CHAPTER VI.

_Of a natural_ Birth, _and the_ Office _of the Midwife._

As the _Birth_ approaches, the Woman grows _hotter_ and _red_ in the Face; the Pains bear more _strongly_ down; the _internal_ Orifice _opens_; the _Vagina_ or _Passage_, at its _Entrance_, becomes more swell’d, as the Child’s Head advances; and the _Membranes_ are more and more _tensely_ stretched; before the _Birth_, the Person is often seized with a _Vomiting_, and _universal_ Tremor, without the Coldness of an _Ague_; and very often a _Humour_, _discolour’d_ with _Blood_, immediately preceeds the _Breach_ of the _Membranes_; when these Symptoms, or several of them, become urgent, ’tis Time to put the Woman in a proper Situation, as describ’d in the preceeding Chapter: The Midwife ought by no Means to break the _Membranes_, but _encourage_ the Woman now to make the best of her Pains, by _strongly bearing down_, as if going to Stool; the Midwife with her Fingers well anointed, putting them gently within the _internal_ Orifice, may cautiously, by separating them, assist its _opening_, and Removing it more behind the Child’s Head, thereby gradually promote its more easy Transmission, and at the same Time prevent, if necessary, the Womb from being too far protruded: After the _Waters_ are _broke_, as it is called, and the _Head_ of the Child comes into the _Passage_, the Midwife may lay hold on each Side of it, taking Care not to bruise it by rough Handling, and drawing it, by _Waving_ her Hands, if necessary, to loosen it, when fixed, rather than in a strait Line, assist the Birth; and if obstructed by the Shoulders in the Passage, inserting a Finger under each Arm-Pit, extricate them by the like Action.

’Tis true, it happens, tho’ unobserv’d by Writers, as far as I remember, that _many_ Women have no _Waters breaking away_, either before or after the Birth; whether absorbed or not, in Time of Labour, I shall not at present determine; this is called, by the Country People, a _dry_ Labour, and often attended with Difficulty; however, if the _Crown_ appear _forward_, the Issue may nevertheless be favourable.

The Child being born, the next Business is to tie the _Navel-string_ with a _waxed_ Thread, so _doubled_, as not to endanger _cutting_, about _two_ Inches from the Child’s Body, making another Ligature near the Body of the Mother, so far distant from the former, as may be convenient for _Cutting_ between _both_ Ligatures, and separating the Infant from its _After-birth_. Midwives are too apt to leave a greater Length, which can be of no Service, but has been thought, on the contrary, by our Countryman CHAPMAN, to occasion _Navel_ Ruptures.

After the _Separation_ of the _Navel-string_, the Care to get the _After-birth_ succeeds; this will often come by the Assistance of Nature, with a gentle Motion of the Hand gradually drawing and loosening it, by the Navel-string: But if it adheres to the _Fund_ of the _Womb_, which is frequently the Case, whether from the _Waters_ being come away before the Birth or otherwise; it must cautiously be separated, and extracted by the Hand, to prevent the most mischievous and fatal Consequences.

The Assistant holding the _Navel-string_ with _one_ Hand, must with great Caution introduce the _other_ into the _Womb_, avoiding _all Violence_ to any Part in the Way, ’till she reaches the _After-birth_, some Part of which probably, being loosened, will be found more _forward_ than the rest; which _taking_ between her _Thumb_ and _Fore-Fingers_, she must, by an easy Motion of her other Fingers, between the _Womb_ and _After-birth_, gradually _separate_ the Parts adhering all _round_, ’till finding the whole free, before the Palm of the Hand and Fingers, she brings it intirely away; for should any Part remain, the poor Woman’s Labour would still continue, and occasion _dangerous_ Floodings, requiring the immediate Assistance of an able Hand, to rescue the Patient from the immediate Hazard of Death.

Sometimes when the _Womb_ has discharged its _Waters_, and the _Child_, by Reason of a Defect of Pains, or otherwise, remains _long_ very _forward_ near the _Birth_, the _Womb_ so _contracts_ about the _After-birth_, as to make the _Separation_ of it very difficult; in which case Assistance is requisite, from one well acquainted with the Structure of the Body; and the longer this is delay’d, the more Danger there will be of all the bad Consequences of the Retention, and Corruption of the _After-birth_ in the Body.

It requires great Care to prevent the _Protrusion_ of the _Womb_ in some Women of a _large Pelvis_, or _Opening_ between the _Bones_; or if the _After-birth_ remains closely fixed, the _Womb_, in a very _open Pelvis_, may be _thrust_ by the Violence of the Pains; or _drawn_ out of the Body by an _unskilful_ Hand, which is commonly very soon fatal to the poor Woman; and I believe happens much oftner than is apprehended, tho’ industriously conceal’d, by _guilty_ Midwives, under the Colour of the poor Woman’s dying in Child-bed, from some other Cause. DEVENTER says, he saw a sad Spectacle at the HAGUE, the _Head_ of the Child excluded to the _Shoulders_ quite without the _Passage_, when Three-fourth Parts of the _Head_ were conceal’d within the _Womb_, the _Crown_ appearing within its _inward Orifice_†.

† See Chir. Op. Part ii. Page 32.

A much worse Case happen’d in my Neighbourhood, _Sept._ 23, 1749. I was call’d to a Woman, whose Child, on the 21st came unexpectedly, without the least Assistance, in the Presence of an _old_ Midwife of _large_ Practice; she puzzled an Hour, as I was inform’d, to bring away the _After-birth_, which closely adhered to the _Fund_ of the _Womb_; while the _unfortunate_ Woman lay senseless, saving the Memory of being long expos’d to the Cold, when she came to herself; after which she continued in violent _Labour-like_ Pains; upon Scrutiny, I found a large _Substance_ in the _Pelvis_, of the Size of a Child’s Head, considerably resisting my Touch; I observ’d on Trial, a Part of the Woman’s Body every Way _interposed_ between my Fingers and this _Substance_, by her Sensibility of my _Touch_; therefore contenting myself with giving her some palliative Medicines, and telling the Persons present, a Mole, as I thought, or Child still remain’d to come away, I for that Time, took my Leave: On the 24th, she was said to be much better; on the 29th, I was again call’d to this poor Woman, and inform’d, that upon her first going to Stool, since I had before seen her, which happen’d the same Day, the large _Substance_ before-mention’d, came intirely out of her Body; to which it join’d by a thinner Substance, of some length: I now perceived it was no less than the _Womb_ turned _inside out_, suspended by its _Ligaments_, and joining to the _Vagina_, but very much swell’d by the Obstruction of the circulating Humours; And an old Gentlewoman, who was present when the Child was born, inform’d me, she saw the Midwife draw this _Body_ from the Woman, by the _Navel-string_, and indeed, the Impression of her _Nails_, in separating the _After-birth_, remain’d still visible at the _Bottom_ of the _Womb_, and the Midwife having long expos’d the Patient, put this _inverted Womb_ again into her Body.

The Condition of the Part, after so long Delay, did not admit the Possibility of rightly reinstating it; I therefore return’d it, as well as I could, into the Pelvis, and introduc’d a Pessary to retain it; and as this Person had already contracted a Hectick, I charg’d her, as she valu’d her Life, to confine herself strictly to a _cooling Milk_, or _vegetable Diet_; she has since had large Discharges of a _bloody_ Corruption, with Portions of a fleshy Confidence from the Parts affected. In _April_, 1751, she told me the Discharge coming from her had long been much abated in Quantity, and what remain’d was the Whites; that she had an inward Fever, and the Piles, for which I gave her my Advice; her Complexion was chang’d from the most florid to a languishing Paleness.

My Brother, much better known in this Country, and longer practis’d in Midwifry, has been concern’d in furnishing Medicines for the Person, whose History I have given, altho’ by Means of his Absence, he did not attend her on the most emergent Occasions.

I have since been call’d to the Assistance of the _old_ Midwife, who attended, and she frankly told me, she had another Woman under the like Circumstance, who died the same Day.

Having related such Things as occur in the most favourable Circumstances of Travil, about which all Midwives ought to be well inform’d, and those Injuries to which Women are sometimes liable, notwithstanding the most _promising_ Appearances: In the next Place I proceed to shew, what are the Symptoms preceeding _difficult_ Labours, which by timely Assistance, may be secured from the most dangerous, if not fatal Consequences, and are of great Moment to be known by Midwives, as well as Matrons and Child-bearing Women, to enable them to judge when it is absolutely necessary to recommend calling that Aid, which is beyond their Capacity to give.