Q. 11. Under what circumstances, and by what means, is it morally, legally, and medically proper, to induce premature labour?
That premature labour may be induced by a mechanical operation, is too well known to the practitioner in midwifery to require any explanation in this place, while, in a work calculated for circulation beyond the confines of the profession, it would be obviously imprudent to enter into any minute details. It becomes our duty, however, to state, that in those cases of distorted pelvis, through which a full grown fœtus cannot pass without mutilation, the operation may be performed with perfect safety, and with equal advantage both to the child and to the mother. We are informed by Dr. Denman[[445]] that there was in 1756 a consultation of the most eminent men in London at that time, to consider of the moral rectitude of, and advantages which might be expected from, this practice, which met with their general approbation; the morality of this mode of practice, however, says Dr. Merriman,[[446]] has been doubted by many other persons, but probably for want of considering the question in a proper point of view; for the proposal was, that labour should be prematurely induced, in those cases only, where it had been decidedly proved that the pelvis was so much contracted in its dimensions, as to render it impossible for a full sized fœtus to pass undiminished; and it is supposed, that this proceeding, while it affords a chance of preserving the child, does not much implicate the life of the mother. Mr. J. Barlow[[447]] has given us the result of an extensive practice in inducing premature labour in cases of distorted pelvis, from which it appears that he has had recourse to this method of delivery eighteen times, in five women, all of whom had been previously delivered once, or oftener, by the crotchet, and that premature labour occurred spontaneously once in two of this number. All the women recovered, a circumstance which adds a further confirmation to the opinion, that the life of the parent is exposed to very little hazard in this way; of the children thus brought into the world, six were dead and twelve were born alive, of which some died soon after birth, one lived ten months, and five were living at the time the account was published. Mr. Barlow’s method consists in exciting premature labour early in the seventh month of pregnancy. Dr. Hull, well known for his controversial zeal on these subjects, has offered some remarks so judicious and important, that it would be an act of injustice to withhold them from the reader. “The propriety of inducing premature labour,” says he, “in any deformed woman, can rarely, if ever, be determined upon before the crotchet has been found indispensably necessary, and actually employed in a previous labour; indeed, unless the contraction of the tube or canal of the pelvis be very considerable and pretty accurately ascertained, it will scarcely be justifiable in any case to have recourse to this practice in all the subsequent pregnancies, until the woman has been delivered a second, or third time, by the crotchet; for it has happened in a very great number of instances, that a woman who has been delivered of her first child by the perforator and crotchet, has been afterwards delivered of one or more living children, at the full time; this observation is made not to discountenance the inducing of premature labour, but to prevent the abuse of it.” Dr. Merriman, whose extensive practice, and generally acknowledged judgment, stamp a peculiar value upon his opinions, has also pointed out the limitations and cautions which he deems necessary to be observed, to render this operation safe and eligible,[[448]] and he concludes by observing that “a regard to his own character should determine the accoucheur, not to perform this operation, unless some other respectable practitioner has seen the patient, and has acknowledged that the operation is advisable.”
Q. 12. What circumstances will justify the Cesarean Operation, and of what value is the section of the Symphysis Pubis, or Sigaultian operation?
Where the size of the pelvis[[449]] will not admit the passage of the child, surgical aid is indispensably necessary; but, says Dr. Merriman,[[450]] it becomes every man to set out with a determination that he will not hastily, nor without due cause, have recourse to instrumental assistance;[[451]] for he may assure himself that if he were easily to yield to his own apprehensions, or to the expressions of alarm by the attendants in the lying-in chamber, and in consequence were to try to expedite the delivery by his instruments, he would, on very many occasions, do irreparable injury to the parent or her child.
Instrumental delivery resolves itself into three classes,—
1. Where neither the mother nor the child is of necessity injured, as by the use of the Forceps[[452]] and Lever.[[453]]
2. Where the mutilation of the child is the principal object, as by the Perforator and Crotchet.
3. Where the mother is wounded, as in the Cæsarean and Sigaultian operations.
It is of the latter class we have now to speak.
Of the Cæsarean Operation: