_Difficulties attending a wrong Position of the_ Child_’s_ Head.
If in the Progress of Travil, the Midwife perceives any Part of
the Head, besides the _Crown_, discoverable by its _Sutures_,
presenting, and it appear _broad_, and very _hard_ to the _Touch_:
If the _Waters_ may be _felt_ descending in a _long_ Form through
the _internal Orifice_, somewhat like a Piece of a Gut distended
with Water: These Appearances presage the utmost Difficulty and
Danger, commonly owing to the small Distance between the _forward_
and _back_ Bones; an ill Situation of the _internal Orifice_; the
_comparative Largeness_ of the Child’s Head; or the _ill_ Site
of the _Womb_; whereby the Head may be pressed against the Bones
_forward_ or _backward_, or somewhat inclined to _either_ Side,
in a wrong Direction for the _Passage_. These Causes, singly or
concurring, render the Case much beyond the Skill, and very often
the Strength, of a Midwife to redress.
When unqualified Midwives observe the Head present to the inward
Orifice, they are too apt to promise good Success, and behave with
the utmost Confidence, wherein they are often egregiously mistaken;
for there cannot be a more difficult Birth, than frequently
happens, when any other Part, instead of the Crown, offers; and
the Misfortune is, the longer Recourse to proper Assistance is
delay’d, the greater the Difficulty becomes every Moment; and the
poor Woman may think herself happy, if she escapes with her Life,
the Danger of a most _fatiguing_ and _tedious_ Labour, succeeded,
perhaps, by such a Relaxation of the _Vagina_ or _Passage_, as
will occasion great Uneasiness in going, or being in an _upright_
Posture, without the immediate Help of Medicines, both externally
and internally; or wearing a _Pessary_ for its Support, during
Life.
Whereas ’tis certain, that if the Mother’s Pains, _strongly bearing
down_, the Muscles of the Belly contracting and becoming sensibly
_hard_ to the _Touch_, don’t manifestly promote the Birth, it must
needs be owing to some Obstruction beyond the Midwife’s Skill;
who in this Circumstance is apt to complain, the Pains are not
sufficiently _strong_, ’till the poor Woman is ready to expire,
from the Loss of her Strength, by her long Suffering under them;
and told she must patiently wait God’s Time, who in Case he
miraculously interpos’d, wants not the Midwife’s Assistance: And
what still adds to this deplorable Calamity, ’tis likely she is
put upon exerting her utmost Strength, assisted by Cordials; when
_encouraging_ her _Labour_ and _provoking_ her _Pains_, ’till the
Obstructions in the Way of the _Birth_ are remov’d, contribute
still further to the Danger attending.
I don’t deny but that in some Cases, a _tedious_ Labour may be
owing to a Defect of _sufficiently_ strong Pains; but as this
often proceeds from _Circumstances_ obstructing the _Birth_,
true Labour naturally takes Place, when they are remov’d; and, by
a right Management of the Hand, is more _effectually_ promoted,
without Cordials or _forcing_ Medicines, where the Pains are
deficient.
Under this Sort of unnatural Birth, may very well be enumerated,
the _Face_ presenting _towards_ the Mother’s Belly, or the _Side_
of the Head coming _Foremost_, for its Passage must be extreamly
difficult in these Postures; as well as when the _Face_ comes
_forward_; for then by Reason of the great Tumour, about the
_Head_, _Face_, _Eyes_, and _Mouth_, from Lodging between the
Bones, the Infant expiring in the Birth, has been often taken for
a Monster. I have often been so happy, when the Head has long
remain’d, wedg’d between the Bones, as to bring the Child alive,
by the _Forceps_, in a few Minutes, if seasonably call’d, when the
Woman in Travil has been in the utmost Danger of Death.
The 5th of _May_, 1751, I met with as bad a Case, as most of this
Kind at WIGGLETON: This Woman, by the Midwife’s Account, seem’d to
be in _Labour_ at Times near a Month, and for a Week last, almost
in continual Pain, with her first Child: as I was call’d late to
her Assistance, I could not judge, by early Appearances, of the
Situation of the _Uterus_, or _Infant_; this is most commonly only
in the Power of the Midwife to observe; her _Waters_ had gradually
drain’d away above a Week, and there still remain’d some Part of
the _Membranes_ depending like a _Gut_ in the _Vagina_, the _Head_
offer’d, firmly wedg’d in the _Pelvis_; the Part most obvious
to the _Touch_, by its Softness and fleshy Consistence, seem’d
to be the _Cheek_: The poor Woman’s Pains, for some Hours, were
_ineffectual_ for want of Strength, her Spirits being exhausted, by
a Labour so fatiguing; there was no Possibility of _turning_ the
Child; I endeavour’d, with some Success, to promote the _Birth_, by
bearing _strongly_ against the inferior Part of the _Os-sacrum_,
but her Weakness, depriving me of the small Benefit of her Pains,
I had for a Time; there was an absolute Necessity for a speedy
Delivery, for the Mother’s Sake: ’Twas with some Difficulty I
overcame her Prejudice, and those Present against the Use of any
Instrument, tho’ at length they yielded; when introducing a _Limb_
of the Extractor on each Side of the Head, and Co-operating with a
small Pain, encouraging the Woman to bear down as strongly as she
could, I immediately brought a Daughter, with a monstrous long Head
alive.
I HAVE, however, met with some Cases, which I could relieve by
no better Method, than lessening the Head; but considering for
whose Benefit I am chiefly Writing, and how dangerous the Use of
Instruments may be in injudicious Hands, I rather choose to advise
Women not to meddle with them, than pretend to relate the Method of
using them.