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

Mauriceau explains this case tolerably justly, where he treats of the footling-extraction.

“Care (says he) should be taken that the child should have its face and belly directly downwards; to prevent, on their being turned upwards, the head of it being, towards the chin, stopped by the os pubis. If therefore it should not be so turned, it must be put into that posture. This will easily be done if, as soon as you begin drawing the child out by the feet, you incline and turn it little by little, in proportion as your extraction of it proceeds, till its heels bear in a direct line with the belly of the mother,”

[Here I must beg leave to interrupt Mr. Mauriceau, to observe, that it is not enough to have hold of the child’s feet to begin turning it: but the breech must have come out: then, if it is not well turned, by placing one hand on the belly, and the other on the breech of the child, there will be time enough easily to turn it immediately and naturally, neither with too much precipitation, nor yet too leisurely, not little by little, or by slow degrees. This last precaution being of no use but to flag an operation, in which a delay may be fatal to the child, without any service to the mother, it only keeping her the longer in pain.]

“There are (he goes on) however children with so large a head, that it remains stopped in the passage after the body is intirely got out, notwithstanding all the precautions that can be used to avoid it. In this case, you must not stand amusing yourself with so much as attempting to bring the child away by the shoulders, for sometimes you will sooner part the body from the neck, than get the child out by this means. But while some other person shall pull it by the two feet or beneath the knees,” [here Monsieur Mauriceau is much out: great care should be taken not to have it pulled by any one, but purely to give the body of the child to be supported by some discret person, while the delivery proceeds as the author goes on to describe] “the operator will disingage little by little the head from between the bones of the passage, which he may do by sliding softly one or two fingers of his left hand into the mouth of the child, to disingage the chin in the first place, and with his right hand, he will embrace the back of the child’s neck, above the shoulders, to draw it afterwards, with the help of one of the fingers of his left hand, employed, as I have just observed, in disingaging the chin. For it is this part which the most contributes to detain the head in the passage, whence it cannot be drawn out before the chin shall have been intirely disingaged. Observe also, that this is to be done with all possible dispatch for fear the child should be suffocated, as would indubitably happen, were he to remain any time thus held and stopped: because the umbilical chord, which will have come out, being turned cold, and strongly compressed by the body or by the head of the child, remaining too long in the passage, the child cannot then be kept alive by means of the mother’s blood, whose motion is stopped in that chord, as well by its cooling which coagulates it, as by the compression which hinders it from circulating, for want of which it is a necessity for the child to breathe, which he cannot do till his head shall be intirely out of the uterus: therefore when once you have begun the extraction of the child, you must try to procure the total issue of it as quick as possible.”

Monsieur Levret, who has wrote for no end on earth but to recommend his tire-tête, seizes the occasion of the foregoing passage extracted from Mauriceau to tell us, page 51, of the first part of his work.

“Mauriceau acknowledges here, that there are children who have the head so large, as for it to remain stopped in the passage, after the body shall have been wholly got out, notwithstanding all the precautions that can be taken to avoid it.”

From whence this zealous instrumentarian draws the following conclusion. “Here (says he) is one of those cases, in which my instrument may be of great service.”

This conclusion however does not to me at all appear a just one.

First, because Mauriceau, after those lines of his, just above quoted by Levret, adds immediately the method of practice pursuable in this case, to give a good account of it without the help of instruments.

Secondly, because we are not at all to be concluded by what any author says, any farther than the truth of things bears him out. Mauriceau[^[35]] might have explained himself better: he might have said, that, in this case, the child should be pushed back a little into the uterus, to have the freer play for its being more easily disingaged: he might have advised, as I have before observed, rather a safer method of proceeding than what he has done. Mr. Levret himself allows this p. 56. Then, still with a view to recommend his forceps, his tire-tête, as being absolutely necessary, he continues thus (p. 58.)