WHAT UNNATURAL LABOUR IS, AND WHENCE IT PROCEEDS; AND WHAT THE MIDWIFE OUGHT TO DO IN SUCH CASES.
SECT. I. What Unnatural Labour is.
IT will be necessary to acquaint my readers that there are three sorts of bad labour, all painful and difficult, but not all properly unnatural, which are as follows:
The first is properly styled hard labour, and it is that wherein the mother and child do suffer very much by extreme pain.
The second is difficult labour, which is thus different from the former, that besides those extreme pains, it is generally attended with some unhappy accident, which, by retarding the birth, makes it very difficult. Neither of those, though hard and difficult, can be called unnatural; for women to bring forth children in pain and sorrow is natural.
'Tis therefore the third sort of labour which I call unnatural and that is, when the child essays to come into the world in a contrary position to that which nature ordained.
To explain this, the reader must know that there is but one right and natural way of posture in which children come to the birth; and that is, when the head comes first, and the body follows after it in a straight line. If, instead of this, the child comes with its feet foremost, or with the side across, it is quite contrary to nature, or, to speak more plainly, unnatural.
SECT. II. Whence hard, difficult, and unnatural Labour proceed.
THE true physical reason why women in general bring forth their children with so much pain is, that the sense of feeling being distributed to the whole body by the nerves, and the mouth of the womb being so straight, that it must of necessity be dilated at the time of her delivery; the dilating thereof stretcheth the nerves, and from thence cometh the pain; some women having more pain in their labour than others, proceeds from their having the mouth of the matrix more full of nerves than others.
Hard and difficult labour may proceed either from the mother or child, or from both; it may proceed from the mother by reason of a general indisposition of her body; from the indisposition of some particular part only, and that principally of the womb, which may be affected with such a weakness as renders the mother unable to expel her burden. It may be also because she is too young, or she may be too old, and so may have the passage too straight, and then, if it be her first child, the parts may be too dry and hard, and cannot easily be dilated. The cholic does also cause labour to be hard and difficult, because it hinders the true pain which should accelerate it. By which means, or which reason rather, all great and acute pains render a woman's labour very difficult. As when the woman is taken with a violent fever, frequent convulsions, or a great flooding, or any other violent distemper, especially when the membranes are thick, and the orifice too straight, or the neck of the womb not sufficiently opened.
Hard labour may also proceed from the child; and this is either when it happens to stick to a mole, or is so weak it cannot break the membranes; also when it is too big, either all over, or its head only; or if the navel vessels should be twisted about its neck as when it proves monstrous, or comes into the birth in an unnatural posture. Sometimes it proceeds from the ignorance of the midwife, who may hinder nature in her work.
SECT. III. How the Midwife must proceed in order to the Delivery of a Woman, in case of hard Labour and great extremity.
IN case the midwife finds a woman in difficult labour, she must endeavour to know the particular obstruction or cause thereof, that she may apply a suitable remedy. When hard labour is caused by a woman's being too young and too straight, the passages must be anointed with oil, hog's lard, or fresh butter, to relax and dilate them the easier. But if a woman be in years, and has hard labour from her first child, let her lower parts be anointed to mollify the inward orifice, which in such case (being more hard and callous), does not easily yield to the distension of labour: and indeed this is the true cause why such women are longer in labour, and why their children in their birth are more subject to bruises than others. Those who are very lean, and have hard labour from that cause, let them moisten their parts with oil and ointments, to make them more smooth and slippery, that the head of the infant in the womb may not be compressed and bruised by the hardness of the mother's bones in its passage. But if the cause be weakness, she ought to be strengthened, the better to enable her to support her pain. Since difficult labour proceeds from divers causes, the midwife must make use of several remedies to women in hard difficult labour, which must be adapted to the causes from whence in proceeds.
I need not tell the judicious midwife that in cases of extremity, when the labour is not only hard, but difficult and dangerous, a far greater care must be had than at other times. In such cases the situation of the womb must be minded, and accordingly her posture of lying must be regulated; which will be best across the bed, being held by those that are of a good strength to prevent her slipping down or moving herself during the time of the operation. Then let her thighs be put asunder as far as may be, and held so while her legs are bent backwards towards her hips, her head leaning upon a bolster, and the reins of her back supported in like manner, her rump and buttocks being lifted up; observing to cover her stomach, belly, and thighs with warm linen, as well for decency's sake as to keep them from the cold.
The woman being in this posture, let the midwife or other operator put up her hand, and try if the neck of the womb be dilated, and then remove the contracted blood that obstructs the passage of the birth, and having gently made way, let the operator tenderly move the infant, having the head anointed with sweet butter, or any harmless pomatum, and if the waters are not come down they may be let forth without any difficulty. And if the infant should attempt to break forth, not with the head foremost nor across, he ought gently to turn it, that he may find the feet; which having done, let him draw forth one, and having fastened it to a ribbon, put it up again, and finding the other, bring them as close as may be: let the woman breathe between whiles, assisting nature what she can by straining in bringing forward the birth, that so he may more easily draw it forth; and that the operator may do it the better, and his hold may be the surer, he must fasten or wrap a linen cloth about the child's thighs, observing to bring it into the world with its feet downwards.
But in case there be a flux of blood, let the operator be well satisfied whether the child or the secundine come first; for sometimes when the secundine has come first, the mouth of the womb has been thereby stopped, and the birth hindered, to the hazard both of the woman and child; and therefore in this case the secundine must be removed by a swift turn, and the child sought for, and drawn forth, as has been directed.
If upon enquiry it appears that the secundine comes first, let the woman be delivered with all convenient speed, because a great flux of blood wilt follow; for then the veins are opened. And on this account two things are to be minded; first, whether the secundine advances forward much or little; if the former, and the head of the child first appears, it must be directed to the neck of the womb, as in the case of natural births; but if there appears any difficulty in the delivery, the best way is to search for the feet, and by them it may be put by with a gentle hand, and the child taken out first; but if the secundine is advanced, so that it cannot be put back, and the child follow it close, then the secundine is to be taken out first with much care, and as swift as may be, and laid aside, without cutting the entrail that is fastened to them; for by that you may be guided to the infant, which, whether it be alive or dead, must be drawn forth by the feet as soon as possible; though this is not to be done but in cases of great necessity, for the order of nature is for the secundine to come last.
SECT. IV. Of the Delivery of a Dead Child.
IN delivering women of a dead child, the operator ought to be certain that the child is dead, which may be known by the falling of the mother's breast, the coldness of her belly, the thickness of her urine, which is attended with a stinking sediment at the bottom; and no motion to be perceived in the child. Also when she turns herself in her bed, the child sways like a lump of lead, and her breath stinks though not used to do so. When the operator is certain that the child is dead, let him or her apply themselves to the saving of the mother, by giving her those things that are most powerful in serving nature in her operations. But if through weakness the womb is not able to co-operate with nature, so that a manual operation is absolutely necessary, let the operator carefully observe the following directions, viz., If the child be found dead with its head foremost, he must take notice that the delivery will be the more difficult, because in this case it is not only impossible that the child should any ways assist in its delivery, but the strength of the mother does also very much fail her; and therefore the more sure and safest way for him is to put up his left hand, sliding it as hollow in the palm as he can, into the neck of the womb, into the lower part thereof towards the feet, and then between the infant and the neck of the matrix; and having a hook in the right hand, couch it close ,and slip it above the left hand, between the head of the child and the flat of his hand, fixing it into the bone of the temple towards the eye; or for want of convenient coming at that, observe to keep the left hand in its place, gently moving and stirring the head with it, and so with the right hand hook draw the child forward, encouraging the woman to put forth her utmost strength, and always drawing when the woman's pains are upon her. The head being thus drawn forth; the operator must with all speed slip his hand under the armholes of the child, and take it forth, giving immediately to the woman a toast of fine wheaten bread in a quarter of a pint of tent, to revive and cherish her spirits. By what I have already shown, the midwife will know what to do in any other case that may fall out, remembering that for a child to come head foremost, and the body to follow in a straight line, is the right posture for the child when it comes to the birth: and if it comes any other way, it will be the wisdom of the midwife, if possible, to bring it to this posture; but if that cannot be done without very great danger, then put it in a posture that it may be brought forth by the feet. And if the midwife, perceiving in what posture the child presents, or that the woman floods, or any other accident happens, by which she finds it is not in her power to deliver it, it will be best for her to send for a man mid-wife in time, rather than put things to the utmost extremity.