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

This brings me to this case particularly, the title of which is prefixed to this section, that of a head stuck in the passage, which the gentlemen-midwives may perhaps second Levret, in maintaining to be an exception to that admirable axiom above quoted, and maintain it purely, in evasion of the conclusion against their miserable instruments, which I aver need never be resorted to, nor never are, but for want of sufficient skill in the manual function to terminate such labors without them.

I answer then to these instrumentarians, that an instrument, even, no more dangerous than a probe, would in so tender a place as I am treating of, not perhaps be quite enough exempt from a possibility of doing mischief, to deserve an exception: but as to those instruments, which are so palpably likely to hurt both mother and child, to injure, in short, or even to destroy both the mould and the cast, they are all of them within the case of exception, or rather exclusion. It is then, in knowing what to do, and in the faculty of operating with the hand according to that knowledge, that the art of midwifery principally consists. If instruments are deemed ingenious, the doing without them is surely not less so.

Now as to the case proposed in this section, that of a child’s head stuck in the passage, I aver, that it is not absolutely impossible to terminate this delivery by the hand.

I am even ready to demonstrate this before any competent judges. I speak by experience. I have hitherto executed with all desirable success this operation without any aid but that of the hand, with a little patience and proper assiduity. I have many and many a time seen it practised at the Hôtel Dieu, and elsewhere. I never in my whole course of practice saw sufficient reason for attempting so hazardous an extraction, as that which is executed by means of a tire-tête. Why then those needless terrors, those superfluous tortures with instruments, to women already in too much pain and anguish? care enough could not be taken to spare those of the weaker-nerved sex in that condition such horrors, the very idea of which, to say no more, is enough to put them into imminent peril of their lives. All the forceps, and the rest of the chirurgical apparatus, especially the more complex instruments, very justly frighten the women, and their friends and assistents for them. Their introduction requires at once a painful, a shocking, and a needless devarication. The patients are put into attitudes capable of making them die with apprehension, if not with shame, from that native modesty of theirs, which, in these cases, may however be pronounced rather a wise instinct than a virtue.

How much preferable is the true midwife’s practice, who will have oftenest prevented, by her knowledge and skill, this very situation! That is to say, if she has been called in time. She knows how to predispose the passages, and by gentle reductions to restore Nature to her right road, where she has been through mispractice driven out of it, or through negligence suffered to deviate from it, or not preventively watched.

I have never but seen, with respect to the uterus in this case, that it was possible to insinuate first one finger, then another, and little by little the whole hand, not indeed a hard hand, as big as a shoulder of mutton, the hand of some lusty he-midwife, but of a midwife, such as it is commonly seen.

When Nature does not proceed as could be wished in her labor-pains, the point is then to husband well the strength of the patient, to restore it where it fails, by giving her good broths and corroboratives, that do not heat, or cooling things, where heating ones have been injudiciously administered. She is then to lie as composed and tranquil as possible; to be cherished, comforted, inheartened. There is, humanly speaking, no fear but her strength will return; her pains must not be irritated, nor herself harrassed with ineffectual interference. Nature will come to herself again: the situation will, by her benign energy, change for the better, and become favorable enough, for the midwife to be able to assist her in the due time with a manual operation, that will terminate happily her delivery. It is at least, with this success, that I have delivered many, who, by the unskilfulness of those who had attended them, at the beginning of their pains, had been reduced to a deplorable condition, by their labor lingering some for upwards of six days.

In short, it is extremely rare that this case of a head stuck in the passage ever happens, unless under the hands of unskilful practitioners, or of over-dilatory or neglectful midwives, who will not have duly attended to the prognostics of this event; who will not have watched and taken the benefit of the favorable critical moment; who give the head time to engage itself, or get fast jammed, for want of their removing the impediments to Nature’s doing the rest, or when help has been called or come too late. It may also be owing to those who hasten too much, who precipitate the women’s labor by forcing draughts, that heat, burn them up, exhaust their strength, and prematurate the coming on of the labor-pains. Some practitioners fatigue them, with making them walk, or keep them up too much.

But when the membranes are not too soon pierced and the waters let out, when the pains are not provoked, when time is given to Nature to form to herself a passage, not omitting the precautions I have summarily intimated; when due care is taken to procure all possible ease of body and mind to the patient; who may vary her posture, sometimes lying along, sometimes sitting up, or well supported when she walks: little by little the head will frank itself a passage with the weight of the body acting by an innate energy, and with a little due assistence of the midwife’s art: and with this practical advertence, that, in these arduous cases, much may be safely left to Nature, but not every thing. There are times in which she cannot bear neglect, but there are none in which she can bear extreme violence.

Here the reader will not expect I should in a treatise, purely calculated to expose the abuses of midwifery, attempt to particularize either all the contingent cases, or all the modes of operation in them. That would require a work a-part. I shall only then, to the four principal cases, in which instruments are so falsely supposed necessary, add a summary account of that of a pendulous belly, which is not without its difficulty.