Posture_; but as strange as it is, it is certainly the most _effectual_,
and the _absolute best One_, which can be devis’d for the _Woman_’s
desir’d _Relief_ in this desperate _Condition_: For by the Help and
Means of it, the WOMB is carried down into the _lowest Part of the
Belly_, through its own _Weight_ only; and consequently releases itself
out of the foremention’d _crooked_ SINUS; which that it may the sooner
and more commodiously do, I put my _Fingers_ into the _VAGINA_ behind,
betwixt the RECTUM and the HEAD of the _Infant_, where I press down the
WOMB, till the _Orifice_ is so far _forced back_, that there is _Room_
enough to hold it up, in order that it may not relapse; and also that
there may be _Room_ for the HEAD to be depressed into, and open the
_Orifice_. Thus the WOMB and the _CHILD_ being at last _forced so far
back_, by an expert _Hand_, the _BIRTH_ may be successfully perfected by
the above-prescrib’d _Means_ and _Method_; provided always that the
_Woman_ has sufficient _Strength_ and _PAINS_ to carry her through the
fatiguing _Tryal_.
BUT we will how suppose, for better Instruction-sake, her _Strength_ to
be quite spent, and the _PAINS_ to be deficient; in this CASE the happy
_Issue_ of the _BIRTH_ is most dubious; but however, then I place the
_Woman_ again as before, and depress the WOMB as much as I can, until I
reduce the _Orifice_ farther up into the _larger Space_ of the _PELVIS_,
that I may the more conveniently _open_ it by the Help of an _inward
Hand_; and by _that_ also moving aside the _Child_’s HEAD, I then seek
for, until I find, the FEET; which, upon the INFANT’s being right
turn’d, with its TOES _downwards_ towards the _Mother_’s RECTUM, I bring
into the _Passage_. Now the FEET being thus in the _Passage_, the
_Woman_ needs not lie any longer in the abovesaid _Posture_; but,
turning herself, may now lie with her FACE _upwards_: When I also give
her previous _Notice_ to prepare herself to _depress_ vigorously; I mean
as much as she can possibly, when occasion requires.
IN the Interim, holding the FEET all the while with my _internal Hand_,
I attract them gently _outwards_, until the BUTTOCKS and the BELLY are
excluded: Then taking fast hold of the _CHILD_ by _one Hand_ under the
BELLY, and the _other_ upon its BACK; I advise the good _Woman_, in
_Case_ she feels no _PAIN_, to behave herself as if the _PAINS_ were
most pressing upon _Her_, and to contribute by _forcing downwards_ what
lies in her Power; whilst I continually _attract_, and gently _draw_ the
INFANT towards me, until by this discreet _Management_ the HEAD is
totally excluded, together with the ARMS into the World. And _thus_ at
length the _Distressed Woman_ may be happily delivered in all these
different _Cases_, and difficult _Conditions_ of Life. Whence I come
to——
[Illustration]
[Illustration]
CHAP. XX.
_Of Preternatural BIRTHS, from the WOMB’s inclining backwards._
Experience teaches us, that the WOMB may be also too much _resupin’d_;
or tending with its _Bottom backwards_, may be pressed too much towards
the SPINE: So that its _Orifice_ is not only raised _too high_ in the
BELLY, but is also so _obliquely seated_, that it no more answers to the
_VAGINA_ in a _right Line_, varying more or less, according to the
Proportion of this _Tendency_ to the BACK-BONE.
FROM this _Posture_ of the WOMB now, it necessarily follows, that the
HEAD (tho’ never so well _turned_) falls upon, and is violently forced
against the OSSA PUBIS; where the tender HEAD sticking, often happens by
its own _Struggles_ and the _Mother_’s _PAINS_, to be grievously
squeez’d and gradually crush’d, so that, until it is removed and brought
into the _PELVIS_, the _Woman_ can by no means bring forth her _INFANT_.
Wherefore the diligent and careful _MIDWIFE_ must (by due Attention)
make it her Business to discern at the _first_ TOUCH this _ill Position_
of the WOMB, and presently upon the _first Pang_ of LABOUR, try to help
both the _MOTHER_ and the _CHILD_.
WHEREAS otherwise the slothful and ignorant _MIDWIFE_, may continue the
poor _Woman_ in an irregular LABOUR perhaps some Days, without
perceiving the HEAD to be fixed upon _these Bones_, always erroneously
imagining the _INFANT_ only to be situated _too high_, (because it lies
out of the reach of her _shallow_ TOUCH) and that it must in due Time
_fall down lower_ within her _Ken_. Or peradventure otherwise, when by
the TOUCH, _she_ feels a kind of _Roundness_ or _Hardness_, thro’ the
WOMB, mistaking _This_ for the HEAD, _she_ thinks the _INFANT_ is well
turned, and wants only _strong PAINS_ to drive it forwards with Success.
THIS _Ignorance_ is chiefly owing to her own _Stupidity_, in that _she_
cannot clearly distinguish between the WOMB and the VAGINA by the TOUCH;
nor the _Orifice_ of the WOMB from the _Parts_ of the _CHILD_, or
_MEMBRANE_; which (in this _Case_) frequently occasions the _Death_ of
many a _Dear MOTHER_ and _INFANT_.
BUT here it is to be moreover noted of this difficult _Situation_ of the
WOMB, that the _MIDWIFE_ (how skilful soever) perhaps can either not
_touch_ the ORIFICE at all, or but very little, except it lies _wide
open_, when she may _touch_ at least some Part of the CIRCLE of the
_Border_: For the HEAD being fixed upon the PUBIS above, the whole
_upper Part_ of the _Edges_ of the ORIFICE can no ways peradventure be
_touched_ with the _Fingers_, which may only reach the _lower Part_ that
is _Open_.
UPON which, these _Fingers_ are cautiously and prudently to be thrust in
farther betwixt the _Neck_ of the BLADDER, and the _Orifice_ of the
WOMB: Then being so near the Neck of the Bladder, a discerning _MIDWIFE_
will feel a sort of a _Circular Border_, namely, that of the _Orifice_
of the WOMB; which if she penetrates with her _Fingers_, she will also
find the hard Part of the HEAD, which is _Smooth_ and _Globular_, or the
opening of the VERTEX; whence she may be certain, that the _INFANT_, as
well as the _WOMB_, is too close to the SPINE of the _Back_. Whereupon
she ought, without loss of Time, to assist and help the _CHILD_ in the
following _Manner_; viz.
SHE is to hinder the _Woman_ from _labouring_ all this while, advising
her to bear and put by her _PAINS_, until this _Posture_ of the _INFANT_
can be duly corrected: In order to which, I would FIRST order the
_Woman_ to _make Water_, if she can, that the BLADDER being thereby
emptied, may not be hurt by the _Pressure_ of the _MIDWIFE_’s _Hand_, or
the _CHILD_’s _Head_: SECONDLY, if the _MEMBRANE_ is not yet broken, and
the PAINS but _few_ and _faint_, I would prescribe a gentle CLYSTER, not
only to awaken _These_, but also to remove all _Inconveniencies_ of the
_RECTUM_: THIRDLY, I would then advise to lay the _Woman_ in a
convenient manner, upon her BACK with the _superior_ Part of her Body
lower than the _inferiour_, that both the WOMB and the INFANT may the
more easily recede or _give way back_.
THEN taking cautiously Hold of the _Border_ of the ORIFICE with the
_Fingers_ of _either Hand_, I would press and draw it _back_ towards the
_RECTUM_, whilst I employ’d my _other Hand_ outwardly upon the
_ABDOMEN_, a little above the _OS PUBIS_: I mean, that the _Child’s
HEAD_ ought to be _thrust back_ a little with the _Hand on the outside_,
pressing it discreetly _down_; as the _ORIFICE_ is to be drawn _back_
towards the _RECTUM_, and at the same time also _downwards_, with the
_internal Hand_.
IN the next Place, as I feel the HEAD and the WOMB mov’d a little
_downwards_, so I would also advise the good _Woman_ to raise the _upper
Part_ of her Body, yet so as not to stir the _Lower_, and to _bend_
herself as much as possible _Forwards_, sitting as if she was going to
_Stool_: Because by this _Posture_, she raises both the INFANT and the
WOMB _behind_, and consequently drives them _BOTH Forwards_, whilst I
would in the _Interim_ keep my _HANDS_ very fast placed as aforesaid,
ready to depress the _HEAD before_, that it may fall directly into the
PELVIS. In short, the _HEAD_ being thus disengag’d, I would now advise
the _Woman_ to observe her _PAINS_, and mutually _labour_ with them what
she can, with her Body mostly still in a _Sitting Posture_, or kneeling
with her _Arms_ conveniently supported.
BUT supposing the _INFANT_ to stick very fast upon the PUBIS (which
commonly happens by _Loss of Time_, or by misimproving a critical
_Minute_;) and that the capable MIDWIFE finds both the MOTHER and the
CHILD in this miserable _Condition_, thro’ the Neglect and Ignorance of
_Another_: In this _Case_ I would lay the _Woman_ altogether upon her
_BACK_, with her _HEAD low_, and her _BODY_ a little _elevated_; then by
the abovesaid _Method_ I would try to depress the _Infant’s HEAD_,
observing however yet not only to press it _down_ from _above_, but also
first to _thrust it back_, and _depressing_ it at the same Time: By thus
_repelling_ it, I would save the tender _HEAD_ from being hurt by the
_Depression_; since otherways these BONES would leave a _Dent_ or an
_Impression_ upon it, if not also wound it over and above.
MOREOVER, supposing that the _MEMBRANE_ should break by Chance, and that
by enlarging the _Orifice_, the _HEAD_ should be much _bared_: Then I
would let the _Border_ of the WOMB alone, and endeavour to thrust my
_FINGERS_ betwixt the _HEAD_ (towards its _Upper Part_) and the _OSSA
PUBIS_; by which means One may most probably draw the _HEAD downwards_,
along with the _Orifice_. However, in fine, this _Case_, (as well as all
other _preternatural BIRTHS_) absolutely requires a sound _Judgment_, a
quick _Comprehension_, a good _Conduct_, an easy _soft Hand_, and a
dextrous gentle _Method_ of treating the _parturient_ and _patient
WOMAN_. But, farther——
WE will again in the next Place _state_ the _CASE_ thus, that suppose
the _HEAD_ is too Big, and the CHILD so much compressed, that it cannot
be brought into the _PELVIS_ without great Trouble and Difficulty: In
this _Condition_, before _Matters_ come to an Extremity, I would
(without Loss of Time) find out the FEET; in order to which, the
_Orifice_ (which is now commonly less _open_) ought to be cautiously
_open’d_ with a gentle _Force_, by thrusting first _one_, and then more
FINGERS _upwards_, which are to be gradually _distended_, until at last
the whole _HAND_ is entered up to the _Wrist_: Whereby (after prudently
breaking the _MEMBRANE_) I would now and then _thrust back_ the HEAD,
and put it upon one _Side_, as much as possible by ART.
BUT upon _This_ here it must be carefully observ’d by the way, that I
would pass my _Hand_ close up along the _INFANT’s Body_ from the
_Orifice_ to the _Fund_ of the WOMB, or to the FEET, that it may not
come between the _SECUNDINE_ and the WOMB, but betwixt the _MEMBRANE_
and the _CHILD_: By this _Method_ I shall neither hurt the WOMB, nor the
_INFANT_; but the _HAND_ distinguishing clearly all the _Parts_ of the
_CHILD_, I cannot miss finding the _Feet_ with the greatest Certainty.
Tho’ I must acknowledge by the By, this to be the _Work_ of a very
strong and agile _HAND_, as well as of a sound and ready _Judgment_;
because of the immense _Labour_ and Difficulty, first in opening the
_narrow ORIFICE_, and then in penetrating through it to the _Bottom_ of
the WOMB, as the _INFANT_ obstructs the Way: not to mention the great
_Inconveniencies_ also besides, which arise from the _Turnings_ and
_Windings_, as well as from the _Length_ and _Constriction_ of the
_Passage_. However yet——
THUS having found _one_ or _both FEET_, I would draw them down _both
together_, if possible, always turning the _TOES_ towards the _FACE_.
Whereas if only _ONE_ can be found to be conveniently _attracted_, as it
often happens, I make it fast by a running _Knot on a broad Ribband_, or
by a certain _Bandage_, called _MITRA_, or with a soft _Linnen Rag_
about four Inches broad; which I _twist_ together, and hold in the _Hand
without the Body_, as I pass the _other_ up along this _LEG_, duly
observing whether it is the _Right_ or the _Left_, that I may know which
of my _HANDS_ will most commodiously find out the _other LEG_; and that
_HAND_ having reached the _CHILD’s Belly_ or _Buttocks_, I slide it
along the _THIGH_ to the other _LEG_: So that the _FOOT_ being thus
found, I bring it also down into the _PASSAGE_, according to the
_POSTURE_ of the _INFANT_.
BOTH _FEET_ being now thus _brought down_, if they chance to be
_ill-turned_, that is, with _TOES_ up and _HEELS downwards_, I
discreetly _turn_ the _CHILD_, whilst I gradually draw forth the _FEET_.
_These_, together with the _BELLY_, being fairly excluded, I hold the
_FEET_ with _one Hand_, whilst I put the _other_ under the _BELLY_ and
_BREAST_, as far as possible: Or, resting the _FEET_ in my _Lap_, with
_one Hand_ above, and _another_ below, I take good hold of the _BODY_,
attracting it gently. Upon this I advise and encourage my _Woman_ now to
_labour_ her best, and that whether she feels any _PAINS_ or not, since
they are now no longer to be waited for with the Impatience of a happy
_Delivery_.
BY this regular _Method_, in fine, the _HEAD_ and _both ARMS_ pass thro’
the _Orifice_ at once, and that without the least _Danger_; because the
_Smoothness_ of the _TEMPLES_ affords always sufficient _Room_ for the
_ARMS_, as the _Orifice_ relaxes and dilates, as has been already
observed[175]. Now _this_, in short, I take, with Submission, to be the
only genuine _METHOD_ of perfecting a successful _DELIVERY_ in the
present _preternatural Condition_, whether the _BIRTH_ be _Dead_ or
_Alive_: So that hence I proceed in course to——
[Illustration]
CHAP. XXI.
_Of Præternatural BIRTHS, from the WOMB’s inclining to either Side._
THO’ the _WOMB_ may be _obliquated_ (as has been said) either to the
_right_ or _left Side_; yet, to abbreviate this Work, I shall contract
_both Situations_ into _one_; and because the ingenious _Reader_ may
easily apply what is said of the _one_ to the _other_, I shall only
treat of that inclining to the _right Side_.
THE most difficult _Posture_ of this kind is, when the _Bottom_ of the
_WOMB_ is placed deeper in the _right Side_ towards the LOINS, tending
more to the _Back_ than the _Forepart_. Which the MIDWIFE may know to
distinguish by the following _Signs_; namely, 1. By the _Place_ where
the Woman feels the _INFANT_ move most. 2. By that part of the _Belly_
which is most pointed and hard on the _Outside_. 3. By trying the Woman
in the beginning of the _Labour_, before the _Pains_ have moved the
_WOMB_ out of its Place, she will find the _Orifice_ of the _WOMB_
suspended higher, compressed to the _Spine_ of the left _OS PUBIS_ or
_COXENDICIS_; by which means the said _Orifice_ cannot be _touched_
without Difficulty; and by no means the _whole_ of it, but only the
_lower Border_. 4. She will find the _INFANT’s Head_ thro’ the _WOMB_
and _VAGINA_ (tho’ not bare) laid _a-cross_ the _PELVIS_, but cannot
come at the _lower Part_ of it; only with one or more _Fingers_, she may
sometimes penetrate betwixt the _Spine_ of the said Bones, and touch the
_VERTEX_.
BY these _Signs_ the _MIDWIFE_ soon finds her _Task_ most heavy and
perplexed; for from thence proceeds the following _Difficulties_.
I. IN this _Posture_ the _INFANT’s Head_ (as soon as it makes the lead
_Apertion_ of the _Orifice_) is fixed upon the _Spine_ of the left _OS
PUBIS_ or _COXENDICIS_; and the _Head_ thus fixed cannot pass forwards,
because those _Bones_ cannot give way: From hence arise the _Aquæ
Furtivæ_, or a flowing of the _Waters_ by Stealth, or as it were, by
_Distillation_; the _Orifice_ as well as the _INFANT’s Head_ being shut
up by the said _Bones_, so that neither the _Head_ nor the _Humours_ can
open it; save only a little on the _lower Side_: Where the _Waters_, by
pressing the _Membranes_ downwards in an _acute Form_, break thro’ that
_acuminated_ Part as they also force the _Head_ upwards, near to the
_Border_ of the said BONES.
II. IT often happens, by these means, that the _right Arm_ is excluded,
and falls down to the _Shoulder_ in the _PASSAGE_, the _INFANT_ being
left dry by the unseasonable flowing of the _Waters_: And the _Arm_
being thus thrust forwards into the _PASSAGE_, the _Head_ is more and
more forced-back _upwards_, so that the _Neck_ of Consequence is so
bent, that it may easily break; and the _Crown_ of the _HEAD_ (falling
against the _Spine_ of the _PUBIS_ or _COXENDICIS_) is so pressed upon
it by the violent _Pains_, that the _BRAIN_ may be readily affringed,
and consequently the _INFANT_ die before _BIRTH_.
III. THE most deplorable _Condition_ of all is when, after all _Pains_
and _Labours_ suffered in vain, the MOTHER herself expires, without
bringing forth her _Child_; as it too often happens, that after a long
continued and miserable _Torment_, the BIRTH is not a Jot advanced,
whereby of course the wretched _Woman_ must undoubtedly _yield up the
Ghost_ for want of effectual _Help_. I say for want of _Help_, because
the _Help_ of such MIDWIVES as are ignorant of the various _Postures_ of
the WOMB, and the _Method_ of correcting them; and of such as do not
thorowly understand the TOUCH, but place all their Hopes in _Nature_ and
_Divine Mercy_; is as nothing, and of no Effect upon this _critical
Occasion_: Since the audacious _Ignorance_ of such Creatures serves only
to tempt GOD and his _Providence_.
HAVING thus defin’d and laid down the fatal Inconveniences of this
_Preternatural Situation_, I come now to shew People concern’d how to
correct it and dispatch a happy _BIRTH_: In order to which, the
_præliminary Articles_ are the _MIDWIFE’S_ indefatigable _Industry_, and
accurate _Attention_ to the Circumstances of Things.
THEN supposing an _INFANT_ to be brought forth _HEAD foremost_; the
_Woman_ is to be placed with the upper part of her Body a little
elevated, the _MIDWIFE_ then finding (by the TOUCH) the _Orifice_ to be
but moderately press’d upon the _Left OS PUBIS_, or _COXENDICIS_; in
this _Case_, she is to be laid down full upon the _right Side_ a little
obliquely, that the WOMB may fall back by its own Weight, and not
relapse against those _Bones_.
NEXT after this I would endeavour to get my _right Hand-Fingers_ above
the upper Border of the _Orifice_, and thereby remove it a little, and
bring it down nearer the _Cavity_ of the PELVIS. To facilitate which
_Work_, I would order some of the _By-Standing Women_ to raise her
_right Side_ a little, which of Consequence raises the WOMB itself; and
thus I would, by raising and letting it down by Degrees, move it
_forwards_ into the _PELVIS_: However, always taking special Care, that
the WOMB, together with the _Head_, do not slip down too far into the
crooked _Sinus_ of the _OS SACRUM_, so as to stick there, (as has been
already precaution’d in the preceding _Chapter_:) to prevent which
unlucky _Accident_, I would advise to apply all possible Care and Pains
in the Beginning, to sustain and keep up the _Orifice_, and to bare the
_HEAD_ sufficiently before its Descent; observing also the same
Management in point of the _Humours_, until the _Membrane_ breaks; which
being broken, I would treat the _Head_ in Manner as aforesaid.
NOW tho’ the _HEAD_ in this _Posture_ offers itself as if it were _bent
aside_, because of the _lateral Distorsion_ of the WOMB, I would first
bring it to a right _Position_, and then manage it as if it had
presented itself _directly_: And besides, the _HEAD_ being thus directed
into the PELVIS, I would always take care that the _Woman’s Body_ be
bent a little towards the _left Side_, that the CHILD may the more
readily be carried down by its own _Weight_ into the _PELVIS_. But, in
short, as to the farther Exclusion of the INFANT, and _After-Birth_, as
well as the _Cleansing_ and _Contraction_ of the WOMB; These Things are
to be perform’d, as directed by the foregoing _Chapter_.
HOWEVER, we will now state the _Case_, and suppose that the _Woman_ is
spent and tired out with continual hard _Labour_, before the capable
_MIDWIFE_ is sent for: Upon this _Condition_ the _BIRTH_ is to be
hastened by all possible prudent Means. In order to which, I would
(without Loss of Time) endeavour to _turn_ the _INFANT_, and extract it
by the _Feet_; Because to direct it otherways into the PELVIS, would be
too tedious upon this Juncture. For to bring it _Head foremost_, would
create vehement _Pains_, which infallibly would expose _both Lives_ to
extream Danger. But now, in fine, having thus at large insisted upon the
various _Cases_ of _Preternatural Births_, arising from the four extream
_oblique Situations_ of the WOMB; It remains yet still, that I also
subjoin a few Words, upon such _Preternatural Cases_, as may proceed
from the less _oblique Positions of the same Body_; and that briefly in
manner following——
[Illustration]
CHAP. XXII.
_Of Præternatural BIRTHS, proceeding from the Median oblique Situations
of the WOMB._
AS the three preceeding _Chapters_ concern only the Extremities of an
_obliquated_ WOMB, so they necessarily lead me in this Place to offer a
short _Hint_ Upon the _Median_ or _Less oblique Uterine Positions_.
Which notwithstanding their great _Variety_, according to the just
Comparison formerly made[176], I shall for Brevity-sake comprehend in
_One_, and treat of in general _Terms_ as subsequently follows.
I. I observe that however conspicuous and remarkable the _Difference_ of
these _Preternatural Postures_ may be, especially _That_ betwixt the
_Four_ mention’d _Extremes_ and the _Natural Situation_ of the WOMB; yet
I fear, that there is too much Reason to suspect, that this _Difference_
is but little known to the generality of _Practitioners_ in _MIDWIFERY_,
otherways I am sure _Patience_ would not be so much cry’d up, or at
least _Time_ would not be so much trifled away, (at every difficult
_LABOUR_) by the _Ordinary Boethogynists_, neither would the Use of
_SHARPS_ be so much practis’d by the _Extraordinary MIDWIFE_.
II. I observe, that tho’ a WOMB _less oblique_, occasions a _less
Difficult_, or more easy _BIRTH_, than any of the _Extremes_, yet the
least Degree of an _oblique uterine Posture_, may be of great Hindrance,
and imminent Danger to the _Woman_, whose attending _MIDWIFE_ is
ignorant of it, as well as of the exact _Method_ of restoring it to its
_Natural State_.
III. I would observe by the way, that as the fatal _Consequences_ of
such Ignorance, have already been sufficiently precaution’d in the
preceeding _Chapters_; so it would be _supervacaneous_, and altogether
needless to re-assume or repeat them in _This_: Wherefore I shall only
farther, once for all, exhort and adjure such _MIDWIVES_, as have any
regard for their own _Consciences_, and the _Lives_ of their Neighbours,
that they would qualify themselves duly in these excellent Points of
Knowledge. And _This_ I have the more Reason to inculcate, because I
never yet knew an assiduous _MIDWIFE_, who was _thus perfectly_ well
endued with the _essential Qualifications_ of her PROFESSION, but the
great _GOD_ rather (to whom the Glory of all Things is due) perpetually
compleated his own _Gifts_, and crown’d the _Labour_ of her Hands with
desirable _Success_.
FOR as the _Husband-Man_, who never _sowed_, can never expect to _reap_;
or as the _Gardener_, who never _planted_, can never hope to _gather_;
so neither can the _MIDWIFE_ who was never regularly qualified, ever
justly hope or expect to effect a happy _DELIVERY_; especially not in
_Cases_ of Difficult and _Preternatural BIRTHS_: Neither can the
_Consequences_ of her Mistakes or Ignorance on the other Hand, ever
detract from, or lessen, the _Divine Power_, which is still the SAME,
and _can always do all Things that it will, but will not always do all
that it can_. Besides _HE_, who has been pleased to lay such _Burthens_
upon us, to try the _Patience_ and _Constancy_ of _One_, and to exercise
the _Industry_ and _Charity_ of _another_; _HE_, I say, often executes
his _Judgments_ upon _some_, for the _Sins_ of _both Offenders_, that
all Things may the more manifestly tend to his own eternal Glory.
IV. I come now in the _fourth_ Place by certain _Demonstration_, to
explain the Nature of a WOMB less _obliquated_, and to lay down the
genuine Method of correcting any _Preternatural Situation_ whatsoever of
the disorder’d or distorted WOMB.