quite contrary to nature, or to speak more plainly, that which I call unnatural.
Now, there are four general ways a child may come wrong. (1) When any of the foreparts of the body first present themselves. (2) When by an unhappy transposition, any of the hinder parts of the body first present themselves. (3) When either of the sides, or, (4) the feet present themselves first. To these, the different wrong postures that a child can present itself in, may be reduced.
SECTION 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 hers. Let him also inform her, for her encouragement, that he doubts not, with the divine blessing, to deliver her safely, and that the pains arising therefrom will not 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 prevails 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 buttocks, and her thighs spread, and so held 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 great strength is required. Let the sheets and blankets cover her thighs for decency's sake, and with respect to the assistants, 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 to the womb with oil or fresh butter, if necessary, that with so more ease he may introduce his hand, which must also be anointed, and having by the signs above 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, under the belly, 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 need 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 also happen that the operator cannot take hold of it with his fingers by reason of its moisture, nor put them up to the side of it, because the passage is filled with 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 (for the child being dead before, there can be no danger in the operation), and let him fasten it there, giving it hold upon one 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 the fingers 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 his hands only, the shoulders being drawn into the passage, and so sliding the fingers of both hands under the armpits, 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 arm up to the shoulders so extremely swelled that the woman must suffer too great violence to have it put back, it is then (being first well assured the child is dead) best to take it off by the shoulder joints, 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 is 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.