There are four things which denominate a woman’s natural labour; the first, that it be at the full time; for, if a woman comes before her time, it cannot be termed natural labour; neither will it be easy as though she had completed her nine months. The second thing is, that it be speedy and without any ill accident: for, when the time of her birth is come, nature is not dilatory in the bringing of it forth, without some ill accident intervene which renders it unnatural. The third is, that the child be alive; for all will grant that the being delivered of a dead child is very unnatural. The fourth thing requisite to a natural birth is, that the child come right: for if the position of the child in the womb be contrary to what is natural, the event will prove it so, by making that which should be a time of life, the death of both the mother and the child.
Having thus told you what I mean by natural labour, I shall next show how the midwife is to proceed therein, in order to the woman’s delivery. When all the foregoing requisites concur, and after the waters be broke of themselves, let there rather be a quilt upon the pallet bedstead than a feather bed, having thereon linen, and cloths in many folds, with other such things as are necessary, and that may be changed according to the exigency requiring it, so that the woman may not be incommoded with the blood, waters, and other filth which are voided in labour. The bed ought so to be ordered, that the woman, being ready to be delivered, should lie on her back upon it, having her body in a convenient posture; that is, her head and breast a little raised, so that she be between lying and sitting; for being so placed, she is best capable of breathing, and likewise will have more strength to bear her pains than if she lays otherwise, or sunk down in bed. Being so placed, she must spread her thighs abroad, folding her legs a little towards her loins, somewhat raised by a small pillow underneath, to the end her groin should have more liberty to retire back; and let her feet be stayed against some firm thing: besides this, let her take hold of some of the good women attending her with her hands, that she may the better stay herself during her pains. She being thus placed at the side of her bed, having her midwife at hand the better to assist as nature requires, let her take courage, and help her pains the best she can, bearing them down when they take her, which she must do by holding her breath, and forcing them as much as possible, in like manner as when she goes to stool; for by such straining, the diaphragm, or midriff, being strongly thrust downwards, necessarily forces down the womb and the child in it. In the meantime, let the midwife endeavour to comfort her all she can, exhorting her to bear her labour courageously, telling her it will be quickly over, and that there is no fear but she will have a speedy delivery. Let her midwife also, having no rings on her fingers, anoint them with oil of fresh butter, and thereby dilate gently the inward orifice of the womb, putting her finger ends into the entry thereof, and then stretch them one from the other, when her pains take her; by this means endeavouring to help forward the child, and thrusting, by little and little, the sides of the orifice towards the hinder part of the child’s head, anointing it with fresh butter, if it be necessary.
When the head of the infant is a little advanced into the inward orifice, the midwife’s phrase is, “It is crowned;” because it girds and surrounds it just as a crown; but when it is so far that the extremities begin to appear without the privy parts, then they say, “The child is in the passage;” and at this time the woman feels herself as it were scratched, or pricked with pins, and is ready to imagine that the midwife hurts her, when it is occasioned by the violent distention of those parts, and the laceration which the sometimes bigness of the child’s head causeth there. When things are in this posture, let the midwife seat herself conveniently to receive the child, which will come quickly, and with her finger ends (which she must be sure to keep close pared) let her endeavour to thrust the crowning of the womb (of which I have spoken before) back over the head of the child; and as soon as it is advanced as far as the ears, or thereabouts, let her take hold of the two sides with her two hands, that when a good pain comes she may quickly draw forth the child, taking care that the navel-string be not entangled about the neck, or any other part, as sometimes it is, lest thereby the after-burden be pulled with violence, and perhaps the womb also, to which it is fastened, and so either cause her to flood, or else break the strings, both which are of bad consequence to the woman, whose delivery may thereby be rendered the more difficult. It must also be carefully observed, that the head should not be drawn forth straight, but shaking it a little from one side to the other, that the shoulders may sooner and easier take their place immediately after it is past, without losing any time, lest the head being past, the child be stopped there by the largeness of the shoulders, and so come in danger of being suffocated and strangled in the passage, as it sometimes happens, for the want of care therein. But as soon as the head is born, if there be need, she may slide her fingers under the arm-pits, and the rest of the body will follow without any difficulty.
As soon as the midwife hath in this manner drawn forth the child, let her put it on one side, lest the blood and water which follow immediately, should do it an injury, by running into its mouth and nose, as they would do if it lay on its back, and so endanger the choaking of it. The child being thus born, the next thing requisite is, to bring away the after-burden: but before that, let the midwife be very careful to examine whether there be more children in the womb; for sometimes a woman may have twins that expected it not; which the midwife may easily know, by the continuance of the pains after the child is born, and the bigness of the mother’s abdomen. But the midwife may be sure of it, if she puts her hand up the entry of the womb, and finds there another watery gathering, and a child in it presenting to the passage; and if she finds it so, she must have a care of going to fetch the after-birth, till the woman be delivered of all the children she is pregnant with. Wherefore the first string must be cut, being first tied with a thread three or four double, and fasten the other end with a string to the woman’s thighs; and then removing the child already born, she must take care to deliver her of the rest, observing all the circumstances as with the first; after which it will be necessary to fetch away the after-birth or births. But of that I shall treat in another section; and first show what is to be done to the new-born infant.
Sect. II. Of the Cutting of the Child’s Navel-String.
Though this is accounted by many but a trifle, yet great care is to be taken about it; and it shows none of the least art and skill of a midwife to do it as it should be; and that it may be so done, the midwife ought to observe, 1. The time. 2. The place. 3. The manner. 4. The event.
1. The time is, as soon as ever the infant comes out of the womb, whether it brings part of the after-burden with it or not; for sometimes the child brings into the world a piece of the amnios upon its head, and is what midwives call the caul, and ignorantly, attribute some extraordinary virtue to the child that is so born: but this opinion is only the effect of their ignorance; for when the child is born with such a crown (as some call it) upon its brows, it generally betokens weakness, and denotes a short life. But to proceed to the matter in hand. As soon as the child is come into the world, it should be considered whether it is weak or strong; and if it be weak, let the midwife gently put back part of the vital and natural blood into the body of the child by its navel; for that recruits a weak child (the vital and natural spirits being communicated by the mother to the child by its navel-string); but if the child be strong, the operation is needless. Only let me advise you, that many children that are born seemingly dead, may be soon brought to life again, if you squeeze six or seven drops of blood out of that part of the navel-string which is cut off, and give it to the child inwardly.
2. As to the place in which it should be cut, that is, whether it should be cut long or short, it is that which authors can scarcely agree in, and which many midwives quarrel about; some prescribing it to be cut at four fingers’ breadth, which is, at best, but an uncertain rule, unless all fingers were of one size.
3. As to the manner in which it must be cut, let the midwife take a brown thread, four or five times double, of an ell long or thereabouts, tied with a single knot at each of the ends, to prevent their entangling; and with this thread so accommodated (which the midwife must have in readiness before the woman’s labour, as also a good pair of scissors, that no time may be lost) let her tie the string within an inch of the abdomen with a double knot, and, turning about the end of the thread, let her tie two more on the other side of the string, reiterating it again, if it be necessary; then let her cut off the navel another inch below the ligatures, towards the after-birth, so that there only remains but two inches of the string, in the midst of which will be the knot we speak of, which must be so close knit as not to suffer a drop of blood to squeeze out of the vessels; but care must be taken, not to knit it so strait as to cut it in two, and therefore, the thread must be pretty thick, and pretty strait cut, it being better too strait than too loose; for some children have miserably lost their lives, with all their blood, before it was discovered, because the navel-string was not well tied; therefore great care must be taken that no blood squeeze through; for if there do, a new knot must be made with the rest of the string. You need not fear to bind the navel-string very hard, because it is void of sense, and that part which you leave falls off in a very few days, sometimes in six or seven, or sooner, but never tarries longer than eight or nine.
4. The last thing I mentioned was the event or consequence, or what follows cutting the navel-string. As soon as the navel-string is cut off, apply a little cotton or lint to the place to keep it warm, lest the cold enter into the body of the child, which it most certainly will do, if you have not bound it hard enough. If the lint or cotton you apply to it be dipped in the oil of roses, it will be the better; and then put another small rag three or four times double upon the abdomen: upon the top of all, put another small bolster; and then swathe it with a linen swathe, four fingers broad, to keep it steady, lest by moving too much, or by being continually stirred from side to side, it comes to fall off before the navel-string which you left remaining is falling off. It is the usual custom of midwives to put a piece of burnt rag to it, which we commonly call tinder; but I would advise them to put a little ammoniac to it, because of its drying quality.