_Vomiting_, that I suppose proceeded from the _natural Sympathy_, which
the STOMACH bears to the WOMB: Whereupon it discharges a certain
_Viscous Matter_, which I have always observ’d, upon its turning
_Bloody_, to presage an easy _LABOUR_, and an expeditious _DELIVERY_.
FARTHER yet, the _MIDWIFE_ must always remember, that when the commenced
_real PAINS_ of _Labour_ chance to cease, the Woman’s _Labouring
Efforts_ must also terminate with them in Course: And as this _Case_
denotes a _Debility_ of the _Expulsive Faculty_; so if it be not both
_Timely_ and _Judiciously_ assisted, It may prove of the worst of
Consequences. In a word, so much I have thought previously _necessary_
to my Purpose, before I enter upon——
[Illustration]
[Illustration]
CHAP. XVII.
_Of the True Method of LAYING the Woman._
UPON this Occasion, the _MIDWIFE_ ought, in the _first place_, carefully
to observe the CONTENTS of the foregoing _Chapter_; and, _Secondly_, To
follow this general RULE, which I lay down out of absolute _Necessity_:
viz. _That the Woman be delivered, and the Child brought forth into the
World as soon as possible after_ FLOODING; and _that_ because the WOMB
immediately, after _This_ is over, falls, shrinks, and contracts itself
again, and of Consequence compresses the _BIRTH_ very closely.
BUT in order to effect _this_ Matter, as much depends upon the right
_Situation_ or _Placing_ of the WOMAN; so I advise, in the first place,
that, as soon as the WATERS begin to flow, _She_ be commodiously
_placed_ either in a BED, CHAIR, or STOOL, properly adapted for that
Purpose, and _laid_ with great Skill and Judgment, not too _Supine_, nor
altogether _Upright_; but (as it were) between a _standing_ and _lying
Posture_: having her _Back_ a little erected for the freer
_Respiration_, and the better LABOUR; with her _Thighs_ at a due Liberty
and Distance, only separated as much as possibly they may; her _Knees_ a
little elevated; her _Feet_ stayed against something _Firm_, and her
_Heels_ bending _Backwards_.
HOWEVER I must farther observe in this place, that the _POSITIONS_ of
_parturient Women_ are very various and different; _some_ doing this
_Work_ (as above) in a _Bed_, _others_ in a _Stool_, and _some_ again I
have seen deliver’d _standing_, and _leaning_ only a little _Forwards_
upon the _Bed-stead_. Hence, I say, that the _POSTURES_ in time of
LABOUR, differ not only according to the _Necessity_, but also sometimes
(in _Natural Easy Cases_) according to the _Custom_ of the WOMAN.
BE that as it will, I would advise all _Labouring Women_, FIRST to make
_Choice_ of a dextrous and ingenious _MIDWIFE_ to attend them at that
_critical Juncture_, since the poetical _Proverb_ (_Accidit in puncto,
quod non speratur in Anno_) holds as True in _BIRTH_ as in any _Case_ I
know; for _some Women_ after having sundry repeated Natural easy
_BIRTHS_, come at last to suffer by some difficult or _preternatural
Accident_, which may happen in a _Moment of Time_.
SECONDLY, I would advise all _parturient Women_, to give themselves over
into the Hands of such a _MIDWIFE_, to be universally _advised_ and
_entirely_ directed by her Conduct: And thus being under the watchful
_Eye_ and diligent _Care_ of the prudent and skilful _MIDWIFE_, the good
_Woman in her Travail_ has Nothing else to do (besides following
_Instruction_) but only to assume _Courage_ and _Resolution_ to assist
her own _PAINS_ as she feels them coming on, by _drawing_ and _holding_
her BREATH, as if she was to _sob_ or _sigh_, by contracting the
_MUSCLES_ of her _Belly_, as much as possible; insomuch that the
forcible _Impression_ may bear alike upon each side of the WOMB, and
depress the _Diaphragma_, which (of Consequence) suppresses the WOMB.
But then again in this _Case_ I would observe briefly, that she is
strictly to regard the _TIME_ of a _right true Travail, as at that
Juncture_ only to use _these_ her best and strongest _Endeavours_.
BUT now to return to the _Duty_ of the attending _MIDWIFE_; as occasion
requires, She is to direct her WOMAN, either to _lie_, _sit_, _stand_,
or _walk_, keeping her always _Warm_, and as close _cover’d_ in Time of
TOUCHING as possible; for the least Breath almost of _Cold Air_ may
occasion _Convulsions_, and _other_ most dangerous _Accidents_.
BECAUSE I have often observ’d _Women_ to be _Costive_ and bound in their
_Bellys_ upon this Occasion, which is of dangerous Consequence, I would
therefore advise in this _Case_ to adhibite a gentle _Emollient
Clyster_; not only that (by the RECTUM being so emptied) there may be
the more _Room_ for the necessary _Dilatation_ of the _PARTS_, but also
that the unfortunate _Effects_ of COSTIVENESS may be timely prevented:
And the same _Means_ I would use, in Case of _Heavy_, _Dull_, or
_Languid PAINS_; ordering the _Clyster_ only in this _Case_ to be made a
little more _Carminative_; as mentioned in the preceeding _Chapter_.
BUT _this_ however I would have done in the _Beginning_ of the
_Travail_, and reiterated (if need so require) before the _CHILD_ be
advanced too far _Forwards_.
NOW the _MIDWIFE_ finding all things in a _Natural Posture_, and the
CHILD in a _Forward way_, is to advance her _Hand_ skilfully, (which at
every individual TOUCH ought to be fresh-anointed with the _Oil_ of
white _Lillies_, _Roses_, &c. or _Fresh-Butter_, _Hogs-Lard_, or
whatsoever of this Nature is readiest at Hand) entering the _ORIFICE_
with the _Fingers-Ends_, dilating it by opening _them_ gently as the
PAINS come on: Thrusting gradually the _Sides_ of the _ORIFICE_ towards
the _OCCIPUT_ or Hinder part of the CHILD’S Head, and moistening these
_Passages_ also with what she uses for her _Hands_.
WHEN the _VERTEX_, or _Crown of the Head_, appears without the
_Privities_, the _MIDWIFE_ most commonly calls out or says the CHILD is
in the _Passage_; and the _parturient Woman_ then finding these Parts
(as it were) scratch’d or prick’d with PINS, often groundlessly imagines
that her _MIDWIFE_ deals roughly by _Her_ with _Nails_ and _Fingers_;
whereas that _Pungency_ is only occasioned by a violent _Distension_, or
perhaps a _Laceration_, sometimes inevitably made, by the BULK of the
_Head_ of the _INFANT_.
HOWEVER that be, and whatever the _Woman_ may think or say, the
_MIDWIFE_ is only to mind her own Business, and discharge her Duty
faithfully upon this _CRISIS_; in order to which, it is now High Time
that she also place herself in a convenient _Posture_ to receive the
_BIRTH_: Which (when advanced as far as the _EARS_, or _thereabouts_)
she is to take gentle hold of, by _both Sides_ of the _HEAD_ with _both
Hands_; so that by this _Means_ she may be ready and able, against the
first _Onset_ of the next good PAIN, to draw forth the CHILD. In doing
whereof, she must take special _Care_ that the _NAVEL-STRING_ be not
entangled about the _Neck_, or any other _Part_, lest the _Secundine_ or
the _Womb_ itself thereby suffer Violence, and consequently cause either
_Flooding_, or break the _String_, which may render the _Case_ dangerous
and the _BIRTH_ difficult.
BUT in thus attracting the _INFANT_, the _MIDWIFE_ must carefully
observe, not to draw the _HEAD_ straight-forwards, but move it gently
from _Side to Side_, that the _Shoulders_ may the more readily and
easily take Place: For _these_ must immediately follow the _HEAD_
without _Loss of Time_, otherways the _BIRTH_ may be strangled in the
_Passage_ by the _WOMB_ shutting upon its _Neck_: To prevent which
_Tragical Catastrophe_, the Cunning Expert _MIDWIFE_ directly slides in
her _Fingers_ under the _Arm-Pitts_, and then draws discreetly the
_BODY_ forth without any Difficulty or Danger.
_THUS_, in fine, We have discreetly deliver’d our good _WOMAN_, in
_Case_ of a _Natural Easy Birth_; but on the other Side, in difficult
and _Preternatural Cases_, the several Conditions and Circumstances will
mightily differ from the Beginning; because in _these_ the _PAINS_ are
not always sufficient to produce the _BIRTH_. Hence it is sometimes more
convenient for the _WOMAN_ to be _Passive_, rather than _Active_;
especially when the POSITION of either the _Womb_, or the _Infant_ is
_Preternatural_: For then it is the _MIDWIFE’s_ whole Business to
_labour_ more than the _WOMAN_; then her ingenious TOUCH is of infinite
Service to the _PARTURIENT_, since by that only she can distinguish the
Degree of the _Ill Situation_ whether of the _CHILD_ or the _WOMB_.
Which being dextrously done, _She_ is in the next Place, prudently to
consider what kind of _POSTURE_, _Sitting_ or _Lying_, is most
convenient, that she may the _better_ discharge her own good _Office_
and _Duty_: Of which I shall treat more particularly in the following
respective _Chapters_; since it still remains here, by the way, that we
also deliver our above-mentioned _Woman_ of her AFTER-BIRTH, _&c._
[Illustration]
CHAP. XVIII.
_Of the Method of Extracting the SECUNDINE_,
&c.
AFTER all, to perfect or finish the _Woman’s DELIVERY_, it still remains
that _She_ be freed of her AFTER-BIRTH, or SECUNDINE. Now this I advise
to be done with all imaginable Speed, after the CHILD _is born_, even
before the _NAVEL-STRING_ is cut: Because the WOMB immediately
_contracts_ itself, so that _This_ cannot be accomplish’d afterwards
without great _Difficulty_.
HOWEVER, I know beforehand, that my Method of performing this Work,
which I am about to lay down, will be thought a strange _Innovation_ in
_Midwifery_; but without any regard to that, in speaking to this
_Point_, I shall _First_ suppose this _Body_ to be already loosen’d from
the WOMB; in which _Case_ the MIDWIFE has nothing to do, but to draw the
_STRING_ gently, which she holds in _One Hand_, twisted twice or thrice
around one or more of her _Fingers_, while she passes the _Other Hand_
into the WOMB, following always the _STRING_ (as her _Guide_) to the
Place where the BURTHEN lies: And where, as in this _Case_, it naturally
presents itself to the ORIFICE, _She_ stretches her _Hand_ up
length-ways, taking hold of it betwixt her _Fingers_; and thus, by the
Assistance of the _other Hand_ always attracting softly the _STRING_,
she brings it at last most commodiously away.
SECONDLY, I shall suppose, in the mean Time, this _Body_ to continue
_fixed_ to the WOMB, either in _Part_ or in _Whole_: In which _Case_, if
in _Part_, the MIDWIFE finding by the TOUCH the other _Loose Part_,
moves her _Hand thither_ betwixt _That_ and the WOMB, shaking or
stirring it gently _backwards_ and _forwards_, until such time as it is
entirely _loosen’d_, when she proceeds as _Before_: But if in _whole_,
and that it sticks very _Fast_, then the _MIDWIFE_ places her _Hindmost
Fingers_ on its _Exteriour Part_ against the WOMB, and her
_Fore-Fingers_ against the _Inside_; so that thus by pulling softly on
all _Sides_ quite round, it is easily _loosen’d_ and _extracted_ as
Above.
THIRDLY, I shall suppose this _SECUNDINE_ also (tho’ loosen’d
successfully) to be so very _Large_, that it cannot pass through the
_ORIFICE_: In this _Case_, I only desire my _deliver’d Woman_ to concur
with me, and behave herself as if she was forcing or expelling the
_CHILD_; for then whilst I at the same time gently attract the _STRING_,
it immediately follows.
I very well know that Mr. _Mauriceau_ and all _others_ either _in_ and
_before_ his Time, teach quite different _Methods_ of extruding the
_AFTER-BIRTH_; such as are by the _WOMAN’s blowing in her Fist, putting
her Finger in her Throat, and the like_; which when the _poor Patient_
has done, and stood them All out _ineffectually_, together with their
many other various _uncertain Experiments_ to no _Purpose_, and none of
them have succeeded (as it has often happen’d): Then at last, and not
till then, they direct the aforesaid _Method_ of the _HAND_ to be used.
But now-a-days, we know better Things than to run such indiscreet
_Risques_, when we may go a safer Way to work; or to make use of
_Uncertainties_, when we know more _Infallible Means_. As I shall, I
hope, make this _Method_ plainly appear to be; notwithstanding all the
great _Cautions_ of those Authors publish’d, and the Difficulties they
make of it in our Practice of _MIDWIFERY_: And that I will endeavour to
do from the following _Considerations_, viz.
I. IF after the BIRTH of the INFANT, the _Hand_ be presently pass’d into
the WOMB, it slips in together with Part of the _Arm_, as far as is
needful, without the least _Trouble_ or _Inconvenience_ to the WOMAN;
the WOMB as well as its ORIFICE continuing always, so long as _this_ may
be done, sufficiently _Open_: And thus the BIRTH maybe skilfully
accomplished or perfected, as it were, in an _Instant_; while _others_
(trying their vain _Projects_) spend many trifling _Hours_ about it, and
it is _ten to one_, if at last they succeed.
II. BY these means, moreover, I presently know whether there be _One_,
_Another_, or _More INFANTS_ to follow; whether there be a _dead CHILD_,
_false CONCEPTION_, or any _Foreign Body_ whatsoever, lodged in the
WOMB; whether any _Part_, or _Pieces_ of the SECUNDINE, or _Membranes_,
or _Lumps_ of _Clotted Blood_, be left behind and retain’d: All which I
propose to bring away either _before_, or _after_ the SECUNDINE, as
Occasion serves, with the greatest _Safety_ as well as _Expedition_.
III. AFTER having thoroughly searched on all _Sides_, and thus duly
cleans’d the WOMB, by continuing my _Hand_ in it, until it contracts
about that _Hand_, first _above_ towards the _Bottom_, and then _below_
towards the _Orifice_, which happens very quickly: I find myself _then_,
by great Experience, able to rectify all _Oblique_ and _Preternatural
Situations_ of the WOMB; as in _Case_ of a PROLAPSUS, (or _Falling
down_) I can hereby move it carefully _Up_ again: If it lies too much
_Backwards_, by elevating it while it gradually contracts, I can easily
bring it _Forwards_, to its _Natural Position_: If it hangs too much
_Forwards_, I can quickly reduce it _Backwards_: If it tends to _either
Side_, I can directly move it to its Center. And thus, in short, I hope
I may be allow’d gently and gradually to restore the WOMB to its
_Natural Place_ and _Posture_, how _Preternaturally_ and _Obliquely_
soever its _Situation_ may happen to be disorder’d.
NOW This being so successfully done, I can, in fine, assure and secure
any _Lying-in-Woman_, that her WOMB is both duly _purg’d_, and naturally
_shut_ again as it ought to be; which I take to be the greatest
_Satisfaction_ the CHILD-BED-WOMAN can conceive in her Condition.
Whereas,
IV. THEY who leave all these Things to mere NATURE, risque their
PATIENT’S future _Welfare_, and very often her _Life_ too, as
innumerable _Tragical Examples_ witness: For NATURE itself most
particularly requires our special _Assistance_ in this _Case_. But
(according to their indifferent _Notions_) it is _Time_ enough to assist
NATURE, when it is found _Deficient_; and then, in _Case_ of EXTREMITY,
they unanimously agree that there is no other way to help or save the
_Woman’s_ LIFE, but by this METHOD of _Manual Operation_. To which I
answer, that NATURE operates not in an _Instant_, but (in all _Cases_)
requires a competent _Time_, to discharge its respective _Functions_;
and being left too long to itself, for want of Help, is many a-time (by
intervening _Accidents_) found at last _Incapable_: Upon which, then
_They_, beginning their Endeavours to _second it_, generally come too
late. For if the _Case_ does not prove to be past all _Remedy_, it is at
least (by this _Protraction of Time_) often rendred not only
_difficult_, but also _desperate_; as will evidently appear in the _Case
in hand_, from what follows, _viz._
I. WHILE _They_ (conformable to the general and universal _Practice_ of
common _MIDWIVES_) expect the _Performance_ of NATURE, or the _Success_
of their _trifling Means_, in the mean time, the _Orifice_ of the WOMB
is so _closely shut up_, that in the space of an Hour or two, it cannot
be _penetrated_, without renovating the most severe racking PAINS to the
_Woman_, who (perhaps) has been sufficiently spent before, by the
DELIVERY of her INFANT, and is _now_ consequently incapable of standing
out the renew’d PANGS: whereby of course _She_ must succumb at last, and
_give up_ the _Ghost_, for want of _Timely Help_; as innumerable
_Instances_ confirm for an undeniable Truth. But,
II. SUPPOSING the _Woman_ to be able to undergo the _PAINS_, yet the
WOMB is however contracted, and the _SECUNDINE_ bound so close up, that
this _Body_, which before adher’d _Cake-ways_ to its _Bottom_ in a
_smooth_ and _broad Form_, is now so squeez’d into a _small_ and _long
Figure_, that it is even now a _Difficulty_ next to Impossible, to reach
the _Bottom_ of the WOMB, and still a _harder Task_ to extract an entire
_Secundine_, without prejudicing the WOMB.
III. THEY who altogether neglect _Manual Operation_, may (I confess)
sometimes _deliver_ their WOMAN, when _Success_ accidentally answers
their WISH: But without this _Mean_, they cannot possibly restore a
_prolaps’d_, _fallen-down_, or an _obliquely situated_ WOMB, to its
_natural Position_. No, to the Contrary, Nothing is more common among
ignorant unwary _MIDWIVES_, than to _invert_ and _draw down_ the
_Bottom_ of the WOMB itself, by pulling the _Navel-String_, as they
foolishly intend by _means_ of it only to extract the _SECUNDINE_.
Neither does the _Mischief_ always end here, but mistaking this _Body_,
when so found by their TOUCH, they immediately imagine it to be the
_Head_ of another INFANT; and persevering in this _false Conjecture_,
they manifestly expose the poor WOMAN to the Hazard of her _Life_.
Neither,
IV. POSSIBLY can _They_, without the _Use_ of the HAND, so cleanse the
WOMB of the _Reliques_ of the _SECUNDINE_, which may stick up and down
to the WOMB; or of the _Pieces_ or _Parts_ of the _Membranes_, which may
remain there; or of the _clotted Blood_, which commonly stays behind.
From hence therefore it necessarily follows, that (without the _Means_
of the HAND) _They_ cannot be Positive or Certain in any _Circumstance_,
relating to the _True State of the Woman_. _They_ can neither assure
Herself, nor those concern’d, that her WOMB is duly purged; if
(perchance) of the _SECUNDINE_, which they may guess at by the _Sight_,
yet not of the _Fragments_ of the _Membranes_, nor of the _clotted
Blood_, which they can never be certain of, but by this METHOD. I
mention these _Things_, because the _least Part_ of EITHER being
retain’d, or left _Behind_ in the WOMB, may cost the WOMAN her _Life_,
as innumerable _Precedents_ do testify. Nor,
V. CAN they possibly secure the _Woman_, that her _WOMB_ is _duly shut
and contracted_; much less can they (without these _Means_) affirm that
it is orderly _situated_ in its _proper natural_ CENTER: By the Neglect
or Fault of which _Condition_, she is not only rendred _Barren_
afterwards, but also most infirm all the Days of her _Life_.
BUT notwithstanding how _plain_ and _easy_ soever, I have endeavour’d to
make out the above-mention’d METHOD, I would over and above recommend
_It_ only to the _judicious_ and _well-qualify’d MIDWIFE_; by no Means
to those that are _ignorant_ in the _Parts_ of _GENERATION_, nor to any
_stiff clumsy-fisted Person_: And that for the _Two following Reasons_;
viz.
I. LEST the STRING (by some _Accident_ or other) should break, and she,
missing this _Guide_ to the _SECUNDINE_, should take _One Part_ for
_Another_, and consequently _dislodge_ the WOMB instead of the
AFTER-BIRTH; which has undoubtedly often happen’d by such blind DOINGS,
notwithstanding this very remarkable _Difference_ between _Them_, that
the _SECUNDINE_ distinguishes itself from the _Other_, by a great many
little _Inequalities_ on the Outside, occasion’d by the ROOTS of the
_Umbilical Vessels_. And,
II. LEST _she_ should unwarily either _break_, _tear_, or _scratch_ the
WOMB, with her _thick_, _fleshy_, _rough_, and _rigid_ HAND, or with her
_stiff_ and _crooked_ FINGERS: _Either_ of which _Accidents_, may give
ORIGIN to various _Misfortunes_; such as a PROLAPSUS, or _Falling-down_,
a _preternatural Flooding_, an _Inflammation_, or _Gangrene_, &c.
BUT we will now, in fine, suppose that the _Ingenuous MIDWIFE_ has after
All discharged her faithful _Duty_ in these Respects, with _Care_,
_Lenity_, and good _Conduct_, as well as with great _Art_ and
_Judgment_: In which _Case_, it only remains, that _she_ take the
necessary and usual _Care_ of the CHILD-BED-WOMAN and INFANT; as
hereafter will be directed in the respective _Chapters_ of _SECTION_
VIth, to come.
IN the mean Time, these curious _Things_ being thus amply premised in
this Place, the READER has no more superfluous _Repetitions_ to expect
concerning _them_ in the following _Performance_: And therefore with
these _Preliminaries_ I conclude my _Fourth SECTION_.
[Illustration]
[Illustration]
SECT. V.
[Illustration]
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_.
THE _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_.