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

With Mons. Levret’s leave (whom I ought to honor, since it is from him I have chiefly taken what he has said against all instruments but his own) I shall then say, that it is against the laws of candor, or of common sense, to seek, from the faults which may be committed in the manual practice, either through ignorance, inadvertence, or want of circumspection, to infer the necessity of instruments.

The point here under discussion turns intirely upon a child extracted by the feet. Now it is extremely rare, that in this case, the head does not follow the body. But if, in exception to this general rule, the head should be stopped in the passage, upon proceeding to disengage it, with all the proper measures and precautions which I have added to those above specified from Mauriceau, the sole aid of the hands will be full sufficient to accomplish the total delivery. But if they were to be ill managed, the risk would be evidently great of detaching the body from the head; and this would change the case from that of the head stuck in the passage, to the one of the head separated from the body, of which I have treated in the preceding section. Without then multiplying cases without necessity, as the reader will easily see, that the first is but the consequence of a mis-treatment of the last, so that, by the same rule, the right management of the last case is a sure prevention of the first, I shall only observe, that it might be shewn, that capable, well-conducted hands are sufficient to guard against both dangers, and shewn, even by Mons. Levret’s own confession, which he so inconsistently contradicts, in favor of his own instrument, without offering any thing like a reason for such a contradiction.

But if the damage in these cases resulting from an unskilful use of the hands should be urged against me: I answer, in the first place, that I am not arguing for any thing but what is to be effectuated by good practice: my point, is only to establish the superiority of skilful hands to the use of instruments: and in these cases, I aver, that even the damages done by the mispractice of defective hands, may be better repaired by sufficient ones, than by a recourse to instruments. How often too are instruments used by such men-operators, as are to the full as unfit to manage such instruments, bad as they are, as some women may be to use their hands! But if I could give no better reason for the rejection of instruments, than the abuse of them, even by the numbers of ignorant superficial men-practitioners that employ them, I should not expect to be heard; and yet the great argument against midwives is the ignorance of a few of them: though that ignorance of theirs could never produce such a multiplicity of horrors, of murders, injuries, tortures of mothers, such mutilations and massacres of children, as the deep learning of the instrumentarians!

My plea then is much more fair. The reader will be pleased to consider, and decide upon his own reflexions, whether, it is not at least probable, from what has been shewn in the cases of the obliquity of the uterus, of a head separate from the body of the fœtus, or even of that reputed most dangerous extremity, the head being hitched in the passage, when the whole body shall have come out, that every thing may be at least as hopefully attempted with the hands alone, as with those instruments, the use of which forms the sole reason for a recourse to men-practitioners; tho’, well considered, nothing could be a stronger reason against such a recourse than their using them. But let us proceed to the next case;

When the head of the fœtus presents itself foremost, but sticks in the passage.

For this section it is, that I have reserved to treat incidentally and more at large of the objections to be made in general to all instruments, and in particular to the principal ones.

Among the severe labors, which give much trouble, and exact much patience from all parties, from the patient, the midwife, and all the assistence, this case may challenge a place. It is that, in which the head of the child having presented itself foremost, and having ingaged itself half way, or thereabouts, in the streight of the bones of the pelvis, and of the orifice of the uterus, the labor-pains remit, languish, and the progress of the labor becomes suspended. Whether there be any mis-conformation of the bones of the pelvis, or whether (as our practitioners are pleased to express it,) the head of the fœtus be too large for the passage, or whether, in short, both these causes concur to the formation of this obstacle, or exist in complication with other circumstances; it is, in this case, we may say the head is hitched, stuck or ingaged in the passage.

Mr. De la Motte, book the 3d. chapter the 20th, describes this state of the fœtus.

“When (says he) the head has struck into the streight of the passage which, at first, affords a great deal less room than were to be wished, for its letting it pass, the head ingages itself as much forward as possible, from the continual and violent pains the woman suffers, which act upon the child, whose head lengthens and flattens, in such a manner, to adjust and mould itself to the passage, that the hairy scalp becomes quite tumefied, so as to make the head look almost like a double head, which however remains stuck fast between the bones, without being able to get out, and only ingages itself the more the more it advances ... but growing larger as it advances, and the aperture which it obliged to force diminishing more and more, makes it so that the head remains at length so jammed in, that it cannot be drawn out without diminishing its volume, which (as this author says) cannot be executed without instruments: as I was obliged to do, to accomplish the following delivery.”

Mr. De la Motte then proceeds to tell us, that he was called to lay the wife of a laborer, the head of whose child was hitched in the passage. After having well examined the state of the mother and child, and ascertained as much as it is possible to ascertain the death of the latter——“I determined, (says he) to finish the delivery, which I did by opening the head of the child with my incision-knife, and scooped out therewith part of the brain. After which, I made use of my hand, with which I got hold of the inside of the skull, and in an instant drew the child out, who appeared to have been dead a long time.”