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They grow looser every day, until the appointed time for delivery; if, therefore, the body is in real need of purging, the woman may do it without danger in the fourth, fifth or sixth month, but neither before nor after that unless in the case of some violent illness, in which it is possible that both mother and child may perish. Apply plasters and ointments to the loins in order to strengthen the fruit in the womb. Take one drachm each of gum Arabic, galangale, bistort, hypocistid and storax, a drachm and a half each of fine bole, nutmeg, mastic, balaust, dragon's blood and myrtle berries, and a sufficient quantity of wax and turpentine and make into a plaster. Apply it to the loins in the winter, and remove it every twenty-four hours, lest the loins should become overheated by it. In the interim, anoint the private parts and loins with countess' balsam but if it be summer time and the loins hot, the following plaster will be more suitable. Take a pound of red roses, two drachms each of mastic and red Sanders, one drachm each of bole ammoniac and red coral, two drachms and a half each of pomegranate seed and prepared coriander seed, two scruples of barberries, one ounce each of oil of mastic and of quinces, and plantain-juice.
Anoint the loins also with sandalwood ointment, and once a week wash them with two parts of rose-water and one of white wine mixed together and warmed at the fire. This will assuage the heat of the loins, get rid of the oil of the plaster from the pores of the skin, and cause the fresh ointment or plaster to penetrate more easily, and to strengthen the womb. Some think that a load-stone laid upon the navel, keeps a woman from abortion. The same thing is also stated of the stone called aetites or eagle-stone, if it is hung round the neck. Samian stone has the same virtue.
Directions for Women when they are taken in Labour, to ensure their safe Delivery, and Directions for Midwives.
Having thus given the necessary directions to pregnant women, how to manage their health during their pregnancy, I will now add what is necessary for them to do, in order that they may be safely delivered.
When the time of birth draws near, the woman must be sure to send for a skilful midwife, and that rather too soon than too late. She must have a pallet bed ready to place it near the fire, so that the midwife and those who are to help her, may be able to pass round it, and give assistance on either side, as may be required. A change of linen must be in readiness, and a small stool to rest her feet against, as she will have more power when her legs are bent, than when they are straight.
When everything is thus ready, and when the woman feels the pains coming on, if the weather be not cold, she should walk about the room, rest on the bed occasionally, waiting for the breaking of the waters, which is a fluid contained in one of the outward membranes, and which flows out thence, when the membrane is broken by the struggles of the child. There is no special time for this discharge, though it generally takes place about two hours before the birth. Movements will also cause the womb to open and dilate, and when lying long in bed will be uncomfortable. If she be very weak she may take some mild cordial to give her strength, if her pain will permit her; and if the labour be tedious, she may be revived with chicken or mutton broth, or she may take a poached egg; but she must be very careful not to eat to excess.
There are many postures in which women are delivered; some sitting in a chair, supported by others, or resting on the bed; some again upon their knees and resting on their arms; but the safest and most commodious way, is in the bed, and then the midwife ought to observe the following rules:—Let her lay the woman upon her back, with her head a little raised by means of a pillow, with similar supports for her loins and buttocks, which latter should also be raised, for if she lies low, she cannot be delivered so easily. Then let her keep her knees and thighs as far apart as she can, her legs bent inward towards each other, and her buttocks, the soles of her feet and her heels being placed upon a small rest, placed for the purpose, so that she may be able to strain the stronger. In case her back should be very weak, a swathing band should be placed under it, the band being doubled four times and about four inches broad. This must be held by two persons who must raise her up a little every time her pains come on, with steady hands and in even time, but if they be not exact in their movements, they had better leave her alone. At the same time two women must hold her shoulders so that she may strain out the foetus more easily; and to facilitate this let one stroke or press the upper part of her stomach gently and by degrees. The woman herself must not be nervous or downhearted, but courageous, and forcing herself by straining and holding her breath.
When delivery is near, the midwife must wait patiently until the child's head, or some limb, bursts the membranes, for if the midwife through ignorance, or through haste to go to some other woman, as some have done, tears the membrane with her nails, she endangers both the woman and the child; for by lying dry and lacking that slipperiness which should make it easy, it comes forth with severe pains.
When the head appears, the midwife must hold it gently between her hands, and draw the child, whenever the woman's pains are upon her, but at no other times; slipping her forefingers under its armpits by degrees, and not using a rough hand in drawing it out, lest the tender infant might become deformed by such means. As soon as the child is taken out, which is usually with its face downwards,—it should be laid upon its back, that it may receive external respiration more freely; then cut the navel string about three inches from the body, tying the end which adheres to it with a silk string, as closely as you can; then cover the child's head and stomach well, allowing nothing to touch its face.
When the child has been thus brought forth, if it be healthy lay it aside, and let the midwife attend to the patient by drawing out the afterbirth; and this she may do by wagging and stirring it up and down, and afterwards drawing it out gently. And if the work be difficult, let the woman hold salt in her hands, close them tightly and breathe hard into them, and by that she will know whether the membranes are broken or not. It may also be known by making her strain or vomit; by putting her fingers down her throat, or by straining or moving her lower parts, but let all be done immediately. If this should fail, let her take a draught of elder water, or the yolk of a new laid egg, and smell a piece of asafoetida, especially if she is troubled with a windy colic. If she happen to take cold, it is a great obstruction to the afterbirth; in such cases the midwife ought to chafe the woman's stomach gently, so as to break, not only the wind, but also to force the secundine to come down. But if these should prove ineffectual, the midwife must insert her hand into the orifice of the womb and draw it out gently.
Having thus discussed common births, or such as are generally easy, I shall now give directions in cases of extremity.
What ought to be done in cases of extremity, especially in women who, in labour, are attacked by a flux of blood, convulsions and fits of wind.
