Part 24

SHE is to hinder the _Woman_ from _labouring_ all this while, advising her to bear and put by her _PAINS_, until this _Posture_ of the _INFANT_ can be duly corrected: In order to which, I would FIRST order the _Woman_ to _make Water_, if she can, that the BLADDER being thereby emptied, may not be hurt by the _Pressure_ of the _MIDWIFE_’s _Hand_, or the _CHILD_’s _Head_: SECONDLY, if the _MEMBRANE_ is not yet broken, and the PAINS but _few_ and _faint_, I would prescribe a gentle CLYSTER, not only to awaken _These_, but also to remove all _Inconveniencies_ of the _RECTUM_: THIRDLY, I would then advise to lay the _Woman_ in a convenient manner, upon her BACK with the _superior_ Part of her Body lower than the _inferiour_, that both the WOMB and the INFANT may the more easily recede or _give way back_.

THEN taking cautiously Hold of the _Border_ of the ORIFICE with the _Fingers_ of _either Hand_, I would press and draw it _back_ towards the _RECTUM_, whilst I employ’d my _other Hand_ outwardly upon the _ABDOMEN_, a little above the _OS PUBIS_: I mean, that the _Child’s HEAD_ ought to be _thrust back_ a little with the _Hand on the outside_, pressing it discreetly _down_; as the _ORIFICE_ is to be drawn _back_ towards the _RECTUM_, and at the same time also _downwards_, with the _internal Hand_.

IN the next Place, as I feel the HEAD and the WOMB mov’d a little _downwards_, so I would also advise the good _Woman_ to raise the _upper Part_ of her Body, yet so as not to stir the _Lower_, and to _bend_ herself as much as possible _Forwards_, sitting as if she was going to _Stool_: Because by this _Posture_, she raises both the INFANT and the WOMB _behind_, and consequently drives them _BOTH Forwards_, whilst I would in the _Interim_ keep my _HANDS_ very fast placed as aforesaid, ready to depress the _HEAD before_, that it may fall directly into the PELVIS. In short, the _HEAD_ being thus disengag’d, I would now advise the _Woman_ to observe her _PAINS_, and mutually _labour_ with them what she can, with her Body mostly still in a _Sitting Posture_, or kneeling with her _Arms_ conveniently supported.

BUT supposing the _INFANT_ to stick very fast upon the PUBIS (which commonly happens by _Loss of Time_, or by misimproving a critical _Minute_;) and that the capable MIDWIFE finds both the MOTHER and the CHILD in this miserable _Condition_, thro’ the Neglect and Ignorance of _Another_: In this _Case_ I would lay the _Woman_ altogether upon her _BACK_, with her _HEAD low_, and her _BODY_ a little _elevated_; then by the abovesaid _Method_ I would try to depress the _Infant’s HEAD_, observing however yet not only to press it _down_ from _above_, but also first to _thrust it back_, and _depressing_ it at the same Time: By thus _repelling_ it, I would save the tender _HEAD_ from being hurt by the _Depression_; since otherways these BONES would leave a _Dent_ or an _Impression_ upon it, if not also wound it over and above.

MOREOVER, supposing that the _MEMBRANE_ should break by Chance, and that by enlarging the _Orifice_, the _HEAD_ should be much _bared_: Then I would let the _Border_ of the WOMB alone, and endeavour to thrust my _FINGERS_ betwixt the _HEAD_ (towards its _Upper Part_) and the _OSSA PUBIS_; by which means One may most probably draw the _HEAD downwards_, along with the _Orifice_. However, in fine, this _Case_, (as well as all other _preternatural BIRTHS_) absolutely requires a sound _Judgment_, a quick _Comprehension_, a good _Conduct_, an easy _soft Hand_, and a dextrous gentle _Method_ of treating the _parturient_ and _patient WOMAN_. But, farther——

WE will again in the next Place _state_ the _CASE_ thus, that suppose the _HEAD_ is too Big, and the CHILD so much compressed, that it cannot be brought into the _PELVIS_ without great Trouble and Difficulty: In this _Condition_, before _Matters_ come to an Extremity, I would (without Loss of Time) find out the FEET; in order to which, the _Orifice_ (which is now commonly less _open_) ought to be cautiously _open’d_ with a gentle _Force_, by thrusting first _one_, and then more FINGERS _upwards_, which are to be gradually _distended_, until at last the whole _HAND_ is entered up to the _Wrist_: Whereby (after prudently breaking the _MEMBRANE_) I would now and then _thrust back_ the HEAD, and put it upon one _Side_, as much as possible by ART.

BUT upon _This_ here it must be carefully observ’d by the way, that I would pass my _Hand_ close up along the _INFANT’s Body_ from the _Orifice_ to the _Fund_ of the WOMB, or to the FEET, that it may not come between the _SECUNDINE_ and the WOMB, but betwixt the _MEMBRANE_ and the _CHILD_: By this _Method_ I shall neither hurt the WOMB, nor the _INFANT_; but the _HAND_ distinguishing clearly all the _Parts_ of the _CHILD_, I cannot miss finding the _Feet_ with the greatest Certainty. Tho’ I must acknowledge by the By, this to be the _Work_ of a very strong and agile _HAND_, as well as of a sound and ready _Judgment_; because of the immense _Labour_ and Difficulty, first in opening the _narrow ORIFICE_, and then in penetrating through it to the _Bottom_ of the WOMB, as the _INFANT_ obstructs the Way: not to mention the great _Inconveniencies_ also besides, which arise from the _Turnings_ and _Windings_, as well as from the _Length_ and _Constriction_ of the _Passage_. However yet——

THUS having found _one_ or _both FEET_, I would draw them down _both together_, if possible, always turning the _TOES_ towards the _FACE_. Whereas if only _ONE_ can be found to be conveniently _attracted_, as it often happens, I make it fast by a running _Knot on a broad Ribband_, or by a certain _Bandage_, called _MITRA_, or with a soft _Linnen Rag_ about four Inches broad; which I _twist_ together, and hold in the _Hand without the Body_, as I pass the _other_ up along this _LEG_, duly observing whether it is the _Right_ or the _Left_, that I may know which of my _HANDS_ will most commodiously find out the _other LEG_; and that _HAND_ having reached the _CHILD’s Belly_ or _Buttocks_, I slide it along the _THIGH_ to the other _LEG_: So that the _FOOT_ being thus found, I bring it also down into the _PASSAGE_, according to the _POSTURE_ of the _INFANT_.

BOTH _FEET_ being now thus _brought down_, if they chance to be _ill-turned_, that is, with _TOES_ up and _HEELS downwards_, I discreetly _turn_ the _CHILD_, whilst I gradually draw forth the _FEET_. _These_, together with the _BELLY_, being fairly excluded, I hold the _FEET_ with _one Hand_, whilst I put the _other_ under the _BELLY_ and _BREAST_, as far as possible: Or, resting the _FEET_ in my _Lap_, with _one Hand_ above, and _another_ below, I take good hold of the _BODY_, attracting it gently. Upon this I advise and encourage my _Woman_ now to _labour_ her best, and that whether she feels any _PAINS_ or not, since they are now no longer to be waited for with the Impatience of a happy _Delivery_.

BY this regular _Method_, in fine, the _HEAD_ and _both ARMS_ pass thro’ the _Orifice_ at once, and that without the least _Danger_; because the _Smoothness_ of the _TEMPLES_ affords always sufficient _Room_ for the _ARMS_, as the _Orifice_ relaxes and dilates, as has been already observed[175]. Now _this_, in short, I take, with Submission, to be the only genuine _METHOD_ of perfecting a successful _DELIVERY_ in the present _preternatural Condition_, whether the _BIRTH_ be _Dead_ or _Alive_: So that hence I proceed in course to——

CHAP. XXI. _Of Præternatural BIRTHS, from the WOMB’s inclining to either Side._

THO’ the _WOMB_ may be _obliquated_ (as has been said) either to the _right_ or _left Side_; yet, to abbreviate this Work, I shall contract _both Situations_ into _one_; and because the ingenious _Reader_ may easily apply what is said of the _one_ to the _other_, I shall only treat of that inclining to the _right Side_.

THE most difficult _Posture_ of this kind is, when the _Bottom_ of the _WOMB_ is placed deeper in the _right Side_ towards the LOINS, tending more to the _Back_ than the _Forepart_. Which the MIDWIFE may know to distinguish by the following _Signs_; namely, 1. By the _Place_ where the Woman feels the _INFANT_ move most. 2. By that part of the _Belly_ which is most pointed and hard on the _Outside_. 3. By trying the Woman in the beginning of the _Labour_, before the _Pains_ have moved the _WOMB_ out of its Place, she will find the _Orifice_ of the _WOMB_ suspended higher, compressed to the _Spine_ of the left _OS PUBIS_ or _COXENDICIS_; by which means the said _Orifice_ cannot be _touched_ without Difficulty; and by no means the _whole_ of it, but only the _lower Border_. 4. She will find the _INFANT’s Head_ thro’ the _WOMB_ and _VAGINA_ (tho’ not bare) laid _a-cross_ the _PELVIS_, but cannot come at the _lower Part_ of it; only with one or more _Fingers_, she may sometimes penetrate betwixt the _Spine_ of the said Bones, and touch the _VERTEX_.

BY these _Signs_ the _MIDWIFE_ soon finds her _Task_ most heavy and perplexed; for from thence proceeds the following _Difficulties_.

I. IN this _Posture_ the _INFANT’s Head_ (as soon as it makes the lead _Apertion_ of the _Orifice_) is fixed upon the _Spine_ of the left _OS PUBIS_ or _COXENDICIS_; and the _Head_ thus fixed cannot pass forwards, because those _Bones_ cannot give way: From hence arise the _Aquæ Furtivæ_, or a flowing of the _Waters_ by Stealth, or as it were, by _Distillation_; the _Orifice_ as well as the _INFANT’s Head_ being shut up by the said _Bones_, so that neither the _Head_ nor the _Humours_ can open it; save only a little on the _lower Side_: Where the _Waters_, by pressing the _Membranes_ downwards in an _acute Form_, break thro’ that _acuminated_ Part as they also force the _Head_ upwards, near to the _Border_ of the said BONES.

II. IT often happens, by these means, that the _right Arm_ is excluded, and falls down to the _Shoulder_ in the _PASSAGE_, the _INFANT_ being left dry by the unseasonable flowing of the _Waters_: And the _Arm_ being thus thrust forwards into the _PASSAGE_, the _Head_ is more and more forced-back _upwards_, so that the _Neck_ of Consequence is so bent, that it may easily break; and the _Crown_ of the _HEAD_ (falling against the _Spine_ of the _PUBIS_ or _COXENDICIS_) is so pressed upon it by the violent _Pains_, that the _BRAIN_ may be readily affringed, and consequently the _INFANT_ die before _BIRTH_.

III. THE most deplorable _Condition_ of all is when, after all _Pains_ and _Labours_ suffered in vain, the MOTHER herself expires, without bringing forth her _Child_; as it too often happens, that after a long continued and miserable _Torment_, the BIRTH is not a Jot advanced, whereby of course the wretched _Woman_ must undoubtedly _yield up the Ghost_ for want of effectual _Help_. I say for want of _Help_, because the _Help_ of such MIDWIVES as are ignorant of the various _Postures_ of the WOMB, and the _Method_ of correcting them; and of such as do not thorowly understand the TOUCH, but place all their Hopes in _Nature_ and _Divine Mercy_; is as nothing, and of no Effect upon this _critical Occasion_: Since the audacious _Ignorance_ of such Creatures serves only to tempt GOD and his _Providence_.

HAVING thus defin’d and laid down the fatal Inconveniences of this _Preternatural Situation_, I come now to shew People concern’d how to correct it and dispatch a happy _BIRTH_: In order to which, the _præliminary Articles_ are the _MIDWIFE’S_ indefatigable _Industry_, and accurate _Attention_ to the Circumstances of Things.

THEN supposing an _INFANT_ to be brought forth _HEAD foremost_; the _Woman_ is to be placed with the upper part of her Body a little elevated, the _MIDWIFE_ then finding (by the TOUCH) the _Orifice_ to be but moderately press’d upon the _Left OS PUBIS_, or _COXENDICIS_; in this _Case_, she is to be laid down full upon the _right Side_ a little obliquely, that the WOMB may fall back by its own Weight, and not relapse against those _Bones_.

NEXT after this I would endeavour to get my _right Hand-Fingers_ above the upper Border of the _Orifice_, and thereby remove it a little, and bring it down nearer the _Cavity_ of the PELVIS. To facilitate which _Work_, I would order some of the _By-Standing Women_ to raise her _right Side_ a little, which of Consequence raises the WOMB itself; and thus I would, by raising and letting it down by Degrees, move it _forwards_ into the _PELVIS_: However, always taking special Care, that the WOMB, together with the _Head_, do not slip down too far into the crooked _Sinus_ of the _OS SACRUM_, so as to stick there, (as has been already precaution’d in the preceding _Chapter_:) to prevent which unlucky _Accident_, I would advise to apply all possible Care and Pains in the Beginning, to sustain and keep up the _Orifice_, and to bare the _HEAD_ sufficiently before its Descent; observing also the same Management in point of the _Humours_, until the _Membrane_ breaks; which being broken, I would treat the _Head_ in Manner as aforesaid.

NOW tho’ the _HEAD_ in this _Posture_ offers itself as if it were _bent aside_, because of the _lateral Distorsion_ of the WOMB, I would first bring it to a right _Position_, and then manage it as if it had presented itself _directly_: And besides, the _HEAD_ being thus directed into the PELVIS, I would always take care that the _Woman’s Body_ be bent a little towards the _left Side_, that the CHILD may the more readily be carried down by its own _Weight_ into the _PELVIS_. But, in short, as to the farther Exclusion of the INFANT, and _After-Birth_, as well as the _Cleansing_ and _Contraction_ of the WOMB; These Things are to be perform’d, as directed by the foregoing _Chapter_.

HOWEVER, we will now state the _Case_, and suppose that the _Woman_ is spent and tired out with continual hard _Labour_, before the capable _MIDWIFE_ is sent for: Upon this _Condition_ the _BIRTH_ is to be hastened by all possible prudent Means. In order to which, I would (without Loss of Time) endeavour to _turn_ the _INFANT_, and extract it by the _Feet_; Because to direct it otherways into the PELVIS, would be too tedious upon this Juncture. For to bring it _Head foremost_, would create vehement _Pains_, which infallibly would expose _both Lives_ to extream Danger. But now, in fine, having thus at large insisted upon the various _Cases_ of _Preternatural Births_, arising from the four extream _oblique Situations_ of the WOMB; It remains yet still, that I also subjoin a few Words, upon such _Preternatural Cases_, as may proceed from the less _oblique Positions of the same Body_; and that briefly in manner following——

CHAP. XXII. _Of Præternatural BIRTHS, proceeding from the Median oblique Situations of the WOMB._

AS the three preceeding _Chapters_ concern only the Extremities of an _obliquated_ WOMB, so they necessarily lead me in this Place to offer a short _Hint_ Upon the _Median_ or _Less oblique Uterine Positions_. Which notwithstanding their great _Variety_, according to the just Comparison formerly made[176], I shall for Brevity-sake comprehend in _One_, and treat of in general _Terms_ as subsequently follows.

I. I observe that however conspicuous and remarkable the _Difference_ of these _Preternatural Postures_ may be, especially _That_ betwixt the _Four_ mention’d _Extremes_ and the _Natural Situation_ of the WOMB; yet I fear, that there is too much Reason to suspect, that this _Difference_ is but little known to the generality of _Practitioners_ in _MIDWIFERY_, otherways I am sure _Patience_ would not be so much cry’d up, or at least _Time_ would not be so much trifled away, (at every difficult _LABOUR_) by the _Ordinary Boethogynists_, neither would the Use of _SHARPS_ be so much practis’d by the _Extraordinary MIDWIFE_.

II. I observe, that tho’ a WOMB _less oblique_, occasions a _less Difficult_, or more easy _BIRTH_, than any of the _Extremes_, yet the least Degree of an _oblique uterine Posture_, may be of great Hindrance, and imminent Danger to the _Woman_, whose attending _MIDWIFE_ is ignorant of it, as well as of the exact _Method_ of restoring it to its _Natural State_.

III. I would observe by the way, that as the fatal _Consequences_ of such Ignorance, have already been sufficiently precaution’d in the preceeding _Chapters_; so it would be _supervacaneous_, and altogether needless to re-assume or repeat them in _This_: Wherefore I shall only farther, once for all, exhort and adjure such _MIDWIVES_, as have any regard for their own _Consciences_, and the _Lives_ of their Neighbours, that they would qualify themselves duly in these excellent Points of Knowledge. And _This_ I have the more Reason to inculcate, because I never yet knew an assiduous _MIDWIFE_, who was _thus perfectly_ well endued with the _essential Qualifications_ of her PROFESSION, but the great _GOD_ rather (to whom the Glory of all Things is due) perpetually compleated his own _Gifts_, and crown’d the _Labour_ of her Hands with desirable _Success_.

FOR as the _Husband-Man_, who never _sowed_, can never expect to _reap_; or as the _Gardener_, who never _planted_, can never hope to _gather_; so neither can the _MIDWIFE_ who was never regularly qualified, ever justly hope or expect to effect a happy _DELIVERY_; especially not in _Cases_ of Difficult and _Preternatural BIRTHS_: Neither can the _Consequences_ of her Mistakes or Ignorance on the other Hand, ever detract from, or lessen, the _Divine Power_, which is still the SAME, and _can always do all Things that it will, but will not always do all that it can_. Besides _HE_, who has been pleased to lay such _Burthens_ upon us, to try the _Patience_ and _Constancy_ of _One_, and to exercise the _Industry_ and _Charity_ of _another_; _HE_, I say, often executes his _Judgments_ upon _some_, for the _Sins_ of _both Offenders_, that all Things may the more manifestly tend to his own eternal Glory.

IV. I come now in the _fourth_ Place by certain _Demonstration_, to explain the Nature of a WOMB less _obliquated_, and to lay down the genuine Method of correcting any _Preternatural Situation_ whatsoever of the disorder’d or distorted WOMB.

IN order to which, I would previously observe, that all such _Postures_ of the WOMB, whether more or less, either tending _aside_, or _prone_, or _supine_, are only best discover’d by the _TOUCH_: Because the _Orifice_ always answering in a _strait Line_ to the opposite _Situation_ of the _Bottom_ of the WOMB, can never fail to shew its _Posture_ to the judicious _MIDWIFE_.

HENCE if the _MIDWIFE_ does but know exactly the _Natural Position_ of the _ORIFICE_, she may thence easily conceive by how much it differs in an _obliquated_ WOMB, and accordingly thereby readily judge whereabouts the _Bottom_ is seated: Which _Situations_ of _Bottom_ and _Orifice_ being known, she can consequently be at no loss to comprehend the _Disposition_ of the whole _Uterine Body_. And if she now remembers or recollects what has been said of _restoring_ and _replacing_ the most _extream_, or most _oblique_ WOMB, she will have no Difficulty in restoring any WOMB _less oblique_ to its _Natural Posture_; This depending entirely upon that Method, to which I refer[177], for Brevity’s sake.

IN short, I shall here only add, that if the _INFANT_ offers itself _well turn’d_, in this _less oblique_ WOMB; the _MIDWIFE_, having restored the WOMB to its right Place and natural _Posture_, will find nothing more to do, but to take Care to facilitate and enlarge the _Passage_, and receive the _CHILD_ tenderly with the _Head foremost_. Whereas in _Case_ the _INFANT_ presents itself _ill-turn’d_ in this WOMB, it is to be very circumspectly extracted by the Feet; as by and by will more amply appear from what ensues, _Viz._——

CHAP. XXIII. _Of Preternatural BIRTHS, proceeding from complicated Causes, of both the INFANT and the WOMB._

BY this sort of _BIRTHS_, I mean such as are _Preternatural_, both in respect of the _Situation_ of the _CHILD_, and of the WOMB. Which complicated _Preternatural BIRTH_ is (of all _others_) the most dangerous; because of an _Indefinity_ of Accidents and Difficulties with which it is always attended, according to the many various _Postures_ in which both the _INFANT_ and the WOMB are found: All which to enumerate here, and to guard particularly against them, as I have done in the preceeding _Cases_, would not only augment the _Bulk_ and _Charge_ of this _WORK_, but also be in some respect altogether _Needless_: Because if I was to content my self to treat this _Chapter_ in _general_ (without descending to _particular_) _TERMS_, I would not doubt but that the ingenious _Reader_ would even thence readily form a clear _IDEA_ of all such _BIRTHS_, from the many different _Cases_ already stated and discussed; which if thoroughly well understood, the Rest cannot but be easily comprehended.

HOWEVER, that I may not leave the weaker _Capacity_, or the doubtful _MIDWIFE_ to the Uncertainties of her own scrupulous _Judgement_, I shall propose and resolve some of the most difficult and dangerous _Cases_ belonging to this _preternatural Subject_, and _that_ as far as is really requisite, in manner following; _viz._——

I. WE Shall suppose that the _INFANT_ is ill-turned, and presents itself _preternaturally_, with FACE, CHIN, HAND, ELBOW, SHOULDER, BREAST, BACK, BELLY, SIDE, BUTTOCK, KNEE, FOOT, or any _other Part_ or _Member_ first, in a WOMB tending _obliquely forwards_. In this _Condition_, I shall _first_ show the _MIDWIFE_ how, and by what _Signs_, she may know and discover such perverse _Postures_; and _secondly_ how, and by what Means, _These_ may be rectify’d, the _CHILD_ extricated, and the _MOTHER_ reliev’d in Life.

THEN as to the _First Point_, I would have it minded, that the TOUCH is the only _Expedient_, by which the _Situation_ of the _INFANT_ in any WOMB, whether _Oblique_ or _Direct_, is to be discover’d and perfectly known. Which when the _MIDWIFE_ finds to be _preternatural_, she needs not much trouble herself about what _precise Part_ offers or comes _first_ in the _PASSAGE_: Because of this short _Rule_, which I would not have her to forget; namely, That, when the HEAD does not present itself _first_ in this complicated _Case_, the _CHILD_ is to be drawn out by the _FEET_. For in this ill _Position_ of both the _INFANT_ and the _WOMB_, the _Version_ of the _CHILD_ succeeds more easily than if the HEAD was _foremost_: Wherefore I would lose no Time, but as Soon as I had discover’d all _Circumstances_ aright, I would commence my Business upon this Occasion, before either the _MOTHER_ or the _INFANT_ are much spent, that I may perform my _Work_, while they both can mutually concur with me towards their own _Relief_; That is, while the WOMB is yet suspended in the _upper Part_ of the PELVIS, and the _Membrane_ not yet broken.

IN order to this _Second Point_, the _Woman_ being commodiously placed, the _MIDWIFE_ is to pass up her _Hand_ into the _VAGINA_, and dispose the _Orifice_ of the WOMB to open, which is now sooner done than if the HEAD came _first_: _This_ being done dextrously, she is to put first _one_ or _two Fingers_, then _all_ of them successively into the _Aperture_; and when that is sufficiently enlarged, she is to penetrate into the WOMB, and either break the _MEMBRANE_, or wait its _spontaneous Breaking_, as she judges best by occurring _Circumstances_. In the next place, she is to look for and find the _FEET_; and, the _TOES_ being always turn’d towards the RECTUM, they are to be forthwith brought into the PASSAGE: proceeding still farther in the due and regular _Method_ of extracting the CHILD, as already taught[178] and dilucidated.