"O shame! where is thy blush?"
It now becomes our most painful but necessary task to explain what that
"process" is to which we have alluded, by giving some extracts from one of
the principal works on midwifery, and in the very words of the treatise,
to prove the gross outrages to which women are obliged to submit when
"attended" by these male practitioners. Nothing but a sense of the
enormity of this monster evil would induce us to contaminate our pages by
the introduction of such garbage; but we are well aware that "general
observations make little impression on the mind even of the most
reflecting reader, if not attended with a detail of facts which proves
that it is well founded; and one authentic example will produce a stronger
conviction than whole chapters of assertion."
EXTRACTS FROM DR. RAMSBOTHAM'S OBSTETRIC MEDICINE AND SURGERY.
"_Duties of the Medical Attendant under Natural Labour._
"From the knowledge which the foregoing pages will afford of the
beneficence displayed by nature throughout the processes of
utero-gestation and labour, and of the admirable contrivances adopted by
her to overcome difficulties and avert dangers, it will be evident that,
in a very large proportion of cases, the duties of the obstetrician must
be few and simple. Generally, indeed, no _active_ assistance is necessary,
until after the birth of the child; all that is required of the attendant
being, that he should remain an observant, though unofficious spectator of
the process, ready to exert himself with promptitude and energy on the
first accession of any alarming symptoms, but equally or more ready to
allow the changes necessary for the completion of nature's object to
proceed, uninterrupted by any meddlesome interference; for no maxim in
obstetric science is of more universal application than that unnecessary
'assistance,' rendered with a view of expediting the termination of the
case, or shortening the sufferings of the patient, is not only useless,
but in the highest degree injurious, and directly calculated to defeat its
own end.
"Let it not be supposed this declaration includes the admission, that a
partial acquaintance with the obstetric branch of medicine is sufficient
for the safe practice of the profession; for although, in thirty-nine
cases out of forty, little is required to be done beyond protecting the
extended structures from injury, separating the child, and extracting the
placenta from the vagina after its total exclusion from the uterine
cavity; still, in the fortieth danger may occur, only to be arrested by
the promptest, the most decisive, and most judiciously directed help.
"Much knowledge[20] is necessary to discriminate the kind of cases in
which assistance is proper, and determine the time at which that
assistance ought to be employed, as well as the mode of its application.
It is this which distinguishes the scientific from the ignorant
obstetrician; it is this important knowledge on which the life, the future
health and comfort of many a parturient woman must depend; which,
nevertheless, has been held in such low estimation by some members of the
profession, as to be thought unworthy of cultivation by the scientific and
literary mind; unfit to be possessed by men of respectable station in
society; and the adaptation of which knowledge to practice has been
characterized, in an official document under the seal of the highest of
our medical corporate associations, as 'an art foreign to the habits of
gentlemen of enlarged academical education.'[21] In the same communication
it is asserted, 'that the most successful practice of midwifery requires
no such laborious preliminary study as is necessary for the practice of
medicine, else discreet matrons, and plain uneducated men in the country,
who frequently arrive at great notoriety in this calling, would not
acquire that credit which they often attain.'... nor, perhaps, are we
generally expected to regulate the number of individuals to be present,
though we may be called upon occasionally to exercise our authority in
this respect. The only persons whom I would willingly admit are the nurse
and some female married friend, the mother, or other near relation, or an
intimate acquaintance, to act as _confidante_ to the sufferer, into whose
sympathizing ear she may whisper all her apprehensions and distresses, and
from whom she may receive those numberless comforts and sustaining
consolations of which she stands so eminently in need. Unmarried females
are neither the most fit companions for the patient, nor the most useful
assistants to the practitioner.[22]
"On being ushered into her chamber, we may engage her in some general
conversation, which will give us an opportunity of observing the
frequency, duration, strength, and character of the pains; and our conduct
must be framed according. Should they be of trifling importance, we may
content ourselves with giving some ordinary directions and retire from the
apartment. But if they are returning with frequency and activity, we must
not allow much time to elapse before we require to make an examination PER
VAGINAM.[23] An objection may be raised by the patient to the necessary
examination being then instituted, under the idea that _no assistance_ can
be rendered her so early in the labour. As I would regard the feelings of
a parturient woman in a degree only secondary to her safety, I would by no
means insist on putting her to this inconvenience, unless I thought it
quite indispensable. But as much valuable information may be gained by
this first examination, and as it is highly desirable to obtain that
information during the progress of the first stage, it is right firmly,
but gently, to urge its propriety. It is seldom, indeed, that she will not
accede to the recommendation of her medical attendant, provided he
possesses her confidence, and conveys his request with becoming
delicacy.[24]
"Much knowledge must be acquired during the first vaginal examination. It
is, first, whether the woman be pregnant;[25] secondly, if she be in
labour; thirdly, whether the membranes have ruptured, or are still entire;
fourthly, how the child is presenting; fifthly, how far the labour is
advanced; and, sixthly, the state of the os uteri, vagina, and perineum,
in regard to their distensibility.... She should be also covered by a
light counterpane, or a blanket and a sheet. In this position (lying on
her left side, with the nates brought to the edge of the bed) _the vaginal
examination_ is to be conducted in the following manner:--The attendant,
sitting rather behind her, and having anointed the two first fingers of
his _right_ hand, with some unctuous substance, mostly in readiness, is to
place them on the labia externa; then gently separating these organs, he
must introduce the first finger into the vagina,[26] in the direction of
its entrance, which is backwards and upwards: or he may take the perineum
as his guide, and insinuate his finger within the genital fissure
posteriorly, close to the fourchette. Having introduced it as high as he
conveniently can, he must pronate his wrist, so that the junction of the
first and second finger shall fit in under the symphysis pubis. In this
way he will be able usually to reach the os uteri without difficulty.
Should that organ, however, be situated so high that he cannot perfectly
command it, rather than remain in ignorance of its condition, and of the
presentation of the child, he may introduce the first two fingers of his
left hand, and as these may be passed higher within the pelvis, they will
give a greater facility for inquiry.
"These examinations are commonly made during the urgency of pain; and this
has given rise to the phrase of 'trying a pain.' It is, however,
desirable, on many accounts, that we should not introduce our finger up to
the os uteri at the time when the uterus is acting strongly, because then
the membranes are protruded into the vagina, and if we press against them
at that moment, we may, probably, rupture the cyst, and lose its influence
in the after progress of the labour. Besides, it is impossible, under such
protrusion, to ascertain the presenting part of the foetus with
precision, because of the quantity of water which is then interposed
between our finger and its person.
"Nevertheless, as it is expected that we should examine while the uterus
is in action--and, indeed, as in many cases the patient would not allow us
to pass our finger at all, were it not for the belief that we can 'assist'
her--and that only in the time of pain, it is necessary that we should
request her to inform us when there is a return, and take that opportunity
of introducing our finger within the external parts. Having gained this
advantage, we must allow it to remain inactive in the vagina while the
pain continues; and upon its cessation, which we have seldom any
difficulty in ascertaining, we may direct it up to the os uteri.
"_Frequent examinations should not be made during the first stage of
labour._
"We can do no good by such a practice after we have once gained the
information we require. We cannot facilitate the descent of the child; we
cannot dilate the parts; but we may do a great deal of injury, for we
denude the vagina of that soft relaxing mucus which is designed by nature
to protect it; and we, moreover, run the risk of destroying the integrity
of the membranous cyst. We may, therefore, predispose the parts to
inflammation, and retard the dilatation of the os uteri itself. As,
however, it is a common idea among women that, under each examination,
material assistance is rendered,[27] we shall frequently be urged, during
the first stage, especially if the labour be rather slower than usual, to
remain in close attendance on the patient's person; and these
solicitations are generally advanced with a degree of fervency, that it
appears the extreme of cruelty not to accede to.
"Should this be the case, the finger may be introduced from time to time,
with the greatest care and gentleness; more to pacify the patient's mind,
and assure her she is not neglected, than with any other view beyond that,
and also watching the progress of dilatation. The more rigid the parts
are, the more do they require the softening influence of the natural
secretion, and the more careful must we be to preserve it.... In about an
hour ... we may see her again, and we may then, if we think it right, make
another examination, to ascertain that the labour is proceeding
satisfactorily.
_Duties during the Second Stage._
"The second stage of labour having commenced, we are summoned to the
patient's room, if we have been absent, and told that 'the waters have
broken.' She is most likely found reclining on the bed, and, probably, the
pains are more urgent than they were before; or, perhaps, they are
somewhat suspended. We now require to make another examination, because it
is possible that the head may have fully entered the cavity, and may be
soon expelled. Finding it low in the pelvis, finding the os uteri almost
entirely dilated, the membranes broken, and the pains strong and coming
on frequently, it is right not to leave the room; but unless the perineum
is somewhat on the stretch, we need not yet take our post exactly by the
bed-side. But as soon as the head has come to press upon the external
parts--particularly when it has made its turn, and is beginning to extend
the structures at the outlet of the pelvis, it becomes our duty to take
our seat by the bed-side, and never to move from our position till the
child has passed. This we do to protect the perineum, in order to prevent
laceration.[28]
"_For the purpose of supporting the perineum_ we sit rather behind the
patient, and apply the palm of the left hand--guarded, for the sake of
delicacy, cleanliness, and convenience, with a soft napkin--steadily and
firmly against the perineal tumour. I have already mentioned that the
thighs must be drawn up towards the abdomen, and the legs bent a little
back upon the thighs, and the whole person lying on the left side; and the
patient is usually placed so that her feet may rest against the
bed-post.[29]
"We render the shoulders also another fixed point, so as to steady the
upper part of the body, by tying a long napkin, or a round towel, to the
same bed-post, and desiring her to hold it in her hand. We tell her, when
the pain comes on to press with her feet against the bed-post, and pull
gently at the towel, cautioning her against straining violently. The
consequence is she so fixes her person as to render it almost impossible
for her to jump away suddenly, or to recede to any distance from us.
Independently of this little manoeuvring, when the head is in any
degree extending the vulva the nurse must be required to raise the right
knee to some distance from the other, by which means the thighs are
separated, and an increased facility given to the exit of the head through
the external parts, as well as some control exerted over the patient's
movements.... After having examined the uterus through the parietes of the
abdomen, we must make an internal examination, more perfectly to assure
ourselves in what way the placenta is disposed of. Twisting the funis
umbilicalis around the first two fingers of the left hand, and bringing it
to its bearing, we pass the first finger of the right hand, previously
anointed, into the vagina, as in a common examination. If the placenta be
entirely _in utero_, which, as just remarked, is most commonly the case
immediately after the child's expulsion, we shall either not be able to
touch it at all, or if it be within reach, we shall only detect a very
small portion of it; we may just feel it offering itself at the os uteri;
but we cannot surround its volume, nor can we probably discover the
insertion of the funis.
"_Removal of the Placenta._--There is no part of natural labour which
requires so much judgment as the conduct of the third stage; for the
slightest mismanagement of the placenta may be productive of most serious
mischief, by converting a perfectly natural into a most dangerous and
complicated case. As long, then, as the placenta remains _in utero_, so
long we must wait, within a certain limit--provided there be no
flooding--for those contractions which are to expel it from the uterus
into the vaginal cavity, &c.; while we are thus watching, we shall most
likely be informed of the return of uterine action, by the woman
complaining of two or three comparatively trifling pains affecting the
back and loins. As it is probable that under these pains the placenta may
have somewhat descended, another examination may then be made _per
vaginam_ to satisfy ourselves on this point, &c.
"The removal of the placenta from the vagina is easily effected. Twisting
the funis umbilicalis two or three times around the first and second
finger of the right hand, we draw it down in a line tending towards the
coccyx, and receive it in the left, placed under the perineum; or we may
introduce the two first fingers and the thumb of the left into the vagina,
embrace the mass between them, squeeze it as we would a sponge, and slowly
extract it....
"Having perfectly satisfied ourselves on this point, we may a second time
take away the napkins soiled with the accumulated discharges, and envelope
the lower part of the patient's person in others that are warm and dry.
Three will be sufficient: one must be partially slid under the left hip;
another may be placed over and around the right hip; and the third carried
between the thighs, directly on the vulva, &c....
"Some practitioners adapt the bandage themselves, and apply it immediately
after the placenta has been removed. I think it preferable, in common
cases, to leave this duty to the nurse; and that it should not be put on
until the body linen of the patient is shifted; because, in the first
place, it appears to me more desirable that perfect quietness should be
preserved until the first changes in the uterus consequent upon labour are
effected, that no disturbance may interrupt their progress; and, in the
second, I cannot help thinking that there is something highly indelicate
in its being applied by a man--much more so, indeed, than any of the
duties we are ordinarily called upon to perform under natural labour. It
is of most service when next the skin. It must be sufficiently broad to
reach from the pubes almost to the ensiform cartilage; and it cannot be
properly adapted unless the abdomen be quite uncovered. In addition, I
would remark that the nurse must know very little of her duties, if she
cannot draw a properly contrived bandage round the person, and give it the
due degree of tightness without incurring danger."
The reader of the preceding extracts will have observed that they begin
with a panegyric on the extraordinary powers of nature in adapting means
to an end; which, nevertheless, the author forthwith proceeds to qualify,
as if he had admitted too much, in giving nature credit for the due
execution of her own work, and her capability for enforcing her own laws,
by enlarging on the profound and scientific knowledge required in the
man-midwife, the opinion expressed by the Royal College of Physicians to
the contrary notwithstanding; and in effect impiously detracting the
infinite power and wisdom of God, "who created man in his own image, in
the image of God created He him; male and female created He them. And God
blessed them, and God said unto them, be fruitful and multiply."
"And God saw everything that He had made, and behold, it was very good."
After descanting on the inutility, and even positively detrimental effects
of _active_ interference in natural labour, he warms with his subject,
and, in the course of the three stages by which he limits and defines the
operations of nature in introducing man into the world, enjoins, in
language horribly disgusting from its technical obscenity, an amount of
grossly indecent interference, only to be measured by the credulity and
endurance of his miserable patient. If the maxim of non-interference which
he inculcates holds good, he deceives and wrongs his patient to a most
shameful extent, by permitting and encouraging the delusion that by these
vaginal examinations he can render her "assistance," or mitigate the
sufferings which nature has ordained; and we assert, without fear of
contradiction, that the man who should dare to practise upon the weakness
of women in such a manner, and at a moment when they are least able to
resist his solicitations, deserves the severest condemnation. In all this
foul tissue of verbiage descriptive of the practice in natural labour
there is nothing which a _female_ attendant of the most ordinary
intelligence could not accomplish with the greatest ease, and yet the
nurse, who is generally a well instructed midwife, is scarcely mentioned
at all, and her duties appear to be confined to a trivial and unimportant
after-operation, which the conscientious and sensitive doctor deems an act
of far greater indelicacy than those eight times repeated _examinations
per vaginam_, and other contact with the patient's person, so sedulously
prescribed, and which, in truth, appear to constitute the whole "art," so
far as the treatment of natural labour is concerned. One more extract will
more than suffice to show the nature of this abuse, which we fear is, from
its daily increasing power and influence upon the female mind, becoming
more and more difficult of cure; but which, when considered in all its
hideous bearings, should arouse even the most callous and indifferent to a
sense of its criminality, and cause the hearts of all who reverence
modesty in woman to swell with righteous indignation at the insults which
a vile custom has mercilessly heaped upon the sex:--
"She now, at length, submitted to an examination _per vaginam_, which I
made from behind, as she stood erect by the bed. The finger failed at
first to reach the os and cervix uteri, until, on pressing upwards, as far
as possible, I found the uterus lying transversely, the os higher than the
body, pointing to the right side, and the body of the uterus lodged in the
left side of the pelvis, near the groin, where it seemed to be firmly
fixed. I now made her kneel on the bed, with the head low, so as to
elevate the nates, and cautiously tried through the rectum, as well as
_per vaginam_, to raise the uterus from its position into the median line,
but without success. An attempt on the following day was with no better
result.... After the interval of a month, I made another examination _per
vaginam_, also of the nipples, and found no change in either. After the
interval of another month I found the nipples and areolae precisely as at
first; but, to my great satisfaction, the uterus had nearly righted itself
in position, and the body of it was rounded and plainly enlarged. The
lady also hinted a suspicion that she had quickened."...
"In this instance my suspicion of pregnancy (which at first was very
slight) rested on the interruption of menstruation alone. The health
improved from the time of quickening, and the pregnancy went on. I may add
that I have no doubt the latero-version of the womb occurred at the period
of the miscarriage;... and that its righting itself, at length, was the
consequence of its increasing bulk."[30]
Such is the practice of man-midwifery! We observe that, in this revolting
case, the disgrace, the shame, the infamy of the poor patient was endured
in vain, and that after all the tentatives, and "manipulations," and
experiments, so perseveringly repeated by the accoucheur, without any
beneficial result whatsoever, nature alone was the true physician.
We will conclude this chapter of horrors in the strong and earnest
language of the late Sir Anthony Carlisle, with the conviction that his
burning words will go right home to the hearts of those who may not
hitherto have given a thought to this fearful violation of the rights of
nature.
"The woman who sacrifices her modesty to fashion, her person to
indignity, and her husband's honour to the sneers and contempt of her male
midwife, is below contempt. She is a disgrace to her sex!
"It is my firm opinion that the practice of man-midwifery compromises the
character and morality of our country. It is demoralizing to society, an
insult to virtuous women, and a foolscap to men. If not checked and
abolished, the pretensions to female modesty, and a respect for the
decorums of society, will eventually be altogether excluded from the
female character."