Chapter II: LEST she should unwarily either break, tear, or scratch the

WOMB, with her _thick_, _fleshy_, _rough_, and _rigid_ HAND, or with her _stiff_ and _crooked_ FINGERS: _Either_ of which _Accidents_, may give ORIGIN to various _Misfortunes_; such as a PROLAPSUS, or _Falling-down_, a _preternatural Flooding_, an _Inflammation_, or _Gangrene_, &c.

BUT we will now, in fine, suppose that the _Ingenuous MIDWIFE_ has after All discharged her faithful _Duty_ in these Respects, with _Care_, _Lenity_, and good _Conduct_, as well as with great _Art_ and _Judgment_: In which _Case_, it only remains, that _she_ take the necessary and usual _Care_ of the CHILD-BED-WOMAN and INFANT; as hereafter will be directed in the respective _Chapters_ of _SECTION_ VIth, to come.

IN the mean Time, these curious _Things_ being thus amply premised in this Place, the READER has no more superfluous _Repetitions_ to expect concerning _them_ in the following _Performance_: And therefore with these _Preliminaries_ I conclude my _Fourth SECTION_.

SECT. V.

CHAP. I.
_Of BIRTH._

MAN’s appointed Time may as reasonably allude to his _BIRTH_, as to his _DEATH_: His _Days_ and his _Months_ (mentioned by holy JOB[158]) being as much determin’d, _naturally_ speaking, in the _One_, as in the _other Case_.

THE _INFANT_ thus being thoroughly ripen’d, and arrived to full _Perfection_ of MATURITY, the _Hour_ approaches, in which it scorns any longer _Confinement_ to such narrow Bounds. For the _Animal Spirits_ being discontented, for want of due _Liberty_ and free _Motion_; the _Vitals_, for want of _Refrigeration_ and _Refreshment_; and the _Natural Spirits_, for want of sufficient _Respiration_ and _Nutrition_: _They_ all concur to make a _Commotion_, and (as it were) a victorious _Revolt_ or an _Effort_ pushing for _CONQUEST_.

THE _INFANT_ being thus irritated, immediately shakes off its _Fetters_, breaks the _Ligaments_, rents the _Membranes_, thrusts through the _Enclosures_, and makes its most vigorous _Attempts_ to enlarge itself from the _Prison_ of the WOMB, into that of the WORLD.

WHICH _Enlargement_ depends very much indeed upon _NATURE_, but more particularly on the _Strength_ and _Vigour_ of the _INFANT_, seconded by a peculiar _Faculty_ of the WOMB, that by degrees is drawn-in to _Consent_, and _Endeavour_ to dislodge and expel its troublesome and obstreperous _GUEST_.

NOW the _INFANT_, during the whole Time of _Gestation_, adhering to the _WOMB_, by the _Umbilicals_, as the _Fruit_ does to the TREE by the _Stalks_, upon this Occasion distends the _WOMB_, and having valiantly turn’d itself, breaks the _Membranes_, and dissolves the _Acetabula_: When also the _Orifice_ of the _WOMB_ is competently open’d; and _That_ (in _Avicenna_’s memorable Words[159]) at the Command of the great GOD. Upon This the _Waters_ flow; the _Umbilicals_ parting from the _WOMB_ and their proper _Vessels_, and the _Veins_ and _Arteries_ of the _SECUNDINE_ severing themselves, in like manner; As ripe _Fruit_, or the _Leaves_ of TREES in _Autumn_ fall-off naturally, or break from their proper _Stalks_.

THUS the _WOMB_, exerting its extensive and expulsive _Faculties_, excludes the Legitimate _INFANT_: To which great _Work_ also, the _Painful Labours_, and _Labouring Pangs_ of the _MOTHER_ (in the manner they happen with the contracted _Spirits_, depress’d _Midriff_, and compress’d _Muscles_ of the ABDOMEN) contribute not a little _Help_. And, in short, this stupendous _Work_ or _Action_ is called _BIRTH_; and is nothing else, but an _Exclusion_ of the _mature CHILD_.

WHICH _BIRTH_ proceeds either from _Causes_ of the _INFANT_, or from _Causes_ of the _WOMB_: Of the _INFANT_, because through the strict _Confinement_ of a narrow Place, and Defect[160] of _Aliment_, and _Refrigeration_, It kicks and spurns for its EXIT: Of the _WOMB_, because about that _Time_, being overloaded and aggrieved by the _Bulk_ and _Weight_ of the CHILD, it endeavours, by its own expulsive _Faculty_, to disburthen itself, and propel or drive it forth to the utmost of its Power. For——

AS it is the proper _Function_ of the STOMACH, to eject the _noxious Humours_ by Vomit, and deject the _Natural Excrements_ into the _INTESTINES_; as it is also the _Office_ of the _RECTUM_ to evacuate the _Fæces_; as likewise the _Profusion of the Urine_ is the _Action_ of the BLADDER; as again the _Extrusion_ of all _fuliginous Matters_ is the _Work_ of the HEART and LUNGS; and as, at last, the _Effusion_ of the _Genital_ SEED (in _Venery_) is the _Operation_ of the _Virile_ TESTICLES: So the _Exclusion_ of the _Mature FOETUS_ is the _Eighth_[161] and last proper _Action_ of the _WOMB_; which is justly deem’d the only _Primary Agent_ and _Active Cause_ of _BIRTH_, as the excluded _FOETUS_ is the _Passive_.

BUT this _BIRTH_ is not always _Uniform_; for as it differs in _Time_, so it does also in _Manner_: From hence we have with respect to the TIME, _Legitimate_ and _Illegitimate BIRTHS_, which being already discuss’d[162], I shall resume nothing by way of _Repetition_ in this Place: And with respect to the MANNER, we have also two general SORTS, namely, _Natural_ and _Preternatural BIRTHS_; which together with their particular _Branches_, I am now to enter upon, without any farther Digression.

CHAP. II.
_Of Natural BIRTHS._

BY a _Natural BIRTH_, I mean nothing else, but that which is perform’d without any _ART_ or _Artificial Means_; which _BIRTH_ (of itself) strictly observes the Order and Appointment of _Nature_: That is, in the _INFANT_’s coming _Head foremost_, _Face downwards_, _Arms following_, extended (along the _Sides_) strait _upwards_, towards the _Thighs_.

_HIPPOCRATES_’s _Reason_[163], in short, for the _CHILD_’s thus turning and presenting itself, is very good; _viz._ Because of all the _Parts_, the HEAD is the Heaviest about the Time of _BIRTH_, as appears more at large from _Sect._ I. _Chap._ 10.

BUT besides this Argument, I believe Wise _Nature_ has also order’d it _thus_; because _This_ indubitably is the most _safe_ and _easy Manner_ of _EXITION_ both for the _Mother_ and _Infant_: Insomuch that by all other _Methods_ of _EXTRACTION_, _One_ or the _Other_, and sometimes _Both Lives_ are, or may be, endanger’d, if not very dextrously perform’d, according to the best Laws of Art and Judgment, as by and by will more manifestly appear.

BUT because I have generally observ’d most _Authors_ to treat promiscuously of _BIRTHS_, not only accounting some, which are really _Natural_, to be _Preternatural_; but also both handling and writing of them as _such_, only because attended with some difficult Circumstances: I shall (in this place) take Leave to make an agreeable _Distinction_ betwixt the _different Sorts_ of _Natural BIRTHS_, in order to make every thing the more clear and obvious to the _Conception_ of the READER. Upon which Account therefore, I shall reduce _These_ to _two Heads_, and that under the TITLES of _Natural Easy_, and _Natural Difficult BIRTHS_.

THE _FIRST_ of which I include in this _Chapter_; but because in this _Case_ (which I call a _Natural Easy BIRTH_), _Nature_ alone always performs the _Work_, without any Help of _ART_ or _Artful Means_; and because also the MIDWIFE (upon this Occasion) has but little or nothing to do, save only to observe the concluding _Chapters_ of the last preceding SECTION; and upon receiving the CHILD, immediately to manage and provide both for the MOTHER and the INFANT according to their several _Necessities_, as hereafter shall be inculcated in the respective _Chapters_ of the next following SECTION: I say, for these _Reasons_, I have no Room here to insist farther on this present HEAD; wherefore I proceed in course to the _SECOND Sort_ of these _BIRTHS_. Namely——

CHAP. III.
_Of Natural Difficult BIRTHS._

THO’ indeed every _difficult Expulsion_ of the _INFANT_, from whatsoever _Cause_ it may proceed, is verily a _Difficult BIRTH_; yet I shall here distinguish a _difficult One_ from a _preternatural BIRTH_; not only that I may thereby, the better avoid the _Confusion_ which others have led themselves into, by treating of BOTH promiscuously, but also that my _Method_ may tend the more to the peculiar Benefit and Advantage of the Ingenious READER.

WHEREFORE I call that a _Difficult BIRTH_; where, notwithstanding the _Figure_ and _Dimensions_ of the _CHILD_, answer in all respects to its proper _natural Posture_, in a _Perpendicular_ WOMB, duly situated, yet the _Exclusion_ of the _INFANT_, is retarded, by some certain _Opposition_ or _Difficulty_. From hence proceeds the real _Difference_ between _This_ and the _Natural Easy BIRTH_, forasmuch as _This_ always requires _less_ or _more_ skilful _Assistance_, according to various Circumstances, and _That_ but _Little_ or _none at all_.

NOW the _Causes_ of _Difficult BIRTHS_ are very various, and according to the _Nature_ of them, _This_ sometimes proves equally as dangerous as the _Preternatural_; but when so it happens, I have commonly observed the _Fault_ to be, for the most Part wholly owing to the arrogant _MIDWIFE_, who either knew not how to remove the _Cause_ and facilitate the _BIRTH herself_, or delay’d applying betimes to some _Abler Person_, for the _Relief_ and _Safety_ of her Labouring _WOMAN_.

HENCE arises a Fundamental MAXIM, which I would lay down for a memorable _Rule_ to all such IGNORANTS; that no _MIDWIFE_ ought to keep a WOMAN in this Condition under her _Hands_ (especially in a _Place_ where extraordinary _Help_ is to be had) any _longer_, than she finds the _Advances_ of _BIRTH_ answer to the Proportion of _Time_ spent about it: But forthwith she ought to deliver her up to the _Care_ of the more Skilful and Judicious _Practiser_ in this ART. In which _Case_, of _Compliance_ and _Condescension_, she is to be highly commended for her tender _Care_, and cautious _Concern_; whereas upon acting contrary to this good _Rule_ out of Pride or Obstinacy, and the _fatal Accident_ ensuing, I have known the _MIDWIFE_ to have been try’d for her _Life_ in the City of _Venice_.

BUT that I may render every thing _Plain_ and _Easy_ to the _Apprehension_ of the weakest READER, by reason that the _Causes_ of _Difficult BIRTHS_ are both _different_ and _numerous_, I shall again reduce them to _Two_ CLASSES; namely, _External_ and _Internal_: The _External_, I shall include in the next following _Chapter_; but the _Internal Causes_, requiring a more Curious and Extensive _Dilucidation_, may (I hope) be pertinently divided into a _Three-fold Difference_; viz. _Causes_ of the MOTHER, of the INFANT, and of the PASSAGES; which I propose to handle particularly, all in their due _Order_. But _First_,

CHAP. IV.
_Of Difficult BIRTHS, proceeding from External Causes._

IN all _difficult Cases_, the CURE or _Remedy_ chiefly depends upon the certain _Knowledge_ of the _Nature of the Case_, and the _Cause_ of the _Difficulty_: Since (according to _Celsus_[164], that noble _Roman Physician_) it is not to be suppos’d that _He_ should know how to _remedy Diseases_, who knows not their _Original Causes_.

FOR as in other _Cases_, so also in _MIDWIFERY_, the _Cause_ being known, the _Difficulty_ is easily remov’d; but especially when it only proceeds from _External Causes_, it requires no great ART, save only the _MIDWIFE_’S particular _Notice_ and discreet _Animadversion_.

AS, _FIRST_, for Instance, in _Case_ of any _Difficulty_, occasion’d by an _Intemperature_, or inclement _Constitution_ of WEATHER and AIR; the more adverse or inclement the WEATHER is, the more tender _Care_ ought to be taken of the _Labouring Woman_: Namely, in SUMMER, when the _Heat_ scorches so much as to dissipate the _Woman’s Strength_, she ought to LABOUR in a _Ground-Chamber_ backwards, which may be strewed (for the Purpose) with _Vine_ or _Willow-Leaves_, _Rose-Water_, and a little _Vinegar_; as it is customary in _hot Countries_.

IN WINTER, when the _Cold_ pinches so as to condense and astringe the WOMB and the _Passages_, she ought to LABOUR in an _Upper-Room_, kept moderately warm with one continued _Fire_; the _MIDWIFE_ rubbing gently the _Hypogastrick_ and _Ischiatick Regions_ every now and then with hot _Cloathes_.

IN SPRING and FALL, when parching dry _Weather_, with _North_ and _East Winds_ most abound, the _MIDWIFE_ ought not only to rub these _Inferiour Regions_ with hot _Cloaths_; but also to qualify the _Influences_ of the _Siccid AIR_, by anointing the _Passages_ with proper _Unguents_.

A SECOND _External Cause_ may proceed from the _Passions_ of the Will or Mind, as it often does from _Fear_ and _Despair_, _Dejection_ and _Pusillanimity_: In which _Case_, it is the _MIDWIFE_’s Duty to encourage her WOMAN by the Hopes of a _Speedy DELIVERY_, and doing well under GOD’s Blessing. When the Cause arises from _Anger_ or _Sorrow_, these are to be assuaged by the repeated _Christian Exhortations_, and _Friendly Admonitions_ of the MIDWIFE and GOSSIPS. When it comes from _Pride_ and _Obstinacy_, as has been the _Case_ of some _Lofty Women_; who (deeming themselves too good, to be treated after the _common Course_ of Mankind) have refused to undergo or permit the proper _Means_, absolutely necessary for their own _Relief_; THIS ought to be severely check’d by the _Company_, especially by the _nearest Friends_; the MIDWIFE (by proper _Remonstrances_) convincing her to her Shame of her obstinate SIN. When it proceeds, in fine, from _Bashfulness_ or too strict a _Modesty_, she may be justly reprehended of _Folly_; for no Woman of good SENSE (how _Modest_ and _Virtuous_ soever) will expose her own _Life_ or her INFANT’s to _Danger_, for the trifling _Fancies_ or _Caprices_ of her own vain Imagination, especially in a _Case_ where _like things happen to All_ equally of Flesh and Blood.

BUT when it happens to proceed from the _Woman_’s being ill-affected, or owing a private _Grudge_ or _Hatred_ to any in the _Company_, (as I once knew it to be the _Cause_ of a difficult and lingring _BIRTH_) _She_ ought to speak her Mind freely, at least to her _MIDWIFE_; who ought to give the _Person_ civil Notice to retire forthwith, for certain Reasons, _&c._

A THIRD _External Cause_ of a _difficult BIRTH_ may proceed from a _wrong Position_, or other _sinistrous Methods_ taken to assist the WOMAN: In which _Case_, such _Inconveniencies_ are to be alter’d, and better _Measures_ practis’d; for _thus_ the _Cause_ being removed, the _BIRTH_ differs in Nothing from _That_ of the _Natural Easy Case_.

WHENCE I come, in the next Place, to speak of _Difficult BIRTHS_, proceeding from _Internal Causes_; and because they are _Three-fold_, as has been before observed, I shall assign them as many respective _Chapters_, treating of _Each_ in their due Order, as mentioned.

CHAP. V.
_Of Difficult BIRTHS, proceeding from Causes of the MOTHER._

IN _this_ (as in the _former Case_) the MIDWIFE must use her most acute and nicest _Judgment_, to find out the particular _Cause_ of the _Difficulty_. Which being done,

I. IF _She_ finds it arises from the WOMAN’s being too _Young_, or too _Old_, of her _first Child_, or too _Lean_ at last; _she_ is to anoint the _Passages_ with proper _Unguents_, which ought to be done some time _before_, as well as in the _Hour_ of _LABOUR_: When _she_ is likewise to employ her _subtile Hand_, in assisting and augmenting the _Dilatation_ of the _Orifice_; as is requisite also in _Case_ of the WOMAN being too _Fat_ or _Gross_.

II. IF the WOMAN be too _small_, _short_, _crooked_, or _misshaped_, not having a _Breast_ strong enough to forward and bear down her _PAINS_; or if she be over _tender_, _sensible_, and _apprehensive_ of _PAIN_; or too _weak_, and not _able_ to contribute or assist by her own forcing _Endeavours_; or _short-winded_, and not capable to constrain her _Spirits_ downwards: In all these _Cases_ she is to be kept _upright_, for the more free _Respiration_, as well as for encreasing her _PAINS_, _standing_ or _walking_ about the Room, according to her _Strength_, being supported under her _Arms_, and not put to BED until at least the _WATERS_ are broke. But, in the mean Time, the _weak_ and _tender_ WOMAN ought to be now and then comforted and refreshed with _fresh soft Eggs_, good _Broths_, _Jellies_, a little _Wine_ and _Toast_, a little _Wine_ and _Water_, or such like convenient _Things_, as well as with the _Hopes_ of a _speedy_ DELIVERY.

III. WHEN the _PAINS_ are not _Natural_ or _Genuine_; but _Spurious_, _Faint_ and _Languid_; or _Shifting_ and _Tergiversant_; such are to be assuaged by proper _Lenitives_ and _Anodynes_; which being regularly done, the _Genuine Pains_ may be excited by proper _Clysters_, and divers other Means. But I would advise none to a _Profuse Use_ of _MEDICINES_ in such _Cases_, since I well know that many a WOMAN has lost her _Life_ by using _dolorifick Medicines_, prescribed by imprudent _MIDWIVES_, without considering, or so much as knowing the true Circumstances of the _Condition_: Whereas in most _Cases_, by the ingenious _Motion_ of an _Experienc’d Hand_ only, the PAINS may be sufficiently awaken’d, and the BIRTH safely promoted.

IV. WHEN the _Difficulty_ proceeds from the _Debility_ of the WOMB, or its _Expulsive Faculty_, not being able or capable to _Exclude_ the _INFANT_, because of a more strong and valid _Retentive Power_: In this _Condition_, if there be no evident _External Cause_ to be obviated, it depends chiefly upon the _Subtile Hand_ of the _MIDWIFE_, to assist the WOMB in its _Function_; and otherways the _PATIENT_ is only to be treated as in the _Case_ of the _weak_ and _tender_ WOMAN above-mentioned.