Part 21

BUT in all the above-mentioned _Cases_, I am sensible, that most _MIDWIVES_ (not knowing better) ascribe the whole _Difficulty_ to the _Orifice_ of the WOMB and the VAGINA; upon which they ignorantly fall atearing and dilating both the _One_ and the _Other_, (never minding the _Point_ of the SACRUM); and finding _these Orifices_ but little _open’d_, notwithstanding the frequent _Repetition_ of very severe _PAINS_, they imagine that their substantial _Hardness_ or _Thickness_ is the only CAUSE: So that therefore (without regarding any _adjacent Part_) they go on violently dilacerating sometimes the _Mouth_ of the WOMB, and sometimes _That_ of the _PRIVITIES_, (as I have found it by Experience) quite to the RECTUM. For such is their _Stupidity_ in this Condition of LIFE (as _Daventer_ well observes) that whilst they _thus_ tear and rend the WOMAN to _Pieces_ in a manner, they allow her to sit over and above with the _Point_ of the OS SACRUM, upon her _Seat_ or _Bed_; or in some other wrong _Posture_, which so presses and confines the OS COCCYGIS at the same Time, that neither of _these_ can move: Not minding at all that the chief _Pressures_ and _Impulses_ of the HEAD, must first bear upon the OS COCCYGIS in order to remove it, before it can effect the _Dilatation_ of the _Orifice_ or _Mouth_ of the WOMB. Thus they spend the WOMAN’s _Strength_ in vain, break her _Spirits_, and ruin her _Constitution_ thro’ Ignorance; whilst a capable _Person_, administring seasonable and judicious _Help_, according to the Circumstances of the _Case_, refreshes _Nature_, renews _Strength_, gives _Courage_, and fills the (otherways languishing and despairing) _WOMAN_, with _Hopes_ and _Assurances_ of a happy _DELIVERY_.

IN short, the True _Method_ of _Delivering_ and helping the WOMAN conveniently, in the different _Conditions_ contain’d in this _Chapter_, depends entirely upon _repelling_ or thrusting back the _Point_ of the OS SACRUM, together with the OS COCCYGIS. I say (therefore) the whole _Point_ of the OS SACRUM, and that _Fleshy Part_ lying about it, is to be _thrust back_ and _dilated_, so that the _Passage_ may be sufficiently opened for the INFANT to pass through; which patent _Dilatation_ is to be promoted by _pressing_ also _back_ the OS COCCYGIS. Now these Things, in short, may be all done cautiously without creating any intense _Pain_, or the least Damage; and _thus_ the obstructed _Passage_ being clear’d and open’d, the BIRTH advances regularly of Course, and the _CHILD_ is born with the greatest _Ease_, in the Space of a few Minutes: Whereas otherways (without the Use of these _Means_) both its _Own_ and the MOTHER’s _Destiny_ may be precarious or uncertain after some _Days_ LABOUR.

THUS it is certain, that by assisting a _Woman_ in LABOUR seasonably and skilfully, her _PAINS_ are happily excited and encreased; whereas, on the contrary, by _imprudent Treatment_ they unhappily cease and vanish, to her great Prejudice. Moreover, daily _Experience_ teaches us, that the very _different_ TOUCHING of Things, occasions different _Sensations_; and from thence it is, that the _dextrous MIDWIFE_ knows by _one_ way of TOUCHING, how to promote the _PAINS_ of _Labour_; and by _another_, how to retard or put them off according as the Necessity of the _Case_ requires; which hereafter will appear more at large.

BUT that we may more particularly satisfy such _MIDWIVES_, of our _Method_ of repressing these BONES, and _Delivering_ the _WOMAN_ in the abovesaid _Cases_; I must add, that, after placing the _PATIENT_ in the most convenient _Posture_ for a _WOMAN_ in _Labour_, as before fully enjoin’d[168], I would direct _Her_ to be _supported_ by two Women, and mov’d so far off the BED or COUCH, that the _Point_ of the OS SACRUM may be free to yield or give way _backwards_, without any the least _Impediment_: Then I would pass my whole _Hand_ at once (being first well anointed or dipp’d in _Oil_) into the _VAGINA_, and from thence (if the _Head_ will admit it) into the _WOMB_, as occasion should require: where, upon opening my _Hand broad_, that it may press equally every where, I turn the _PALM upwards_, and the _BACK downwards_ against the _RECTUM_, and the _OS SACRUM_: Thus I extend my _Fingers_ as far as possible to the _Head_, thrusting it a little _backwards_, rather than hinder my _Hand_ from being firmly placed against the OS COCCYGIS: Upon my _Hand_ being thus properly placed, as soon as the _PAIN_ begins to threaten (which I commonly perceive before the _WOMAN_) I advise her, to make good Use of the approaching _Pains_, in order to _Labour_ mutually, and depress with all her Power, promising her my most faithful _Assistance_: By which Time, as soon as the PAINS have seiz’d her, and she doing her _Part_, I press my HAND _backwards_, first _softly_, and by degrees more _strongly_, against the _Point_ of the SACRUM, bringing it at the same time gradually _downwards_, that I may thereby make Room for the _Head_ sliding the same way; so that the more _severe_ the _PAINS_ are, the more I depress still, and the _harder_ I press down with _Effectual PAIN_, the more vigorously and successfully the _WOMAN_ is able to _Labour_.

THUS I enlarge the _Passage_ with great Moderation, so that the INFANT’s _Head_ succeeds or follows my _Hand_, as I bring it by little and little _back_ again; and this adviseable _Method_ I would reiterate as often as the _Case_ should require, always encouraging my _WOMAN_, by the most obliging Words: Upon which _She_ suffering no _PAIN_ in vain, finds immediate _Relief_, recovers her _Strength_, recollects her _Spirits_, and by jointly _labouring_ her _Best_ with all her Force and Might, at last produces her CHILD with Comfort and Satisfaction, whilst I congratulate her upon the Success of being a _joyful MOTHER_.

BUT supposing by the way, that the _INFANT_ offers its _Buttocks_ first, they being neither so _round_ nor _hard_ as the _HEAD_, I would then intrude all my _Fingers_ into the WOMB more easily; some of which (or sometimes _All_) I would pass into the _Orifice_ of the WOMB under the _Buttocks_ as before into the _VAGINA_. Now my _HAND_ being placed there, I intently observe the _PAINS_ as they come on; then inviting the _Woman_ to _Labour_, I gradually press _backwards_ as hard as I can conveniently, drawing my _HAND downwards_ as before: But if in attracting it so, the _HAND_ should slide too much out of the WOMB, (which however I endeavour to prevent) while the _PAINS_ are yet upon her; then as soon as they are over, I pass it up again, that I may be ready against their _Return_. And _this_ I would reiterate upon every _PAIN_, so that the CHILD (guided by my _HAND_) may slide down at every Turn, until at last the _Passage_ is so dilated, that it may advance gradually with _ease_ into the World.

BY these judicious _Means_; forcing back the _OS COCCYGIS_ by the _Pressure_ of the _HAND_, as the _PAINS_ come on, I may not only dilate the _Passage_, and enlarge the _Orifice_ of the WOMB; but also upon retracting the _HAND_ by degrees, I can gradually attract the _CHILD_ out of the WOMB, through the _Narrowness_ of the _PELVIS_: And thus, by this curious ART, (which I take to be one of the chief _Points_ belonging to MIDWIFERY) I do fairly _deliver_ the WOMAN, who by no other _Means_ whatsoever, could be preserved, together with her _INFANT_, in all Probability.

HOWEVER, tho’ I have candidly laid down this _Method_, (conformable to the Doctrine of the most excellent and ingenious _Instructers_) yet I would not advise every coarse _Clumsy HAND_ to undertake it, nor _such_ as are not thoroughly acquainted with the _Parts_ of Generation: For this _Performance_ requires _Judgment_ and _Prudence_, as well as ART and _Experience_. But however yet in _Case_ of _Necessity_, where no _Extraordinary Person’s Assistance_ can be had, as it often happens in the _Country_, the _Ordinary MIDWIFE_ ought not to neglect her _Duty_: nevertheless, before she offers to attempt this piece of extraordinary _Skill_, she ought to be very certain that these _BONES_ are the great _Impediment_ and _Difficulty_ of the Delivery.

CHAP. X. _Of Difficult BIRTHS, proceeding from Causes of the BLADDER and RECTUM_.

DIFFICULTY in _BIRTH_ may also proceed from the _BLADDER_, as (in like manner) it may from the _RECTUM_ or _Strait Gut_.

I. FROM the _BLADDER_, when affected with _Tumours_, _Ulcers_, or _Glands_, obstructing the _Passages_; which however is more frequently occasioned by _Stones_ lodged in the _BLADDER_, or in its _Neck_: In either of which _Conditions_, the MIDWIFE, by dilating the _Passage_ with a subtile _HAND_, must repel the _OS COCCYGIS_ according to ART (as taught in the preceeding _Chapter_) that the _HEAD_ in falling down, may the less offend the _BLADDER_.

II. THE same _Difficulty_ may arise from the _RECTUM_, when it happens in the same _Manner_, to be affected with such obdurated _Glands_, _Tumours_, &c. for the _Consequence_ is the same in shutting up the _Passages_: In which _Case_ the _MIDWIFE_ is to depress gently such _Excrescences_, of what kind soever, with her cautious _HAND_, and consequently to dilate the _Passages_ by degrees (how much soever obstructed) for receiving the _Head_ of the _INFANT_; always having a respect to the _affected Parts_, and bearing no harder upon them than Necessity requires.

MOREOVER sometimes it happens, that the only _Difficulty_ in _LABOUR_ proceeds from _hardened Excrements_ in this _Gut_, which may as effectually stop or shut up the _Passage_, as any thing else, until duly voided and evacuated by _one_ or _more_ proper _CLYSTERS_, as Occasion directs.

BUT sometimes it also happens, that such _Difficulties_ arise from the falling out of the _Fundament_ by the strong and violent _THROWS_ that the _Woman_ Suffers in LABOUR: In which _Condition_, if the _CHILD_ is very forward in the _Passage_, before it _happens_, it may be prevented by dissuading or hindering the WOMAN from _Labouring_ so vehemently; but if it happen’d before that time, it must be left so until the _BIRTH_ be accomplished; after which time, it is to be put up exactly, and reduced to its proper _Place_, in the same manner as the WOMB might be (in Case of its _Prolapse_, as mentioned in the following _Chapter_) after duly _fomenting_ and _bathing_ it with proper _Applicatives_: advertising always to use no _CLYSTERS_, in time of CHILD-BED; because such Means would readily excite it again to a slippery _Relapse_.

CHAP. XI. _Of Difficult BIRTHS proceeding from the Causes of the VAGINA._

DIFFICULTY likewise in _LABOUR_ may also arise from the _VAGINA_, or _Neck_ of the WOMB; this _Part_ being no less liable to the Affection of _Tumours_, _Glands_, _Ulcers_, &c. than any _Other_ before-mentioned: In _Either_ of which _Cases_, my above-mentioned _Method_ in the foregoing _Chapter_, shall suffice for the _MIDWIFE_’s _Instruction_; as also in _Case_ of an _Inflation_ or _Inflammation_ of the _Pudendum_.

BUT sometimes also this _Difficulty_ happens from the falling down of the _VAGINA_; which _Accident_ may as well precede as follow after the BIRTH, and _that_ by the _Orifice_ of the WOMB pressing _hard_ into that of the _Privities_: So that sometimes, when the _MEMBRANE_ is _broke_, the _Head_ of the _INFANT_, as well as the _Orifice_ of the WOMB, slides down so far, as to hang out of the _Body_; whereby the stressed _Ligaments_ (being too much relaxed) give way to the falling down not only of the _VAGINA_, but also of the WOMB it self.

IN this sad _Condition_ the WOMAN must keep her BED, and her _Body_ equally situated, that either the fallen _VAGINA_ or _WOMB_, may recover and be immediately restored to its _proper Place_; which being done, other Matters may be easily prevented by the _Care_ and Diligence of the prudent _MIDWIFE_, stopping and restraining the _Orifice_ of the WOMB before it comes so far to that Extremity: Wherefore _she_ ought to keep it up in the _VAGINA_ (as much as possible) with her HANDS, until the WOMAN has happily extruded both the _CHILD_ and the _AFTER-BIRTH_.

UPON This afterwards, _she_ is to use her best Endeavours, to restore both the WOMB and _VAGINA_ to their due _Situation_; laying the _Wrinkles Smooth_ in their proper _Order_, not one upon another, then placing the WOMAN conveniently in BED, with her _Head_ and _Shoulders_ declining, _Exsiccant_ or _drying MEDICINES_ are to be judiciously applied, and _Strengthening_ or _Astringent Fomentations_ often used; whereby (in good Time) _both_ may be again confirmed in their proper Natural _Places_.

NOW having thus, in fine, candidly explained the _Different Causes_ of all _Difficult BIRTHS_, and carefully laid down the _genuine Methods_ of correcting and removing them, and consequently of _Delivering_ the good WOMAN successfully in all such nice _Cases_, it remains now in Course that I proceed to——

CHAP. XII. _Of Preternatural BIRTHS._

SUCH _BIRTHS_, (properly speaking) are only _Preternatural_, which degenerate from the _Natural_, in respect either to the _Situation_ of the INFANT, or the WOMB, or of _both_ these jointly: Such (I say) may be well call’d _Preternatural_, because of the imminent Danger that (in these _Conditions_) threatens both the MOTHER and the CHILD.

HENCE we find the Difference between _This_ and the _Natural BIRTH_; in as much as the _One_ depends entirely upon ART, and the _Other_ merely upon NATURE: In _That_ the _INFANT_ is artificially extracted by the _Hand_, but in _this_ it is naturally extruded by the _PAINS_.

_HIPPOCRATES_ gives[169] us a _Two-fold-Cause_ or Reason of a _Preternatural BIRTH_; to wit, the _Amplitude_ of the WOMB, and the _inordinate Motion_ of the Woman about the Time of _LABOUR_: Who, because of her afflicting _PAINS_ and great _Ailments_, keeps her Body in a restless and unsteady _Posture_, throwing herself sometimes _here_, and sometimes _there_, sometimes on _One side_, and sometimes on _Another_ through Uneasiness. By which means it cannot be otherways, but that the _INFANT_ may be easily turn’d into some _Preternatural Situation_.

AND to _These Causes_, _Senertus_, _Rodericus à Castro_, &c. add the _Two_ following; namely, the _Solidity_ of the _MEMBRANES_, and the _Debility_ of the _Head_ of the _CHILD_: Because (as they well observe) when _This_ is not strong enough to break through _Those_, the _INFANT_ endeavouring it otherways, (with _Feet_ or _Hands_) may readily fall into some _Preternatural Position_.

BUT because I find, that _Preternatural BIRTHS_ deviate in different Degrees, and vary in many respects from the _Natural_, and _that_ also according to a great Variety of _CAUSES_ (no ways known to those most _Learned Authors_) but only of late discovered; I shall now again reduce the different _Species_ of _Preternatural BIRTHS_ to four _Classes_; namely, _Preternatural BIRTHS_ on Part of the _INFANT_, on Part of the WOMB, on Part of _Both_ those jointly, and lastly on Part of some _intervening Accidents_.

IN treating of which, I shall according to my best Judgment, _state_ these respective _HEADS_ in due Order, and assign each its proper _Branches_; which I shall particularly discuss in brief _Terms_, for the Facility and Benefit of the _Candid READER_, whether _MAN_ or _Woman-Midwife_; That they may (by this plain and easy Method) be enabled the more readily to judge of, and distinguish the several Circumstances, and consequently the better discharge their Duties (upon Occasion) to the Comfort and Satisfaction of those _PATIENTS_ concerned, and the Honour of their own ingenious _Profession_.

BUT before I enter upon _These_, I would willingly in this place, previously subjoin a Word or two of _Advice_ (by way of _Precaution_) to the Young _Andro-Boethogynist_: Which, in short, consists in this _Point_, that as it is the too common _Practice_ here in _England_, for an obstinate SET of _Women_ to keep their _Labouring PATIENTS_ so long under their own Hands only, until the very last _Extremity_; so I would not counsel him at that Time, when sent for, upon such a ticklish Occasion, to go _Head-long_ to such a _Work_, nor to undertake the DELIVERY of such a _Woman_, before He makes some requisite _Observations_: And _that_ I mean no ways because of any Danger of the _Preternatural BIRTH_ which she labours under, how difficult soever it may be; but merely, on account of the _Woman_’s exhausted _Strength_ and _Ability_, to undergo the respective _Operation_ in her weaken’d _Condition_; which I would very much question in most Women, after _One_, _Two_, or _Three Hours_ strong LABOUR, and that in SOME far sooner, notwithstanding that _others_ have been known to stand it out, and struggle a much _longer Time_.

HOWEVER, be this as it will, I commonly guess at the _Woman’s State of Ability_, not only by her PULSE, if _strong_ or _weak_, _unequal_ or _intermitting_; by her EYES, if _dejected_; by her SPEECH, if _faint_; by touching the EXTREMITIES of her Body, if _frigid_: but also by some other SYMPTOMS, which infallibly appear, if the _Woman_ be too far spent, such as _Cold Sweats_, _Swoonings_, _Convulsions_, _Loss of Sense_, &c. Whereupon I say in these _Cases_, it is more adviseable to let alone or decline the _Office_, than to undertake such a precarious uncertain Piece of _Work_; because if the _Woman_ happens to die under his _Hand_, He may perhaps be (however unjustly) blam’d for the errant _Midwife_’s Faults, or at least He will scarce avoid the CENSURE of the _Ignorant_ and _Malevolous_.

YET this _Advice_ (however wholesome and prudent) is, I confess, what I would but seldom have Recourse to, or follow myself, notwithstanding the worst _Consequences_ of the _Case_; since as long as there is _Life_, there is _Hope_ with me, by the Blessing of GOD: Which tho’ never so _little_, I should think myself obliged in Conscience to do what both ART and NATURE command, and rather in all _Conditions_ of LIFE to attempt an uncertain CURE[170], than abandon the _Distressed_ to certain DEATH, as some _Politicians_ in _Physical_ Affairs commonly do, who prize their vain _Reputation_ above the LIFE of their Neighbour. But _thus_, in short, (for my own Part) I would chuse to _act_, because I have often seen, and known _NATURE_ to have perform’d, and recover’d a weak spent parturient PATIENT, even beyond all human Probability.

NOT but that I would take the proper _Precautions_ along with me, before putting my _Hand_ to the critical _Work_, upon any such desperate or dangerous _Occasion_, by giving my ingenuous PROGNOSTICK to the nearest _Friends_ and _By-standers_ of the extreme _Danger_ that both LIVES may be in: Whereupon after thoroughly examining all _Circumstances_, with respect to the CHILD, whether _One_ or _More_, _Dead_ or _Alive_, &c. I would chearfully begin my _Endeavours_ to relieve the afflicted Woman, encouraging and exhorting her in the first Place, for GOD’s-sake, as well as _her own_, and the tender INFANT’s _Life_, to put herself entirely into my HANDS, to undergo her LABOUR patiently, and contribute what she can to the DELIVERY.

BUT to return from this pardonable _Digression_ to what is here proposed; as I come first to speak of _Preternatural BIRTHS_ on the part of the INFANT, I would observe that all ill _Postures_ of the CHILD, in a WOMB well situated, are the only _Causes_ (meant in this place) of _Preternatural BIRTHS_ on its _own Part_: Which _Postures_ being very various and different, and each requiring a different peculiar _Operation_; I shall _state_ them particularly (as above-mentioned) and _that_ in their respective _Chapters_, after the manner following: _viz._—

CHAP. XIII. _Of Præternatural BIRTHS, by the FACE’s being turn’d upwards; or bent forwards, and the CROWN backwards._

AMONG the many various _Preternatural Positions_ of the _INFANT_, I cannot but reckon THIS _One_: FIRST when, tho’ the _CHILD_ offers itself _Head foremost_, yet the FACE is turn’d upwards; and _that_ because the _INFANT_ in such a _Posture_ can never be commodiously bent and adapted to the _Form_ of the PELVIS.

IN this _Case_, the _MIDWIFE_ ought to take special Care, that the HEAD _fall down directly_ and safely, without being _hurt_, whilst she endeavours to bring it _forward_: For this Purpose, she is to enlarge the _Passage_ as much as possible, dilating the _Privities_, and depressing the OS COCCYGIS; which however must be done, without lifting the HEAD with her _Hand_, for fear of bruising the FACE against the OS PUBIS. By this Method the _BIRTH_ (how _Preternatural_ soever) may be pretty well and easily perform’d.

BUT because the _CHILD_ can only be said to be _well turn’d_, when it comes with its CHIN leaning upon its _Breast_, and its _Top_ or _Crown_ of the HEAD tending directly to the _Orifice_; I reckon THIS _another Preternatural Position_, when the _INFANT_ presents itself with the CROWN bent _backwards_, and consequently with the FACE _forwards_: By reason that in this _Case_, the _Orifice_ itself and all the rest of the _Passage_ must be much more dilated, than in the _natural Condition_; and the HEAD (being thus bent _backwards_) requires more severe PAINS and hard LABOUR, to make it slide through the _Passages_.

IN which _Case_, the _MIDWIFE_, having timely discover’d this _Situation_ by the TOUCH, ought immediately (upon the flowing of the _Waters_) to bend the HEAD gently _forwards_ to the BREAST, all the while adverting to handle the FACE, especially the _Nose_ and _Eyes_, very tenderly: And to this End, the _Woman_ may be laid down on her _Back_, with her _Head_ low; by no means _labouring_ with the _PAINS_, before the HEAD of the _CHILD_ is so conveniently turned: which may be thus most properly perform’d; _viz._ By laying the Palm of the _Hand_ on the _INFANT_’s _Breast_, near its _Throat_, pressing it entirely _back_ towards the _Fund_ of the WOMB; by which means the HEAD falls _forwards_ of its own Accord upon the _MIDWIFE_’s _Arm_, and _she_ with-drawing her _Hand_, will find the HEAD _well turn’d_.

BUT supposing the HEAD to be very strictly bent or pressed _back_, then the _MIDWIFE_ is to attract it gently _forwards_ by her _Thumb_, or _Fore-Finger_ thrust into its MOUTH; or by the Points of all _Four_ thrust betwixt the WOMB and the _back Part_ of the HEAD. And thus, in fine, the HEAD being _well Turned_, and dextrously brought into the _Passage_; the _Woman_ is then to be placed commodiously for _BIRTH_, and to labour her _Best_ as in other _Cases_.

HOWEVER to this _Case_, I must add, by way of _Remark_ for the _MIDWIFE_’s farther Information and better Government, that, if the HEAD is not brought into the _Passage_, as soon as the _Waters_ have flow’d, it commonly happens, that the HANDS offer themselves _first_; which if she do not instantly repel, the HEAD is turn’d up _forwards_ with the FACE, near the _Chin_, upon the OS PUBIS; in which _Condition_, by reason of the _Siccity_ and _Contraction_ of the WOMB, the only Expedient is to _thrust back_ the ARMS, and so passing the _Hand_ under the _CHILD_’S _Breast_, to take hold of, and extract it by the FEET.

CHAP. XIV. _Of Præternatural BIRTHS, by the Hand, Elbow, Shoulder, Knees, or Buttocks presenting first._