SECT. V.

CHAP. I. Of BIRTH.

MAN’s appointed Time may as reasonably allude to his BIRTH, as to his DEATH: His Days and his Months (mentioned by holy Job^[158]) being as much determin’d, naturally speaking, in the One, as in the other Case.

THE INFANT thus being thoroughly ripen’d, and arrived to full Perfection of Maturity, the Hour approaches, in which it scorns any longer Confinement to such narrow Bounds. For the Animal Spirits being discontented, for want of due Liberty and free Motion; the Vitals, for want of Refrigeration and Refreshment; and the Natural Spirits, for want of sufficient Respiration and Nutrition: They all concur to make a Commotion, and (as it were) a victorious Revolt or an Effort pushing for CONQUEST.

228THE INFANT being thus irritated, immediately shakes off its Fetters, breaks the Ligaments, rents the Membranes, thrusts through the Enclosures, and makes its most vigorous Attempts to enlarge itself from the Prison of the Womb, into that of the World.

WHICH Enlargement depends very much indeed upon NATURE, but more particularly on the Strength and Vigour of the INFANT, seconded by a peculiar Faculty of the Womb, that by degrees is drawn-in to Consent, and Endeavour to dislodge and expel its troublesome and obstreperous GUEST.

NOW the INFANT, during the whole Time of Gestation, adhering to the WOMB, by the Umbilicals, as the Fruit does to the Tree by the Stalks, upon this Occasion distends the WOMB, and having valiantly turn’d itself, breaks the Membranes, and dissolves the Acetabula: When also the Orifice of the WOMB is competently open’d; and That (in Avicenna’s memorable Words^[159]) at the Command of the great God. Upon This the Waters flow; the Umbilicals parting from the WOMB and their proper Vessels, and the Veins and Arteries of the SECUNDINE severing themselves, in like manner; As ripe Fruit, or the Leaves of Trees in Autumn fall-off naturally, or break from their proper Stalks.

THUS the WOMB, exerting its extensive and expulsive Faculties, excludes the Legitimate INFANT: To which great Work also, the Painful Labours, and Labouring Pangs of the MOTHER (in the manner they happen with the contracted Spirits, depress’d Midriff, and compress’d Muscles of the Abdomen) contribute not a little Help. And, in short, this stupendous Work or Action is called BIRTH; and is nothing else, but an Exclusion of the mature CHILD.

WHICH BIRTH proceeds either from Causes of the INFANT, or from Causes of the WOMB: Of the INFANT, because through the strict Confinement of a narrow Place, and Defect^[160] of Aliment, and Refrigeration, 229It kicks and spurns for its Exit: Of the WOMB, because about that Time, being overloaded and aggrieved by the Bulk and Weight of the Child, it endeavours, by its own expulsive Faculty, to disburthen itself, and propel or drive it forth to the utmost of its Power. For——

AS it is the proper Function of the Stomach, to eject the noxious Humours by Vomit, and deject the Natural Excrements into the INTESTINES; as it is also the Office of the RECTUM to evacuate the Fæces; as likewise the Profusion of the Urine is the Action of the Bladder; as again the Extrusion of all fuliginous Matters is the Work of the Heart and Lungs; and as, at last, the Effusion of the Genital Seed (in Venery) is the Operation of the Virile Testicles: So the Exclusion of the Mature FOETUS is the Eighth^[161] and last proper Action of the WOMB; which is justly deem’d the only Primary Agent and Active Cause of BIRTH, as the excluded FOETUS is the Passive.

BUT this BIRTH is not always Uniform; for as it differs in Time, so it does also in Manner: From hence we have with respect to the Time, Legitimate and Illegitimate BIRTHS, which being already discuss’d^[162], I shall resume nothing by way of Repetition in this Place: And with respect to the Manner, we have also two general Sorts, namely, Natural and Preternatural BIRTHS; which together with their particular Branches, I am now to enter upon, without any farther Digression.

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CHAP. II. Of Natural BIRTHS.

BY a Natural BIRTH, I mean nothing else, but that which is perform’d without any ART or Artificial Means; which BIRTH (of itself) strictly observes the Order and Appointment of Nature: That is, in the INFANT’s coming Head foremost, Face downwards, Arms following, extended (along the Sides) strait upwards, towards the Thighs.

HIPPOCRATES’s Reason^[163], in short, for the CHILD’s thus turning and presenting itself, is very good; viz. Because of all the Parts, the Head is the Heaviest about the Time of BIRTH, as appears more at large from Sect. I. Chap. 10.

BUT besides this Argument, I believe Wise Nature has also order’d it thus; because This indubitably is the most safe and easy Manner of EXITION both for the Mother and Infant: Insomuch that by all other Methods of EXTRACTION, One or the Other, and sometimes Both Lives are, or may be, endanger’d, if not very dextrously perform’d, according to the best Laws of Art and Judgment, as by and by will more manifestly appear.

BUT because I have generally observ’d most Authors to treat promiscuously of BIRTHS, not only accounting some, which are really Natural, to be Preternatural; but also both handling and writing of them as such, only because attended with some difficult Circumstances: I shall (in this place) take Leave to make an agreeable Distinction betwixt the different Sorts of Natural BIRTHS, in order to make every thing the more clear and obvious to the Conception of the Reader. Upon which Account therefore, I shall reduce These to two 231Heads, and that under the Titles of Natural Easy, and Natural Difficult BIRTHS.

THE FIRST of which I include in this Chapter; but because in this Case (which I call a Natural Easy BIRTH), Nature alone always performs the Work, without any Help of ART or Artful Means; and because also the Midwife (upon this Occasion) has but little or nothing to do, save only to observe the concluding Chapters of the last preceding Section; and upon receiving the Child, immediately to manage and provide both for the Mother and the Infant according to their several Necessities, as hereafter shall be inculcated in the respective Chapters of the next following Section: I say, for these Reasons, I have no Room here to insist farther on this present Head; wherefore I proceed in course to the SECOND Sort of these BIRTHS. Namely——

CHAP. III. Of Natural Difficult BIRTHS.

THO’ indeed every difficult Expulsion of the INFANT, from whatsoever Cause it may proceed, is verily a Difficult BIRTH; yet I shall here distinguish a difficult One from a preternatural BIRTH; not only that I may thereby, the better avoid the Confusion which others have led themselves into, by treating of Both promiscuously, but also that my Method may tend the more to the peculiar Benefit and Advantage of the Ingenious Reader.

WHEREFORE I call that a Difficult BIRTH; where, notwithstanding the Figure and Dimensions of the CHILD, answer in all respects to its proper natural Posture, in a Perpendicular Womb, duly situated, yet the Exclusion of the INFANT, is retarded, by some certain Opposition or Difficulty. From hence proceeds 232the real Difference between This and the Natural Easy BIRTH, forasmuch as This always requires less or more skilful Assistance, according to various Circumstances, and That but Little or none at all.

NOW the Causes of Difficult BIRTHS are very various, and according to the Nature of them, This sometimes proves equally as dangerous as the Preternatural; but when so it happens, I have commonly observed the Fault to be, for the most Part wholly owing to the arrogant MIDWIFE, who either knew not how to remove the Cause and facilitate the BIRTH herself, or delay’d applying betimes to some Abler Person, for the Relief and Safety of her Labouring WOMAN.

HENCE arises a Fundamental Maxim, which I would lay down for a memorable Rule to all such Ignorants; that no MIDWIFE ought to keep a Woman in this Condition under her Hands (especially in a Place where extraordinary Help is to be had) any longer, than she finds the Advances of BIRTH answer to the Proportion of Time spent about it: But forthwith she ought to deliver her up to the Care of the more Skilful and Judicious Practiser in this Art. In which Case, of Compliance and Condescension, she is to be highly commended for her tender Care, and cautious Concern; whereas upon acting contrary to this good Rule out of Pride or Obstinacy, and the fatal Accident ensuing, I have known the MIDWIFE to have been try’d for her Life in the City of Venice.

BUT that I may render every thing Plain and Easy to the Apprehension of the weakest Reader, by reason that the Causes of Difficult BIRTHS are both different and numerous, I shall again reduce them to Two Classes; namely, External and Internal: The External, I shall include in the next following Chapter; but the Internal Causes, requiring a more Curious and Extensive Dilucidation, may (I hope) be pertinently divided into a Three-fold Difference; viz. Causes of the Mother, of the 233Infant, and of the Passages; which I propose to handle particularly, all in their due Order. But First,

CHAP. IV. Of Difficult BIRTHS, proceeding from External Causes.

IN all difficult Cases, the Cure or Remedy chiefly depends upon the certain Knowledge of the Nature of the Case, and the Cause of the Difficulty: Since (according to Celsus^[164], that noble Roman Physician) it is not to be suppos’d that He should know how to remedy Diseases, who knows not their Original Causes.

FOR as in other Cases, so also in MIDWIFERY, the Cause being known, the Difficulty is easily remov’d; but especially when it only proceeds from External Causes, it requires no great Art, save only the MIDWIFE’S particular Notice and discreet Animadversion.

AS, FIRST, for Instance, in Case of any Difficulty, occasion’d by an Intemperature, or inclement Constitution of Weather and Air; the more adverse or inclement the Weather is, the more tender Care ought to be taken of the Labouring Woman: Namely, in Summer, when the Heat scorches so much as to dissipate the Woman’s Strength, she ought to Labour in a Ground-Chamber backwards, which may be strewed (for the Purpose) with Vine or Willow-Leaves, Rose-Water, and a little Vinegar; as it is customary in hot Countries.

IN Winter, when the Cold pinches so as to condense and astringe the Womb and the Passages, she ought to Labour in an Upper-Room, kept moderately warm with one continued Fire; the MIDWIFE rubbing gently the 234Hypogastrick and Ischiatick Regions every now and then with hot Cloathes.

IN Spring and Fall, when parching dry Weather, with North and East Winds most abound, the MIDWIFE ought not only to rub these Inferiour Regions with hot Cloaths; but also to qualify the Influences of the Siccid AIR, by anointing the Passages with proper Unguents.

A Second External Cause may proceed from the Passions of the Will or Mind, as it often does from Fear and Despair, Dejection and Pusillanimity: In which Case, it is the MIDWIFE’s Duty to encourage her Woman by the Hopes of a Speedy DELIVERY, and doing well under God’s Blessing. When the Cause arises from Anger or Sorrow, these are to be assuaged by the repeated Christian Exhortations, and Friendly Admonitions of the Midwife and Gossips. When it comes from Pride and Obstinacy, as has been the Case of some Lofty Women; who (deeming themselves too good, to be treated after the common Course of Mankind) have refused to undergo or permit the proper Means, absolutely necessary for their own Relief; This ought to be severely check’d by the Company, especially by the nearest Friends; the Midwife (by proper Remonstrances) convincing her to her Shame of her obstinate Sin. When it proceeds, in fine, from Bashfulness or too strict a Modesty, she may be justly reprehended of Folly; for no Woman of good Sense (how Modest and Virtuous soever) will expose her own Life or her Infant’s to Danger, for the trifling Fancies or Caprices of her own vain Imagination, especially in a Case where like things happen to All equally of Flesh and Blood.

BUT when it happens to proceed from the Woman’s being ill-affected, or owing a private Grudge or Hatred to any in the Company, (as I once knew it to be the Cause of a difficult and lingring BIRTH) She ought to speak her Mind freely, at least to her MIDWIFE; who ought to give the Person civil Notice to retire forthwith, for certain Reasons, &c.

235A Third External Cause of a difficult BIRTH may proceed from a wrong Position, or other sinistrous Methods taken to assist the Woman: In which Case, such Inconveniencies are to be alter’d, and better Measures practis’d; for thus the Cause being removed, the BIRTH differs in Nothing from That of the Natural Easy Case.

WHENCE I come, in the next Place, to speak of Difficult BIRTHS, proceeding from Internal Causes; and because they are Three-fold, as has been before observed, I shall assign them as many respective Chapters, treating of Each in their due Order, as mentioned.

CHAP. V. Of Difficult BIRTHS, proceeding from Causes of the MOTHER.

IN this (as in the former Case) the Midwife must use her most acute and nicest Judgment, to find out the particular Cause of the Difficulty. Which being done,

I. IF She finds it arises from the Woman’s being too Young, or too Old, of her first Child, or too Lean at last; she is to anoint the Passages with proper Unguents, which ought to be done some time before, as well as in the Hour of LABOUR: When she is likewise to employ her subtile Hand, in assisting and augmenting the Dilatation of the Orifice; as is requisite also in Case of the Woman being too Fat or Gross.

II. IF the Woman be too small, short, crooked, or misshaped, not having a Breast strong enough to forward and bear down her PAINS; or if she be over tender, sensible, and apprehensive of PAIN; or too weak, and not able to contribute or assist by her own forcing Endeavours; or short-winded, and not capable to constrain her Spirits downwards: In all these Cases she is to be kept upright, 236for the more free Respiration, as well as for encreasing her PAINS, standing or walking about the Room, according to her Strength, being supported under her Arms, and not put to Bed until at least the WATERS are broke. But, in the mean Time, the weak and tender Woman ought to be now and then comforted and refreshed with fresh soft Eggs, good Broths, Jellies, a little Wine and Toast, a little Wine and Water, or such like convenient Things, as well as with the Hopes of a speedy Delivery.

III. WHEN the PAINS are not Natural or Genuine; but Spurious, Faint and Languid; or Shifting and Tergiversant; such are to be assuaged by proper Lenitives and Anodynes; which being regularly done, the Genuine Pains may be excited by proper Clysters, and divers other Means. But I would advise none to a Profuse Use of MEDICINES in such Cases, since I well know that many a Woman has lost her Life by using dolorifick Medicines, prescribed by imprudent MIDWIVES, without considering, or so much as knowing the true Circumstances of the Condition: Whereas in most Cases, by the ingenious Motion of an Experienc’d Hand only, the Pains may be sufficiently awaken’d, and the Birth safely promoted.

IV. WHEN the Difficulty proceeds from the Debility of the Womb, or its Expulsive Faculty, not being able or capable to Exclude the INFANT, because of a more strong and valid Retentive Power: In this Condition, if there be no evident External Cause to be obviated, it depends chiefly upon the Subtile Hand of the MIDWIFE, to assist the Womb in its Function; and otherways the PATIENT is only to be treated as in the Case of the weak and tender Woman above-mentioned.

V. WHEN the Woman is taken with any Acute Disease, the BIRTH is to be prompted by all safe Means; and if a Natural DELIVERY does not presently succeed, an Artificial one must (without Loss of Time) be undertaken. As in the Case of immoderate and continual Floodings, with concomitant Convulsions, which always 237proceed from the Separation of the SECUNDINE (either in whole or in part) from the Womb, and happen many different ways, as already mentioned at large^[165].

IN these Cases, especially if the Secundine is found (by the Touch) at the Orifice, there is no Hope of Stopping them by any other Means, than by delivering the Woman; which now the sooner done, the better (for saving two Lives) and that whether at full time of Reckoning or not. But this Operation, I conceive, is to be most discreetly Undertaken in the manner following, viz.

THE Woman is to be placed in Bed, with the Upper and Lower Part of her Body almost equal, then the Midwife is gently and gradually to introduce her Fingers into the Orifice, dilating it cautiously with one or two, until she can enter them All; when opening the Matrix by Degrees, she gets in her Whole Hand, and thereby first carefully tears the Membrane with her Nails, if the WATERS are not previously broke: Then she puts her Hand in the same Membrane to the Infant’s Feet, seeking them in their Place, where they are to be found, when they don’t present themselves at First: Because, the Hold by the FEET being Better, it is more easy to deliver by Them, in this Case, than by the HEAD, or any other Part. After this the FEET being found, the Child is easily turn’d, as long as the Womb is loose and slippery, and the Humours not quite flown off; which being nicely done, the FEET are to be drawn out both together, if possible; but if otherways, they must be drawn down separately, with great Caution: And so being conjoin’d or held fast together, they are to be drawn forward with one Hand, whilst the other is circumspectly thrust towards the Knees or Buttocks of the Child, in order thereby to turn also the whole Body of the Infant, so that its Face, Belly, and Toes may tend downwards towards the RECTUM.

IN this Posture the Child may be gently and gradually extracted with Ease; next the SECUNDINE must be 238fetch’d away in its Turn, and lastly the Womb is to be thoroughly cleans’d of all heterogeneous Bodies, as formerly directed^[166]. And thus the Womb (having yielded up its Contents) immediately contracts, by which MEANS of divine Appointment, the Vessels close and shut firmly, and consequently the FLUX ceases, together with all the concomitant SYMPTOMS.

BUT it is to be well remembred, that this Operation ought to be timely perform’d; that is, before the Woman has lost too much Blood, or is too much spent; in which Condition such a painful Attempt would but accelerate her Death. As to her Regimen next, upon this melancholy Occasion, She must be duly provided for beforehand, that she may be able to undergo and stand out such an extream difficult DELIVERY; and afterwards, that she may recruit her Spirits, and retrieve her exhausted Strength: For which Purposes, she ought to be supplied from time to time with some good Broths, Jellys, and a little generous Wine, smelling continually Rose-Vinegar, and applying repeated warm Toasts dipt in Wine (in which Cinnamon has been infus’d or boil’d) to the Region of her Heart, as also Napkins dipt in a Mixture of Water and Vinegar about her Reins, in order for turning the Course of the Flux.

THESE Things being all duly and artfully perform’d, the Patient (under God) will soon recover and be in Statu quo. Now These, in short, are all the principal and most common Causes of difficult Births proceeding from the part of the Mother; which being thus discussed with all Brevity, I go on to——

239

CHAP. VI. Of Difficult BIRTHS proceeding from Causes of the INFANT.

IT sometimes also happens, that the Difficulty in Labour arises from the Infant: And that FIRST when Two or More strive for Priority in BIRTH.

NOW this Condition the Midwife can no otherways distinguish or discover, but by the Touch; and when the one is more forward than the other, ’tis not to be done or known, until she has even touch’d the very Fund of the Womb: Because sometimes it so happens, that One Child has its Hands and Feet so intermix’d, that whatever way She turns her Hand, she finds Legs or Arms, Hands or Feet, which often deceives Midwives, believing there are TWINS. But in this perplex’d Case the most sure and only certain Sign, is, when she feels two Heads or two Backs; for then she cannot be Mistaken, since one Body cannot have two Heads, unless it be a Monster, which may be soon discover’d by feeling if the double Head be fix’d to one and the same Body.

BUT in the Case of TWINS or more Children (as long as they come right) the Delivery is perform’d, as if the Woman had but One, in the Natural Case already Stated; so that I shall repeat or recapitulate Nothing of what I have said, only that the After-Birth, or Births are not to be touch’d, until all the CHILDREN are Born: Upon which drawing gently the Navel Strings (in their Turns) with the One Hand, the Other brings them forth easily and orderly; as is set forth more fully in Sect. IV. Chap. 18.

A SECOND difficult LABOUR may proceed from the Weakness and Debility of the Infant, or from its being 240too Small-grown; in which Case, both the Woman and the Midwife are to use their best mutual Endeavours to promote the BIRTH, since the CHILD can do little or nothing for itself, and the Less it is, the less it is affected with the THROWS of the Mother, and the less Impression her Impulses make upon it: Whereupon Nature is to be assisted in this weak Condition by all convenient Means, whereof THAT of the Agile or Nimble Hand is the most effectual.

A THIRD difficult BIRTH may proceed from the Infant’s being too Big; In which Place I must previously apprize the READER, that I no ways mean a MONSTER or Hydropical CHILD, but only One full, well, or Big-grown, which is only reckoned too Big in regard of the Maternal Passages, which may be too Small in Proportion.

IN this Case, there is an absolute Necessity for Manual Assistance, since the PAINS (however penetrating or forcible) cannot effect the Work. But and if the INFANT is fallen down (well turn’d) into the Pelvis, the Midwife using her best and most skilful Endeavours to dilate the Passages below near the Os Coccygis, the Child may be easily brought forth (without any dangerous Instrument) by her dextrous Hand only accomplishing the Work. In the mean Time, however, it is to be minded always, that This is still more safely and commodiously done by the Feet, than by the Head, after carefully dilating the Os Coccygis, taking this Opportunity in the beginning of the Labour, before the INFANT is too much press’d down into the Pelvis.

NOW these are, in fine, the most common Causes on the Part of the INFANT, whence I come to touch upon difficult BIRTHS, proceeding from Causes of the Passages; which, because they are various, I subdivide into a Fivefold Diversity; viz. Difficult BIRTHS, proceeding from Causes of the Membranes, from Causes of the Pelvis, from Causes of the Bones of the Pelvis, from Causes of the Bladder and Rectum, and from 241Causes of the Vagina: And because all these require to be singularly explain’d, and particularly insisted upon, I shall assign them as many respective Chapters. And First——

CHAP. VII. Of Difficult BIRTHS, proceeding from Causes of the MEMBRANES.

SUCH Difficulties as These, in BIRTH, may arise, FIRST from the Strength and Firmness of the Membranes; when they happen to be so gross, callous, or thick, that the INFANT cannot easily break through them.

In this Case, when the MIDWIFE finds the Orifice of the Womb sufficiently dilated, for the Circumference of the Head, and the Child so forward in the Passage, that it is ready for BIRTH, and only impeded by the rigid or stiff Membrane; then she has just Authority to break it gently with her Nails and Fingers; taking Care in the Act not to draw the Membrane towards her, because thereby the Secundine (of which the Membrane, tho’ distinguish’d from the Placenta, is in Effect, but the Thinner Part) would be untimely separated from the Womb, and the INFANT undone, unless presently Born.

BUT the MIDWIFE, after All, must always remember, not to attempt This, before these mentioned Signs are obvious to her Touch; otherways the Waters being too soon discharged, the CHILD is left behind, the Passages grow dry, and that which might have been an Easy and Speedy, proves a Difficult and Lingring BIRTH.

AND the self-same Consequences arise from the Weakness and Tenuity of the MEMBRANES; when they 242are so thin and soft, that they break, and the Waters (which are destin’d to lubricate and moisten the Passages) flow before their Time: In both which Cases, the Office of the Waters must be supply’d by proper Fomentations, and Oils, which (however costly) falls far short of the Effect of what is so Natural. However, in short, neither of these Conditions, under the diligent Hand of the expert Midwife, can differ far from the Case of an Easy BIRTH, as already defin’d; wherefore I proceed regularly to——

CHAP. VIII. Of Difficult BIRTHS, proceeding from the Causes of the PELVIS.

DIFFICULT BIRTHS on part of the Passages, happen frequently, because of some perverse Form of the PELVIS, in these Respects; as by its being either too Large, too Narrow, or too Smooth. But that I may be the better understood in this Matter: FIRST, by a PELVIS too large, I mean such an One, as is so in comparison with the Womb or Infant; in which Condition, as the Womb can neither be firmly fix’d, compactly inclos’d, or duly supported, so neither can the Head of the Infant and the WATERS be exactly depressed upon the Orifice: Hence it often happens, that (besides the Midwife’s careful Hand) the Privities are the best, if not the only Defence, against both the Womb and the Child’s falling out of the Body.

SECONDLY, By a PELVIS too small, I mean, such an One as is so, in Consideration of the Size of the whole Body; in which Condition, the INFANT commonly answering to that Proportion, its Head can by no Possibility pass thro’ the PELVIS, in a Womb well seated, without great Force, by which Means the Womb may be easily turn’d obliquely: And thus consequently 243the Smallness of the PELVIS, may sometimes prove the Cause of a Preternatural, as well as of a Difficult BIRTH; and not only so, but also the Death of both the MOTHER and CHILD may ensue thereupon, unless timely deliver’d by an Artful Hand.

THIRDLY, By a PELVIS too smooth, I mean such an One, whose Distance betwixt the OSSA PUBIS and the prominent Part of the OS SACRUM is too narrow; in which Condition, tho’ the Womb be well placed, it cannot admit the Head (especially if large and well-grown) without great Difficulty: And this smooth PELVIS may also very easily turn the Womb (either way) obliquely, and consequently prove of the same dangerous consequential Effect with the preceeding Case.

HENCE (I think) it evidently appears, how necessary it is that all MIDWIVES should not only know the Form and Size of the PELVIS, but also the Situation and Connexion of its Bones, as already describ’d at large^[167], that she may thereby the better distinguish the Circumstances by plainly discerning the Causes, and judge accurately of the Position of both the WOMB and the INFANT; so that in the beginning of the Labour, she may immediately discover how the Pelvis and its Entrance is form’d, whether Large or Narrow, Smooth or Round.

FOR this Reason, the first Thing that the MIDWIFE ought to do, when she comes to a Woman in Labour, is to try by the Touch, how all is circumstantiated, with respect to these Things; and This is to be done before the WOMB and the CHILD are fallen down into the Pelvis, that she may contrive her Work accordingly. Because sometimes the Exclusion of the INFANT, is to be hoped for, from the Pains only; sometimes Nature is to be prudently assisted; sometimes there is an absolute Necessity for extracting the Child (without loss of Time) by an Artful Hand, as will hereafter more clearly appear; and sometimes again the same Necessity obliges us to protract the 244BIRTH, than we may save One or Both Lives: As in the Case of a smooth Pelvis, the Os Pubis and the Vertebræ of the Sacrum being but little distant, the Child’s Head is stopped; when if the Mother should labour much, or endeavour to force an expeditious BIRTH, its tender Head (of course) must suffer in proportion; Or perhaps the Brain may break, by so hard a Pressure against the Bones; or, finally (which is worse) it may be so closely squeez’d between the Bones, that both the MOTHER and the INFANT may peradventure die, before any BIRTH can possibly succeed or come happily into the World.

BUT in this critical Condition, the Woman is to labour gently, and bear her PAINS (how violent soever) patiently; the MIDWIFE always directing the Head, at the same time by her safe Hand, into the larger Space; by which Means at last, it passes gradually through that narrow Passage without the least Danger.

THE same also is the Condition when the PELVIS is too small or narrow; for by the Woman’s labouring gently and deliberately, the Head is depressed softly into an oblique Figure, and passes easily by Degrees: Whereas, on the other hand, if it is forced by Violence, it becomes flat and broad, and consequently incapable of Passing, if not also dash’d to Pieces, as aforesaid.

HENCE we clearly see, how easily Ignorance in this Point, may lead common Midwives into the grossest of Mistakes; For what is more ordinary with them, even in all Cases, than to advise the Woman to strong Labour, and to force her to violent Depressions: Insomuch that Some have Arrogance enough to carry their Bottles or Powders about them, of which they neither know the Quality nor Virtue; taking them only as they are told (by the confident Quacks or Mercenary Hands which vend them) that they may encrease and promote the Pains of Labour, and This without having any regard to the Form of the Pelvis, or the Position of either the WOMB, or the INFANT.

245IN short, the mature Consideration of this very Case, was not the least Motive which induced me to the Work in Hand; since I cannot but heartily commiserate so many fine delicate Women, as are thus every day miserably handled, tormented, and exhausted, by the preposterous Management of such indiscreet and imprudent MIDWIVES. I may well say exhausted, or worn-out; This being too evident, from the vast Number of most beautiful Women, who, by this ill-manag’d Condition, (notwithstanding they have all along heretofore, enjoy’d a good State of Health, together with the Affluence of other Worldly Blessings) have been more dejected and broken both in Complexion and Constitution, after one or two BIRTHS, than some others (judiciously and expertly delivered) have been after Twenty: Such is the great Difference betwixt the unskilful Hands or Conduct of common Midwives, and those Dextrous Touches or ingenious Operations of the more judicious Andro-Boethogynists. Whence I come in Course to——

CHAP. IX. Of Difficult BIRTHS, proceeding from Causes of the Bones of the PELVIS.

THE Reader may easily conceive, by the way, that these are neither to be made bigger or lesser by Art; notwithstanding which, by using them Skilfully, and treating them Judiciously, many a Difficult BIRTH may not only be prevented, but also many a Life saved, as will manifestly appear from what follows.

NOW the Bones, upon which the Success of the BIRTH chiefly depends, are the Os Coccygis, and the Point of the Sacrum; which sometimes bend too much inwards, and thereby obstruct and render the Passage so narrow, that no BIRTH can possibly succeed. And 246again, It sometimes happens, that the INFANT falling down into the PELVIS, and presenting itself Head foremost, is oppos’d and stopped there by the Os Coccygis: As it also sometimes falls out, that the Shoulders stick fast against the Edge of these Bones; or the Buttocks falling down and offering themselves first, may be so fastened or affixed to them, that they can never be extracted.

THESE Misfortunes may proceed from Either of these two different Causes; viz. Either from the Grossness or large Size of these Parts of the Infant, or from the Narrowness of the PELVIS, occasion’d by an ill Position of its Bones, particularly of the Os Coccygis; which Bone when the Head cannot make it yield or move, neither can it then possibly reach the Orifice of the Womb, to dilate it sufficiently: And, in short, if the Head cannot effect this essential Point, much less can the Buttocks, or any other Part be supposed capable of doing it.

BUT in all the above-mentioned Cases, I am sensible, that most MIDWIVES (not knowing better) ascribe the whole Difficulty to the Orifice of the Womb and the Vagina; upon which they ignorantly fall atearing and dilating both the One and the Other, (never minding the Point of the Sacrum); and finding these Orifices but little open’d, notwithstanding the frequent Repetition of very severe PAINS, they imagine that their substantial Hardness or Thickness is the only Cause: So that therefore (without regarding any adjacent Part) they go on violently dilacerating sometimes the Mouth of the Womb, and sometimes That of the PRIVITIES, (as I have found it by Experience) quite to the Rectum. For such is their Stupidity in this Condition of Life (as Daventer well observes) that whilst they thus tear and rend the Woman to Pieces in a manner, they allow her to sit over and above with the Point of the Os Sacrum, upon her Seat or Bed; or in some other wrong Posture, which so presses and confines the Os Coccygis at the same Time, that neither of these can move: 247Not minding at all that the chief Pressures and Impulses of the Head, must first bear upon the Os Coccygis in order to remove it, before it can effect the Dilatation of the Orifice or Mouth of the Womb. Thus they spend the Woman’s Strength in vain, break her Spirits, and ruin her Constitution thro’ Ignorance; whilst a capable Person, administring seasonable and judicious Help, according to the Circumstances of the Case, refreshes Nature, renews Strength, gives Courage, and fills the (otherways languishing and despairing) WOMAN, with Hopes and Assurances of a happy DELIVERY.

IN short, the True Method of Delivering and helping the Woman conveniently, in the different Conditions contain’d in this Chapter, depends entirely upon repelling or thrusting back the Point of the Os Sacrum, together with the Os Coccygis. I say (therefore) the whole Point of the Os Sacrum, and that Fleshy Part lying about it, is to be thrust back and dilated, so that the Passage may be sufficiently opened for the Infant to pass through; which patent Dilatation is to be promoted by pressing also back the Os Coccygis. Now these Things, in short, may be all done cautiously without creating any intense Pain, or the least Damage; and thus the obstructed Passage being clear’d and open’d, the Birth advances regularly of Course, and the CHILD is born with the greatest Ease, in the Space of a few Minutes: Whereas otherways (without the Use of these Means) both its Own and the Mother’s Destiny may be precarious or uncertain after some Days Labour.

THUS it is certain, that by assisting a Woman in Labour seasonably and skilfully, her PAINS are happily excited and encreased; whereas, on the contrary, by imprudent Treatment they unhappily cease and vanish, to her great Prejudice. Moreover, daily Experience teaches us, that the very different Touching of Things, occasions different Sensations; and from thence it is, that the dextrous MIDWIFE knows by one way of Touching, how to promote the PAINS of Labour; 248and by another, how to retard or put them off according as the Necessity of the Case requires; which hereafter will appear more at large.

BUT that we may more particularly satisfy such MIDWIVES, of our Method of repressing these Bones, and Delivering the WOMAN in the abovesaid Cases; I must add, that, after placing the PATIENT in the most convenient Posture for a WOMAN in Labour, as before fully enjoin’d^[168], I would direct Her to be supported by two Women, and mov’d so far off the Bed or Couch, that the Point of the Os Sacrum may be free to yield or give way backwards, without any the least Impediment: Then I would pass my whole Hand at once (being first well anointed or dipp’d in Oil) into the VAGINA, and from thence (if the Head will admit it) into the WOMB, as occasion should require: where, upon opening my Hand broad, that it may press equally every where, I turn the PALM upwards, and the BACK downwards against the RECTUM, and the OS SACRUM: Thus I extend my Fingers as far as possible to the Head, thrusting it a little backwards, rather than hinder my Hand from being firmly placed against the Os Coccygis: Upon my Hand being thus properly placed, as soon as the PAIN begins to threaten (which I commonly perceive before the WOMAN) I advise her, to make good Use of the approaching Pains, in order to Labour mutually, and depress with all her Power, promising her my most faithful Assistance: By which Time, as soon as the Pains have seiz’d her, and she doing her Part, I press my Hand backwards, first softly, and by degrees more strongly, against the Point of the Sacrum, bringing it at the same time gradually downwards, that I may thereby make Room for the Head sliding the same way; so that the more severe the PAINS are, the more I depress still, and the harder I press down with Effectual PAIN, the more vigorously and successfully the WOMAN is able to Labour.

249THUS I enlarge the Passage with great Moderation, so that the Infant’s Head succeeds or follows my Hand, as I bring it by little and little back again; and this adviseable Method I would reiterate as often as the Case should require, always encouraging my WOMAN, by the most obliging Words: Upon which She suffering no PAIN in vain, finds immediate Relief, recovers her Strength, recollects her Spirits, and by jointly labouring her Best with all her Force and Might, at last produces her Child with Comfort and Satisfaction, whilst I congratulate her upon the Success of being a joyful MOTHER.

BUT supposing by the way, that the INFANT offers its Buttocks first, they being neither so round nor hard as the HEAD, I would then intrude all my Fingers into the Womb more easily; some of which (or sometimes All) I would pass into the Orifice of the Womb under the Buttocks as before into the VAGINA. Now my HAND being placed there, I intently observe the PAINS as they come on; then inviting the Woman to Labour, I gradually press backwards as hard as I can conveniently, drawing my HAND downwards as before: But if in attracting it so, the HAND should slide too much out of the Womb, (which however I endeavour to prevent) while the PAINS are yet upon her; then as soon as they are over, I pass it up again, that I may be ready against their Return. And this I would reiterate upon every PAIN, so that the Child (guided by my HAND) may slide down at every Turn, until at last the Passage is so dilated, that it may advance gradually with ease into the World.

BY these judicious Means; forcing back the OS COCCYGIS by the Pressure of the HAND, as the PAINS come on, I may not only dilate the Passage, and enlarge the Orifice of the Womb; but also upon retracting the HAND by degrees, I can gradually attract the CHILD out of the Womb, through the Narrowness of the PELVIS: And thus, by this curious Art, (which I take to be one of the chief Points 250belonging to Midwifery) I do fairly deliver the Woman, who by no other Means whatsoever, could be preserved, together with her INFANT, in all Probability.

HOWEVER, tho’ I have candidly laid down this Method, (conformable to the Doctrine of the most excellent and ingenious Instructers) yet I would not advise every coarse Clumsy HAND to undertake it, nor such as are not thoroughly acquainted with the Parts of Generation: For this Performance requires Judgment and Prudence, as well as Art and Experience. But however yet in Case of Necessity, where no Extraordinary Person’s Assistance can be had, as it often happens in the Country, the Ordinary MIDWIFE ought not to neglect her Duty: nevertheless, before she offers to attempt this piece of extraordinary Skill, she ought to be very certain that these BONES are the great Impediment and Difficulty of the Delivery.

CHAP. X. Of Difficult BIRTHS, proceeding from Causes of the BLADDER and RECTUM.

DIFFICULTY in BIRTH may also proceed from the BLADDER, as (in like manner) it may from the RECTUM or Strait Gut.

I. FROM the BLADDER, when affected with Tumours, Ulcers, or Glands, obstructing the Passages; which however is more frequently occasioned by Stones lodged in the BLADDER, or in its Neck: In either of which Conditions, the Midwife, by dilating the Passage with a subtile HAND, must repel the OS COCCYGIS according to Art (as taught in the preceeding Chapter) that the HEAD in falling down, may the less offend the BLADDER.

251II. THE same Difficulty may arise from the RECTUM, when it happens in the same Manner, to be affected with such obdurated Glands, Tumours, &c. for the Consequence is the same in shutting up the Passages: In which Case the MIDWIFE is to depress gently such Excrescences, of what kind soever, with her cautious HAND, and consequently to dilate the Passages by degrees (how much soever obstructed) for receiving the Head of the INFANT; always having a respect to the affected Parts, and bearing no harder upon them than Necessity requires.

MOREOVER sometimes it happens, that the only Difficulty in LABOUR proceeds from hardened Excrements in this Gut, which may as effectually stop or shut up the Passage, as any thing else, until duly voided and evacuated by one or more proper CLYSTERS, as Occasion directs.

BUT sometimes it also happens, that such Difficulties arise from the falling out of the Fundament by the strong and violent THROWS that the Woman Suffers in Labour: In which Condition, if the CHILD is very forward in the Passage, before it happens, it may be prevented by dissuading or hindering the Woman from Labouring so vehemently; but if it happen’d before that time, it must be left so until the BIRTH be accomplished; after which time, it is to be put up exactly, and reduced to its proper Place, in the same manner as the Womb might be (in Case of its Prolapse, as mentioned in the following Chapter) after duly fomenting and bathing it with proper Applicatives: advertising always to use no CLYSTERS, in time of Child-Bed; because such Means would readily excite it again to a slippery Relapse.

252

CHAP. XI. Of Difficult BIRTHS proceeding from the Causes of the VAGINA.

DIFFICULTY likewise in LABOUR may also arise from the VAGINA, or Neck of the Womb; this Part being no less liable to the Affection of Tumours, Glands, Ulcers, &c. than any Other before-mentioned: In Either of which Cases, my above-mentioned Method in the foregoing Chapter, shall suffice for the MIDWIFE’s Instruction; as also in Case of an Inflation or Inflammation of the Pudendum.

BUT sometimes also this Difficulty happens from the falling down of the VAGINA; which Accident may as well precede as follow after the Birth, and that by the Orifice of the Womb pressing hard into that of the Privities: So that sometimes, when the MEMBRANE is broke, the Head of the INFANT, as well as the Orifice of the Womb, slides down so far, as to hang out of the Body; whereby the stressed Ligaments (being too much relaxed) give way to the falling down not only of the VAGINA, but also of the Womb it self.

IN this sad Condition the Woman must keep her Bed, and her Body equally situated, that either the fallen VAGINA or WOMB, may recover and be immediately restored to its proper Place; which being done, other Matters may be easily prevented by the Care and Diligence of the prudent MIDWIFE, stopping and restraining the Orifice of the Womb before it comes so far to that Extremity: Wherefore she ought to keep it up in the VAGINA (as much as possible) with her Hands, until the Woman has happily extruded both the CHILD and the AFTER-BIRTH.

253UPON This afterwards, she is to use her best Endeavours, to restore both the Womb and VAGINA to their due Situation; laying the Wrinkles Smooth in their proper Order, not one upon another, then placing the Woman conveniently in Bed, with her Head and Shoulders declining, Exsiccant or drying MEDICINES are to be judiciously applied, and Strengthening or Astringent Fomentations often used; whereby (in good Time) both may be again confirmed in their proper Natural Places.

NOW having thus, in fine, candidly explained the Different Causes of all Difficult BIRTHS, and carefully laid down the genuine Methods of correcting and removing them, and consequently of Delivering the good Woman successfully in all such nice Cases, it remains now in Course that I proceed to——

CHAP. XII. Of Preternatural BIRTHS.

SUCH BIRTHS, (properly speaking) are only Preternatural, which degenerate from the Natural, in respect either to the Situation of the Infant, or the Womb, or of both these jointly: Such (I say) may be well call’d Preternatural, because of the imminent Danger that (in these Conditions) threatens both the Mother and the Child.

HENCE we find the Difference between This and the Natural BIRTH; in as much as the One depends entirely upon Art, and the Other merely upon Nature: In That the INFANT is artificially extracted by the Hand, but in this it is naturally extruded by the PAINS.

HIPPOCRATES gives^[169] us a Two-fold-Cause or Reason of a Preternatural BIRTH; to wit, the Amplitude 254of the Womb, and the inordinate Motion of the Woman about the Time of LABOUR: Who, because of her afflicting PAINS and great Ailments, keeps her Body in a restless and unsteady Posture, throwing herself sometimes here, and sometimes there, sometimes on One side, and sometimes on Another through Uneasiness. By which means it cannot be otherways, but that the INFANT may be easily turn’d into some Preternatural Situation.

AND to These Causes, Senertus, Rodericus à Castro, &c. add the Two following; namely, the Solidity of the MEMBRANES, and the Debility of the Head of the CHILD: Because (as they well observe) when This is not strong enough to break through Those, the INFANT endeavouring it otherways, (with Feet or Hands) may readily fall into some Preternatural Position.

BUT because I find, that Preternatural BIRTHS deviate in different Degrees, and vary in many respects from the Natural, and that also according to a great Variety of CAUSES (no ways known to those most Learned Authors) but only of late discovered; I shall now again reduce the different Species of Preternatural BIRTHS to four Classes; namely, Preternatural BIRTHS on Part of the INFANT, on Part of the Womb, on Part of Both those jointly, and lastly on Part of some intervening Accidents.

IN treating of which, I shall according to my best Judgment, state these respective HEADS in due Order, and assign each its proper Branches; which I shall particularly discuss in brief Terms, for the Facility and Benefit of the Candid READER, whether MAN or Woman-Midwife; That they may (by this plain and easy Method) be enabled the more readily to judge of, and distinguish the several Circumstances, and consequently the better discharge their Duties (upon Occasion) to the Comfort and Satisfaction of those PATIENTS concerned, and the Honour of their own ingenious Profession.

255BUT before I enter upon These, I would willingly in this place, previously subjoin a Word or two of Advice (by way of Precaution) to the Young Andro-Boethogynist: Which, in short, consists in this Point, that as it is the too common Practice here in England, for an obstinate Set of Women to keep their Labouring PATIENTS so long under their own Hands only, until the very last Extremity; so I would not counsel him at that Time, when sent for, upon such a ticklish Occasion, to go Head-long to such a Work, nor to undertake the Delivery of such a Woman, before He makes some requisite Observations: And that I mean no ways because of any Danger of the Preternatural BIRTH which she labours under, how difficult soever it may be; but merely, on account of the Woman’s exhausted Strength and Ability, to undergo the respective Operation in her weaken’d Condition; which I would very much question in most Women, after One, Two, or Three Hours strong Labour, and that in Some far sooner, notwithstanding that others have been known to stand it out, and struggle a much longer Time.

HOWEVER, be this as it will, I commonly guess at the Woman’s State of Ability, not only by her Pulse, if strong or weak, unequal or intermitting; by her Eyes, if dejected; by her Speech, if faint; by touching the Extremities of her Body, if frigid: but also by some other Symptoms, which infallibly appear, if the Woman be too far spent, such as Cold Sweats, Swoonings, Convulsions, Loss of Sense, &c. Whereupon I say in these Cases, it is more adviseable to let alone or decline the Office, than to undertake such a precarious uncertain Piece of Work; because if the Woman happens to die under his Hand, He may perhaps be (however unjustly) blam’d for the errant Midwife’s Faults, or at least He will scarce avoid the Censure of the Ignorant and Malevolous.

YET this Advice (however wholesome and prudent) is, I confess, what I would but seldom have Recourse to, or follow myself, notwithstanding the worst Consequences 256of the Case; since as long as there is Life, there is Hope with me, by the Blessing of God: Which tho’ never so little, I should think myself obliged in Conscience to do what both Art and Nature command, and rather in all Conditions of Life to attempt an uncertain Cure^[170], than abandon the Distressed to certain Death, as some Politicians in Physical Affairs commonly do, who prize their vain Reputation above the Life of their Neighbour. But thus, in short, (for my own Part) I would chuse to act, because I have often seen, and known NATURE to have perform’d, and recover’d a weak spent parturient Patient, even beyond all human Probability.

NOT but that I would take the proper Precautions along with me, before putting my Hand to the critical Work, upon any such desperate or dangerous Occasion, by giving my ingenuous Prognostick to the nearest Friends and By-standers of the extreme Danger that both Lives may be in: Whereupon after thoroughly examining all Circumstances, with respect to the Child, whether One or More, Dead or Alive, &c. I would chearfully begin my Endeavours to relieve the afflicted Woman, encouraging and exhorting her in the first Place, for God’s-sake, as well as her own, and the tender Infant’s Life, to put herself entirely into my Hands, to undergo her Labour patiently, and contribute what she can to the Delivery.

BUT to return from this pardonable Digression to what is here proposed; as I come first to speak of Preternatural BIRTHS on the part of the Infant, I would observe that all ill Postures of the Child, in a Womb well situated, are the only Causes (meant in this place) of Preternatural BIRTHS on its own Part: Which Postures being very various and different, and each requiring a different peculiar Operation; I shall state them particularly (as above-mentioned) and that in their respective Chapters, after the manner following: viz.—

257

CHAP. XIII. Of Præternatural BIRTHS, by the FACE’s being turn’d upwards; or bent forwards, and the CROWN backwards.

AMONG the many various Preternatural Positions of the INFANT, I cannot but reckon This One: First when, tho’ the CHILD offers itself Head foremost, yet the Face is turn’d upwards; and that because the INFANT in such a Posture can never be commodiously bent and adapted to the Form of the Pelvis.

IN this Case, the MIDWIFE ought to take special Care, that the Head fall down directly and safely, without being hurt, whilst she endeavours to bring it forward: For this Purpose, she is to enlarge the Passage as much as possible, dilating the Privities, and depressing the Os Coccygis; which however must be done, without lifting the Head with her Hand, for fear of bruising the Face against the Os Pubis. By this Method the BIRTH (how Preternatural soever) may be pretty well and easily perform’d.

BUT because the CHILD can only be said to be well turn’d, when it comes with its Chin leaning upon its Breast, and its Top or Crown of the Head tending directly to the Orifice; I reckon This another Preternatural Position, when the INFANT presents itself with the Crown bent backwards, and consequently with the Face forwards: By reason that in this Case, the Orifice itself and all the rest of the Passage must be much more dilated, than in the natural Condition; and the Head (being thus bent backwards) requires more severe Pains and hard Labour, to make it slide through the Passages.

258IN which Case, the MIDWIFE, having timely discover’d this Situation by the Touch, ought immediately (upon the flowing of the Waters) to bend the Head gently forwards to the Breast, all the while adverting to handle the Face, especially the Nose and Eyes, very tenderly: And to this End, the Woman may be laid down on her Back, with her Head low; by no means labouring with the PAINS, before the Head of the CHILD is so conveniently turned: which may be thus most properly perform’d; viz. By laying the Palm of the Hand on the INFANT’s Breast, near its Throat, pressing it entirely back towards the Fund of the Womb; by which means the Head falls forwards of its own Accord upon the MIDWIFE’s Arm, and she with-drawing her Hand, will find the Head well turn’d.

BUT supposing the Head to be very strictly bent or pressed back, then the MIDWIFE is to attract it gently forwards by her Thumb, or Fore-Finger thrust into its Mouth; or by the Points of all Four thrust betwixt the Womb and the back Part of the Head. And thus, in fine, the Head being well Turned, and dextrously brought into the Passage; the Woman is then to be placed commodiously for BIRTH, and to labour her Best as in other Cases.

HOWEVER to this Case, I must add, by way of Remark for the MIDWIFE’s farther Information and better Government, that, if the Head is not brought into the Passage, as soon as the Waters have flow’d, it commonly happens, that the Hands offer themselves first; which if she do not instantly repel, the Head is turn’d up forwards with the Face, near the Chin, upon the Os Pubis; in which Condition, by reason of the Siccity and Contraction of the Womb, the only Expedient is to thrust back the Arms, and so passing the Hand under the CHILD’S Breast, to take hold of, and extract it by the Feet.

259

CHAP. XIV. Of Præternatural BIRTHS, by the Hand, Elbow, Shoulder, Knees, or Buttocks presenting first.

THE CHILD also sometimes offers itself preternaturally to the Orifice, with its Hand, Elbow, Shoulder, Knees, or Buttocks first: In which Condition, the Hand always gives an easier BIRTH than the Elbow, the Elbow than the Shoulder, the Shoulder than the Knees, and the Knees than the Buttocks: For the Hand being commonly placed near the Head, it is no great Wonder, if it presents itself before, or along with it; as sometimes (after Flooding) the Hand may slide together with the Head obliquely to either Side, and thereby either Elbow or Shoulder unfortunately fall into the Passage.

THIS is one great Reason, why I have before inculcated, that the MIDWIFE ought to be diligent and accurate in Touching her Woman, even before the Membrane breaks, that she may thereby discover and prevent this Case: Which is easily perform’d, either by repelling the Hands, or by pinching the INFANT sensibly by the Fingers, and then it soon retracts them; for thus, in short, by moving my own Hand seasonably, the Head (of its own accord) slips of course down into the Passage. But and if it happens otherways, ’tis no difficult Matter to turn and bring it down, by directing my Fingers beyond the Face to the CHILD’s Forehead; which however must be done immediately after Flooding: Whereas, if This be neglected until the dry Womb is contracted, Then, and in that Condition, the FEET may be looked for, which (in such a Posture) are soon found, with the KNEES next the 260Belly; and the INFANT may be readily drawn out by them. But

WHEN it so happens, that the CHILD comes with its KNEES foremost, it commonly has its LEGS folded towards the BUTTOCKS; by which means many a MIDWIFE has been deceiv’d, especially when she feels but one KNEE, mistaking it for the HEAD, because of its Hardness and Roundness.

IN this preternatural Condition, the INFANT must be stopped and hindered from advancing farther; wherefore having placed the Woman aright, I would gently repel the KNEES, that I may the more commodiously unfold the complicated LEGS, one after another; which I commonly do by directing one or more Fingers under the Ham, gradually along behind the LEG, until I come to the Foot; drawing always a little obliquely, that I may come the easier to its Extremity: And thus, in short, having disengaged the One, I accordingly manage the Other after the same manner; and by bringing both FEET at last together, I finish my Work, as if the Child had come FEET foremost, of which in course.

MOREOVER again it also happens sometimes, that the CHILD falls with its BUTTOCKS forwards; in which preternatural Condition, the Midwife must industriously prevent it from coming too low in the Passage, before it be duly corrected or rectify’d; since the Infant cannot possibly come, after this manner, into the World; unless it be very small, and the PASSAGE, on the other hand, very large. Wherefore in this Case, after the Woman is decently laid upon her Back, with her Head declining, I would advise to thrust back the BUTTOCKS as well as possible; then passing up my Hand along the THIGHS to the Legs, I would take hold of the FEET, and bring them gently, and one by one, forth gradually; which being done, I would attract them by the HEELS towards the Side as far as the Length of the BUTTOCKS; and then at last taking good Hold under the HIPS, I would easily and softly 261with the greatest Deliberation, draw out the whole Body successively.

CHAP. XV. Of Preternatural BIRTHS, by the Breast, Belly, or Back, presenting first; and the INFANT’s lying transverse.

SOMETIMES likewise the CHILD offers its Breast or Belly first, along with the Navel-string; which Preternatural Figure is most dangerous for the BIRTH, because of the Body’s bending backwards.

IN this difficult Case, the attentive MIDWIFE places her Woman conveniently, as soon as the Waters have flow’d, and sliding her Hand into the Womb, removes the String, and endeavours to bring the HEAD forwards into the PASSAGE; which she easily performs, as long as the Infant is suspended on high, and its Back not too much bent, by putting-in her Hand gently up to the hinder Part of the CHILD’S Head, attracting it gradually downwards. But if in this Condition the BIRTH be fallen too far down, it is more adviseable first to attract the FEET considerately.

I say considerately, because it is not sufficient to penetrate with the Hand to the FEET; which however yet, in this Posture is pretty difficult: But also to know exactly in what manner they are to be drawn down; since it is no indifferent Matter to understand how that is to be rightly perform’d with Success. Wherefore I shall in this place take upon me to set forth two different Ways of Turning the INFANT in this Condition; viz.

I. I would either First pass my Right Hand to the Left Thigh of the CHILD, and taking hold of it near the KNEE, push it upwards with my Thumb, drawing it at the same time downwards with my Fingers placed 262behind: Thus I would bring down one KNEE to the Passage, leaving the Foot yet above, and then the other KNEE in its Turn; which being done, I would change my Hand, and put the Left up to the INFANT’s Belly or Breast; where, as I thrust back its Body upwards, there is presently Room enough: then I would take hold again of one or both KNEES, to move the CHILD higher, that so the FEET may be more conveniently brought into the Passage one by one, if not Both at once: Or, upon the LEGS being bent with the Right Hand, and the KNEES brought into the Passage (as above) I would take hold of them below the Ham, and bring them past the Orifice of the Womb, till the FEET are before the Passage; whereupon I would then readily endeavour to extract the Infant by the FEET. Or, Secondly,

II. I would put my Right Hand up along the Belly to either Thigh, or Knee, having at the same time a thin Bandage doubled and dipp’d in Oil, upon my Fingers’ Ends, in order to be put about the Knee, that I may attract it gently thereby; which I would draw out again by the Right Hand, whilst my Left holds the Ends of the Bandage, that they may not move out of their Place: Then I would take the Extremities of the Bandage in my Right Hand, attracting it softly thereby, whilst I pass up my Left into the Womb, to thrust the CHILD’s Belly upwards. By which ingenious and regular Means, I think, Dr. Daventer first moved the upper Part of the Body upwards, and the Feet downwards, because the Knees are thereby brought nearer to the Orifice. Now these, in short, are the only safe, and proper Methods to be taken in this present Case, or nice Conjuncture; because, by all other inconsiderate and temerarious Means, the INFANT’s Loins may be twisted, its Hips or Knees disjointed, its Feet lamed, and itself at last quite lost or destroy’d.

IN like manner it happens not very seldom, that the INFANT comes with its Back forwards into the Passage; and in this Posture the Navel-String falls 263commonly down there, so that besides itself, nothing else is to be felt by the Touch: In this Case, the Midwife is to observe well the Flooding; immediately upon which, she is to seek for the Feet, which are more easily come at than the HEAD, tho’ the same is even also a very difficult Task, by reason that the CHILD’s Back takes up the whole Space of Room; which, notwithstanding, must be cautiously done, and the INFANT discreetly extracted by them.

BUT again sometimes, the BIRTH lies also Transverse, or a-cross the Womb; in which dangerous Case, I confess the MIDWIFE cannot well perceive, so as to distinguish Matters by the Touch, before Flooding: Because the INFANT (swimming in the Waters) is as yet seated high, and then moving its Hands and Feet variously, she sometimes feels one, and sometimes another Member at the Orifice; or, one Moment she finds Something, and another Nothing at all there. However, in fine, she may perceive the Humours most commonly compressed into an acuminated or oblong Form.

WHEREFORE in this difficult Preternatural Condition, the MIDWIFE ought primarily and chiefly to consider and discover the Posture of the Womb, whether it be direct or oblique; since according to That she must proceed in assisting her Woman with true Discretion. As for Example, if she finds it in a streight or natural State, and the Waters sufficiently exuberant, extended length-ways, &c. as aforesaid, She must, without Loss of Time, break the MEMBRANE, and presently, removing all Impediments of HAND, FOOT, or NAVEL-STRING, judiciously direct the HEAD into the Passage; which may be very easily and safely done immediately upon the Flooding. Whereas if this Method be delay’d, or not taken in due Time, and consequently the HANDS (as the readiest) present themselves to the Orifice first: In this Condition, I would lay the Woman discreetly upon her Back, with the upper Part of her Body lowest; after which, I would move the INFANT’s Hands back with my own; whereby at 264the same time bringing its FEET into the Passage, I would in the next Place gently extract the whole Body with all possible Conduct and Success.

CHAP. XVI. Of Preternatural BIRTHS, by the Feet presenting first.

IN like manner again, it often happens, that the CHILD offers its FEET foremost; which next to a Natural BIRTH is the most easy and safe Position, however I have been oblig’d to postpone it to the rest, for Method’s sake: In this Case, the MIDWIFE, observing one FOOT presenting itself in the Passage after FLOODING, ought to stop and retain it there, that it may not slide through, until she meets with the other. In order to which Performance, she must immediately seek for it, with either Hand, according as she perceives the INFANT’s great Toe situated, since it is only to be sought for along its Side; and being found, it is to be gently drawn down, and placed near its Fellow in the Passage.

BUT it falls out sometimes, that the MIDWIFE comes too late, and finds one LEG so far through, that the Buttocks are strictly confin’d: In this Condition, I would advise to lay the Woman conveniently upon her Back, with her Head low, that both the Womb and the Child may retreat a little; then taking hold of the right LEG with my Right Hand, I would thrust the INFANT back, till the whole Foot (or at least the Knee) is brought back into the Orifice of the Womb, in order that I may have the more Room for passing my Hand along the LEG: By which means I get hold of the other Foot; and bringing it also into the Passage, I 265place it along with the other, that both may come forth successfully together.

WHICH Thing, happening so when it will, that both FEET are excluded, whether done spontaneously or by Art, they are never to be repell’d or thrust back again; but, on the contrary, the way is to be duly cleared for their Passage; This being a very commodious Situation, provided the Child be well turned, I mean, with HEELS and BUTTOCKS upwards, and TOES and BELLY downwards: Whereas, if otherways, the CHIN may be easily hooked upon the OSSA PUBIS; which (if not so happily turned at first) I commonly prevent in the most adviseable manner following; viz.

UPON attracting the INFANT, I turn it cautiously at the same time, using both Hands in the ensuing Method; namely, The One I put up under its Body as far as possible, whilst with the Other I hold both FEET together: Insomuch that by this Means I gradually turn, not only the FEET and the LEGS, but also the whole Body; bringing it always forwards in the Interim, till at last it lies with its BELLY downwards, and is out above half way: Upon this I then give my Woman the Motion, to begin her Labour and endeavour her Best; because the HEAD and ARMS must necessarily pass through All at once. For notwithstanding the contrary Opinion of most Authors, who teach us to draw down the Arms one by one, and place them upon the Body, I cannot but agree with Daventer, and positively advise in this and all such other like Cases, to leave the Arms about the HEAD, that they may be excluded along with it: Because, as he says, tho’ the Woman in so doing, is obliged to force her INFANT forwards with all possible Endeavours, yet like a small transient Cloud, it is soon over.

WHEREFORE I commonly make it my Business to prevent the Woman’s PAINS, until I have brought the CHILD this Length; when allowing her a little Time to rest, I heartily encourage and positively promise Her, that, she performing her Part effectually, 266(by using all her Strength, and behaving herself as if the PAINS were most really pressing upon her, whether so or not) the BIRTH will immediately succeed: And upon this Promise, with the PATIENT’s mutual Assistances concurring, I never yet fail’d; neither will any Persons who faithfully and ingeniously follow this Method, in comfortably helping the Woman upon such an Occasion, by drawing the CHILD cautiously downwards, with whatsoever judicious Force: I mean not downwards, according to the Woman’s Length, but downwards towards the strait Gut. And as I every Moment insinuate to the MOTHER, that her BABE’s Life depends entirely upon her vigorous confederate Labour; so she mutually concurring with me, in endeavouring to do our Best, the Agrippa INFANT is presently brought forth to the great Satisfaction of Both.

BY these Means and Methods, we prevent the Tragical Consequences, which Mr. Portal and many others confess they have often met with in their Practice; viz. That the HEAD has been sometimes pulled-off from the SHOULDERS, or that the CHILD has been frequently stifled, by the Womb’s contracting and shutting-up about the NECK: Which was altogether owing to the injudicious Method of their Practice, in drawing down the Arms awkwardly (as mentioned above) along the Sides of the Body.

CHAP. XVII. Of Preternatural BIRTHS, by Two, or more INFANTS presenting themselves ill-Turn’d.

THIS Case also happens sometimes remarkably; upon which, if Both or All are contain’d in one and the same SECUNDINE, or when the MEMBRANES are broken, then the right Version is very 267difficult; not so much for want of Room, as because their HANDS and FEET are commonly interwoven and twisted together: In which preternatural Condition, when so complicated and entangled, they are to be unfolded and cleared off one another with the nicest Circumspection and Judgment.

BUT besides, farther, they are otherways, only to be treated in this difficult Point, as if there was but one CHILD; for turning them always One by One duly, I would bring all their Feet into the Passage, and consequently handle them, as if they had offer’d themselves so at first. The first CHILD being born, I would give it to the next capable Person to tie and cut its String; whilst I directly repass up my Hand, to seek for the other’s Feet, by which I would also draw it forth, after breaking its proper MEMBRANES, in Case the second Flooding is not yet over, and that notwithstanding the Head should present itself First.

BUT and if it happens, that each CHILD has its own proper and distinct SECUNDINE, and That of the INFANT already brought forth chance to be loose and separated from the Womb; In that Case, I would presently fetch it away, and then extract the other INFANT, as long as there is any yet left behind, and that also by the Feet, as aforesaid: Whereas otherwise, the BIRTHS, together with the Constriction of their UMBILICALS, are to be previously accomplished.

IN fine, having thus accounted for all the Preternatural BIRTHS whatsoever, which may or can occur on the Part of the INFANT, and that conformable to the most nice and polite Rules of Art; It remains now in the next place, that I acquit myself in a consonant manner, with respect to Those proceeding from the Part of the Womb. Of which First in general——

268

CHAP. XVIII. Of Preternatural BIRTHS, proceeding from Causes of the WOMB.

MOST, if not all, Authors having hitherto imagin’d, that all Preternatural BIRTHS took their sole Rise and Origin from the wrong Positions of the INFANTS only; I come in this place, with all due Submission, not only to affirm a quite contrary Opinion, but also to lay down a directly opposite Maxim: Namely, that the most difficult and dangerous Preternatural BIRTHS proceed merely from the ill Situation of the Womb; which I take to be the most common Cause of the Child’s wrong Posture. The Truth of which I hope to make evidently appear, to all such, who know and will consider, that this Noble Part is no less subject to various Accidents and different Diseases, than the Rest of the Body; which springing from divers Sources, may rationally be suppos’d to occasion Preternatural BIRTHS, and those more or less dangerous, according to the Nature of the Efficient: as for Instance,

IN Case of an Inflammation, Exulceration, Putrefaction, or the Womb’s being Schirrous, Callous, or Hard; affected with a Carcinoma or Cancer; an obdurated Gland, Cicatrix, or any carnous Excrescence; or in Case of the Womb’s being Dry and Rigid, and the Orifice’s being Hard and Thick, as commonly happens to Women in Years, especially of their First CHILD; I say, from either of these, or any such like Causes, a Preternatural BIRTH may ensue, and that even tho’ the Pelvis and Passage be larger, but much more if those be narrower, and the Point of the Os Sacrum bent Inwards.

I. IN the Larger Pelvis, the greatest Difficulty of this BIRTH proceeds from too great a Descent of the 269Womb; which relaxes the Ligaments and Fibres of the Vagina, and so much depresses the Bladder, that an Incontinency of Urine presently follows, which in this Case is commonly succeeded by a Falling Down of the Womb or Vagina, as already observ’d in Chap. XI. where the Diligent Midwife will find the due Method of preventing such growing Mischiefs, and of opening the Orifice of the Womb both safely and readily, and consequently Delivering her Woman more easily and expeditiously, with good Success as well as Security.

II. IN the narrower Pelvis, the MIDWIFE needs no ways fear the above-named Accident, and therefore is not to be at so much Pains in retaining the Orifice in its proper Place, whatever Trouble she may have in opening it; which would be no easy Task, was not the Os Coccygis to be thrust back, (as set forth, Chap. IX.) And which I must (for this Reason) recommend once more to all Careful MIDWIVES, as the best and most effectual Method of performing this happy Apertion.

FROM what is said here therefore, we may now conclude, that a great Variety of Causes may subject the Womb to a Diversity of Accidents, and those of sundry Degrees, which may more or less affect its Motion and Situation, as already set forth^[171].

AND hence it is that we have so many Degrees of Preternatural BIRTHS on Part of the Womb, All which to enumerate particularly in this Place, would be a Work as Superfluous as Tedious: wherefore, to be brief, I shall here also reduce them to the Four following, (as before mentioned, Sect. IV. Chap. 13.) viz. Preternatural BIRTHS, proceeding from an oblique Situation of the Womb inclining Forwards, or Backwards, or to (either Side) Right or Left: which fourfold Situation of the Womb may be rightly and properly compar’d to the Four Cardinal Points of the Compass, as the rest of its oblique Positions may be analogously adequated to the Collateral 270and Middle Points: For because, as they decline from the Meridian, and derive themselves from East, West, North, and South, as formerly observ’d^[172]; so those are less difficult BIRTHS, and branch out from the Four mentioned Extremities: since the Womb, like a Magnetick Needle, may run quite round, and be ill-seated every way, or on every side. In all which Cases, the INFANT must absolutely be Turned; which Performance in any oblique Womb, requires a competent solid Knowledge and sound Judgment, as well as the best adapted and experienced Hands. But of those, more particularly hereafter; and First, accordingly——

CHAP. XIX. Of Preternatural BIRTHS, from the WOMB’s inclining Forwards.

IN speaking to this critical Point, I shall first give the Reason of such a BIRTH, occasion’d by this Position; to wit, The WOMB hanging much forwards, especially in Women carrying it too low in the Abdomen, the INFANT (betwixt the Pains) must needs be forced upon the Os Sacrum, or the Vertebræ bending inwards; which stops the Head that it cannot conveniently or without Obstruction fall into the Pelvis.

HOWEVER, in this Condition we suppose the INFANT to be well turn’d, I mean (both here and elsewhere) well turn’d in respect of the WOMB, with the Crown of the Head lying against the Orifice; than which nothing can be more Right or Natural in regard of the WOMB itself, nor more Wrong and Preternatural in respect of the PELVIS and Vagina of the WOMB, in this forward Situation: Because by reason of this Posture, 271the INFANT falls transverse upon the Ossa Pelvis, especially upon the Os Sacrum or hindmost Vertebræ; upon which it commonly offers itself with the Face prone or turn’d Downwards, tho’ it is not brought forth, but with the Face Supine or Upwards. For as it passes, it must be turn’d round, partly in a Circle, with its Head prone, and Feet drawn up under it; which happens not in the WOMB, but only as it passes the Orifice into the PELVIS or VAGINA.

NOW what I mean is more plainly This, that as soon as the Infant comes into the Turning (which it must pass) it necessarily bends and crooks itself, as it finds its Passage bent or crooked; by which means the Face is sometimes turn’d down, and sometimes upwards: And This proceeds from That, in short, as soon as the Head begins to enter the Orifice, it presently fixes upon (and sticks fast to) the last Vertebræ of the Loins standing forwards, or to the Os Sacrum; so that it cannot naturally or possibly go forwards, except the Head is bent downwards, and the Neck and whole Body be accommodated to that Bending.

HENCE it is, that THAT which just now was situated prone upon its Belly in the WOMB, now passing through the VAGINA, is bent upwards supine upon its BACK; and from thence it’s evident, that That Inversion is not properly in the WOMB, but in the VAGINA, or (if you please) in the Confines of Both: And, in fine, this forward Inversion (as it happens) occasions a most difficult Preternatural BIRTH.

BUT this, in short, happens to the Woman with CHILD, because her WOMB hangs forward, or is resupin’d, according to the Depression made on the WOMB by the Intestines, forcing it this or that way; or to either Side, as will by and by more fully appear^[173]. But——

SINCE it is most requisite to know presently in the Beginning of LABOUR, whether the WOMB be placed forwards, in order that the Means of Help may 272be taken accordingly; I shall in the second place add the SIGNS, or Tokens, by which the MIDWIFE may know this Position of the WOMB, and what she has best to do in such a nice ticklish STATE of Affairs.

FIRST then, She may know it, principally, by the Hanging forwards and Thickness of the Belly, or perhaps by the good Woman’s Information of the Place, where she chiefly feels the INFANT stirring; for it cannot move but where ’tis placed.

HOWEVER yet a prudent MIDWIFE will have no great regard to such Uncertainties, but betake herself immediately to that which cannot fail her, the Touch; which (in this Case) affords her the following certain SIGNS; viz.

I. THE Orifice of the Womb is suspended higher than usual; which she cannot Touch, by reaching, without a great deal of Difficulty.

II. SHE can only Touch the lower Border of the Orifice, and that only as the Womb hangs more or less forwards; and by no means the upper Edge, except the Orifice has begun to fall down.

III. SHE cannot at all, or very hardly, get her Finger into the opening of the Orifice, and because of that Difficulty, it must then also be crooked or bent.

IV. SHE will find the Orifice opposite to the bending of the last Vertebræ or the Os Sacrum, and feel it so strongly pressed against the said Vertebræ, when the Pains come on, that it cannot fall down: and lastly, she’ll feel the Waters (if they hang over the Passage) in a thin slender Form.

UPON This the Skilfull MIDWIFE finding these concurring SIGNS, she may be assur’d that the Womb hangs too much forwards; which Condition requires the immediate Help of Ingenuity and ART to correct this ill untoward Position, and to promote the BIRTH expeditiously. But then these Things are to be carefully perceived and distinguished in the Beginning of Labour, before the Pains have either closed up, or too much depressed the Orifice; yea, in short, even before it sensibly 273opens: since afterwards all those SIGNS are variously chang’d and alter’d, till at last they entirely vanish.

WHEREFORE let it be deem’d as a certain Rule, that the true Posture of the WOMB is always best discover’d by the Touch in the Beginning of the Labour: At which time may the Orifice be suspended never so high, the MIDWIFE ought to penetrate so far, until she reaches it; if not sufficiently with her Fingers, the whole Hand is to be judiciously used, and passed up that Length, because this particular Touch is absolutely Necessary for that good End: Insomuch that if any Labouring Woman be against this manual Operation or opposes it, she thereby debars her MIDWIFE of an infallible Method, of discovering the true Posture of her Womb, and consequently of taking the most immediate proper Means for Her own as well as her Infant’s Relief.

BUT now supposing, after all, the MIDWIFE to be certain that the Womb hanging too much forwards, in a prominent Belly bearing pretty much out, is deeper depressed than it ought to be; She is obliged then in this Circumstance to consider accordingly how to correct this Preternatural Situation, and assist both the Mother and Infant for the best: To which End, She ought First to endeavour that the Head may fall down into the Pelvis, even to the bending of the Os Coccygis; and then, Secondly, She is thence to advance the Head gradually, that the Exclusion of the CHILD may be expedited and intirely perfected at last.

NOW in order that the Head, together with the Orifice of the Womb, may be so discreetly brought forwards into the Pelvis, the Woman is to be placed with the upper part of her Body lower than the inferiour; I mean, with Head and Shoulders bending downwards, and the Buttocks upwards; by which Means, the Bottom of the Womb is elevated, and gives the Orifice an Opportunity of being brought more easily into the Pelvis.

274THEN the parturient Woman being so placed, the MIDWIFE (using both Hands) ought to clear the Womb, together with the Head of the Infant, by putting the one up, as far as there’s occasion, into the Vagina, and laying the other upon the Woman’s Belly, in manner following: viz.——

THE Hand in the Vagina is (by having two or three of its Fingers Ends extended to the upper Border of the Orifice of the Womb) to move it a little beyond the Head of the CHILD, and to direct it into the Mouth of the Pelvis, so that it may fall the more readily down into the design’d Place. But in this critical Juncture the MIDWIFE must always take special Care not to squeeze or press the Top of the Head too much, nor to handle it too hard, lest She should thereby wound, if not also kill the Infant.

AGAIN the Business of the other Hand, used externally, is to drive back the Womb, by pressing the Abdomen; which must be perform’d also with great Caution and Judgement, not by drawing the Hand from above downwards, but pressing as much as the Woman can bear it, from below upwards; so that (if possible) the Womb may be thereby resupin’d or turn’d backwards. Minding always, by the way, that

THIS Pressure of the Womb is not to be attempted, before the one Hand is first conveniently placed within. But if all This Menage should not yet succeed the first time according to Wish, then it may be safely repeated again by turns so often, until the MIDWIFE feels the Crown of the Head; that is to say, till She feels the Borders of the Orifice quite round about hanging over the Entrance of the Pelvis. Upon which happy Discovery, she may with reason rejoice in her Labour, and be heartily glad of her good Success: Because now the Force of good depressing Pains only will effectually perfect the Work.

BUT before Matters are happily brought this prepared Length, the bearing Woman is upon no account to begin her LABOUR; since That would not only be 275in vain, and otherways debilitate the Strength of her Body; but also be of great Hindrance to the Midwife (to whom all the LABOUR hitherto belongs) who, as she feels the PAINS growing and rushing in upon the Woman, before their proper Time, ought to charge her strictly, to forbear working along with them, and as much as possible to abstain from any co-operating Depression. And in fine, as the MIDWIFE by having her Hand diligently apply’d to the Orifice of the Womb, by strict Attention, may most commonly observe, and previously discern the approaching PAINS, before the Patient Woman herself can be sensible of them: So she ought also for her own helping Part, ex Officio, to be quiet and attempt nothing till Then, but take her convenient Opportunities, always as soon as the PAINS are over.

THUS by seasonably lending Nature an artificial helping Hand, Both jointly may easily effect, what neither can do separately: For as it sometimes happens, that the MIDWIFE ought to cease, while she perceives (by the Pains) that Nature is a working, and therefore ought to work only when the PAINS are past; so it also falls out often, upon other Occasions, that she is to work along with the PAINS, and when those are past, to cease. And thus, in fine, according to different Circumstances, the discreet MIDWIFE knows always the Needfull, what’s to be done, or let alone.

BUT in this Place, I doubt not, many MIDWIVES will object, and say, How is it possible for Us to perceive the PAINS coming on before the parturient Woman herself? To which I ingenuously answer, that This also is one of the many Advantages of the Touch; since by That, I can presently feel a kind of subtile Motion, Contraction, or Compression beginning in the Orifice of the Womb; which is only observable as the Muscles are affected with a New Sense, excited by a New Influx of the Spirits; occasioning a New Force or Impression upon the Womb, which we commonly call a Pang: So that, in short, by distinguishing this Motion from 276others, I am always able to foretell or advise the Woman of what is a-coming, and to admonish her accordingly of her bounden Duty, as the Case requires.

MATTERS now being fairly brought thus far, that the Orifice and the Head begin to slide down into the PELVIS; the MIDWIFE is at this Time to study how to succour and assist the CHILD, by rendring its Passage easy. In order to which, she must first observe to raise the upper Part of the Woman’s Body a little, and give her some short Respite, before she offers to bring the Orifice into the PELVIS; because the Posture above-directed, occasions considerable Pain as well as great Inconveniency: Which being done, the Woman for the future is to sympathize with every PAIN, and Labour as much as possible, co-operating mutually with them; since now the Pains (by the Assistance of the Head) begin to open the Orifice, and gradually force the Infant forward to its Birth.

HOWEVER yet the MIDWIFE ought in this Case, to be very careful in sustaining, and nice in keeping up the Orifice of the Womb, lest it should fall down together with the Vertex or Crown of the HEAD into the Sinus Sacri; which is a Point so curious and critical, tho’ an Accident too common, that I dare well say, not one in Fifty Practitioners in MIDWIFERY understands it thoroughly; otherways I am confident, and morally certain, that many fine Women would have been living Monuments of their Ingenuity, who are at this day only the Dead Remains of their Ignorance.

THIS I think is past all Contradiction, when we consider, how some Practisers sacrifice the Infant, first by opening, and (as they call it) braining the HEAD, and then by drawing it forth with their Instrument call’d FORCEPS: How others also esteem themselves Masters of the greatest ARCANUM, boasting that they can, without so much as braining the HEAD, extract the INFANT by their Tool call’d an EDUCTOR: How a Third Set again pretending themselves to be the only genuine Sons of Apollo, come 277slily to correct the Rest, by fixing only a couple of Hooks in the Eyes, Ears, or somewhere else in the Child’s HEAD; by which means they as wretchedly produce the innocent dead Babe as any of the others: For it can no more be suppos’d to survive this cruel Treatment, than the other mentioned Barbarities; not to speak of the Anguish and Perplexity over and above, besides the real Danger all the while brought upon the distressed Mother.

UPON this grand Affair of Life and Death, the Desidious and Capricious MIDWIFE cries at length, God knows I have taken all the Pains and Care I could, but to no Purpose, for this or that trifling Reason, falsely alledged. The SURGEON (if he don’t pretend the CHILD to be already Dead) says, Come, it is better to dispense with one Life than Two; One must go, &c. In consequence of which, he prepares his FORCEPS, EDUCTOR, KNIVES, HOOKS, &c. to draw out the INFANT Dead, or Alive, Whole or in Pieces, by such disingenuous and barbarous Means to save the MOTHER. Thus behold the excellent Art of MIDWIFERY ignorantly perverted! O Deplorable Woman! O Miserable Babe! How much abused! when there is no other Mean left to rescue the tender Life of the poor Mother, but by the massacrous Death of her dearest CHILD! This Case indeed would be very Melancholy, but Glory be to GOD who has neither left the One nor the Other to perish at this untimely or inhuman Rate, excepting it be by Ignorance, or Wilfulness, &c. as aforesaid: No, on the contrary he has provided an EXPEDIENT for every Extremity, and a REMEDY for every Malady, as in the present Case will appear farther by what follows, Viz.——

THAT such Tragical Events may be prudently prevented, I use my constant and unwearied Endeavours to sustain the Orifice, that it may not come below its proper Place; and that having clear’d the HEAD of the WOMB, I may only bring it alone down; 278which I can much more easily do, than if it was cover’d about with the Womb, sticking fast (as above) in the SINUS SACRI. And supposing the MEMBRANE to press strongly instead of the Head, I treat it all one as if it was the Head, taking always Care not to break it, tho’ the forming of the WATERS is not to be obstructed; for which Cause, I upon all Occasions stretch out my Fingers wide, applying them only to the Edges of the Orifice, not to the Membrane: And this I continue doing, until the MEMBRANE spontaneously breaks; upon which I manage the Head as aforesaid.

THUS the Infant’s HEAD being excluded with the Crown foremost, there is no more Occasion to be at any Pains in keeping up the Orifice; wherefore I now suffer it, together with the HEAD, to fall down past the Bending of the OS SACRUM; which now also, the major Part of it being bare, more easily happens, than it possibly could whilst it was cover’d with the Orifice. Upon this, that the Child may be farther relieved and brought out, I now again make use of both Hands, the one inwardly, the other outwardly, as before: But as the Condition is now much alter’d from what it was at that time, I at present proceed after a quite different Manner, and work along with the Pains, resting only as their Force ceases: For thus I not only observe the Pains my self, but also at the same time encourage my Woman to Labour, and to persist in her LABOUR with all her Strength; and by Turns, as the PAINS come on, to conjoin their Force with her own and my mutual Endeavours, in the manner following: namely,

HAVING One Hand in the Vagina, with its Back turn’d towards the Rectum, I thrust very cautiously the Points of my Fingers as far as I can under the HEAD, where I hold that Hand constantly, until the PAIN comes on; laying the other Hand upon the Belly, about that Part where the Bottom of the Womb lies: Then as I perceive the PAINS come on, I begin to work with both Hands; to wit, by pressing 279the internal Hand gently downwards, against the Point of the Sacrum to remove it back out of the way; whilst by the external Hand, I gently raise the Womb into a resupine Posture, pressing it also softly downwards: I mean softly in Proportion (howsoever) to the Force of the PAIN: for as it gradually encreases, and more and more excites strong Labour; so I also by degrees press down more strongly.

HOWEVER yet the External Depression ought always to be Moderate, as the Internal ought to be Strong and Vigorous: Whereupon Matters being carefully well observ’d, (as laid down in Chap. 9.) no MIDWIFE needs be afraid of hurting her Patient Woman in the least; no rather, on the contrary, the more Strength I use now, the more grateful and agreeable I prove to Her being thus circumstantiated. And, in fine, the upper Part of the CHILD’s Body being once past that Sinuous Bending above, it presently breaks out all together, and comes away so happily into the World. After which the MIDWIFE is only farther to behave herself with respect to both the Mother and the Child, as in the Natural Case^[174], carefully cleansing, restoring, contracting, and shutting the Womb as Before. In a Word, with so great Success at last the BIRTH is accomplished, provided these Precepts be carefully and timely observed.