_Directions for Women when they are taken in Labour, to ensure
their safe Delivery, and Directions for Midwives._
Having thus given the necessary directions to pregnant women, how to
manage their health during their pregnancy, I will now add what is
necessary for them to do, in order that they may be safely delivered.
When the time of birth draws near, the woman must be sure to send for a
skilful midwife, and that rather too soon than too late. She must have a
pallet bed ready to place it near the fire, so that the midwife and
those who are to help her, may be able to pass round it, and give
assistance on either side, as may be required. A change of linen must be
in readiness, and a small stool to rest her feet against, as she will
have more power when her legs are bent, than when they are straight.
When everything is thus ready, and when the woman feels the pains coming
on, if the weather be not cold, she should walk about the room, rest on
the bed occasionally, waiting for the breaking of the waters, which is a
fluid contained in one of the outward membranes, and which flows out
thence, when the membrane is broken by the struggles of the child. There
is no special time for this discharge, though it generally takes place
about two hours before the birth. Movements will also cause the womb to
open and dilate, and when lying long in bed will be uncomfortable. If
she be very weak she may take some mild cordial to give her strength, if
her pain will permit her; and if the labour be tedious, she may be
revived with chicken or mutton broth, or she may take a poached egg; but
she must be very careful not to eat to excess.
There are many postures in which women are delivered; some sitting in a
chair, supported by others, or resting on the bed; some again upon their
knees and resting on their arms; but the safest and most commodious way,
is in the bed, and then the midwife ought to observe the following
rules:--Let her lay the woman upon her back, with her head a little
raised by means of a pillow, with similar supports for her loins and
buttocks, which latter should also be raised, for if she lies low, she
cannot be delivered so easily. Then let her keep her knees and thighs as
far apart as she can, her legs bent inward towards each other, and her
buttocks, the soles of her feet and her heels being placed upon a small
rest, placed for the purpose, so that she may be able to strain the
stronger. In case her back should be very weak, a swathing band should
be placed under it, the band being doubled four times and about four
inches broad. This must be held by two persons who must raise her up a
little every time her pains come on, with steady hands and in even time,
but if they be not exact in their movements, they had better leave her
alone. At the same time two women must hold her shoulders so that she
may strain out the foetus more easily; and to facilitate this let one
stroke or press the upper part of her stomach gently and by degrees. The
woman herself must not be nervous or downhearted, but courageous, and
forcing herself by straining and holding her breath.
When delivery is near, the midwife must wait patiently until the child's
head, or some limb, bursts the membranes, for if the midwife through
ignorance, or through haste to go to some other woman, as some have
done, tears the membrane with her nails, she endangers both the woman
and the child; for by lying dry and lacking that slipperiness which
should make it easy, it comes forth with severe pains.
When the head appears, the midwife must hold it gently between her
hands, and draw the child, whenever the woman's pains are upon her, but
at no other times; slipping her forefingers under its armpits by
degrees, and not using a rough hand in drawing it out, lest the tender
infant might become deformed by such means. As soon as the child is
taken out, which is usually with its face downwards,--it should be laid
upon its back, that it may receive external respiration more freely;
then cut the navel string about three inches from the body, tying the
end which adheres to it with a silk string, as closely as you can; then
cover the child's head and stomach well, allowing nothing to touch its
face.
When the child has been thus brought forth, if it be healthy lay it
aside, and let the midwife attend to the patient by drawing out the
afterbirth; and this she may do by wagging and stirring it up and down,
and afterwards drawing it out gently. And if the work be difficult, let
the woman hold salt in her hands, close them tightly and breathe hard
into them, and by that she will know whether the membranes are broken or
not. It may also be known by making her strain or vomit; by putting her
fingers down her throat, or by straining or moving her lower parts, but
let all be done immediately. If this should fail, let her take a draught
of elder water, or the yolk of a new laid egg, and smell a piece of
asafoetida, especially if she is troubled with a windy colic. If she
happen to take cold, it is a great obstruction to the afterbirth; in
such cases the midwife ought to chafe the woman's stomach gently, so as
to break, not only the wind, but also to force the secundine to come
down. But if these should prove ineffectual, the midwife must insert her
hand into the orifice of the womb and draw it out gently.
Having thus discussed common births, or such as are generally easy, I
shall now give directions in cases of extremity.
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