retrieve her exhaustedStrength: For which Purposes, she ought to be supplied from time to time with some goodBroths,Jellys, and a little generousWine, smelling continuallyRose-Vinegar, and applying repeated warmToastsdipt inWine(in whichCinnamonhas been infus’d or boil’d) to theRegionof herHeart, as alsoNapkinsdipt in a Mixture ofWaterandVinegarabout herReins, in order for turning theCourseof theFlux.
THESEThings being all duly and artfully perform’d, thePatient(under God) will soonrecoverand bein Statu quo. NowThese, in short, are all theprincipaland most commonCausesofdifficultBirthsproceeding from the part of theMother; which being thus discussed with all Brevity, I go on to——