The Female Physician / Containing all the diseases incident to that sex, in virgins, wives, and widows; together with their causes and symptoms, their degrees of danger, and respective methods of prevention and cure: to which is added, the whole art of new improv'd midwifery; comprehending the necessary qualifications of a midwife, and particular directions for laying women, in all cases of difficult and preternatural births; together with the diet and regimen of both the mother and child.

by John Maubray

THUS the Infant’s HEAD being excluded with the Crown foremost, there is no more Occasion to be at any Pains in keeping up the Orifice; wherefore I now suffer it, together with the HEAD, to fall down past the Bending of the OS SACRUM; which now also, the major Part of it being bare, more easily happens, than it possibly could whilst it was cover’d with the Orifice. Upon this, that the Child may be farther relieved and brought out, I now again make use of both Hands, the one inwardly, the other outwardly, as before: But as the Condition is now much alter’d from what it was at that time, I at present proceed after a quite different Manner, and work along with the Pains, resting only as their Force ceases: For thus I not only observe the Pains my self, but also at the same time encourage my Woman to Labour, and to persist in her LABOUR with all her Strength; and by Turns, as the PAINS come on, to conjoin their Force with her own and my mutual Endeavours, in the manner following: namely,

HAVING One Hand in the Vagina, with its Back turn’d towards the Rectum, I thrust very cautiously the Points of my Fingers as far as I can under the HEAD, where I hold that Hand constantly, until the PAIN comes on; laying the other Hand upon the Belly, about that Part where the Bottom of the Womb lies: Then as I perceive the PAINS come on, I begin to work with both Hands; to wit, by pressing the internal Hand gently downwards, against the Point of the Sacrum to remove it back out of the way; whilst by the external Hand, I gently raise the Womb into a resupine Posture, pressing it also softly downwards: I mean softly in Proportion (howsoever) to the Force of the PAIN: for as it gradually encreases, and more and more excites strong Labour; so I also by degrees press down more strongly.

HOWEVER yet the External Depression ought always to be Moderate, as the Internal ought to be Strong and Vigorous: Whereupon Matters being carefully well observ’d, (as laid down in Chap. 9.) no MIDWIFE needs be afraid of hurting her Patient Woman in the least; no rather, on the contrary, the more Strength I use now, the more grateful and agreeable I prove to Her being thus circumstantiated. And, in fine, the upper Part of the CHILD’s Body being once past that Sinuous Bending above, it presently breaks out all together, and comes away so happily into the World. After which the MIDWIFE is only farther to behave herself with respect to both the Mother and the Child, as in the Natural Case[^[174]], carefully cleansing, restoring, contracting, and shutting the Womb as Before. In a Word, with so great Success at last the BIRTH is accomplished, provided these Precepts be carefully and timely observed.

BUT that the Ingenious may be at no Loss in this momentous Affair upon any Occasion, we shall now particularly state the Case, in which the ordinary Midwife has thro’ Ignorance or Negligence, let Matters come so far, that the acuminated or lower Part of the Womb is fallen into the Pelvis; and the Orifice, together with the Head, is broken thro’ into the crooked Sinus of the Os Sacrum, and is fixed-up there; that the Membrane is broke; that the Infant’s Head is but a little bare; that the poor Woman (after the Fatigues of a strong or long Travail) is quite spent and tired; and finally, that all these Things have happen’d before the extraordinary MIDWIFE is perhaps sent for, or at least before He can conveniently be with the Woman.

IN this Pitiful Case, the Head being yet but a little bared, and sticking fast in the Sinus of the Os Coccygis (as abovesaid) the CHILD cannot possibly make any Impression upon the Orifice, so as to open it; and therefore the Situation of the Womb is to be alter’d: In order to which, I first place the Woman on a commodious Seat adapted to the Purpose, such as upon a Pallet, or Low Bed, or some Pillows laid on the Ground; that she may lie with her Face downwards upon her Knees, with her Head low; her Arms being supported with so many Pillows as are requisite to sustain her Body (leaning upon them) without moving.

NOW I doubt not but some People will think this a strange helpless Posture; but as strange as it is, it is certainly the most effectual, and the absolute best One, which can be devis’d for the Woman’s desir’d Relief in this desperate Condition: For by the Help and Means of it, the Womb is carried down into the lowest Part of the Belly, through its own Weight only; and consequently releases itself out of the foremention’d crooked Sinus; which that it may the sooner and more commodiously do, I put my Fingers into the VAGINA behind, betwixt the Rectum and the Head of the Infant, where I press down the Womb, till the Orifice is so far forced back, that there is Room enough to hold it up, in order that it may not relapse; and also that there may be Room for the Head to be depressed into, and open the Orifice. Thus the Womb and the CHILD being at last forced so far back, by an expert Hand, the BIRTH may be successfully perfected by the above-prescrib’d Means and Method; provided always that the Woman has sufficient Strength and PAINS to carry her through the fatiguing Tryal.

BUT we will how suppose, for better Instruction-sake, her Strength to be quite spent, and the PAINS to be deficient; in this Case the happy Issue of the BIRTH is most dubious; but however, then I place the Woman again as before, and depress the Womb as much as I can, until I reduce the Orifice farther up into the larger Space of the PELVIS, that I may the more conveniently open it by the Help of an inward Hand; and by that also moving aside the Child’s Head, I then seek for, until I find, the Feet; which, upon the Infant’s being right turn’d, with its Toes downwards towards the Mother’s Rectum, I bring into the Passage. Now the Feet being thus in the Passage, the Woman needs not lie any longer in the abovesaid Posture; but, turning herself, may now lie with her Face upwards: When I also give her previous Notice to prepare herself to depress vigorously; I mean as much as she can possibly, when occasion requires.

IN the Interim, holding the Feet all the while with my internal Hand, I attract them gently outwards, until the Buttocks and the Belly are excluded: Then taking fast hold of the CHILD by one Hand under the Belly, and the other upon its Back; I advise the good Woman, in Case she feels no PAIN, to behave herself as if the PAINS were most pressing upon Her, and to contribute by forcing downwards what lies in her Power; whilst I continually attract, and gently draw the Infant towards me, until by this discreet Management the Head is totally excluded, together with the Arms into the World. And thus at length the Distressed Woman may be happily delivered in all these different Cases, and difficult Conditions of Life. Whence I come to——