It should also be observed, that it is wrong for the midwife to leave a woman newly lain-in, however happily delivered. It is necessary to stay by her for some hours afterwards, till she is in such a state of tranquility and ease, as may leave nothing to fear of those after-disasters which too often happen.
Some celebrated practitioners and authors upon midwifery have been surprized to see women, after their going their time without mis-adventure, and after having been readily and happily brought to bed die suddenly. There are too many of both the female and the men-midwives who have no notion of this misfortune till it is too late to prevent it. The cause of this melancholic accident is unknown to many practitioners of the art. Some have confessed their ignorance of it: others have erroneously, others deficiently accounted for it. But all are surprized when the patient is the victim of it: especially as it follows, in some cases that afford the best grounded hopes.
Messieurs Mauriceau and De la Motte give us examples of these unexpected deaths. The first, in his 230th observation, says,
“I delivered a woman of a very corpulent habit, aged about thirty-five years, of her first child, which was a lusty girl, alive, and that came naturally. This woman had been near two days in labor, with small slow pains or throws, after which the waters having burst forth with a strong throw, she had subsequently favorable ones, which made her bring forth as happily as one could wish. I immediately delivered her: but to my great surprize, scarce had she been a quarter of an hour after delivery, that she of a sudden fell into violent faintings, with an oppression at the breast, and a great agitation of the whole body, which was instantly followed by a convulsion, caused by a loss of blood, of which she died a quarter of an hour afterwards.
“This (adds Mr. Mauriceau) was one of those kind of fatalities which no human prudence can elude or parry.”
La Motte had the same case happened under his hands, which I need not repeat here, being inserted in the first part of this work, where, p. 131, I ventured to promise an essay of mine, to give a less unsatisfactory reason of such deaths, than what is to be found even in those two celebrated authors whom our cotemporaries consider as their masters in the art of midwifery. These impute those unforeseen deaths to occult and inevitable causes. I own, I do not intirely think them either occult or inevitable. I doubtless may be mistaken, but of this I am sure, I shall advance nothing but what is authenticated to me by my own observation and experience.
An over-repletion of blood, and a defect in the contraction of the uterus, of which all the vessel being open are too slow in recovering their occlusion, are generally speaking, the causes of these diseases. I could support this opinion by some chirurgical axioms, but I presume it will be thought more satisfactorily proved by the success of the method of practice, which I would recommend to prevent or cure those dangerous or rather fatal causes.
As to know that a woman may thus perish unexpectedly a quarter of an hour after delivery, is enough to require the being on one’s guard for using a salutary prevention; I would advise attention, especially to her constitution.
Whenever therefore a pregnant woman is observed to be remarkably corpulent, and full of blood, with a good constitution, she should be advised to lose some blood, once or twice during her pregnancy, by way of precaution. This is of great service to rarefy the blood, and obviate those excessive hemorrhages, which are to be dreaded on their lying-in. Then nothing is to be precipitated during their labors, that Nature may have full time to predispose the uterus to enter into contraction by due degrees, that is to say, neither too quick, not too slow. But if, notwithstanding these precautions, there should, after delivery, supervene any considerable loss of blood, followed with faintings or oppressions, the patient must be stirred, excited to cough and sneeze contributively to the evacuation of the blood, which otherwise is apt to clot in the uterus, and would suffocate her if not expelled.
If by this mean the evacuation does not naturally take place, which may be perceived by the faintings of the patient, the midwife must, without losing time, put her hand into the bowel, and extract all the clots of blood she will not fail of finding there, and of which the presence, as being extraneous matter, necessarily oppose the contraction of this organ, and quickly suffocates the woman, if she is not timely relieved.