CHAP. V.
Of Difficult BIRTHS, proceeding from Causes of the MOTHER.
IN this (as in the former Case) the Midwife must use her most acute and nicest Judgment, to find out the particular Cause of the Difficulty. Which being done,
I. IF She finds it arises from the Woman’s being too Young, or too Old, of her first Child, or too Lean at last; she is to anoint the Passages with proper Unguents, which ought to be done some time before, as well as in the Hour of LABOUR: When she is likewise to employ her subtile Hand, in assisting and augmenting the Dilatation of the Orifice; as is requisite also in Case of the Woman being too Fat or Gross.
II. IF the Woman be too small, short, crooked, or misshaped, not having a Breast strong enough to forward and bear down her PAINS; or if she be over tender, sensible, and apprehensive of PAIN; or too weak, and not able to contribute or assist by her own forcing Endeavours; or short-winded, and not capable to constrain her Spirits downwards: In all these Cases she is to be kept upright, for the more free Respiration, as well as for encreasing her PAINS, standing or walking about the Room, according to her Strength, being supported under her Arms, and not put to Bed until at least the WATERS are broke. But, in the mean Time, the weak and tender Woman ought to be now and then comforted and refreshed with fresh soft Eggs, good Broths, Jellies, a little Wine and Toast, a little Wine and Water, or such like convenient Things, as well as with the Hopes of a speedy Delivery.
III. WHEN the PAINS are not Natural or Genuine; but Spurious, Faint and Languid; or Shifting and Tergiversant; such are to be assuaged by proper Lenitives and Anodynes; which being regularly done, the Genuine Pains may be excited by proper Clysters, and divers other Means. But I would advise none to a Profuse Use of MEDICINES in such Cases, since I well know that many a Woman has lost her Life by using dolorifick Medicines, prescribed by imprudent MIDWIVES, without considering, or so much as knowing the true Circumstances of the Condition: Whereas in most Cases, by the ingenious Motion of an Experienc’d Hand only, the Pains may be sufficiently awaken’d, and the Birth safely promoted.
IV. WHEN the Difficulty proceeds from the Debility of the Womb, or its Expulsive Faculty, not being able or capable to Exclude the INFANT, because of a more strong and valid Retentive Power: In this Condition, if there be no evident External Cause to be obviated, it depends chiefly upon the Subtile Hand of the MIDWIFE, to assist the Womb in its Function; and otherways the PATIENT is only to be treated as in the Case of the weak and tender Woman above-mentioned.
V. WHEN the Woman is taken with any Acute Disease, the BIRTH is to be prompted by all safe Means; and if a Natural DELIVERY does not presently succeed, an Artificial one must (without Loss of Time) be undertaken. As in the Case of immoderate and continual Floodings, with concomitant Convulsions, which always proceed from the Separation of the SECUNDINE (either in whole or in part) from the Womb, and happen many different ways, as already mentioned at large[[165]].
IN these Cases, especially if the Secundine is found (by the Touch) at the Orifice, there is no Hope of Stopping them by any other Means, than by delivering the Woman; which now the sooner done, the better (for saving two Lives) and that whether at full time of Reckoning or not. But this Operation, I conceive, is to be most discreetly Undertaken in the manner following, viz.
THE Woman is to be placed in Bed, with the Upper and Lower Part of her Body almost equal, then the Midwife is gently and gradually to introduce her Fingers into the Orifice, dilating it cautiously with one or two, until she can enter them All; when opening the Matrix by Degrees, she gets in her Whole Hand, and thereby first carefully tears the Membrane with her Nails, if the WATERS are not previously broke: Then she puts her Hand in the same Membrane to the Infant’s Feet, seeking them in their Place, where they are to be found, when they don’t present themselves at First: Because, the Hold by the FEET being Better, it is more easy to deliver by Them, in this Case, than by the HEAD, or any other Part. After this the FEET being found, the Child is easily turn’d, as long as the Womb is loose and slippery, and the Humours not quite flown off; which being nicely done, the FEET are to be drawn out both together, if possible; but if otherways, they must be drawn down separately, with great Caution: And so being conjoin’d or held fast together, they are to be drawn forward with one Hand, whilst the other is circumspectly thrust towards the Knees or Buttocks of the Child, in order thereby to turn also the whole Body of the Infant, so that its Face, Belly, and Toes may tend downwards towards the RECTUM.