Part 13
THESE are distinguished into two kinds, the one natural, the other preternatural.
THE natural one, is that in which the fœtus comes out in the most ordinary way, when it presents the head foremost.
IT is deemed preternatural, when the fœtus presents in the passage any other part than the head.
THESE two kinds are again subdivided into two distinctions of labor, of easy or difficult, because both the natural and preternatural mode of delivery may be easy or difficult.
THE delivery is termed easy when the fœtus comes out readily, and without the aid of art.
IT is termed difficult, when the labor of it is hard, and the fœtus does not make its way out but with pain, and with the help and assistent industry of the midwife.
IN the cases of a natural and easy delivery, there is little or no actual occasion for the presence of the midwife, beyond that of receiving the fœtus, tying the navel-string, giving the child to be kept warm, and then delivering the mother of the after-birth. The spirits of the patient are then to be recomposed, her agitation calmed, a warm and soft linnen cloth applied to the stomach; a warm shift and bed-gown put on her; a linnen cloth to be laid on four-fold over the belly; a double-napkin round her, and she to be placed in a bed well warmed. Such is the summary of the process to be observed in those common cases.
IN the deliveries, on a preternatural labor, when they are easy, the same method takes place: there being no difference, but that in one the child will have been received by the head, in the other by the feet.
THESE kinds of labors are so easy, that there is no need of demonstrating their being to be terminated without the aid of instruments. When the fœtus presents itself promisingly, Nature is best left to her own action, and nothing should be precipitated in the manual function, unless some unexpected accident should intervene, and require interposition, such as a great flooding, or other exigency.
AS to the preternatural delivery, the better practice is not to delay the extraction of the fœtus, after the discharge of the waters; nor stay till her strength shall have been exhausted. On the presenting of a fair hold, and a sufficient overture, no difficulty should be made of extracting.
ALL that is to be observed then, is not to prematurate this extraction: not to proceed, in short, like those unskilful, or inconsiderate practitioners, who are no sooner entered the patient’s room, but they want to have their operation dispatched out of hand. Nothing can be more important to the well-doing of the patient, than for no violence to be used to Nature, who loves to go her own full time, without disturbance or molestation. In this point then great caution and circumspection are requisite.
IT should also be observed, that it is wrong for the midwife to leave a woman newly lain-in, however happily delivered. It is necessary to stay by her for some hours afterwards, till she is in such a state of tranquility and ease, as may leave nothing to fear of those after-disasters which too often happen.
SOME celebrated practitioners and authors upon midwifery have been surprized to see women, after their going their time without mis-adventure, and after having been readily and happily brought to bed die suddenly. There are too many of both the female and the men-midwives who have no notion of this misfortune till it is too late to prevent it. The cause of this melancholic accident is unknown to many practitioners of the art. Some have confessed their ignorance of it: others have erroneously, others deficiently accounted for it. But all are surprized when the patient is the victim of it: especially as it follows, in some cases that afford the best grounded hopes.
MESSIEURS MAURICEAU and De la Motte give us examples of these unexpected deaths. The first, in his 230th observation, says,
“I DELIVERED a woman of a very corpulent habit, aged about thirty-five years, of her first child, which was a lusty girl, alive, and that came naturally. This woman had been near two days in labor, with small slow pains or throws, after which the waters having burst forth with a strong throw, she had subsequently favorable ones, which made her bring forth as happily as one could wish. I immediately delivered her: but to my great surprize, scarce had she been a quarter of an hour after delivery, that she of a sudden fell into violent faintings, with an oppression at the breast, and a great agitation of the whole body, which was instantly followed by a convulsion, caused by a loss of blood, of which she died a quarter of an hour afterwards.
“THIS (adds Mr. Mauriceau) was one of those kind of fatalities which no human prudence can elude or parry.”
LA MOTTE had the same case happened under his hands, which I need not repeat here, being inserted in the first part of this work, where, p. 131, I ventured to promise an essay of mine, to give a less unsatisfactory reason of such deaths, than what is to be found even in those two celebrated authors whom our cotemporaries consider as their masters in the art of midwifery. These impute those unforeseen deaths to occult and inevitable _causes_. I own, I do not intirely think them either occult or inevitable. I doubtless may be mistaken, but of this I am sure, I shall advance nothing but what is authenticated to me by my own observation and experience.
AN over-repletion of blood, and a defect in the contraction of the uterus, of which all the vessel being open are too slow in recovering their occlusion, are generally speaking, the causes of these diseases. I could support this opinion by some chirurgical axioms, but I presume it will be thought more satisfactorily proved by the success of the method of practice, which I would recommend to prevent or cure those dangerous or rather fatal causes.
AS to know that a woman may thus perish unexpectedly a quarter of an hour after delivery, is enough to require the being on one’s guard for using a salutary prevention; I would advise attention, especially to her constitution.
WHENEVER therefore a pregnant woman is observed to be remarkably corpulent, and full of blood, with a good constitution, she should be advised to lose some blood, once or twice during her pregnancy, by way of precaution. This is of great service to rarefy the blood, and obviate those excessive hemorrhages, which are to be dreaded on their lying-in. Then nothing is to be precipitated during their labors, that Nature may have full time to predispose the uterus to enter into contraction by due degrees, that is to say, neither too quick, not too slow. But if, notwithstanding these precautions, there should, after delivery, supervene any considerable loss of blood, followed with faintings or oppressions, the patient must be stirred, excited to cough and sneeze contributively to the evacuation of the blood, which otherwise is apt to clot in the uterus, and would suffocate her if not expelled.
IF by this mean the evacuation does not naturally take place, which may be perceived by the faintings of the patient, the midwife must, without losing time, put her hand into the bowel, and extract all the clots of blood she will not fail of finding there, and of which the presence, as being extraneous matter, necessarily oppose the contraction of this organ, and quickly suffocates the woman, if she is not timely relieved.
THESE hemorrhages are but too frequent, especially with those women who neglect the precautionary bleeding; and such sudden death too commonly the consequence of neglecting, or of not knowing that the most salutary practice, in these cases, is to well evacuate the uterus by the operation of the hand, where Nature appears in the least tardy or deficient.
THE long experience I have of this manual help, which has never failed of success with me, warrants my averring, that there is little or no danger, in these cases, to women, provided the midwife employs herself dextrously to clear them while time serves. Their relief is instantaneous. They come to themselves presently: they are restored to a freedom of respiration: nor will they have so much as been sensible of this operation of the hand, which will nevertheless have saved their lives.
THERE have been men-midwives, that pass even for learned, but who from their ignorance of this so simple and easy method of relief, have been in the disagreeable circumstance of seeing many women perish under their hands, though they had to all appearance been very happily delivered.
WITH respect to pregnant women, there is again another point of great consequence to ascertain. Great care must be taken not to mistake the signs of delivery. This is a very essential matter. Nothing scarce can be more dangerous, than to excite a woman to the last labor-pains, which will not fail of exhausting that strength of her’s, in vain, which had so much better be reserved for the support of her in the time she will really need it. So that a midwife ought to make it her business clearly to distinguish the spurious pains from the true ones. Where a woman near her time feels pains in the belly, the loins, or even the sexual parts; they are not always to be taken for the true labor-pains. In this point, the _touching_ will be a great guidance.
IF the fœtus is still high in the uterus, and the situation of it does not indicate a readiness for extrusion; if the waters are not sufficiently prepared, or their pressure down not in due forwardness, the pains must be assuaged by some calming anodine remedies: the patient must be left to her rest, till things declare themselves more openly; and then, as she will not have been fruitlessly fatigued and tormented, the labor may proceed happily.
THERE have been men-practitioners so very unskilful, or at a loss for delivering women by the operation of their _hands_, that they tortured their _heads_ to discover _medicines_ to save themselves the tediousness of Nature’s taking her own time, as if she was to do her work the better for their hurrying her. Towards the atchievement of this end, they brought into play certain drugs, to which they gave the appellation of hysteric, and placed or pretended to place great confidence in them.
EVEN some of our modern practitioners prove, at least, by their practice, that they have faith in the virtue of such drugs, since they continue to use them. They are still suffered to make a figure in many of the Pharmacopœas, though no sure experience hitherto has verified their efficacy. On the contrary, a thousand and a thousand examples might be quoted in demonstration of their insufficiency and danger. I shall content myself with producing here the testimony of Mr. De la Motte, in the second book of his observations, and he is not the only man-midwife that does such medicines the justice of disapproving them.
_Observation_ 174.
“A CELEBRATED man-midwife of this town (says Mr. de la Motte) pretended to have a marvellous powder to provoke labor-pains, and accelerate parturition. This powder was composed of galbanum, myrrh, savin, rue, and other drugs, of which he made the patient take a dose, to hasten a delivery, when the labor was lingering, from half a drachm to a drachm, and after the effect of this medicine, which ended commonly in leaving the patient in a worse condition than before the taking it, he substituted the use of the crotchet, which was indeed an infallible method of putting a speedy end to the labor; and of which he as well as his fellow-practitioners made such a murderous use, the aid of the hand well conducted being unknown to them.
“THE same operator (says Mr. de la Motte) was sent for to assist a lady who had continued in labour for three days, to whom he proposed a dose of his powders, to which she readily consented in the hopes of a speedy delivery. Unluckily, not most certainly for the lady, but for the honor of the powders, the operator, not having had the providence of having them about him, was forced to go home for them. The lady, in the mean while, was brought very happily to bed, just as he was re-entering the room with his dose for her. What a pity this was! What would not have been the boast of the virtue of those pretious powders, if the delivery had waited for them but half a quarter of an hour, though they would not have had the least share in it, since it would have been purely the work of Nature and Time.
“THIS celebrated man-midwife was called to two other women of my acquaintance, of whom the labor somewhat resembled that of this lady, but of which the consequences were very different: he had made them take his powders to no manner of purpose, when seeing that a day had passed without their producing the expected effect, he had recourse to his _crotchet_, with which he quickly _dispatched_ both the deliveries.”
_Observation_ 174, of the same Mr. De la Motte.
“A GENTLEMAN who lived upon his fortune, without professing surgery, though he had served his time to it, and had even formerly exercised it, not only in France, but in Italy, and in other foreign countries, told me, in conversation, that he had an infallible remedy to make a woman bring forth instantaneously, however lingering and difficult her labor might naturally be. Of this, he said, he had made undoubted experiments, and that he had obtained this secret from an Italian, under oath of not disclosing it to any one. He was more than a little surprized at finding me without curiosity to learn from him this pretended secret, which he imagined must concern me so much, as one who made open prefession of the obstetrical art; and still greater was his surprize at seeing me change the subject, without any sign of attention to what he had been saying on this head.”
“IN process of time, he married, and his wife being pregnant was got into the time of her labor-pains towards delivery. It became now expedient for him to declare this famous secret to me, which was no other than half a drachm of borax in a glass of any innocent liquid agreeable to the palate of the patient. But as this dose happened to be administered by one who had no sort of faith in it, it had no effect: his wife lay four days and four nights in labor; the child died the moment after it was born, and the mother narrowly escaped following it.”
_Observation_ 176, (of M. De la Motte)
“AS I was at Caën, a town of Normandy, attending the lying-in of a lady there, an old stander of a practitioner of that place, and a man of good abilities, told me, that he had been lately sent for to a woman who had continued several days in labor, with slow and moderate pains. As he found the fœtus well situated, he made the patient take an infusion of three drachms of sena in the juice of a Seville orange, in order to quicken the throws and advance the delivery, which indeed came on ten or twelve hours afterwards, but the woman died, one may say, immediately after it.
“TO this account (continues M. De la Motte) I opposed, for answer, that being at Bayeux, on the like occasion, an old practitioner in surgery of that place, in conjunction with whom I had been called to visit a patient, told me, in conversation, that he understood midwifery very well, that he had even, not long before terminated a delivery given over by another surgeon; that the child, one arm of which hung out, was dead, before he put his hand to it, and that the mother, though well delivered, died soon after.”
THESE examples may suffice to prove, that the notion of giving histeric medicines, for which the inventors did not forget to make themselves be well paid, existed in M. De la Motte’s time, who is not but a modern author: nor are they even to this hour absolutely exploded, tho’ some of the men-midwives themselves have joined Mr. de la Motte’s cry against them. It gives however those men-practitioners, who exclaim against a quackery in others, by which themselves get nothing, a good sort of an air: it serves even to render that more pernicious quackery of their instruments the less obnoxious to suspicion. Nothing is easier to give up than that by which nothing is got. If the instruments were not a plea for the very essence of such a thing as a man-midwife, they too would be given up. However, it will hardly be denied, that those same pompous histeric medicines were the invention of _learned_ men-practitioners, and not of those poor ignorant midwives, who, with respect to women in labor, are of opinion, that there can nothing be more effectual for their well-doing, than in the first place giving Nature fair-play, and, when requisite, to assist her with the management of _natural_ hands skilfully conducted: always observing neither to lapse nor precipitate the critical time of such assistence. In the mean time, let a humane reader but reflect how many mothers and children must have been, and perhaps still continue to be the victims of a reliance in such medicines, and he will allow, that such errors of practice, tho’ not capital in the intention, are too often deplorably so in the effect. Is it not true to say, considering the havock of the human species, so presumably made by quackery and empiricism in general, that the lives of the subject are less sacred than their property? Surely they are less guarded, either by the laws, or by common sense.
AS to a fœtus that presents an arm, or any other part than the head or feet, there is rarely any thing to do but to slide the hand all along that arm, or other part it may present, to find out the feet, and terminate the delivery; without its being necessary to attempt the reduction of any part or member.
MOST of the writers on midwifery often start difficulties where there are really none. They often give us emphatical accounts of a head too large, and a passage too narrow, in which they state them as difficulties that are invincible, when the case is far from being so. When the fœtus presents fair, and is in a good posture, our method of practice is, to advise the patient to remain as quiet a-bed as possible, avoiding every thing that may tend to fatigue her body, or hurry her spirits, to reserve in short her strength as much as possible. With time and patience the head of the fœtus scarcely ever fails of moulding itself to the passage, through a particular providence of Nature, which has so ordered it, that the parietal bones of the head of the fœtus, so flexile as to ride over one another, form a kind of oval figure, which facilitates the issue, and dispose it for making way for itself, through the extrusive pressure of the labor-throws. Mean while nothing should be done to irritate the pains; the membranes should not be unnecessarily or untimely burst, which loses the benefit of the waters. You can hardly, in this case, rely too much on the benevolent efforts of Nature: she is constantly at work for the patient’s delivery. Interruptions sometimes only serve to mar or retard a favorable crisis: but all abrupt force or violence is carefully to be avoided. As to bad postures of children, I shall treat of them in the sequel, and of the means to remedy them.
Of DIFFICULT and SEVERE Cases.
IF an easy delivery requires nothing of extraordinary assistence; it is not so with a difficult one. All the knowledge, experience, dexterity, strength, prudence, tenderness, charity, and presence of mind, of which a woman is capable, are requisite to accomplish certain laborious deliveries.
IT has been, in all times, very well known, that the most natural situation for the fœtus coming into the world, is that, in which the head presents first, it being that which commonly makes way for the rest of the body. Yet this delivery may become difficult, in proportion to the obstacles incident to it: obstacles not always surmountable, without great skill and industry employed in aid of Nature.
ON the other hand, when it is felt that the fœtus presents any other part than the head, this position, called preternatural, oftenest occasions the delivery to be more laborious and hard to accomplish, in proportion to the more or less trouble there may be to search and come rightly at the feet.
MANY English and French authors have given us a long enumeration of the causes which may make deliveries difficult and laborious. The curious may have recourse to them; as for me, who have not proposed to myself here a treatise compleat on all points, I shall content myself with setting forth only what tends to fullfil my proposed aim, that is to say, to take notice of those principal points, which first moved insufficient midwives to call in surgery to their assistence, to remedy their blunders, to retrieve their mischief, or to repair their omissions. I shall consider the kinds of exigencies, which the men-operators seized for a pretext of employing their iron and steel-instruments, the use of the natural hand, being yet more unknown to them than to the meanest midwife, and by this means, for the cure of confessedly a great evil, obtruded an infinitely greater one, and more extensive, in every sense, and in every point of light, that of men taking the practical part of midwifery into their own hands, or rather into their artificial ones of iron and steel, from which they derive all the authority of their introduction in the character of men-midwives.
THE labors then which are generally speaking looked on the most nice, and arduous, may be comprized under the following heads.
1st. THE obliquity of the uterus or womb.
2dly. THE extraction of the head of the fœtus severed from the body, and which shall have remained in the uterus.
3dly. THAT labor in which the head of the fœtus remains hitched in the passage, the body being intirely come out of the uterus.
4thly. WHEN the head of the fœtus presents itself foremost, but sticks in the passage.
TO these I shall add the case of the pendulous belly, which is not without its difficulty.
OF all these classes of labors I shall treat separately. But before I proceed on them, I presume, that it may not be improper preliminarily to corroborate what I have said of the intrusion of the men into the practice of a profession, of the essential part of which they were so ignorant and disqualified for it, by the testimony which one of the best men-midwives in Europe has not refused to the truth.
THIS is M. de la Motte, one of the ablest and most intelligent modern writers on the subject of midwifery, of which his works form an incontestable proof. The ingenuity and candor with which he has written, must render him less suspected than any other. This is no midwife. He is a man, and esteemed an able practitioner, who learned the principles of the art from Madam la Marche, head-midwife of the Hôtel Dieu at Paris. He made his advantage of the works of his predecessors Mauriceau, Peu, and of all the best authors on this subject. All that was worth it in them he has transfused into his own writings; and that in a very clear manner. He collected whatever the best physicians had usefully said on the diseases of mother and child: in short, he has added many good observations and reflexions of his own, in the journals of his manual practice: the reading of his works, with some precaution however, cannot but be useful to the students of the art.