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If the child happens at any time to be swollen through cold or violence, or has contracted a watery humour, if it is alive, such means must be used as are least injurious to the child or mother; but if it be dead, the humours must be let out by incisions, to facilitate the birth.
If, as often happens, the child is presented feet foremost, with the hands spreading out from the hips, the midwife must in such a case be provided with the necessary ointments to rub and anoint the child with, to help it coming forth, lest it should turn into the womb again, holding both the infant's arms close to the hips at the same time, that it may come out in this manner; but if it proves too big, the womb must be well anointed. The woman should also take a sneezing powder, to make her strain; the attendant may also stroke her stomach gently to make the birth descend, and to keep it from returning.
It happens occasionally, that the child presenting itself with the feet first, has its arms extended above its head; but the midwife must not receive it so, but put it back into the womb, unless the passage be extraordinarily wide, and then she must anoint both the child and the womb, and it is not safe to draw it out, which must, therefore, be done in this manner.—The woman must lie on her back with her head low and her buttocks raised; and then the midwife must compress the stomach and the womb with a gentle hand, and by that means put the child back, taking care to turn the child's face towards the mother's back, raising up its thighs and buttocks towards the navel, so that the birth may be more natural.
If the child happens to come out with one foot, with the arm extended along the side and the other foot turned backwards; then the woman must be immediately put to bed and laid in the above-described position; when the midwife must immediately put back the foot which appears so, and the woman must rock herself from side to side, until she finds that the child has turned, but she must not alter her position nor turn upon her face. After this she may expect her pains and must have great assistance and cordials so as to revive and support her spirits.
At other times it happens that the child lies across in the womb, and falls upon its side; in this case the woman must not be urged in her labour; therefore, the midwife when she finds it so, must use great diligence to reduce it to its right form, or at least to such a form in the womb as may make the delivery possible and most easy by moving the buttocks and guiding the head to the passage; and if she be successful in this, let the woman rock herself to and fro, and wait with patience till it alters its way of lying.
Sometimes the child hastens simply by expanding its legs and arms; in which, as in the former case, the woman must rock herself, but not with violence, until she finds those parts fall to their proper station; or it may be done by a gentle compression of the womb; but if neither of them avail, the midwife must close the legs of the infant with her hand, and if she can get there, do the like by the arms, and so draw it forth; but if it can be reduced of itself to the posture of a proper birth it is better.
If the infant comes forward, both knees forward, and the hands hanging down upon the thighs, then the midwife must put both knees upward, till the feet appear; taking hold of which with her left hand let her keep her right hand on the side of the child, and in that posture endeavour to bring it forth. But if she cannot do this, then also the woman must rock herself until the child is in a more convenient posture for delivery.
Sometimes it happens that the child presses forward with one arm extended on its thighs, and the other raised over its head, and the feet stretched out at length in the womb. In such case, the midwife must not attempt to receive the child in that posture, but must lay the woman on the bed in the manner aforesaid, making a soft and gentle compression on her belly, oblige the child to retire; which if it does not, then must the midwife thrust it back by the shoulder, and bring the arm that was stretched above the head to its right station; for there is most danger in these extremities; and, therefore, the midwife must anoint her hands and the womb of the woman with sweet butter, or a proper pomatum, and thrust her hand as near as she can to the arm of the infant, and bring it to the side. But if this cannot be done, let the woman be laid on the bed to rest a while; in which time, perhaps, the child may be reduced to a better posture; which the midwife finding, she must draw tenderly the arms close to the hips and so receive it.
If an infant come with its buttocks foremost, and almost double, then the midwife must anoint her hand and thrust it up, and gently heaving up the buttocks and back, strive to turn the head to the passage, but not too hastily, lest the infant's retiring should shape it worse: and therefore, if it cannot be turned with the hand, the woman must rock herself on the bed, taking such comfortable things as may support her spirits, till she perceives the child to turn.
If the child's neck be bowed, and it comes forward with its shoulders, as it sometimes doth, with the hands and feet stretched upwards, the midwife must gently move the shoulders, that she may direct the head to the passage; and the better to effect it, the woman must rock herself as aforesaid.
These and other like methods are to be observed in case a woman hath twins, or three children at a birth, which sometimes happens: for as the single birth hath but one natural and many unnatural forms, even so it may be in a double and treble birth.
Wherefore, in all such cases the midwife must take care to receive the first which is nearest the passage; but not letting the other go, lest by retiring it should change the form; and when one is born, she must be speedy in bringing forth the other. And this birth, if it be in the natural way, is more easy, because the children are commonly less than those of single birth, and so require a less passage. But if this birth come unnaturally, it is far more dangerous than the other.
In the birth of twins, let the midwife be very careful that the secundine be naturally brought forth, lest the womb, being delivered of its burden, fall, and so the secundine continue longer there than is consistent with the woman's safety.
But if one of the twins happens to come with the head, and the other with the feet foremost, then let the midwife deliver the natural birth first; and if she cannot turn the other, draw it out in the posture in which it presses forward; but if that with its feet downward be foremost, she may deliver that first, turning the other aside. But in this case the midwife must carefully see that it be not a monstrous birth, instead of twins, a body with two heads, or two bodies joined together, which she may soon know if both the heads come foremost, by putting up her hand between them as high as she can; and then, if she finds they are twins she may gently put one of them aside to make way for the other, taking the first which is most advanced, leaving the other so that it do not change its position. And for the safety of the other child, as soon as it comes forth out of the womb, the midwife must tie the navel-string, as has before been directed, and also bind, with a large, long fillet, that part of the navel which is fastened to the secundine, the more readily to find it.
The second infant being born, let the midwife carefully examine whether there be not two secundines, for sometimes it falls out, that by the shortness of the ligaments it retires back to the prejudice of the woman. Wherefore, lest the womb should close, it is most expedient to hasten them forth with all convenient speed.