Part 25

II. WE will suppose moreover, that the INFANT is _ill-seated_, and presents itself _preternaturally_ with any of the aforementioned _Members first_, in a WOMB hanging _obliquely to either Side_. In this _Case_, I would sincerely advise the _MIDWIFE_, to lose no Time in opening the WOMB, breaking the MEMBRANE, turning the CHILD, and extracting it by the FEET: Because in this _Posture_ of both the _BIRTH_ and the _WOMB_, Experience has taught me that nothing can be safer and less dangerous than this _Method_, when ingeniously and presently perform’d with Dexterity.

IT is true indeed it may be _objected_, that I dissent in _this Matter_, from most (if not from all) _Authors_: To which I _answer_, in short, that _Those_ from whom I do differ, were never acquainted with this _complicated preternatural Condition_, but always supposed the _WOMB_ to continue in its proper Place, never dreaming of its various _Motion_, nor suspecting its _oblique Situation_; erroneously imagining all _preternatural BIRTHS_ to proceed merely from the ill _Version_ of the INFANT: In which _Circumstance_ however, when it happens so, I confess they are so far in the right, that the HEAD is to be _first_ brought into the PASSAGE, and the CHILD excluded by it with all possible Expedition.

BUT that I may farther elucidate the true _State_ of this _Case_, as it becomes me to speak the _Truth_ ingenuously, it is my candid Opinion that, in any _oblique Posture_ of the _WOMB_, it is the safest, quickest, and most convenient _Method_ to extract the INFANT by the FEET, and that presently in the _Beginning_ of the LABOUR, either before or at least presently after FLOODING, as occasion requires. For this very Reason, and to this Purpose, I hope, I may farther justly lay down _one certain Rule_; namely, that all _BIRTHS ill-turn’d_, in a _WOMB ill-seated_, are to be rightly _turn’d_ again, and drawn out by the FEET. Which _Rule_, if duly observed, will, I am positive, save a World of _Women_ and _Children_, that otherwise must inevitably perish; since as for my part, I know no _Situation_ of the INFANT in an _oblique WOMB_, more difficult or dangerous than the HEAD’s _offering itself first_; and _that_ because the _BIRTH_ cannot be then _turned_ without the greatest _Difficulty_ and most extreme _Pains_.

THIS, in short, will be readily granted by All, who do consider or conceive that the _WOMB_ (being fixed by _Ligaments_ on both sides) is always more inclinable to _fall Forwards_ or _Backwards_, than to either _Side_, and first most commonly _bends back_ before it comes to any _lateral Posture_; and that from hence of consequence, the _WOMB_ is _distorted_ as well as _obliquely situated_. By reason of which _Distortion_, if the _CHILD_ comes _Head foremost_, it falls down in the PELVIS _obliquely_; and tho’ a judicious _MIDWIFE_ may bring the HEAD directly into the PELVIS, yet the _Shoulders_ following, must needs fall upon the PELVIS _a-cross_, in its narrower Part; whereby of reasonable Consequence the INFANT must be distorted in the _Passage_.

NOW in this _Case_, no PAINS, how violent soever, can avail to force forwards the _BIRTH_ so fixed upon these _Bones_; wherefore (I say) when the _WOMB_ is thus _seated_, it is most safe in the _Beginning_ of the _LABOUR_, to open its _Orifice_, break the _Membrane_, turn the _CHILD_, and take it out by the _FEET_; since by the HEAD’s coming now _foremost_, both _Lives_ are at Stake and in great Jeopardy.

HOWEVER yet it may be again _objected_, that I have already prescribed another _Method_ in _Chap._ 21; _viz._ of bringing the _Orifice_ together with the HEAD into the PELVIS, and promoting the _BIRTH_ in that Manner: To this I _answer_, that my _Reason_ for so doing, was not only to convince some People, that I know _their Method_ as well as _my own_; but also to whet or assist the _Judgment_ of such good _MIDWIVES_ as cannot forsake their own old _By-Paths_; Not that I ever design’d to recommend _it_ to any, tho’ I must however acknowledge, that sometimes it may effect the desirable _Ends_; but according to the _Rules_ of irrefragable _Truth_, and sound Judgment, we find that, in this _Position_ of the WOMB, let the _BIRTH_ offer itself as it will, the only laudable _Method_ is without Loss of Time to extract the INFANT, and deliver the _Woman_ as above-directed.

III. I observe upon the whole, that as the immediate present _Case_ is applicable to either (_right_ or _left_) _Side_; so what is said of the foregoing _Condition_, with respect to the WOMB’s _inclining forwards_, may be easily apply’d to the _Case_ of its _tending backwards_: Only with this considerable Difference, that the _oblique forward Posture_ of the WOMB, is the most commodious of the _Four_ mentioned _Extremes_, and consequently admits of a more easy _Exclusion_ of the _BIRTH_ by the _Head_, than any of the rest mentioned.

NOT but that either of these grand or complicated _preternatural BIRTHS_ imply and prognosticate imminent Danger to the _MOTHER_, or the _CHILD_, or _Both_; as well as incredible _Labour_ and _Fatigue_ to the faithful _MIDWIFE_; who, in such _Cases_, can less distinctly feel, less commodiously handle, and more difficultly come at the Matter, so as to dispose the _INFANT_’S _Members_ for _Attraction_, than in any other _Condition_ of _BIRTH_: Hence it is, in short, that so many _MIDWIVES_ are liable to the most egregious Mistakes, and unaccountable Deceptions upon these unlucky Occasions. But——

AGAIN farther, I hope I may freely speak my Mind, and openly avow, that the most of these BIRTHS proceed merely from want of seasonable and skilful _Assistance_ in the beginning of the LABOUR: Because the _BIRTH_ (however well seated then) by reason of the _bad Situation_ of the WOMB, cannot possibly pass thro’ the PELVIS of itself; and not being judiciously assisted at that nice Juncture, behold, from a _Natural_, it falls on a sudden also into a _Preternatural Posture_. From hence we have this extreme difficult and most dangerous sort of _Preternatural BIRTHS_, as will more conspicuously appear from a deliberate _Reflection_ upon the preceding _Chapters_. And This much (I hope) may finally suffice any intelligent _Reader_, to conceive the different _Circumstances_ of all _complicated Preternatural BIRTHS_ whatsoever. Whence I go on to the _Fourth_ and last Sort of _Preternatural BIRTHS_ proposed; namely, _Those_ proceeding from intervening _accidental Causes_; which because they are also different, I shall handle briefly and separately in the ensuing Manner; _viz._——

CHAP. XXIV. _Of Preternatural BIRTHS, proceeding from the NAVEL-STRING’s coming first, and that either alone, or with some other Member._

AMONG the various unhappy _Accidents_, which may happen in or about the Time of LABOUR, the present _Case_ is none of the most auspicious; in as much as it may, in sundry Respects, occasion a very difficult _Preternatural BIRTH_, according to the Difference of Circumstances: For the NAVEL-STRING having fallen down and come _first_ in the _Passage_, may be variously turn’d, and consequently cause several and sundry _Inconveniences_, as follow, _viz._——

I. WHEN the _Umbilical Vessel_ falls down alone into the PASSAGE, without any other _Part_, the _BIRTH_ is then commonly situated a-cross in the WOMB; and in this _Condition_, _BACK_ or _BELLY_, _HAND_ or _FOOT_, may be probably expected to come _first_: Wherefore the active _MIDWIFE_ ought to discover the _real Posture_ by the TOUCH, and _that_ at least before all the _Waters_ are yet flow’d off and evacuated; and then betimes to fetch away the _CHILD_ by the _FEET_, unless the HEAD be more convenient or pat for the Purpose. But these _Cases_ being already particularly discussed[179], I shall add nothing farther upon them in this Place.

II. THE _String_ may fall down _double_, and so swell with _Cold_, as to obstruct the _Passage_, which however is but the smallest Consideration in this _Condition_, because by its hanging down _double_, it may be so shortned, that the _CHILD_ may be detain’d, appending by it in the _Orifice_, until the BLOOD of the _Umbilicals_ coagulating either by _Cold_, or by _Compression_ in the _Passage_, the due _Circulation_ is obstructed, and the INFANT expos’d to the greatest of _Dangers_, if a very speedy _DELIVERY_ does not prevent the fatal Accident.

THE Prudent _MIDWIFE_ ought always to be very sollicitous about this _Case_, making it her particular _Care_ from the beginning of the LABOUR, as soon as perceiv’d by the TOUCH, and before the _Waters_ break, to avert or hinder its either coming _before_, or _along with the_ HEAD, by removing it judiciously according to _Art_. But supposing she comes too late to prevent the _Mischief_, and that the STRING is already in the _Passage_; then it is to be _put back behind the_ HEAD immediately, and kept there until the HEAD be fully directed into and lodg’d in the _Passage_. However it sometimes happens that it cannot be kept-up so _long_, and that the _MIDWIFE_, whatever _Pains_ she may take, cannot hinder it from extruding itself at every PANG: In this _Condition_, I would advise her (without delay) to extract the BIRTH by the FEET, and that notwithstanding the HEAD should be _foremost_.

III. IT also happens sometimes, that the STRING without hanging down, is variously compress’d betwixt the HEAD and the _Bones_ of the PELVIS, which (stopping or impeding the _Motion_ of the BLOOD) soon occasions the INFANT’s inevitable Death.

IN which _Case_, if pressed against the OSSA PUBIS, having laid the _Woman_ on her _Back_ with her _Head low_, and the _lower Part of her Body raised_, I would press _back_ the INFANT’s _Head_, and put the _STRING_ as much as possible behind it; upon which, then I would bring the _Head_ forthwith into the PELVIS, unless it be more convenient to _turn_ and _extract_ it by the _FEET_.

AS also, tho’ seldom, it may happen, that the _Umbilical_ may be _pressed back_ by the HEAD against the OS SACRUM: In which State of Affairs, I would turn the _Woman_, if Strength may permit, upon her KNEES, whilst I employ either _Hand_ on the _Back Part_, in order to remove the HEAD, how firmly soever fixed: Whereas if the _Patient_ be weak, I would lay her upon either _Side_, drawing up one _Foot_ to her _Belly_, for the Advantage of obtaining more Room, in order to effect the same Thing; which, tho’ difficult, is no impossible _Task_ for the expert _MIDWIFE_.

BUT if it chances to be pressed against either of the OSSA ILIA, having laid the _Woman_ on the contrary _Side_, with the _lower Part_ of her Body elevated, I would remove the _HEAD_ with the opposite _Hand_, and free the _STRING_; proceeding otherways as in the former _Cases_, with _HEAD_ or _FEET_, as I should find most convenient.

IV. AGAIN, it also sometimes comes to pass, that the _STRING_ is found lying upon the _Forehead_, which is indeed most _dangerous_; but it is easily removed with good Judgement to the _Temples_ of the HEAD, which I take to be a safe _Position_, because there the _Pressure_ is much less aggravated.

V. MOREOVER it likewise sometimes happens, that the _STRING_ comes along with the _Shoulder_, _Elbow_, _Hand_, _Foot_, &c. without touching the _HEAD_: Upon this then as soon as the _Humours_ have flow’d, I would pass my _Hand_ quickly up, and bring the _CHILD_, _Head_ or _Feet foremost_ into the _Passage_, according to its _Situation_, always detaining or stopping the _STRING_ from coming out before the _BIRTH_: Whereas if the _STRING_ be already excluded along with the _Foot_ or the _Arm_, it is to be _repelled_ with all necessary Speed, Conduct, and Caution, and then the _INFANT_ ought to be dextrously drawn out by the _Feet_.

VI. I have also seen the _CHILD_ brought forth by the _HEAD_, with the _Umbilical_ circumvolv’d, or turn’d twice or thrice round the _NECK_; by which means of the _STRING_’s being so much shortned, the _BIRTH_ was stopped or retained in the _Passage_: Upon this Occasion, I endeavour’d to slacken the _STRING_, and so bring it over the _HEAD_, but finding it too _strait_ and _short_ to be so ordered, I _tied_ it in two places (at about two or three _Inches_ distance) and then _cut it in two_ betwixt the _Ligatures_: That being done, it was my Business to lose no Time in attracting the _INFANT_ and delivering the _WOMAN_; otherways in this _Condition_, it would have soon expired.

CHAP. XXV. _Of Preternatural BIRTHS, from the AFTER-BIRTH’s coming first into the PASSAGE._

ANOTHER _Preternatural Accident_ to which the _BIRTH_ is also sometimes liable, is the _Falling down of the_ PLACENTA into the _Orifice_ of the WOMB; which of course must needs obstruct the _Passage_, and prevent the timely _Egress_ of the _INFANT_.

NOW tho’ the ignorant MIDWIFE often occasions this untoward _Accident_ by her own unskilful and imprudent _Treatment_, or rough and indecent _Usage_; yet the Ingenious _MIDWIFE_ discovers this _Case_ in time by _two_ certain different _Ways_: Namely, FIRST, by the TOUCH, when she can neither feel the _MEMBRANE_, nor the naked _HEAD_; but (on the contrary) perceives a thick, soft, fleshy, boneless _Substance_: SECONDLY, by a _Bloody Flooding_, which constantly attends this _Condition_; whereby both the _MOTHER_ and the _CHILD_ are imminently endangered, as is already more abundantly set forth[180]: Unless the skilful _MIDWIFE_ can prevent the fatal _Consequence_, by accelerating the _BIRTH_; which, however yet, is not to be rashly attempted without due Circumspection.

BUT notwithstanding the daring _Difficulties_, and time-serving _Precautions_, mentioned by most _Authors_ of my reading and revolving, in this _Case_; I can conceive no extraordinary _Perplexity_ which can attend it, if the _DELIVERY_ be but _timely_ or _seasonably_ undertaken, before the _Woman’s Strength_ and _Blood_ be too much exhausted. I know _Daventer_, _Peu_, and some _others_, make long _Ambages_ or Circumlocutions upon this _Head_; for _some_ are at great Pains to teach us how to perforate the _SECUNDINE_ with a _Hair-Needle_ instead of our _Fingers_, and _others_ how to keep it back, until the _INFANT_ be first born: But for my part, as I already foresee sundry _Difficulties_ that will arise in these Practices, so I shall be loth to come into them, and that because——

FIRST, in penetrating the PLACENTA with any _acute Instrument_, the _CHILD_ (if not the _MOTHER_ also) may be easily wounded: SECONDLY, supposing it to be done with the FINGERS, the _Hole_ must be dilated in proportion to the _Aperture_ of the Mouth of the WOMB, and then _this_ mangled MASS must be dispersed to _all Sides_ of the _Orifice_; by which Means, _Daventer_ himself acknowledges, that it often perfectly _congeals_ with BLOOD, and sticks so fast to the WOMB or VAGINA, that the _Ignorant_ would not only take them to be _grown together_, but also believe them rather to be _one and the same Body_: Which consequently must require both great _Pains_ and _Difficulty_ to be separated, and at last a very diligent _Scrutiny_ must be made, that no _Fragment_ be left any where _Behind_, since in this _Condition_ no just _Conjecture_ can be made by the Eye: THIRDLY, by retaining the _SECUNDINE_ in the WOMB, when its heaviest and most bulky _Part_ (the PLACENTA) is fallen down into the _Entrance_, let it be never so judiciously managed and moved, it possesses a considerable deal of _Room_, and consequently obstructs the _Operation_ of the _MIDWIFE_’s _Hand_, lying as a cross thwarting _Impediment_ in her way, which at the same Time _blockades_ or totally shuts up the _Passage_ of the _CHILD_.

WHEREFORE, and considering that this _Body_, when so loosened and separated from the WOMB, can never possibly be any more _serviceable_; but, on the contrary, highly _detrimental_ to both the _MOTHER_ and the _INFANT_, as aforesaid; I cannot but be of Opinion, that it is both the safest and shortest Way, to extract the _SECUNDINE first_; by which expeditious _Step_, the _MIDWIFE_ not only gains more _Room_ to turn the CHILD, but also (this being done) she can much more commodiously draw it out by the HEELS: Animadverting always by the way, that in this critical _Condition_, the _BIRTH_ must immediately follow the _SECUNDINE_, without the Loss of one Moment’s Time, and _that_ especially for stopping the _Floodings_, which would otherways not only soon suffocate the weak INFANT, but also in a short Space of Time effect the certain _Death_ of the tender MOTHER.

CHAP. XXVI. _Of Preternatural BIRTHS, proceeding from the Death of the INFANT._

AMONG the many _Preternatural BIRTHS_ mentioned, I think _that_ of a _Dead CHILD_, may now at last justly take place.

BUT because this _Case_ is too commonly mistaken, and that the _Live INFANT_ is too often taken for _Dead_, and consequently the wretched innocent _Creature_ treated accordingly; I think it may not be amiss, before I enter upon this DELIVERY, that I make a few previous requisite _Remarks_; by which the extraordinary _MIDWIFE_, who is commonly sent for too late, may perfectly know whether the _BIRTH_ be _dead_ or _alive_; to the End that, so also in Case of _Necessity_, it may be accordingly managed: Since in this fatal _Condition_ I have known _several Persons_ to have been grossly deceiv’d, who have depended upon the _Relation_ of the sick WOMAN, or taken it upon the _Credit_ of the ignorant attending _MIDWIFE_.

FIRST then I know it to be ALIVE, if, by laying my _Hand_ on the MOTHER’s _Belly_, I find it _stir_ or _move_: Or, SECONDLY, If I have not full _Satisfaction_ this way, I would convey my _Hand_ into the WOMB, as soon as the _Waters_ break, to feel the _Pulsation_ of the NAVEL-STRING; which the nearer I feel to the _CHILD_’s _Belly_, the stronger I find it _beat_, if ALIVE: Or, THIRDLY, I would put my _Finger_ into the _INFANT_’s _Mouth_ to feel its _Tongue_, which (if ALIVE) I should perceive it to _stir_, as if it would _suck_.

WHEREAS, on the contrary, we may know it to be DEAD, when a certain nauseous and cadaverous _Humour_ flows from the WOMB: Or, when the _Woman_ feels a great ponderous _Weight_ in her _BELLY_, tumbling always towards that _Side_, which she inclines to, or lies upon: As also when we find the _CHILD cold_ in the WOMB; or the _Umbilical_ Vessel without PULSE; or the TONGUE _immoveable_: Or lastly, when I perceive the _Dissolution of the Cuticle_ on the Top of the HEAD, I am then positive that the FOETUS is DEAD; because, as _this_ is not easily _dissolved_, neither does it happen immediately, but some Space of time after DEATH.

IN this _Case_ then of a _dead CHILD_, the _Labour_ is commonly lingring and dangerous, because of the few, faint, and slow _PAINS_ which seize the _Woman_; so that _Nature_, being half overthrown by the _Death_ of the _INFANT_, which now can no ways help itself, absolutely requires to be assisted by the most expeditious ART: And _that_ best, in my humble Opinion, by the _Means_ and _Method_ following, _viz._——

FIRST I would endeavour to awaken and promote the _PAINS_, by one or more sharp and strong _Clysters_: But SECONDLY, if _these_ do not succeed so expeditiously as necessary, I would introduce my _Hand_ into the WOMB, sliding it all along under the BELLY towards the FEET; and so, with _Face_ and _Breast_ downwards, I would gently extract it by them; in the same manner, as if it was ALIVE. Only, in this _Case_, great _Care_ must be taken, that the HEAD may not unhappily _sever_ itself from the _Body_, and consequently _stay behind_ in the WOMB; which Accident may easily happen in the _Passage_, especially if the _BIRTH_ is any ways _putrefy’d_.

HOWEVER, after all, in _Case_ of such an untoward _Occurrence_, I would still excuse myself from the _Use_ of an EDUCTOR, and debar myself from the Practice of any _Instrument_ whatsoever, save only that of my own natural HAND; which, I think, in all _Conditions_ of _BIRTHS_, whether _Natural_ or _Preternatural_, _Dead_ or _Alive_, is solely _obliged_, and only best serves, according to the _Rules_ of my _Profession_, to discharge the _Duty_ of all the _INSTRUMENTS_ in the _Surgeon’s Shop_; excepting only in the _Case_ of a _MONSTER_ or a very _Hydropical CHILD_.

BUT in the present _Circumstance_ of the HEAD’s being separated from the _Body_, as soon as I have extracted the _CARCASE_, as above; I would instantly convey back my _Hand_ into the _WOMB_, and put one or two of its _Fingers_ into the _Mouth_ of the _HEAD_, placing my _Thumb_ under the _Chin_: For by _thus_ taking Hold of it by the _Jaw_, I would extract it gently, and _that_ with the greatest _Ease_ and _Safety_ to the _PATIENT Woman_.

NOW having thus, in fine, both particularly and at large, treated of the several _Sorts_ of _Natural_, _Difficult_, and _Preternatural BIRTHS_: And having also for the common _Good of Mankind_, without any Affectation, Hesitation, or Reservation, candidly laid down, and ingenuously set forth the most _certain_, _brief_, _plain_, _easy_, and _unprejudiced INSTRUCTIONS_, which perhaps have ever yet been committed to PRINT, upon the excellent _Subject_ of _MIDWIFERY_: And having likewise, in a Word _lastly_, for the true _Direction_ and good _Government_ of all _MIDWIVES_, fairly laid (as it were) and faithfully _delivered_ the _big-belly’d Woman_, in every relative _Case_ or _Condition_ of _BIRTH_, which may or can happen to her: It now only remains, I would modestly think, that I should (in the next place) come to take all the necessary _Care_, and make the most requisite _Provision_ possible for the perfect _Recovery_ of my CHILD-BED-WOMAN; and _that_ in the ensuing _Method_.

SECT. VI.

CHAP. I. _Of the DIET and REGIMEN of the Puerperial or Child-Bed-Woman._

THE _Good Woman_ being now delivered, and laid in CHILD-BED, may rightly be compared to a SHIP, which, after a dangerous nine or ten Months _Voyage_, rides at _Anchor_ in her PORT; where, tho’ arriv’d with great Security, yet if not well _moor’d_ against sudden _Winds_ and _Storms_, she may perhaps at last drive from her _Anchors_ and suffer SHIPWRECK: So in like manner if both the MOTHER and the CHILD be not duly taken _Care_ of after the _BIRTH_, _Both_ may be still expos’d to the Danger of _DEATH_. Wherefore, to prevent all such melancholy _Accidents_, I shall first point out the proper _REGIMEN_ of the _One_, and then successively direct THAT of the _Other_, in the following Manner; _viz._——

I. THEN, immediately after the _BIRTH_, a soft gentle _Closure_ may be apply’d to the WOMB for repelling of the _cold Air_; of which we must be now very cautious, if we will _avert_ the fatal _Consequences_ that may thereby happen: As also a small _Plaister_ of GALBANUM with a little _Civet_ in its Center, may be applied to the _NAVEL_ for attracting, or rather retaining the WOMB in its proper Place, where the _MIDWIFE_’s careful _Hand_ has fixed it after the _DELIVERY_.

II. THE _Patient_ having her _Body_ wrap’d about with a _warm Cloth_, and her _Hips_ girt round with the same, is to be placed conveniently in a _warm_ BED; that is, directly upon her _Back-Bone_, with her _Head_ and _Body_ a little elevated, for her _breathing_ and _cleansing_ the Better; as her _Thighs_ and _Legs_ also are to be stretched down close together: Whereupon _now_, if not _before_, she ought to have a little good _Chicken_ or _Pullet-Broth_ for her Refreshment; which being done, all _Doors_ and _Windows_ are to be shut, and the _Bed-Curtains_ drawn close, that she may rest and sleep quietly.