There are many postures in which women are delivered; some sitting in a chair, supported by others, or resting on the bed; some again upon their knees and resting on their arms; but the safest and most commodious way, is in the bed, and then the midwife ought to observe the following rules:—Let her lay the woman upon her back, with her head a little raised by means of a pillow, with similar supports for her loins and
buttocks, which latter should also be raised, for if she lies low, she cannot be delivered so easily. Then let her keep her knees and thighs as far apart as she can, her legs bent inward towards each other, and her buttocks, the soles of her feet and her heels being placed upon a small rest, placed for the purpose, so that she may be able to strain the stronger. In case her back should be very weak, a swathing band should be placed under it, the band being doubled four times and about four inches broad. This must be held by two persons who must raise her up a little every time her pains come on, with steady hands and in even time, but if they be not exact in their movements, they had better leave her alone. At the same time two women must hold her shoulders so that she may strain out the foetus more easily; and to facilitate this let one stroke or press the upper part of her stomach gently and by degrees. The woman herself must not be nervous or downhearted, but courageous, and forcing herself by straining and holding her breath.
When delivery is near, the midwife must wait patiently until the child's head, or some limb, bursts the membranes, for if the midwife through ignorance, or through haste to go to some other woman, as some have done, tears the membrane with her nails, she endangers both the woman
and the child; for by lying dry and lacking that slipperiness which should make it easy, it comes forth with severe pains.
When the head appears, the midwife must hold it gently between her hands, and draw the child, whenever the woman's pains are upon her, but at no other times; slipping her forefingers under its armpits by degrees, and not using a rough hand in drawing it out, lest the tender infant might become deformed by such means. As soon as the child is taken out, which is usually with its face downwards,—it should be laid upon its back, that it may receive external respiration more freely; then cut the navel string about three inches from the body, tying the end which adheres to it with a silk string, as closely as you can; then cover the child's head and stomach well, allowing nothing to touch its face.
When the child has been thus brought forth, if it be healthy lay it aside, and let the midwife attend to the patient by drawing out the afterbirth; and this she may do by wagging and stirring it up and down, and afterwards drawing it out gently. And if the work be difficult, let the woman hold salt in her hands, close them tightly and breathe hard into them, and by that she will know whether the membranes are broken or not. It may also be known by making her strain or vomit; by putting her fingers down her throat,
or by straining or moving her lower parts, but let all be done immediately. If this should fail, let her take a draught of elder water, or the yolk of a new laid egg, and smell a piece of asafoetida, especially if she is troubled with a windy colic. If she happen to take cold, it is a great obstruction to the afterbirth; in such cases the midwife ought to chafe the woman's stomach gently, so as to break, not only the wind, but also to force the secundine to come down. But if these should prove ineffectual, the midwife must insert her hand into the orifice of the womb and draw it out gently.
Having thus discussed common births, or such as are generally easy, I shall now give directions in cases of extremity.