Part 20

A SECOND _External Cause_ may proceed from the _Passions_ of the Will or Mind, as it often does from _Fear_ and _Despair_, _Dejection_ and _Pusillanimity_: In which _Case_, it is the _MIDWIFE_’s Duty to encourage her WOMAN by the Hopes of a _Speedy DELIVERY_, and doing well under GOD’s Blessing. When the Cause arises from _Anger_ or _Sorrow_, these are to be assuaged by the repeated _Christian Exhortations_, and _Friendly Admonitions_ of the MIDWIFE and GOSSIPS. When it comes from _Pride_ and _Obstinacy_, as has been the _Case_ of some _Lofty Women_; who (deeming themselves too good, to be treated after the _common Course_ of Mankind) have refused to undergo or permit the proper _Means_, absolutely necessary for their own _Relief_; THIS ought to be severely check’d by the _Company_, especially by the _nearest Friends_; the MIDWIFE (by proper _Remonstrances_) convincing her to her Shame of her obstinate SIN. When it proceeds, in fine, from _Bashfulness_ or too strict a _Modesty_, she may be justly reprehended of _Folly_; for no Woman of good SENSE (how _Modest_ and _Virtuous_ soever) will expose her own _Life_ or her INFANT’s to _Danger_, for the trifling _Fancies_ or _Caprices_ of her own vain Imagination, especially in a _Case_ where _like things happen to All_ equally of Flesh and Blood.

BUT when it happens to proceed from the _Woman_’s being ill-affected, or owing a private _Grudge_ or _Hatred_ to any in the _Company_, (as I once knew it to be the _Cause_ of a difficult and lingring _BIRTH_) _She_ ought to speak her Mind freely, at least to her _MIDWIFE_; who ought to give the _Person_ civil Notice to retire forthwith, for certain Reasons, _&c._

A THIRD _External Cause_ of a _difficult BIRTH_ may proceed from a _wrong Position_, or other _sinistrous Methods_ taken to assist the WOMAN: In which _Case_, such _Inconveniencies_ are to be alter’d, and better _Measures_ practis’d; for _thus_ the _Cause_ being removed, the _BIRTH_ differs in Nothing from _That_ of the _Natural Easy Case_.

WHENCE I come, in the next Place, to speak of _Difficult BIRTHS_, proceeding from _Internal Causes_; and because they are _Three-fold_, as has been before observed, I shall assign them as many respective _Chapters_, treating of _Each_ in their due Order, as mentioned.

CHAP. V. _Of Difficult BIRTHS, proceeding from Causes of the MOTHER._

IN _this_ (as in the _former Case_) the MIDWIFE must use her most acute and nicest _Judgment_, to find out the particular _Cause_ of the _Difficulty_. Which being done,

I. IF _She_ finds it arises from the WOMAN’s being too _Young_, or too _Old_, of her _first Child_, or too _Lean_ at last; _she_ is to anoint the _Passages_ with proper _Unguents_, which ought to be done some time _before_, as well as in the _Hour_ of _LABOUR_: When _she_ is likewise to employ her _subtile Hand_, in assisting and augmenting the _Dilatation_ of the _Orifice_; as is requisite also in _Case_ of the WOMAN being too _Fat_ or _Gross_.

II. IF the WOMAN be too _small_, _short_, _crooked_, or _misshaped_, not having a _Breast_ strong enough to forward and bear down her _PAINS_; or if she be over _tender_, _sensible_, and _apprehensive_ of _PAIN_; or too _weak_, and not _able_ to contribute or assist by her own forcing _Endeavours_; or _short-winded_, and not capable to constrain her _Spirits_ downwards: In all these _Cases_ she is to be kept _upright_, for the more free _Respiration_, as well as for encreasing her _PAINS_, _standing_ or _walking_ about the Room, according to her _Strength_, being supported under her _Arms_, and not put to BED until at least the _WATERS_ are broke. But, in the mean Time, the _weak_ and _tender_ WOMAN ought to be now and then comforted and refreshed with _fresh soft Eggs_, good _Broths_, _Jellies_, a little _Wine_ and _Toast_, a little _Wine_ and _Water_, or such like convenient _Things_, as well as with the _Hopes_ of a _speedy_ DELIVERY.

III. WHEN the _PAINS_ are not _Natural_ or _Genuine_; but _Spurious_, _Faint_ and _Languid_; or _Shifting_ and _Tergiversant_; such are to be assuaged by proper _Lenitives_ and _Anodynes_; which being regularly done, the _Genuine Pains_ may be excited by proper _Clysters_, and divers other Means. But I would advise none to a _Profuse Use_ of _MEDICINES_ in such _Cases_, since I well know that many a WOMAN has lost her _Life_ by using _dolorifick Medicines_, prescribed by imprudent _MIDWIVES_, without considering, or so much as knowing the true Circumstances of the _Condition_: Whereas in most _Cases_, by the ingenious _Motion_ of an _Experienc’d Hand_ only, the PAINS may be sufficiently awaken’d, and the BIRTH safely promoted.

IV. WHEN the _Difficulty_ proceeds from the _Debility_ of the WOMB, or its _Expulsive Faculty_, not being able or capable to _Exclude_ the _INFANT_, because of a more strong and valid _Retentive Power_: In this _Condition_, if there be no evident _External Cause_ to be obviated, it depends chiefly upon the _Subtile Hand_ of the _MIDWIFE_, to assist the WOMB in its _Function_; and otherways the _PATIENT_ is only to be treated as in the _Case_ of the _weak_ and _tender_ WOMAN above-mentioned.

V. WHEN the WOMAN is taken with any _Acute Disease_, the _BIRTH_ is to be prompted by all safe _Means_; and if a _Natural DELIVERY_ does not presently succeed, an _Artificial_ one must (without Loss of _Time_) be undertaken. As in the _Case_ of immoderate and continual _Floodings_, with concomitant _Convulsions_, which always proceed from the Separation of the _SECUNDINE_ (either in whole or in part) from the WOMB, and happen many different ways, as already mentioned at large[165].

IN these _Cases_, especially if the SECUNDINE is found (by the TOUCH) at the _Orifice_, there is no Hope of _Stopping_ them by any other _Means_, than by _delivering_ the WOMAN; which now the _sooner_ done, the _better_ (for saving two _Lives_) and _that_ whether at full time of _Reckoning_ or not. But this _Operation_, I conceive, is to be most discreetly _Undertaken_ in the manner following, _viz._

THE _Woman_ is to be placed in BED, with the _Upper_ and _Lower_ Part of her Body almost _equal_, then the MIDWIFE is gently and gradually to introduce her _Fingers_ into the _Orifice_, dilating it cautiously with _one_ or _two_, until she can enter them _All_; when opening the MATRIX by Degrees, she gets in her _Whole Hand_, and thereby _first_ carefully tears the _Membrane_ with her _Nails_, if the _WATERS_ are not previously broke: Then she puts her _Hand_ in the same _Membrane_ to the INFANT’s _Feet_, seeking them in their _Place_, where they are to be found, when they don’t present themselves at _First_: Because, the _Hold_ by the _FEET_ being _Better_, it is more easy to _deliver_ by _Them_, in this Case, than by the _HEAD_, or any _other Part_. After _this_ the _FEET_ being found, the CHILD is easily _turn’d_, as long as the WOMB is loose and slippery, and the _Humours_ not quite flown off; which being nicely done, the _FEET_ are to be drawn out _both together_, if possible; but if otherways, _they_ must be drawn down _separately_, with _great_ Caution: And so being conjoin’d or held fast together, they are to be drawn forward with _one Hand_, whilst the _other_ is circumspectly thrust towards the _Knees_ or _Buttocks_ of the CHILD, in order thereby to turn also the whole Body of the INFANT, so that its _Face_, _Belly_, and _Toes_ may tend downwards towards the _RECTUM_.

IN this _Posture_ the CHILD may be gently and gradually extracted with Ease; next the _SECUNDINE_ must be fetch’d away in its Turn, and lastly the WOMB is to be thoroughly cleans’d of all _heterogeneous_ Bodies, as formerly directed[166]. And thus the WOMB (having yielded up its _Contents_) immediately contracts, by which _MEANS_ of divine Appointment, the Vessels close and shut firmly, and consequently the _FLUX_ ceases, together with all the concomitant _SYMPTOMS_.

BUT it is to be well remembred, that this _Operation_ ought to be _timely_ perform’d; that is, before the WOMAN has lost too much _Blood_, or is too much spent; in which _Condition_ such a painful Attempt would but accelerate her _Death_. As to her _Regimen_ next, upon this melancholy Occasion, _She_ must be duly provided for _beforehand_, that she may be able to undergo and stand out such an extream difficult _DELIVERY_; and afterwards, that she may recruit her _Spirits_, and retrieve her exhausted _Strength_: For which Purposes, she ought to be supplied from time to time with some good _Broths_, _Jellys_, and a little generous _Wine_, smelling continually _Rose-Vinegar_, and applying repeated warm _Toasts_ dipt in _Wine_ (in which _Cinnamon_ has been infus’d or boil’d) to the _Region_ of her HEART, as also _Napkins_ dipt in a Mixture of _Water_ and _Vinegar_ about her REINS, in order for turning the _Course_ of the FLUX.

THESE Things being all duly and artfully perform’d, the PATIENT (under God) will soon _recover_ and be _in Statu quo_. Now _These_, in short, are all the _principal_ and most common _Causes_ of _difficult_ BIRTHS proceeding from the part of the MOTHER; which being thus discussed with all Brevity, I go on to——

CHAP. VI. _Of Difficult BIRTHS proceeding from Causes of the INFANT._

IT sometimes also happens, that the _Difficulty_ in LABOUR arises from the INFANT: And _that FIRST_ when _Two_ or _More_ strive for _Priority_ in _BIRTH_.

NOW this _Condition_ the MIDWIFE can no otherways distinguish or discover, but by the TOUCH; and when the _one_ is more _forward_ than the _other_, ’tis not to be done or known, until she has even _touch’d_ the very _Fund_ of the WOMB: Because sometimes it so happens, that _One_ CHILD has its _Hands_ and _Feet_ so intermix’d, that whatever way _She_ turns her _Hand_, she finds _Legs_ or _Arms_, _Hands_ or _Feet_, which often deceives MIDWIVES, believing there are _TWINS_. But in this perplex’d _Case_ the most sure and only certain _Sign_, is, when she feels _two Heads_ or _two Backs_; for then she cannot be Mistaken, since _one Body_ cannot have _two Heads_, unless it be a MONSTER, which may be soon discover’d by feeling if the _double Head_ be fix’d to _one_ and the _same Body_.

BUT in the _Case_ of _TWINS_ or _more Children_ (as long as they come right) the DELIVERY is perform’d, as if the _Woman_ had but ONE, in the _Natural Case_ already Stated; so that I shall repeat or recapitulate Nothing of what I have said, only that the AFTER-BIRTH, or BIRTHS are not to be _touch’d_, until all the _CHILDREN_ are Born: Upon which drawing gently the _Navel Strings_ (in their Turns) with the _One Hand_, the _Other_ brings them forth easily and orderly; as is set forth more fully in SECT. IV. _Chap._ 18.

A SECOND _difficult LABOUR_ may proceed from the _Weakness_ and _Debility_ of the INFANT, or from its being too _Small-grown_; in which _Case_, both the WOMAN and the MIDWIFE are to use their best mutual _Endeavours_ to promote the _BIRTH_, since the _CHILD_ can do little or nothing for itself, and the _Less_ it is, the less it is affected with the _THROWS_ of the _Mother_, and the less _Impression_ her Impulses make upon it: Whereupon _Nature_ is to be assisted in this weak _Condition_ by all convenient _Means_, whereof _THAT_ of the _Agile_ or _Nimble Hand_ is the most effectual.

A THIRD _difficult BIRTH_ may proceed from the INFANT’s being too _Big_; In which Place I must previously apprize the _READER_, that I no ways mean a _MONSTER_ or _Hydropical CHILD_, but only _One full_, _well_, or _Big-grown_, which is only reckoned too _Big_ in regard of the _Maternal Passages_, which may be too _Small_ in Proportion.

IN this _Case_, there is an absolute Necessity for _Manual Assistance_, since the PAINS (however penetrating or forcible) cannot effect the _Work_. But and if the _INFANT_ is fallen down (well turn’d) into the PELVIS, the MIDWIFE using her best and most skilful Endeavours to _dilate_ the _Passages_ below near the OS COCCYGIS, the CHILD may be easily brought forth (without any dangerous _Instrument_) by her dextrous _Hand_ only accomplishing the _Work_. In the mean Time, however, it is to be minded always, that _This_ is still more safely and commodiously done by the FEET, than by the HEAD, after carefully dilating the OS COCCYGIS, taking this Opportunity in the beginning of the LABOUR, before the _INFANT_ is too much press’d down into the PELVIS.

NOW _these_ are, in fine, the most common _Causes_ on the Part of the _INFANT_, whence I come to touch upon _difficult BIRTHS_, proceeding from _Causes_ of the _Passages_; which, because they are various, I subdivide into a _Fivefold Diversity_; viz. _Difficult BIRTHS_, proceeding from _Causes_ of the MEMBRANES, from _Causes_ of the PELVIS, from _Causes_ of the BONES of the PELVIS, from _Causes_ of the BLADDER and RECTUM, and from _Causes_ of the VAGINA: And because all these require to be singularly explain’d, and particularly insisted upon, I shall assign them as many respective _Chapters_. And _First_——

CHAP. VII. _Of Difficult BIRTHS, proceeding from Causes of the MEMBRANES._

SUCH _Difficulties_ as These, in _BIRTH_, may arise, _FIRST_ from the _Strength_ and _Firmness_ of the MEMBRANES; when they happen to be so _gross_, _callous_, or _thick_, that the _INFANT_ cannot easily break through them.

In this _Case_, when the _MIDWIFE_ finds the _Orifice_ of the WOMB sufficiently dilated, for the _Circumference_ of the HEAD, and the CHILD so forward in the _Passage_, that it is ready for _BIRTH_, and only impeded by the rigid or stiff MEMBRANE; then _she_ has just Authority to break it gently with her _Nails_ and _Fingers_; taking Care in the ACT not to draw the MEMBRANE towards _her_, because thereby the SECUNDINE (of which the MEMBRANE, tho’ distinguish’d from the PLACENTA, is in Effect, but the _Thinner Part_) would be untimely separated from the WOMB, and the _INFANT undone_, unless presently _Born_.

BUT the _MIDWIFE_, after All, must always remember, not to attempt _This_, before these mentioned _Signs_ are obvious to her TOUCH; otherways the WATERS being too soon discharged, the _CHILD_ is left behind, the _Passages_ grow dry, and _that_ which might have been an _Easy_ and _Speedy_, proves a _Difficult_ and _Lingring BIRTH_.

AND the self-same _Consequences_ arise from the _Weakness_ and _Tenuity_ of the _MEMBRANES_; when they are so _thin_ and _soft_, that they break, and the WATERS (which are destin’d to lubricate and moisten the _Passages_) flow before their Time: In both which _Cases_, the _Office_ of the WATERS must be supply’d by proper _Fomentations_, and _Oils_, which (however costly) falls far short of the _Effect_ of what is so _Natural_. However, in short, neither of these _Conditions_, under the diligent _Hand_ of the expert MIDWIFE, can differ far from the _Case_ of an _Easy BIRTH_, as already defin’d; wherefore I proceed regularly to——

CHAP. VIII. _Of Difficult BIRTHS, proceeding from the Causes of the PELVIS._

DIFFICULT _BIRTHS_ on part of the _Passages_, happen frequently, because of some perverse _Form_ of the _PELVIS_, in these Respects; as by its being either too _Large_, too _Narrow_, or too _Smooth_. But that I may be the better understood in this Matter: _FIRST_, by a _PELVIS_ too _large_, I mean such an _One_, as is so in comparison with the WOMB or INFANT; in which _Condition_, as the Womb can neither be firmly _fix’d_, compactly _inclos’d_, or duly supported, so neither can the HEAD of the _Infant_ and the _WATERS_ be exactly depressed upon the _Orifice_: Hence it often happens, that (besides the MIDWIFE’S careful _Hand_) the _Privities_ are the best, if not the only _Defence_, against both the WOMB and the CHILD’S falling out of the Body.

SECONDLY, By a _PELVIS_ too _small_, I mean, _such_ an _One_ as is so, in Consideration of the SIZE of the whole Body; in which _Condition_, the _INFANT_ commonly answering to that _Proportion_, its _Head_ can by no Possibility pass thro’ the _PELVIS_, in a WOMB well seated, without great _Force_, by which Means the WOMB may be easily turn’d _obliquely_: And thus consequently the _Smallness_ of the _PELVIS_, may sometimes prove the _Cause_ of a _Preternatural_, as well as of a _Difficult BIRTH_; and not only so, but also the _Death_ of both the _MOTHER_ and _CHILD_ may ensue thereupon, unless timely deliver’d by an _Artful Hand_.

THIRDLY, By a _PELVIS_ too _smooth_, I mean such an _One_, whose _Distance_ betwixt the _OSSA PUBIS_ and the prominent Part of the _OS SACRUM_ is too _narrow_; in which _Condition_, tho’ the WOMB be well placed, it cannot admit the _Head_ (especially if large and well-grown) without great _Difficulty_: And this _smooth PELVIS_ may also very easily turn the WOMB (either way) _obliquely_, and consequently prove of the same dangerous consequential _Effect_ with the preceeding _Case_.

HENCE (I think) it evidently appears, how necessary it is that all _MIDWIVES_ should not only know the _Form_ and _Size_ of the _PELVIS_, but also the _Situation_ and _Connexion_ of its BONES, as already describ’d at large[167], that _she_ may thereby the better distinguish the _Circumstances_ by plainly discerning the _Causes_, and judge accurately of the _Position_ of both the _WOMB_ and the _INFANT_; so that in the beginning of the LABOUR, she may immediately discover how the PELVIS and its _Entrance_ is form’d, whether _Large_ or _Narrow_, _Smooth_ or _Round_.

FOR this Reason, the _first Thing_ that the _MIDWIFE_ ought to do, when she comes to a _Woman_ in LABOUR, is to try by the TOUCH, how all is circumstantiated, with respect to these Things; and _This_ is to be done before the _WOMB_ and the _CHILD_ are fallen down into the PELVIS, that she may contrive her _Work_ accordingly. Because sometimes the _Exclusion_ of the _INFANT_, is to be hoped for, from the PAINS only; sometimes _Nature_ is to be prudently assisted; sometimes there is an absolute Necessity for _extracting_ the CHILD (without loss of Time) by an _Artful Hand_, as will hereafter more clearly appear; and sometimes again the same Necessity obliges us to _protract_ the _BIRTH_, than we may save _One_ or _Both Lives_: As in the _Case_ of a _smooth_ PELVIS, the OS PUBIS and the VERTEBRÆ of the SACRUM being but little distant, the CHILD’s _Head_ is stopped; when if the MOTHER should labour much, or endeavour to force an expeditious _BIRTH_, its tender _Head_ (of course) must suffer in proportion; Or perhaps the BRAIN may break, by so hard a _Pressure_ against the _Bones_; or, finally (which is worse) it may be so closely squeez’d between the _Bones_, that both the _MOTHER_ and the _INFANT_ may peradventure die, before any _BIRTH_ can possibly succeed or come happily into the World.

BUT in this critical _Condition_, the WOMAN is to _labour_ gently, and bear her _PAINS_ (how violent soever) patiently; the _MIDWIFE_ always directing the _Head_, at the same time by her safe _Hand_, into the _larger Space_; by which _Means_ at last, it passes gradually through that _narrow Passage_ without the least _Danger_.

THE same also is the _Condition_ when the _PELVIS_ is too _small_ or _narrow_; for by the _Woman_’s labouring gently and deliberately, the _Head_ is depressed softly into an _oblique Figure_, and passes easily by Degrees: Whereas, on the other hand, if it is forced by _Violence_, it becomes _flat_ and _broad_, and consequently incapable of _Passing_, if not also _dash’d to Pieces_, as aforesaid.

HENCE we clearly see, how easily _Ignorance_ in this Point, may lead common MIDWIVES into the grossest of _Mistakes_; For what is more ordinary with them, even in all _Cases_, than to advise the WOMAN to _strong Labour_, and to force her to _violent Depressions_: Insomuch that SOME have _Arrogance_ enough to carry their BOTTLES or POWDERS about them, of which they neither know the _Quality_ nor _Virtue_; taking them only as they are told (by the confident QUACKS or _Mercenary Hands_ which vend them) that they may encrease and promote the PAINS of Labour, and _This_ without having any regard to the _Form_ of the PELVIS, or the _Position_ of either the _WOMB_, or the _INFANT_.

IN short, the mature _Consideration_ of this very CASE, was not the least _Motive_ which induced me to the WORK in Hand; since I cannot but heartily commiserate so many fine delicate WOMEN, as are _thus_ every day miserably handled, tormented, and exhausted, by the _preposterous Management_ of such indiscreet and imprudent _MIDWIVES_. I may well say _exhausted_, or _worn-out_; _This_ being too evident, from the vast Number of most beautiful _Women_, who, by this ill-manag’d _Condition_, (notwithstanding they have all along heretofore, enjoy’d a good State of _Health_, together with the _Affluence_ of other Worldly _Blessings_) have been more dejected and broken both in _Complexion_ and _Constitution_, after _one_ or _two BIRTHS_, than some _others_ (judiciously and expertly _delivered_) have been after _Twenty_: Such is the great _Difference_ betwixt the unskilful _Hands_ or _Conduct_ of common MIDWIVES, and those Dextrous TOUCHES or ingenious _Operations_ of the more judicious _Andro-Boethogynists_. Whence I come in Course to——

CHAP. IX. _Of Difficult BIRTHS, proceeding from Causes of the Bones of the PELVIS._

THE READER may easily conceive, by the way, that _these_ are neither to be made _bigger_ or _lesser_ by ART; notwithstanding which, by using them _Skilfully_, and treating them _Judiciously_, many a _Difficult BIRTH_ may not only be prevented, but also many a LIFE saved, as will manifestly appear from what follows.

NOW the _Bones_, upon which the Success of the _BIRTH_ chiefly depends, are the OS COCCYGIS, and the Point of the SACRUM; which sometimes bend too much _inwards_, and thereby obstruct and render the PASSAGE so _narrow_, that no _BIRTH_ can possibly succeed. And again, It sometimes happens, that the _INFANT_ falling down into the _PELVIS_, and presenting itself _Head foremost_, is oppos’d and stopped there by the OS COCCYGIS: As it also sometimes falls out, that the _Shoulders_ stick fast against the _Edge_ of these BONES; or the _Buttocks_ falling down and offering themselves _first_, may be so fastened or affixed to them, that they can never be _extracted_.

THESE Misfortunes may proceed from _Either_ of these two different _Causes_; viz. Either from the _Grossness_ or large _Size_ of these _Parts_ of the INFANT, or from the _Narrowness_ of the _PELVIS_, occasion’d by an ill _Position_ of its _Bones_, particularly of the OS COCCYGIS; which _Bone_ when the _Head_ cannot make it yield or move, neither can it then possibly reach the _Orifice_ of the WOMB, to dilate it sufficiently: And, in short, if the _Head_ cannot effect this _essential Point_, much less can the _Buttocks_, or any other _Part_ be supposed capable of doing it.