_What ought to be done in cases of extremity, especially in women
who, in labour, are attacked by a flux of blood, convulsions and
fits of wind._
If the woman's labour be hard and difficult, greater care must be taken
than at other times. And, first of all, the situation of the womb and
her position in lying must be across the bed, and she must be held by
strong persons to prevent her from slipping down or moving during the
surgeon's operations. Her thighs must be put as far apart as possible,
and held so, whilst her head must rest upon a bolster, and her loins be
supported in the same manner. After her rump and buttocks have been
raised, be careful to cover her stomach, belly and thighs with warm
clothes, to keep them from the cold.
When the woman is in this position, let the operator put up his or her
hand, if the neck of the womb be dilated, and remove the coagulated
blood that obstructs the passage of the birth; and by degrees make way
gently, let him remove the infant tenderly, having first anointed his
hand with butter or some harmless salve. And if the waters have not come
down, they may then be let out without difficulty. Then, if the infant
should attempt to come out head foremost, or crosswise, he should turn
it gently, to find the feet. Having done this, let him draw out one and
fasten it with ribbon and then put it up again, and by degrees find the
other, bringing them as close together and as even as possible, and
between whiles let the woman breathe, and she should be urged to strain
so as to help nature in the birth, that it may be brought forth. And to
do this more easily, and that the hold may be surer, wrap a linen cloth
round the child's thighs, taking care to bring it into the hand face
downwards.
In case of flux of blood, if the neck of the womb be open, it must be
considered whether the infant or the _secundine_, generally called the
afterbirth, comes first, and as the latter happens to do so
occasionally, it stops the mouth of the womb and hinders the birth, and
endangers both the woman's and the child's life. In this case the
afterbirth must be removed by a quick turn. They have deceived many
people, who, feeling their softness, have supposed that the womb was not
dilated, and by that means the woman and child, or at least the latter,
have been lost. When the afterbirth has been removed, the child must be
sought for and drawn out, as directed above; and if the woman or the
child die in such a case, the midwife or the surgeon are blameless
because they have used their best endeavours.
If it appears upon examination that the afterbirth comes first, let the
woman be delivered as quickly as possible, because a great flow of blood
will follow, for the veins are opened, and on this account two things
have to be considered.
_First_:--The manner in which the afterbirth advances, whether it be
much or little. If the former, and the head of the child appears first,
it may be guided and directed towards the neck of the womb, as in the
case of natural birth, but if there appears any difficulty in the
delivery, the best way is to look for the feet, and draw it out by them;
but if the latter, the afterbirth may be put back with a gentle hand,
and the child taken out first. But if the afterbirth has come so far
forward that it cannot be put back, and the child follows it closely,
then the afterbirth must be removed very carefully, and as quickly as
may be, and laid aside without cutting the entrail that is fastened to
it; for you may be guided to the infant by it, which must be drawn out
by the feet, whether it be alive or dead, as quickly as possible; though
this is not to be done except in cases of great necessity, for in other
cases the afterbirth ought to come last.
In drawing out a dead child, these directions should be carefully
followed by the surgeon, viz.--If the child be found to be dead, its
head appearing first, the delivery will be more difficult; for it is an
evident sign that the woman's strength is beginning to fail her, that,
as the child is dead and has no natural power, it cannot be assisting in
its own delivery in any way. Therefore the most certain and the safest
way for the surgeon is, to put up his left hand, sliding it into the
neck of the womb, and into the lower part of it towards the feet, as
hollow in the palm as he can, and then between the head of the infant
and the neck of the womb. Then, having a forceps in the right hand, slip
it up above the left hand, between the head of the child and the flat of
the hand, fixing it in the bars of the temple near the eye. As these
cannot be got at easily in the occipital bone, be careful still to keep
the hand in its place, and gently move the head with it, and so with the
right hand and the forceps draw the child forward, and urge the woman to
exert all her strength, and continue drawing whenever her pains come on.
When the head is drawn out, he must immediately slip his hand under the
child's armpits, and take it quite out, and give the woman a piece of
toasted white bread, in a quarter of a pint of Hippocras wine.
If the former application fails let the woman take the following potion
hot when she is in bed, and remain quiet until she begins to feel it
operating.
Take seven blue figs, cut them into pieces and add five grains each of
fenugreek, motherwort and rue seed, with six ounces each of water of
pennyroyal and motherwort; reduce it to half the quantity by boiling and
after straining add one drachm of troches of myrrh and three grains of
saffron; sweeten the liquor with loaf sugar, and spice it with
cinnamon.--After having rested on this, let her strain again as much as
possible, and if she be not successful, make a fumigation of half a
drachm each of castor, opopanax, sulphur and asafoetida, pounding them
into a powder and wetting the juice of rue, so that the smoke or fumes
may go only into the matrix and no further.
If this have not the desired effect, then the following plaster should
be applied:--Take an ounce and a half of balganum, two drachms of
colocynth, half an ounce each of the juice of motherwort and of rue, and
seven ounces of virgin bees' wax: pound and melt them together,
spreading them on a cere-cloth so that they may spread from the navel to
the os pubis and extending to the flanks, at the same time making a
pessary of wood, enclosing it in a silk bag, and dipping it in a
decoction of one drachm each of sound birthwort, savin colocinthis,
stavescare and black hellebore, with a small sprig or two of rue.
But if these things have not the desired effect, and the woman's danger
increases, let the surgeon use his instruments to dilate and widen the
womb, for which purpose the woman must be placed on a chair, so that she
may turn her buttocks as far from its back as possible, at the same time
drawing up her legs as close as she can and spreading her thighs open as
wide as possible; or if she is very weak it may be better to lay her on
the bed with her head downwards, her buttocks raised and both legs drawn
up. Then the surgeon may dilate the womb with his speculum matrices and
draw out the child and the afterbirth together, if it be possible, and
when this is done, the womb must be well washed and anointed, and the
woman put back to bed and comforted with spices and cordials. This
course must be adopted in the case of dead children and moles,
afterbirths and false births, which will not come out of themselves, at
the proper time. If the aforementioned instrument will not widen the
womb sufficiently, then other instruments, such as the drake's bill, or
long pincers, ought to be used.
If any inflammation, swelling or congealed blood happens to be
contracted in the womb under the film of these tumours, either before or
after the birth, let the midwife lance it with a penknife or any
suitable instrument, and squeeze out the matter, healing it with a
pessary dipped in oil of red roses.
If the child happens at any time to be swollen through cold or violence,
or has contracted a watery humour, if it is alive, such means must be
used as are least injurious to the child or mother; but if it be dead,
the humours must be let out by incisions, to facilitate the birth.
If, as often happens, the child is presented feet foremost, with the
hands spreading out from the hips, the midwife must in such a case be
provided with the necessary ointments to rub and anoint the child with,
to help it coming forth, lest it should turn into the womb again,
holding both the infant's arms close to the hips at the same time, that
it may come out in this manner; but if it proves too big, the womb must
be well anointed. The woman should also take a sneezing powder, to make
her strain; the attendant may also stroke her stomach gently to make the
birth descend, and to keep it from returning.
It happens occasionally, that the child presenting itself with the feet
first, has its arms extended above its head; but the midwife must not
receive it so, but put it back into the womb, unless the passage be
extraordinarily wide, and then she must anoint both the child and the
womb, and it is not safe to draw it out, which must, therefore, be done
in this manner.--The woman must lie on her back with her head low and
her buttocks raised; and then the midwife must compress the stomach and
the womb with a gentle hand, and by that means put the child back,
taking care to turn the child's face towards the mother's back, raising
up its thighs and buttocks towards the navel, so that the birth may be
more natural.
If the child happens to come out with one foot, with the arm extended
along the side and the other foot turned backwards; then the woman must
be immediately put to bed and laid in the above-described position; when
the midwife must immediately put back the foot which appears so, and the
woman must rock herself from side to side, until she finds that the
child has turned, but she must not alter her position nor turn upon her
face. After this she may expect her pains and must have great assistance
and cordials so as to revive and support her spirits.
At other times it happens that the child lies across in the womb, and
falls upon its side; in this case the woman must not be urged in her
labour; therefore, the midwife when she finds it so, must use great
diligence to reduce it to its right form, or at least to such a form in
the womb as may make the delivery possible and most easy by moving the
buttocks and guiding the head to the passage; and if she be successful
in this, let the woman rock herself to and fro, and wait with patience
till it alters its way of lying.
Sometimes the child hastens simply by expanding its legs and arms; in
which, as in the former case, the woman must rock herself, but not with
violence, until she finds those parts fall to their proper station; or
it may be done by a gentle compression of the womb; but if neither of
them avail, the midwife must close the legs of the infant with her hand,
and if she can get there, do the like by the arms, and so draw it forth;
but if it can be reduced of itself to the posture of a proper birth it
is better.
If the infant comes forward, both knees forward, and the hands hanging
down upon the thighs, then the midwife must put both knees upward, till
the feet appear; taking hold of which with her left hand let her keep
her right hand on the side of the child, and in that posture endeavour
to bring it forth. But if she cannot do this, then also the woman must
rock herself until the child is in a more convenient posture for
delivery.
Sometimes it happens that the child presses forward with one arm
extended on its thighs, and the other raised over its head, and the feet
stretched out at length in the womb. In such case, the midwife must not
attempt to receive the child in that posture, but must lay the woman on
the bed in the manner aforesaid, making a soft and gentle compression on
her belly, oblige the child to retire; which if it does not, then must
the midwife thrust it back by the shoulder, and bring the arm that was
stretched above the head to its right station; for there is most danger
in these extremities; and, therefore, the midwife must anoint her hands
and the womb of the woman with sweet butter, or a proper pomatum, and
thrust her hand as near as she can to the arm of the infant, and bring
it to the side. But if this cannot be done, let the woman be laid on the
bed to rest a while; in which time, perhaps, the child may be reduced to
a better posture; which the midwife finding, she must draw tenderly the
arms close to the hips and so receive it.
If an infant come with its buttocks foremost, and almost double, then
the midwife must anoint her hand and thrust it up, and gently heaving up
the buttocks and back, strive to turn the head to the passage, but not
too hastily, lest the infant's retiring should shape it worse: and
therefore, if it cannot be turned with the hand, the woman must rock
herself on the bed, taking such comfortable things as may support her
spirits, till she perceives the child to turn.
If the child's neck be bowed, and it comes forward with its shoulders,
as it sometimes doth, with the hands and feet stretched upwards, the
midwife must gently move the shoulders, that she may direct the head to
the passage; and the better to effect it, the woman must rock herself as
aforesaid.
These and other like methods are to be observed in case a woman hath
twins, or three children at a birth, which sometimes happens: for as
the single birth hath but one natural and many unnatural forms, even so
it may be in a double and treble birth.
Wherefore, in all such cases the midwife must take care to receive the
first which is nearest the passage; but not letting the other go, lest
by retiring it should change the form; and when one is born, she must be
speedy in bringing forth the other. And this birth, if it be in the
natural way, is more easy, because the children are commonly less than
those of single birth, and so require a less passage. But if this birth
come unnaturally, it is far more dangerous than the other.
In the birth of twins, let the midwife be very careful that the
secundine be naturally brought forth, lest the womb, being delivered of
its burden, fall, and so the secundine continue longer there than is
consistent with the woman's safety.
But if one of the twins happens to come with the head, and the other
with the feet foremost, then let the midwife deliver the natural birth
first; and if she cannot turn the other, draw it out in the posture in
which it presses forward; but if that with its feet downward be
foremost, she may deliver that first, turning the other aside. But in
this case the midwife must carefully see that it be not a monstrous
birth, instead of twins, a body with two heads, or two bodies joined
together, which she may soon know if both the heads come foremost, by
putting up her hand between them as high as she can; and then, if she
finds they are twins she may gently put one of them aside to make way
for the other, taking the first which is most advanced, leaving the
other so that it do not change its position. And for the safety of the
other child, as soon as it comes forth out of the womb, the midwife must
tie the navel-string, as has before been directed, and also bind, with a
large, long fillet, that part of the navel which is fastened to the
secundine, the more readily to find it.
The second infant being born, let the midwife carefully examine whether
there be not two secundines, for sometimes it falls out, that by the
shortness of the ligaments it retires back to the prejudice of the
woman. Wherefore, lest the womb should close, it is most expedient to
hasten them forth with all convenient speed.
If two infants are joined together by the body, as sometimes it
monstrously falls out, then, though the head should come foremost, yet
it is proper, if possible, to turn them and draw them forth by the feet,
observing, when they come to the hips, to draw them out as soon as may
be. And here great care ought to be used in anointing and widening the
passage. But these sort of births rarely happening, I need to say the
less of them, and, therefore, shall show how women should be ordered
after delivery.
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