CHAP. VIII.
Of Difficult BIRTHS, proceeding from the Causes of the PELVIS.
DIFFICULT BIRTHS on part of the Passages, happen frequently, because of some perverse Form of the PELVIS, in these Respects; as by its being either too Large, too Narrow, or too Smooth. But that I may be the better understood in this Matter: FIRST, by a PELVIS too large, I mean such an One, as is so in comparison with the Womb or Infant; in which Condition, as the Womb can neither be firmly fix’d, compactly inclos’d, or duly supported, so neither can the Head of the Infant and the WATERS be exactly depressed upon the Orifice: Hence it often happens, that (besides the Midwife’s careful Hand) the Privities are the best, if not the only Defence, against both the Womb and the Child’s falling out of the Body.
SECONDLY, By a PELVIS too small, I mean, such an One as is so, in Consideration of the Size of the whole Body; in which Condition, the INFANT commonly answering to that Proportion, its Head can by no Possibility pass thro’ the PELVIS, in a Womb well seated, without great Force, by which Means the Womb may be easily turn’d obliquely: And thus consequently the Smallness of the PELVIS, may sometimes prove the Cause of a Preternatural, as well as of a Difficult BIRTH; and not only so, but also the Death of both the MOTHER and CHILD may ensue thereupon, unless timely deliver’d by an Artful Hand.
THIRDLY, By a PELVIS too smooth, I mean such an One, whose Distance betwixt the OSSA PUBIS and the prominent Part of the OS SACRUM is too narrow; in which Condition, tho’ the Womb be well placed, it cannot admit the Head (especially if large and well-grown) without great Difficulty: And this smooth PELVIS may also very easily turn the Womb (either way) obliquely, and consequently prove of the same dangerous consequential Effect with the preceeding Case.
HENCE (I think) it evidently appears, how necessary it is that all MIDWIVES should not only know the Form and Size of the PELVIS, but also the Situation and Connexion of its Bones, as already describ’d at large[[167]], that she may thereby the better distinguish the Circumstances by plainly discerning the Causes, and judge accurately of the Position of both the WOMB and the INFANT; so that in the beginning of the Labour, she may immediately discover how the Pelvis and its Entrance is form’d, whether Large or Narrow, Smooth or Round.
FOR this Reason, the first Thing that the MIDWIFE ought to do, when she comes to a Woman in Labour, is to try by the Touch, how all is circumstantiated, with respect to these Things; and This is to be done before the WOMB and the CHILD are fallen down into the Pelvis, that she may contrive her Work accordingly. Because sometimes the Exclusion of the INFANT, is to be hoped for, from the Pains only; sometimes Nature is to be prudently assisted; sometimes there is an absolute Necessity for extracting the Child (without loss of Time) by an Artful Hand, as will hereafter more clearly appear; and sometimes again the same Necessity obliges us to protract the BIRTH, than we may save One or Both Lives: As in the Case of a smooth Pelvis, the Os Pubis and the Vertebræ of the Sacrum being but little distant, the Child’s Head is stopped; when if the Mother should labour much, or endeavour to force an expeditious BIRTH, its tender Head (of course) must suffer in proportion; Or perhaps the Brain may break, by so hard a Pressure against the Bones; or, finally (which is worse) it may be so closely squeez’d between the Bones, that both the MOTHER and the INFANT may peradventure die, before any BIRTH can possibly succeed or come happily into the World.
BUT in this critical Condition, the Woman is to labour gently, and bear her PAINS (how violent soever) patiently; the MIDWIFE always directing the Head, at the same time by her safe Hand, into the larger Space; by which Means at last, it passes gradually through that narrow Passage without the least Danger.
THE same also is the Condition when the PELVIS is too small or narrow; for by the Woman’s labouring gently and deliberately, the Head is depressed softly into an oblique Figure, and passes easily by Degrees: Whereas, on the other hand, if it is forced by Violence, it becomes flat and broad, and consequently incapable of Passing, if not also dash’d to Pieces, as aforesaid.
HENCE we clearly see, how easily Ignorance in this Point, may lead common Midwives into the grossest of Mistakes; For what is more ordinary with them, even in all Cases, than to advise the Woman to strong Labour, and to force her to violent Depressions: Insomuch that Some have Arrogance enough to carry their Bottles or Powders about them, of which they neither know the Quality nor Virtue; taking them only as they are told (by the confident Quacks or Mercenary Hands which vend them) that they may encrease and promote the Pains of Labour, and This without having any regard to the Form of the Pelvis, or the Position of either the WOMB, or the INFANT.
IN short, the mature Consideration of this very Case, was not the least Motive which induced me to the Work in Hand; since I cannot but heartily commiserate so many fine delicate Women, as are thus every day miserably handled, tormented, and exhausted, by the preposterous Management of such indiscreet and imprudent MIDWIVES. I may well say exhausted, or worn-out; This being too evident, from the vast Number of most beautiful Women, who, by this ill-manag’d Condition, (notwithstanding they have all along heretofore, enjoy’d a good State of Health, together with the Affluence of other Worldly Blessings) have been more dejected and broken both in Complexion and Constitution, after one or two BIRTHS, than some others (judiciously and expertly delivered) have been after Twenty: Such is the great Difference betwixt the unskilful Hands or Conduct of common Midwives, and those Dextrous Touches or ingenious Operations of the more judicious Andro-Boethogynists. Whence I come in Course to——