Yet nothing is more true, nor indeed more likely to be true, than that besides the natural pains of labor not having been obviated by a due preventive method of assuagement; besides their having been unskilfully attended to in the article of the delivery, through the natural unhandiness of the men-midwives, it does not unrarely happen, that their defective practice, not only occasions to the women much greater pains, but even much greater danger than would probably have been the case, I will not say if a midwife, but even if Nature had barely been left to herself, that is to say, if nature had been neither injured by a clumsy aukward attempt to help her, nor injudiciously interrupted, nor prematurely forced or cruelly hurried. The patient is however delivered, and delivered so that, if she was better informed, or less blinded with joy, instead if thanking the operator, to whom she attributes her deliverance, she would have to impute to him all the increase of pain she had unnecessarily suffered, all the increase of danger of which this man so thanked was himself the author. Then it is, that even in a subject so serious, a judicious by-stander might give himself the comedy of observing the airs of consequence, which an operator assumes for a woman under his case not losing the life, of which but for him she would most probably not have been in the least danger. Thus a man, whose all of merit well weighed, is no more than not having been able to consummate the destruction of mother and child, in spite of the kindness of nature, shall for that negative merit be allowed the positive one of having performed wonders of art. Then it is that the mother naturally in a rapture of joy at her deliverance, in which she never remembers but with a gratitude, of which she only mistakes the object, by paying to the operator, what in fact was due to nature; then it is, I say, that the mother, father or parties concerned, for want of making due allowances in a point they are so excusable for not understanding, cordially join the self-applause of the man-midwife. Nor does it unfrequently happen, that one of these instrumentarians, after an operation, for which he deserves the severest censure, and of which, whatever necessity he had to plead was originally owing to his own unskilfulness or omission, shall strut about the room, and florishing his butcher’s steel, sing an Io Peean to himself, “for that his victorious art had saved nature as it were by enchantment”[[11]]. Then it is, that in full chorus the deluded parties, in the innocence of their heads and hearts, hold up their hands to heaven, and piously exclaim, “what a narrow escape the patient had, thanks to the learned Dr. and what a mercy it was she had not been trusted to such an ignorant creature as a midwife must be.”
This folly has even sometimes gone so far, that when a woman has, through a man-midwife’s mispractice, suffered perhaps a wrong, so deep as to be disqualified for ever after for being a mother, or had a fine child, literally speaking, murdered (secundum artem indeed) he has, what with scientific jargon, through the cloud of which it was impossible for persons unversed in the matter to discern the truth, what with an air of importance, and what with especially her own weak prepossession in favor of the superiority of men to women-practitioners, known how to impose on her the most atrocious injury for so great a service as that of saving life is for ever held. The deceived patient then thinks she cannot thank him too much, nor reward him sufficiently for what he could be scarce punished enough, if proportionably to the mischief he had done; and to which his mis-representations have perhaps even made herself innocently an accomplice.
This indeed is easily to be accounted for. A pregnant woman must especially, in the moment of her labor-pains, think herself too much in the power of the operator, to whom she has trusted herself, to dispute his judgment. She may even, and that is probably oftenest the case, have too good an opinion of it, to dispute it. Her labor is severe, and, as before observed, severe, or at least the more so, very likely from some fault of his. Her deliverance lingers; Nature, from some vice of conformation, or defect of art in her assistent, appears faint, remiss, insufficient, in short, in her expulsive efforts; in the mean time, the pains of the patient grow more and more intense and intolerable: the man-midwife, either perplexed or impatient, or not knowing what better to do, has recourse to those fatal instruments, with which the odds are so great, that he will gall, bruise, or irreparably wound the child, or the mother[[12]]. In some cases indeed, he may take the dreadful advantage of the mother’s agonies of pain, to use those instruments, and do her a mischief she may not just then feel, from the pain of the operation being absorbed in the greater one; to use them, I say, unobserved by her[[13]].
But where the exigency appears yet greater, where, in short, the operator imagines, as he too often imagines such an extremity where it does not exist, as that either the mother or the child must perish, it is his maxim, and certainly a very just one, to consider the mother’s safety, as the preferable object. Of this preference then he makes a merit, so much the more acceptable to the mother for her own self-preservation being so palpably concerned, and so much the less disputable for her not knowing but he may be in the right, as to the reality of the fatal dilemma. In such a doubt, if nature takes the part of the child’s life, which is at stake in the decision, she also much more strongly and reasonably takes the part of the mother’s own existence in the mother’s own breast. She cannot then deny the premisses, of which she is no judge, when the inference is not only in favor of her life, but even a very just one upon the admission of those premisses. The temptation also of a quick riddance from a violent state of pain, is too great a temptation for a weak woman, overpowered with her actual feelings in that rack of nature, to resist: she acquiesces then, or perhaps her husband, her friends, equally ignorant with herself of the truth of things, and duly simpathizing with her in her impatience of her longer suffering, even virtuously, even piously acquiesce in the recourse to these instruments, which are so sure of destroying the child, and hardly ever fail of doing the mother great and sometimes irreparable mischief.
When then the child has been destroyed, the mother damaged; in satisfaction for all this tragic-work, what have you but perhaps the learned Doctor’s assertion, “[[14]]that if this force had not been used, the mother must have been lost as well as the child.”
Now granting what is the utmost that candor can be expected to grant, that in but the doubt of the mother’s life, it is right to sacrifice the life of the child to that doubt, and much more to the certainty of the mother’s life not to be otherwise saved, than by these fatal instruments, I beg and entreat all fathers and mothers, or who are likely to be so, to consider with themselves whether:
In the first place, an experienced midwife is not more likely to prevent such an extremity by previous management, proper anticipations, and actual handiness during the labor-pains, than the aukward man-practitioner (as most of them evidently are) who must, naturally speaking, be so much her inferior in those points of her art, which conduce essentially to the smoothing the way for, and effectuating a delivery; and from the defect of which points that necessity which, is pleaded of a recourse to instruments, originally takes its rise. So that in fact they who are the authors of the danger, pretend to remove it, and how? by an evil only inferior to death itself, from which however those are not always safe, to whose safety so much is sacrificed in vain.
In the next place, it may well be recommended to consideration, whether, as the common methods[[15]] confessedly allowed by the men-midwives to be the preferable ones, since the recourse to instruments is not even by them allowed, until the common methods are exhausted, there is not great reason, without breach of charity, to imagine that the natural unfitness of the men for the common methods does not determine especially the common men-midwives to an over-hasty recourse to the extraordinary ones, and make them see very dangerous symptoms, where they are no better than phantoms of their own creation; so that by their eagerness to embrace them for an excuse, they lose to the patient that benefit of patience in general, which Dr. Smellie himself allows in a particular case[[16]]. To which patience the midwives are so much more inclined than the men, as indeed they may well be, since, should that even be exhausted, they have no instruments to fly to for the abridgment of a labor: and where they understand their business, not only every thing is best done without them, but the want of them is prevented.
But besides the common motive of impatience in the men-practitioners for resorting to that dangerous expedient of making short work, of which the women are unhappily incapable[[17]], or at least which the good artists among them hold in the contempt and detestation it deserves; are there no other motives from which recourse may be had to the instruments? I have hinted at some: but as the matter is of infinite importance, from the use made of these instruments, in introducing men into the practice of an art so appropriated to the women, it cannot but be of service even to the public, to discuss the justice at least of some of those hints, and examine whether there is any farther foundation for my fears, that the precipitancy of the men in their resorting to instruments, or to the prematurely forcing a delivery, to the utmost danger if both mother and child, whether, in short, the pretence of extremities may not, in some cases, have even other causes, than a natural incapacity for the common method, an ignorance of better practice, or their impatience.
I have before remarked what I here repeat, and repeat it without the least apprehension of being justly taxed with breach of charity, that a mere sordid view of lucre, of supplementing, in short, deficiencies of success in other professions, was originally the foundation in this country of that novel sect of men-midwives, which we have in our days seen so much multiplied. If any can imagine that the instrumentarians, with their crotchets, their forceps, and the rest of their iron or steel apparatus, had more in view the relief of the distressed females, from the dangers to them in the ignorance of the midwives, than they had their own interest, in the stepping into the place of those they so injuriously decried; if any, I say, can believe that sheer humanity, and not sordid gain, was their view, I can only pity a credulity, that must proceed more from a goodness of the heart, than of the head. But to whoever will deign to consult his own reason, exercised upon facts and the nature of things, may easily satisfy himself, that interest, and interest only, inspired and actuated these intruders into a province so little made for them, of which there can hardly be a stronger presumption than the very recommendation of instruments, of which not one of them but must know the perniciousness, though they make it the capital handle of the introduction of themselves. Not one of them but rails at them, and uses them. Now, as I may safely take it for granted, that interest is at the bottom of this innovation, where that same interest is the principle, it will hardly be denied me, that it is generally speaking the leading or the governing one. It is rarely contented with acting a second part. It often exacts sacrifices, but is rarely itself one. All the actions and procedure of its votaries take the tincture of it. Humanity and all the virtuous or tender passions are either totally excluded, or exist with little or no efficacy in a heart enslaved by interest.