Chapter VI: Of unnatural Labour

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

The right and natural birth is, when the child comes with its head first; and yet this is too short a definition of a natural birth: for if any part of the head but the crown comes first, so that the body follows not in a straight line, it is a wrong and difficult birth, even though the head comes first. Therefore, if the child comes with its feet first, or with the side across, it is quite contrary to nature, or, to speak more plainly, that which I call unnatural.

Now, there are four general ways a child may come wrong. 1. When any of the fore parts of the body first present themselves. 2. When, by an unhappy transportation, any of the hinder parts of the body first present themselves. 3. When either of the sides, or, 4. the feet present themselves first. To these the different wrong postures that a child can present itself may be reduced.

SECT. I. _How to deliver a Woman of a Dead Child, by Manual Operation._

When manual operation is necessary, let the operator acquaint the woman of the absolute necessity there is for such an operation; and that, as the child has already lost its life, there is no other way left for the saving of hers. Let him also inform her, for her encouragement, that he doubts not, with the divine blessing, to deliver her safely; and that the pain arising thereby will not to be so great as she fears. Then let him stir up the woman’s pains by giving her some sharp clyster, to excite her throes to bear down and bring forth the child. And if this prevail not, let him proceed with the manual operation.

First, therefore, let her be placed across the bed that he may operate the easier, and let her lie on her back, with her hips a little higher than her head, or at least the body equally placed, when it is necessary to put back or turn the infant to give it a better posture. Being thus situated, she must fold her legs so as her heels be towards her body, and her thighs spread, and held so by a couple of strong persons: there must be others also to support her under her arms, that the body may not slide down when the child is drawn forth; for which, sometimes, a great strength is required. Let the sheets and blankets cover her thighs, for decency’s sake, and with respect to the assistance, and also to prevent her catching cold; the operator herein governing himself as well with respect to his convenience, and the facility and surety of the operation, as to other things. Then let him anoint the entrance of the womb with oil or fresh butter, if necessary, that so with more ease he may introduce his hand, which must also be anointed; and having, by the signs before-mentioned, received satisfaction that the child is dead, he must do his endeavours to fetch it away as soon as he possibly can. If the child offer the head first, he must gently put it back, until he hath liberty to introduce his hand quite into the womb; then sliding it along to find the feet, let him draw it forth by them, being very careful to keep the head from being locked into the passage, and that it be not separated from the body; which may be effected the more easily, because the child being very rotten and putrefied, the operator needs not be so mindful to keep the breast and face downwards as he is in living births. But if, notwithstanding all these precautions, by reason of the child’s putrefaction, the head should be separated and left behind in the womb, it must be drawn forth according to the directions which have been given in the third section of this chapter. But when the head, coming first, is so far advanced that it cannot well be put back, it is better to draw it forth so, than to torment the woman too much by putting it back to turn it and bring it by the feet: but the head being a part round and slippery, it may so happen that the operator cannot take hold of it by reason of its moisture, nor put them up to the side of it, because of its bigness; he must therefore take a proper instrument, and put it up as far as he can, without violence, between the womb and the child’s head, observing to keep the point of it towards the head (for the child being dead before, there can be no danger in the operation,) and let him fasten it there, giving it hold of the bones of the skull, that it may not slide; and after it is well fixed in the head, he may therewith draw it forth, keeping the ends of his left hand flat upon the opposite side, the better to help to disengage it, and by wagging it a little, to conduct it directly out of the passage, until the head be quite born; and then taking hold of it with the hands only, the shoulders may be drawn into the passage, and so sliding the fingers of both hands under the arm-pits, the child may be quite delivered; and then the after-burden fetched, to finish the operation, being careful not to pluck the navel-string too hard, lest it break, as often happens, when it is corrupt.

If the dead child comes with the arms up to the shoulder so extremely swelled that the woman must suffer too great violence to have it put back, it is then (being first well assured that the child is dead) best to take it off by the shoulder points, by twisting three or four times about, which is very easily done by reason of the softness and tenderness of the body. After the arm is so separated, and no longer possesses the passage, the operator will have more room to put up his hand into the womb, to fetch the child by the feet and bring it away.

But although the operator be sure the child is dead in the womb, yet he must not therefore presently use instruments, because they are never to be used but when hands are not sufficient, and there is no other remedy to prevent the woman’s danger, or to bring forth the child any other way; and the judicious operator will choose that way which is the least hazardous and most safe.

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

There is nothing more obvious to those whose business it is to assist labouring women, than that the several unnatural postures in which children present themselves at their birth, are the occasion of most of the bad labour and ill accidents that happen unto them in that condition.

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

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

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

As soon as the midwife has found both the child’s feet, she may draw them forth, and holding them together, may bring them by little in this manner; taking afterwards hold of the arms and thighs, as soon as she can come at them, drawing them so till the hips come forth. While this is doing, let her observe to wrap the parts in a single cloth, that so her hands, being always greasy, slide not on the infant’s body, which is very slippery, because of the vicious humours which are all over it; which being done, she may take hold under the hips, so as to draw it forth to the beginning of the breast; and let her on both sides with her hand bring down the child’s hand along its body, which she may easily find; and then let her take care that the belly and face of the child be downwards: for, if they should be upwards, there would be some danger of its being stopped by the chin, over the share-bone; and therefore, if it be not so, she must turn it to the posture; which may easily be done, if she takes proper hold of the body when the breast and arms are forth, in the manner as we have said, and draws it, turning it in proportion on that side which it most inclines to, till it be turned with the face downwards; and so, having brought it to the shoulders, let her lose no time, desiring the woman at the same time to bear down, that so drawing the head at that instant may take its place, and not be stopped in the passage. Some children there are whose heads are so big, that when the whole body is born, yet that stops the passage, though the midwife takes all possible care to prevent it. And when this happens, she must endeavour to draw forth the child by the shoulders, taking care that she separate not the body from the head, (as I have known it done by the midwife,) discharging it by little and little from the bones in the passage with the fingers of each hand, sliding them on each side opposite the other, sometimes above and sometimes under, till the work be ended; endeavouring to despatch it as soon as possible, lest the child be suffocated, as it will unavoidably be, if it remain long in that posture; and this being well and carefully effected, she may soon after fetch away the after-birth, as I have before directed.

SECT. III. _How to bring away the Head of the Child, when separated from
the Body, and left behind in the Womb._

Though the utmost care be taken in bringing away the child by the feet, yet if it happen to be dead, it is sometimes so putrefied and corrupt, that with the least pull the head separates from the body, and remains alone in the womb, and cannot be brought away but with a manual operation and great difficulty, it being extremely slippery, by reason of the place where it is, and from the roundness of its figure, on which no hold can be taken; and so very great is the difficulty in this case, that sometimes two or three able practitioners of midwifery have, one after the other, left the operation unfinished, as not able to effect it, after the utmost industry, skill and strength; so that the woman, not being able to be delivered, perished. To prevent which fatal accident, let the following operation be observed.

When the infant’s head separates from the body, and is left alone behind, whether through putrefaction or otherwise, let the operator immediately, without any delay, whilst the womb is still open, direct up his right hand to the mouth of the head (for no other hole can there be had), and having found it, let him put one or two of his fingers into it, and the thumb under its chin; then let him draw it by little and little, holding it by the jaws: but if that fails, as sometimes it will, when putrefied, then let him pull out the right hand, and slide up his left with which he must support the head, and with the right let him take a narrow instrument called a _crotchet_, but let it be strong, and with a single branch, which he must guide along the inside of his hand, with the point of it towards it, for fear of hurting the womb; and having thus introduced it, let him turn it towards the head, to strike either in an eye-hole, or the hole of an ear, or behind the head, or else between the sutures, as he finds it most convenient and easy; and then draw forth the head so fastened with the said instrument, still helping to conduct it with his left hand; but when he hath it brought near the passage, being strongly fastened to the instrument, let him remember to draw forth his hand, that the passage, not being filled with it, may be larger and easier, keeping still a finger or two on the side of the head, the better to disengage it.

There is also another method, with more ease and less hardship than the former: let the operator take a soft fillet or linen slip, of about four fingers’ breadth, and the length of three quarters of an ell, or thereabouts, taking the two ends with the left hand, and the middle with the right, and let him so put it up with his right as that it may be beyond the head, to embrace it as a sling doth a stone, and afterwards draw forth the fillet by the two ends together; it will thus be easily drawn forth, the fillet not hindering the least passage, because it takes up little or no space.

When the head is fetched out of the womb, care must be taken that not the least part of it be left behind, and likewise to cleanse the womb of the after-burden, if yet remaining. If the burden be wholly separated from the side of the womb, that ought to be first brought away, because it may also hinder the taking hold of the head. But if it still adheres to the womb, it must not be meddled with till the head be brought away; for if one should endeavour to separate it from the womb, it might then cause a flooding, which would be augmented by the violence of the operation; the vessels to which it is joined remaining for the most part open as long as the womb is distended, which the head causeth while it is retained in it, and cannot be closed till this strange body be voided, and this it doth by contracting and compressing itself together, as has been more fully before explained. Besides, the after-birth remaining thus cleaving to the womb during the operation prevents it from receiving easily either bruise or hurt.

SECT. IV. _How to deliver a Woman when the Child’s Head is presented to
the Birth._

Though some may think it a natural labour, when the child’s head comes first; yet, if the child’s head present not the right way, even that is an unnatural labour; and therefore, though the head comes first, yet if it be the side of the head instead of the crown, it is very dangerous both to the mother and child, for the child’s neck would be broken, if born in that manner; and by how much the mother’s pains continue to bear the child, which is impossible unless the head be rightly placed, the more the passages are stopped. Therefore, as soon as the position of the child is known, the woman must be laid with all speed, lest the child should advance further into this vicious posture, and thereby render it more difficult to thrust it back, which must be done, in order to place the head right in the passage, as it ought to be.

To this purpose, therefore, place the woman so that her thighs may be a little higher than her head and shoulders, causing her to lean a little upon the opposite side to the child’s ill posture; then let the operator slide up his hand, well anointed with oil, by the side of the child’s head, to bring it right gently with his fingers between the head and the womb; but if the head be so engaged that it cannot be done that way, he must put his hand up to the shoulders, that so by thrusting them back a little into the womb, sometimes on the one side and sometimes on the other, he may, by little and little, give a natural position. I confess it would be better, if the operator could put back the child by its shoulders with both hands: but the head takes up so much room, that he can only make use of his fingers, with which he must perform this operation, and with the help of the finger ends of the other hand put forward the child’s birth, as in natural labour.

Some children present their face first, having their hands turned back, in which posture it is extremely difficult for a child to be born; and if it continues so long, the face will be swelled, and become black and blue, so that it will at first appear monstrous, which is occasioned as well by the compression of it in that place, as by the midwife’s fingers in handling it, in order to place it in a better posture. But this blackness will wear away in three or four days’ time, by anointing it often with oil of sweet almonds. To deliver the birth, the same operation must be used as in the former, when the child comes first with the side of the head; only let the midwife or operator work very gently, to avoid as much as possible the bruising the face.

SECT. V. _How to Deliver a Woman when the Child presents one or both
Hands together with the Head._

Sometimes the infant will present some other part together with its head; which if it does, it is usually with one or both its hands; and this hinders the birth, because the hands take up part of that passage which is little enough for the head alone: besides when this happens, they generally cause the head to lean on one side; and therefore this position may be well styled unnatural. When the child presents thus, the first thing to be done, after it is perceived, must be to prevent it from coming down more, or engaging further in the passage; and therefore the operator having placed the woman on the bed, with her head lower than her thighs, must guide and put back the infant’s hand with his own as much as may be, or both of them, if they both come down, to give way to the child’s head; and this being done, if the head be on one side, it must be brought into its natural posture, in the middle of the passage, that it may come in a straight line, and then proceed as directed in the foregoing section.

SECT. VI. _How a Woman ought to be delivered, when the Hands and Feet of
the Infant come together._

There are none but will readily grant, that when the hands and feet of an infant present together, the labour must be unnatural; because it is possible a child can be born in that manner. In this case therefore, when the midwife guides her hand to the orifice of the womb, she will perceive only many fingers close together; and if it be not sufficiently dilated, it will be a good while before the hands and feet be sufficiently distinguished; for they are sometimes so shut and pressed together, that they seem to be all of one and the same shape: but where the womb is open enough to introduce the hand into it, she will easily know which are the hands and which are the feet; and having taken particular notice thereof, let her slide up her hand, and presently direct it towards the infant’s breast, which she will find very near, and then let her very gently thrust back the body towards the bottom of the womb leaving the feet in the same place where she found them: and then, having placed the woman in a convenient posture, that is to say, her thighs a little raised above her breast, and (which situation ought also to be observed when the child is to be put back into the womb), let the midwife afterwards take hold of the child by the feet, and draw it forth, as is directed in the second section.

This labour, though somewhat troublesome, yet is much better than when the child presents only its hands; for then the child must be quite turned round before it can be drawn forth; but in this they are ready, presenting themselves, and there is little to do but to lift and thrust back the upper part of the body, which is almost done of itself, by drawing by the feet alone.

I confess there are many authors that have written of labours, who would have all wrong births reduced to a natural figure; which is, to turn it that it may come with the head first. But those that have written thus are such as never understood the practical part; for if they had the least experience therein, they would know that it is impossible; at least, if it were to be done, that violence must necessarily be used in doing it, that would very probably be the death of both mother and child in the operation.

I would therefore lay down, as a general rule, that whensoever a child presents itself wrong to the birth, in what posture soever, from the shoulders to the feet, it is the best way, and the soonest done, to draw it out by the feet; and that it is better to search for them, if they do not present themselves, than to try to put them into their natural posture, and place the head foremost; for the great endeavours necessary to be used in turning the child in the womb, do so much weaken both the mother and the child, that there remains not afterwards strength enough to commit the operation to the work of nature; for, usually, the woman hath no more throes or pains fit for labour after she has been so wrought upon: for which reason it would be difficult, and tedious at best; and the child by such an operation made very weak, would be in extreme danger of perishing before it could be born. It is therefore much better in these cases to bring it away immediately by the feet; searching for them, as I have already directed, when they do not present themselves; by which the mother will be prevented a tedious labour, and the child be often brought alive into the world, who otherwise could hardly escape death.

SECT. VII. _How a Woman should be delivered that has Twins, which
present themselves in different Postures._

We have already spoken something of the birth of twins in the chapter of natural labour; for it is not an unnatural labour barely to have twins, provided they come in a right position to the birth. But when they present themselves in different postures, they come properly under the denomination of unnatural labours; and if when one child presents itself in a wrong figure, it makes the labour dangerous and unnatural, it must needs make it much more so when there are several, and render it not only more painful to the mother and children, but to the operator also; for they often trouble each other, and hinder both their births. Besides which, the womb is so filled with them, that the operator can hardly introduce his hand without much violence, which he must do, if they are to be turned or thrust back to give them a better position.

When a woman is pregnant with two children, they rarely present to the birth together, the one generally being more forward than the other; and that is the reason that but one is felt, and that many times the midwife knows not that there are twins till the first is born, and that she is going to fetch away the after-birth. In the first chapter, wherein I treated of natural labour, I have showed how a woman should be delivered of twins, presenting themselves both right; and therefore, before I close the chapter of unnatural labour, it only remains that I show what ought to be done when they either both come wrong, or one of them only, as for the most part it happens; the first generally coming right, and the second with the feet forward, or in some worse posture. In such a case, the birth of the first must be hastened as much as possible, to make way for the second, which is best brought away by the feet, without endeavouring to place it right, because it has been, as well as its mother, already tired and weakened by the birth of the first, and there would be greater danger of its death than likelihood of its coming out of the womb that way.

But if, when the first is born naturally, the second should likewise offer its head to the birth, it would be then best to leave nature to finish what she has so well begun; and if nature should be too slow in her work, some of those things mentioned in the fourth chapter, to accelerate the birth, may be properly enough applied: and if, after that, the second birth should be yet delayed, let a manual operation be deferred no longer; but the woman being properly placed, as has been before directed, let the operator direct his hand gently into the womb to find the feet, and so draw forth the second child, which will be the more easily effected, because there is a way made sufficiently by the birth of the first; and if the waters of this second child be not broke, as it often happens, yet, intending to bring it by the feet, he need not scruple to break the membranes with his fingers; for though, when the birth of a child is left to the operation of nature, it is necessary that the waters should break of themselves, yet when the child is brought out of the womb by art, there is no danger of breaking them; nay, on the contrary, it becomes necessary; for without the waters are broken, it would be impossible to turn the child.

But herein principally lies the cares of the operator, that he be not deceived, when either the hands or feet of both children offer themselves together to the birth; in this case he ought well to consider the operation, as, whether they be not joined together, or any way monstrous; and which part belongs to one child, and which to the other; that so they may be fetched one after the other, and not both together, as may be, if it were not duly considered; taking the right foot of the one and the left of the other, and so drawing them together, as if they belonged to one body, because there is a left and a right, by which means it would be impossible ever to deliver them. But a skilful operator will easily prevent this, if, having found two or three of several children presenting together in the passage, and taking aside two of the forwardest, a right and a left, and sliding his arm along the legs and thighs up to the wrist, he finds they both belong to one body; of which being thus assured, he may begin to draw forth the nearest, without regarding which is the strongest or weakest, bigger or less, living or dead, having first put aside that part of the other child which offers to have the more way, and so dispatch the first as soon as may be, observing the same rules as if there were but one, that is keeping the breast and face downwards, with every circumstance directed in that section where the child comes with its feet first, and not fetch the burden till the second child is born. And therefore, when the operator hath drawn forth one child, he must separate it from the burden, having tied and cut the navel-string, and then fetch the other by the feet in the same manner, and afterwards bring away the after-burden with the two strings as hath been before showed. If the children present any other part but the feet, the operator may follow the same method as directed in the foregoing section where the several unnatural positions are fully treated of.