Sect. V. How to Deliver a Woman when the Child presents one or both Hands together with the Head.
Sometimes the infant will present some other part together with its head; which if it does, it is usually with one or both its hands; and this hinders the birth, because the hands take up part of that passage which is little enough for the head alone: besides when this happens, they generally cause the head to lean on one side; and therefore this position may be well styled unnatural. When the child presents thus, the first thing to be done, after it is perceived, must be to prevent it from coming down more, or engaging further in the passage; and therefore the operator having placed the woman on the bed, with her head lower than her thighs, must guide and put back the infant’s hand with his own as much as may be, or both of them, if they both come down, to give way to the child’s head; and this being done, if the head be on one side, it must be brought into its natural posture, in the middle of the passage, that it may come in a straight line, and then proceed as directed in the foregoing section.
Sect. VI. How a Woman ought to be delivered, when the Hands and Feet of the Infant come together.
There are none but will readily grant, that when the hands and feet of an infant present together, the labour must be unnatural; because it is possible a child can be born in that manner. In this case therefore, when the midwife guides her hand to the orifice of the womb, she will perceive only many fingers close together; and if it be not sufficiently dilated, it will be a good while before the hands and feet be sufficiently distinguished; for they are sometimes so shut and pressed together, that they seem to be all of one and the same shape: but where the womb is open enough to introduce the hand into it, she will easily know which are the hands and which are the feet; and having taken particular notice thereof, let her slide up her hand, and presently direct it towards the infant’s breast, which she will find very near, and then let her very gently thrust back the body towards the bottom of the womb leaving the feet in the same place where she found them: and then, having placed the woman in a convenient posture, that is to say, her thighs a little raised above her breast, and (which situation ought also to be observed when the child is to be put back into the womb), let the midwife afterwards take hold of the child by the feet, and draw it forth, as is directed in the second section.
This labour, though somewhat troublesome, yet is much better than when the child presents only its hands; for then the child must be quite turned round before it can be drawn forth; but in this they are ready, presenting themselves, and there is little to do but to lift and thrust back the upper part of the body, which is almost done of itself, by drawing by the feet alone.
I confess there are many authors that have written of labours, who would have all wrong births reduced to a natural figure; which is, to turn it that it may come with the head first. But those that have written thus are such as never understood the practical part; for if they had the least experience therein, they would know that it is impossible; at least, if it were to be done, that violence must necessarily be used in doing it, that would very probably be the death of both mother and child in the operation.
I would therefore lay down, as a general rule, that whensoever a child presents itself wrong to the birth, in what posture soever, from the shoulders to the feet, it is the best way, and the soonest done, to draw it out by the feet; and that it is better to search for them, if they do not present themselves, than to try to put them into their natural posture, and place the head foremost; for the great endeavours necessary to be used in turning the child in the womb, do so much weaken both the mother and the child, that there remains not afterwards strength enough to commit the operation to the work of nature; for, usually, the woman hath no more throes or pains fit for labour after she has been so wrought upon: for which reason it would be difficult, and tedious at best; and the child by such an operation made very weak, would be in extreme danger of perishing before it could be born. It is therefore much better in these cases to bring it away immediately by the feet; searching for them, as I have already directed, when they do not present themselves; by which the mother will be prevented a tedious labour, and the child be often brought alive into the world, who otherwise could hardly escape death.
Sect. VII. How a Woman should be delivered that has Twins, which present themselves in different Postures.
We have already spoken something of the birth of twins in the chapter of natural labour; for it is not an unnatural labour barely to have twins, provided they come in a right position to the birth. But when they present themselves in different postures, they come properly under the denomination of unnatural labours; and if when one child presents itself in a wrong figure, it makes the labour dangerous and unnatural, it must needs make it much more so when there are several, and render it not only more painful to the mother and children, but to the operator also; for they often trouble each other, and hinder both their births. Besides which, the womb is so filled with them, that the operator can hardly introduce his hand without much violence, which he must do, if they are to be turned or thrust back to give them a better position.
When a woman is pregnant with two children, they rarely present to the birth together, the one generally being more forward than the other; and that is the reason that but one is felt, and that many times the midwife knows not that there are twins till the first is born, and that she is going to fetch away the after-birth. In the first chapter, wherein I treated of natural labour, I have showed how a woman should be delivered of twins, presenting themselves both right; and therefore, before I close the chapter of unnatural labour, it only remains that I show what ought to be done when they either both come wrong, or one of them only, as for the most part it happens; the first generally coming right, and the second with the feet forward, or in some worse posture. In such a case, the birth of the first must be hastened as much as possible, to make way for the second, which is best brought away by the feet, without endeavouring to place it right, because it has been, as well as its mother, already tired and weakened by the birth of the first, and there would be greater danger of its death than likelihood of its coming out of the womb that way.