Having thus looked into the cause of hard labour, I will now show the industrious midwife how she may minister some relief to the labouring woman under these difficult circ.u.mstances. But it will require judgment and understanding in the midwife, when she finds a woman in difficult labour, to know the particular obstruction, or cause thereof, that so a suitable remedy may be applied; as for instance, when it happens by the mother's being too young and too narrow, she must be gently treated, and the pa.s.sages anointed with oil, hog's lard, or fresh b.u.t.ter, to relax and dilate them the easier, lest there should happen a rupture of any part when the child is born; for sometimes the peritoneum breaks, with the skin from the privities to the fundament.

But if the woman be in years with her first child, let her lower parts be anointed to mollify the inward orifice, which in such a case being more hard and callous, does not easily yield to the distention of labour, which is the true cause why such women are longer in labour, and also why their children, being forced against the inward orifice of the womb (which, as I have said, is a little callous) are born with great b.u.mps and bruises on their heads.

Those women who are very small and mis-shaped, should not be put to bed, at least until the waters are broken, but rather kept upright and a.s.sisted to walk about the chamber, by being supported under the arms; for by that means, they will breathe more freely, and mend their pains better than on the bed, because there they lie all of a heap. As for those that are very lean, and have hard labour from that cause, let them moisten the parts with oil and ointments, to make them more smooth and slippery, that the head of the infant, and the womb be not so compressed and bruised by the hardness of the mother's bones which form the pa.s.sage. If the cause be weakness, she ought to be strengthened, the better to support her pains, to which end give her good jelly broths, and a little wine with a toast in it. If she fears her pains, let her be comforted, a.s.suring her that she will not endure any more, but be delivered in a little time. But if her pains be slow and small, or none at all, they must be provoked by frequent and pretty strong clysters; let her walk about her chamber, so that the weight of the child may help them forward. If she flood or have strong convulsions she must then be helped by a speedy delivery; the operation I shall relate in this section of unnatural labours. If she be costive, let her use clysters, which may also help to dispel colic, at those times very injurious because attended with useless pains, and because such bear not downward, and so help not to forward the birth. If she find an obstruction or stoppage of the urine, by reason of the womb's bearing too much on the bladder, let her lift up her belly a little with her hands, and try if by that she receives any benefit; if she finds she does not, it will be necessary to introduce a catheter into her bladder, and thereby draw forth her urine. If the difficulty be from the ill posture of the woman, let her be placed otherwise, in a posture more suitable and convenient for her; also if it proceeds from indispositions of the womb, as from its oblique situation, etc., it must be remedied, as well as it can be, by the placing her body accordingly; or, if it be a vicious conformation, having the neck too hard, too callous, too straight, it must be anointed with oil and ointments, as before directed. If the membranes be so strong that the waters do not break in due time, they may be broken with the fingers, if the midwife be first well a.s.sured that the child is come forward into the pa.s.sage, and ready to follow presently after; or else, by the breaking of the waters too soon, the child may be in danger of remaining dry a long time; to supply which defect, you may moisten the parts with fomentations, decoctions, and emollient oils; which yet is not half so well as when nature does her work in her own time, with the ordinary slime and waters. The membranes sometimes do press forth with the waters, three or four fingers' breadth out of the body before the child resembling a bladder full of water; but there is no great danger in breaking them, if they be not already broken; for when the case is so, the child is always in readiness to follow, being in the pa.s.sage, but let the midwife be very careful not to pull it with her hand, lest the after-burden be thereby loosened before its time, for it adheres thereto very strongly. If the navel-string happen to come first, it must presently be put up again, and kept so, if possible, or otherwise, the woman must be immediately delivered. But if the after-burden should come first, it must not be put up again by any means; for the infant having no further occasion for it, it would be but an obstacle if it were put up; in this case, it must be cut off, having tied the navel-string, and afterwards draw forth the child with all speed that may be, lest it be suffocated.

SECT. V.--_Of Women labouring of a dead Child._

When the difficulty of labour arises from a dead child, it is a great danger to a mother and great care ought to be taken therein; but before anything be done, the midwife ought to be well a.s.sured that the child is dead indeed, which may be known by these signs.

(1) The breast suddenly slacks, or falls flat, or bags down. (2) A great coldness possesses the belly of the mother, especially about the navel.

(3) Her urine is thick, with a filthy stinking settling at the bottom.

(4) No motion of the child can be perceived; for the trial whereof, let the midwife put her hand into warm water, and lay it upon the belly, for that, if it is alive, will make it stir. (5) She is very subject to dreams of dead men, and affrighted therewith. (6) She has extraordinary longings to eat such things as are contrary to nature. (7) Her breath stinks, though not used so to do. (8) When she turns herself in her bed, the child sways that way like a lump of lead.

These things being carefully observed, the midwife may make a judgment whether the child be alive or dead, especially if the woman take the following prescription:--"Take half a pint of white wine and burn it, and add thereto half an ounce of cinnamon, but no other spices whatever, and when she has drunk it, if her travailing pains come upon her, the child is certainly dead; but if not, the child may possibly be either weak or sick, but not dead. This will bring her pains upon her if it be dead, and will refresh the child and give her ease if it be living; for cinnamon refresheth and strengtheneth the child.

Now, if upon trial it be found the child is dead, let the mother do all she can to forward the delivery, because a dead child can in no wise be helpful therein. It will be necessary, therefore, that she take some comfortable things to prevent her fainting, by reason of the putrid vapours arising from the dead child. And in order to her delivery let her take the following herbs boiled in white wine (or at least as many of them as you can get), viz., dittany, betony, pennyroyal, sage, feverfew, centaury, ivy leaves and berries. Let her also take sweet basil in powder, and half a drachm at a time in white wine; let her privities also be anointed with the juice of the garden tansey. Or take the tansey in the summer when it can most plentifully be had, and before it runs up to flower, and having bruised it well, boil it in oil until the juice of it be consumed. If you set it in the sun, after you have mixed it with oil, it will be more effectual. This, an industrious midwife, who would be prepared against all events, ought to have always by her. As to the manner of her delivery, the same methods must be used as are mentioned in the section of natural labour. And here again, I cannot but commend the stone aet.i.tes, held near the privities, whose magnetic virtue renders it exceedingly necessary on this occasion, for it draws the child any way with the same facility that the load-stone draws iron.

Let the midwife also make a strong decoction of hyssop with water, and let the woman drink it very hot, and it will in a little time bring away the dead child.

If, as soon as she is delivered of the dead child, you are in doubt that part of the afterbirth is left behind in the body (for in such cases as these many times it rots, and comes away piece-meal), let her continue drinking the same decoction until her body be cleansed.

A decoction made of herbs, muster-wort, used as you did the decoction of hyssop, works the effect. Let the midwife also take the roots of pollodum and stamp them well; warm them a little and bind them on the sides of her feet, and it will soon bring away the child either dead or alive.

The following medicines also are such as stir up the expulsive faculty, but in this case they must be stronger, because the motion of the child ceases.

Take savine, round birthwort, trochisks of myrrh, castor, cinnamon and saffron, each half a drachm; make a powder, give a drachm.

Or she may purge first, and then apply an emollient, anointing her about the womb with oil of lilies, sweet almonds, camomiles, hen and goose-grease. Also foment to get out the child, with a decoction of mercury, orris, wild cuc.u.mbers, saecus, broom flowers. Then anoint the privities and loins with ointment of sow-bread. Or, take coloquintida, agaric, birthwort, of each a drachm; make a powder, add ammoniac.u.m dissolved in wine, ox-gall, each two drachms. Or make a fume with an a.s.s's hoof burnt, or gallianum, or castor, and let it be taken in with a funnel.

To take away pains and strengthen the parts, foment with the decoction of mugwort, mallows, rosemary, with wood myrtle, St. John's wort, each half an ounce, spermaceti two drachms, deer's suet, an ounce; with wax make an ointment. Or take wax six ounces, spermaceti an ounce; melt them, dip flux therein, and lay it all over her belly.

If none of these things will do, the last remedy is to try surgery, and then the midwife ought without delay to send for an expert and able man-midwife, to deliver her by manual operation, of which I shall treat more at large in the next chapter.

FOOTNOTES:

[10] Horse-parsley.

CHAPTER VI

_Of Unnatural Labour._

In showing the duty of a midwife, when the child-bearing woman's labour is unnatural, it will be requisite to show, in the first place, what I mean by unnatural labour, for that women do bring forth in pain and sorrow is natural and common to all. Therefore, that which I call unnatural is, when the child comes to the birth in a contrary posture to that which nature ordained, and in which the generality of the children come into the world.

The right and natural birth is when the child comes with its head first; and yet this is too short a definition of a natural birth; for if any part of the head but the crown comes first, so that the body follows not in a straight line, it is a wrong and difficult birth, even though the head comes first. Therefore, if the child comes with its feet first, or with the side across, it is 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 b.u.t.tocks, 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 a.s.sistants, 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 b.u.t.ter, 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 pa.s.sage; 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 pa.s.sage 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 pa.s.sage, until the head be quite born; and then, taking hold of it with his hands only, the shoulders being drawn into the pa.s.sage, 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 a.s.sured 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 pa.s.sage, 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.

SECT. II.--_How a Woman must be Delivered when the Child's Feet come first._

There is nothing more obvious to those whose business it is to a.s.sist labouring women, than that the several unnatural postures in which children present themselves at the birth are the occasions of most of the bad labours and ill accidents that happen to them in that condition.

And since midwives are often obliged, because of their unnatural situations, to draw the children forth by the feet, I conceive it to be most proper first to show how a child must be brought forth that presents itself in that posture, because it will be a guide to several of the rest.

I know indeed in this case it is the advice of several authors to change the figure, and place the head so that it may present to the birth, and this counsel I should be very much inclined to follow, could they but also show how it may be done. But it will appear very difficult, if not impossible to be performed, if we would avoid the danger that by such violent agitations both the mother and the child must be put into, and therefore my opinion is, that it is better to draw forth by the feet, when it presents itself in that posture, than to venture a worse accident by turning it.

As soon, therefore, as the waters are broken, and it is known that the child come thus and that the womb is open enough to admit the midwife's or operator's hand into it, or else by anointing the pa.s.sage with oil or hog's grease, to endeavour to dilate it by degrees, using her fingers to this purpose, spreading them one from the other, after they are together entered, and continue to do so until they be sufficiently dilated, then taking care that her nails be well pared, no rings on her fingers and her hands well anointed with oil or fresh b.u.t.ter, and the woman placed in the manner directed in the former section, let her gently introduce her hand into the entrance of the womb, where finding the child's feet, let her draw it forth in the manner I shall presently direct; only let her first see whether it presents one foot or both, and if but one foot, she ought to consider whether it be the right foot or the left, and also in what fashion it comes; for by that means she will soon come to know where to find the other, which as soon as she knows and finds, let her draw it forth with the other; but of this she must be specially careful, viz., that the second be not the foot of another child; for if so, it may be of the utmost consequence, for she may sooner split both mother and child, than draw them forth. But this may be easily prevented if she but slide the hand up by the first leg and thigh to the waist, and there finding both thighs joined together, and descending from one and the same body. And this is also the best means to find the other foot, when it comes but with one.

As soon as the midwife has found both the child's feet, she may draw them forth, and holding them together, may bring them little 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, so that her hands being always greasy slide not in 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 the same danger of its being stopped by the chin, over the share-bone, and therefore, if it be not so she must turn it to that posture; which may easily be done if she takes a proper hold of the body when the b.r.e.a.s.t.s and arms are forth, in the manner we have said, and draw it, turning it in proportion on that side 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 pa.s.sage, 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 pa.s.sage 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 dispatch 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 putrid 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 well be taken; and so very great is the difficulty in this case that sometimes two or three very able pract.i.tioners in 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 owing to putrefaction or otherwise, let the operator immediately, without any delay, while the womb is yet 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 little by little, holding it by the jaws; but if that fails, as sometimes it will when putrefied, then let him pull off the right hand and slide up his left, with which he must support the head, and with the right hand let him take a narrow instrument called a _crochet_, 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 eyehole, or the hole of the 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 brought it near the pa.s.sage, being strongly fastened to the instrument, let him remember to draw forth his hand, that the pa.s.sage 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 does 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 pa.s.sage, because it takes up little or no s.p.a.ce.

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 until 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._