Chapter II: THE same Difficulty may arise from the RECTUM, when it happens

in the same _Manner_, to be affected with such obdurated _Glands_, _Tumours_, &c. for the _Consequence_ is the same in shutting up the _Passages_: In which _Case_ the _MIDWIFE_ is to depress gently such _Excrescences_, of what kind soever, with her cautious _HAND_, and consequently to dilate the _Passages_ by degrees (how much soever obstructed) for receiving the _Head_ of the _INFANT_; always having a respect to the _affected Parts_, and bearing no harder upon them than Necessity requires.

MOREOVER sometimes it happens, that the only _Difficulty_ in _LABOUR_ proceeds from _hardened Excrements_ in this _Gut_, which may as effectually stop or shut up the _Passage_, as any thing else, until duly voided and evacuated by _one_ or _more_ proper _CLYSTERS_, as Occasion directs.

BUT sometimes it also happens, that such _Difficulties_ arise from the falling out of the _Fundament_ by the strong and violent _THROWS_ that the _Woman_ Suffers in LABOUR: In which _Condition_, if the _CHILD_ is very forward in the _Passage_, before it _happens_, it may be prevented by dissuading or hindering the WOMAN from _Labouring_ so vehemently; but if it happen’d before that time, it must be left so until the _BIRTH_ be accomplished; after which time, it is to be put up exactly, and reduced to its proper _Place_, in the same manner as the WOMB might be (in Case of its _Prolapse_, as mentioned in the following _Chapter_) after duly _fomenting_ and _bathing_ it with proper _Applicatives_: advertising always to use no _CLYSTERS_, in time of CHILD-BED; because such Means would readily excite it again to a slippery _Relapse_.

CHAP. XI.
_Of Difficult BIRTHS proceeding from the Causes of the VAGINA._

DIFFICULTY likewise in _LABOUR_ may also arise from the _VAGINA_, or _Neck_ of the WOMB; this _Part_ being no less liable to the Affection of _Tumours_, _Glands_, _Ulcers_, &c. than any _Other_ before-mentioned: In _Either_ of which _Cases_, my above-mentioned _Method_ in the foregoing _Chapter_, shall suffice for the _MIDWIFE_’s _Instruction_; as also in _Case_ of an _Inflation_ or _Inflammation_ of the _Pudendum_.

BUT sometimes also this _Difficulty_ happens from the falling down of the _VAGINA_; which _Accident_ may as well precede as follow after the BIRTH, and _that_ by the _Orifice_ of the WOMB pressing _hard_ into that of the _Privities_: So that sometimes, when the _MEMBRANE_ is _broke_, the _Head_ of the _INFANT_, as well as the _Orifice_ of the WOMB, slides down so far, as to hang out of the _Body_; whereby the stressed _Ligaments_ (being too much relaxed) give way to the falling down not only of the _VAGINA_, but also of the WOMB it self.

IN this sad _Condition_ the WOMAN must keep her BED, and her _Body_ equally situated, that either the fallen _VAGINA_ or _WOMB_, may recover and be immediately restored to its _proper Place_; which being done, other Matters may be easily prevented by the _Care_ and Diligence of the prudent _MIDWIFE_, stopping and restraining the _Orifice_ of the WOMB before it comes so far to that Extremity: Wherefore _she_ ought to keep it up in the _VAGINA_ (as much as possible) with her HANDS, until the WOMAN has happily extruded both the _CHILD_ and the _AFTER-BIRTH_.

UPON This afterwards, _she_ is to use her best Endeavours, to restore both the WOMB and _VAGINA_ to their due _Situation_; laying the _Wrinkles Smooth_ in their proper _Order_, not one upon another, then placing the WOMAN conveniently in BED, with her _Head_ and _Shoulders_ declining, _Exsiccant_ or _drying MEDICINES_ are to be judiciously applied, and _Strengthening_ or _Astringent Fomentations_ often used; whereby (in good Time) _both_ may be again confirmed in their proper Natural _Places_.

NOW having thus, in fine, candidly explained the _Different Causes_ of all _Difficult BIRTHS_, and carefully laid down the _genuine Methods_ of correcting and removing them, and consequently of _Delivering_ the good WOMAN successfully in all such nice _Cases_, it remains now in Course that I proceed to——

CHAP. XII.
_Of Preternatural BIRTHS._

SUCH _BIRTHS_, (properly speaking) are only _Preternatural_, which degenerate from the _Natural_, in respect either to the _Situation_ of the INFANT, or the WOMB, or of _both_ these jointly: Such (I say) may be well call’d _Preternatural_, because of the imminent Danger that (in these _Conditions_) threatens both the MOTHER and the CHILD.

HENCE we find the Difference between _This_ and the _Natural BIRTH_; in as much as the _One_ depends entirely upon ART, and the _Other_ merely upon NATURE: In _That_ the _INFANT_ is artificially extracted by the _Hand_, but in _this_ it is naturally extruded by the _PAINS_.

_HIPPOCRATES_ gives[169] us a _Two-fold-Cause_ or Reason of a _Preternatural BIRTH_; to wit, the _Amplitude_ of the WOMB, and the _inordinate Motion_ of the Woman about the Time of _LABOUR_: Who, because of her afflicting _PAINS_ and great _Ailments_, keeps her Body in a restless and unsteady _Posture_, throwing herself sometimes _here_, and sometimes _there_, sometimes on _One side_, and sometimes on _Another_ through Uneasiness. By which means it cannot be otherways, but that the _INFANT_ may be easily turn’d into some _Preternatural Situation_.

AND to _These Causes_, _Senertus_, _Rodericus à Castro_, &c. add the _Two_ following; namely, the _Solidity_ of the _MEMBRANES_, and the _Debility_ of the _Head_ of the _CHILD_: Because (as they well observe) when _This_ is not strong enough to break through _Those_, the _INFANT_ endeavouring it otherways, (with _Feet_ or _Hands_) may readily fall into some _Preternatural Position_.

BUT because I find, that _Preternatural BIRTHS_ deviate in different Degrees, and vary in many respects from the _Natural_, and _that_ also according to a great Variety of _CAUSES_ (no ways known to those most _Learned Authors_) but only of late discovered; I shall now again reduce the different _Species_ of _Preternatural BIRTHS_ to four _Classes_; namely, _Preternatural BIRTHS_ on Part of the _INFANT_, on Part of the WOMB, on Part of _Both_ those jointly, and lastly on Part of some _intervening Accidents_.

IN treating of which, I shall according to my best Judgment, _state_ these respective _HEADS_ in due Order, and assign each its proper _Branches_; which I shall particularly discuss in brief _Terms_, for the Facility and Benefit of the _Candid READER_, whether _MAN_ or _Woman-Midwife_; That they may (by this plain and easy Method) be enabled the more readily to judge of, and distinguish the several Circumstances, and consequently the better discharge their Duties (upon Occasion) to the Comfort and Satisfaction of those _PATIENTS_ concerned, and the Honour of their own ingenious _Profession_.

BUT before I enter upon _These_, I would willingly in this place, previously subjoin a Word or two of _Advice_ (by way of _Precaution_) to the Young _Andro-Boethogynist_: Which, in short, consists in this _Point_, that as it is the too common _Practice_ here in _England_, for an obstinate SET of _Women_ to keep their _Labouring PATIENTS_ so long under their own Hands only, until the very last _Extremity_; so I would not counsel him at that Time, when sent for, upon such a ticklish Occasion, to go _Head-long_ to such a _Work_, nor to undertake the DELIVERY of such a _Woman_, before He makes some requisite _Observations_: And _that_ I mean no ways because of any Danger of the _Preternatural BIRTH_ which she labours under, how difficult soever it may be; but merely, on account of the _Woman_’s exhausted _Strength_ and _Ability_, to undergo the respective _Operation_ in her weaken’d _Condition_; which I would very much question in most Women, after _One_, _Two_, or _Three Hours_ strong LABOUR, and that in SOME far sooner, notwithstanding that _others_ have been known to stand it out, and struggle a much _longer Time_.

HOWEVER, be this as it will, I commonly guess at the _Woman’s State of Ability_, not only by her PULSE, if _strong_ or _weak_, _unequal_ or _intermitting_; by her EYES, if _dejected_; by her SPEECH, if _faint_; by touching the EXTREMITIES of her Body, if _frigid_: but also by some other SYMPTOMS, which infallibly appear, if the _Woman_ be too far spent, such as _Cold Sweats_, _Swoonings_, _Convulsions_, _Loss of Sense_, &c. Whereupon I say in these _Cases_, it is more adviseable to let alone or decline the _Office_, than to undertake such a precarious uncertain Piece of _Work_; because if the _Woman_ happens to die under his _Hand_, He may perhaps be (however unjustly) blam’d for the errant _Midwife_’s Faults, or at least He will scarce avoid the CENSURE of the _Ignorant_ and _Malevolous_.

YET this _Advice_ (however wholesome and prudent) is, I confess, what I would but seldom have Recourse to, or follow myself, notwithstanding the worst _Consequences_ of the _Case_; since as long as there is _Life_, there is _Hope_ with me, by the Blessing of GOD: Which tho’ never so _little_, I should think myself obliged in Conscience to do what both ART and NATURE command, and rather in all _Conditions_ of LIFE to attempt an uncertain CURE[170], than abandon the _Distressed_ to certain DEATH, as some _Politicians_ in _Physical_ Affairs commonly do, who prize their vain _Reputation_ above the LIFE of their Neighbour. But _thus_, in short, (for my own Part) I would chuse to _act_, because I have often seen, and known _NATURE_ to have perform’d, and recover’d a weak spent parturient PATIENT, even beyond all human Probability.

NOT but that I would take the proper _Precautions_ along with me, before putting my _Hand_ to the critical _Work_, upon any such desperate or dangerous _Occasion_, by giving my ingenuous PROGNOSTICK to the nearest _Friends_ and _By-standers_ of the extreme _Danger_ that both LIVES may be in: Whereupon after thoroughly examining all _Circumstances_, with respect to the CHILD, whether _One_ or _More_, _Dead_ or _Alive_, &c. I would chearfully begin my _Endeavours_ to relieve the afflicted Woman, encouraging and exhorting her in the first Place, for GOD’s-sake, as well as _her own_, and the tender INFANT’s _Life_, to put herself entirely into my HANDS, to undergo her LABOUR patiently, and contribute what she can to the DELIVERY.

BUT to return from this pardonable _Digression_ to what is here proposed; as I come first to speak of _Preternatural BIRTHS_ on the part of the INFANT, I would observe that all ill _Postures_ of the CHILD, in a WOMB well situated, are the only _Causes_ (meant in this place) of _Preternatural BIRTHS_ on its _own Part_: Which _Postures_ being very various and different, and each requiring a different peculiar _Operation_; I shall _state_ them particularly (as above-mentioned) and _that_ in their respective _Chapters_, after the manner following: _viz._—

CHAP. XIII.
_Of Præternatural BIRTHS, by the FACE’s being turn’d upwards; or bent
forwards, and the CROWN backwards._

AMONG the many various _Preternatural Positions_ of the _INFANT_, I cannot but reckon THIS _One_: FIRST when, tho’ the _CHILD_ offers itself _Head foremost_, yet the FACE is turn’d upwards; and _that_ because the _INFANT_ in such a _Posture_ can never be commodiously bent and adapted to the _Form_ of the PELVIS.

IN this _Case_, the _MIDWIFE_ ought to take special Care, that the HEAD _fall down directly_ and safely, without being _hurt_, whilst she endeavours to bring it _forward_: For this Purpose, she is to enlarge the _Passage_ as much as possible, dilating the _Privities_, and depressing the OS COCCYGIS; which however must be done, without lifting the HEAD with her _Hand_, for fear of bruising the FACE against the OS PUBIS. By this Method the _BIRTH_ (how _Preternatural_ soever) may be pretty well and easily perform’d.

BUT because the _CHILD_ can only be said to be _well turn’d_, when it comes with its CHIN leaning upon its _Breast_, and its _Top_ or _Crown_ of the HEAD tending directly to the _Orifice_; I reckon THIS _another Preternatural Position_, when the _INFANT_ presents itself with the CROWN bent _backwards_, and consequently with the FACE _forwards_: By reason that in this _Case_, the _Orifice_ itself and all the rest of the _Passage_ must be much more dilated, than in the _natural Condition_; and the HEAD (being thus bent _backwards_) requires more severe PAINS and hard LABOUR, to make it slide through the _Passages_.

IN which _Case_, the _MIDWIFE_, having timely discover’d this _Situation_ by the TOUCH, ought immediately (upon the flowing of the _Waters_) to bend the HEAD gently _forwards_ to the BREAST, all the while adverting to handle the FACE, especially the _Nose_ and _Eyes_, very tenderly: And to this End, the _Woman_ may be laid down on her _Back_, with her _Head_ low; by no means _labouring_ with the _PAINS_, before the HEAD of the _CHILD_ is so conveniently turned: which may be thus most properly perform’d; _viz._ By laying the Palm of the _Hand_ on the _INFANT_’s _Breast_, near its _Throat_, pressing it entirely _back_ towards the _Fund_ of the WOMB; by which means the HEAD falls _forwards_ of its own Accord upon the _MIDWIFE_’s _Arm_, and _she_ with-drawing her _Hand_, will find the HEAD _well turn’d_.

BUT supposing the HEAD to be very strictly bent or pressed _back_, then the _MIDWIFE_ is to attract it gently _forwards_ by her _Thumb_, or _Fore-Finger_ thrust into its MOUTH; or by the Points of all _Four_ thrust betwixt the WOMB and the _back Part_ of the HEAD. And thus, in fine, the HEAD being _well Turned_, and dextrously brought into the _Passage_; the _Woman_ is then to be placed commodiously for _BIRTH_, and to labour her _Best_ as in other _Cases_.

HOWEVER to this _Case_, I must add, by way of _Remark_ for the _MIDWIFE_’s farther Information and better Government, that, if the HEAD is not brought into the _Passage_, as soon as the _Waters_ have flow’d, it commonly happens, that the HANDS offer themselves _first_; which if she do not instantly repel, the HEAD is turn’d up _forwards_ with the FACE, near the _Chin_, upon the OS PUBIS; in which _Condition_, by reason of the _Siccity_ and _Contraction_ of the WOMB, the only Expedient is to _thrust back_ the ARMS, and so passing the _Hand_ under the _CHILD_’S _Breast_, to take hold of, and extract it by the FEET.

CHAP. XIV.
_Of Præternatural BIRTHS, by the Hand, Elbow, Shoulder, Knees, or
Buttocks presenting first._

THE _CHILD_ also sometimes offers itself _preternaturally_ to the _Orifice_, with its HAND, ELBOW, SHOULDER, KNEES, or BUTTOCKS _first_: In which _Condition_, the HAND always gives an easier _BIRTH_ than the ELBOW, the ELBOW than the SHOULDER, the SHOULDER than the KNEES, and the KNEES than the BUTTOCKS: For the HAND being commonly placed near the _Head_, it is no great Wonder, if it presents itself _before_, or _along_ with it; as sometimes (after _Flooding_) the HAND may slide together with the _Head_ obliquely to either _Side_, and thereby either ELBOW or SHOULDER unfortunately fall into the _Passage_.

THIS is one great Reason, why I have before inculcated, that the _MIDWIFE_ ought to be diligent and accurate in _Touching_ her Woman, even before the MEMBRANE breaks, that she may thereby discover and prevent this _Case_: Which is easily perform’d, either by _repelling_ the HANDS, or by pinching the _INFANT_ sensibly by the _Fingers_, and then it soon retracts them; for thus, in short, by moving my own _Hand_ seasonably, the HEAD (of its own accord) slips of course down into the _Passage_. But and if it happens otherways, ’tis no difficult Matter to _turn_ and bring it down, by directing my _Fingers_ beyond the FACE to the _CHILD_’s _Forehead_; which however must be done immediately after FLOODING: Whereas, if _This_ be neglected until the _dry_ WOMB is contracted, THEN, and in that _Condition_, the _FEET_ may be looked for, which (in such a _Posture_) are soon found, with the _KNEES_ next the _Belly_; and the _INFANT_ may be readily drawn out by them. But

WHEN it so happens, that the _CHILD_ comes with its _KNEES foremost_, it commonly has its _LEGS_ folded towards the _BUTTOCKS_; by which means many a _MIDWIFE_ has been deceiv’d, especially when _she_ feels but one _KNEE_, mistaking it for the _HEAD_, because of its _Hardness_ and _Roundness_.

IN this _preternatural Condition_, the _INFANT_ must be stopped and hindered from advancing _farther_; wherefore having placed the _Woman_ aright, I would gently repel the _KNEES_, that I may the more commodiously _unfold_ the complicated _LEGS_, one after another; which I commonly do by directing _one_ or _more Fingers_ under the HAM, gradually along behind the _LEG_, until I come to the FOOT; drawing always a little _obliquely_, that I may come the easier to its _Extremity_: And thus, in short, having disengaged the _One_, I accordingly manage the _Other_ after the same manner; and by bringing both _FEET_ at last together, I finish my _Work_, as if the _Child_ had come _FEET_ foremost, of which in course.

MOREOVER again it also happens sometimes, that the _CHILD_ falls with its _BUTTOCKS forwards_; in which _preternatural Condition_, the MIDWIFE must industriously prevent it from coming _too low_ in the PASSAGE, before it be duly corrected or rectify’d; since the INFANT cannot possibly come, after this manner, into the World; unless it be very _small_, and the _PASSAGE_, on the other hand, very _large_. Wherefore in this _Case_, after the _Woman_ is decently laid upon her _Back_, with her _Head_ declining, I would advise to thrust back the _BUTTOCKS_ as well as possible; then passing up my _Hand_ along the _THIGHS_ to the _Legs_, I would take hold of the _FEET_, and bring them gently, and one by one, forth gradually; which being done, I would attract them by the _HEELS_ towards the _Side_ as far as the Length of the _BUTTOCKS_; and then at last taking good _Hold_ under the _HIPS_, I would easily and softly with the greatest _Deliberation_, draw out the whole Body successively.

CHAP. XV.
_Of Preternatural BIRTHS, by the Breast, Belly, or Back, presenting
first; and the INFANT’s lying transverse._

SOMETIMES likewise the _CHILD_ offers its BREAST or BELLY _first_, along with the _Navel-string_; which _Preternatural Figure_ is most dangerous for the _BIRTH_, because of the _Body’s bending backwards_.

IN this difficult _Case_, the attentive _MIDWIFE_ places her _Woman_ conveniently, as soon as the _Waters_ have flow’d, and sliding her _Hand_ into the WOMB, removes the _String_, and endeavours to bring the _HEAD forwards_ into the _PASSAGE_; which she easily performs, as long as the INFANT is suspended on high, and its _Back_ not too much _bent_, by putting-in her _Hand_ gently up to the _hinder Part_ of the _CHILD_’S _Head_, attracting it gradually _downwards_. But if in this _Condition_ the _BIRTH_ be fallen too _far down_, it is more adviseable _first_ to attract the _FEET_ considerately.

I say _considerately_, because it is not sufficient to penetrate with the _Hand_ to the _FEET_; which however yet, in this _Posture_ is pretty difficult: But also to know exactly in what manner they are to be _drawn down_; since it is no indifferent Matter to understand how that is to be rightly perform’d with Success. Wherefore I shall in this place take upon me to set forth _two different Ways of Turning the INFANT_ in this _Condition_; viz.

I. I would _either_ FIRST pass my _Right Hand_ to the _Left Thigh_ of the _CHILD_, and taking hold of it near the _KNEE_, push it _upwards_ with my _Thumb_, drawing it at the same time _downwards_ with my _Fingers_ placed behind: _Thus_ I would bring _down one KNEE_ to the _Passage_, leaving the FOOT yet above, and then the _other KNEE_ in its Turn; which being done, I would change my _Hand_, and put the _Left_ up to the _INFANT_’s _Belly_ or _Breast_; where, as I _thrust back_ its Body _upwards_, there is presently _Room_ enough: then I would take hold again of _one_ or _both KNEES_, to move the _CHILD higher_, that so the _FEET_ may be more conveniently brought into the _Passage_ one by one, if not _Both_ at once: Or, upon the _LEGS_ being bent with the _Right Hand_, and the _KNEES_ brought into the _Passage_ (as above) I would take hold of them below the HAM, and bring them past the _Orifice_ of the WOMB, till the _FEET_ are before the _Passage_; whereupon I would then readily endeavour to extract the INFANT by the _FEET_. _Or_, SECONDLY,

II. I would put my _Right Hand_ up along the _Belly_ to either THIGH, or KNEE, having at the same time a thin _Bandage_ doubled and dipp’d in _Oil_, upon my _Fingers’ Ends_, in order to be put about the KNEE, that I may attract it gently thereby; which I would draw out again by the _Right Hand_, whilst my _Left_ holds the Ends of the _Bandage_, that they may not move out of their Place: Then I would take the Extremities of the _Bandage_ in my _Right Hand_, attracting it softly thereby, whilst I pass up my _Left_ into the WOMB, to thrust the _CHILD_’s _Belly upwards_. By which ingenious and regular Means, I think, Dr. _Daventer_ first moved the _upper Part_ of the BODY _upwards_, and the FEET _downwards_, because the KNEES are thereby brought nearer to the _Orifice_. Now these, in short, are the only safe, and proper _Methods_ to be taken in this present _Case_, or nice Conjuncture; because, by all _other_ inconsiderate and temerarious _Means_, the _INFANT_’s LOINS may be _twisted_, its HIPS or KNEES _disjointed_, its FEET _lamed_, and itself at last quite lost or destroy’d.

IN like manner it happens not very seldom, that the _INFANT_ comes with its BACK _forwards_ into the _Passage_; and in this _Posture_ the NAVEL-STRING falls commonly down _there_, so that besides _itself_, nothing else is to be felt by the TOUCH: In this _Case_, the MIDWIFE is to observe well the FLOODING; immediately upon which, _she_ is to seek for the FEET, which are more easily come at than the _HEAD_, tho’ the same is even also a very difficult TASK, by reason that the _CHILD_’s _Back_ takes up the whole Space of _Room_; which, notwithstanding, must be cautiously done, and the _INFANT_ discreetly extracted by _them_.

BUT again sometimes, the _BIRTH_ lies also _Transverse_, or a-cross the WOMB; in which dangerous _Case_, I confess the _MIDWIFE_ cannot well perceive, so as to distinguish Matters by the _Touch_, before _Flooding_: Because the _INFANT_ (swimming in the _Waters_) is as yet seated high, and then moving its HANDS and FEET variously, _she_ sometimes feels _one_, and sometimes _another Member_ at the _Orifice_; or, one Moment she finds _Something_, and another _Nothing_ at all there. However, in fine, _she_ may perceive the _Humours_ most commonly compressed into an _acuminated_ or _oblong Form_.

WHEREFORE in this difficult _Preternatural Condition_, the _MIDWIFE_ ought primarily and chiefly to consider and discover the _Posture_ of the WOMB, whether it be _direct_ or _oblique_; since according to THAT _she_ must proceed in assisting her _Woman_ with true Discretion. As for _Example_, if _she_ finds it in a streight or _natural State_, and the _Waters_ sufficiently exuberant, extended _length-ways_, &c. as aforesaid, _She_ must, without _Loss of Time_, break the _MEMBRANE_, and presently, removing all _Impediments_ of _HAND_, _FOOT_, or _NAVEL-STRING_, judiciously direct the _HEAD_ into the _Passage_; which may be very easily and safely done immediately upon the FLOODING. Whereas if _this Method_ be delay’d, or not taken in _due Time_, and consequently the _HANDS_ (as the readiest) present themselves to the _Orifice first_: In this _Condition_, I would lay the _Woman_ discreetly upon her _Back_, with the _upper Part_ of her Body _lowest_; after which, I would move the _INFANT_’s _Hands_ back with my _own_; whereby at the same time bringing its _FEET_ into the _Passage_, I would in the next Place gently extract the whole Body with all possible _Conduct_ and _Success_.

CHAP. XVI.
_Of Preternatural BIRTHS, by the Feet presenting first._

IN like manner again, it often happens, that the _CHILD_ offers its _FEET foremost_; which next to a _Natural BIRTH_ is the most easy and safe _Position_, however I have been oblig’d to postpone it to the _rest_, for Method’s sake: In this _Case_, the _MIDWIFE_, observing _one FOOT_ presenting itself in the _Passage_ after _FLOODING_, ought to stop and retain it _there_, that it may not slide through, until _she_ meets with the _other_. In order to which Performance, _she_ must immediately seek for _it_, with either _Hand_, according as she perceives the _INFANT_’s great _Toe_ situated, since it is only to be sought for along its _Side_; and being found, it is to be gently _drawn down_, and placed near its _Fellow_ in the _Passage_.

BUT it falls out sometimes, that the _MIDWIFE_ comes too late, and finds _one LEG_ so far through, that the BUTTOCKS are strictly confin’d: In this _Condition_, I would advise to lay the _Woman_ conveniently upon her _Back_, with her _Head_ low, that both the WOMB and the CHILD may _retreat_ a little; then taking hold of the _right LEG_ with my _Right Hand_, I would thrust the _INFANT back_, till the whole FOOT (or at least the KNEE) is brought back into the _Orifice_ of the WOMB, in order that I may have the more _Room_ for passing my _Hand_ along the _LEG_: By which means I get hold of the _other_ FOOT; and bringing it also into the _Passage_, I place it along with the _other_, that both may come forth successfully together.

WHICH Thing, happening so when it will, that _both FEET_ are excluded, whether done _spontaneously_ or by ART, they are never to be _repell’d_ or _thrust back_ again; but, on the contrary, the way is to be duly cleared for their PASSAGE; _This_ being a very commodious _Situation_, provided the CHILD be _well turned_, I mean, with _HEELS_ and _BUTTOCKS upwards_, and _TOES_ and _BELLY downwards_: Whereas, if otherways, the _CHIN_ may be easily hooked upon the _OSSA PUBIS_; which (if not so happily _turned_ at first) I commonly prevent in the most adviseable manner following; _viz._

UPON attracting the _INFANT_, I _turn_ it cautiously at the same time, using _both Hands_ in the ensuing _Method_; namely, The _One_ I put up under its _Body_ as far as possible, whilst with the _Other_ I hold both _FEET_ together: Insomuch that by this Means I gradually _turn_, not only the _FEET_ and the _LEGS_, but also the _whole Body_; bringing it always _forwards_ in the Interim, till at last it lies with its _BELLY downwards_, and is _out_ above half way: Upon this I then give my _Woman_ the Motion, to begin her LABOUR and endeavour her _Best_; because the _HEAD_ and _ARMS_ must necessarily pass through _All at once_. For notwithstanding the contrary Opinion of most _Authors_, who teach us to draw down the ARMS _one_ by _one_, and place them upon the _Body_, I cannot but agree with _Daventer_, and positively advise in _this_ and all such _other like Cases_, to leave the ARMS about the _HEAD_, that they may be excluded along with it: Because, as he says, tho’ the _Woman_ in so doing, is obliged to force her _INFANT forwards_ with all possible Endeavours, yet like a small transient CLOUD, it is soon over.

WHEREFORE I commonly make it my Business to prevent the _Woman_’s _PAINS_, until I have brought the _CHILD_ this _Length_; when allowing her a little Time to rest, I heartily encourage and positively promise _Her_, that, she performing her _Part_ effectually, (by using all her _Strength_, and behaving herself as if the _PAINS_ were most really _pressing_ upon her, whether so or not) the _BIRTH_ will immediately succeed: And upon this _Promise_, with the _PATIENT_’s mutual Assistances concurring, I never yet fail’d; neither will any _Persons_ who faithfully and ingeniously follow this _Method_, in comfortably helping the _Woman_ upon such an Occasion, by drawing the _CHILD_ cautiously _downwards_, with whatsoever judicious _Force_: I mean not _downwards_, according to the _Woman_’s LENGTH, but _downwards_ towards the _strait Gut_. And as I every Moment insinuate to the _MOTHER_, that her _BABE_’s _Life_ depends entirely upon her vigorous confederate LABOUR; so _she_ mutually concurring with me, in endeavouring to do our _Best_, the AGRIPPA _INFANT_ is presently _brought forth_ to the great Satisfaction of _Both_.

BY these _Means_ and _Methods_, we prevent the _Tragical Consequences_, which Mr. _Portal_ and many _others_ confess they have often met with in their _Practice_; viz. That the _HEAD_ has been sometimes pulled-off from the _SHOULDERS_, or that the _CHILD_ has been frequently _stifled_, by the WOMB’s contracting and shutting-up about the _NECK_: Which was altogether owing to the injudicious _Method_ of their Practice, in drawing down the ARMS awkwardly (as mentioned above) along the SIDES of the _Body_.

CHAP. XVII.
_Of Preternatural BIRTHS, by Two, or more INFANTS presenting themselves
ill-Turn’d._

THIS _Case_ also happens sometimes remarkably; upon which, if _Both_ or _All_ are contain’d in _one_ and the _same SECUNDINE_, or when the _MEMBRANES_ are broken, _then_ the right VERSION is very difficult; not so much for want of _Room_, as because their _HANDS_ and _FEET_ are commonly interwoven and twisted together: In which _preternatural Condition_, when so complicated and entangled, they are to be unfolded and cleared off _one another_ with the nicest Circumspection and Judgment.

BUT besides, farther, they are otherways, only to be treated in this difficult Point, as if there was but _one CHILD_; for _turning_ them always _One_ by _One_ duly, I would bring all their FEET into the _Passage_, and consequently handle them, as if they had offer’d themselves so at _first_. The _first CHILD_ being born, I would give it to the next capable _Person_ to tie and cut its STRING; whilst I directly repass up my _Hand_, to seek for the _other_’s FEET, by which I would also _draw it forth_, after breaking its proper _MEMBRANES_, in Case the _second_ FLOODING is not yet over, and _that_ notwithstanding the HEAD should present itself _First_.

BUT and if it happens, that _each CHILD_ has its own proper and _distinct SECUNDINE_, and _That_ of the _INFANT_ already _brought forth_ chance to be loose and separated from the WOMB; In that _Case_, I would presently fetch it away, and then extract the _other INFANT_, as long as there is _any_ yet left behind, and _that_ also by the FEET, as aforesaid: Whereas otherwise, the _BIRTHS_, together with the _Constriction_ of their _UMBILICALS_, are to be previously accomplished.

IN fine, having _thus_ accounted for all the _Preternatural BIRTHS_ whatsoever, which may or can occur on the _Part_ of the _INFANT_, and _that_ conformable to the most nice and polite _Rules_ of ART; It remains now in the next place, that I acquit myself in a consonant manner, with respect to _Those_ proceeding from the _Part_ of the WOMB. Of which _First_ in general——

CHAP. XVIII.
_Of Preternatural BIRTHS, proceeding from Causes of the WOMB._

MOST, if not all, _Authors_ having hitherto imagin’d, that all _Preternatural BIRTHS_ took their sole _Rise_ and _Origin_ from the wrong _Positions_ of the _INFANTS_ only; I come in this place, with all due Submission, not only to affirm a quite contrary _Opinion_, but also to lay down a directly opposite MAXIM: Namely, that the most difficult and dangerous _Preternatural BIRTHS_ proceed merely from the ill _Situation_ of the WOMB; which I take to be the most common _Cause_ of the CHILD’s wrong _Posture_. The Truth of which I hope to make evidently appear, to all such, who know and will consider, that this _Noble Part_ is no less subject to various _Accidents_ and different _Diseases_, than the _Rest_ of the BODY; which springing from divers _Sources_, may rationally be suppos’d to occasion _Preternatural BIRTHS_, and _those_ more or less dangerous, according to the _Nature_ of the EFFICIENT: as for _Instance_,

IN _Case_ of an _Inflammation_, _Exulceration_, _Putrefaction_, or the WOMB’s being _Schirrous_, _Callous_, or _Hard_; affected with a CARCINOMA or _Cancer_; an obdurated _Gland_, _Cicatrix_, or any _carnous Excrescence_; or in _Case_ of the WOMB’s being _Dry_ and _Rigid_, and the _Orifice_’s being _Hard_ and _Thick_, as commonly happens to WOMEN _in Years_, especially of their _First CHILD_; I say, from either of _these_, or any such like _Causes_, a _Preternatural BIRTH_ may ensue, and _that_ even tho’ the PELVIS and PASSAGE be _larger_, but much more if _those_ be _narrower_, and the Point of the OS SACRUM bent _Inwards_.

I. IN the _Larger_ PELVIS, the greatest _Difficulty_ of this _BIRTH_ proceeds from too great a _Descent_ of the WOMB; which relaxes the _Ligaments_ and _Fibres_ of the VAGINA, and so much depresses the _Bladder_, that an _Incontinency_ of URINE presently follows, which in this _Case_ is commonly succeeded by a _Falling Down_ of the WOMB or VAGINA, as already observ’d in _Chap._ XI. where the Diligent MIDWIFE will find the due _Method_ of preventing such growing _Mischiefs_, and of opening the _Orifice_ of the WOMB both safely and readily, and consequently _Delivering_ her _Woman_ more easily and expeditiously, with good Success as well as Security.