Aristotle's works: / Containing the Master-piece, Directions for Midwives, and Counsel and Advice to Child-bearing Women with Various Useful Remedies

by pseud. Aristotle

Sect. I. How to deliver a Woman of a Dead Child, by Manual Operation.

When manual operation is necessary, let the operator acquaint the woman of the absolute necessity there is for such an operation; and that, as the child has already lost its life, there is no other way left for the saving of hers. Let him also inform her, for her encouragement, that he doubts not, with the divine blessing, to deliver her safely; and that the pain arising thereby will not to be so great as she fears. Then let him stir up the woman’s pains by giving her some sharp clyster, to excite her throes to bear down and bring forth the child. And if this prevail not, let him proceed with the manual operation.

First, therefore, let her be placed across the bed that he may operate the easier, and let her lie on her back, with her hips a little higher than her head, or at least the body equally placed, when it is necessary to put back or turn the infant to give it a better posture. Being thus situated, she must fold her legs so as her heels be towards her body, and her thighs spread, and held so by a couple of strong persons: there must be others also to support her under her arms, that the body may not slide down when the child is drawn forth; for which, sometimes, a great strength is required. Let the sheets and blankets cover her thighs, for decency’s sake, and with respect to the assistance, and also to prevent her catching cold; the operator herein governing himself as well with respect to his convenience, and the facility and surety of the operation, as to other things. Then let him anoint the entrance of the womb with oil or fresh butter, if necessary, that so with more ease he may introduce his hand, which must also be anointed; and having, by the signs before-mentioned, received satisfaction that the child is dead, he must do his endeavours to fetch it away as soon as he possibly can. If the child offer the head first, he must gently put it back, until he hath liberty to introduce his hand quite into the womb; then sliding it along to find the feet, let him draw it forth by them, being very careful to keep the head from being locked into the passage, and that it be not separated from the body; which may be effected the more easily, because the child being very rotten and putrefied, the operator needs not be so mindful to keep the breast and face downwards as he is in living births. But if, notwithstanding all these precautions, by reason of the child’s putrefaction, the head should be separated and left behind in the womb, it must be drawn forth according to the directions which have been given in the third section of this chapter. But when the head, coming first, is so far advanced that it cannot well be put back, it is better to draw it forth so, than to torment the woman too much by putting it back to turn it and bring it by the feet: but the head being a part round and slippery, it may so happen that the operator cannot take hold of it by reason of its moisture, nor put them up to the side of it, because of its bigness; he must therefore take a proper instrument, and put it up as far as he can, without violence, between the womb and the child’s head, observing to keep the point of it towards the head (for the child being dead before, there can be no danger in the operation,) and let him fasten it there, giving it hold of the bones of the skull, that it may not slide; and after it is well fixed in the head, he may therewith draw it forth, keeping the ends of his left hand flat upon the opposite side, the better to help to disengage it, and by wagging it a little, to conduct it directly out of the passage, until the head be quite born; and then taking hold of it with the hands only, the shoulders may be drawn into the passage, and so sliding the fingers of both hands under the arm-pits, the child may be quite delivered; and then the after-burden fetched, to finish the operation, being careful not to pluck the navel-string too hard, lest it break, as often happens, when it is corrupt.

If the dead child comes with the arms up to the shoulder so extremely swelled that the woman must suffer too great violence to have it put back, it is then (being first well assured that the child is dead) best to take it off by the shoulder points, by twisting three or four times about, which is very easily done by reason of the softness and tenderness of the body. After the arm is so separated, and no longer possesses the passage, the operator will have more room to put up his hand into the womb, to fetch the child by the feet and bring it away.

But although the operator be sure the child is dead in the womb, yet he must not therefore presently use instruments, because they are never to be used but when hands are not sufficient, and there is no other remedy to prevent the woman’s danger, or to bring forth the child any other way; and the judicious operator will choose that way which is the least hazardous and most safe.

Sect. II. How a Woman must be Delivered, when the Child’s Feet come first.

There is nothing more obvious to those whose business it is to assist labouring women, than that the several unnatural postures in which children present themselves at their birth, are the occasion of most of the bad labour and ill accidents that happen unto them in that condition.

And since midwives are very often obliged, because of the unnatural situations, to draw the children forth by the feet, I conceive it to be most proper first to show how a child must be brought forth that presents itself in that posture, because it will be a guide to several of the rest.

I know indeed in this case it is the advice of several authors to change the figure, and place the head so that it may present to the birth; and this counsel I should be very inclinable to follow, could they but also show how it may be done. But it will appear very difficult, if not impossible, to be performed, if we would avoid the danger that by such violent agitations both the mother and the child must be put into; and therefore my opinion is, that it is better to draw forth by the feet, when it presents itself in that posture, than to venture a worse accident by turning it.

As soon, therefore, as the waters are broken, and it is known that the child comes thus, and that the womb is open enough to admit the midwife’s or operator’s hand into it, or else by anointing the passage with oil or hog’s grease, to endeavour to dilate it by degrees, using her fingers to this purpose, spreading them one from the other, after they are together entered, and continuing to do so till they be sufficiently dilated, then, taking care that her nails be well pared, no rings on her fingers, and her hands well anointed with oil or fresh butter, and the woman placed in the manner directed in the former section, let her gently introduce her hand into the entrance of the womb, where, finding the child’s feet, let her draw it forth in the manner I shall presently direct; only let her first see whether it presents one foot or both; and if but one foot, she ought to consider whether it be the right foot or left, and also in what fashion it comes: for, by that means, she will soon come to know where to find the other, which, as soon as she knows and finds, let her gently draw it forth with the other; but of this she must be especially careful, viz. that the second be not the foot of another child; for, if so, it may be of the utmost consequence, for she may sooner split both mother and child, than draw them forth: but this may be easily prevented, if she but slide the hand up by the first leg and thigh to the twist, and there find both thighs joined together, and descending from one and the same body. And this is also the best means to find the other foot, when it comes but with one.