Part 18

AND it is not only requisite that the Woman in LABOUR be _touched_, before her _Pains_ come on, because then the _Membrane_ containing the _Humours_ being loose, the INFANT’s _Posture_ may be the better distinguish’d; but the same TOUCH also is to be continued during the _Force_ of the _Pains_, the better to know their _Nature_ and _Effects_; whether the INFANT continues still at the _Passage_ or not; and whether the _Humours_ are contracted _length-ways_, or press’d into a _Flat Form_, and the like. For after the _Pains_ are over, it is easily to be perceiv’d, whether they have _promoted_ the BIRTH or _Not_.

BUT during this _Performance_ of the TOUCH, great Care must be taken not to handle the _Membranes_ containing the _Humours_ too roughly, lest they should break in the Action.

NOW that the MIDWIFE may the more readily perform her TOUCH, she must take good Heed to what is said of the _Cavity_ of the[157] PELVIS: for as it rises from the _Bottom_ obliquely, ascending forwards; so, upon this Occasion, in seeking for the _Orifice_ of the WOMB, she must not thrust her _Fingers_ streight along according to the _Length_ of the Body, towards the bending of the OS SACRUM; but guide them _upwards_ from the _Bottom_, as if thro’ the VAGINA, she would touch the _Navel_: For Thus her _Hand_ being turn’d inward, and her _Fingers_ tending towards the _Navel_, the _Orifice_ of the WOMB lying directly in the way, she meets with it readily at first. Whereas they who go otherways to work, seek it in vain, and find it with Difficulty.

THIS Observation I thought the more requisite in this Place, because _MIDWIVES_ not accurately understanding the _Situation_ of the _Bones_ of the PELVIS, think that the WOMB and its _Neck_ or VAGINA reach according to the _Length_ of the Woman, and make use of their _Hands_ accordingly: First hurting the VAGINA and RECTUM in the Bending of the SACRUM; and then finding no farther _Passage_ for their _Fingers_; but being altogether ignorant of the above-mentioned Method of finding the said _Orifice_, they are very often surpriz’d, fall into great _Confusion_ for want of better _Instruction_. Whence I proceed to——

CHAP. XV. _Of the various Uses and Advantages of the TOUCH._

BY the TOUCH then, to be brief, the _MIDWIFE_ gains the certain _Knowledge_ of the following important _Heads_: viz.

FIRST, Whether a _Woman_ be with _CHILD_ or not: For I must needs own, that some of the most certain _Signs_ of _Pregnancy_ are discover’d by the _TOUCH_; since the WOMB shuts itself close up, immediately after CONCEPTION, and its _Orifice_ becomes more _pointed_, _hard_, and _solid_, resembling (according to _Mauriceau’s_ just Comparison) the _Mouth_ of a _Puppy_ newly pupp’d.

BUT in time of the _INFANT_’s ripening, this _Orifice_ begins to _swell_, and becomes _softer_, _smoother_, and _thinner_ than it was Before.

SECONDLY, The _MIDWIFE_ discovers by the _TOUCH_, whether the Time of BIRTH is near at hand, and how near it is. However, in speaking to this Point, I desire to be rightly understood, not meaning _Miscarriages_, or _Illegitimate BIRTHS_, but only such as are intirely _Legitimate_.

AS then the _INFANT_ advances in _Maturation_, so the _Orifice_ of the WOMB from the _Third Month_, grows _smoother_, _thinner_, and _softer_; and consequently the more _smooth_, _thin_, and _soft_ it appears at any time afterwards to the _TOUCH_, so much the _nearer_ draws on the _Time_ of BIRTH.

IN _some Women_, this _ORIFICE_ begins to open two or three _Months_ before BIRTH; and this _Aperture_ enlarging itself by degrees, becomes soon as wide as a _Shilling-Piece_, when the _Motion_ of the _INFANT_ may be distinctly perceiv’d: And in _others_ it is so much more enlarged, that one single _Pain_ or two accomplishes the BIRTH.

BUT as all _Women_ are not _alike_, so this _RULE_ will admit of sundry _Exceptions_; for _strong-body’d_ Women, Women of their _First Child_, and those somewhat in Years, their WOMBS continue generally shut up to the last, and open not without the severest _Pains_: And not only so, but the _Orifice_ of the WOMB differs also, in all difficult and _Preternatural Cases_, as well by reason of its own _oblique Situation_, as of the _INFANT_’s ill Posture. For this Reason it is, that an Experienced and Judicious _Hand_ is most requisite upon such Occasions; since such an _One_ can clearly distinguish, what _Another_ cannot so much as guess at.

THIRDLY, The _MIDWIFE_ immediately knows by the _TOUCH_, whether the Woman be taken with the real and genuine LABOUR-PAINS or _Not_. Which is a Point of the _greatest Moment_; since as it is of bad Consequence to _delay_ the BIRTH, when the Woman is so taken, especially if the _WOMB_ and _INFANT_ be _Both_ well situated, lest the _Pains_ should vanish, and the Opportunity of DELIVERY should thereby be lost: so, on the other hand, to force a Woman to LABOUR, unseasonably, when but seiz’d with _Bastard-Pains_, is a most pernicious Thing.

BUT both these _Cases_ too often happen, even to the _Hazard_, if not the _Loss_ also of both LIVES; especially the _Latter_, when the _MIDWIFE_ does not know how to distinguish these _False Pains_, either the _Cholick_, or other _Gripes_, from the _genuine Pains_ by the _TOUCH_: As will be more fully and amply explain’d in the next following _Chapter_.

GIVE me Leave to say then, that BIRTH is not to be provok’d by any Means, until the _MIDWIFE_, by touching the _Orifice_ of the WOMB, is certain, that the Woman labours under the _True Pains_; which is not to be judiciously suppos’d to happen before the _Seventh Month_ at soonest.

_BIRTH_ at that Time approaching, the Woman is afflicted with great PAINS in her _Groin_, _Loins_, and about the _Navel_, tending downwards with a depressing Force upon the WOMB and other _Private Parts_. But these PAINS are not continual, for they only go-off and come-on by _turns_; at which Time, by their violent _Depressure_, the _MIDWIFE_ finds the _Orifice_ of the WOMB _open_, or at least _opening_, and upon Renewal of the PAIN, she finds it more and more dilated and relaxed: whereas, on the other hand, when the PAINS are _Spurious_, they disperse themselves through the whole _Body_, as well as the _Abdomen_; and then the WOMB (as if it were securing itself) is found more closely _contracted_.

FOURTHLY, It is likewise well known by the _TOUCH_, whether the BIRTH will be _Easy_ and _Speedy_, or _Difficult_ and _Lingring_, on several Occasions: 1. When the _MIDWIFE_ finds the _Head_ of the INFANT and the lower Part of the WOMB fallen into the _Cavity_ of the PELVIS, so that _She_ can touch it in the Confines of the VAGINA: 2. When the _Orifice_ of the WOMB is very soft, thin, and wide-open, so that (through it) she finds the _Head_ of the INFANT foremost, without any Obstruction by the _Arms_ or _Umbilical Vessels_ in the way, between the _Head_ of the INFANT, and _Orifice_ of the WOMB; as often happens: And, 3. When the _Humours_, by the _right Situation_ of the WOMB and the INFANT, are found compressed into a _Flat Form_. I say, when Matters are found so (by the _TOUCH_) in this _Natural Posture_, there is no great doubt (under GOD) of a _Speedy_ and _Easy_ DELIVERY.

WHEREAS, on the contrary, when the _Orifice_ is found by Experience _higher_, _little_ or not at all _open_; _sharp_, _hard_, and _thick_, with the _Humours_ pressed up length-ways: _Then_ the _Case_ is quite revers’d, and the _MIDWIFE_, if she _understands_ her Business, must resolve to _sweat at her Work_.

NOW the Reason of such _Difficult_ BIRTHS commonly proceeds, either from the _wrong Situation_ of the INFANT, or _That_ of the WOMB; the _latter_ of which always occasions the greater _Difficulty_, especially when it is accidentally join’d with the _First_, to a vast Degree of _Aggravation_: Of which, as follows of course.

FIFTHLY, Another _Advantage_ of the _TOUCH_, is the truly Knowing whether the INFANT be in a _Natural_, or _Preternatural Posture_. For the _MIDWIFE_ finding the _Orifice_ of the WOMB so _open_, that it admits one or two _Fingers_, she may distinctly feel the _Chin_ of the INFANT in a _Natural Position_, lying forwards on its _Breast_, and the _Neck_ in the _Middle_ of the _Orifice_, or streight _Before_ it; so that the _Head_ being foremost and lowest within the Borders of the _Orifice_, the _Fingers_ cannot pass any _Farther_.

HOWEVER, supposing the _Clunes_, _Knee_, or _Elbow_, to present themselves _First_ in the _ORIFICE_; It is true, they have their _Roundness_, but then they are easily distinguished from the _Head_: For the _Globular Part_ of it is much _broader_ and _smoother_, than either _Knee_ or _Elbow_, and _harder_ than the _Buttocks_; which _Fleshy Part_ is soon distinguished from the _Bones_, or the _soft Membrane_ betwixt the _Bones_ of the HEAD.

BUT as a capable _MIDWIFE_ can hereby distinguish all _These_ with Facility, even before the _Waters_ begin to flow; so I need not mention the _Hands_, which distinguish themselves by the _Fingers_, as the _Feet_ do, by the _Toes_ or _Heels_; and the _Navel-string_ discovers itself by its _Softness_, _Thinness_, and _Roundness_: All which, however yet, are more easily known when the _Membrane_ is broke, and the _Waters_ have actually flown. For the _Parts_, which were before covered with this _Membrane_, lie now naked in the _ORIFICE_: Hence it often unluckily happens, that _few MIDWIVES_ make an exact _Scrutiny_, about the _Situation_ of the INFANT, till this Time of FLOODING; erroneously thinking they are then _soon_ enough, which is an unaccountable Mistake; as will hereafter abundantly appear.

SIXTHLY, It is perfectly known by the TOUCH, whether the WOMB be in a _Natural_ or _Preternatural Posture_, as is plainly taught more at large in the foregoing _Chapter_.

FINALLY, in short, we most assuredly know by the TOUCH, what is proper to be done in all _Preternatural Cases_, upon giving _Assistance_ both to the MOTHER and INFANT; as hereafter will fully appear by a more copious _Dissertation_ to that Purpose.

CHAP. XVI. _Of the Genuine and Spurious LABOUR-PAINS._

THE sole Reason I add this _Chapter_, is, because our common _MIDWIVES_ are so often mistaken, and do so frequently err in this _Point_, having no thorough-pac’d _Knowledge_ of either sort of these _PAINS_: For when she comes to a Woman, taken ill with severe _PAINS_ in the _Belly_ or _Loins_, being ignorant of the accurate Nicety of the TOUCH, she presently concludes _These_ to be the true _labouring PAINS_, because they indeed often resemble them very much; and she farther finding perhaps the _ORIFICE_ a little _relax’d_ and _open_, expects it to enlarge to her Satisfaction. Which, however, not answering her Hopes, nor the _PAINS_ encreasing; she endeavours by _stimulating Medicines_ and other sinistrous _Means_, conformable to the perverse _Rules_ of her PRACTICE, to raise and provoke _Them_: So that this, in short, is the _Cause_, not only of many an _untimely BIRTH_, but also too commonly of many an _untimely DEATH_.

NOW the _Wind-Cholick_, either in the Lower or Upper Part of the _Belly_, occasions frequent racking _PAINS_, as do also the HUMOURS by Virtue of their _Acidity_, corroding the _Intestines_; and these _Mordacious PAINS_ are generally attended with a subsequent _Looseness_. In which _Cases_, I always use proper _mitigating_ and _repelling_ MEANS, (such as a _Carminative_ and _Emollient Clyster_, &c: upon extreme Occasions); which proper _Means_ infallibly answer my Ends in either Condition. For if the _PAINS_ that afflict the Woman are _Spurious_, They are thereby suddenly _laid_ and repressed; and if _Genuine_, These very self-same _Means_ most effectually promote and advance _them_ to _BIRTH_.

BUT again, _some Women_ are taken with a mix’d Complication of _Genuine_ and _Spurious_, or _Real_ and _False PAINS_, that are properly called _Tergiversant_; which one Moment seem to _depress_ the _BIRTH_, and _encourage_ the Woman to LABOUR; and the next convert themselves into scatter’d CRAMPS, and other contracting _PAINS_: And these dispersed _Bastard-Pains_ are always more pernicious to the Woman, than the most severe _natural_ LABOUR-PAINS: _This Case_ is also easily distinguished by the TOUCH; which done, the _false wandring Pains_ are first to be assuag’d or carry’d off, before the _BIRTH_ can well succeed.

NOW, as to the real _Natural_ and _Genuine Pains_, They are, (methinks) in short, easily to be judged of by the _Manner_ in which they always seize the _Woman_; viz.

I. FROM the _Navel_ downwards to the _Groin_, reflecting towards the _Loins_, with a depressing and bearing down upon the WOMB and PRIVITIES, as occasionally mentioned in the preceding _Chapter_: And tho’ _These_ are intermitting (not _continual_) _PAINS_, yet their Severity and Violence extenuate the _Umbilical_, and protuberate the _Genital Parts_, opening and distending the _Passages_. But besides, as the _Blood_ is exagitated and fermented, it excites a Velocity of PULSE, and a _Redness of Face_; whilst the BELLY waxes _Fiery-hot_, and a _Feverish Shivering_ or _Trembling-Fit_ invades the _whole Woman_, especially the inferiour LIMBS, but without any _Frigidity_.

II. THE _Membranes_, with their _Contents_, which _MIDWIVES_ commonly call the _Gathering of the Waters_, now present themselves at the _Orifice_ before the _Head_ of the INFANT, resembling (to the TOUCH) _Abortive Eggs_ without any SHELL: upon _These_ breaking, the _Waters_ begin to flow; at first more _Sparingly_, but by and by more _profusely_, and at last a _waterish Blood_ follows, when a _GIRL_ is to be born; or a _pure-colour’d Blood_, when a _BOY_: But I also farther distinguish the _BIRTH_ of an approaching _BOY_ from _that_ of a _GIRL_, by the _Labour-Pains_; for in the _first Case_, these are far more severe and penetrating, and accordingly the _BIRTH_ much more expeditious, than in _Case_ of a _GIRL_: In which (however) the _PAINS_ are more constant and regular.

III. AND now, at last, the _OSSA COCCYGIS_ and _COXENDICIS_ begin to yield, and give way; while the _Bottom_ contracts, the _Orifice_ of the WOMB opens, and the VAGINA dilates itself fully: So that _now_, and not _before_, most of the abovesaid _Signs_ evidently appear, I give my patient _Woman_ the WORD to _Labour her best_; because if she begins _sooner_, she too much debilitates both _Herself_ and fatigues the _CHILD_ before its due Time.

MOREOVER, I have seen _some Women_ in LABOUR taken with a sudden _Vomiting_, that I suppose proceeded from the _natural Sympathy_, which the STOMACH bears to the WOMB: Whereupon it discharges a certain _Viscous Matter_, which I have always observ’d, upon its turning _Bloody_, to presage an easy _LABOUR_, and an expeditious _DELIVERY_.

FARTHER yet, the _MIDWIFE_ must always remember, that when the commenced _real PAINS_ of _Labour_ chance to cease, the Woman’s _Labouring Efforts_ must also terminate with them in Course: And as this _Case_ denotes a _Debility_ of the _Expulsive Faculty_; so if it be not both _Timely_ and _Judiciously_ assisted, It may prove of the worst of Consequences. In a word, so much I have thought previously _necessary_ to my Purpose, before I enter upon——

CHAP. XVII. _Of the True Method of LAYING the Woman._

UPON this Occasion, the _MIDWIFE_ ought, in the _first place_, carefully to observe the CONTENTS of the foregoing _Chapter_; and, _Secondly_, To follow this general RULE, which I lay down out of absolute _Necessity_: viz. _That the Woman be delivered, and the Child brought forth into the World as soon as possible after_ FLOODING; and _that_ because the WOMB immediately, after _This_ is over, falls, shrinks, and contracts itself again, and of Consequence compresses the _BIRTH_ very closely.

BUT in order to effect _this_ Matter, as much depends upon the right _Situation_ or _Placing_ of the WOMAN; so I advise, in the first place, that, as soon as the WATERS begin to flow, _She_ be commodiously _placed_ either in a BED, CHAIR, or STOOL, properly adapted for that Purpose, and _laid_ with great Skill and Judgment, not too _Supine_, nor altogether _Upright_; but (as it were) between a _standing_ and _lying Posture_: having her _Back_ a little erected for the freer _Respiration_, and the better LABOUR; with her _Thighs_ at a due Liberty and Distance, only separated as much as possibly they may; her _Knees_ a little elevated; her _Feet_ stayed against something _Firm_, and her _Heels_ bending _Backwards_.

HOWEVER I must farther observe in this place, that the _POSITIONS_ of _parturient Women_ are very various and different; _some_ doing this _Work_ (as above) in a _Bed_, _others_ in a _Stool_, and _some_ again I have seen deliver’d _standing_, and _leaning_ only a little _Forwards_ upon the _Bed-stead_. Hence, I say, that the _POSTURES_ in time of LABOUR, differ not only according to the _Necessity_, but also sometimes (in _Natural Easy Cases_) according to the _Custom_ of the WOMAN.

BE that as it will, I would advise all _Labouring Women_, FIRST to make _Choice_ of a dextrous and ingenious _MIDWIFE_ to attend them at that _critical Juncture_, since the poetical _Proverb_ (_Accidit in puncto, quod non speratur in Anno_) holds as True in _BIRTH_ as in any _Case_ I know; for _some Women_ after having sundry repeated Natural easy _BIRTHS_, come at last to suffer by some difficult or _preternatural Accident_, which may happen in a _Moment of Time_.

SECONDLY, I would advise all _parturient Women_, to give themselves over into the Hands of such a _MIDWIFE_, to be universally _advised_ and _entirely_ directed by her Conduct: And thus being under the watchful _Eye_ and diligent _Care_ of the prudent and skilful _MIDWIFE_, the good _Woman in her Travail_ has Nothing else to do (besides following _Instruction_) but only to assume _Courage_ and _Resolution_ to assist her own _PAINS_ as she feels them coming on, by _drawing_ and _holding_ her BREATH, as if she was to _sob_ or _sigh_, by contracting the _MUSCLES_ of her _Belly_, as much as possible; insomuch that the forcible _Impression_ may bear alike upon each side of the WOMB, and depress the _Diaphragma_, which (of Consequence) suppresses the WOMB. But then again in this _Case_ I would observe briefly, that she is strictly to regard the _TIME_ of a _right true Travail, as at that Juncture_ only to use _these_ her best and strongest _Endeavours_.

BUT now to return to the _Duty_ of the attending _MIDWIFE_; as occasion requires, She is to direct her WOMAN, either to _lie_, _sit_, _stand_, or _walk_, keeping her always _Warm_, and as close _cover’d_ in Time of TOUCHING as possible; for the least Breath almost of _Cold Air_ may occasion _Convulsions_, and _other_ most dangerous _Accidents_.

BECAUSE I have often observ’d _Women_ to be _Costive_ and bound in their _Bellys_ upon this Occasion, which is of dangerous Consequence, I would therefore advise in this _Case_ to adhibite a gentle _Emollient Clyster_; not only that (by the RECTUM being so emptied) there may be the more _Room_ for the necessary _Dilatation_ of the _PARTS_, but also that the unfortunate _Effects_ of COSTIVENESS may be timely prevented: And the same _Means_ I would use, in Case of _Heavy_, _Dull_, or _Languid PAINS_; ordering the _Clyster_ only in this _Case_ to be made a little more _Carminative_; as mentioned in the preceeding _Chapter_.

BUT _this_ however I would have done in the _Beginning_ of the _Travail_, and reiterated (if need so require) before the _CHILD_ be advanced too far _Forwards_.

NOW the _MIDWIFE_ finding all things in a _Natural Posture_, and the CHILD in a _Forward way_, is to advance her _Hand_ skilfully, (which at every individual TOUCH ought to be fresh-anointed with the _Oil_ of white _Lillies_, _Roses_, &c. or _Fresh-Butter_, _Hogs-Lard_, or whatsoever of this Nature is readiest at Hand) entering the _ORIFICE_ with the _Fingers-Ends_, dilating it by opening _them_ gently as the PAINS come on: Thrusting gradually the _Sides_ of the _ORIFICE_ towards the _OCCIPUT_ or Hinder part of the CHILD’S Head, and moistening these _Passages_ also with what she uses for her _Hands_.

WHEN the _VERTEX_, or _Crown of the Head_, appears without the _Privities_, the _MIDWIFE_ most commonly calls out or says the CHILD is in the _Passage_; and the _parturient Woman_ then finding these Parts (as it were) scratch’d or prick’d with PINS, often groundlessly imagines that her _MIDWIFE_ deals roughly by _Her_ with _Nails_ and _Fingers_; whereas that _Pungency_ is only occasioned by a violent _Distension_, or perhaps a _Laceration_, sometimes inevitably made, by the BULK of the _Head_ of the _INFANT_.

HOWEVER that be, and whatever the _Woman_ may think or say, the _MIDWIFE_ is only to mind her own Business, and discharge her Duty faithfully upon this _CRISIS_; in order to which, it is now High Time that she also place herself in a convenient _Posture_ to receive the _BIRTH_: Which (when advanced as far as the _EARS_, or _thereabouts_) she is to take gentle hold of, by _both Sides_ of the _HEAD_ with _both Hands_; so that by this _Means_ she may be ready and able, against the first _Onset_ of the next good PAIN, to draw forth the CHILD. In doing whereof, she must take special _Care_ that the _NAVEL-STRING_ be not entangled about the _Neck_, or any other _Part_, lest the _Secundine_ or the _Womb_ itself thereby suffer Violence, and consequently cause either _Flooding_, or break the _String_, which may render the _Case_ dangerous and the _BIRTH_ difficult.

BUT in thus attracting the _INFANT_, the _MIDWIFE_ must carefully observe, not to draw the _HEAD_ straight-forwards, but move it gently from _Side to Side_, that the _Shoulders_ may the more readily and easily take Place: For _these_ must immediately follow the _HEAD_ without _Loss of Time_, otherways the _BIRTH_ may be strangled in the _Passage_ by the _WOMB_ shutting upon its _Neck_: To prevent which _Tragical Catastrophe_, the Cunning Expert _MIDWIFE_ directly slides in her _Fingers_ under the _Arm-Pitts_, and then draws discreetly the _BODY_ forth without any Difficulty or Danger.

_THUS_, in fine, We have discreetly deliver’d our good _WOMAN_, in _Case_ of a _Natural Easy Birth_; but on the other Side, in difficult and _Preternatural Cases_, the several Conditions and Circumstances will mightily differ from the Beginning; because in _these_ the _PAINS_ are not always sufficient to produce the _BIRTH_. Hence it is sometimes more convenient for the _WOMAN_ to be _Passive_, rather than _Active_; especially when the POSITION of either the _Womb_, or the _Infant_ is _Preternatural_: For then it is the _MIDWIFE’s_ whole Business to _labour_ more than the _WOMAN_; then her ingenious TOUCH is of infinite Service to the _PARTURIENT_, since by that only she can distinguish the Degree of the _Ill Situation_ whether of the _CHILD_ or the _WOMB_. Which being dextrously done, _She_ is in the next Place, prudently to consider what kind of _POSTURE_, _Sitting_ or _Lying_, is most convenient, that she may the _better_ discharge her own good _Office_ and _Duty_: Of which I shall treat more particularly in the following respective _Chapters_; since it still remains here, by the way, that we also deliver our above-mentioned _Woman_ of her AFTER-BIRTH, _&c._

CHAP. XVIII. _Of the Method of Extracting the SECUNDINE_,

&c.

AFTER all, to perfect or finish the _Woman’s DELIVERY_, it still remains that _She_ be freed of her AFTER-BIRTH, or SECUNDINE. Now this I advise to be done with all imaginable Speed, after the CHILD _is born_, even before the _NAVEL-STRING_ is cut: Because the WOMB immediately _contracts_ itself, so that _This_ cannot be accomplish’d afterwards without great _Difficulty_.