Chapter III

_Of the Parts proper to a Child in the Womb. How it is formed there, and
the Manner of its Situation therein._

In the last chapter I treated of conception, showing what it was, how accomplished, its signs, and how she who has conceived ought to order herself during the time of her pregnancy. Now, before I come to speak of her delivery, it is necessary that the midwife be first made acquainted with the parts proper to a child in the womb, and also, that she be shown how it is formed; and the manner of its situation and decumbiture there; which are so necessary to her, that without the knowledge thereof, no one can tell how to deliver a woman as she ought. This, therefore, shall be the work of this chapter. I shall begin with the first of these.

SECT. I. _Of the Parts proper to a Child in the womb._

In this section I must first tell you what I mean by the parts proper to a child in the womb; and they are only those that either help or nourish it, whilst it is lodged in that dark repository of nature, and that help to clothe and defend it there, and are cast away, as of no more use, after it is born; and these are two: viz. the umbilicurs, or navel vessels, and the secundinum. By the first it is nourished, and by the second clothed and defended from wrong. Of each of these I shall speak distinctly: and, first,

_Of the Umbilicurs, or Navel Vessels._

These are four in number: viz. one vein, two arteries, and the vessel which is called the urachos.

1. The vein is that by which the infant is nourished, from the time of its conception till the time of its delivery; till, being brought into the light of this world it has the same way of concocting its food that we have. This vein ariseth from the liver of the child, and is divided into parts when it has passed the navel; and these two are divided and subdivided, the branches being upheld by the skin called _chorion_ (of which I shall speak by and by), and are joined to the veins of the mother’s womb, from whence they have their blood for the nourishment of the child.

2. The arteries are two on each side, which proceed from the back branches of the great artery of the mother; and the vital blood is carried by those to the child, being ready concocted by the mother.

3. A nervous or sinewy production is led from the bottom of the bladder of the infant to the navel, and this is called _urachos_; and its use is to convey the urine of the infant from the bladder to the alantois. Anatomists do very much vary in their opinions concerning this; some denying any such thing to be in the delivery of the woman; and others, on the contrary, affirming it: but experience has testified there is such a thing; for Bartholomew Carbrolius, the ordinary doctor of anatomy to the College of Physicians at Montpelier, in France, records the history of a maid, whose water, being a long time stopped, at last issued out through the navel. And Johannes Fernelius speaks of the same thing that happened to a man of thirty years of age, who, having a stoppage at the neck of the bladder, his urine issued out of his navel many months together, and that without any prejudice at all to his health; which he ascribes to the ill lying of his navel whereby the urachos was not well dried. And Volchier Coitas quotes such another instance in a maid of thirty-four years of age, at Nuremberg, in Germany. These instances, though they happen but seldom, are sufficient to prove that there is such a thing as an urachos in men.

These four vessels before-mentioned, viz. one vein, two arteries, and the urachos, do join near to the navel, and are united by a skin, which they have from the chorion, and so become like a gut or rope, and are altogether void of sense, and this is that which women call the navel-string. The vessels are thus joined together, that so they may neither be broken, severed nor entangled; and when the infant is born are of no use, save only to make up the ligament which stops the hole of the navel, and some other physical use, &c.

_Of the_ SECUNDINE, _or After-Birth_.

Setting aside the name given to this by the Greeks and Latins, it is called in English by the name of secundine, after-birth, or after-burden; which are held to be four in number.

I. The _first_ is called placentia, because it resembles the form of a cake, and is knit both to the navel and chorion, and makes up the greatest part of the secundine, or after-birth. The flesh of it is like that of the melt, or spleen, soft, red, and tending something to blackness, and hath many small veins and arteries in it; and certainly the chief use of it is, for containing the child in the womb.

2. The _second_ is the chorion. This skin, and that called the amnios, involve the child round, both above and underneath, and on both sides, which the alantois doth not. This skin is that which is most commonly called the secundine, as it is thick and white, garnished with many small veins and arteries, ending in the placentia before named, being very light and slippery. Its use is not only to cover the child round about, but also to receive and safely bind up the roots of the veins and arteries or navel vessels before described.

3. The _third_ thing which makes up the secundine is the alantois, of which there is a great dispute among anatomists. Some say, there is such a thing, and others that there is not. Those that will have it to be a membrane, say it is white, soft, and exceeding thin, and just under the placentia, where it is knit to the urachos, from whence it receives the urine; and its office is to keep it separate from the sweat, that the saltness may not offend the tender skin of the child.

4. The _fourth_ and last covering of the child is called amnios; and it is white, soft, and transparent, being nourished by some very small veins and arteries. Its use is not only to enwrap the child, but also to retain the sweat of the child.

Having thus described the parts proper to a child in the womb, I will next proceed to speak of the formation of the child therein, as soon as I have explained the hard terms of this section, that those for whose help it is designed, may understand what they read. A _vein_ is that which receives blood from the liver, and distributes it in several branches to all parts of the body. _Arteries_ proceed from the heart, are in continual motion, and by their continual motion quicken the body. _Nerve_ is the same with _sinew_, and is that by which the brain adds sense and motion to the body. _Placentia_ properly signifies a _sugar cake_; but in this section it is used to signify a spongy piece of flesh, resembling a cake, full of veins and arteries, and is made to receive the mother’s blood appointed for the infant’s nourishment in the womb. The _chorion_ is the outward skin which compasseth the child in the womb. The _alantois_ is the skin that holds the urine of the child during the time that it abides in the womb. The _urachos_ is the vessel that conveys the urine from the child in the womb to the _allantois_. I now proceed to

SECT. II. _Of the Formation of the Child in the Womb._

The woman having conceived, the first thing which is operative in the conception is the spirit whereof the seed is full, which nature quickening by the heat of the womb, stirs up to action. The internal spirits therefore, separate the parts that are less pure, which are thick, cold and clammy, from those that are more pure and noble. The less pure are cast to the outside, and with these the seed is circled round, and the membranes made, in which that seed which is most pure is wrapped round, and kept close together, that it may be defended from cold and other accidents, and operate the better.

The first thing that is formed is the amnios; the next the chorion; and they enwrap the seed round like a curtain. Soon after this (for the seed thus shut up in the woman lies not idle) the navel vein is bred, which pierceth those skins, being yet very tender, and carries a drop of blood from the veins of the mother’s womb to the seed: from which drop the vena cava, or chief vein, proceeds, from which all the rest of the veins which nourish the body spring; and now the seed hath something to nourish it, whilst it performs the rest of nature’s work, also blood administered to every part of it, to form flesh.

This vein being formed, the navel arteries are soon after formed; then the great artery, of which all the others are but branches; and then the heart; for the liver furnisheth the arteries with blood to form the heart, the arteries being made of seed, but the heart and the flesh of blood. After this the brain is formed, then the nerves to give sense and motion to the infant. Afterwards the bones and flesh are formed; and of the bones, first the vertebræ or chine bones, and then the skull, &c. As to the time this curious part of workmanship is formed, having already in the preceding Chapter, spoken distinctly and at large upon this point, and also of the nourishment of the child in the womb, I shall here only refer the reader thereto, and proceed to show the manner in which the child lies in the womb.

SECT. III. _Of the manner of the Child’s lying in the Womb._

This is a thing so essential for a midwife to know, that she can be no midwife who is ignorant of it: and yet even about this, authors extremely differ; for there are not two in ten that agree what is the form that the child lies in the womb, or in what fashion it lies there; and yet this may arise in a great measure from the different figures that the child is found in, according to the different times of the woman’s pregnancy; for near the time of its deliverance out of the winding chambers of nature, it oftentimes changes the form in which it lay before for another.

I will now show the several situations of the child in the mother’s womb, according to the different times of pregnancy, by which those that are contrary to nature, and are the chief cause of all ill labours, will be more easily conceived by the understanding midwife. It ought, therefore, in the first place, to be observed, that the infant, as well male as female, is generally situated in the midst of the womb; for though sometimes, to appearance, a woman’s belly seems higher on one side than another, yet it is so with respect to the belly only, and not to her womb, in the midst of which it is always placed.

But, in the second place, a woman’s great belly makes different figures, according to the different times of pregnancy; for, when she is young with child, the embryo is always found of a round figure, a little oblong, having the spine moderately turned inwards, the thighs folded, and a little raised, to which the legs are so raised, and her heels touch the buttocks; the arms are bending, and the hands placed upon the knees, towards which the head is inclining forwards, so that the chin toucheth the breast; in which posture it resembles one sitting to ease nature, and stooping down with the head to see what comes from him. The spine of its back is at that time placed towards the mother’s, the head uppermost, the face downwards; and proportionably to its growth, it extends its members by a little and little, which were exactly folded in the first month.

In this posture it usually keeps till the seventh or eighth month; and then by a natural propensity and disposition of the upper part of the body, the head is turned downwards toward the inward orifice of the womb, tumbling as it were over its head, so that then the feet are uppermost, and the face towards the mother’s great gut; and this turning of the infant in this manner, with its head downwards, towards the latter end of a woman’s reckoning, is so ordered by nature, that it may be thereby the better disposed for its passage into the world at the time of its mother’s labour, which is not then far off (and, indeed, some children turn not at all until the very time of birth); for in this posture all its joints are most easily extended in coming forth; for, by this means the arms and legs cannot hinder its birth, because they cannot be bended against the inward orifice of the womb; and the rest of the body being very supple, passeth without any difficulty after the head which is hard and big, being past the birth. It is true, there are divers children that lie in the womb in another posture, and come to birth with their feet downwards, especially if there be twins; for then by the different motions they do disturb one another, that they seldom come both in the same posture at the time of labour, but when one will come with the head, and another with the feet, or perhaps lie across; and sometimes neither of them will come right. But, however the child may be situated in the womb, or in whatever posture it presents itself at the time of birth, if it be not with its head forwards, as I have before described, it is always against nature, and the delivery will occasion the more pain and danger, and require greater care and skill from the midwife, than when the labour is more natural.

CHAP. IV.
_A Guide to Women in Travail, showing what is to be done when they fall
in Labour, in order to their Delivery._

The end of all that we have been treating of is, the bringing forth a child into the world with safety both to the mother and infant, as the whole time of a woman’s pregnancy may very well be termed a kind of labour; for, from the time of her conception to the time of her delivery, she labours under many difficulties, is subject to many distempers, and in continual danger, from one effect or other, till the time of birth comes; and when that comes, the great labour and travail come along with it, insomuch that then all the other labours are forgotten, and that only is called the time of her labour; and to deliver her safely is the principal business of the midwife; and to assist her therein, shall be the chief design of this chapter. The time of the child’s being ready for its birth, when nature endeavours to ease it forth, is that which is properly the time of a woman’s labour; nature then labouring to be eased of its burden. And since many child-bearing women (especially the first child) are often mistaken in their reckoning, and so, when they draw near their time, take every pain they meet with for their labour, which often proves prejudicial and troublesome to them, when it is not so; I will in the first section of this chapter, set down some signs, by which a woman may know when the true time of her labour is come.

SECT. I. _The Signs of the true Time of a Woman’s Labour._

When pregnant women, especially of their first, perceive any extraordinary pain in the abdomen, they immediately send for their midwife, as taking it for their labour; and then if the midwife be not a skilful and experienced woman, to know the time of labour, but takes it for granted without further inquiry (for some such there are), and so goes about to put her into labour before nature is prepared for it, she may endanger the lives of both mother and child by breaking the amnios and chorion. These pains, which are often mistaken for labour, are removed by warm cloths laid to the abdomen, and the application of a clyster or two, by which those pains which precede a true labour are rather furthered than hindered. There are also other pains incident to a woman in that condition from a flux of the abdomen, which are easily known by the frequent stools that follow them.

The signs, therefore, of labour, some few days before, are, that the woman’s abdomen, which before lay high, sinks down, and hinders her from walking so easily as she used to do; also there flows from the womb slimy humours, which nature has appointed to moisten and smooth the passage, that its inward orifice may be the more easily dilated when there is occasion; which beginning to open at this time, suffers that slime to fall away, which proceeds from the glandules, called _prostata_. These are signs preceding the labour; but when she is presently falling into labour, the signs are, great pains about the region of the reins and loins, which, coming and retreating by intervals, are answered in the bottom of the abdomen by congruous throes, and sometimes the face is red and inflamed, the blood being much heated by the endeavours a woman makes to bring forth her child; and likewise, because during these strong throes her respiration is intercepted, which causes the blood to have recourse to her face; also her privy parts are swelled by the infant’s head lying in the birth, which, by often thrusting, causes those parts to descend outwards. She is much subject to vomiting, which is a sign of labour and speedy delivery, though by ignorant people thought otherwise; for good pains are thereby excited by the sympathy there is between the womb and the stomach. Also when the birth is near, women are troubled with a trembling in the thighs and legs, not with cold, like the beginning of an ague fit, but with the heat of the whole body; though, it must be granted, this does not happen always. Also, if the humours which then flow from the womb are discoloured with blood, which the midwives call _shows_, it is an infallible mark of the birth being near. And if then the midwife puts up her fingers into the neck of the womb, she will find the inner orifice dilated; at the opening of which, the membranes of the infant, containing the water, present themselves, and are strongly forced down with each pain she hath; at which time one may perceive them sometimes to resist, and then again press forward the finger, being more or less hard and extended, according as the pains are stronger or weaker. These membranes, with the waters in them when they are before the head of the child, which the midwives call _the gathering of the waters_, resemble to the touch of the finger those eggs which have no shell, but are covered only with a simple membrane. After this, the pains still redoubling, the membranes are broken by a strong impulsion of the waters, which flow away, and the head of the infant is presently felt naked, and presents itself at the inward orifice of the womb. When these waters come thus away, then the midwife may be assured the birth is very near, this being the most certain sign there can be; for the _amnios alantios_, which contained those waters, being broken by the pressing forward of the birth, the child is no better able to subsist long in the womb afterwards, than a naked man in a heap of snow. Now, these waters, if the child comes presently after them, facilitate the labour, by making the passage slippery; and, therefore, let no midwife (as some have foolishly done) endeavour to force away the water, for nature knows best when the true time of the birth is, and therefore refrains the water till that time. But if by accident the water breaks away too long before the birth, then such things as will hasten may be safely administered, and what these are I will show in another section.

SECT. II. _How a woman ought to be ordered when the Time if her Labour
is come._

When it is known that the true time of her labour is come by the signs laid down in the foregoing section, of which those that are most to be relied on are pains and strong throes in the abdomen, forcing downwards towards the womb, and a dilation of the inward orifice, which may be perceived by touching it with the finger, and the gathering of the waters before the head of the child, and thrusting down of the membranes which contain them; through which, between the pains, one may in some manner with the finger discover the part which presents (as we said before), especially if it be the head of the child, by its roundness and hardness; I say, if these things concur and are evident, the midwife may be sure it is the time of the woman’s labour; and care must be taken to get all things necessary to comfort her in that time. And the better to help her, be sure to see she be not strait-laced: you may also give her one strong clyster or more, if there be occasion, provided it be done at the beginning, and before the child be too forward; for it will be difficult for her to receive them afterwards. The benefit accruing thereby will be, that they excite her gut to discharge itself of its excrements, that so, the rectum being emptied, there may be more space for the dilation of the passage; likewise to cause the pains to bear the more downward, through endeavours she makes when she is at stool; and in the meantime, all other necessary things for her labour should be put in order, both for the mother and the child. To this end, some get a midwife’s stool; but a pallet-bed, girded, is much the best way, placed near the fire, if the reason require; which pallet ought to be placed, that there may be easy access to it on every side, that the woman may be more readily assisted as there is occasion.

If the woman abounds with blood, to bleed her a little may not be improper, for thereby she will both breathe better, and have her breasts more at liberty, and likewise the more strength to bear down her pains; and this may be done without danger, because the child being about that time ready to be born, has no more need of the mother’s blood for its nourishment: besides, this evacuation does many times prevent her having a fever after delivery. Also, before her delivery, if her strength will permit, let her walk up and down her chamber; and that she may have strength so to do, it will be necessary to give her some good strengthening things, such as jelly, broth, new-laid eggs, or some spoonfuls of burnt wine; and let her by all means hold out her pains, bearing them down as much as she can at the time when they take her; and let the midwife from time to time touch the inward orifice with her finger, to know whether the waters are ready to break, and whether the birth will follow soon after. Let her also anoint the woman’s privities with emollient oil, hog’s grease, and fresh butter, if she find they are hard to be dilated. Let the midwife likewise be all the time near the labouring woman, and diligently observe her gestures, complaints, and pains; for by this she may guess pretty well how her labour advanceth, because when she changes her ordinary groans into loud cries, it is a sign the child is very near the birth; for at that time her pains are greater and more frequent. Let the woman, likewise, by intervals rest herself on the bed, to regain her strength, but not too long, especially if she be little, short, and thick; for such women have always worse labour, if they lie long on their beds in their travail. It is better, therefore, that she walk about her chamber as much as she can, the woman supporting her under the arms, if it be necessary; for by this means, the weight of the child causeth the inward orifice of the womb to dilate the sooner than in bed; and if her pains be stronger and more frequent, her labour will not be near so long.

Let not the labouring women be concerned at those qualms and vomitings which perhaps she may find come upon her, for they will be much for her advantage in the issue, however uneasy she may be for the time, as they further her throes and pains by provoking downwards.

When the waters of the child are ready and gathered (which may be perceived through the membranes to present themselves to the inward orifice) to the bigness of the whole dilation, the midwife ought to let them break of themselves, and not, like some hasty midwives, who being impatient of the woman’s long labour, break them, intending thereby to hasten their business, when instead thereof they retard it; for, by the too hasty breaking of these waters (which nature designed to cause the infant to slide forth more easy) the passage remains dry, by which means the pains and throes of the labouring woman are less efficacious to bring forth than they would otherwise have been. It is therefore much the better way to let the waters break of themselves; after which the midwife may with ease feel the child by that part which first presents, and thereby discerns whether it comes right, that is, with the head foremost, for that is the most proper and natural way of its birth. If the head comes right, she will find it round, big, hard, and equal; but if it be any other part, she will find it unequal, rugged, and soft or hard, according to the nature of the part it is. And this being the true time when a woman ought to be delivered, if nature be not wanting to perform its office; therefore, when the midwife finds the birth thus coming forward, let her hasten to assist and deliver it, for it ordinarily happens soon after, if it be natural.

But if it happens, as sometimes it may, that the waters break away too long before the birth, in such a case those things that hasten nature may be safely administered. For which purpose, make use of pennyroyal, dittany, juniper-berries, betony, and feverfew, boiled in white wine, and give a draught of it; or it would be much better to take the juice of it when it is in its prime, which is in May, and having clarified it, make it into syrup, with double its weight of sugar, and keep it all the year, to use when occasion calls for it: mugwort used in the same manner, is also good in this case; also, a drachm of cinnamon powder, given inwardly, profits much in this case; and so does tansey, boiled, and applied to the privities; or an oil of it, so made and used, as you were taught before. The following prescriptions are very good to speedy deliverance to women in travail.

1. A decoction of white wine made in savory, and drank.

2. Take wild tansey, or silver weed, bruise it, and apply it to the woman’s nostrils.

3. Take date stones, and beat them to powder, and let her take half a drachm of them in white wine at a time.

4. Take parsley and bruise it, and press out the juice, and dip a linen cloth in it, and put it up so dipped into the mouth of the womb: it will presently cause the child to come away, though it be dead, and will bring away the after-burden. Also, the juice of parsley is a thing of so great virtue (especially stone parsley) that being drunk by a pregnant woman it cleanseth not only the womb, but also the child in the womb, of all gross humours.

5. A scruple of castorum in powder, in any convenient liquor, is very good to be taken in such a case; and so also is two or three drops of spirit of castorum in any convenient liquor; also eight or nine drops of spirit of myrrh, given in any convenient liquor, gives speedy deliverance.

6. Give a woman in such a case another woman’s milk to drink: it will cause speedy delivery, and almost without pain.

7. The juice of leeks, being drunk with warm water, highly operates to cause speedy delivery.

8. Take peony seeds, and beat them into powder, and mix the powder with oil, with which oil anoint the loins and privities of the woman and child; it will give her deliverance speedily, and with less pain than can be imagined.

9. Take a swallow’s nest, and dissolve it in water, strain it, and drink it warm; it gives delivery with great speed and much ease.

Note this also in general, that all things that move the terms, are good for making the delivery easy; such as myrrh, white amber in white wine, or lily-water, two scruples or a drachm; or cassia lignea, dittany, each a drachm; cinnamon half a drachm, saffron a scruple; give a drachm: or take borax mineral a drachm; and give it in sack: or take cassia lignea a drachm: dittany, amber, of each a drachm; cinnamon, borax, of each a drachm and a half; saffron a scruple; and give her half a drachm: or give her some drops of oil of hazel in convenient liquor; or two or three drops of oil of cinnamon in vervain water. Some prepare the secundine thus:—Take the navel-string and dry it in an oven, take two drachms of the powder, cinnamon a drachm, saffron half a scruple, with juice of savin make trochisks; give two drachms: or wash the secundine in wine, and bake it in a pot; then wash it in endive water and wine; take half a drachm of it: long pepper, galangal, of each half a drachm: plantain and endive seed, of each half a drachm; lavender seed four scruples; make a powder: or take laudanum two drachms; storax, calamile, benzoin, of each half a drachm; musk ambergris, each six grains; make a powder, or trochisks for a fume. Or use pessaries to provoke the birth; take galbanum dissolved in vinegar, an ounce; myrrh two drachms; with oil of oats make a pessary.

_An Ointment for the Navel._

Take oil of keir two ounces, juice of savin an ounce, of leeks and mercury each half an ounce; boil them to the consumption of the juice; add galbanum dissolved in vinegar half an ounce; myrrh two drachms, storax liquid a drachm; round bistort, sowbread, cinnamon, saffron a drachm; with wax make an ointment, and apply it.

If the birth be retarded through the weakness of the mother, refresh her by applying wine and soap to the nose; confect. alkermas diamarg.

These things may be applied to help nature in her delivery, when the child comes to the birth the right way, and yet the birth be retarded: but if she finds the child comes the wrong way, and is not able to deliver the woman as she ought to be, by helping nature, and saving both mother and child (for it is not enough to lay a woman, if it might be done any other way with more safety and ease, and less hazard both to woman and child), then let her send speedily for better and more able help; and not as I once knew a midwife do, who, when a woman she was to deliver had hard labour, rather than a man-midwife should be sent for, undertook to deliver the woman herself (though told it was a man’s business), and in her attempting it brought away the child but left the head in the mother’s womb; and had not a man-midwife been presently sent for, the mother had lost her life as well as the child: such persons may rather be termed butchers than midwives. But supposing the woman’s labour be natural, I will next show what the midwife ought to do, in order to her delivery.