Part 23

SINCE it is most requisite to know presently in the _Beginning_ of _LABOUR_, whether the _WOMB_ be placed _forwards_, in order that the Means of Help may be taken accordingly; I shall in the _second place_ add the _SIGNS_, or _Tokens_, by which the _MIDWIFE_ may know this _Position_ of the _WOMB_, and what _she_ has best to do in such a nice ticklish _STATE_ of Affairs.

FIRST then, _She_ may know it, principally, by the _Hanging forwards_ and _Thickness_ of the BELLY, or perhaps by the good _Woman’s Information_ of the PLACE, where she chiefly feels the _INFANT_ stirring; for it cannot _move_ but where ’tis _placed_.

HOWEVER yet a prudent _MIDWIFE_ will have no great regard to such _Uncertainties_, but betake herself immediately to _that_ which cannot fail her, the TOUCH; which (in this _Case_) affords her the following certain _SIGNS_; viz.

I. THE _Orifice_ of the WOMB is suspended _higher_ than usual; which _she_ cannot _Touch_, by reaching, without a great deal of _Difficulty_.

II. SHE can only _Touch_ the lower Border of the _Orifice_, and that only as the WOMB hangs more or less _forwards_; and by no means the _upper Edge_, except the _Orifice_ has begun to _fall down_.

III. SHE cannot at all, or very hardly, get her _Finger_ into the opening of the _Orifice_, and because of that Difficulty, it must then also be _crooked_ or _bent_.

IV. SHE will find the _Orifice_ opposite to the _bending_ of the last VERTEBRÆ or the OS SACRUM, and feel it so strongly pressed against the said VERTEBRÆ, when the _Pains_ come on, that it cannot _fall down_: and lastly, she’ll feel the WATERS (if they hang over the _Passage_) in a thin _slender Form_.

UPON _This_ the Skilfull _MIDWIFE_ finding these concurring _SIGNS_, _she_ may be assur’d that the WOMB hangs too much _forwards_; which _Condition_ requires the immediate _Help_ of _Ingenuity_ and _ART_ to correct this ill untoward _Position_, and to promote the _BIRTH_ expeditiously. But then _these Things_ are to be carefully perceived and distinguished in the _Beginning_ of LABOUR, before the PAINS have either closed up, or too much depressed the _Orifice_; yea, in short, even before it sensibly _opens_: since afterwards all those _SIGNS_ are variously chang’d and alter’d, till at last they entirely _vanish_.

WHEREFORE let it be deem’d as a certain _Rule_, that the true _Posture_ of the _WOMB_ is always best discover’d by the TOUCH in the _Beginning_ of the LABOUR: At which time may the _Orifice_ be suspended never so _high_, the _MIDWIFE_ ought to penetrate so far, until _she reaches_ it; if not sufficiently with her FINGERS, the _whole Hand_ is to be judiciously used, and passed up that Length, because this particular TOUCH is absolutely Necessary for that good End: Insomuch that if any _Labouring Woman_ be against this _manual Operation_ or opposes it, _she_ thereby debars her _MIDWIFE_ of an infallible _Method_, of discovering the true _Posture_ of her WOMB, and consequently of taking the most immediate proper MEANS for _Her own_ as well as her INFANT’s Relief.

BUT now supposing, after all, the _MIDWIFE_ to be certain that the WOMB _hanging too much forwards_, in a prominent BELLY bearing pretty much out, is deeper depressed than it ought to be; _She_ is obliged then in this _Circumstance_ to consider accordingly how to correct this _Preternatural Situation_, and assist both the MOTHER and INFANT for the best: To which End, _She_ ought FIRST to endeavour that the HEAD may _fall down_ into the PELVIS, even to the _bending_ of the OS COCCYGIS; and then, SECONDLY, _She_ is thence to advance the HEAD gradually, that the _Exclusion_ of the _CHILD_ may be expedited and intirely perfected at last.

NOW in order that the HEAD, together with the _Orifice_ of the WOMB, may be so discreetly brought _forwards_ into the PELVIS, the _Woman_ is to be placed with the _upper part of her Body lower than the inferiour_; I mean, with _Head and Shoulders bending downwards_, and the _Buttocks upwards_; by which Means, the _Bottom_ of the WOMB is elevated, and gives the _Orifice_ an Opportunity of being brought more easily into the PELVIS.

THEN the parturient _Woman being so placed_, the _MIDWIFE_ (using both _Hands_) ought to clear the WOMB, together with the _Head_ of the INFANT, by putting the _one_ up, as far as there’s occasion, into the VAGINA, and laying the _other_ upon the _Woman_’s BELLY, in manner following: _viz._——

THE _Hand_ in the VAGINA is (by having two or three of its _Fingers Ends_ extended to the upper Border of the _Orifice_ of the WOMB) to move it a little beyond the _Head_ of the _CHILD_, and to direct it into the _Mouth_ of the PELVIS, so that it may fall the more readily down into the design’d Place. But in this critical Juncture the _MIDWIFE_ must always take special _Care_ not to squeeze or press the _Top_ of the HEAD too much, nor to handle it too hard, lest _She_ should thereby _wound_, if not also _kill_ the INFANT.

AGAIN the Business of the _other Hand_, used externally, is to _drive back_ the WOMB, by pressing the _Abdomen_; which must be perform’d also with great Caution and Judgement, not by drawing the HAND from _above downwards_, but pressing as much as the _Woman_ can bear it, from _below upwards_; so that (if possible) the WOMB may be thereby _resupin’d_ or turn’d _backwards_. Minding always, by the way, that

THIS _Pressure_ of the WOMB is not to be attempted, before the _one Hand_ is first conveniently placed _within_. But if all _This Menage_ should not yet succeed the _first time_ according to Wish, then it may be safely repeated again by turns so often, until the _MIDWIFE_ feels the _Crown_ of the HEAD; that is to say, till _She_ feels the Borders of the _Orifice_ quite round about _hanging over the Entrance of the_ PELVIS. Upon which happy _Discovery_, she may with reason rejoice in her _Labour_, and be heartily glad of her good _Success_: Because now the _Force_ of good depressing PAINS only will effectually perfect the Work.

BUT before Matters are happily brought this prepared _Length_, the _bearing Woman_ is upon no account to begin her _LABOUR_; since _That_ would not only be in _vain_, and otherways debilitate the Strength of her Body; but also be of great _Hindrance_ to the MIDWIFE (to whom all the _LABOUR_ hitherto belongs) who, as _she_ feels the _PAINS_ growing and rushing in upon the _Woman_, before their proper Time, ought to charge her strictly, to forbear _working_ along with them, and as much as possible to abstain from any _co-operating Depression_. And in fine, as the _MIDWIFE_ by having her _Hand_ diligently apply’d to the _Orifice_ of the WOMB, by strict Attention, may most commonly observe, and previously discern the approaching _PAINS_, before the Patient _Woman_ herself can be sensible of them: So she ought also for her _own helping Part_, _ex Officio_, to be quiet and attempt nothing till _Then_, but take her convenient _Opportunities_, always as soon as the _PAINS_ are over.

THUS by seasonably lending NATURE an artificial _helping Hand_, BOTH _jointly_ may easily effect, what _neither_ can do _separately_: For as it sometimes happens, that the _MIDWIFE_ ought to _cease_, while she perceives (by the PAINS) that _Nature_ is a working, and therefore ought to _work_ only when the _PAINS_ are past; so it also falls out often, upon other Occasions, that _she_ is to _work_ along with the _PAINS_, and when those are _past_, to _cease_. And thus, in fine, according to different _Circumstances_, the discreet _MIDWIFE_ knows always the NEEDFULL, _what’s to be done_, or _let alone_.

BUT in this Place, I doubt not, many _MIDWIVES_ will object, and say, How is it possible for _Us_ to perceive the _PAINS_ coming on before the parturient _Woman herself_? To which I ingenuously _answer_, that _This_ also is one of the many Advantages of the TOUCH; since by _That_, I can presently feel a kind of _subtile Motion_, _Contraction_, or _Compression_ beginning in the _Orifice_ of the WOMB; which is only observable as the _Muscles_ are affected with a _New Sense_, excited by a _New Influx_ of the SPIRITS; occasioning a _New Force_ or _Impression_ upon the WOMB, which we commonly call a PANG: So that, in short, by distinguishing _this Motion_ from _others_, I am always able to foretell or advise the _Woman_ of what is a-coming, and to admonish her accordingly of her bounden DUTY, as the _Case_ requires.

MATTERS now being fairly brought thus far, that the _Orifice_ and the HEAD begin to slide down into the _PELVIS_; the _MIDWIFE_ is at this Time to study how to succour and assist the _CHILD_, by rendring its _Passage_ easy. In order to which, _she_ must first observe to raise the _upper Part_ of the Woman’s Body a little, and give her some short _Respite_, before she offers to bring the _Orifice_ into the _PELVIS_; because the _Posture_ above-directed, occasions considerable _Pain_ as well as great Inconveniency: Which being done, the _Woman_ for the future is to _sympathize_ with every _PAIN_, and _Labour_ as much as possible, co-operating mutually with them; since now the PAINS (by the Assistance of the HEAD) begin to open the _Orifice_, and gradually force the INFANT forward to its _Birth_.

HOWEVER yet the _MIDWIFE_ ought in this _Case_, to be very careful in sustaining, and nice in keeping up the _Orifice_ of the _Womb_, lest it should _fall down_ together with the _Vertex_ or _Crown_ of the _HEAD_ into the _Sinus Sacri_; which is a _Point_ so curious and critical, tho’ an _Accident_ too common, that I dare well say, not one in _Fifty Practitioners_ in _MIDWIFERY_ understands it thoroughly; otherways I am confident, and morally certain, that many _fine Women_ would have been _living Monuments_ of their _Ingenuity_, who are at this day only the _Dead Remains_ of their _Ignorance_.

THIS I think is past all _Contradiction_, when we consider, how some _Practisers_ sacrifice the INFANT, first by _opening_, and (as they call it) _braining_ the HEAD, and then by drawing it forth with their _Instrument_ call’d _FORCEPS_: How _others_ also esteem themselves _Masters_ of the greatest _ARCANUM_, boasting that they can, without so much as _braining_ the _HEAD_, extract the _INFANT_ by their _Tool_ call’d an _EDUCTOR_: How a _Third Set_ again pretending themselves to be the only _genuine Sons_ of APOLLO, come slily to correct the _Rest_, by fixing only a couple of HOOKS in the _Eyes_, _Ears_, or somewhere else in the Child’s _HEAD_; by which means they as wretchedly produce the _innocent_ dead _Babe_ as any of the _others_: For it can no more be suppos’d to _survive_ this cruel _Treatment_, than the other mentioned _Barbarities_; not to speak of the _Anguish_ and _Perplexity_ over and above, besides the real Danger all the while brought upon the _distressed Mother_.

UPON this grand Affair of Life and Death, the Desidious and Capricious _MIDWIFE_ cries at length, GOD knows I have taken all the _Pains_ and Care I could, but to no _Purpose_, for this or that trifling _Reason_, falsely alledged. The _SURGEON_ (if he don’t pretend the _CHILD_ to be already _Dead_) says, Come, it is better to dispense with _one Life_ than _Two_; _One must go_, &c. In consequence of which, he prepares his _FORCEPS_, _EDUCTOR_, _KNIVES_, _HOOKS_, &c. to draw out the _INFANT Dead_, or _Alive_, _Whole_ or in _Pieces_, by such disingenuous and barbarous _Means_ to save the _MOTHER_. Thus behold the excellent _Art_ of _MIDWIFERY_ ignorantly perverted! O Deplorable Woman! O Miserable Babe! How much abused! when there is no _other Mean_ left to rescue the tender _Life_ of the poor _Mother_, but by the massacrous _Death_ of her dearest _CHILD_! This _Case_ indeed would be very _Melancholy_, but Glory be to _GOD_ who has neither left the _One_ nor the _Other_ to perish at this untimely or inhuman Rate, excepting it be by _Ignorance_, or _Wilfulness_, &c. as aforesaid: No, on the contrary he has provided an _EXPEDIENT_ for every _Extremity_, and a _REMEDY_ for every _Malady_, as in the present _Case_ will appear farther by what follows, _Viz._——

THAT such _Tragical Events_ may be prudently prevented, I use my constant and unwearied Endeavours to sustain the _Orifice_, that it may not come below its proper _Place_; and that having clear’d the _HEAD_ of the _WOMB_, I may only bring _it_ alone down; which I can much more easily do, than if it was cover’d about with the WOMB, sticking fast (as above) in the _SINUS SACRI_. And supposing the _MEMBRANE_ to press strongly instead of the HEAD, I treat it all one as if it was the HEAD, taking always Care not to _break_ it, tho’ the _forming_ of the _WATERS_ is not to be obstructed; for which Cause, I upon all Occasions stretch out my _Fingers_ wide, applying them only to the Edges of the _Orifice_, not to the _Membrane_: And this I continue doing, until the _MEMBRANE_ spontaneously _breaks_; upon which I manage the _Head_ as aforesaid.

THUS the _Infant’s HEAD_ being excluded with the _Crown foremost_, there is no more Occasion to be at any Pains in _keeping up the Orifice_; wherefore I now suffer it, together with the _HEAD_, to _fall down_ past the _Bending_ of the _OS SACRUM_; which now also, the _major Part_ of it being bare, more easily happens, than it possibly could whilst it was cover’d with the _Orifice_. Upon this, that the CHILD may be farther relieved and brought out, I now again make use of both _Hands_, the _one_ inwardly, the other _outwardly_, as before: But as the _Condition_ is now much _alter’d_ from what it was at that time, I at present proceed after a quite _different Manner_, and work along with the PAINS, _resting_ only as their _Force_ ceases: For thus I not only observe the PAINS my self, but also at the same time encourage my _Woman_ to _Labour_, and to persist in her _LABOUR_ with all her Strength; and by Turns, as the _PAINS_ come on, to conjoin their _Force_ with her own and my mutual _Endeavours_, in the manner following: namely,

HAVING _One Hand_ in the _Vagina_, with its _Back_ turn’d towards the RECTUM, I thrust very cautiously the Points of my _Fingers_ as far as I can under the _HEAD_, where I hold that _Hand_ constantly, until the _PAIN_ comes on; laying the _other Hand_ upon the _Belly_, about that Part where the _Bottom_ of the WOMB lies: Then as I perceive the _PAINS_ come on, I begin to work with both _Hands_; to wit, by pressing the _internal Hand_ gently _downwards_, against the Point of the SACRUM to remove it _back_ out of the way; whilst by the _external Hand_, I gently raise the WOMB into a _resupine Posture_, pressing it also softly _downwards_: I mean _softly_ in Proportion (howsoever) to the _Force_ of the _PAIN_: for as it gradually _encreases_, and more and more excites strong LABOUR; so I also by degrees _press down more strongly_.

HOWEVER yet the _External Depression_ ought always to be _Moderate_, as the _Internal_ ought to be _Strong_ and _Vigorous_: Whereupon _Matters_ being carefully well observ’d, (as laid down in _Chap._ 9.) no _MIDWIFE_ needs be afraid of _hurting_ her _Patient Woman_ in the least; no rather, on the contrary, the more _Strength_ I use now, the more grateful and agreeable I prove to _Her_ being thus circumstantiated. And, in fine, the _upper Part_ of the _CHILD_’s Body being once past that _Sinuous Bending_ above, it presently breaks out all together, and comes away so happily into the World. After which the _MIDWIFE_ is only farther to behave herself with respect to both the MOTHER and the CHILD, as in the _Natural Case_[174], carefully cleansing, restoring, contracting, and shutting the WOMB as _Before_. In a Word, with so great Success at last the _BIRTH_ is accomplished, provided these _Precepts_ be carefully and timely observed.

BUT that the _Ingenious_ may be at no _Loss_ in this momentous Affair upon any Occasion, we shall now particularly _state_ the CASE, in which the ordinary MIDWIFE has thro’ Ignorance or Negligence, let _Matters_ come so far, that the _acuminated_ or _lower Part_ of the WOMB is fallen into the PELVIS; and the _Orifice_, together with the HEAD, is broken thro’ into the _crooked Sinus_ of the OS SACRUM, and is fixed-up there; that the MEMBRANE is _broke_; that the _Infant_’s HEAD is but a little _bare_; that the poor _Woman_ (after the _Fatigues_ of a strong or long _Travail_) is quite spent and tired; and _finally_, that all these Things have _happen’d_ before the extraordinary _MIDWIFE_ is perhaps sent for, or at least before He can conveniently be with the _Woman_.

IN this Pitiful _Case_, the HEAD being yet but a little _bared_, and sticking fast in the _Sinus_ of the OS COCCYGIS (as abovesaid) the _CHILD_ cannot possibly make any _Impression_ upon the _Orifice_, so as to open it; and therefore the _Situation_ of the WOMB is to be alter’d: In order to which, I first place the _Woman_ on a commodious _Seat_ adapted to the Purpose, such as upon a _Pallet_, or _Low Bed_, or some _Pillows_ laid on the Ground; that she may lie with her FACE _downwards upon her Knees_, with her _Head low_; her _Arms_ being supported with so many _Pillows_ as are requisite to sustain her _Body_ (leaning upon them) without moving.

NOW I doubt not but some People will think this a _strange helpless Posture_; but as strange as it is, it is certainly the most _effectual_, and the _absolute best One_, which can be devis’d for the _Woman_’s desir’d _Relief_ in this desperate _Condition_: For by the Help and Means of it, the WOMB is carried down into the _lowest Part of the Belly_, through its own _Weight_ only; and consequently releases itself out of the foremention’d _crooked_ SINUS; which that it may the sooner and more commodiously do, I put my _Fingers_ into the _VAGINA_ behind, betwixt the RECTUM and the HEAD of the _Infant_, where I press down the WOMB, till the _Orifice_ is so far _forced back_, that there is _Room_ enough to hold it up, in order that it may not relapse; and also that there may be _Room_ for the HEAD to be depressed into, and open the _Orifice_. Thus the WOMB and the _CHILD_ being at last _forced so far back_, by an expert _Hand_, the _BIRTH_ may be successfully perfected by the above-prescrib’d _Means_ and _Method_; provided always that the _Woman_ has sufficient _Strength_ and _PAINS_ to carry her through the fatiguing _Tryal_.

BUT we will how suppose, for better Instruction-sake, her _Strength_ to be quite spent, and the _PAINS_ to be deficient; in this CASE the happy _Issue_ of the _BIRTH_ is most dubious; but however, then I place the _Woman_ again as before, and depress the WOMB as much as I can, until I reduce the _Orifice_ farther up into the _larger Space_ of the _PELVIS_, that I may the more conveniently _open_ it by the Help of an _inward Hand_; and by _that_ also moving aside the _Child_’s HEAD, I then seek for, until I find, the FEET; which, upon the INFANT’s being right turn’d, with its TOES _downwards_ towards the _Mother_’s RECTUM, I bring into the _Passage_. Now the FEET being thus in the _Passage_, the _Woman_ needs not lie any longer in the abovesaid _Posture_; but, turning herself, may now lie with her FACE _upwards_: When I also give her previous _Notice_ to prepare herself to _depress_ vigorously; I mean as much as she can possibly, when occasion requires.

IN the Interim, holding the FEET all the while with my _internal Hand_, I attract them gently _outwards_, until the BUTTOCKS and the BELLY are excluded: Then taking fast hold of the _CHILD_ by _one Hand_ under the BELLY, and the _other_ upon its BACK; I advise the good _Woman_, in _Case_ she feels no _PAIN_, to behave herself as if the _PAINS_ were most pressing upon _Her_, and to contribute by _forcing downwards_ what lies in her Power; whilst I continually _attract_, and gently _draw_ the INFANT towards me, until by this discreet _Management_ the HEAD is totally excluded, together with the ARMS into the World. And _thus_ at length the _Distressed Woman_ may be happily delivered in all these different _Cases_, and difficult _Conditions_ of Life. Whence I come to——

CHAP. XX. _Of Preternatural BIRTHS, from the WOMB’s inclining backwards._

Experience teaches us, that the WOMB may be also too much _resupin’d_; or tending with its _Bottom backwards_, may be pressed too much towards the SPINE: So that its _Orifice_ is not only raised _too high_ in the BELLY, but is also so _obliquely seated_, that it no more answers to the _VAGINA_ in a _right Line_, varying more or less, according to the Proportion of this _Tendency_ to the BACK-BONE.

FROM this _Posture_ of the WOMB now, it necessarily follows, that the HEAD (tho’ never so well _turned_) falls upon, and is violently forced against the OSSA PUBIS; where the tender HEAD sticking, often happens by its own _Struggles_ and the _Mother_’s _PAINS_, to be grievously squeez’d and gradually crush’d, so that, until it is removed and brought into the _PELVIS_, the _Woman_ can by no means bring forth her _INFANT_. Wherefore the diligent and careful _MIDWIFE_ must (by due Attention) make it her Business to discern at the _first_ TOUCH this _ill Position_ of the WOMB, and presently upon the _first Pang_ of LABOUR, try to help both the _MOTHER_ and the _CHILD_.

WHEREAS otherwise the slothful and ignorant _MIDWIFE_, may continue the poor _Woman_ in an irregular LABOUR perhaps some Days, without perceiving the HEAD to be fixed upon _these Bones_, always erroneously imagining the _INFANT_ only to be situated _too high_, (because it lies out of the reach of her _shallow_ TOUCH) and that it must in due Time _fall down lower_ within her _Ken_. Or peradventure otherwise, when by the TOUCH, _she_ feels a kind of _Roundness_ or _Hardness_, thro’ the WOMB, mistaking _This_ for the HEAD, _she_ thinks the _INFANT_ is well turned, and wants only _strong PAINS_ to drive it forwards with Success.

THIS _Ignorance_ is chiefly owing to her own _Stupidity_, in that _she_ cannot clearly distinguish between the WOMB and the VAGINA by the TOUCH; nor the _Orifice_ of the WOMB from the _Parts_ of the _CHILD_, or _MEMBRANE_; which (in this _Case_) frequently occasions the _Death_ of many a _Dear MOTHER_ and _INFANT_.

BUT here it is to be moreover noted of this difficult _Situation_ of the WOMB, that the _MIDWIFE_ (how skilful soever) perhaps can either not _touch_ the ORIFICE at all, or but very little, except it lies _wide open_, when she may _touch_ at least some Part of the CIRCLE of the _Border_: For the HEAD being fixed upon the PUBIS above, the whole _upper Part_ of the _Edges_ of the ORIFICE can no ways peradventure be _touched_ with the _Fingers_, which may only reach the _lower Part_ that is _Open_.

UPON which, these _Fingers_ are cautiously and prudently to be thrust in farther betwixt the _Neck_ of the BLADDER, and the _Orifice_ of the WOMB: Then being so near the Neck of the Bladder, a discerning _MIDWIFE_ will feel a sort of a _Circular Border_, namely, that of the _Orifice_ of the WOMB; which if she penetrates with her _Fingers_, she will also find the hard Part of the HEAD, which is _Smooth_ and _Globular_, or the opening of the VERTEX; whence she may be certain, that the _INFANT_, as well as the _WOMB_, is too close to the SPINE of the _Back_. Whereupon she ought, without loss of Time, to assist and help the _CHILD_ in the following _Manner_; viz.