AMONGthe various unhappyAccidents, which may happen in or about the Time ofLabour, the presentCaseis none of the most auspicious; in as much as it may, in sundry Respects, occasion a very difficultPreternatural BIRTH, according to the Difference of Circumstances: For theNavel-Stringhaving fallen down and comefirstin thePassage, may be variously turn’d, and consequently cause several and sundryInconveniences, as follow,viz.——
I.WHENtheUmbilical Vesselfalls down alone into thePassage, without any otherPart, theBIRTHis then commonly situated a-cross in theWomb; and in thisCondition,BACKorBELLY,HANDorFOOT, may be probably expected to comefirst: Wherefore the activeMIDWIFEought to discover thereal Postureby theTouch, andthatat least before all theWatersare yet flow’d off and evacuated; and then betimes to fetch away theCHILDby theFEET, unless theHeadbe more convenient or pat for the Purpose. But theseCasesbeing already particularly discussed[179], I shall add nothing farther upon them in this Place.
II.THEStringmay fall downdouble, and so swell withCold, as to obstruct thePassage, which however is but the smallest Consideration in thisCondition, because by its hanging downdouble, it may be soshortned, that theCHILDmay be detain’d, appending by it in theOrifice, until theBloodof theUmbilicalscoagulating either byCold, or byCompressionin thePassage, the dueCirculationis obstructed, and theInfantexpos’d to the greatest ofDangers, if a very speedyDELIVERYdoes not prevent the fatal Accident.
THEPrudentMIDWIFEought always to be very sollicitous about thisCase, making it her particularCarefrom the beginning of theLabour, as soon as perceiv’d by theTouch, and before theWatersbreak, to avert or hinder its either comingbefore, oralong with theHead, by removing it judiciously according toArt. But supposing she comes too late to prevent theMischief, and that theStringis already in thePassage; then it is to beput back behind theHeadimmediately, and kept there until theHeadbe fully directed into and lodg’d in thePassage. However it sometimes happens that it cannot be kept-up solong, and that theMIDWIFE, whateverPainsshe may take, cannot hinder it from extruding itself at everyPang: In thisCondition, I would advise her (without delay) to extract theBirthby theFeet, and that notwithstanding theHeadshould beforemost.
III.ITalso happens sometimes, that theStringwithout hanging down, is variously compress’d betwixt theHeadand theBonesof thePelvis, which (stopping or impeding theMotionof theBlood) soon occasions theInfant’s inevitable Death.
INwhichCase, if pressed against theOssa Pubis, having laid theWomanon herBackwith herHead low, and thelower Part of her Body raised, I would pressbacktheInfant’sHead, and put theSTRINGas much as possible behind it; upon which, then I would bring theHeadforthwith into thePelvis, unless it be more convenient toturnandextractit by theFEET.
ASalso, tho’ seldom, it may happen, that theUmbilicalmay bepressed backby theHeadagainst theOs Sacrum: In which State of Affairs, I would turn theWoman, if Strength may permit, upon herKnees,whilst I employ eitherHandon theBack Part, in order to remove theHead, how firmly soever fixed: Whereas if thePatientbe weak, I would lay her upon eitherSide, drawing up oneFootto herBelly, for the Advantage of obtaining more Room, in order to effect the same Thing; which, tho’ difficult, is no impossibleTaskfor the expertMIDWIFE.
BUTif it chances to be pressed against either of theOssa Ilia, having laid theWomanon the contrarySide, with thelower Partof her Body elevated, I would remove theHEADwith the oppositeHand, and free theSTRING; proceeding otherways as in the formerCases, withHEADorFEET, as I should find most convenient.
IV.AGAIN, it also sometimes comes to pass, that theSTRINGis found lying upon theForehead, which is indeed mostdangerous; but it is easily removed with good Judgement to theTemplesof theHead, which I take to be a safePosition, because there thePressureis much less aggravated.
V.MOREOVERit likewise sometimes happens, that theSTRINGcomes along with theShoulder,Elbow,Hand,Foot, &c. without touching theHEAD: Upon this then as soon as theHumourshave flow’d, I would pass myHandquickly up, and bring theCHILD,HeadorFeet foremostinto thePassage, according to itsSituation, always detaining or stopping theSTRINGfrom coming out before theBIRTH: Whereas if theSTRINGbe already excluded along with theFootor theArm, it is to berepelledwith all necessary Speed, Conduct, and Caution, and then theINFANTought to be dextrously drawn out by theFeet.
VI. I have also seen theCHILDbrought forth by theHEAD, with theUmbilicalcircumvolv’d, or turn’d twice or thrice round theNECK; by which means of theSTRING’s being so much shortned, theBIRTHwas stopped or retained in thePassage: Upon this Occasion, I endeavour’d to slacken theSTRING, and so bring it over theHEAD, but finding it toostraitandshortto be so ordered, Itiedit in two places (at about two or threeInchesdistance) and thencut it in twobetwixt theLigatures: That being done, it was my Business to lose no Time in attracting theINFANTand delivering theWOMAN; otherways in thisCondition, it would have soon expired.