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

Of the EXTRACTION of the head of the Fœtus, severed from the Body, and which shall have remained in the Uterus.

I agree with our modern writers, that there can hardly exist a more vexatious accident, than that of the head’s remaining in the uterus, after the extraction of the body. There are many causes of this effect. The death of the child for some time past, so that the waters may have had time to relax, to macerate the fibres, and thereby to render them incapable of resisting any efforts; there will result from thence a great difficulty of procuring the total issue of the dead fœtus, without dismembering it.

Some mis-conformation of parts in the mother may also contribute to it, or the obliquity of the uterus, where the child is brought away by the feet.

Independently of all these causes, this accident is almost always the effect of unskilfulness; it is, in truth, so rare, that it will scarce ever happen, where the delivery is conducted by an accurate and able practitioner of the art. If we have some examples, that even under skilful hands this case has come into existence, a thorough examination of it would shew, that it was only owing to the cruel necessity the practitioner may have been under, of being aided by persons not duly qualified to afford the least effectual help, or to conceive what they were directed to do.

But, however that may be, the damage is not absolutely without remedy. The great point is, without loss of time, to introduce the hand into the uterus, which does not proceed in its contraction, but gradually and leisurely enough, to give leave for the needful evacuation. It is true, that this operation requires a very nice skilful hand; with which, where it is found, surely no instrument, nor other invention, can come into competition.

This accident has appeared to occasion such severe labors, that many practitioners, and Peu, among others, (page 308) have advised abandoning the expulsion to Nature, rather than to fatigue the patient by fruitless and torturous attempts, to the success of which such obstacles presented themselves, as they looked upon to be unsurmountable.

Mauriceau (Aphor. 240) is of the same opinion, which he thus expresses. “When the head of the fœtus shall have remained in the uterus, which is no longer open enough to give it passage forth, it is better to commit the expulsion to Nature, than to attempt the extraction with too much violence.”

These practitioners ground their opinion on that Nature, always wise and intent on self-preservation, taking more care to expel a superfluity, than even to attract the needful, often discharges herself, and that without violence, if she is but ever so little assisted, of all extraneous bodies, or other things retained in us against her intention.

Messieurs de la Motte, Peu, and Viardel adduce examples of Nature’s doing spontaneously, what some of our later moderns are for absolutely doing themselves by means of those curious instruments, in which they make such a parade of the rare inventiveness of their genius, particularly in the extraction of a head remaining detached in the uterus, on its contracting some hours after the unskilful operation of some deficient practitioners. In such cases, I say, those gentlemen furnish instances of Nature’s expelling the superfluous and extraneous incumbrance, with only the help of some glysters, and other remedies administered to the patient.

Now though no one can be more intimately convinced than I am, that Nature, acting for ever upon surer principles than Art, possesses resources which she often displays in the most desperate exigencies; I own, that in this case I am not for totally relying upon her beneficence[^[32]]. Here is a wrong to redress, not owing to her, but to deficient practice; and this wrong can hardly be repaired by her alone, unless something of a better practice contributes to relieve her. That practice is not, however, the less recommendable for being plain and obvious. The most gentle, the most guarded, but withal the most efficacious means must be tried, little by little, to insinuate the fingers and hand into the uterus, how closely contracted soever it may be; for yield it will; and then seize the head by the mouth, the occipital cavity, or whatever other part affords the least slippery hold, without waiting whole hours, as do certain ignorant or negligent practitioners with respect to the after-birth, who give time to the uterus to enter into too strong contraction.