A Treatise on the Art of Midwifery / Setting Forth Various Abuses Therein, Especially as to the Practice With Instruments: the Whole Serving to Put All Rational Inquirers in a Fair Way of Very Safely Forming Their Own Judgement Upon the Question; Which It Is Best to Employ, in Cases of Pregnancy and Lying-in, a Man-midwife; Or, a Midwife

by Elizabeth Nihell

But after taking the liberty of dissenting from that celebrated man-midwife in cases of obliquity, as to the practical part, which I take indeed to be his own discovery, it is but just I should offer what I conceive to be the true midwife’s practice, for terminating happily the labor of a woman in the case of obliquity of the uterus: submitting the same to better judgment.

All the deflexions or byasses of the uterus, whatever they are, are to be known by the touch. An expert and knowing hand will never fail of ascertaining the discovery of them. I say, an expert and knowing hand, for without an exact knowledge of the figure of the whole pelvis, the situation of the bladder, of the rectum, the vagina, and the uterus, before and after pregnancy, the situation of the orifice with respect to the pelvis, there is no distinguishing for example, an over-elevated orifice from one too low, nor a direct from an oblique one. In vain would one conceive clearly what those terms signify, or have some knowledge of the distinctive parts of the female sex, without one has at the same time sufficient experience, and fineness of sense in the touching part. Without these qualifications there is no proceeding but darkling, and in danger of deception.

The orifice of the uterus is always diametrically opposite to the fundus of it. When then you know what the situation of the orifice of the uterus is, when in its due place, you may, if well versed in touching, calculate any aberration from the right line, and by the situation of the orifice giving that of the fundus, know how the rest is disposed.

When, by touching, I perceive, there is an obliquity of the uterus in the case, in the proper time, I desire the patient to lay on her back, and introducing my finger, endeavour to come at the orifice of the uterus. Upon getting hold of it, I support it so long as the labor-throw continues, and I take care the child should not engage itself too much.

I am obliged, with my hand, continually to repeat this service; and after resting a little from the fatigue, whenever I can snatch a moment safely for such relaxation, I re-introduce my finger, as before, in order to prevent the pains, and hinder the orifice from falling, that is to say, from sinking, so as to turn too much backwards, or from rising too high, or, in short, from deviating towards the right or the left, according to the circumstances or kinds of inclination that may present themselves. I also take great care, that the child may not engage itself too far under the os pubis. I do not discontinue these cares, these attentions, until, whatever assiduity, length of time, or trouble it may cost me, I shall have arrived at rectifying the wrong direction, by thus constantly supporting the internal orifice, till, in short, I have brought it, little by little, to turn and come directly on a line with the external orifice. By this management of the hand, I procure the child a fair opening, and its falling forward, without being wrapped up or embarrassed in the uterus.

And yet, in certain cases of obliquity I sometimes find so great an inversion of order, such an intanglement, that the child presents itself in the vagina with the body of the uterus covering it wholly, and by its volume totally impeding the coming at the orifice.

I have before observed, that I required my patients, in these cases, to lye upon their backs, and this, because, if they set up straight, the uterus would overset, and render the obstacle, if not invincible, at least, much more hard to remove.

However, both to ease my patients, and to prevent the child’s ingaging itself too far in the pelvis, I get them, according to the circumstances, to keep still lain down, but to turn sometimes to one side, sometimes to the other, without ceasing my attentions, without discontinuing to rectify the turn of the internal orifice from over the summit of the child’s head, and to uphold the said orifice, if it should tend to turn backwards, to depress it downward, by a gentle pressure, if it is inclined to rise towards the os pubis. This operation, this support, this depression, ought always to be managed with as much tenderness as skill, and there cannot be too much of both.

Certain it is, that the bad situation of the uterus often occasions a severe and difficult labor. A midwife therefore, from the very first of the labor-pains, cannot bestow too much attention to the giving such preventive or actual aid as I have proposed. Nothing, on these occasions, is more dangerous than delay. The pretious moments of operation must not be lost, least the child, coming to engage itself, should throw us into an embarrassment yet greater than the first.

In the beginning of the labor, it is no very great matter, to know exactly, what part the child presents to the orifice of an oblique uterus. It is enough to know, that it is not the head, in order to determine you, in due time, to the footling-extraction. What I mean is, that as soon as a good position shall have been procured to the orifice of the uterus; if it is any other part but the head that presents itself at that orifice, and that it is sufficiently dilated for the hand to get by gentle degrees introduced, dilated, in short, to about the diameter of a crown-piece, then, if the membranes do not break of themselves, the midwife should pierce them, and search for the feet of the child, to bring it away. But if the head it is that presents at the orifice, there is no need of any hurry: it is even better to wait till the membranes burst of themselves, unless they should be come out of the vagina, in which case they are to be opened, in order to terminate the delivery, not with scissors, but with the fingers alone.