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

AMONG the various unhappy Accidents, which may happen in or about the Time of Labour, the present Case is none of the most auspicious; in as much as it may, in sundry Respects, occasion a very difficult Preternatural BIRTH, according to the Difference of Circumstances: For the Navel-String having fallen down and come first in the Passage, may be variously turn’d, and consequently cause several and sundry Inconveniences, as follow, viz.——

I. WHEN the Umbilical Vessel falls down alone into the Passage, without any other Part, the BIRTH is then commonly situated a-cross in the Womb; and in this Condition, BACK or BELLY, HAND or FOOT, may be probably expected to come first: Wherefore the active MIDWIFE ought to discover the real Posture by the Touch, and that at least before all the Waters are yet flow’d off and evacuated; and then betimes to fetch away the CHILD by the FEET, unless the Head be more convenient or pat for the Purpose. But these Cases being already particularly discussed[^[179]], I shall add nothing farther upon them in this Place.

II. THE String may fall down double, and so swell with Cold, as to obstruct the Passage, which however is but the smallest Consideration in this Condition, because by its hanging down double, it may be so shortned, that the CHILD may be detain’d, appending by it in the Orifice, until the Blood of the Umbilicals coagulating either by Cold, or by Compression in the Passage, the due Circulation is obstructed, and the Infant expos’d to the greatest of Dangers, if a very speedy DELIVERY does not prevent the fatal Accident.

THE Prudent MIDWIFE ought always to be very sollicitous about this Case, making it her particular Care from the beginning of the Labour, as soon as perceiv’d by the Touch, and before the Waters break, to avert or hinder its either coming before, or along with the Head, by removing it judiciously according to Art. But supposing she comes too late to prevent the Mischief, and that the String is already in the Passage; then it is to be put back behind the Head immediately, and kept there until the Head be fully directed into and lodg’d in the Passage. However it sometimes happens that it cannot be kept-up so long, and that the MIDWIFE, whatever Pains she may take, cannot hinder it from extruding itself at every Pang: In this Condition, I would advise her (without delay) to extract the Birth by the Feet, and that notwithstanding the Head should be foremost.

III. IT also happens sometimes, that the String without hanging down, is variously compress’d betwixt the Head and the Bones of the Pelvis, which (stopping or impeding the Motion of the Blood) soon occasions the Infant’s inevitable Death.

IN which Case, if pressed against the Ossa Pubis, having laid the Woman on her Back with her Head low, and the lower Part of her Body raised, I would press back the Infant’s Head, and put the STRING as much as possible behind it; upon which, then I would bring the Head forthwith into the Pelvis, unless it be more convenient to turn and extract it by the FEET.

AS also, tho’ seldom, it may happen, that the Umbilical may be pressed back by the Head against the Os Sacrum: In which State of Affairs, I would turn the Woman, if Strength may permit, upon her Knees, whilst I employ either Hand on the Back Part, in order to remove the Head, how firmly soever fixed: Whereas if the Patient be weak, I would lay her upon either Side, drawing up one Foot to her Belly, for the Advantage of obtaining more Room, in order to effect the same Thing; which, tho’ difficult, is no impossible Task for the expert MIDWIFE.

BUT if it chances to be pressed against either of the Ossa Ilia, having laid the Woman on the contrary Side, with the lower Part of her Body elevated, I would remove the HEAD with the opposite Hand, and free the STRING; proceeding otherways as in the former Cases, with HEAD or FEET, as I should find most convenient.

IV. AGAIN, it also sometimes comes to pass, that the STRING is found lying upon the Forehead, which is indeed most dangerous; but it is easily removed with good Judgement to the Temples of the Head, which I take to be a safe Position, because there the Pressure is much less aggravated.

V. MOREOVER it likewise sometimes happens, that the STRING comes along with the Shoulder, Elbow, Hand, Foot, &c. without touching the HEAD: Upon this then as soon as the Humours have flow’d, I would pass my Hand quickly up, and bring the CHILD, Head or Feet foremost into the Passage, according to its Situation, always detaining or stopping the STRING from coming out before the BIRTH: Whereas if the STRING be already excluded along with the Foot or the Arm, it is to be repelled with all necessary Speed, Conduct, and Caution, and then the INFANT ought to be dextrously drawn out by the Feet.