DIFFICULTBIRTHSon part of thePassages, happen frequently, because of some perverseFormof thePELVIS, in these Respects; as by its being either tooLarge, tooNarrow, or tooSmooth. But that I may be the better understood in this Matter:FIRST, by aPELVIStoolarge, I mean such anOne, as is so in comparison with theWomborInfant; in whichCondition, as the Womb can neither be firmlyfix’d, compactlyinclos’d, or duly supported, so neither can theHeadof theInfantand theWATERSbe exactly depressed upon theOrifice: Hence it often happens, that (besides theMidwife’scarefulHand) thePrivitiesare the best, if not the onlyDefence, against both theWomband theChild’sfalling out of the Body.
SECONDLY, By aPELVIStoosmall, I mean,suchanOneas is so, in Consideration of theSizeof the whole Body; in whichCondition, theINFANTcommonly answering to thatProportion, itsHeadcan by no Possibility pass thro’ thePELVIS, in aWombwell seated, without greatForce, by which Means theWombmay be easily turn’dobliquely: And thus consequentlytheSmallnessof thePELVIS, may sometimes prove theCauseof aPreternatural, as well as of aDifficult BIRTH; and not only so, but also theDeathof both theMOTHERandCHILDmay ensue thereupon, unless timely deliver’d by anArtful Hand.
THIRDLY, By aPELVIStoosmooth, I mean such anOne, whoseDistancebetwixt theOSSA PUBISand the prominent Part of theOS SACRUMis toonarrow; in whichCondition, tho’ theWombbe well placed, it cannot admit theHead(especially if large and well-grown) without greatDifficulty: And thissmooth PELVISmay also very easily turn theWomb(either way)obliquely, and consequently prove of the same dangerous consequentialEffectwith the preceedingCase.
HENCE(I think) it evidently appears, how necessary it is that allMIDWIVESshould not only know theFormandSizeof thePELVIS, but also theSituationandConnexionof itsBones, as already describ’d at large[167], thatshemay thereby the better distinguish theCircumstancesby plainly discerning theCauses, and judge accurately of thePositionof both theWOMBand theINFANT; so that in the beginning of theLabour, she may immediately discover how thePelvisand itsEntranceis form’d, whetherLargeorNarrow,SmoothorRound.
FORthis Reason, thefirst Thingthat theMIDWIFEought to do, when she comes to aWomaninLabour, is to try by theTouch, how all is circumstantiated, with respect to these Things; andThisis to be done before theWOMBand theCHILDare fallen down into thePelvis, that she may contrive herWorkaccordingly. Because sometimes theExclusionof theINFANT, is to be hoped for, from thePainsonly; sometimesNatureis to be prudently assisted; sometimes there is an absolute Necessity forextractingtheChild(without loss of Time) by anArtful Hand, as will hereafter more clearly appear; and sometimes again the same Necessity obliges us toprotracttheBIRTH, than we may saveOneorBoth Lives: As in theCaseof asmoothPelvis, theOs Pubisand theVertebræof theSacrumbeing but little distant, theChild’sHeadis stopped; when if theMothershould labour much, or endeavour to force an expeditiousBIRTH, its tenderHead(of course) must suffer in proportion; Or perhaps theBrainmay break, by so hard aPressureagainst theBones; or, finally (which is worse) it may be so closely squeez’d between theBones, that both theMOTHERand theINFANTmay peradventure die, before anyBIRTHcan possibly succeed or come happily into the World.
BUTin this criticalCondition, theWomanis tolabourgently, and bear herPAINS(how violent soever) patiently; theMIDWIFEalways directing theHead, at the same time by her safeHand, into thelarger Space; by whichMeansat last, it passes gradually through thatnarrow Passagewithout the leastDanger.
THEsame also is theConditionwhen thePELVISis toosmallornarrow; for by theWoman’s labouring gently and deliberately, theHeadis depressed softly into anoblique Figure, and passes easily by Degrees: Whereas, on the other hand, if it is forced byViolence, it becomesflatandbroad, and consequently incapable ofPassing, if not alsodash’d to Pieces, as aforesaid.
HENCEwe clearly see, how easilyIgnorancein this Point, may lead commonMidwivesinto the grossest ofMistakes; For what is more ordinary with them, even in allCases, than to advise theWomantostrong Labour, and to force her toviolent Depressions: Insomuch thatSomehaveArroganceenough to carry theirBottlesorPowdersabout them, of which they neither know theQualitynorVirtue; taking them only as they are told (by the confidentQuacksorMercenary Handswhich vend them) that they may encrease and promote thePainsof Labour, andThiswithout having any regard to theFormof thePelvis, or thePositionof either theWOMB, or theINFANT.
INshort, the matureConsiderationof this veryCase, was not the leastMotivewhich induced me to theWorkin Hand; since I cannot but heartily commiserate so many fine delicateWomen, as arethusevery day miserably handled, tormented, and exhausted, by thepreposterous Managementof such indiscreet and imprudentMIDWIVES. I may well sayexhausted, orworn-out;Thisbeing too evident, from the vast Number of most beautifulWomen, who, by this ill-manag’dCondition, (notwithstanding they have all along heretofore, enjoy’d a good State ofHealth, together with theAffluenceof other WorldlyBlessings) have been more dejected and broken both inComplexionandConstitution, afteroneortwo BIRTHS, than someothers(judiciously and expertlydelivered) have been afterTwenty: Such is the greatDifferencebetwixt the unskilfulHandsorConductof commonMidwives, and those DextrousTouchesor ingeniousOperationsof the more judiciousAndro-Boethogynists. Whence I come in Course to——