of the WOMB, whether more or less, either tending _aside_, or _prone_,
or _supine_, are only best discover’d by the _TOUCH_: Because the
_Orifice_ always answering in a _strait Line_ to the opposite
_Situation_ of the _Bottom_ of the WOMB, can never fail to shew its
_Posture_ to the judicious _MIDWIFE_.
HENCE if the _MIDWIFE_ does but know exactly the _Natural Position_ of
the _ORIFICE_, she may thence easily conceive by how much it differs in
an _obliquated_ WOMB, and accordingly thereby readily judge whereabouts
the _Bottom_ is seated: Which _Situations_ of _Bottom_ and _Orifice_
being known, she can consequently be at no loss to comprehend the
_Disposition_ of the whole _Uterine Body_. And if she now remembers or
recollects what has been said of _restoring_ and _replacing_ the most
_extream_, or most _oblique_ WOMB, she will have no Difficulty in
restoring any WOMB _less oblique_ to its _Natural Posture_; This
depending entirely upon that Method, to which I refer[177], for
Brevity’s sake.
IN short, I shall here only add, that if the _INFANT_ offers itself
_well turn’d_, in this _less oblique_ WOMB; the _MIDWIFE_, having
restored the WOMB to its right Place and natural _Posture_, will find
nothing more to do, but to take Care to facilitate and enlarge the
_Passage_, and receive the _CHILD_ tenderly with the _Head foremost_.
Whereas in _Case_ the _INFANT_ presents itself _ill-turn’d_ in this
WOMB, it is to be very circumspectly extracted by the Feet; as by and by
will more amply appear from what ensues, _Viz._——
[Illustration]
CHAP. XXIII.
_Of Preternatural BIRTHS, proceeding from complicated Causes, of both
the INFANT and the WOMB._
BY this sort of _BIRTHS_, I mean such as are _Preternatural_, both in
respect of the _Situation_ of the _CHILD_, and of the WOMB. Which
complicated _Preternatural BIRTH_ is (of all _others_) the most
dangerous; because of an _Indefinity_ of Accidents and Difficulties with
which it is always attended, according to the many various _Postures_ in
which both the _INFANT_ and the WOMB are found: All which to enumerate
here, and to guard particularly against them, as I have done in the
preceeding _Cases_, would not only augment the _Bulk_ and _Charge_ of
this _WORK_, but also be in some respect altogether _Needless_: Because
if I was to content my self to treat this _Chapter_ in _general_
(without descending to _particular_) _TERMS_, I would not doubt but that
the ingenious _Reader_ would even thence readily form a clear _IDEA_ of
all such _BIRTHS_, from the many different _Cases_ already stated and
discussed; which if thoroughly well understood, the Rest cannot but be
easily comprehended.
HOWEVER, that I may not leave the weaker _Capacity_, or the doubtful
_MIDWIFE_ to the Uncertainties of her own scrupulous _Judgement_, I
shall propose and resolve some of the most difficult and dangerous
_Cases_ belonging to this _preternatural Subject_, and _that_ as far as
is really requisite, in manner following; _viz._——
I. WE Shall suppose that the _INFANT_ is ill-turned, and presents itself
_preternaturally_, with FACE, CHIN, HAND, ELBOW, SHOULDER, BREAST, BACK,
BELLY, SIDE, BUTTOCK, KNEE, FOOT, or any _other Part_ or _Member_ first,
in a WOMB tending _obliquely forwards_. In this _Condition_, I shall
_first_ show the _MIDWIFE_ how, and by what _Signs_, she may know and
discover such perverse _Postures_; and _secondly_ how, and by what
Means, _These_ may be rectify’d, the _CHILD_ extricated, and the
_MOTHER_ reliev’d in Life.
THEN as to the _First Point_, I would have it minded, that the TOUCH is
the only _Expedient_, by which the _Situation_ of the _INFANT_ in any
WOMB, whether _Oblique_ or _Direct_, is to be discover’d and perfectly
known. Which when the _MIDWIFE_ finds to be _preternatural_, she needs
not much trouble herself about what _precise Part_ offers or comes
_first_ in the _PASSAGE_: Because of this short _Rule_, which I would
not have her to forget; namely, That, when the HEAD does not present
itself _first_ in this complicated _Case_, the _CHILD_ is to be drawn
out by the _FEET_. For in this ill _Position_ of both the _INFANT_ and
the _WOMB_, the _Version_ of the _CHILD_ succeeds more easily than if
the HEAD was _foremost_: Wherefore I would lose no Time, but as Soon as
I had discover’d all _Circumstances_ aright, I would commence my
Business upon this Occasion, before either the _MOTHER_ or the _INFANT_
are much spent, that I may perform my _Work_, while they both can
mutually concur with me towards their own _Relief_; That is, while the
WOMB is yet suspended in the _upper Part_ of the PELVIS, and the
_Membrane_ not yet broken.
IN order to this _Second Point_, the _Woman_ being commodiously placed,
the _MIDWIFE_ is to pass up her _Hand_ into the _VAGINA_, and dispose
the _Orifice_ of the WOMB to open, which is now sooner done than if the
HEAD came _first_: _This_ being done dextrously, she is to put first
_one_ or _two Fingers_, then _all_ of them successively into the
_Aperture_; and when that is sufficiently enlarged, she is to penetrate
into the WOMB, and either break the _MEMBRANE_, or wait its _spontaneous
Breaking_, as she judges best by occurring _Circumstances_. In the next
place, she is to look for and find the _FEET_; and, the _TOES_ being
always turn’d towards the RECTUM, they are to be forthwith brought into
the PASSAGE: proceeding still farther in the due and regular _Method_ of
extracting the CHILD, as already taught[178] and dilucidated.
II. WE will suppose moreover, that the INFANT is _ill-seated_, and
presents itself _preternaturally_ with any of the aforementioned
_Members first_, in a WOMB hanging _obliquely to either Side_. In this
_Case_, I would sincerely advise the _MIDWIFE_, to lose no Time in
opening the WOMB, breaking the MEMBRANE, turning the CHILD, and
extracting it by the FEET: Because in this _Posture_ of both the _BIRTH_
and the _WOMB_, Experience has taught me that nothing can be safer and
less dangerous than this _Method_, when ingeniously and presently
perform’d with Dexterity.
IT is true indeed it may be _objected_, that I dissent in _this Matter_,
from most (if not from all) _Authors_: To which I _answer_, in short,
that _Those_ from whom I do differ, were never acquainted with this
_complicated preternatural Condition_, but always supposed the _WOMB_ to
continue in its proper Place, never dreaming of its various _Motion_,
nor suspecting its _oblique Situation_; erroneously imagining all
_preternatural BIRTHS_ to proceed merely from the ill _Version_ of the
INFANT: In which _Circumstance_ however, when it happens so, I confess
they are so far in the right, that the HEAD is to be _first_ brought
into the PASSAGE, and the CHILD excluded by it with all possible
Expedition.
BUT that I may farther elucidate the true _State_ of this _Case_, as it
becomes me to speak the _Truth_ ingenuously, it is my candid Opinion
that, in any _oblique Posture_ of the _WOMB_, it is the safest,
quickest, and most convenient _Method_ to extract the INFANT by the
FEET, and that presently in the _Beginning_ of the LABOUR, either before
or at least presently after FLOODING, as occasion requires. For this
very Reason, and to this Purpose, I hope, I may farther justly lay down
_one certain Rule_; namely, that all _BIRTHS ill-turn’d_, in a _WOMB
ill-seated_, are to be rightly _turn’d_ again, and drawn out by the
FEET. Which _Rule_, if duly observed, will, I am positive, save a World
of _Women_ and _Children_, that otherwise must inevitably perish; since
as for my part, I know no _Situation_ of the INFANT in an _oblique
WOMB_, more difficult or dangerous than the HEAD’s _offering itself
first_; and _that_ because the _BIRTH_ cannot be then _turned_ without
the greatest _Difficulty_ and most extreme _Pains_.
THIS, in short, will be readily granted by All, who do consider or
conceive that the _WOMB_ (being fixed by _Ligaments_ on both sides) is
always more inclinable to _fall Forwards_ or _Backwards_, than to either
_Side_, and first most commonly _bends back_ before it comes to any
_lateral Posture_; and that from hence of consequence, the _WOMB_ is
_distorted_ as well as _obliquely situated_. By reason of which
_Distortion_, if the _CHILD_ comes _Head foremost_, it falls down in the
PELVIS _obliquely_; and tho’ a judicious _MIDWIFE_ may bring the HEAD
directly into the PELVIS, yet the _Shoulders_ following, must needs fall
upon the PELVIS _a-cross_, in its narrower Part; whereby of reasonable
Consequence the INFANT must be distorted in the _Passage_.
NOW in this _Case_, no PAINS, how violent soever, can avail to force
forwards the _BIRTH_ so fixed upon these _Bones_; wherefore (I say) when
the _WOMB_ is thus _seated_, it is most safe in the _Beginning_ of the
_LABOUR_, to open its _Orifice_, break the _Membrane_, turn the _CHILD_,
and take it out by the _FEET_; since by the HEAD’s coming now
_foremost_, both _Lives_ are at Stake and in great Jeopardy.
HOWEVER yet it may be again _objected_, that I have already prescribed
another _Method_ in _Chap._ 21; _viz._ of bringing the _Orifice_
together with the HEAD into the PELVIS, and promoting the _BIRTH_ in
that Manner: To this I _answer_, that my _Reason_ for so doing, was not
only to convince some People, that I know _their Method_ as well as _my
own_; but also to whet or assist the _Judgment_ of such good _MIDWIVES_
as cannot forsake their own old _By-Paths_; Not that I ever design’d to
recommend _it_ to any, tho’ I must however acknowledge, that sometimes
it may effect the desirable _Ends_; but according to the _Rules_ of
irrefragable _Truth_, and sound Judgment, we find that, in this
_Position_ of the WOMB, let the _BIRTH_ offer itself as it will, the
only laudable _Method_ is without Loss of Time to extract the INFANT,
and deliver the _Woman_ as above-directed.
III. I observe upon the whole, that as the immediate present _Case_ is
applicable to either (_right_ or _left_) _Side_; so what is said of the
foregoing _Condition_, with respect to the WOMB’s _inclining forwards_,
may be easily apply’d to the _Case_ of its _tending backwards_: Only
with this considerable Difference, that the _oblique forward Posture_ of
the WOMB, is the most commodious of the _Four_ mentioned _Extremes_, and
consequently admits of a more easy _Exclusion_ of the _BIRTH_ by the
_Head_, than any of the rest mentioned.
NOT but that either of these grand or complicated _preternatural BIRTHS_
imply and prognosticate imminent Danger to the _MOTHER_, or the _CHILD_,
or _Both_; as well as incredible _Labour_ and _Fatigue_ to the faithful
_MIDWIFE_; who, in such _Cases_, can less distinctly feel, less
commodiously handle, and more difficultly come at the Matter, so as to
dispose the _INFANT_’S _Members_ for _Attraction_, than in any other
_Condition_ of _BIRTH_: Hence it is, in short, that so many _MIDWIVES_
are liable to the most egregious Mistakes, and unaccountable Deceptions
upon these unlucky Occasions. But——
AGAIN farther, I hope I may freely speak my Mind, and openly avow, that
the most of these BIRTHS proceed merely from want of seasonable and
skilful _Assistance_ in the beginning of the LABOUR: Because the _BIRTH_
(however well seated then) by reason of the _bad Situation_ of the WOMB,
cannot possibly pass thro’ the PELVIS of itself; and not being
judiciously assisted at that nice Juncture, behold, from a _Natural_, it
falls on a sudden also into a _Preternatural Posture_. From hence we
have this extreme difficult and most dangerous sort of _Preternatural
BIRTHS_, as will more conspicuously appear from a deliberate
_Reflection_ upon the preceding _Chapters_. And This much (I hope) may
finally suffice any intelligent _Reader_, to conceive the different
_Circumstances_ of all _complicated Preternatural BIRTHS_ whatsoever.
Whence I go on to the _Fourth_ and last Sort of _Preternatural BIRTHS_
proposed; namely, _Those_ proceeding from intervening _accidental
Causes_; which because they are also different, I shall handle briefly
and separately in the ensuing Manner; _viz._——
[Illustration]
[Illustration]
CHAP. XXIV.
_Of Preternatural BIRTHS, proceeding from the NAVEL-STRING’s coming
first, and that either alone, or with some other Member._
AMONG the various unhappy _Accidents_, which may happen in or about the
Time of LABOUR, the present _Case_ is none of the most auspicious; in as
much as it may, in sundry Respects, occasion a very difficult
_Preternatural BIRTH_, according to the Difference of Circumstances: For
the NAVEL-STRING having fallen down and come _first_ in the _Passage_,
may be variously turn’d, and consequently cause several and sundry
_Inconveniences_, as follow, _viz._——
I. WHEN the _Umbilical Vessel_ falls down alone into the PASSAGE,
without any other _Part_, the _BIRTH_ is then commonly situated a-cross
in the WOMB; and in this _Condition_, _BACK_ or _BELLY_, _HAND_ or
_FOOT_, may be probably expected to come _first_: Wherefore the active
_MIDWIFE_ ought to discover the _real Posture_ by the TOUCH, and _that_
at least before all the _Waters_ are yet flow’d off and evacuated; and
then betimes to fetch away the _CHILD_ by the _FEET_, unless the HEAD be
more convenient or pat for the Purpose. But these _Cases_ being already
particularly discussed[179], I shall add nothing farther upon them in
this Place.
II. THE _String_ may fall down _double_, and so swell with _Cold_, as to
obstruct the _Passage_, which however is but the smallest Consideration
in this _Condition_, because by its hanging down _double_, it may be so
shortned, that the _CHILD_ may be detain’d, appending by it in the
_Orifice_, until the BLOOD of the _Umbilicals_ coagulating either by
_Cold_, or by _Compression_ in the _Passage_, the due _Circulation_ is
obstructed, and the INFANT expos’d to the greatest of _Dangers_, if a
very speedy _DELIVERY_ does not prevent the fatal Accident.
THE Prudent _MIDWIFE_ ought always to be very sollicitous about this
_Case_, making it her particular _Care_ from the beginning of the
LABOUR, as soon as perceiv’d by the TOUCH, and before the _Waters_
break, to avert or hinder its either coming _before_, or _along with
the_ HEAD, by removing it judiciously according to _Art_. But supposing
she comes too late to prevent the _Mischief_, and that the STRING is
already in the _Passage_; then it is to be _put back behind the_ HEAD
immediately, and kept there until the HEAD be fully directed into and
lodg’d in the _Passage_. However it sometimes happens that it cannot be
kept-up so _long_, and that the _MIDWIFE_, whatever _Pains_ she may
take, cannot hinder it from extruding itself at every PANG: In this
_Condition_, I would advise her (without delay) to extract the BIRTH by
the FEET, and that notwithstanding the HEAD should be _foremost_.
III. IT also happens sometimes, that the STRING without hanging down, is
variously compress’d betwixt the HEAD and the _Bones_ of the PELVIS,
which (stopping or impeding the _Motion_ of the BLOOD) soon occasions
the INFANT’s inevitable Death.
IN which _Case_, if pressed against the OSSA PUBIS, having laid the
_Woman_ on her _Back_ with her _Head low_, and the _lower Part of her
Body raised_, I would press _back_ the INFANT’s _Head_, and put the
_STRING_ as much as possible behind it; upon which, then I would bring
the _Head_ forthwith into the PELVIS, unless it be more convenient to
_turn_ and _extract_ it by the _FEET_.
AS also, tho’ seldom, it may happen, that the _Umbilical_ may be
_pressed back_ by the HEAD against the OS SACRUM: In which State of
Affairs, I would turn the _Woman_, if Strength may permit, upon her
KNEES, whilst I employ either _Hand_ on the _Back Part_, in order to
remove the HEAD, how firmly soever fixed: Whereas if the _Patient_ be
weak, I would lay her upon either _Side_, drawing up one _Foot_ to her
_Belly_, for the Advantage of obtaining more Room, in order to effect
the same Thing; which, tho’ difficult, is no impossible _Task_ for the
expert _MIDWIFE_.
BUT if it chances to be pressed against either of the OSSA ILIA, having
laid the _Woman_ on the contrary _Side_, with the _lower Part_ of her
Body elevated, I would remove the _HEAD_ with the opposite _Hand_, and
free the _STRING_; proceeding otherways as in the former _Cases_, with
_HEAD_ or _FEET_, as I should find most convenient.
IV. AGAIN, it also sometimes comes to pass, that the _STRING_ is found
lying upon the _Forehead_, which is indeed most _dangerous_; but it is
easily removed with good Judgement to the _Temples_ of the HEAD, which I
take to be a safe _Position_, because there the _Pressure_ is much less
aggravated.
V. MOREOVER it likewise sometimes happens, that the _STRING_ comes along
with the _Shoulder_, _Elbow_, _Hand_, _Foot_, &c. without touching the
_HEAD_: Upon this then as soon as the _Humours_ have flow’d, I would
pass my _Hand_ quickly up, and bring the _CHILD_, _Head_ or _Feet
foremost_ into the _Passage_, according to its _Situation_, always
detaining or stopping the _STRING_ from coming out before the _BIRTH_:
Whereas if the _STRING_ be already excluded along with the _Foot_ or the
_Arm_, it is to be _repelled_ with all necessary Speed, Conduct, and
Caution, and then the _INFANT_ ought to be dextrously drawn out by the
_Feet_.
VI. I have also seen the _CHILD_ brought forth by the _HEAD_, with the
_Umbilical_ circumvolv’d, or turn’d twice or thrice round the _NECK_; by
which means of the _STRING_’s being so much shortned, the _BIRTH_ was
stopped or retained in the _Passage_: Upon this Occasion, I endeavour’d
to slacken the _STRING_, and so bring it over the _HEAD_, but finding it
too _strait_ and _short_ to be so ordered, I _tied_ it in two places (at
about two or three _Inches_ distance) and then _cut it in two_ betwixt
the _Ligatures_: That being done, it was my Business to lose no Time in
attracting the _INFANT_ and delivering the _WOMAN_; otherways in this
_Condition_, it would have soon expired.
[Illustration]
CHAP. XXV.
_Of Preternatural BIRTHS, from the AFTER-BIRTH’s coming first into the
PASSAGE._
ANOTHER _Preternatural Accident_ to which the _BIRTH_ is also sometimes
liable, is the _Falling down of the_ PLACENTA into the _Orifice_ of the
WOMB; which of course must needs obstruct the _Passage_, and prevent the
timely _Egress_ of the _INFANT_.
NOW tho’ the ignorant MIDWIFE often occasions this untoward _Accident_
by her own unskilful and imprudent _Treatment_, or rough and indecent
_Usage_; yet the Ingenious _MIDWIFE_ discovers this _Case_ in time by
_two_ certain different _Ways_: Namely, FIRST, by the TOUCH, when she
can neither feel the _MEMBRANE_, nor the naked _HEAD_; but (on the
contrary) perceives a thick, soft, fleshy, boneless _Substance_:
SECONDLY, by a _Bloody Flooding_, which constantly attends this
_Condition_; whereby both the _MOTHER_ and the _CHILD_ are imminently
endangered, as is already more abundantly set forth[180]: Unless the
skilful _MIDWIFE_ can prevent the fatal _Consequence_, by accelerating
the _BIRTH_; which, however yet, is not to be rashly attempted without
due Circumspection.
BUT notwithstanding the daring _Difficulties_, and time-serving
_Precautions_, mentioned by most _Authors_ of my reading and revolving,
in this _Case_; I can conceive no extraordinary _Perplexity_ which can
attend it, if the _DELIVERY_ be but _timely_ or _seasonably_ undertaken,
before the _Woman’s Strength_ and _Blood_ be too much exhausted. I know
_Daventer_, _Peu_, and some _others_, make long _Ambages_ or
Circumlocutions upon this _Head_; for _some_ are at great Pains to teach
us how to perforate the _SECUNDINE_ with a _Hair-Needle_ instead of our
_Fingers_, and _others_ how to keep it back, until the _INFANT_ be first
born: But for my part, as I already foresee sundry _Difficulties_ that
will arise in these Practices, so I shall be loth to come into them, and
that because——
FIRST, in penetrating the PLACENTA with any _acute Instrument_, the
_CHILD_ (if not the _MOTHER_ also) may be easily wounded: SECONDLY,
supposing it to be done with the FINGERS, the _Hole_ must be dilated in
proportion to the _Aperture_ of the Mouth of the WOMB, and then _this_
mangled MASS must be dispersed to _all Sides_ of the _Orifice_; by which
Means, _Daventer_ himself acknowledges, that it often perfectly
_congeals_ with BLOOD, and sticks so fast to the WOMB or VAGINA, that
the _Ignorant_ would not only take them to be _grown together_, but also
believe them rather to be _one and the same Body_: Which consequently
must require both great _Pains_ and _Difficulty_ to be separated, and at
last a very diligent _Scrutiny_ must be made, that no _Fragment_ be left
any where _Behind_, since in this _Condition_ no just _Conjecture_ can
be made by the Eye: THIRDLY, by retaining the _SECUNDINE_ in the WOMB,
when its heaviest and most bulky _Part_ (the PLACENTA) is fallen down
into the _Entrance_, let it be never so judiciously managed and moved,
it possesses a considerable deal of _Room_, and consequently obstructs
the _Operation_ of the _MIDWIFE_’s _Hand_, lying as a cross thwarting
_Impediment_ in her way, which at the same Time _blockades_ or totally
shuts up the _Passage_ of the _CHILD_.
WHEREFORE, and considering that this _Body_, when so loosened and
separated from the WOMB, can never possibly be any more _serviceable_;
but, on the contrary, highly _detrimental_ to both the _MOTHER_ and the
_INFANT_, as aforesaid; I cannot but be of Opinion, that it is both the
safest and shortest Way, to extract the _SECUNDINE first_; by which
expeditious _Step_, the _MIDWIFE_ not only gains more _Room_ to turn the
CHILD, but also (this being done) she can much more commodiously draw it
out by the HEELS: Animadverting always by the way, that in this critical
_Condition_, the _BIRTH_ must immediately follow the _SECUNDINE_,
without the Loss of one Moment’s Time, and _that_ especially for
stopping the _Floodings_, which would otherways not only soon suffocate
the weak INFANT, but also in a short Space of Time effect the certain
_Death_ of the tender MOTHER.
[Illustration]
CHAP. XXVI.
_Of Preternatural BIRTHS, proceeding from the Death of the INFANT._
AMONG the many _Preternatural BIRTHS_ mentioned, I think _that_ of a
_Dead CHILD_, may now at last justly take place.
BUT because this _Case_ is too commonly mistaken, and that the _Live
INFANT_ is too often taken for _Dead_, and consequently the wretched
innocent _Creature_ treated accordingly; I think it may not be amiss,
before I enter upon this DELIVERY, that I make a few previous requisite
_Remarks_; by which the extraordinary _MIDWIFE_, who is commonly sent
for too late, may perfectly know whether the _BIRTH_ be _dead_ or
_alive_; to the End that, so also in Case of _Necessity_, it may be
accordingly managed: Since in this fatal _Condition_ I have known
_several Persons_ to have been grossly deceiv’d, who have depended upon
the _Relation_ of the sick WOMAN, or taken it upon the _Credit_ of the
ignorant attending _MIDWIFE_.
FIRST then I know it to be ALIVE, if, by laying my _Hand_ on the
MOTHER’s _Belly_, I find it _stir_ or _move_: Or, SECONDLY, If I have
not full _Satisfaction_ this way, I would convey my _Hand_ into the
WOMB, as soon as the _Waters_ break, to feel the _Pulsation_ of the
NAVEL-STRING; which the nearer I feel to the _CHILD_’s _Belly_, the
stronger I find it _beat_, if ALIVE: Or, THIRDLY, I would put my
_Finger_ into the _INFANT_’s _Mouth_ to feel its _Tongue_, which (if
ALIVE) I should perceive it to _stir_, as if it would _suck_.