It requires great Care to prevent the Protrusion of the Womb in some Women of a large Pelvis, or Opening between the Bones; or if the After-birth remains closely fixed, the Womb, in a very open Pelvis, may be thrust by the Violence of the Pains; or drawn out of the Body by an unskilful Hand, which is commonly very soon fatal to the poor Woman; and I believe happens much oftner than is apprehended, tho’ industriously conceal’d, by guilty Midwives, under the Colour of the poor Woman’s dying in Child-bed, from some other Cause. DEVENTER says, he saw a sad Spectacle at the HAGUE, the Head of the Child excluded to the Shoulders quite without the Passage, when Three-fourth Parts of the Head were conceal’d within the Womb, the Crown appearing within its inward Orifice†.
† See Chir. Op. Part ii. Page 32.
A much worse Case happen’d in my Neighbourhood, Sept. 23, 1749. I was call’d to a Woman, whose Child, on the 21st came unexpectedly, without the least Assistance, in the Presence of an old Midwife of large Practice; she puzzled an Hour, as I was inform’d, to bring away the After-birth, which closely adhered to the Fund of the Womb; while the unfortunate Woman lay senseless, saving the Memory of being long expos’d to the Cold, when she came to herself; after which she continued in violent Labour-like Pains; upon Scrutiny, I found a large Substance in the Pelvis, of the Size of a Child’s Head, considerably resisting my Touch; I observ’d on Trial, a Part of the Woman’s Body every Way interposed between my Fingers and this Substance, by her Sensibility of my Touch; therefore contenting myself with giving her some palliative Medicines, and telling the Persons present, a Mole, as I thought, or Child still remain’d to come away, I for that Time, took my Leave: On the 24th, she was said to be much better; on the 29th, I was again call’d to this poor Woman, and inform’d, that upon her first going to Stool, since I had before seen her, which happen’d the same Day, the large Substance before-mention’d, came intirely out of her Body; to which it join’d by a thinner Substance, of some length: I now perceived it was no less than the Womb turned inside out, suspended by its Ligaments, and joining to the Vagina, but very much swell’d by the Obstruction of the circulating Humours; And an old Gentlewoman, who was present when the Child was born, inform’d me, she saw the Midwife draw this Body from the Woman, by the Navel-string, and indeed, the Impression of her Nails, in separating the After-birth, remain’d still visible at the Bottom of the Womb, and the Midwife having long expos’d the Patient, put this inverted Womb again into her Body.
The Condition of the Part, after so long Delay, did not admit the Possibility of rightly reinstating it; I therefore return’d it, as well as I could, into the Pelvis, and introduc’d a Pessary to retain it; and as this Person had already contracted a Hectick, I charg’d her, as she valu’d her Life, to confine herself strictly to a cooling Milk, or vegetable Diet; she has since had large Discharges of a bloody Corruption, with Portions of a fleshy Confidence from the Parts affected. In April, 1751, she told me the Discharge coming from her had long been much abated in Quantity, and what remain’d was the Whites; that she had an inward Fever, and the Piles, for which I gave her my Advice; her Complexion was chang’d from the most florid to a languishing Paleness.
My Brother, much better known in this Country, and longer practis’d in Midwifry, has been concern’d in furnishing Medicines for the Person, whose History I have given, altho’ by Means of his Absence, he did not attend her on the most emergent Occasions.
I have since been call’d to the Assistance of the old Midwife, who attended, and she frankly told me, she had another Woman under the like Circumstance, who died the same Day.
Having related such Things as occur in the most favourable Circumstances of Travil, about which all Midwives ought to be well inform’d, and those Injuries to which Women are sometimes liable, notwithstanding the most promising Appearances: In the next Place I proceed to shew, what are the Symptoms preceeding difficult Labours, which by timely Assistance, may be secured from the most dangerous, if not fatal Consequences, and are of great Moment to be known by Midwives, as well as Matrons and Child-bearing Women, to enable them to judge when it is absolutely necessary to recommend calling that Aid, which is beyond their Capacity to give.
CHAPTER VII. The Difficulty from the Membranes.
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N unforeseen Difficulty may occur, when Appearances are otherwise favourable, from the Strength of the Membranes, obstructing the Birth, and requiring great Caution to prevent; for in this Case, the Operator must break the Membranes, in order to promote the Birth; and as the Waters, they contain, are a Means to open the internal Orifice, lubricate the Passage, and facilitate the Birth; the breaking the Membranes too soon, will render the Labour more tedious; and should it be too long delay’d, the Patient’s Misery would be prolonged; wherefore the Midwife must not break them, before the Orifice is sufficiently open to admit the Head, when she may tear them with her Nails, but by no Means pull them, for as they adhere to the After-birth, she might by that Means separate it, and bring on a Flooding.