Part 22

THE _CHILD_ also sometimes offers itself _preternaturally_ to the _Orifice_, with its HAND, ELBOW, SHOULDER, KNEES, or BUTTOCKS _first_: In which _Condition_, the HAND always gives an easier _BIRTH_ than the ELBOW, the ELBOW than the SHOULDER, the SHOULDER than the KNEES, and the KNEES than the BUTTOCKS: For the HAND being commonly placed near the _Head_, it is no great Wonder, if it presents itself _before_, or _along_ with it; as sometimes (after _Flooding_) the HAND may slide together with the _Head_ obliquely to either _Side_, and thereby either ELBOW or SHOULDER unfortunately fall into the _Passage_.

THIS is one great Reason, why I have before inculcated, that the _MIDWIFE_ ought to be diligent and accurate in _Touching_ her Woman, even before the MEMBRANE breaks, that she may thereby discover and prevent this _Case_: Which is easily perform’d, either by _repelling_ the HANDS, or by pinching the _INFANT_ sensibly by the _Fingers_, and then it soon retracts them; for thus, in short, by moving my own _Hand_ seasonably, the HEAD (of its own accord) slips of course down into the _Passage_. But and if it happens otherways, ’tis no difficult Matter to _turn_ and bring it down, by directing my _Fingers_ beyond the FACE to the _CHILD_’s _Forehead_; which however must be done immediately after FLOODING: Whereas, if _This_ be neglected until the _dry_ WOMB is contracted, THEN, and in that _Condition_, the _FEET_ may be looked for, which (in such a _Posture_) are soon found, with the _KNEES_ next the _Belly_; and the _INFANT_ may be readily drawn out by them. But

WHEN it so happens, that the _CHILD_ comes with its _KNEES foremost_, it commonly has its _LEGS_ folded towards the _BUTTOCKS_; by which means many a _MIDWIFE_ has been deceiv’d, especially when _she_ feels but one _KNEE_, mistaking it for the _HEAD_, because of its _Hardness_ and _Roundness_.

IN this _preternatural Condition_, the _INFANT_ must be stopped and hindered from advancing _farther_; wherefore having placed the _Woman_ aright, I would gently repel the _KNEES_, that I may the more commodiously _unfold_ the complicated _LEGS_, one after another; which I commonly do by directing _one_ or _more Fingers_ under the HAM, gradually along behind the _LEG_, until I come to the FOOT; drawing always a little _obliquely_, that I may come the easier to its _Extremity_: And thus, in short, having disengaged the _One_, I accordingly manage the _Other_ after the same manner; and by bringing both _FEET_ at last together, I finish my _Work_, as if the _Child_ had come _FEET_ foremost, of which in course.

MOREOVER again it also happens sometimes, that the _CHILD_ falls with its _BUTTOCKS forwards_; in which _preternatural Condition_, the MIDWIFE must industriously prevent it from coming _too low_ in the PASSAGE, before it be duly corrected or rectify’d; since the INFANT cannot possibly come, after this manner, into the World; unless it be very _small_, and the _PASSAGE_, on the other hand, very _large_. Wherefore in this _Case_, after the _Woman_ is decently laid upon her _Back_, with her _Head_ declining, I would advise to thrust back the _BUTTOCKS_ as well as possible; then passing up my _Hand_ along the _THIGHS_ to the _Legs_, I would take hold of the _FEET_, and bring them gently, and one by one, forth gradually; which being done, I would attract them by the _HEELS_ towards the _Side_ as far as the Length of the _BUTTOCKS_; and then at last taking good _Hold_ under the _HIPS_, I would easily and softly with the greatest _Deliberation_, draw out the whole Body successively.

CHAP. XV. _Of Preternatural BIRTHS, by the Breast, Belly, or Back, presenting first; and the INFANT’s lying transverse._

SOMETIMES likewise the _CHILD_ offers its BREAST or BELLY _first_, along with the _Navel-string_; which _Preternatural Figure_ is most dangerous for the _BIRTH_, because of the _Body’s bending backwards_.

IN this difficult _Case_, the attentive _MIDWIFE_ places her _Woman_ conveniently, as soon as the _Waters_ have flow’d, and sliding her _Hand_ into the WOMB, removes the _String_, and endeavours to bring the _HEAD forwards_ into the _PASSAGE_; which she easily performs, as long as the INFANT is suspended on high, and its _Back_ not too much _bent_, by putting-in her _Hand_ gently up to the _hinder Part_ of the _CHILD_’S _Head_, attracting it gradually _downwards_. But if in this _Condition_ the _BIRTH_ be fallen too _far down_, it is more adviseable _first_ to attract the _FEET_ considerately.

I say _considerately_, because it is not sufficient to penetrate with the _Hand_ to the _FEET_; which however yet, in this _Posture_ is pretty difficult: But also to know exactly in what manner they are to be _drawn down_; since it is no indifferent Matter to understand how that is to be rightly perform’d with Success. Wherefore I shall in this place take upon me to set forth _two different Ways of Turning the INFANT_ in this _Condition_; viz.

I. I would _either_ FIRST pass my _Right Hand_ to the _Left Thigh_ of the _CHILD_, and taking hold of it near the _KNEE_, push it _upwards_ with my _Thumb_, drawing it at the same time _downwards_ with my _Fingers_ placed behind: _Thus_ I would bring _down one KNEE_ to the _Passage_, leaving the FOOT yet above, and then the _other KNEE_ in its Turn; which being done, I would change my _Hand_, and put the _Left_ up to the _INFANT_’s _Belly_ or _Breast_; where, as I _thrust back_ its Body _upwards_, there is presently _Room_ enough: then I would take hold again of _one_ or _both KNEES_, to move the _CHILD higher_, that so the _FEET_ may be more conveniently brought into the _Passage_ one by one, if not _Both_ at once: Or, upon the _LEGS_ being bent with the _Right Hand_, and the _KNEES_ brought into the _Passage_ (as above) I would take hold of them below the HAM, and bring them past the _Orifice_ of the WOMB, till the _FEET_ are before the _Passage_; whereupon I would then readily endeavour to extract the INFANT by the _FEET_. _Or_, SECONDLY,

II. I would put my _Right Hand_ up along the _Belly_ to either THIGH, or KNEE, having at the same time a thin _Bandage_ doubled and dipp’d in _Oil_, upon my _Fingers’ Ends_, in order to be put about the KNEE, that I may attract it gently thereby; which I would draw out again by the _Right Hand_, whilst my _Left_ holds the Ends of the _Bandage_, that they may not move out of their Place: Then I would take the Extremities of the _Bandage_ in my _Right Hand_, attracting it softly thereby, whilst I pass up my _Left_ into the WOMB, to thrust the _CHILD_’s _Belly upwards_. By which ingenious and regular Means, I think, Dr. _Daventer_ first moved the _upper Part_ of the BODY _upwards_, and the FEET _downwards_, because the KNEES are thereby brought nearer to the _Orifice_. Now these, in short, are the only safe, and proper _Methods_ to be taken in this present _Case_, or nice Conjuncture; because, by all _other_ inconsiderate and temerarious _Means_, the _INFANT_’s LOINS may be _twisted_, its HIPS or KNEES _disjointed_, its FEET _lamed_, and itself at last quite lost or destroy’d.

IN like manner it happens not very seldom, that the _INFANT_ comes with its BACK _forwards_ into the _Passage_; and in this _Posture_ the NAVEL-STRING falls commonly down _there_, so that besides _itself_, nothing else is to be felt by the TOUCH: In this _Case_, the MIDWIFE is to observe well the FLOODING; immediately upon which, _she_ is to seek for the FEET, which are more easily come at than the _HEAD_, tho’ the same is even also a very difficult TASK, by reason that the _CHILD_’s _Back_ takes up the whole Space of _Room_; which, notwithstanding, must be cautiously done, and the _INFANT_ discreetly extracted by _them_.

BUT again sometimes, the _BIRTH_ lies also _Transverse_, or a-cross the WOMB; in which dangerous _Case_, I confess the _MIDWIFE_ cannot well perceive, so as to distinguish Matters by the _Touch_, before _Flooding_: Because the _INFANT_ (swimming in the _Waters_) is as yet seated high, and then moving its HANDS and FEET variously, _she_ sometimes feels _one_, and sometimes _another Member_ at the _Orifice_; or, one Moment she finds _Something_, and another _Nothing_ at all there. However, in fine, _she_ may perceive the _Humours_ most commonly compressed into an _acuminated_ or _oblong Form_.

WHEREFORE in this difficult _Preternatural Condition_, the _MIDWIFE_ ought primarily and chiefly to consider and discover the _Posture_ of the WOMB, whether it be _direct_ or _oblique_; since according to THAT _she_ must proceed in assisting her _Woman_ with true Discretion. As for _Example_, if _she_ finds it in a streight or _natural State_, and the _Waters_ sufficiently exuberant, extended _length-ways_, &c. as aforesaid, _She_ must, without _Loss of Time_, break the _MEMBRANE_, and presently, removing all _Impediments_ of _HAND_, _FOOT_, or _NAVEL-STRING_, judiciously direct the _HEAD_ into the _Passage_; which may be very easily and safely done immediately upon the FLOODING. Whereas if _this Method_ be delay’d, or not taken in _due Time_, and consequently the _HANDS_ (as the readiest) present themselves to the _Orifice first_: In this _Condition_, I would lay the _Woman_ discreetly upon her _Back_, with the _upper Part_ of her Body _lowest_; after which, I would move the _INFANT_’s _Hands_ back with my _own_; whereby at the same time bringing its _FEET_ into the _Passage_, I would in the next Place gently extract the whole Body with all possible _Conduct_ and _Success_.

CHAP. XVI. _Of Preternatural BIRTHS, by the Feet presenting first._

IN like manner again, it often happens, that the _CHILD_ offers its _FEET foremost_; which next to a _Natural BIRTH_ is the most easy and safe _Position_, however I have been oblig’d to postpone it to the _rest_, for Method’s sake: In this _Case_, the _MIDWIFE_, observing _one FOOT_ presenting itself in the _Passage_ after _FLOODING_, ought to stop and retain it _there_, that it may not slide through, until _she_ meets with the _other_. In order to which Performance, _she_ must immediately seek for _it_, with either _Hand_, according as she perceives the _INFANT_’s great _Toe_ situated, since it is only to be sought for along its _Side_; and being found, it is to be gently _drawn down_, and placed near its _Fellow_ in the _Passage_.

BUT it falls out sometimes, that the _MIDWIFE_ comes too late, and finds _one LEG_ so far through, that the BUTTOCKS are strictly confin’d: In this _Condition_, I would advise to lay the _Woman_ conveniently upon her _Back_, with her _Head_ low, that both the WOMB and the CHILD may _retreat_ a little; then taking hold of the _right LEG_ with my _Right Hand_, I would thrust the _INFANT back_, till the whole FOOT (or at least the KNEE) is brought back into the _Orifice_ of the WOMB, in order that I may have the more _Room_ for passing my _Hand_ along the _LEG_: By which means I get hold of the _other_ FOOT; and bringing it also into the _Passage_, I place it along with the _other_, that both may come forth successfully together.

WHICH Thing, happening so when it will, that _both FEET_ are excluded, whether done _spontaneously_ or by ART, they are never to be _repell’d_ or _thrust back_ again; but, on the contrary, the way is to be duly cleared for their PASSAGE; _This_ being a very commodious _Situation_, provided the CHILD be _well turned_, I mean, with _HEELS_ and _BUTTOCKS upwards_, and _TOES_ and _BELLY downwards_: Whereas, if otherways, the _CHIN_ may be easily hooked upon the _OSSA PUBIS_; which (if not so happily _turned_ at first) I commonly prevent in the most adviseable manner following; _viz._

UPON attracting the _INFANT_, I _turn_ it cautiously at the same time, using _both Hands_ in the ensuing _Method_; namely, The _One_ I put up under its _Body_ as far as possible, whilst with the _Other_ I hold both _FEET_ together: Insomuch that by this Means I gradually _turn_, not only the _FEET_ and the _LEGS_, but also the _whole Body_; bringing it always _forwards_ in the Interim, till at last it lies with its _BELLY downwards_, and is _out_ above half way: Upon this I then give my _Woman_ the Motion, to begin her LABOUR and endeavour her _Best_; because the _HEAD_ and _ARMS_ must necessarily pass through _All at once_. For notwithstanding the contrary Opinion of most _Authors_, who teach us to draw down the ARMS _one_ by _one_, and place them upon the _Body_, I cannot but agree with _Daventer_, and positively advise in _this_ and all such _other like Cases_, to leave the ARMS about the _HEAD_, that they may be excluded along with it: Because, as he says, tho’ the _Woman_ in so doing, is obliged to force her _INFANT forwards_ with all possible Endeavours, yet like a small transient CLOUD, it is soon over.

WHEREFORE I commonly make it my Business to prevent the _Woman_’s _PAINS_, until I have brought the _CHILD_ this _Length_; when allowing her a little Time to rest, I heartily encourage and positively promise _Her_, that, she performing her _Part_ effectually, (by using all her _Strength_, and behaving herself as if the _PAINS_ were most really _pressing_ upon her, whether so or not) the _BIRTH_ will immediately succeed: And upon this _Promise_, with the _PATIENT_’s mutual Assistances concurring, I never yet fail’d; neither will any _Persons_ who faithfully and ingeniously follow this _Method_, in comfortably helping the _Woman_ upon such an Occasion, by drawing the _CHILD_ cautiously _downwards_, with whatsoever judicious _Force_: I mean not _downwards_, according to the _Woman_’s LENGTH, but _downwards_ towards the _strait Gut_. And as I every Moment insinuate to the _MOTHER_, that her _BABE_’s _Life_ depends entirely upon her vigorous confederate LABOUR; so _she_ mutually concurring with me, in endeavouring to do our _Best_, the AGRIPPA _INFANT_ is presently _brought forth_ to the great Satisfaction of _Both_.

BY these _Means_ and _Methods_, we prevent the _Tragical Consequences_, which Mr. _Portal_ and many _others_ confess they have often met with in their _Practice_; viz. That the _HEAD_ has been sometimes pulled-off from the _SHOULDERS_, or that the _CHILD_ has been frequently _stifled_, by the WOMB’s contracting and shutting-up about the _NECK_: Which was altogether owing to the injudicious _Method_ of their Practice, in drawing down the ARMS awkwardly (as mentioned above) along the SIDES of the _Body_.

CHAP. XVII. _Of Preternatural BIRTHS, by Two, or more INFANTS presenting themselves ill-Turn’d._

THIS _Case_ also happens sometimes remarkably; upon which, if _Both_ or _All_ are contain’d in _one_ and the _same SECUNDINE_, or when the _MEMBRANES_ are broken, _then_ the right VERSION is very difficult; not so much for want of _Room_, as because their _HANDS_ and _FEET_ are commonly interwoven and twisted together: In which _preternatural Condition_, when so complicated and entangled, they are to be unfolded and cleared off _one another_ with the nicest Circumspection and Judgment.

BUT besides, farther, they are otherways, only to be treated in this difficult Point, as if there was but _one CHILD_; for _turning_ them always _One_ by _One_ duly, I would bring all their FEET into the _Passage_, and consequently handle them, as if they had offer’d themselves so at _first_. The _first CHILD_ being born, I would give it to the next capable _Person_ to tie and cut its STRING; whilst I directly repass up my _Hand_, to seek for the _other_’s FEET, by which I would also _draw it forth_, after breaking its proper _MEMBRANES_, in Case the _second_ FLOODING is not yet over, and _that_ notwithstanding the HEAD should present itself _First_.

BUT and if it happens, that _each CHILD_ has its own proper and _distinct SECUNDINE_, and _That_ of the _INFANT_ already _brought forth_ chance to be loose and separated from the WOMB; In that _Case_, I would presently fetch it away, and then extract the _other INFANT_, as long as there is _any_ yet left behind, and _that_ also by the FEET, as aforesaid: Whereas otherwise, the _BIRTHS_, together with the _Constriction_ of their _UMBILICALS_, are to be previously accomplished.

IN fine, having _thus_ accounted for all the _Preternatural BIRTHS_ whatsoever, which may or can occur on the _Part_ of the _INFANT_, and _that_ conformable to the most nice and polite _Rules_ of ART; It remains now in the next place, that I acquit myself in a consonant manner, with respect to _Those_ proceeding from the _Part_ of the WOMB. Of which _First_ in general——

CHAP. XVIII. _Of Preternatural BIRTHS, proceeding from Causes of the WOMB._

MOST, if not all, _Authors_ having hitherto imagin’d, that all _Preternatural BIRTHS_ took their sole _Rise_ and _Origin_ from the wrong _Positions_ of the _INFANTS_ only; I come in this place, with all due Submission, not only to affirm a quite contrary _Opinion_, but also to lay down a directly opposite MAXIM: Namely, that the most difficult and dangerous _Preternatural BIRTHS_ proceed merely from the ill _Situation_ of the WOMB; which I take to be the most common _Cause_ of the CHILD’s wrong _Posture_. The Truth of which I hope to make evidently appear, to all such, who know and will consider, that this _Noble Part_ is no less subject to various _Accidents_ and different _Diseases_, than the _Rest_ of the BODY; which springing from divers _Sources_, may rationally be suppos’d to occasion _Preternatural BIRTHS_, and _those_ more or less dangerous, according to the _Nature_ of the EFFICIENT: as for _Instance_,

IN _Case_ of an _Inflammation_, _Exulceration_, _Putrefaction_, or the WOMB’s being _Schirrous_, _Callous_, or _Hard_; affected with a CARCINOMA or _Cancer_; an obdurated _Gland_, _Cicatrix_, or any _carnous Excrescence_; or in _Case_ of the WOMB’s being _Dry_ and _Rigid_, and the _Orifice_’s being _Hard_ and _Thick_, as commonly happens to WOMEN _in Years_, especially of their _First CHILD_; I say, from either of _these_, or any such like _Causes_, a _Preternatural BIRTH_ may ensue, and _that_ even tho’ the PELVIS and PASSAGE be _larger_, but much more if _those_ be _narrower_, and the Point of the OS SACRUM bent _Inwards_.

I. IN the _Larger_ PELVIS, the greatest _Difficulty_ of this _BIRTH_ proceeds from too great a _Descent_ of the WOMB; which relaxes the _Ligaments_ and _Fibres_ of the VAGINA, and so much depresses the _Bladder_, that an _Incontinency_ of URINE presently follows, which in this _Case_ is commonly succeeded by a _Falling Down_ of the WOMB or VAGINA, as already observ’d in _Chap._ XI. where the Diligent MIDWIFE will find the due _Method_ of preventing such growing _Mischiefs_, and of opening the _Orifice_ of the WOMB both safely and readily, and consequently _Delivering_ her _Woman_ more easily and expeditiously, with good Success as well as Security.

II. IN the _narrower_ PELVIS, the _MIDWIFE_ needs no ways fear the above-named _Accident_, and therefore is not to be at so much Pains in _retaining_ the ORIFICE in its proper Place, whatever Trouble she may have in _opening_ it; which would be no easy TASK, was not the OS COCCYGIS to be _thrust back_, (as set forth, _Chap._ IX.) And which I must (for this Reason) recommend once more to all Careful _MIDWIVES_, as the best and most effectual METHOD of performing this happy _Apertion_.

FROM what is said here therefore, we may now conclude, that a great _Variety_ of CAUSES may subject the WOMB to a Diversity of ACCIDENTS, and _those_ of sundry _Degrees_, which may more or less affect its _Motion_ and _Situation_, as already set forth[171].

AND hence it is that we have so many _Degrees_ of _Preternatural BIRTHS_ on _Part_ of the WOMB, _All_ which to enumerate particularly in this Place, would be a WORK as _Superfluous_ as _Tedious_: wherefore, to be brief, I shall here also reduce them to the FOUR following, (as before mentioned, SECT. IV. _Chap._ 13.) viz. _Preternatural BIRTHS_, proceeding from an _oblique Situation_ of the WOMB inclining _Forwards_, or _Backwards_, or to (either _Side_) _Right_ or _Left_: which fourfold _Situation_ of the WOMB may be rightly and properly compar’d to the _Four Cardinal Points_ of the COMPASS, as the rest of its _oblique Positions_ may be analogously adequated to the _Collateral_ and _Middle Points_: For because, as they decline from the _Meridian_, and derive themselves from EAST, WEST, NORTH, and SOUTH, as formerly observ’d[172]; so _those_ are less difficult _BIRTHS_, and branch out from the _Four_ mentioned Extremities: since the WOMB, like a _Magnetick Needle_, may run quite round, and be ill-seated every way, or on every _side_. In all which _Cases_, the _INFANT_ must absolutely be _Turned_; which _Performance_ in any _oblique_ WOMB, requires a competent solid _Knowledge_ and sound _Judgment_, as well as the best adapted and experienced _Hands_. But of _those_, more particularly hereafter; and _First_, accordingly——

CHAP. XIX. _Of Preternatural BIRTHS, from the WOMB’s inclining Forwards._

IN speaking to this critical _Point_, I shall _first_ give the _Reason_ of such a _BIRTH_, occasion’d by this _Position_; to wit, The _WOMB_ hanging much _forwards_, especially in _Women_ carrying it too _low_ in the ABDOMEN, the _INFANT_ (betwixt the _Pains_) must needs be forced upon the OS SACRUM, or the VERTEBRÆ bending _inwards_; which stops the HEAD that it cannot conveniently or without Obstruction fall into the PELVIS.

HOWEVER, in this _Condition_ we suppose the _INFANT_ to be _well turn’d_, I mean (both _here_ and _elsewhere_) _well turn’d_ in respect of the _WOMB_, with the _Crown_ of the HEAD lying against the _Orifice_; than which nothing can be more _Right_ or _Natural_ in regard of the _WOMB_ itself, nor more _Wrong_ and _Preternatural_ in respect of the _PELVIS_ and _Vagina_ of the _WOMB_, in this _forward Situation_: Because by reason of this _Posture_, the _INFANT_ falls _transverse_ upon the OSSA PELVIS, especially upon the OS SACRUM or _hindmost_ VERTEBRÆ; upon which it commonly offers itself with the FACE _prone_ or _turn’d Downwards_, tho’ it is not brought forth, but with the FACE _Supine_ or _Upwards_. For as it passes, it must be _turn’d round_, partly in a _Circle_, with its HEAD _prone_, and FEET drawn up under it; which happens not in the _WOMB_, but only as it passes the _Orifice_ into the _PELVIS_ or _VAGINA_.

NOW what I mean is more plainly _This_, that as soon as the INFANT comes into the _Turning_ (which it must pass) it necessarily _bends_ and _crooks_ itself, as it finds its PASSAGE _bent_ or _crooked_; by which means the FACE is sometimes _turn’d down_, and sometimes _upwards_: And _This proceeds_ from THAT, in short, as soon as the HEAD begins to enter the _Orifice_, it presently fixes upon (and sticks fast to) the last VERTEBRÆ of the _Loins_ standing _forwards_, or to the OS SACRUM; so that it cannot naturally or possibly go _forwards_, except the HEAD is _bent downwards_, and the _Neck_ and whole _Body_ be accommodated to that BENDING.

HENCE it is, that _THAT_ which just now was _situated prone_ upon its BELLY in the _WOMB_, now passing through the _VAGINA_, is _bent upwards supine_ upon its _BACK_; and from thence it’s evident, that _That Inversion_ is not properly in the _WOMB_, but in the _VAGINA_, or (if you please) in the _Confines_ of BOTH: And, in fine, this _forward Inversion_ (as it happens) occasions a most difficult _Preternatural BIRTH_.

BUT _this_, in short, happens to the _Woman_ with _CHILD_, because her _WOMB hangs forward_, or is _resupin’d_, according to the _Depression_ made on the _WOMB_ by the _Intestines_, forcing it _this_ or _that way_; or to either _Side_, as will by and by more fully appear[173]. But——