DIRECTIONS FOR MIDWIVES H0W TO ASSIST WOMEN IN THE TIME OF THEIR LABOUR; AND H0W CHILDBEARING WOMEN SHOULD BE ORDERED IN THE TIME OF THEIR LYING-IN.
SECT. I. How a Midwife ought to be qualified.
A MIDWIFE ought to be of middle age, neither too old nor too young, not subject to diseases, fears, or sudden frights; nor are the qualifications assigned to a good surgeon improper for a midwife, viz., A lady's hand, a hawk's eye, and a lion's heart; to which it may be added activity of body and a convenient strength, with caution and diligence; not subject to drowsiness, nor apt to be impatient. She ought to be sober and affable, not subject to passion, but bountiful and compassionate and her temper cheerful and pleasant, that she may the better comfort her patients in their sorrow. Nor must she be very hasty, though her business may perhaps require her in another place, lest she should make more haste than good speed. But above all, she ought to be qualified with the fear of God, which is the principal thing in every state and condition, and will furnish her on all occasions both with knowledge and discretion. But now I proceed to more particular directions.
SECT. II. What must be done when the Woman's time of Labour is come.
When the time of birth draws near, and the good woman finds her travailing pains begin to come upon her, let her send for a midwife in time, better too soon than too late, and get things ready which are proper upon such occasions. When the midwife is come, let the first thing she does be to find whether the true time of the birth be come. The want of observing this hath spoiled many a child, and endangered the life of the mother, or at least put her to twice as much pain as she needed: for unskilful midwives, not minding this, have given things to force down the child, and thereby disturbed the natural course of her labours; whereas nature works best in her own time and way. I do confess it is somewhat difficult to know the true time of some women's labour, they being troubled with pains so long before their true hour comes; in some, weeks before: the reason of which is the heat of the reins, which is manifest by the swelling of the legs. And therefore when women with child find their legs to swell much, they may be assured their reins are too hot. wherefore, my advice to such women is to cool their reins before the time of their labour, which may be effectually done by anointing the reins of the back with the oil of poppies and violets, or water-lilies, and they may avoid that hard labour which they usually undergo whose reins are hot: which, that they may the better prevent, Let me recommend to you the decoction of plantain leaves and roots, which is thus made: make a strong decoction of them in water and then, having strained and clarified it with the white of an egg, boil it into a syrup with its equal weight of sugar, and keep it for use. But since it is so necessary for midwives to know the true time of a woman's labour, the following section will rightly inform them.
SECT. III. Signs by which the true time of a woman's Labour may be known.
when women draw near to the time of their reckoning, especially with the first child, and perceive any extraordinary pains in their belly, they immediately send for their midwife, as taking it for their labour, though perhaps those pains which are so often mistaken for labour are only caused by the cholic, and proceed from wind; which pains, though they come and go, griping the whole belly, are yet without any forcing downward into the womb, as is done by those that go before labour. But these cholic pains may be removed by warm cloths laid upon the belly, and the application of a clyster or two, by which those pains that precede a true labour are rather furthered than hindered. There are also other pains incident to women in that condition from the flux of the belly, which are easily known by the frequent stools that follow them.
But to speak more directly of the matter; the signs of labour some few days before, are: that the woman's belly, which before lay high, sinks down, and hinders her from walking so easily as she used to do; also there flows from the womb slimy humours, which nature has appointed to moisten and make smooth the passage, that its inward orifice may be the more easily dilated when there is occasion, which, beginning to open at that time, suffers that slime to flow away, which proceeds from the glands called prestætæ. These are signs preceding labour.
But when she is presently falling into labour, the signs are, great pains about the reins and loins, at which, coming and retreating by intervals, answer in the bottom of the belly by congruous throws; and sometimes the face is red and inflamed, the blood being much heated by the endeavours a woman makes to bring forth the child; and likewise because during the strongest throws her perspiration is intercepted, which causes the blood to have recourse to her face; her privy parts are also swelled by the infant's head lying in the birth, which by often thrusting, causes those parts to distend outward. She is likewise much subject to vomiting, which is also a sign of good labour and speedy delivery, though by a great many ignorant women thought otherwise; for good pains are hereby excited and redoubled, which vomiting is occasioned by the sympathy there is between the womb and the stomach. Also when the birth is near, most women are troubled with a trembling of the thighs and legs; not with cold, like the beginning of an ague fit, but with the heat of the whole body; though this indeed does not happen always. Also, if the humours which then flow from the womb are discoloured with blood (which is what the midwife calls shows), it is an infallible mark of the birth being near: and then if the midwife puts her finger up the neck of the womb, she will find the inner orifice dilated; at the opening of which the membrane of the infant containing the waters, present themselves, and are strongly forced downwards with each pain she hath; at which time one may perceive them sometimes to resist the finger, and then again to press forwards, being more or less hard and extended, according as the pains are stronger or weaker. These membranes with the water in them, when they are before the head of the child, which the midwives call the gathering of the womb, resembles to the touch of the fingers those eggs which have yet no shell, but are covered only by a simple membrane. After this the pains still redoubling, the membranes are broken by the strong impression of the waters, which presently flow away, and then the head of the infant is presently felt naked and presents itself at the inward orifice of the womb. When those waters come thus away, then the midwife may be assured the birth is very near, this being the most certain sign that can be, for the Amnion and Allantois being broken (which contained those waters) by the pressing forward of the birth, the child is no more able to subsist in the womb afterwards than a naked man in a heap of snow. Now these waters, if the child come presently after them, facilitate the labour, by making the passage slippery: and therefore let no midwife use means to force away the water; for nature knows best when the true time of the birth is, and therefore retains the water till the time; but if by accident the water breaks away too long before the birth, then such things as will hasten it may be safely administered.
SECT. IV. What is to be done at the time of labour.
When the midwife is satisfied that it is the true time of labour, she must take care to get all things ready that are necessary to comfort the travailing woman in that time; and the better to do it, let her see that she be not straight laced. She may also give her a pretty strong clyster, if she finds there is occasion for it; but with this proviso, that it be done at the beginning and before the child lie too forward; for otherwise it will be difficult for her to receive it. The advantage of which clyster is, that the gut thereby will ho excited to discharge itself of its excrements, and the Rectum being emptied there will be more space for the dilating of the passage; likewise to cause the pains to bear more downwards, through the endeavours she makes when other necessary things for her labour to put in order, both for the mother and the child.
As to the manner of the delivery, various midwives use different ways; some are delivered sitting on a midwife's stool. But, for my own part, I think that a pallet bed, girded, and placed near the fire, that the good woman may come on each side, and be the more readily assisted, is much the best way.
And if the labouring woman abounds with blood, it may not be improper to let her bleed a little; for by that means she wilt both breathe the better, and have her breath more at liberty, and likewise more strength to bear down her pain: and this may be done without danger, because the child being now ready to be born, needs not the mother's blood for its nourishment any longer; and not only so, but this evacuation does many times prevent her having a fever after delivery. Likewise, if her strength will permit, let her walk up and down her chamber; and the better to enable her thereto, let her take some good strengthening things such as new laid eggs, jelly, broth, some spoonfuls of burnt wine; and encourage her to hold off her pain, bearing them down when they take her all that she can. And let the midwife often touch the inward orifice with her finger, that she may better know whether the waters are going to break, and whether the birth will follow soon after; for generally the birth follows in two hours after the afflux of the water. And to help it afterwards, let her anoint the woman's privities with emollient oil, hog grease, and fresh butter; especially if she find them too hard to be dilated.
Let the midwife also be near the labouring woman all the while, and diligently observe her gestures, pains and complaints; for by this she may guess pretty well how her labour goes forward; for when she changes her groans into loud cries it is a great sign the birth is near; at which time her pains are greater and more frequent. Let her also sometimes rest herself on her bed to increase her strength, but not too long at a time, for to lie too long at a time will retard her labour, and therefore it is better for her to walk about her chamber as much as she can; which, that she may the better do, let the good woman support her under her arms, if it be necessary; for by walking, the weight of the child causes the inward orifice of the womb to dilate much sooner than it would do if she lay upon her bed; besides, by walking, her pains will be stronger and frequenter, and by consequence her labour will not be near so long. If she finds any sick qualms let her not he discouraged; and if she finds any motions to vomit, let her not suppress them, but rather give way to them; for it wi1l (however uneasy and irksome they be for the present) be much for her benefit, because they further the pains and provoke downwards.
SECT. V. How to provide the Birth, and cause speedy Delivery.
When the birth is long deferred after the coming down of the waters, let her hasten the birth by drinking a good draught of wine wherein dittany, red coral, juniper berries, betony, penny royal, and featherfew have been boiled, or the juice of featherfew taken in its prime (which is in May) and clarified, and so boiled up in a syrup, and twice its weight of sugar, is very good upon this occasion. Also mugwort used in the same manner works the same effect. And so also does a dram of cinnamon in powder given inwardly, or tansy bruised and applied to the privities. Likewise the stone Ætites held to the privities does in a very little time draw forth the child and the after-burden, but great care must be taken to remove it gently, or else it will draw forth the womb and all, so great is its magnetic delivery. Also a decoction of savory made with white wine and drank gives a woman speedy delivery. Also wild tansy or silverweed bruised and applied to the woman's nostrils is very good. So also are date stones beaten to powder, and half a dram of them taken in white wine: parsley is of excellent use on this occasion; for if you bruise it and press out the juice, and then dip a linen cloth in it and put it up; being so dipped into the mouth of the womb, it will presently cause the child to come away though it be dead, and will bring away the after-burden also. The juice of parsley being of great virtue, especially the stone parsley, being drank by a woman with child, it cleareth not only the womb, but also the child in the womb of all gross humours. A scruple of castorum in powder in any convenient liquor is very good to be taken in such a case, and so also are two or three drops of spirit of castorum in any convenient liquor. Eight or nine drops of the spirit of myrrh, given in a convenient liquor, have the same effect. Or give a woman in travail another woman's milk to drink; it will cause speedy delivery. Also the juice of leeks being drunk with warm water hath a mighty operation, coinage speedy delivery. Take peony seed, beat them to powder, and mix the powder with oil; with which oil anoint the loins and privities of the woman with child; it gives her deliverance very speedy, and with less pain than can be imagined. And this may be noted for a general rule: that all those things that move the terms are good for making the delivery easy. There arc several other things efficacious in this case; but I need not heap medicines unnecessary, those I have already named being sufficient.
When any of the forenamed medicines have hastened the birth, let the midwife lay the woman in a posture for delivery. And first, let the woman be conducted to the pallet bed, placed at a convenient distance from the fire, according to the season of the year; and let there be a quilt laid, and let it have thereon a linen cloth in many folds, with such other things as are necessary, which may he changed according as the occasion requires it: that so the woman may not be incommoded with blood, waters, and other filth, which are voided in labour. Then let her lay the woman upon her back, having her head a little raised by the help of a pillow, having the like help to support her reins and buttocks, that her rump may lie high; for if she lie low she cannot very well be delivered. Then let her keep her knees and thighs as far asunder as she can, her legs being bowed towards her buttocks, and let her feet be stayed against a log or some other firm thing; and let two women hold her two shoulders, that she may strain out the birth with more advantage, holding in her breath, and forcing herself as much as possible, in like manner as when she goes to stool: for by such straining the diaphragm, or midriff, being strongly thrust downwards, necessarily forces down the womb, and the child in it. In the meantime let the midwife encourage her all she can, and take care that she have no rings on her hand when she anoints the parts: then with her finger let her gently dilate the inward orifice of the womb; and putting her fingers in the entry thereof, stretch them from one another when her pains take her; by this means endeavour to help forward the child, and thrusting by little and little the sides of the orifice towards the hinder part of the child's head, anointing those parts with fresh butter, in case it is necessary. And when the head of the infant is somewhat advanced into this inward orifice, it is usual among midwives to say it is crowned, because it both girds and surrounds it like a crown; but when it is gone so far, and the extremity begins to appear without the privy parts, they then say the child is in the passage; and at this time woman feels herself as if she was scratched or pricked with pins, and is ready to think that the midwife hurts her; whereas in truth it is only occasioned by the violent distension of those parts, which sometimes even suffer laceration through the bigness of the child's head. When things are come to this posture, let the midwife seat herself conveniently to receive the child, which will now come very quickly, and with her fingers' end, which she ought also to keep pared, let her endeavour to thrust the crowning of the womb back over the head of the child. And as soon as it is advanced as far as the ears, or thereabouts, let her take hold of the sides with her two hands, and wait till the good pain comes, and then quickly draw forth the child, taking care that the navel string be not entangled about the child's neck, or any other part, as sometimes it is, lest thereby the after burden be pulled with violence, and perhaps the womb also, to which it is fastened, and so either cause her to flood, or else break the string, both which are of bad consequence to the woman, and render her delivery the more difficult. Great care must be taken that the head be not drawn forth straight, but shake it a little from one side to the other, that the shoulders may the sooner and easier take its place immediately after it is past; which must be done without losing any time, lest the head being passed, the child stops there by the largeness of the shoulders, and so be in danger of being suffocated in the passage, as it has sometimes happened for want of care therein. When the head is born, she may slide in her fingers under the armpits, and the rest of the body will follow without difficulty. As soon as the midwife hath in this manner drawn forth the child, let her lay it on one side, lest the blood and water which follow it immediately should do it any injury, by running into its mouth and nose, as it would do ii it lay on its back, and so endanger the choking of it. The child being thus drawn forth, the next thing requisite is to bring away the after-burden; but before that, let the midwife be very careful to examine whether there be any more children in the womb, for sometimes a woman may have twins; of which the midwife may satisfy herself both by the continuance of the woman's throws and the bigness of her belly. But this is not so certain as to put her hand up the passage; and if so, she must have a care how she goes about the after-birth, till the woman be delivered. The first string must be cut and tied with a thread three or four double, and the ends fastened with a string to the woman's thigh to prevent the inconvenience it may cause by hanging between the thighs.
SECT. VI. Of the After-burden.
UNTIL the after-burden is brought away, which sometimes is more difficult to do than the child, and altogether as dangerous, if it be not speedily done, the woman cannot properly be said to be safely delivered, though the child be born.
Therefore, as soon as the child is born, before the midwife either ties or cuts the navel string, lest the womb should close, let her, having taken the string, wind it once or twice about one or two of the fingers of the left hand joined together, the better to hold it, with which she may take single hold of it above the left, near the privities, drawing likewise with that very gently, resting a while, with the forefinger of the same hand extending and stretching along the string towards the entry of the Vagina, always observing for the more facility to draw it from the side to which the burden least inclines, for in so doing the rest will separate the better; and extraordinary care must be taken that it he not drawn forth with too much violence, lest in breaking the string near the burden, the midwife be obliged to put her whole hand into the womb to deliver the woman; and she had need to take care in this matter, that so the womb itself, to which sometimes this burden is fastened very strongly, be not drawn away with it, which has sometimes happens. It is therefore necessary to assist nature with proper remedies, which are in general whatever has been before mentioned, to cause a speedy delivery: for whatever has magnetic virtue to bring away the birth has the same to bring away the after-birth. Besides which, the midwife ought to consider that the good woman cannot but be much spent by the fatigue she has already undergone in bringing forth the infant, and therefore should be sure to take care to give her something to comfort her. To which purpose some good Jelly broths, and a little wine with a toast in it, and other comforting things will be necessary. Sneezing being conclusive to bring away the after-birth, let her take a little white hellebore in powder to cause her to sneeze. Tansy and the stone Ætites, applied as before directed, is very efficacious in this. The smoke of marigold flowers, received up a woman's privities by a funnel, will bring away the after-birth, though the midwife has lost her hold. Or if you boil mugwort in water till it be very soft, and then take it out and apply it like a poultice to the navel of the woman in travail, it instantly brings away both the birth and after-birth; but as soon as they are come forth, it must be instantly taken away, lest it should bring away the womb also.
SECT. VII. How to cut the Child's navel-string.
AFTER the birth and after-birth are safely brought away, the midwife ought to take care to cut the navel-string; which though it be by some esteemed a thing of small matter, yet it requires none of the least skill of a midwife to do it with that care and prudence that it ought. and therefore, to instruct the industrious midwife a little therein. As soon as the child is come into the world, let her consider whether it be weak or strong; and if it be weak, let hear gently put back part of the vital and natural blood in the body of the child, by the navel, for that recruits a weak child, the vital and natural spirits being communicated by the mother to the child by its navel-string. But if the child be strong there is no need of it. Only it will not be amiss to let the midwife know, that many children that are born seemingly dead may be brought to life again, if she squeeze six or seven drops of blood out of that part of the navel-string which is cut off, and give it the child inwardly.
As to the cutting it short or long, authors can scarce agree about it, nor midwives neither; some prescribe it to be cut at four fingers breadth, which is at the best an uncertain rule, unless all fingers were of one size. 'Tis a received opinion, that the parts adapted to generation are either contracted or dilated, according to the cutting of the navel-string; which is the reason that midwives are generally so kind to their own sex, that they leave a longer part of the navel-string of a male than the female, because they would hive the male well provided for the encounters of Venus. And the reason they give why they cut those more short is, because they believe it makes them modest, and their parts narrower, which makes them more acceptable to their husbands. But whether this be so or not (which yet some of the greatest searchers into the secrets of nature affirm for a truth) yet certain it is that great care ought to be used about cutting of the navel-string; and especially, that after it is cut, it be not suffered to touch the ground, for if it be, the child will never be able to hold its water, but be subject all its lifetime to a diabetes, as experience often confirms; but as to this manner of cutting the navel-string, let the midwife take a brown thread, three or four times double, of an ell long, or thereabouts, tied with a single knot at each of the ends, to prevent their entangling; and with this thread so accommodated (which the midwife ought to have in readiness before the woman's labour, as also a good pair of scissors, that so no time may be lost), let her tie the string within an inch of the belly with a double knot, and, turning about the ends of the thread, let her tie two or more on the side of the string, reiterating it again, if it be necessary; then let her cut off the navel-string another inch below the ligature towards the afterbirth, so that there only remains but two inches of the string, in the midst of which will be the knot spoken of, which must be so straight knit as not to suffer a drop of blood to squeeze out of the vessels, but yet care must be taken not to knit it so straight as to cut in two, and therefore the thread must he pretty thick and pretty straight knit, it being better too straight than too loose. Some children have miserably lost their lives, before it hath been discovered that the navel-string was not well tied. Therefore great care must be taken that no blood squeeze through, for if there do, new knots must be made with the rest of the string. You need not fear to bind the navel-string very hard, because it is void of sense; and that part of it which you leave on, falls off of its own accord in a few days, ordinarily six or seven, and sometimes in less time: but it is very rare that it tarries longer than the eighth or ninth day.
As soon as the navel-string is cut off, apply a little cotton or lint to the place to keep it warm, lest the cold enter into the body of the child, which it will unavoidably do in case it be not bound hard enough; and if the lint or cotton you apply to it be dipped in oil of roses, it will be the better: then having put another small rag, three or four times double, upon the belly of the child, above the navel, lay the string so wrapped upon it that it may touch the naked belly.
Upon the top of all put another small bolster; and then swathe it in a linen swathe, four fingers broad, to keep it steady, lest by rolling too much, or being continually stirred from side to side, it comes to fall off, before the navel-string which you left remaining is fallen off. 'Tis the usual custom of midwives to put a piece of burnt rag to it; but I would advise them to put a small quantity of bole armoniac, because of its drying quality. Thus much may suffice as to cutting the navel-string and delivery of a woman in labour, where the labour is natural, and no ill accident happens. But it sometimes so falls out, that the labour is not only hard and difficult, but unnatural also, in which the midwife must take other measures.