Of the Parts proper to a Child in the womb; How it is formed there, and the manner of its Situation therein.
Of the Parts proper to a Child in the womb; How it is formed there, and the manner of its Situation therein.
In the last chapter I treated of conception, showed what it was, how accomplished and its signs, and how she who has conceived ought to order herself during the time of her pregnancy. Now, before I come to speak of her delivery, it is necessary that the midwife be first made acquainted with the parts proper to a child in the womb, and also that she be shown how it is formed, and the manner of its situation and decumbiture there; which are so necessary to her, that without the knowledge thereof, no one can tell how to deliver a woman as she ought. This, therefore, shall be the work of this chapter. I shall begin with the first of these.
In this section, I must first tell you what I mean by the parts proper to a child in the womb; and they are only those that either help or nourish it; and whilst it is lodged in that dark repository of nature, and that help to clothe and defend it there and are cast away, as of nomore use, after it is born, and these are two, viz., the umbilicars, or navel vessels, and the secundinum. By the first it is nourished, and by the second clothed and defended from wrong. Of each of these I shall speak distinctly; and first,
These are four in number, viz.:—one vein, two arteries, and the vessel which is called the urachos.
(1) The vein is that on which the infant is nourished, from the time of its conception till the time of its delivery; till being brought into the light of the world, it has the same way of concocting the food we have. This vein ariseth from the liver of the child, and is divided into two parts when it has passed the navel; and these two are divided and subdivided, the branches being upheld by the skin calledchorion(of which I speak by and by), and are joined to the veins of the mother's womb, from whence they have their blood for the nourishment of the child.
(2) The arteries are two on each side which proceed from the back branches of the great artery of the mother, and the vital blood is carried by those to the child being ready concocted by the mother.
(3) A nervous or sinewy production is led from the bottom of the bladder of the infant to the navel, and this is calledurachos, and its use is, to convey the urine of the infant from the bladder to the alantois. Anatomists do very much vary in their opinion concerning this, some denying any such thing to be in the delivery of the woman, and others on the contrary affirming it; but experience has testified there is such a thing, for Bartholomew Carbrolius, the ordinary doctor of anatomy to the College of Physicians at Montpellier in France, records the history of a maid, whose water being a long time stopped, at last issued out through the navel. And Johannes Fernelius speaks of the same thing that happened to a man of thirty years of age, who having a stoppage at the neck of the bladder, his urine issued out of his navel for many months together, and that without any prejudice at all to his health, which he ascribes to the ill lying of his navel, whereby the urachos was not well dried. And Volchier Coitas quotes such another instance in a maid of thirty-four at Nuremburg in Germany. These instances, though they happen but seldom, are sufficient to prove that there is such a thing as anurachos in men.
These four vessels before mentioned, viz., one vein, two arteries and the urachos, join nearthe navel, and are united by a skin which they have from the chorion and so become like a gut or rope, and are altogether void of sensibility, and this is that which women call the navel-string. The vessels are thus joined together, that so they may neither be broken, severed nor entangled; and when the infant is born are of no use save only to make up the ligament which stops the hole of the navel and for some other physical use, etc.
Setting aside the name given to this by the Greeks and Latins, it is called in English by the name of secundine, after-birth or after-burden; which are held to be four in number.
(1) Thefirstis called placenta, because it resembles the form of a cake, and is knit both to the navel and chorion, and makes up the greatest part of the secundine or after-birth. The flesh of it is like that of the melt or spleen, soft, red and tending something to blackness, and hath many small veins and arteries in it: and certainly the chief use of it is, for containing the child in the womb.
(2) Thesecondis the chorion. This skin and that called the amnios, involve the child round, both above and underneath, and on bothsides, which the alantois does not. This skin is that which is most commonly called the secundine, as it is thick and white garnished with many small veins and arteries, ending in the placenta before named, being very light and slippery. Its use is, not only to cover the child round about, but also to receive, and safely bind up the roots of the veins and arteries or navel vessels before described.
(3) Thethirdthing which makes up the secundine in the alantois, of which there is a great dispute amongst anatomists. Some say there is such a thing, and others that there is not. Those who will have it to be a membrane, say it is white, soft and exceedingly thin, and just under the placenta, where it is knit to the urachos, from which it receives the urine; and its office is to keep it separate from the sweat, that the saltness of it may not offend the tender skin of the child.
(4) Thefourth, and last covering of the child is called amnios; and it is white, soft and transparent, being nourished by some very small veins and arteries. Its use is, not only to enwrap the child, but also to retain the sweat of the child.
Having thus described the parts proper to a child in the womb, I will next proceed to speak of the formation of the child therein, as soonas I have explained the hard terms of the section, that those for whose help it is designed, may understand what they read. Aveinis that which receives blood from the liver, and distributes in several branches to all parts of the body.Nerveis the same withsinew, and is that by which the brain adds sense and motion to the body.Placenta, properly signifiessugarcake; but in this section it is used to signify a spongy piece of flesh resembling a cake, full of veins and arteries, and is made to receive a mother's blood appointed for the infant's nourishment in the womb. Thechorionis an outward skin which compasseth the child in the womb. Theamniosis the inner skin which compasseth the child in the womb. Thealantoisis the skin that holds the urine of the child during the time that it abides in the womb. Theurachosis the vessel that conveys the urine from the child in the womb to thealantois. I now proceed to
To speak of the formation of the child in the womb, we must begin where nature begins, and, that is at the act of coition, in which the womb having received the generative seed (without which there can be no conception), the womb immediately shuts up itself so close that thepoint of a needle cannot enter the inward orifice; and this it does, partly to hinder the issuing out of the seed again, and partly to cherish it by an inward heat, the better to provoke it to action; which is one reason why women's bellies are so lank at their first conception. The woman having thus conceived, the first thing which is operative in conception is the spirit whereof the seed is full, which, nature quickening by the heat of the womb, stirs up the action. The internal spirits, therefore, separate the parts that are less pure, which are thick, cold and clammy, from those that are more pure and noble. The less pure are cast to the outside, and with these seed is circled round and the membrane made, in which that seed that is most pure is wrapped round and kept close together, that it may be defended from cold and other accidents, and operate the better.
The first thing that is formed is the amnios; the next the chorion; and they enwrap the seed round like a curtain. Soon after this (for the seed thus shut up in the woman lies not idle), the navel vein is bred, which pierceth those skins, being yet very tender, and carries a drop of blood from the veins of the mother's womb to the seed; from which drop the vena cava, or chief vein, proceeds, from which all the rest of the veins which nourish the body spring; andnow the seed hath something to nourish it, whilst it performs the rest of nature's work, and also blood administered to every part of it, to form flesh.
This vein being formed, the navel arteries are soon after formed; then the great artery, of which all the others are but branches; and then the heart, for the liver furnisheth the arteries with blood to form the heart, the arteries being made of seed, but the heart and the flesh, of blood. After this the brain is formed, and then the nerves to give sense and motion to the infant. Afterwards the bones and flesh are formed; and of the bones, first of all, the vertebrae or chine bones, and then the skull, etc. As to the time in which this curious part of nature's workmanship is formed, having already in Chapter II of the former part of this work spoken at large upon this point, and also of the nourishment of the child in the womb, I shall here only refer the reader thereto, and proceed to show the manner in which the child lies in the womb.
This is a thing so essential for a midwife to know, that she can be no midwife who is ignorantof it; and yet even about this authors extremely differ; for there are not two in ten that agree what is the form that the child lies in the womb, or in what fashion it lies there; and yet this may arise in a great measure from the different times of the women's pregnancy; for near the time of its deliverance out of those winding chambers of nature it oftentimes changes the form in which it lay before, for another.
I will now show the several situations of the child in the mother's womb, according to the different times of pregnancy, by which those that are contrary to nature, and are the chief cause of ill labours, will be more easily conceived by the understanding midwife. It ought, therefore, in the first place to be observed, that the infant, as well male as female, is generally situated in the midst of the womb; for though sometimes, to appearance a woman's belly seems higher on one side than the other, yet it is so with respect to the belly only, and not to her womb, in the midst of which it is always placed.
But, in the second place, a woman's great belly makes different figures, according to the different times of pregnancy; for when she is young with child, the embryo is always found of a round figure, a little long, a little oblong, having the spine moderately turned inwards, and the thighs folded, and a little raised, towhich the legs are so raised, that the heels touch the buttocks; the arms are bending, and the hands placed upon the knees, towards which part of the body, the head is turned downwards towards the inward orifice of the womb, tumbling as it were over its head so that then the feet are uppermost, and the face towards the mother's great gut; and this turning of the infant in this manner, with its head downwards, towards the latter end of a woman's reckoning, is so ordered by nature, that it may be thereby the better disposed of its passage into the world at the time of its mother's labour, which is not then far off (and indeed some children turn not at all until the very time of birth); for in this posture all its joints are most easily extended in coming forth; for by this means its arms and legs cannot hinder its birth, because they cannot be bent against the inner orifice of the womb and the rest of the body, being very supple, passeth without any difficulty after the head, which is hard and big; being passed the head is inclined forward, so that the chin toucheth the breast, in which posture, it resembles one sitting to ease nature, and stooping down with the head to see what comes from him. The spine of the back is at that time placed towards the mother's, the head uppermost, the face downwards; and proportionately to its growth, it extends itsmembers by little and little, which were exactly folded in the first month. In this posture it usually keeps until the seventh or eighth month, and then by a natural propensity and disposition of the upper first. It is true there are divers children, that lie in the womb in another posture, and come to birth with their feet downwards, especially if there be twins; for then, by their different motions they do so disturb one another, that they seldom come both in the same posture at the time of labour, but one will come with the head, and another with the feet, or perhaps lie across; but sometimes neither of them will come right. But, however the child may be situated in the womb, or in whatever posture it presents itself at the time of birth, if it be not with its head forwards, as I have before described, it is always against nature, and the delivery will occasion the more pain and danger, and require greater care and skill from the midwife, than when the labour is more natural.
A Guide for Women in Travail, showing what is to be done when they fall in Labour, in order to their Delivery.
A Guide for Women in Travail, showing what is to be done when they fall in Labour, in order to their Delivery.
The end of all that we have been treating of is, the bringing forth of a child into the world with safety both to the mother and the infant, as the whole time of a woman's pregnancy may be termed a kind of labour; for, from the time of the conception to the time of her delivery, she labours under many difficulties, is subject to many distempers, and in continual danger, from one affection or other, till the time of birth comes; and when that comes, the greatest labour and travail come along with it, insomuch that then all the other labours are forgotten, and that only is called the time of her labours, and to deliver her safely is the principal business of the midwife; and to assist therein, shall be the chief design of this chapter. The time of the child's being ready for its birth, when nature endeavours to cast it forth, is that which is properly the time of a woman's labour; nature then labouring to be eased of its burden. And since many child-bearing women, (especially the first child) are often mistaken in their reckoning and so, when they draw near their timetake every pain they meet with for their labour, which often proves prejudicial and troublesome to them, when it is not so, I will in the first section of this chapter, set down some signs, by which a woman may know when the true time of her labour is come.
When women with child, especially of their first, perceive any extraordinary pains in the belly, they immediately send for their midwife, as taking it for their labour; and then if the midwife be not a skilful and experienced woman, to know the time of labour, but takes it for granted without further inquiry (for some such there are), and so goes about to put her into labour before nature is prepared for it, she may endanger the life of both mother and child, by breaking the amnios and chorion. These pains, which are often mistaken for labour, are removed by warm clothes laid to the belly, and the application of a clyster or two, by which those pains which precede a true labour, are rather furthered than hindered. There are also other pains incident to a woman in that condition from the flux of the belly, which are easily known by the frequent stools that follow them.
The signs, therefore, of labour, some few days before, are that the woman's belly, which before lay high, sinks down, and hinders her from walking so easily as she used to do; also there flow from the womb slimy humours, which nature has appointed to moisten and smooth the passage that its inward orifice may be the more easily dilated when there is occasion; which beginning to open at this time, suffers that slime to flow away, which proceeds from the Glandules calledprostata. These are signs preceding the labour; but when she is presently falling into labour, the signs are, great pains about the region of the reins and loins, which coming and retreating by intervals, are answered in the bottom of the belly by congruous throes, and sometimes the face is red and inflamed, the blood being much heated by the endeavours a woman makes to bring forth her child; and likewise, because during these strong throes her respiration is intercepted, which causes the blood to have recourse to her face; also her privy parts are swelled by the infant's head lying in the birth, which, by often thrusting, causes those parts to descend outwards. She is much subject to vomiting, which is a good sign of good labour and speedy delivery, though by ignorant people thought otherwise; for good pains are thereby excited and redoubled; whichvomiting is excited by the sympathy there is between the womb and the stomach. Also, when the birth is near, women are troubled with a trembling in the thighs and legs, not with cold, like the beginning of an ague fit, but with the heat of the whole body, though it must be granted, this does not happen always. Also, if the humours which then flow from the womb are discoloured with the blood, which the midwives callshows, it is an infallible mark of the birth being near. And if then the midwife puts up her fingers into the neck of the womb, she will find the inner orifice dilated; at the opening of which the membranes of the infant, containing the waters, present themselves and are strongly forced down with each pain she hath; at which time one may perceive them sometimes to resist, and then again press forward the finger, being more or less hard and extended, according as the pains are stronger or weaker. These membranes, with the waters in them, when they are before the head of the child, midwives callthe gathering of the waters, resemble to the touch of the fingers those eggs which have no shell, but are covered only with a simple membrane. After this, the pains still redoubling the membranes are broken by a strong impulsation of these waters, which flow away, and then the head of the infant is presentlyfelt naked, and presents itself at the inward orifice of the womb. When these waters come thus away, then the midwife may be assured the birth is very near, this being the most certain sign that can be; for theamnios alantois, which contained these waters, being broken by the pressing forward of the birth, the child is no better able to subsist long in the womb afterwards than a naked man in a heap of snow. Now, these waters, if the child comes presently after them, facilitate the labour by making the passage slippery; and therefore, let no midwife (as some have foolishly done) endeavour to force away the water, for nature knows best when the true time of birth is, and therefore retains the waters till that time. But if by accident the water breaks away too long before the birth, then such things as will hasten it, may be safely administered, and what these are, I will show in another section.
When it is known that the true time of her labour is come by the signs laid down in the foregoing, of which those most to be relied upon are pains and strong throes in the belly, forcing downwards towards the womb, and a dilationof the inward orifice, which may be perceived by touching it with the finger, and the gathering of the waters before the head of the child, and thrusting down the membranes which contain them; through which, between the pains, one may in some manner with the finger discover the part which presents itself (as we have said before), especially if it be the head of the child, by its roundness and hardness; I say, if these things concur and are evident, the midwife may be sure it is the time of the woman's labour, and care must be taken to get all those things that are necessary to comfort her at that time. And the better to help her, be sure to see that she is not tightly laced; you must also give her one strong clyster or more, if there be occasion, provided it be done at the beginning, and before the child be too forward, for it will be difficult for her to receive them afterwards. The benefit accruing therefrom will be, that they excite the gut to discharge itself of its excrements, so that the rectum being emptied there may be the more space for the dilation of the passage; likewise to cause the pains to bear the more downward, through the endeavours she makes when she is at stool, and in the meantime, all other necessary things for her labour should be put in order, both for the mother and the child. To this end, some get a midwife's; but a pallet bed, girded,is much the best way, placed near the fire, if the season so require, which pallet ought to be so placed, that there may be easy access to it on every side, that the woman may be the more easily assisted, as there is occasion.
If the woman abounds with blood, to bleed her a little more may not be improper, for thereby she will both breathe the better, and have her breasts more at liberty, and likewise more strength to bear down her pains; and this may be done without danger because the child being about ready to be born, has no more need of the mother's blood for its nourishment; besides, this evacuation does many times prevent her having a fever after delivery. Also, before her delivery, if her strength will permit, let her walk up and down her chamber; and that she may have strength so to do, it will be necessary to give her good strengthening things, such as jelly, broth, new laid eggs, or some spoonfuls of burnt wine; and let her by all means hold out her pains, bearing them down as much as she can, at the time when they take her; and let the midwife from time to time touch the inward orifice with her finger, to know whether the waters are ready to break and whether the birth will follow soon after. Let her also anoint the woman's privities with emollient oil, hog's grease, and fresh butter, if she find they are hard to bedilated. Let the midwife, likewise, all the time be near the labouring woman, and diligently observe her gestures, complaints, and pains, for by this she may guess pretty well how far her labour advanceth, because when she changeth her ordinary groans into loud cries, it is a sign that the child is near the birth; for at the time her pains are greater and more frequent. Let the woman likewise, by intervals, rest herself upon the bed to regain her strength, but not too long, especially if she be little, short and thick, for such women have always worse labour if they lie long on their beds in their travail. It is better, therefore, that she walk about her chamber as long as she can, the woman supporting her under the arms, if it be necessary; for by this means, the weight of the child causes the inward orifices of the womb to dilate the sooner than in bed, and if her pains be stronger and more frequent, her labour will not be near so long. Let not the labouring woman be concerned at those qualms and vomitings which, perhaps, she may find come upon her, for they will be much for her advantage in the issue, however uneasy she may be for a time, as they further her pains and throes by provoking downward.
When the waters of the child are ready and gathered (which may be perceived through themembranes presenting themselves to the orifice) to the bigness of the whole dilatation, the midwife ought to let them break of themselves, and not, like some hasty midwives, who being impatient of the woman's long labour, break them, intending thereby to hasten their business, when instead thereof, they retard it; for by the too hasty breaking of these waters (which nature designed to make the child slip more easy), the passage remains dry by which means the pains and throes of the labouring woman are less efficacious to bring forth the infant than they would otherwise have been. It is, therefore, much the better way to let the waters break of themselves; after which the midwife may with ease feel the child by that part which first presents, and thereby discern whether it comes right, that is, with the head foremost, for that is the proper and most natural way of the birth. If the head comes right, she will find it big, round, hard and equal; but if it be any other part, she will find it rugged, unequal, soft and hard, according to the nature of the part it is. And this being the true time when a woman ought to be delivered, if nature be not wanting to perform its office, therefore, when the midwife finds the birth thus coming forward let her hasten to assist and deliver it, for it ordinarily happens soon after, if it be natural.
But if it happens, as it sometimes may, that the waters break away too long before the birth, in such a case, those things which hasten nature may safely be administered. For which purpose make use of pennyroyal, dittany, juniper berries, red coral, betony and feverfew, boiled in white wine, and give a drachm of it, or it would be much better to take the juice of it when it is in its prime, which is in May, and having clarified it, make it into a syrup with double its weight of sugar, and keep it all the year, to use when occasion calls for it; mugwort used in the same manner is also good in this case; also a drachm of cinnamon powder given inwardly profits much in this case; and so does tansey broiled and applied to the privities; or an oil of it, so, made and used, as you were taught before. The stoneaetitesheld to the privities, is of extraordinary virtue, and instantly draws away, both child and after-burden; but great care must be taken to remove it presently, or it will draw forth womb and all; for such is the magnetic virtue of this stone that both child and womb follow it as readily as iron doth the load-stone or the load-stone the north star.
There are many things that physicians affirm are good in this case; among which are an ass's or horse's hoof, hung near the privities; a piece of red coral hung near the said place. A load-stonehelps very much, held in the woman's left hand; or the skin cut off a snake, girt about the middle, next to the skin. These things are mentioned by Mizaldus, but setting those things aside, as not so certain, notwithstanding Mizaldus quotes them, the following prescriptions are very good to speedy deliverance to women in travail.
(1) A decoction of white wine made in savory, and drank.
(2) Take wild tansey, or silver weed, bruise it, and apply to the woman's nostrils.
(3) Take date stones, and beat them to powder, and let her take half a drachm of them in white wine at a time.
(4) Take parsley and bruise it and press out the juice, and dip a linen cloth in it, and put it so dipped into the mouth of the womb; it will presently cause the child to come away, though it be dead, and it will bring away the after-burden. Also the juice of the parsley is a thing of so great virtue (especially stone parsley) that being drank by a woman with child, it cleanseth not only the womb, but also the child in the womb, of all gross humours.
(5) A scruple of castorum in powder, in any convenient liquor, is very good to be taken in such a case, and so also is two or three drops of castorum in any convenient liquor; or eight ornine drops of spirits of myrrh given in any convenient liquor, gives speedy deliverance.
(6) Give a woman in such a case another woman's milk to drink; it will cause speedy delivery, and almost without pain.
(7) The juice of leeks, being drunk with warm water, highly operates to cause speedy delivery.
(8) Take peony seeds and beat them into a powder, and mix the powder with oil, with which oil anoint the privities of the woman and child; it will give her deliverance speedily, and with less pain than can be imagined.
(9) Take a swallow's nest and dissolve it in water, strain it, and drink it warm, it gives delivery with great speed and much ease.
Note this also in general, that all that move the terms are good for making the delivery easy, such as myrrh, white amber in white wine, or lily water, two scruples or a drachm; or cassia lignea, dittany, each a drachm; cinnamon, half a drachm, saffron, a scruple; give a drachm, or take borax mineral, a drachm, and give it in sack; or take cassia lignea, a drachm; dittany, amber, of each a drachm; cinnamon, borax, of each a drachm and a half; saffron, a scruple, and give her half a drachm; or give her some drops of oil of hazel in convenient liquor; or two or three drops of oil of cinnamon in vervainwater. Some prepare the secundine thus:—Take the navel-string and dry it in an oven, take two drachms of the powder, cinnamon a drachm, saffron half a scruple, with the juice of savin make trochisks; give two drachms; or wash the secundine in wine and bake it in a pot; then wash it in endive water and wine, take half a drachm of it; long pepper, galangal, of each half a drachm; plantain and endive seed, of each half a drachm; lavender seed, four scruples; make a powder, or take laudanum, two drachms; storax, calamite, benzoin, of each half a drachm; musk, ambergris each six grains, make a powder or trochisks for a fume. Or use pessaries to provoke the birth; take galbanum dissolved in vinegar, an ounce; myrrh, two drachms, with oil of oat make a pessary.
Take oil of keir, two ounces, juice of savine an ounce, of leeks and mercury, each half an ounce; boil them to the consumption of the juice; add galbanum dissolved in vinegar, half an ounce, myrrh, two drachms, storax liquid a drachm, round bitwort, sowbread, cinnamon, saffron, a drachm, with wax make an ointment and apply it.
If the birth be retarded through the weaknessof the mother, refresh her by applying wine and soap to the nose, confect. alkermas. diamarg.
These things may be applied to help nature in her delivery when the child comes to the birth the right way, and yet the birth be retarded; but if she finds the child comes the wrong way, and that she is not able to deliver the woman as she ought to be, by helping nature, and saving both mother and child (for it is not enough to lay a woman if it might be done any other way with more safety and ease, and less hazard to woman and child), then let her send speedily for the better and more able to help; and not as I once knew a midwife do, who, when a woman she was to deliver had hard labour, rather than a man-midwife should be sent for, undertook to deliver the woman herself (though told it was a man's business), and in her attempting it, brought away the child, but left the head in the mother's womb; and had not a man midwife been presently sent for, the mother had lost her life as well as the child; such persons may rather be termed butchers than midwives. But supposing the woman's labour to be natural, I will next show what the midwife ought to do, in order of her delivery.
Of Natural Labour; What it is and what the Midwife is to do in such Labour.
Of Natural Labour; What it is and what the Midwife is to do in such Labour.
There are four things which denominate a woman's natural labour; the first is, that it be at the full time, for if a woman comes before her time, it cannot be termed natural labour, neither will it be so easy as though she had completed her nine months. The second thing is, that it be speedy, and without any ill accident; for when the time of her birth come, nature is not dilatory in the bringing it forth, without some ill accident intervene, which renders it unnatural.
The third is, that the child be alive; for all will grant, that the being delivered of a dead child is very unnatural. The fourth is, that the child come right, for if the position of the child in the womb be contrary to that which is natural, the event will prove it so, by making that which should be a time of life, the death both of the mother and the child.
Having thus told you what I mean by natural labour, I shall next show how the midwife is to proceed therein, in order to the woman's delivery.When all the foregoing requisites concur, and after the waters be broken of themselves, let there rather a quilt be laid upon the pallet bedstead than a feather bed, having there-on linen and cloths in many folds, with such other things as are necessary, and that may be changed according to the exigency requiring it, so that the woman may not be incommoded with the blood, waters and other filth which are voided in labour. The bed ought to be ordered, that the woman being ready to be delivered, should lie on her back upon it, having her body in a convenient posture; this is, her head and breast a little raised, so that she may be between lying and sitting, for being so placed, she is best capable of breathing, and, likewise, will have more strength to bear her pains than if she lay otherwise, or sunk down in her bed. Being so placed, she must spread her thighs abroad, folding her legs a little towards her buttocks, somewhat raised by a little pillow underneath, to the end that her rumps should have more liberty to retire back; and let her feet be stayed against some firm thing; besides this, let her take firm hold of some of the good women attending her, with her hands, that she may the better stay herself during her pains. She being thus placed at her bed, having her midwife at hand, the better to assist as nature may require, let her takecourage, and help her pains as best she can, bearing them down when they take her, which she must do by holding her breath, and forcing them as much as possible, in like manner as when she goes to stool, for by such straining, the diaphragm, or midriff, being strongly thrust downward, necessarily forces down the womb and the child in it. In the meantime, let the midwife endeavour to comfort her all she can, exhorting her to bear her labour courageously, telling her it will be quickly over, and that there is no fear but that she will have a speedy delivery. Let the midwife also, having no rings on her fingers, anoint them with oil of fresh butter, and therewith dilate gently the inward orifice of the womb putting her finger ends into the entry thereof, and then stretch them one from the other, when her pains take her; by this means endeavouring to help forward the child, and thrusting by little and little, the sides of the orifice towards the hinder part of the child's head, anointing it with fresh butter if it be necessary.
When the head of the infant is a little advanced into the inward orifice, the midwife's phrase is:—"It is crowned"; because it girds and surrounds it just as a crown; but when it is so far that the extremities begin to appear without the privy parts, then they say, "The infantis in the passage"; and at this time the woman feels herself as if it were scratched, or pricked with pins, and is ready to imagine that the midwife hurts her, when it is occasioned by the violent distension of those parts and the laceration which sometimes the bigness of the child's head causeth there. When things are in this posture, let the midwife seat herself conveniently to receive the child, which will come quickly, and with her finger ends (which she must be sure to keep close pared) let her endeavour to thrust the crowning of the womb (of which I have spoken before), back over the head of the child, and as soon as it is advanced as far as the ears, or thereabouts, let her take hold of the two sides with her two hands, that when a good pain comes she may quickly draw forth the child, taking care that the navel-string be not entangled about the neck or any part, as sometimes it is, lest thereby the after-burden be pulled with violence, and perhaps the womb also, to which it is fastened, and so either cause her to flood or else break the strings, both which are of bad consequence to the woman, whose delivery may thereby be rendered the more difficult. It must also be carefully observed that the head be not drawn forth straight, but shaking it a little from one side to the other, that the shoulders may sooner and easier taketheir places immediately after it is past, without losing time, lest the head being past, the child be stopped there by the largeness of the shoulders, and so come in danger of being suffocated and strangled in the passage, as it sometimes happens, for the want of care therein. But as soon as the head is born, if there be need, she may slide her fingers under the armpits, and the rest of the body will follow without any difficulty.
As soon as the midwife hath in this manner drawn forth the child, let her put it on one side, lest the blood and water which follows immediately, should do it any injury by running into its mouth and nose, as they would do, if it lay on its back; and so endanger the choking of it. The child being thus born, the next thing requisite is, to bring away the after-burden, but before that let the midwife be very careful to examine whether there be more children in the womb; for sometimes a woman may have twins that expected it not; which the midwife may easily know by the continuance of the pains after the child is born, and the bigness of the mother's belly. But the midwife may be sure of it, if she puts her hand up to the entry of the womb, and finds there another watery gathering, and the child in it presenting to the passage, and if she find it so, she must have acare of going to fetch the after-birth, till the woman be delivered of all the children she is pregnant with. Wherefore the first string must be cut, being first tied with a thread three or four times double, and fasten the other end with string to the woman's thighs, to prevent the inconvenience it may cause by hanging between the thighs; and then removing the child already born, she must take care to deliver her of the rest, observing all the circumstances as with the first; after which, it will be necessary to fetch away the after-birth, or births. But of that I shall treat in another section, and first show what is to be done to the new-born infant.
Though this is accounted by many but as 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 should 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 partof 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 mid wives call thecaul, and ignorantly attribute some extraordinary virtue to the child so born; but this opinion is only the effect of their ignorance; for when a 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 comes 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 natural and vital 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 soon be 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 fourfingers' breadth, which is, at best, but an uncertain rule, unless all fingers were of one size. It is a received opinion, that the parts adapted to the generation are contracted and dilated according to the cutting of the navel-string, and this is the reason why midwives are generally so kind to their own sex, that they leave a longer part of the navel-string of a male than female, because they would have the males well provided for the encounters of Venus; and the reason they give, why they cut that of the female shorter is, because they believe it makes them more acceptable to their husbands. Mizaldus was not altogether of the opinion of these midwives, and he, therefore, ordered the navel string to be cut long both in male and female children; for which he gives the following reason, that the instrument of generation follows the proportion of it; and therefore, if it be cut too short in a female, it will be a hindrance to her having children. I will not go about to contradict the opinions of Mizaldus; these, experience has made good:—That one is, that if the navel-string of a child, after it be cut, be suffered to touch the ground, the child will never hold its water, either sleeping or waking, but will be subjected to an involuntary making of water all its lifetime. The other is, that a piece of a child's navel-string carried about one, sothat it touch his skin, defends him that wears it from the falling sickness and convulsions.
(3) As to the manner 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 woman 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 belly 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-string 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 out 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, and that 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. When you have thus cut the navel-string, then take care the piece that falls off touch not the ground, for the reason I told you Mizaldus gave, which experience has justified.
(4) The last thing I mentioned, was the event or consequence, or what follows cutting the navel-string. As soon as it is cut, 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 oil of roses, it will be the better, and then put another small rag three or four times double upon the belly; 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 from being continually stirred from side to side, it comes to fall off before the navel-string, which you left remaining, is fallen 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 rather advise them to puta little ammoniac to it, because of its drying qualities.
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 than the 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 fingers on 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 forefinger of the same hand, extended and stretched forth along the string towards the entrance of the vagina, always observing, for the greater facility, to drawit 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 the burden is sometimes very strongly fastened, be drawn away with it, as 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 effecting this work, I will lay down the following rules.
(1) Use the same means of 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 there were then.
(2) Considering that the labouring woman cannot but 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 necessary.
(3) A little hellebore in powder, to make her sneeze, is in this case very proper.
(4) Tansey, and the stone aetites, 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 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 feverfew and mugwort have the same operation taken as the former.
(6) Alexanders[10]boiled in wine, and the wine drank, also sweet servile, sweet cicily, angelica roots, and musterwort, are excellent remedies in this case.
(7) Or, if this fail, the smoke of marigolds, received up a woman's privities by a funnel, have been known to bring away the after-birth, even when the midwife let go her hold.
(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. But special care must be taken to remove it as soon as they come away, lest by its long tarrying it should draw away the womb also.