SECT. V. (continued 2)

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 280all 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 281BIRTH 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——

282

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, 283thro’ 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.

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: 284Secondly, 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 285Child 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 286Head, 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.

287BOTH 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 288apply 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.

289II. 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, 290or 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.

291HOWEVER, 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.

292I. 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 293MIDWIFE 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 294upon 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 295would 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 296can 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.

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 297various 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.

298NOW 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 299feel, 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.——

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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 301shortned, 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, 302whilst 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 303and 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.

304BUT 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.

305WHEREFORE, 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 306I 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 307the 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 308faithfully 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.

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