Midwifery and the diseases of women

by Joel Shew

It matters little, however, what instrument or material is used to effect the object in question. The cord being immediately after birth a dead substance, possessing no sensibility whatever, we may bite it off, or we may use a shell, a sharp knife, or a pair of good scissors or shears, whichever method we choose, remembering always that it is of little consequence how we do it, and that it is as natural, precisely, for a man to exercise his ingenuity in making and using a convenient instrument as it is for a brute to use his teeth.

In the time of Hippocrates, it was not customary to divide the umbilical cord previously to the expulsion of the placenta. If this was slow in coming away, the child was placed upon a pile of wool, or on a leather bottle with a small hole in it, so that by the gradual subsidence of the skin or pile of wool, the weight of the child might draw almost by insensible degrees upon the placenta. In this way it was extracted without violence.

In modern times, it has been almost universally the custom to separate the child very soon after delivery, and before the after-birth has come away. “As soon as the child cries lustily, proceed at once to separate the cord,” is the common doctrine among medical practitioners. But it is better, evidently, to wait, before this is done, until all pulsation has ceased in the cord. If we take the cord between the thumb and finger, we readily ascertain when its pulsation has ceased. It has a large vein in it for the transmission of blood from the mother to the child, and two small arteries, which return the impure or worn-out blood after it has gone the rounds of the fetal circulation. Blood is the only nourishment the child has while it is in the mother’s womb. Hence it would be manifestly improper to rob the child of any portion of the fluid coming from the mother to it.

The ancients not only waited for the expulsion of the after-birth before tying the cord, but if the child was at all feeble or dead at birth, the placenta, when expelled, was laid upon its belly as a comforting and restoring application. This practice, singular as it may appear to us in modern times, is not altogether without its philosophy; the mild, genial warmth of the after-birth was supposed to act favorably on the feeble powers of life, if such existed, or if it was dead, it was supposed the infant might thus be recovered.

Speaking of later methods, Dr. Denman observes: “It has been the practice to divide the funis (cord) immediately after the birth of the child; and the weaker this was, the more expedition it was thought necessary to use; for the child being supposed to be in a state similar to that of an apoplectic patient, a certain portion of blood might, by this means, be discharged from the divided funis, and the imminent danger instantly removed. There is another method which I have seen practiced, the very reverse of the preceding; for in this the loss of any quantity of blood being considered as injurious, the navel-string was not divided, but the blood contained in its vessels was repeatedly stroked from the placenta toward the body of the child. In all these different methods, and many others founded on caprice, or on directly contrary principles, children have been treated in different times and countries, and yet they have generally done well; the operations of nature being very stubborn, and, happily, admitting of considerable deviation and interruption, without the prevention of her ends.”

“There is yet, in all things,” continues this author, “a perfectly right as well as a wrong method; and, though the advantage or disadvantage of either may be overlooked, the propriety and advantage of the right method must be evidently proved by individual cases, and of course by the general result of practice. In this, as well as in many other points, we have been too fond of interfering with art, and have consigned too little to nature, as if the human race had been destined to wretchedness and disaster, from the moment of birth, beyond the allotment of other creatures.”

It is the testimony of this author, however, that some children, after they had began to breathe, had respiration checked, and died after the cord was divided in consequence, this having been done too soon. Beyond a doubt, many children have been destroyed in this way, and in this, as in many other things in the healing art, medical men have been too much in the habit of interfering with nature, and thwarting her in her operations.

It is the order of nature, and moreover a truly wonderful phenomenon, that in proportion as respiration becomes established in the new-born child, the pulsation in the umbilical cord begins to cease, first at the placenta, and so gradually onward to the child; physiologists are puzzled to explain the circumstance, but the fact is plain.

Hence it follows, that if the cord were left to itself, without any ligature, it would not expose the child to hemorrhage, or other accidents, even though it should be cut clean, and not contused or torn; some little blood might flow from the cut end, but every thing being left to nature, this could amount to but little, and such as would do no harm. But for the sake of cleanliness, it is proper that a ligature should be applied.

But it will be objected, that in some cases—though very rare—children have been known to bleed to death at the umbilicus. This has, indeed, happened in some few cases, in spite of ligatures, and every thing else in the way of styptics that could be applied. But these extreme cases are not to serve as guides in forming rules of practice. Nature has exceptions to all her rules. Besides, we may account for many of these occurrences, by the fact that the natural operations are often perverted by improper treatment. Thus, if children are swathed tightly, as has been too often the case in civilized society, compressing the chest and the abdomen, and causing them to cry from distress, the embarrassed state of the viscera suffices to disorder the general circulation, and enable the blood again to pass out of the navel.