Chapter V

OF NATURAL LABOUR; WHAT IT IS; AND WHAT THE MIDWIFE IS TO DO IN SUCH A
LABOUR.

SECT. I. _What Natural Labour is._

There are four things which denominate a woman’s natural labour; the first, that it be at the full time; for, if a woman comes before her time, it cannot be termed natural labour; neither will it be easy as though she had completed her nine months. The second thing is, that it be speedy and without any ill accident: for, when the time of her birth is come, nature is not dilatory in the bringing of it forth, without some ill accident intervene which renders it unnatural. The third is, that the child be alive; for all will grant that the being delivered of a dead child is very unnatural. The fourth thing requisite to a natural birth is, that the child come right: for if the position of the child in the womb be contrary to what is natural, the event will prove it so, by making that which should be a time of life, the death of both the mother and the child.

Having thus told you what I mean by natural labour, I shall next show how the midwife is to proceed therein, in order to the woman’s delivery. When all the foregoing requisites concur, and after the waters be broke of themselves, let there rather be a quilt upon the pallet bedstead than a feather bed, having thereon linen, and cloths in many folds, with other such things as are necessary, and that may be changed according to the exigency requiring it, so that the woman may not be incommoded with the blood, waters, and other filth which are voided in labour. The bed ought so to be ordered, that the woman, being ready to be delivered, should lie on her back upon it, having her body in a convenient posture; that is, her head and breast a little raised, so that she be between lying and sitting; for being so placed, she is best capable of breathing, and likewise will have more strength to bear her pains than if she lays otherwise, or sunk down in bed. Being so placed, she must spread her thighs abroad, folding her legs a little towards her loins, somewhat raised by a small pillow underneath, to the end her groin should have more liberty to retire back; and let her feet be stayed against some firm thing: besides this, let her take hold of some of the good women attending her with her hands, that she may the better stay herself during her pains. She being thus placed at the side of her bed, having her midwife at hand the better to assist as nature requires, let her take courage, and help her pains the best she can, bearing them down when they take her, which she must do by holding her breath, and forcing them as much as possible, in like manner as when she goes to stool; for by such straining, the diaphragm, or midriff, being strongly thrust downwards, necessarily forces down the womb and the child in it. In the meantime, let the midwife endeavour to comfort her all she can, exhorting her to bear her labour courageously, telling her it will be quickly over, and that there is no fear but she will have a speedy delivery. Let her midwife also, having no rings on her fingers, anoint them with oil of fresh butter, and thereby dilate gently the inward orifice of the womb, putting her finger ends into the entry thereof, and then stretch them one from the other, when her pains take her; by this means endeavouring to help forward the child, and thrusting, by little and little, the sides of the orifice towards the hinder part of the child’s head, anointing it with fresh butter, if it be necessary.

When the head of the infant is a little advanced into the inward orifice, the midwife’s phrase is, “It is crowned;” because it girds and surrounds it just as a crown; but when it is so far that the extremities begin to appear without the privy parts, then they say, “The child is in the passage;” and at this time the woman feels herself as it were scratched, or pricked with pins, and is ready to imagine that the midwife hurts her, when it is occasioned by the violent distention of those parts, and the laceration which the sometimes bigness of the child’s head causeth there. When things are in this posture, let the midwife seat herself conveniently to receive the child, which will come quickly, and with her finger ends (which she must be sure to keep close pared) let her endeavour to thrust the crowning of the womb (of which I have spoken before) back over the head of the child; and as soon as it is advanced as far as the ears, or thereabouts, let her take hold of the two sides with her two hands, that when a good pain comes she may quickly draw forth the child, taking care that the navel-string be not entangled about the neck, or any other part, as sometimes it is, lest thereby the after-burden be pulled with violence, and perhaps the womb also, to which it is fastened, and so either cause her to flood, or else break the strings, both which are of bad consequence to the woman, whose delivery may thereby be rendered the more difficult. It must also be carefully observed, that the head should not be drawn forth straight, but shaking it a little from one side to the other, that the shoulders may sooner and easier take their place immediately after it is past, without losing any time, lest the head being past, the child be stopped there by the largeness of the shoulders, and so come in danger of being suffocated and strangled in the passage, as it sometimes happens, for the want of care therein. But as soon as the head is born, if there be need, she may slide her fingers under the arm-pits, and the rest of the body will follow without any difficulty.

As soon as the midwife hath in this manner drawn forth the child, let her put it on one side, lest the blood and water which follow immediately, should do it an injury, by running into its mouth and nose, as they would do if it lay on its back, and so endanger the choaking of it. The child being thus born, the next thing requisite is, to bring away the after-burden: but before that, let the midwife be very careful to examine whether there be more children in the womb; for sometimes a woman may have twins that expected it not; which the midwife may easily know, by the continuance of the pains after the child is born, and the bigness of the mother’s abdomen. But the midwife may be sure of it, if she puts her hand up the entry of the womb, and finds there another watery gathering, and a child in it presenting to the passage; and if she finds it so, she must have a care of going to fetch the after-birth, till the woman be delivered of all the children she is pregnant with. Wherefore the first string must be cut, being first tied with a thread three or four double, and fasten the other end with a string to the woman’s thighs; and then removing the child already born, she must take care to deliver her of the rest, observing all the circumstances as with the first; after which it will be necessary to fetch away the after-birth or births. But of that I shall treat in another section; and first show what is to be done to the new-born infant.

SECT. II. _Of the Cutting of the Child’s Navel-String._

Though this is accounted by many but a trifle, yet great care is to be taken about it; and it shows none of the least art and skill of a midwife to do it as it should be; and that it may be so done, the midwife ought to observe, 1. The time. 2. The place. 3. The manner. 4. The event.

1. The time is, as soon as ever the infant comes out of the womb, whether it brings part of the after-burden with it or not; for sometimes the child brings into the world a piece of the amnios upon its head, and is what midwives call the _caul_, and ignorantly, attribute some extraordinary virtue to the child that is so born: but this opinion is only the effect of their ignorance; for when the child is born with such a crown (as some call it) upon its brows, it generally betokens weakness, and denotes a short life. But to proceed to the matter in hand. As soon as the child is come into the world, it should be considered whether it is weak or strong; and if it be weak, let the midwife gently put back part of the vital and natural blood into the body of the child by its navel; for that recruits a weak child (the vital and natural spirits being communicated by the mother to the child by its navel-string); but if the child be strong, the operation is needless. Only let me advise you, that many children that are born seemingly dead, may be soon brought to life again, if you squeeze six or seven drops of blood out of that part of the navel-string which is cut off, and give it to the child inwardly.

2. As to the place in which it should be cut, that is, whether it should be cut long or short, it is that which authors can scarcely agree in, and which many midwives quarrel about; some prescribing it to be cut at four fingers’ breadth, which is, at best, but an uncertain rule, unless all fingers were of one size.

3. As to the manner in which it must be cut, let the midwife take a brown thread, four or five times double, of an ell long or thereabouts, tied with a single knot at each of the ends, to prevent their entangling; and with this thread so accommodated (which the midwife must have in readiness before the woman’s labour, as also a good pair of scissors, that no time may be lost) let her tie the string within an inch of the abdomen with a double knot, and, turning about the end of the thread, let her tie two more on the other side of the string, reiterating it again, if it be necessary; then let her cut off the navel another inch below the ligatures, towards the after-birth, so that there only remains but two inches of the string, in the midst of which will be the knot we speak of, which must be so close knit as not to suffer a drop of blood to squeeze out of the vessels; but care must be taken, not to knit it so strait as to cut it in two, and therefore, the thread must be pretty thick, and pretty strait cut, it being better too strait than too loose; for some children have miserably lost their lives, with all their blood, before it was discovered, because the navel-string was not well tied; therefore great care must be taken that no blood squeeze through; for if there do, a new knot must be made with the rest of the string. You need not fear to bind the navel-string very hard, because it is void of sense, and that part which you leave falls off in a very few days, sometimes in six or seven, or sooner, but never tarries longer than eight or nine.

4. The last thing I mentioned was the event or consequence, or what follows cutting the navel-string. As soon as the navel-string is cut off, apply a little cotton or lint to the place to keep it warm, lest the cold enter into the body of the child, which it most certainly will do, if you have not bound it hard enough. If the lint or cotton you apply to it be dipped in the oil of roses, it will be the better; and then put another small rag three or four times double upon the abdomen: upon the top of all, put another small bolster; and then swathe it with a linen swathe, four fingers broad, to keep it steady, lest by moving too much, or by being continually stirred from side to side, it comes to fall off before the navel-string which you left remaining is falling off. It is the usual custom of midwives to put a piece of burnt rag to it, which we commonly call tinder; but I would advise them to put a little ammoniac to it, because of its drying quality.

SECT. III. _How to bring away the After-burden._

A woman cannot be said to be fairly delivered, though the child be born, till the after-burden be also taken from her; herein differing from most animals, who, when they have brought forth their young cast forth nothing else but some water, and the membranes which contained them. But women have an after-labour, which sometimes proves more dangerous than the first: and how to bring it safely away, without prejudice to her, shall be my business to show in this section.

As soon as the child is born, before the midwife either ties or cuts the navel-string, lest the womb should close, let her take the string and wind it once or twice about one or two of the fingers of her left hand joined together, the better to hold it, with which she may draw it moderately, and with the right hand she may only take a single hold of it above the left near the privities, drawing likewise with that very gently, resting the while the fore-finger of the string towards the same hand, extended and stretched forth along the entrance of the vagina, always observing, for greater facility, to draw it from the side where the burden cleaves least; for, in so doing, the rest will separate the better: and special care must be taken that it be not drawn forth with too much violence, lest by breaking the string near the burden the midwife be obliged to put the whole hand into the womb to deliver the woman; and she need to be a very skilful person that undertakes it, lest the womb, to which this burden is sometimes very strongly fastened, be drawn away with it, as it has sometimes happened. It is, therefore, best to use such remedies as may assist nature. And here take notice, that what brings away the birth, will also bring away the after-birth. And therefore, for affecting this work, I will lay down the following rules.

1. Use the same means in bringing away the after-birth that you made use of to bring away the birth; for the same care and circumspection are needful now that were then.

2. Considering the labouring woman cannot but be much spent by what she has already undergone in bringing forth the infant; be therefore sure to give her something to comfort her. And in this case good jelly broths, also a little wine and toast in it, and other comforting things, will be very necessary.

3. A little hellebore in powder, to make her sneeze, is in this case very proper.

4. Tansey and the stone ætites, applied as before directed, are also of good use in this case.

5. If you take the herb vervain, and either boil it in wine, or make a syrup with the juice of it, which you may do by adding to it double its weight of sugar, (having clarified the juice before you boil it), a spoonful of that given to the woman is very efficacious to bring away the secundine; and featherfew and mugwort have the same operation, taken as the former.

6. Alexander boiled in wine, and the wine drank, also sweet servile, sweet cicily, angelica roots, and muster-wort, are excellent remedies in this case.

7. Or, if this fail, the smoke of marigolds, received up a woman’s privities by a funnel, has been known to bring away the after-birth, even when the midwife let go her hand.

8. Boil mugwort in water till it be very soft; then take it out, and apply it in the manner of a poultice to the navel of the labouring woman, and it instantly brings away the birth and after-birth. But special care must be taken to remove it as soon as they come away, lest by its longer tarrying it should draw away the womb also.

SECT. IV. _Of Laborious and Difficult Labours, and how the Midwife is to
proceed therein._

There are three sorts of bad labours, all painful and difficult, but not all properly unnatural. It will be necessary therefore to distinguish these.

The _first_ of these labours is that wherein the mother and child suffer very much by extreme pain and difficulty, even though the child come right; and this is distinguishably called the laborious labour.

The _second_ is that which is difficult, and differs not much from the former, except that, besides those extraordinary pains, it is generally attended with some unhappy accident, which by retarding the birth, causes the difficulty: but these difficulties being removed, it accelerates the birth, and hastens the delivery.

Some have asked, what is the reason that women bring forth their children with so much pain? I answer, the sense of feeling is distributed to the whole body by the nerves; and the mouth of the womb being so strait that it must of necessity be dilated at the time of the woman’s delivery, the dilating thereof stretches the nerves, and from thence comes the pain. And therefore the reason why some women have more pain in their labour than others, proceeds from their having the mouth of the matrix more full of nerves than others. The best way to remove those difficulties that occasion hard pains and labour, is to show first from whence they proceed. Now the difficulty of labour proceeds either from the mother, or child, or both.

From the mother, by reason of the indisposition of the body, or from some particular part only, and chiefly the womb, as when the woman is weak, and the mother is not active to expel the burden, or from weakness or disease, or want of spirits; or it may be from some strong passion of the mind with which she was once possessed; she may be too young, and so may have the passage too strait; or too old, and then, if it be her first child, because her pains are too dry and hard, and cannot easily be dilated, as happens also to them which are too lean; likewise those who are either small, short or deformed, as crooked women, who have not breath enough to help their pains, and to bear them down, and persons that are crooked having sometimes the bones of the passage not well shaped. The cholic also hinders labour, by preventing the true pains; and all great and active pains, as when the woman is taken with a violent fever, a great flooding, frequent convulsions, bloody flux, or any other great distemper. Also, excrements retained cause much difficulty, and so does a stone in the bladder or when the bladder is full of urine, without being able to void it; or when the woman is troubled with great and painful piles. It may also be from the passages, when the membranes are thick, the orifice too strait, and the neck of the womb not sufficiently open, the passages pressed and strained by tumours in the adjacent parts, or when the bones are too firm, and will not open, which very much endangers the mother and child; or when the passages are not slippery, by reason of the waters being broke too soon, or the membranes being too thin. The womb may also be out of order with respect to its bad situation, or conformation, having its neck too strait, hard, and callous, which may easily be so naturally, or may come by accident, being many times caused by a tumor, an imposthume, ulcer, or superfluous flesh.

As to hard labour occasioned by the child it is when the child happens to stick to a mole, or when it is so weak it cannot break the membranes; or if it be too big all over, or at the head only, or if the natural vessels are twisted about its neck; when the belly is hydropical; or when it is monstrous, having two heads, or joined to another child; also, when the child is dead, or so weak that it can contribute nothing to its birth; likewise when it comes wrong; or when there are two or more. And to all these various difficulties there is oftentimes one more, and that is, the ignorance of the midwife, who, for want of understanding in her business, hinders nature in her work instead of helping her.

Having thus looked into the cases of hard labour, I will now show the industrious midwife how she may minister some relief to the labouring woman under these difficult circumstances. 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 or too strait, she must be gently treated, and the passages anointed with oil, hog’s lard, or fresh butter, 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 of 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 humps and bruises on their heads.

Those women that are very small and misshapen, should not be put to bed, at least, till their waters are broke, but rather kept upright, and assisted 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 on 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 forms the passage. 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, assuring her that she will not endure many 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 the chamber, that so the weight of child may help them forwards. If she flood, or have strong convulsions, she must be then helped by a speedy delivery; the operation I shall relate in the section of unnatural labours. If she be costive, let her use clysters which may also help to dispel the cholic, 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 the womb bears too much on the bladder, let her lift up her abdomen a little with her hand, and try if 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 proceed from the indisposition of the womb, as from its oblique situation, &c. it must be remedied, as well as it can, by placing her body accordingly; or, if it be a vicious conformation, having the neck too hard, too callous, and too strait, it must be anointed with oils and ointments, as before directed. If the membranes be so strong as that the waters do not break in due time, they may be broken with the fingers, if the midwife be first well assured that the child is forward in the passage, or else, by breaking the waters too soon, the child may remain 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 water. These 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 then no great danger to break them, if they be not already broken; for when the case is so, the child is always in readiness to follow, being in the passage; 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 in 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 the speed that may be, lest it be suffocated.

SECT. V. _Of Women labouring with a dead Child._

When the difficulty of labour arises from a dead child, it is a case of great danger to the mother, and great care ought to be taken therein; but before any thing be done, the midwife ought to be well assured 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 abdomen of the mother, especially about the navel. 3. Her urine is thick, and a filthy stinking settles at the bottom. 4. No motion of the child can be perceived; for the trial whereof, let the midwife put her hand in warm water, and lay it upon the abdomen; for that, if it is alive, will make it stir. 5. She is very subject to dream of dead men, and be affrighted therewith. 6. She has extravagant 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 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 spice whatever; and when she has drank 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, if it be living; for cinnamon refresheth and strengtheneth the child.”

Now, if upon trial, it be found that the child is dead, let the mother do all she can to forward the delivery, because a dead child can be nowise helpful therein. It will be necessary, therefore, that she make some comfortable things to prevent her fainting, by reason of the putrid vapours ascending 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, featherfew, centuary, 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 be also anointed with the juice of the garden-tansey. Or take the tansey in the summer, when it can be most plentifully had, and before it runs up to the flower, and having bruised it well, boil it in oil till 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 ætites, 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 loadstone 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 after-birth is left behind in the body (for in such cases as these, many times, it rots, and comes away piecemeal), let her continue drinking the same decoction till her body be cleansed.

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

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

Take savin, round birthwort, trochisks of myrrh, afaran roots, cinnamon, 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, camomile, hen and goose grease. Also foment, to get out the child with a decoction of mercury, orris, wild cucumbers, sæcus, broom flowers. Then anoint the privities and loins with ointment of sowbread. Or, take coloquintida, birthwort, of each a drachm; make a powder; add ammoniacum dissolved in wine, ox-gall, each two drachms; with oil of keir make an ointment. Or this pessary:

Take birthwort, orris, black hellebore, coloquintida, myrrh, each a drachm; powdered ammoniacum dissolved in wine, ox-gall, each two drachms. Or make a fume with an ass’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, spermatic two drachms; deer’s suet an ounce; with wax make anointment. Or,

Take wax six ounces, spermaceti an ounce; melt them, dip flax therein, and lay it all over her abdomen.

If none of these things will do, the last remedy is to use 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 in the next chapter.