CHAPTER XI.

_Difficulties attending a wrong Position of the_ Child_’s_ Head.

If in the Progress of Travil, the Midwife perceives any Part of the Head, besides the _Crown_, discoverable by its _Sutures_, presenting, and it appear _broad_, and very _hard_ to the _Touch_: If the _Waters_ may be _felt_ descending in a _long_ Form through the _internal Orifice_, somewhat like a Piece of a Gut distended with Water: These Appearances presage the utmost Difficulty and Danger, commonly owing to the small Distance between the _forward_ and _back_ Bones; an ill Situation of the _internal Orifice_; the _comparative Largeness_ of the Child’s Head; or the _ill_ Site of the _Womb_; whereby the Head may be pressed against the Bones _forward_ or _backward_, or somewhat inclined to _either_ Side, in a wrong Direction for the _Passage_. These Causes, singly or concurring, render the Case much beyond the Skill, and very often the Strength, of a Midwife to redress.

When unqualified Midwives observe the Head present to the inward Orifice, they are too apt to promise good Success, and behave with the utmost Confidence, wherein they are often egregiously mistaken; for there cannot be a more difficult Birth, than frequently happens, when any other Part, instead of the Crown, offers; and the Misfortune is, the longer Recourse to proper Assistance is delay’d, the greater the Difficulty becomes every Moment; and the poor Woman may think herself happy, if she escapes with her Life, the Danger of a most _fatiguing_ and _tedious_ Labour, succeeded, perhaps, by such a Relaxation of the _Vagina_ or _Passage_, as will occasion great Uneasiness in going, or being in an _upright_ Posture, without the immediate Help of Medicines, both externally and internally; or wearing a _Pessary_ for its Support, during Life.

Whereas ’tis certain, that if the Mother’s Pains, _strongly bearing down_, the Muscles of the Belly contracting and becoming sensibly _hard_ to the _Touch_, don’t manifestly promote the Birth, it must needs be owing to some Obstruction beyond the Midwife’s Skill; who in this Circumstance is apt to complain, the Pains are not sufficiently _strong_, ’till the poor Woman is ready to expire, from the Loss of her Strength, by her long Suffering under them; and told she must patiently wait God’s Time, who in Case he miraculously interpos’d, wants not the Midwife’s Assistance: And what still adds to this deplorable Calamity, ’tis likely she is put upon exerting her utmost Strength, assisted by Cordials; when _encouraging_ her _Labour_ and _provoking_ her _Pains_, ’till the Obstructions in the Way of the _Birth_ are remov’d, contribute still further to the Danger attending.

I don’t deny but that in some Cases, a _tedious_ Labour may be owing to a Defect of _sufficiently_ strong Pains; but as this often proceeds from _Circumstances_ obstructing the _Birth_, true Labour naturally takes Place, when they are remov’d; and, by a right Management of the Hand, is more _effectually_ promoted, without Cordials or _forcing_ Medicines, where the Pains are deficient.

Under this Sort of unnatural Birth, may very well be enumerated, the _Face_ presenting _towards_ the Mother’s Belly, or the _Side_ of the Head coming _Foremost_, for its Passage must be extreamly difficult in these Postures; as well as when the _Face_ comes _forward_; for then by Reason of the great Tumour, about the _Head_, _Face_, _Eyes_, and _Mouth_, from Lodging between the Bones, the Infant expiring in the Birth, has been often taken for a Monster. I have often been so happy, when the Head has long remain’d, wedg’d between the Bones, as to bring the Child alive, by the _Forceps_, in a few Minutes, if seasonably call’d, when the Woman in Travil has been in the utmost Danger of Death.

The 5th of _May_, 1751, I met with as bad a Case, as most of this Kind at WIGGLETON: This Woman, by the Midwife’s Account, seem’d to be in _Labour_ at Times near a Month, and for a Week last, almost in continual Pain, with her first Child: as I was call’d late to her Assistance, I could not judge, by early Appearances, of the Situation of the _Uterus_, or _Infant_; this is most commonly only in the Power of the Midwife to observe; her _Waters_ had gradually drain’d away above a Week, and there still remain’d some Part of the _Membranes_ depending like a _Gut_ in the _Vagina_, the _Head_ offer’d, firmly wedg’d in the _Pelvis_; the Part most obvious to the _Touch_, by its Softness and fleshy Consistence, seem’d to be the _Cheek_: The poor Woman’s Pains, for some Hours, were _ineffectual_ for want of Strength, her Spirits being exhausted, by a Labour so fatiguing; there was no Possibility of _turning_ the Child; I endeavour’d, with some Success, to promote the _Birth_, by bearing _strongly_ against the inferior Part of the _Os-sacrum_, but her Weakness, depriving me of the small Benefit of her Pains, I had for a Time; there was an absolute Necessity for a speedy Delivery, for the Mother’s Sake: ’Twas with some Difficulty I overcame her Prejudice, and those Present against the Use of any Instrument, tho’ at length they yielded; when introducing a _Limb_ of the Extractor on each Side of the Head, and Co-operating with a small Pain, encouraging the Woman to bear down as strongly as she could, I immediately brought a Daughter, with a monstrous long Head alive.

I HAVE, however, met with some Cases, which I could relieve by no better Method, than lessening the Head; but considering for whose Benefit I am chiefly Writing, and how dangerous the Use of Instruments may be in injudicious Hands, I rather choose to advise Women not to meddle with them, than pretend to relate the Method of using them.