I will now show the several situations of the child in the mother’s womb, according to the different times of pregnancy, by which those that are contrary to nature, and are the chief cause of all ill labours, will be more easily conceived by the understanding midwife. It ought, therefore, in the first place, to be observed, that the infant, as well male as female, is generally situated in the midst of the womb; for though sometimes, to appearance, a woman’s belly seems higher on one side than another, yet it is so with respect to the belly only, and not to her womb, in the midst of which it is always placed.
But, in the second place, a woman’s great belly makes different figures, according to the different times of pregnancy; for, when she is young with child, the embryo is always found of a round figure, a little oblong, having the spine moderately turned inwards, the thighs folded, and a little raised, to which the legs are so raised, and her heels touch the buttocks; the arms are bending, and the hands placed upon the knees, towards which the head is inclining forwards, so that the chin toucheth the breast; in which posture it resembles one sitting to ease nature, and stooping down with the head to see what comes from him. The spine of its back is at that time placed towards the mother’s, the head uppermost, the face downwards; and proportionably to its growth, it extends its members by a little and little, which were exactly folded in the first month.
In this posture it usually keeps till the seventh or eighth month; and then by a natural propensity and disposition of the upper part of the body, the head is turned downwards toward the inward orifice of the womb, tumbling as it were over its head, so that then the feet are uppermost, and the face towards the mother’s great gut; and this turning of the infant in this manner, with its head downwards, towards the latter end of a woman’s reckoning, is so ordered by nature, that it may be thereby the better disposed for its passage into the world at the time of its mother’s labour, which is not then far off (and, indeed, some children turn not at all until the very time of birth); for in this posture all its joints are most easily extended in coming forth; for, by this means the arms and legs cannot hinder its birth, because they cannot be bended against the inward orifice of the womb; and the rest of the body being very supple, passeth without any difficulty after the head which is hard and big, being past the birth. It is true, there are divers children that lie in the womb in another posture, and come to birth with their feet downwards, especially if there be twins; for then by the different motions they do disturb one another, that they seldom come both in the same posture at the time of labour, but when one will come with the head, and another with the feet, or perhaps lie across; and sometimes neither of them will come right. But, however the child may be situated in the womb, or in whatever posture it presents itself at the time of birth, if it be not with its head forwards, as I have before described, it is always against nature, and the delivery will occasion the more pain and danger, and require greater care and skill from the midwife, than when the labour is more natural.
CHAP. IV.
A Guide to Women in Travail, showing what is to be done when they fall in Labour, in order to their Delivery.
The end of all that we have been treating of is, the bringing forth a child into the world with safety both to the mother and infant, as the whole time of a woman’s pregnancy may very well be termed a kind of labour; for, from the time of her conception to the time of her delivery, she labours under many difficulties, is subject to many distempers, and in continual danger, from one effect or other, till the time of birth comes; and when that comes, the great labour and travail come along with it, insomuch that then all the other labours are forgotten, and that only is called the time of her labour; and to deliver her safely is the principal business of the midwife; and to assist her therein, shall be the chief design of this chapter. The time of the child’s being ready for its birth, when nature endeavours to ease it forth, is that which is properly the time of a woman’s labour; nature then labouring to be eased of its burden. And since many child-bearing women (especially the first child) are often mistaken in their reckoning, and so, when they draw near their time, take every pain they meet with for their labour, which often proves prejudicial and troublesome to them, when it is not so; I will in the first section of this chapter, set down some signs, by which a woman may know when the true time of her labour is come.
Sect. I. The Signs of the true Time of a Woman’s Labour.
When pregnant women, especially of their first, perceive any extraordinary pain in the abdomen, they immediately send for their midwife, as taking it for their labour; and then if the midwife be not a skilful and experienced woman, to know the time of labour, but takes it for granted without further inquiry (for some such there are), and so goes about to put her into labour before nature is prepared for it, she may endanger the lives of both mother and child by breaking the amnios and chorion. These pains, which are often mistaken for labour, are removed by warm cloths laid to the abdomen, and the application of a clyster or two, by which those pains which precede a true labour are rather furthered than hindered. There are also other pains incident to a woman in that condition from a flux of the abdomen, which are easily known by the frequent stools that follow them.
The signs, therefore, of labour, some few days before, are, that the woman’s abdomen, which before lay high, sinks down, and hinders her from walking so easily as she used to do; also there flows from the womb slimy humours, which nature has appointed to moisten and smooth the passage, that its inward orifice may be the more easily dilated when there is occasion; which beginning to open at this time, suffers that slime to fall away, which proceeds from the glandules, called prostata. These are signs preceding the labour; but when she is presently falling into labour, the signs are, great pains about the region of the reins and loins, which, coming and retreating by intervals, are answered in the bottom of the abdomen by congruous throes, and sometimes the face is red and inflamed, the blood being much heated by the endeavours a woman makes to bring forth her child; and likewise, because during these strong throes her respiration is intercepted, which causes the blood to have recourse to her face; also her privy parts are swelled by the infant’s head lying in the birth, which, by often thrusting, causes those parts to descend outwards. She is much subject to vomiting, which is a sign of labour and speedy delivery, though by ignorant people thought otherwise; for good pains are thereby excited by the sympathy there is between the womb and the stomach. Also when the birth is near, women are troubled with a trembling in the thighs and legs, not with cold, like the beginning of an ague fit, but with the heat of the whole body; though, it must be granted, this does not happen always. Also, if the humours which then flow from the womb are discoloured with blood, which the midwives call shows, it is an infallible mark of the birth being near. And if then the midwife puts up her fingers into the neck of the womb, she will find the inner orifice dilated; at the opening of which, the membranes of the infant, containing the water, present themselves, and are strongly forced down with each pain she hath; at which time one may perceive them sometimes to resist, and then again press forward the finger, being more or less hard and extended, according as the pains are stronger or weaker. These membranes, with the waters in them when they are before the head of the child, which the midwives call the gathering of the waters, resemble to the touch of the finger those eggs which have no shell, but are covered only with a simple membrane. After this, the pains still redoubling, the membranes are broken by a strong impulsion of the waters, which flow away, and the head of the infant is presently felt naked, and presents itself at the inward orifice of the womb. When these waters come thus away, then the midwife may be assured the birth is very near, this being the most certain sign there can be; for the amnios alantios, which contained those waters, being broken by the pressing forward of the birth, the child is no better able to subsist long in the womb afterwards, than a naked man in a heap of snow. Now, these waters, if the child comes presently after them, facilitate the labour, by making the passage slippery; and, therefore, let no midwife (as some have foolishly done) endeavour to force away the water, for nature knows best when the true time of the birth is, and therefore refrains the water till that time. But if by accident the water breaks away too long before the birth, then such things as will hasten may be safely administered, and what these are I will show in another section.
Sect. II. How a woman ought to be ordered when the Time if her Labour is come.
When it is known that the true time of her labour is come by the signs laid down in the foregoing section, of which those that are most to be relied on are pains and strong throes in the abdomen, forcing downwards towards the womb, and a dilation of the inward orifice, which may be perceived by touching it with the finger, and the gathering of the waters before the head of the child, and thrusting down of the membranes which contain them; through which, between the pains, one may in some manner with the finger discover the part which presents (as we said before), especially if it be the head of the child, by its roundness and hardness; I say, if these things concur and are evident, the midwife may be sure it is the time of the woman’s labour; and care must be taken to get all things necessary to comfort her in that time. And the better to help her, be sure to see she be not strait-laced: you may also give her one strong clyster or more, if there be occasion, provided it be done at the beginning, and before the child be too forward; for it will be difficult for her to receive them afterwards. The benefit accruing thereby will be, that they excite her gut to discharge itself of its excrements, that so, the rectum being emptied, there may be more space for the dilation of the passage; likewise to cause the pains to bear the more downward, through endeavours she makes when she is at stool; and in the meantime, all other necessary things for her labour should be put in order, both for the mother and the child. To this end, some get a midwife’s stool; but a pallet-bed, girded, is much the best way, placed near the fire, if the reason require; which pallet ought to be placed, that there may be easy access to it on every side, that the woman may be more readily assisted as there is occasion.