Chapter III: AND now, at last, the OSSA COCCYGIS and COXENDICIS begin to

yield, and give way; while the _Bottom_ contracts, the _Orifice_ of the WOMB opens, and the VAGINA dilates itself fully: So that _now_, and not _before_, most of the abovesaid _Signs_ evidently appear, I give my patient _Woman_ the WORD to _Labour her best_; because if she begins _sooner_, she too much debilitates both _Herself_ and fatigues the _CHILD_ before its due Time.

MOREOVER, I have seen _some Women_ in LABOUR taken with a sudden _Vomiting_, that I suppose proceeded from the _natural Sympathy_, which the STOMACH bears to the WOMB: Whereupon it discharges a certain _Viscous Matter_, which I have always observ’d, upon its turning _Bloody_, to presage an easy _LABOUR_, and an expeditious _DELIVERY_.

FARTHER yet, the _MIDWIFE_ must always remember, that when the commenced _real PAINS_ of _Labour_ chance to cease, the Woman’s _Labouring Efforts_ must also terminate with them in Course: And as this _Case_ denotes a _Debility_ of the _Expulsive Faculty_; so if it be not both _Timely_ and _Judiciously_ assisted, It may prove of the worst of Consequences. In a word, so much I have thought previously _necessary_ to my Purpose, before I enter upon——

CHAP. XVII.
_Of the True Method of LAYING the Woman._

UPON this Occasion, the _MIDWIFE_ ought, in the _first place_, carefully to observe the CONTENTS of the foregoing _Chapter_; and, _Secondly_, To follow this general RULE, which I lay down out of absolute _Necessity_: viz. _That the Woman be delivered, and the Child brought forth into the World as soon as possible after_ FLOODING; and _that_ because the WOMB immediately, after _This_ is over, falls, shrinks, and contracts itself again, and of Consequence compresses the _BIRTH_ very closely.

BUT in order to effect _this_ Matter, as much depends upon the right _Situation_ or _Placing_ of the WOMAN; so I advise, in the first place, that, as soon as the WATERS begin to flow, _She_ be commodiously _placed_ either in a BED, CHAIR, or STOOL, properly adapted for that Purpose, and _laid_ with great Skill and Judgment, not too _Supine_, nor altogether _Upright_; but (as it were) between a _standing_ and _lying Posture_: having her _Back_ a little erected for the freer _Respiration_, and the better LABOUR; with her _Thighs_ at a due Liberty and Distance, only separated as much as possibly they may; her _Knees_ a little elevated; her _Feet_ stayed against something _Firm_, and her _Heels_ bending _Backwards_.

HOWEVER I must farther observe in this place, that the _POSITIONS_ of _parturient Women_ are very various and different; _some_ doing this _Work_ (as above) in a _Bed_, _others_ in a _Stool_, and _some_ again I have seen deliver’d _standing_, and _leaning_ only a little _Forwards_ upon the _Bed-stead_. Hence, I say, that the _POSTURES_ in time of LABOUR, differ not only according to the _Necessity_, but also sometimes (in _Natural Easy Cases_) according to the _Custom_ of the WOMAN.

BE that as it will, I would advise all _Labouring Women_, FIRST to make _Choice_ of a dextrous and ingenious _MIDWIFE_ to attend them at that _critical Juncture_, since the poetical _Proverb_ (_Accidit in puncto, quod non speratur in Anno_) holds as True in _BIRTH_ as in any _Case_ I know; for _some Women_ after having sundry repeated Natural easy _BIRTHS_, come at last to suffer by some difficult or _preternatural Accident_, which may happen in a _Moment of Time_.

SECONDLY, I would advise all _parturient Women_, to give themselves over into the Hands of such a _MIDWIFE_, to be universally _advised_ and _entirely_ directed by her Conduct: And thus being under the watchful _Eye_ and diligent _Care_ of the prudent and skilful _MIDWIFE_, the good _Woman in her Travail_ has Nothing else to do (besides following _Instruction_) but only to assume _Courage_ and _Resolution_ to assist her own _PAINS_ as she feels them coming on, by _drawing_ and _holding_ her BREATH, as if she was to _sob_ or _sigh_, by contracting the _MUSCLES_ of her _Belly_, as much as possible; insomuch that the forcible _Impression_ may bear alike upon each side of the WOMB, and depress the _Diaphragma_, which (of Consequence) suppresses the WOMB. But then again in this _Case_ I would observe briefly, that she is strictly to regard the _TIME_ of a _right true Travail, as at that Juncture_ only to use _these_ her best and strongest _Endeavours_.

BUT now to return to the _Duty_ of the attending _MIDWIFE_; as occasion requires, She is to direct her WOMAN, either to _lie_, _sit_, _stand_, or _walk_, keeping her always _Warm_, and as close _cover’d_ in Time of TOUCHING as possible; for the least Breath almost of _Cold Air_ may occasion _Convulsions_, and _other_ most dangerous _Accidents_.

BECAUSE I have often observ’d _Women_ to be _Costive_ and bound in their _Bellys_ upon this Occasion, which is of dangerous Consequence, I would therefore advise in this _Case_ to adhibite a gentle _Emollient Clyster_; not only that (by the RECTUM being so emptied) there may be the more _Room_ for the necessary _Dilatation_ of the _PARTS_, but also that the unfortunate _Effects_ of COSTIVENESS may be timely prevented: And the same _Means_ I would use, in Case of _Heavy_, _Dull_, or _Languid PAINS_; ordering the _Clyster_ only in this _Case_ to be made a little more _Carminative_; as mentioned in the preceeding _Chapter_.

BUT _this_ however I would have done in the _Beginning_ of the _Travail_, and reiterated (if need so require) before the _CHILD_ be advanced too far _Forwards_.

NOW the _MIDWIFE_ finding all things in a _Natural Posture_, and the CHILD in a _Forward way_, is to advance her _Hand_ skilfully, (which at every individual TOUCH ought to be fresh-anointed with the _Oil_ of white _Lillies_, _Roses_, &c. or _Fresh-Butter_, _Hogs-Lard_, or whatsoever of this Nature is readiest at Hand) entering the _ORIFICE_ with the _Fingers-Ends_, dilating it by opening _them_ gently as the PAINS come on: Thrusting gradually the _Sides_ of the _ORIFICE_ towards the _OCCIPUT_ or Hinder part of the CHILD’S Head, and moistening these _Passages_ also with what she uses for her _Hands_.

WHEN the _VERTEX_, or _Crown of the Head_, appears without the _Privities_, the _MIDWIFE_ most commonly calls out or says the CHILD is in the _Passage_; and the _parturient Woman_ then finding these Parts (as it were) scratch’d or prick’d with PINS, often groundlessly imagines that her _MIDWIFE_ deals roughly by _Her_ with _Nails_ and _Fingers_; whereas that _Pungency_ is only occasioned by a violent _Distension_, or perhaps a _Laceration_, sometimes inevitably made, by the BULK of the _Head_ of the _INFANT_.

HOWEVER that be, and whatever the _Woman_ may think or say, the _MIDWIFE_ is only to mind her own Business, and discharge her Duty faithfully upon this _CRISIS_; in order to which, it is now High Time that she also place herself in a convenient _Posture_ to receive the _BIRTH_: Which (when advanced as far as the _EARS_, or _thereabouts_) she is to take gentle hold of, by _both Sides_ of the _HEAD_ with _both Hands_; so that by this _Means_ she may be ready and able, against the first _Onset_ of the next good PAIN, to draw forth the CHILD. In doing whereof, she must take special _Care_ that the _NAVEL-STRING_ be not entangled about the _Neck_, or any other _Part_, lest the _Secundine_ or the _Womb_ itself thereby suffer Violence, and consequently cause either _Flooding_, or break the _String_, which may render the _Case_ dangerous and the _BIRTH_ difficult.

BUT in thus attracting the _INFANT_, the _MIDWIFE_ must carefully observe, not to draw the _HEAD_ straight-forwards, but move it gently from _Side to Side_, that the _Shoulders_ may the more readily and easily take Place: For _these_ must immediately follow the _HEAD_ without _Loss of Time_, otherways the _BIRTH_ may be strangled in the _Passage_ by the _WOMB_ shutting upon its _Neck_: To prevent which _Tragical Catastrophe_, the Cunning Expert _MIDWIFE_ directly slides in her _Fingers_ under the _Arm-Pitts_, and then draws discreetly the _BODY_ forth without any Difficulty or Danger.

_THUS_, in fine, We have discreetly deliver’d our good _WOMAN_, in _Case_ of a _Natural Easy Birth_; but on the other Side, in difficult and _Preternatural Cases_, the several Conditions and Circumstances will mightily differ from the Beginning; because in _these_ the _PAINS_ are not always sufficient to produce the _BIRTH_. Hence it is sometimes more convenient for the _WOMAN_ to be _Passive_, rather than _Active_; especially when the POSITION of either the _Womb_, or the _Infant_ is _Preternatural_: For then it is the _MIDWIFE’s_ whole Business to _labour_ more than the _WOMAN_; then her ingenious TOUCH is of infinite Service to the _PARTURIENT_, since by that only she can distinguish the Degree of the _Ill Situation_ whether of the _CHILD_ or the _WOMB_. Which being dextrously done, _She_ is in the next Place, prudently to consider what kind of _POSTURE_, _Sitting_ or _Lying_, is most convenient, that she may the _better_ discharge her own good _Office_ and _Duty_: Of which I shall treat more particularly in the following respective _Chapters_; since it still remains here, by the way, that we also deliver our above-mentioned _Woman_ of her AFTER-BIRTH, _&c._

CHAP. XVIII.
_Of the Method of Extracting the SECUNDINE_,

&c.

AFTER all, to perfect or finish the _Woman’s DELIVERY_, it still remains that _She_ be freed of her AFTER-BIRTH, or SECUNDINE. Now this I advise to be done with all imaginable Speed, after the CHILD _is born_, even before the _NAVEL-STRING_ is cut: Because the WOMB immediately _contracts_ itself, so that _This_ cannot be accomplish’d afterwards without great _Difficulty_.

HOWEVER, I know beforehand, that my Method of performing this Work, which I am about to lay down, will be thought a strange _Innovation_ in _Midwifery_; but without any regard to that, in speaking to this _Point_, I shall _First_ suppose this _Body_ to be already loosen’d from the WOMB; in which _Case_ the MIDWIFE has nothing to do, but to draw the _STRING_ gently, which she holds in _One Hand_, twisted twice or thrice around one or more of her _Fingers_, while she passes the _Other Hand_ into the WOMB, following always the _STRING_ (as her _Guide_) to the Place where the BURTHEN lies: And where, as in this _Case_, it naturally presents itself to the ORIFICE, _She_ stretches her _Hand_ up length-ways, taking hold of it betwixt her _Fingers_; and thus, by the Assistance of the _other Hand_ always attracting softly the _STRING_, she brings it at last most commodiously away.

SECONDLY, I shall suppose, in the mean Time, this _Body_ to continue _fixed_ to the WOMB, either in _Part_ or in _Whole_: In which _Case_, if in _Part_, the MIDWIFE finding by the TOUCH the other _Loose Part_, moves her _Hand thither_ betwixt _That_ and the WOMB, shaking or stirring it gently _backwards_ and _forwards_, until such time as it is entirely _loosen’d_, when she proceeds as _Before_: But if in _whole_, and that it sticks very _Fast_, then the _MIDWIFE_ places her _Hindmost Fingers_ on its _Exteriour Part_ against the WOMB, and her _Fore-Fingers_ against the _Inside_; so that thus by pulling softly on all _Sides_ quite round, it is easily _loosen’d_ and _extracted_ as Above.

THIRDLY, I shall suppose this _SECUNDINE_ also (tho’ loosen’d successfully) to be so very _Large_, that it cannot pass through the _ORIFICE_: In this _Case_, I only desire my _deliver’d Woman_ to concur with me, and behave herself as if she was forcing or expelling the _CHILD_; for then whilst I at the same time gently attract the _STRING_, it immediately follows.

I very well know that Mr. _Mauriceau_ and all _others_ either _in_ and _before_ his Time, teach quite different _Methods_ of extruding the _AFTER-BIRTH_; such as are by the _WOMAN’s blowing in her Fist, putting her Finger in her Throat, and the like_; which when the _poor Patient_ has done, and stood them All out _ineffectually_, together with their many other various _uncertain Experiments_ to no _Purpose_, and none of them have succeeded (as it has often happen’d): Then at last, and not till then, they direct the aforesaid _Method_ of the _HAND_ to be used. But now-a-days, we know better Things than to run such indiscreet _Risques_, when we may go a safer Way to work; or to make use of _Uncertainties_, when we know more _Infallible Means_. As I shall, I hope, make this _Method_ plainly appear to be; notwithstanding all the great _Cautions_ of those Authors publish’d, and the Difficulties they make of it in our Practice of _MIDWIFERY_: And that I will endeavour to do from the following _Considerations_, viz.

I. IF after the BIRTH of the INFANT, the _Hand_ be presently pass’d into the WOMB, it slips in together with Part of the _Arm_, as far as is needful, without the least _Trouble_ or _Inconvenience_ to the WOMAN; the WOMB as well as its ORIFICE continuing always, so long as _this_ may be done, sufficiently _Open_: And thus the BIRTH maybe skilfully accomplished or perfected, as it were, in an _Instant_; while _others_ (trying their vain _Projects_) spend many trifling _Hours_ about it, and it is _ten to one_, if at last they succeed.

II. BY these means, moreover, I presently know whether there be _One_, _Another_, or _More INFANTS_ to follow; whether there be a _dead CHILD_, _false CONCEPTION_, or any _Foreign Body_ whatsoever, lodged in the WOMB; whether any _Part_, or _Pieces_ of the SECUNDINE, or _Membranes_, or _Lumps_ of _Clotted Blood_, be left behind and retain’d: All which I propose to bring away either _before_, or _after_ the SECUNDINE, as Occasion serves, with the greatest _Safety_ as well as _Expedition_.