The Pro­vince of Mid­wives in the Prac­tice of their Art, by Wil­liam Clark, M. D. 1698–ca. 1780.

THE

PROVINCE

OF

MIDWIVES

IN THE

Practice of their A RT :

Ins­truct­ing them in the time­ly Know­ledge of such Dif­fi­cul­ties as re­quire the As­sist­ance of M EN ,

For the Preservation of

MOTHER and CHILD.

Very nec­es­sary for the Per­us­al of ALL the SEX int­er­est­ed in the Sub­ject,

And interspersed with some

New and Useful O BSERVATIONS .

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By WILLIAM CLARK, M. D.

And of the College of P HYSICIANS .

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Molliter Aufer Onus. O VID. F ASTI.

Printed for William Frederick , in B ATH ; and sold by M. Cooper , in Pater-Noster-Row , L ONDON .

MDCCLI.

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ADVERTISEMENT TO THE READER.

HE fol­low­ing small Tract will ap­pear con­temp­ti­ble to those who judge of the Worth of Books by their Bulk; but the Auth­or be­lieves such as are prac­tis’d in Mid­wif­ry will ack­now­ledge both the Want and Use­ful­ness of an Es­say of this Kind.

The Division of the Chapters, naturally arising from the various Circumstances which are treated of, will rather assist than burden the Memory, and admit of a ready Recourse to the short Instructions, in the Knowledge and Practice absolutely necessary, given under each Head.

The Reader will the more readily excuse any Defect in the Stile, when he considers the Necessity of a strict Expression on the Subject and the Difficulty a Man lies under, who writes not to the learned and experienced, but chiefly for the Sake of Persons ignorant in Anatomy and Philosophy, on a Subject which for the most Part excludes Information by Sight.

On such a Subject it will not be imagined Vanity or Applause can incline a Man to write a Pamphlet, rather than a Volume; when the Author is not conscious of having omitted the Instruction to be found in any Book extant, within the Limits of his Design; and hopes Experience will teach its Value both to Midwives and Matrons; and that the Perusal will not at all injure, if it does not improve, the most knowing and experienced.

HE Case of Child-bearing Women is very lamentable, in the Country especially, by Reason of the Ignorance and Unskilfulness of Midwives ; for by their Negligence and perverse Management, many Mothers and Children are destroyed, to the great Misfortune of particular Families, as well as of the Publick , at a Time when it suffers by the Loss of useful Hands, from too many other Causes. It were therefore to be wished, that all Midwives were so far appris’d of their Duty, as to be able to distinguish between Cases within their Abilities, and such Difficulties as may occasion the Loss of the Mother, or Child, or both, for Want of necessary Assistance.

They who intend to practice Midwifry in P ARIS , are oblig’d to attend anatomical Lectures and Dissections , that their Judgments may be inform’d, by the Knowledge of the Structure of the Body, for an Undertaking so hazardous in ignorant Hands.

London, at present, affords equal Advantages of Information; for the anatomical Wax-work, with suitable Lectures, might furnish as good a Qualification, with less Offence than real Dissections; and there are not wanting those who professedly instruct both Sexes by mechanical Demonstrations .

And for the future, it is to be hoped, there will be no Necessity for Men to have Recourse to P ARIS for Observation , since we have Infirmaries at Home for the Accommodation of Women in Child-bed; and tho’ they are expos’d naked to the Eye in the Hotel de Dieu , it must be confess’d, that the fundamental Rules of the Art are not built on what the Eye of the Observer can possibly discover in the most expert Operators ; but depend on Circumstances conceal’d from Sight, within the Body of the Patient.

But whatever Advantages L ONDON and W ESTMINSTER afford for the Instruction of Midwives, the Country is entirely destitute of them; and the best Books on the Subject, adorn’d with elegant Figures, can give but a very imperfect Notion of the Parts they represent, to any who have not attended Dissections , or seen more natural Resemblances than Cuts.

The Figures in Books, exhibit the Bones of the Pelvis , a Variety of Situations of the Infant, and Uterus , the Placenta and umbilical Vessels and Membranes, &c. whereas it would be no less serviceable to those, who assist Women in Travel, to be acquainted with the Viscera, liable to suffer by a difficult Labour; for the Liver , Spleen , Sweetbread and Kidneys , if not the principal Contents of the Chest, may be so injured by the ill Position of the Child, Compression of the Parts, and rash Assistance, as to prove fatal, more or lets immediately; occasioning Inflammations , Suppurations , Mortifications , Schirrhu’s , Cancers , or Consumptions .

The best Writers of Midwifry, such as Mauriceau , Deventer , De la Motte , Heister and others, explain the Causes of difficult Births, and the proper Methods of Assistance; but instead of improving most Country Midwives, fill them with Conceits of what, it is impossible, they should understand, and thereby occasion the Loss of great Numbers of Women and Children.

In order therefore that Midwives may acquit themselves with Reputation, and that Child-bearing Women may be the better Judges for themselves, or the charitable Part of the Sex, who are past these Dangers, the better able to assist their Friends and Neighbours, I shall endeavour to shew how far they may act with Safety under the Disadvantage of Country Practice, and describe those Symptoms, which for the most Part accompany hard Labours, very probably beyond their Abilities; when they will justly incur the Censure of Inhumanity and Rashness to depend upon their own Skill.

N this Chapter I have avoided the Use of Terms of Art, or explain’d them, in Regard to those for whom I chiefly write, as far as my Regard to Decency admits; but if any Word should occur not easily understood by any of my Readers, almost any English Dictionary will explain its Meaning; and it cannot be expected that any Book can instruct those who cannot read, tho’ I am sorry to say too many such assume the Office of Midwives .

As Curiosity may reasonably induce many of the Sex concern’d in the Subject of these Sheets, to be inform’d of somewhat of the Provision supreme Wisdom has made for the Existence of Children in the Womb, I shall briefly mention the most obvious Instruments relating to their Breeding and Birth, without puzzling my Readers with minute anatomical Descriptions.

The Vagina, or Passage, lies between the Neck of the Bladder and the large or strait Gut; it is connected at the inward extreme to the Womb , and called the outward Orifice at its beginning.

The Womb lies between the Bladder and Strait Gut , and is connected to both; during the Time of Breeding it increases in its Dimensions , and rising higher in the Body, by Reason of the Weight and Substance of it, with its Contents, at the Fund, or remote End of it, may be liable to swag too much forward or backward , or incline more or less to either Side, especially in such, as by their Occasions of Industry in Life are obliged to a Variety of indirect Situations; by which Means the inward Orifice is perverted from a direct Site with Respect to the Passage, and obstructs an easy Exclusion of the Infant in Travel.

The Placenta or After-birth , adhering to the Fund of the Womb , receives the Mother ’s Blood, by the Umbilical-Vessels , or Navel-String , conveys it to the Child for its Nourishment, and retransmits what is superfluous; maintaining by the Intercourse of Arteries and Veins , the Circulation of the Blood between Mother and Child.

The Membranes closely connected to the Placenta , and the Fund of the Womb , between both which they seem to take their Rise, contain the Humours in which the Infant swims, the better to preserve it from Injuries, by its Pressure against unyielding Parts, and the Humours before, and after the Breaking of the Membranes , commonly call’d the Breaking of the Waters , in the Birth, very much facilitate it, by opening the inward Orifice of the Womb , and lubricating the Passage for the Child: These Membranes come away with the Placenta , under the Name of the After-birth , or Secundines , indifferently.

The Pelvis or Bason , wherein the Uterus or Womb is seated, is form’d by the forward Bones, commonly call’d the Share-Bone , the Hip-Bones and their Continuation on each Side, and the lower Part of the Back-Bone , all which are so contiguous to each other, as to form this Cavity, generally much larger in Women than Men, cloathed with Muscles, between which the Vagina is inserted.

The right Formation of the Pelvis , is of the greatest Consequence in Favour of an easy Birth; when the Bones forming it, forward and backward , and on each Side, both above and below, don’t too much approach each other, and prevent the Exclusion of the Child between, by a free Admission.

S HALL pass over the Symptoms of Pregnancy, and the Distinctions of true and false Conceptions, as Things of which Midwives can seldom be expected to be proper Judges, and proceed to their Business, Natural Labours ; comprehending, under this Name, all such Cases, which require no further Assistance than Midwives , in a general Way, may easily give; or in their Absence a Nurse, or any sensible Woman, who has attended Deliveries.

After the Woman has gone her due Time of Nine Months, the most usual Term; the Signs preceeding Labour are Pains about the Back, Navel and Loins; a considerable Falling of the Tumour of the Belly, by the Burden’s sinking lower; and incommoding the Woman in walking; a more frequent Inclination to make Water: These Symptoms increase in Proportion as the Birth approaches; but as the most certain Knowledge of natural Births, can only be obtained by Touching the Woman in Labour, after having premised some Things concerning her proper Situation; I shall direct how it ought to be done.

ANY in the Country choose to be on their Legs or Knees , supported by a Woman on each Side, or lean on a Chair or Bed, and pass well enough through the present Scene of their Miseries: But I would preferably advise a Posture between lying and sitting , on a Pallet or common Bed, the Head and Shoulders being rais’d by Bolsters or Pillows, the Feathers beat back from the Bed’s Feet, to support the hollow of the Loins, and prevent the Pressure of any Thing against the Bottom of the Back Bone, to obstruct the Passage of the Child.

This Situation is most commodious, during Labour, for a Woman to assist her Pains with the greater Freedom of Respiration, and the least Fatigue and Expence of Spirits; especially if the labouring Woman lay hold of a folded Napkin, held stiffly for that Purpose, drawing her Feet upwards towards her Seat, separating her Knees, and fixing her Feet against something that will not easily give Way.

If the Person in Labour will not be in Bed, the End may be answered by her sitting in another ’s Lap, with the Bottom of her Back-Bone situate between the other’s Knees, with her own separated and supported, and Feet fixed as aforesaid, to favour her bearing down.

’Tis inconsistent with the Design of my Writing to describe all the convenient Situations, necessary in Cases of Difficulty, yet when the Operator has rectified all Obstructions to the Birth, the same Situation of the Body upon a Slope , from the Head downwards is most suitable, even altho’, for Conveniency, she should be deliver’d lying on one Side.

I shall, on this Occasion, observe, what I have found Advantageous in my own Experience, as well as consonant to the Advice of the best Writers on the Subject: That the Delivery on the Back , by the Assistance of one placed on each Side , supporting her by the Hams , with her Knees separated , and raising her Back Bone a little from the Bed during the Activity of Pains, and the Midwife ’s Assistance of either Sex, is vastly preferable to the Delivery on one Side , to which I impute the Loss of many Children brought by Turning , as well as a more tedious Labour in other Cases; because this Posture, in some Degree, contracts the Passage , and only admits the proper Separation of one Knee.

HIS ought to be put in Practice, as soon as, from the Symptoms given in the Third Chapter, it is reasonable to expect the Birth approaching; and a Child-bearing Person would be very much her own Enemy to refuse the only Means of giving a true Information of her Case, and the Knowledge how to do her the most effectual Service.

The Midwife, having her Nails well pared, and very smooth, and her Fingers anointed with Oil or Lard, must introduce the two fore Fingers of either Hand into the Passage or Neck of the Womb , as far as its inward Orifice, directing them with a gentle and easy Motion, somewhat upwards, as it were with a Tendency through the Passage towards the Navel ; in this Search she will find the internal Orifice, joining the Passage or Neck of the Womb more or less open, relaxed, and thinner than usual; and cautiously protruding her Fingers farther, she may possibly touch the Crown of the Child’s Head; she will easily, by the Sutures , or Opening between the Bones of the Skull, distinguish the Crown : Keeping her Fingers in this Situation, during the Beginning, and Continuance of strong Pains, she will observe the Waters contain’d in the Membranes including the Child, and After-birth forming within the inward Orifice, as if something like a Bladder blown , or distended with Water, presented to the Touch , dilating the Orifice with each Throw ; these Appearances presage a speedy and easy Birth.

S the Birth approaches, the Woman grows hotter and red in the Face; the Pains bear more strongly down; the internal Orifice opens ; the Vagina or Passage , at its Entrance , becomes more swell’d, as the Child’s Head advances; and the Membranes are more and more tensely stretched; before the Birth , the Person is often seized with a Vomiting , and universal Tremor, without the Coldness of an Ague ; and very often a Humour , discolour’d with Blood , immediately preceeds the Breach of the Membranes ; when these Symptoms, or several of them, become urgent, ’tis Time to put the Woman in a proper Situation, as describ’d in the preceeding Chapter: The Midwife ought by no Means to break the Membranes , but encourage the Woman now to make the best of her Pains, by strongly bearing down , as if going to Stool; the Midwife with her Fingers well anointed, putting them gently within the internal Orifice, may cautiously, by separating them, assist its opening , and Removing it more behind the Child’s Head, thereby gradually promote its more easy Transmission, and at the same Time prevent, if necessary, the Womb from being too far protruded: After the Waters are broke , as it is called, and the Head of the Child comes into the Passage , the Midwife may lay hold on each Side of it, taking Care not to bruise it by rough Handling, and drawing it, by Waving her Hands, if necessary, to loosen it, when fixed, rather than in a strait Line, assist the Birth; and if obstructed by the Shoulders in the Passage, inserting a Finger under each Arm-Pit, extricate them by the like Action.

’Tis true, it happens, tho’ unobserv’d by Writers, as far as I remember, that many Women have no Waters breaking away , either before or after the Birth; whether absorbed or not, in Time of Labour, I shall not at present determine; this is called, by the Country People, a dry Labour, and often attended with Difficulty; however, if the Crown appear forward , the Issue may nevertheless be favourable.

The Child being born, the next Business is to tie the Navel-string with a waxed Thread, so doubled , as not to endanger cutting , about two Inches from the Child’s Body, making another Ligature near the Body of the Mother, so far distant from the former, as may be convenient for Cutting between both Ligatures, and separating the Infant from its After-birth . Midwives are too apt to leave a greater Length, which can be of no Service, but has been thought, on the contrary, by our Countryman C HAPMAN , to occasion Navel Ruptures.

After the Separation of the Navel-string , the Care to get the After-birth succeeds; this will often come by the Assistance of Nature, with a gentle Motion of the Hand gradually drawing and loosening it, by the Navel-string: But if it adheres to the Fund of the Womb , which is frequently the Case, whether from the Waters being come away before the Birth or otherwise; it must cautiously be separated, and extracted by the Hand, to prevent the most mischievous and fatal Consequences.

The Assistant holding the Navel-string with one Hand, must with great Caution introduce the other into the Womb , avoiding all Violence to any Part in the Way, ’till she reaches the After-birth , some Part of which probably, being loosened, will be found more forward than the rest; which taking between her Thumb and Fore-Fingers , she must, by an easy Motion of her other Fingers, between the Womb and After-birth , gradually separate the Parts adhering all round , ’till finding the whole free, before the Palm of the Hand and Fingers, she brings it intirely away; for should any Part remain, the poor Woman’s Labour would still continue, and occasion dangerous Floodings, requiring the immediate Assistance of an able Hand, to rescue the Patient from the immediate Hazard of Death.

Sometimes when the Womb has discharged its Waters , and the Child , by Reason of a Defect of Pains, or otherwise, remains long very forward near the Birth , the Womb so contracts about the After-birth , as to make the Separation of it very difficult; in which case Assistance is requisite, from one well acquainted with the Structure of the Body; and the longer this is delay’d, the more Danger there will be of all the bad Consequences of the Retention, and Corruption of the After-birth in the Body.

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. D EVENTER says, he saw a sad Spectacle at the H AGUE , 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.

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.

HE Navel-string , by a Variety of Convolutions, sometimes obstructs the Birth, for being shortned, by its Contortions about the Neck, or any Part of the Body, the Labour will become unnatural , by Reason tho’ the Pains are strong , the Navel-string , by its shortness , will pull the Child back with each Pain; and here an unskilful Management may break the String, and occasion a dangerous Flooding; but as the Woman’s Pains will prove ineffectual , notwithstanding their Strength and Force, the Midwife will, by this Means, find the Case out of her Province; I mean, where the Navel-string is very much abbreviated .

If the Navel-string comes forward before the Child’s Head, it will seldom remain, when put backward by the Hand; therefore, if the Midwife has any Regard for the Life of the Child, she ought to call for Assistance, before the Birth is further advanc’d, or it will be extremely difficult, if not impossible, to save the Infant; and she would probably be foil’d for want of sufficient Strength, had she Skill to save it.

HE Placenta or After-birth , being from any violent Shock or Accident, more or less, separated from its Seat, during any Time of Breeding, will produce a Flooding, in Proportion to its Quantity, dangerous , which is sometimes so violent, as to occasion Death in an Hour’s Time; and nothing but instant Delivery can prevent it. When the Case is not so desparate, as all the Blood in the Mother’s Body, necessary to support her own and Infant’s Life, may be drain’d away, the Consequence may be equally fatal in a more lingering Way.

The 26th Feb. 1748, I was sent for to a Woman at M OUNTAIN -D EVEREL , within about Five Weeks of her Time, in a violent Flooding; her Midwife gave her an Opiate, which she thought check’d her Flooding, excepting that once a Week, it became very violent, for about three Weeks past; when I came, the Neighbours told me she had lost a Pail full of Blood; the poor Woman was so weak, that her Pulse were scarcely perceptible, and her Voice but a Whisper; I was unwilling to meddle, for fear she should die under my Hands, but yielded to the Importunity of her Friends: It was with great Difficulty I introduced the Tops of my two Fore-fingers and Thumbs into the internal Orifice , which I gradually dilated, ’till I could pass my Hand, when by turning , I brought away a dead Child, depriv’d of its Nutriment by the great Loss of its maternal Blood; but had considerable Trouble in getting the After-birth , by Reason of its Adhesion : After Delivery, the Flooding immediately very much abated, the poor Woman reviv’d to Admiration, and I left her the next Day, as well as could be expected in so low a Circumstance, tho’ dubious of her Recovery: I heard she died five or six Weeks after; but I am well satisfied, had she had an earlier Recourse for Assistance, she might have recover’d.

In these Cases, Midwives are too apt to trust to their own Judgments, instead of calling for better Assistance; and tho’ they have Recourse to external Applications , Ligatures , and Opiates , these Things, injudiciously practis’d, are frequently more detrimental than beneficial: For Instance, should the Arteries be compress’d by too tight a Ligature of the Arms and Legs , the Flooding would become more violent.

When ignorant Midwives, by rashly pulling the Navel-string , break it, or by the Adhesion of the After-birth , find it out of their Power to bring it away, they are apt to persuade People, it will come without further Help, which seldom happens; on the Contrary it most frequently occasions Death, more or less suddenly, or Hecticks and Consumptions, when left to corrupt in the Body: The Uterus sometimes so strongly contracts about, and embraces it, that it may be impossible, after a few Hours Delay, to procure it, as I found in a Case that occur’d to me at C OLEHORN , the 30th Sept. 1748, tho’ little more than four Hours passed, from the Time the Midwife broke the String close to the Placenta , for the Part of the Uterus next the Placenta was so contracted, as barely to admit the Tops of my two Fore-fingers; I endeavour’d, with all possible Caution, to make a larger Aperture, but in the ill Situation of the Uterus , at the Extent of my Reach, all my Attempts were in Vain; this Woman rested well the succeeding Night, and had no extraordinary Complaints when I left her in the Morning, first prescribing what I thought most suitable to her Condition: I afterwards heard she died with a Frenzy, succeeding a Suppression of the usual Purgations; where the Corruption of the Placenta takes Place, the Case is, at least, more Chronical, and the Secundines , gradually wasting, come away Piece-meal, the Patient labouring under a Hectick from the Contagion of putrid Humours, mixing with the circulating Fluids.

I have at other Times, after a longer Delay, been more successful; the 28th December , the same Year, I was call’d, by Order of the late Lord W EYMOUTH , to the Assistance of a poor Woman at H ORNISHAM , whose After-birth had been retain’d three Days; she had contracted a Fever from its Putrefaction, which was so great, that scarcely any Body could bear the Room, and had lost a great deal of Blood by Flooding; the poor Woman soon recover’d after her Delivery, in the Use of a little Medicine, from his Lordship’s House: I have seldom found the Business difficult, when speedily call’d in the like Cases.

N the Fifth Chapter I have told, how the Midwife may judge, by touching, of an easy Birth; carefully introducing her two Fore-fingers into the Passage, to find the internal Orifice of the Womb in the Beginning of Labour; now, in doing this, if the Orifice, she is in Search for, does not readily occur, she has great Reason to apprehend Difficulty; and if not well acquainted with the Parts she handles, by rude Usage, piercing through any Part of the Vagina , which presents to the Touch , may do Mischief. Such an Injury was done to one of Box, where I was called Sept. 21, 1748. This Woman had been in Labour several Days; the Midwife having, the last Time, been with her eighteen Hours, the Pole of the Child’s Head lay upon the Share-bone, which was rectifyed by one Limb of the Extractor and brought into the Passage; the other Limb being joined, the Infant was soon born; but what before surprized me, was to find a Passage , for my Fingers, considerably remote from the internal Orifice , with great Complaints of a smarting Pain when I touch’d it; a Suppuration follow’d, but the Woman soon recover’d, after the frequent Use of an emollient and discutient Fomentation.

When the Orifice presents rightly, and is easily found, it is next of Consequence to observe, whether the Pains relax , open and enlarge it; for should it remain thick and contracted , instead of relaxing and growing thinner, if the Infant comes rightly directed, the Woman’s Pains are not genuine but spurious ; it will then be proper to give an emollient and carminative Glyster, and probably the false Pains will be reliev’d, and the true succeed; or some Time may intervene, before her true Labour, especially if the full Time of Breeding should not be expired.

If the Midwife cannot reach the internal Orifice , and the Child’s Head lays high , the Orifice may possibly lay high , backwards or forwards , or more or less so, inclining Sideways ; the Reason of which may be apprehended, from the brief Account of the Womb , and the Pelvis , in the Second Chapter. In this Case it may be with great Difficulty, the Assistant can reach the nearest Margin of the internal Orifice , tho’ well instructed and experienced, and it will often require the Hand of an expert Artist, early in Labour to rectify it, or turn the Child, when Travil is advanced; or if too long neglected may occasion the Death of one, or both Mother and Child.

F in the Progress of Travil, the Midwife perceives any Part of the Head, besides the Crown , discoverable by its Sutures , presenting, and it appear broad , and very hard to the Touch : If the Waters may be felt descending in a long Form through the internal Orifice , somewhat like a Piece of a Gut distended with Water: These Appearances presage the utmost Difficulty and Danger, commonly owing to the small Distance between the forward and back Bones; an ill Situation of the internal Orifice ; the comparative Largeness of the Child’s Head; or the ill Site of the Womb ; whereby the Head may be pressed against the Bones forward or backward , or somewhat inclined to either Side, in a wrong Direction for the Passage . These Causes, singly or concurring, render the Case much beyond the Skill, and very often the Strength, of a Midwife to redress.

When unqualified Midwives observe the Head present to the inward Orifice, they are too apt to promise good Success, and behave with the utmost Confidence, wherein they are often egregiously mistaken; for there cannot be a more difficult Birth, than frequently happens, when any other Part, instead of the Crown, offers; and the Misfortune is, the longer Recourse to proper Assistance is delay’d, the greater the Difficulty becomes every Moment; and the poor Woman may think herself happy, if she escapes with her Life, the Danger of a most fatiguing and tedious Labour, succeeded, perhaps, by such a Relaxation of the Vagina or Passage , as will occasion great Uneasiness in going, or being in an upright Posture, without the immediate Help of Medicines, both externally and internally; or wearing a Pessary for its Support, during Life.

Whereas ’tis certain, that if the Mother’s Pains, strongly bearing down , the Muscles of the Belly contracting and becoming sensibly hard to the Touch , don’t manifestly promote the Birth, it must needs be owing to some Obstruction beyond the Midwife’s Skill; who in this Circumstance is apt to complain, the Pains are not sufficiently strong , ’till the poor Woman is ready to expire, from the Loss of her Strength, by her long Suffering under them; and told she must patiently wait God’s Time, who in Case he miraculously interpos’d, wants not the Midwife’s Assistance: And what still adds to this deplorable Calamity, ’tis likely she is put upon exerting her utmost Strength, assisted by Cordials; when encouraging her Labour and provoking her Pains , ’till the Obstructions in the Way of the Birth are remov’d, contribute still further to the Danger attending.

I don’t deny but that in some Cases, a tedious Labour may be owing to a Defect of sufficiently strong Pains; but as this often proceeds from Circumstances obstructing the Birth , true Labour naturally takes Place, when they are remov’d; and, by a right Management of the Hand, is more effectually promoted, without Cordials or forcing Medicines, where the Pains are deficient.

Under this Sort of unnatural Birth, may very well be enumerated, the Face presenting towards the Mother’s Belly, or the Side of the Head coming Foremost , for its Passage must be extreamly difficult in these Postures; as well as when the Face comes forward ; for then by Reason of the great Tumour, about the Head , Face , Eyes , and Mouth , from Lodging between the Bones, the Infant expiring in the Birth, has been often taken for a Monster. I have often been so happy, when the Head has long remain’d, wedg’d between the Bones, as to bring the Child alive, by the Forceps , in a few Minutes, if seasonably call’d, when the Woman in Travil has been in the utmost Danger of Death.

The 5th of May , 1751, I met with as bad a Case, as most of this Kind at W IGGLETON : This Woman, by the Midwife’s Account, seem’d to be in Labour at Times near a Month, and for a Week last, almost in continual Pain, with her first Child: as I was call’d late to her Assistance, I could not judge, by early Appearances, of the Situation of the Uterus , or Infant ; this is most commonly only in the Power of the Midwife to observe; her Waters had gradually drain’d away above a Week, and there still remain’d some Part of the Membranes depending like a Gut in the Vagina , the Head offer’d, firmly wedg’d in the Pelvis ; the Part most obvious to the Touch , by its Softness and fleshy Consistence, seem’d to be the Cheek : The poor Woman’s Pains, for some Hours, were ineffectual for want of Strength, her Spirits being exhausted, by a Labour so fatiguing; there was no Possibility of turning the Child; I endeavour’d, with some Success, to promote the Birth , by bearing strongly against the inferior Part of the Os-sacrum , but her Weakness, depriving me of the small Benefit of her Pains, I had for a Time; there was an absolute Necessity for a speedy Delivery, for the Mother’s Sake: ’Twas with some Difficulty I overcame her Prejudice, and those Present against the Use of any Instrument, tho’ at length they yielded; when introducing a Limb of the Extractor on each Side of the Head, and Co-operating with a small Pain, encouraging the Woman to bear down as strongly as she could, I immediately brought a Daughter, with a monstrous long Head alive.

I HAVE, however, met with some Cases, which I could relieve by no better Method, than lessening the Head; but considering for whose Benefit I am chiefly Writing, and how dangerous the Use of Instruments may be in injudicious Hands, I rather choose to advise Women not to meddle with them, than pretend to relate the Method of using them.

HE Arm or Shoulder presenting, is so well known to be attended with Difficulty, that few Women will attempt such Deliveries, unless they are so very ignorant, as to imagine they can bring the Child by pulling at an Arm .

As our Miscarriages, or rather Misfortunes, in Practice, may no less contribute to the Information of others, by Caution, than our Success, by Example; I shall not scruple to give a candid Relation of the most fatal Occurrence, which ever fell to my Lot.

The 12th September , 1748, I was called to a Woman at T ROUBRIDGE , her Matrix lay forward in a prominent Abdomen hanging very low, the Os-uteri Internum lay very much backward , both Hands presented to it, this Woman had been very ill the preceeding Week, and in extreme Misery the last Twenty-four Hours; with a great deal of Trouble, I got and drew towards me one Foot , with the Heel turn’d towards the Mother’s Belly ; in drawing the Infant so far as the Arm-pits , I found the Face of the Child did not turn so readily as I expected towards the Mother’s Back ; as soon as I had brought the Feet some Distance without the Vagina , while I endeavour’d to extract the Child by hold of its Thighs , the Midwife, unknown to me, officiously laying hold of the Infant’s Feet , exerted her Strength at the same Time with mine; I intended to leave the Arms according to D EVENTER , as a Security to the more safe Transmission of the Head ; and while our united Strength was exerted, I found the Neck gave way, with something of an audible Crack; and with some Surprize, looking about me, saw the Midwife labouring at the Child’s Feet , and check’d her, as acting very rashly, without my Direction; thus we had really separated the Spine of the Neck , and the Head only adhering to the Body by the Skin , was with little or no Force separated from it: In passing my Hand, after a tye on the Navel-string , I found the Head fell back into the prominent Part of the Abdomen , insomuch that I could only reach the separated Part of the Neck , and I endeavour’d, in vain, to get hold of the Head by the Crotchet : While I was thus employ’d, a Flooding came on, by the Separation of the Placenta , which quick’ned my Endeavours, from the Apprehensions of her sudden Death, if she was not immediately deliver’d; but the poor Woman, much spent with Fatigue and Loss of Blood, begg’d I would desist, preferring Death to Life; in which being join’d by the People present, and not a little exhausted of Spirit and Strength myself, I was, much against my Will, obliged to leave her to her Fate.

Here I would observe, it appear’d the Body was that of a large Boy, and tho’ I find G IFFARD and others made no Scruple of leaving the Arms of a small Child, I must join with them in advising not to bring a large one , without first procuring the Arms ; tho’ I will not say, whether the Method of delivering on one Side instead of the Back , the lower Part somewhat raised from the Bed, at the same Time encouraging Labour with Hopes of immediate Delivery, recommended by D EVENTER , may not occasion the Danger of leaving the Arms .

There are Variety of other wrong Situations , and Cases of Difficulty, which I could illustrate by Examples in my own Practice, and may be found in the Observations of M AURICEAU D E-LA -M OTTE , G IFFARD and others, for the Information of such as practise Midwifry, that have no Relation to the Information of Midwives, either in their own Practice, or Occasions of Assistance.

HE Case of Twins may, in many Country Places, be esteemed beyond the Skill of Women practicing Midwifry; but as they are not alike ignorant, and this Delivery, with a right Management, is attended with no great Difficulty, I shall describe it as plainly as I can.

If a Child comes naturally by the Force of the Mother ’s Pains, and the After-birth does not easily follow, the Midwife, by passing her Hand to separate its Adhesion as directed in the sixth Chapter, will readily find whether another Child still remains to be born, by the Appearance of other Membranes , including Waters , &c. And as where more than one is to be born, they are generally proportionably smaller, and tho’ the first Child comes naturally, the second may not, she need not wait for the Birth of the other, by the meer Force of Nature, for this would greatly hazard the Life of the Child, and sometimes of the Mother, by a Flooding; but ought to break the Membranes , and search for the Feet , carefully preventing their being intangled with the Navel-string ; and having got both in her Hand, draw them into the Passage ; if the Child’s Toes point to the Mother’s Back , there will be no Danger of the Chin or Nose being hung on the Bones before, and she may draw the Feet forth with the rest of the Body , without delaying to bring down the Arms , encouraging the Mother to assist in the mean Time, by bearing down with or without Pains .

In Case the Child’s Toes should point to the Mother’s Belly , the Midwife, in drawing the Child forth from the Hips forward , must gradually turn the Belly of the Child towards the Mother’s Back , by the Assistance of the other Hand in the proceeding.

If the Woman be straiter, or the Child larger, than ordinary, when she has brought the Infant into the Passage somewhat short of the Arm-pits , she must, by introducing her Fingers, first over one Shoulder , cautiously bring down one Arm , and then in like Manner the other , and drawing the Child forward, she must make Use of both Hands to extricate the Head ; the Fingers of one Hand between the Mother’s Back and Child’s Jaws , bearing and drawing them from the Back-bone , and with the Fingers of the other Hand over the Shoulders , and the flat against the Child’s Back , draw it forth, the Mother as aforesaid assisting all the while.

Writers advise putting two Fingers into the Child’s Mouth ; but as great Injury has often been done that Way, it is much safer to bring the Child by bearing with the Fingers against its Jaws . If an Arm should be broke in bringing down , let it be spliced with thin Paste-board, and bound at its full Extent to preserve its right Shape.

In fetching an Infant by turning , ’tis necessary to draw its Feet into the Passage , with the Toes situate towards the Infant’s Belly , for it may be extreamly difficult, if not impossible, to draw it backwards, contrary to the natural Bent of its Thighs and Back ; and a Limb may sometimes as easily be pull’d off, as the Child brought to the Birth this Way; the Midwife must therefore make Use of the right , or left Hand in doing it, which happens to be most convenient, to the natural bending of the Infant’s Body.

I THINK it cannot be safe for a Woman to turn a Child upon ether Occasions requiring it; their Strength, as well as Skill being frequently inferior to the Task; besides, there may be great Danger of injuring the Vitals of the Mother in other Cases, especially after the Operation is unseasonably delay’d.

As each Child has a Navel-string, as well as After-birth belonging to it (tho’ both Placenta ’s are sometimes so joined as easily to be distinguished) the Care respecting the Navel-string , already related in the Sixth Chapter, must of Course be taken for the First-born, and its Secundines left, ’till after the Birth of the Second, when both, if necessary, must be separated and brought away, as there advis’d, with Regard to one alone, and the Navel-string of the last Infant tied after the same Manner as in the Birth of one Infant.

D EAD Child is often born with abundantly more Difficulty than a living one, for the last by its Struggles considerably promotes its own Birth; whereas, the first lies immoveably in the same Posture, without changing Situation by its own Activity.

When the Death of the Child proceeds from any accidental Injury, the breeding Woman commonly knows it, by the Perception of a Weight within her, in the Part where it lies, instead of its usual Motions, which from that Time cease, and occasion, not without Reason, a Solicitude for the best Assistance.

One of my Neighbours, whom I lately deliver’d, had the Misfortune to fall flat on her Face, between the 7th and 8th Month of her Pregnancy; from which Time to that of her Labour, above three Weeks after, she had a continual Sensation of a Weight within her, without any of the Child’s Motions, as before this Accident, although it was not succeeded by a Flooding , as is common upon a partial or total Separation of the Placenta : She had frequently been attacked with Pains resembling Travil, for above two Weeks before it came on effectually; in this Case after I had brought the Child by turning , I found the Secundines extremely offensive, by Reason of their Putrefaction.

From Causes less manifest, ’tis a Thing more precarious to judge of the Infant’s Death; the Woman in Travil has not perceived the Motion of the Child for some Days, while it was yet living; a cadacerous Smell is not infallible; the coming away of the Child’s Excrement , may proceed from the Compression of its Abdomen in the Birth , especially when the Buttocks present; these Appearances therefore can only be a Foundation at best for probable Conjecture; nothing short of the Peeling of the Cuticle or Scarf-Skin of the Child upon Touching it, can be a certain Token of its Death.

FTER Delivery, tis too universal a Practice to palliate the After-pains by Opiates , which if given beyond the Proportion, necessary to take off the Spasms attending, are mischievous, tending to obstruct the natural Cleansings, so absolutely necessary to succeed; and as these Pains cease of Course for the most Part in two or three Days, it were much better to have recourse to Sperma Ceti dissolv’d with the Yolk of an Egg in a Draught of Caudle, or a Linctus of Sallad Oil and Sugar, if Oil of Sweet Almonds cannot be had fresh, as often as the Pains are violent.

Particular Occasions may indeed require other Methods, but then ’tis best to be well advis’d, whether Opiates , or other Medicines are necessary. During their Purgations, the Woman, in Child-bed, ought to be kept warm, from all Danger of taking cold, to a Degree of sensible Perspiration, and if she has no Stool by the third Day, which commonly brings, with the Milk, a feverish Heat, a Kitchen Glyster ought to be given and repeated in costive Habits, as there is Occasion.

I SHALL conclude with some Things of the Care of Infants newly born; a Subject the more interesting, as our Natives are known greatly to decrease from the free Use of Spirituous Liquors; which Loss might in some Degree be repaired by a better Care of their Offspring, who are not only expos’d to suffer by the Ignorance of Midwives, but must undergo a second Martyrdom from swadling and cramming.

Their fond Nurses greatly contribute to the general Cause of all their Distempers, Indigestion , frequently feeding them ’till they return it by the Mouth, which under these Circumstances, unless supply’d by a Looseness, is the only Means of their Preservation from more immediate Death.

This Overcharge of their Stomachs, producing Crudities, gives them the most excruciating Pains in their Bowels; occasioning very often Fevers and Convulsions, and yet their Cries are customarily appeas’d by more Food, furnishing an Encrease of sharp Crudities in their Bowels; and ’tis well if Syrup of Poppies, Godfrey ’s Cordial, or some other Opiate, be not given to stifle their Complaints, but in Effect to encrease the Mischief, by confining the Acrimony of an Overload within them.

Infants are born with their Stomachs and Intestines charged with the Recrements of the Humours in which they swim, before Birth, and the glandular Secretions within them, which will naturally purge away with the first Milk they draw from the Mother’s Breast; and they would sleep, were they not too soon fed, ’till this Provision of Nature is ready for them, as Dr. C ADOGAN found from Experience in his own Family; but as the Humour of Feeding them sooner generally obtains, and the Mother too often is not the Nurse; Half a Drachm of Castile Soap diffolv’d in a Spoonful or two of thin Caudle, and sweetened with Honey, would cleanse the Child, and prevent many Distempers, owing to a Retention of Impurities within them before the Birth, if given soon after.

’Tis well worth remarking, that the Food the Nurse takes communicates its Nature to the Milk, so that the Child may be intoxicated by her giving Suck too soon after strong Drink or Spirituous Liquors, by which Means many are destroy’d; it is likewise well known, if the Nurse takes a Purge, her Milk will purge the Child.

This informs us, that when the Child is troubled with Gripes, attended with green, sour-smelling Stools, the Mother, or Nurse, by being confin’d to an Animal Diet, will, in a great Degree, prevent the Gripes, Looseness, or Convulsions, occasion’d by the Acidities of the Child’s Stomach and Bowels, from the contrary Qualities communicated to her Milk. On the Contrary, a vegetable Diet will greatly relieve the same Complaints, attended with strong smelling Stools, and a Tendency to the Putrefaction of the Humours, and the Child’s Spoon-meat, when any Thing is given besides the Mother’s Milk, may be regulated accordingly: In the mean Time, in both Cases, these Indigestions ought to be purged off with a few Grains of Rhubarb, or double the Quantity infus’d at Night in a Spoonful of common Drink, strain’d and sweetened with Honey.