As soon as the midwife has found both the child’s feet, she may draw them forth, and holding them together, may bring them by little in this manner; taking afterwards hold of the arms and thighs, as soon as she can come at them, drawing them so till the hips come forth. While this is doing, let her observe to wrap the parts in a single cloth, that so her hands, being always greasy, slide not on the infant’s body, which is very slippery, because of the vicious humours which are all over it; which being done, she may take hold under the hips, so as to draw it forth to the beginning of the breast; and let her on both sides with her hand bring down the child’s hand along its body, which she may easily find; and then let her take care that the belly and face of the child be downwards: for, if they should be upwards, there would be some danger of its being stopped by the chin, over the share-bone; and therefore, if it be not so, she must turn it to the posture; which may easily be done, if she takes proper hold of the body when the breast and arms are forth, in the manner as we have said, and draws it, turning it in proportion on that side which it most inclines to, till it be turned with the face downwards; and so, having brought it to the shoulders, let her lose no time, desiring the woman at the same time to bear down, that so drawing the head at that instant may take its place, and not be stopped in the passage. Some children there are whose heads are so big, that when the whole body is born, yet that stops the passage, though the midwife takes all possible care to prevent it. And when this happens, she must endeavour to draw forth the child by the shoulders, taking care that she separate not the body from the head, (as I have known it done by the midwife,) discharging it by little and little from the bones in the passage with the fingers of each hand, sliding them on each side opposite the other, sometimes above and sometimes under, till the work be ended; endeavouring to despatch it as soon as possible, lest the child be suffocated, as it will unavoidably be, if it remain long in that posture; and this being well and carefully effected, she may soon after fetch away the after-birth, as I have before directed.
Sect. III. How to bring away the Head of the Child, when separated from the Body, and left behind in the Womb.
Though the utmost care be taken in bringing away the child by the feet, yet if it happen to be dead, it is sometimes so putrefied and corrupt, that with the least pull the head separates from the body, and remains alone in the womb, and cannot be brought away but with a manual operation and great difficulty, it being extremely slippery, by reason of the place where it is, and from the roundness of its figure, on which no hold can be taken; and so very great is the difficulty in this case, that sometimes two or three able practitioners of midwifery have, one after the other, left the operation unfinished, as not able to effect it, after the utmost industry, skill and strength; so that the woman, not being able to be delivered, perished. To prevent which fatal accident, let the following operation be observed.
When the infant’s head separates from the body, and is left alone behind, whether through putrefaction or otherwise, let the operator immediately, without any delay, whilst the womb is still open, direct up his right hand to the mouth of the head (for no other hole can there be had), and having found it, let him put one or two of his fingers into it, and the thumb under its chin; then let him draw it by little and little, holding it by the jaws: but if that fails, as sometimes it will, when putrefied, then let him pull out the right hand, and slide up his left with which he must support the head, and with the right let him take a narrow instrument called a crotchet, but let it be strong, and with a single branch, which he must guide along the inside of his hand, with the point of it towards it, for fear of hurting the womb; and having thus introduced it, let him turn it towards the head, to strike either in an eye-hole, or the hole of an ear, or behind the head, or else between the sutures, as he finds it most convenient and easy; and then draw forth the head so fastened with the said instrument, still helping to conduct it with his left hand; but when he hath it brought near the passage, being strongly fastened to the instrument, let him remember to draw forth his hand, that the passage, not being filled with it, may be larger and easier, keeping still a finger or two on the side of the head, the better to disengage it.
There is also another method, with more ease and less hardship than the former: let the operator take a soft fillet or linen slip, of about four fingers’ breadth, and the length of three quarters of an ell, or thereabouts, taking the two ends with the left hand, and the middle with the right, and let him so put it up with his right as that it may be beyond the head, to embrace it as a sling doth a stone, and afterwards draw forth the fillet by the two ends together; it will thus be easily drawn forth, the fillet not hindering the least passage, because it takes up little or no space.
When the head is fetched out of the womb, care must be taken that not the least part of it be left behind, and likewise to cleanse the womb of the after-burden, if yet remaining. If the burden be wholly separated from the side of the womb, that ought to be first brought away, because it may also hinder the taking hold of the head. But if it still adheres to the womb, it must not be meddled with till the head be brought away; for if one should endeavour to separate it from the womb, it might then cause a flooding, which would be augmented by the violence of the operation; the vessels to which it is joined remaining for the most part open as long as the womb is distended, which the head causeth while it is retained in it, and cannot be closed till this strange body be voided, and this it doth by contracting and compressing itself together, as has been more fully before explained. Besides, the after-birth remaining thus cleaving to the womb during the operation prevents it from receiving easily either bruise or hurt.
Sect. IV. How to deliver a Woman when the Child’s Head is presented to the Birth.
Though some may think it a natural labour, when the child’s head comes first; yet, if the child’s head present not the right way, even that is an unnatural labour; and therefore, though the head comes first, yet if it be the side of the head instead of the crown, it is very dangerous both to the mother and child, for the child’s neck would be broken, if born in that manner; and by how much the mother’s pains continue to bear the child, which is impossible unless the head be rightly placed, the more the passages are stopped. Therefore, as soon as the position of the child is known, the woman must be laid with all speed, lest the child should advance further into this vicious posture, and thereby render it more difficult to thrust it back, which must be done, in order to place the head right in the passage, as it ought to be.
To this purpose, therefore, place the woman so that her thighs may be a little higher than her head and shoulders, causing her to lean a little upon the opposite side to the child’s ill posture; then let the operator slide up his hand, well anointed with oil, by the side of the child’s head, to bring it right gently with his fingers between the head and the womb; but if the head be so engaged that it cannot be done that way, he must put his hand up to the shoulders, that so by thrusting them back a little into the womb, sometimes on the one side and sometimes on the other, he may, by little and little, give a natural position. I confess it would be better, if the operator could put back the child by its shoulders with both hands: but the head takes up so much room, that he can only make use of his fingers, with which he must perform this operation, and with the help of the finger ends of the other hand put forward the child’s birth, as in natural labour.
Some children present their face first, having their hands turned back, in which posture it is extremely difficult for a child to be born; and if it continues so long, the face will be swelled, and become black and blue, so that it will at first appear monstrous, which is occasioned as well by the compression of it in that place, as by the midwife’s fingers in handling it, in order to place it in a better posture. But this blackness will wear away in three or four days’ time, by anointing it often with oil of sweet almonds. To deliver the birth, the same operation must be used as in the former, when the child comes first with the side of the head; only let the midwife or operator work very gently, to avoid as much as possible the bruising the face.