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Take oil of keir, two ounces, juice of savine an ounce, of leeks and mercury, each half an ounce; boil them to the consumption of the juice; add galbanum dissolved in vinegar, half an ounce, myrrh, two drachms, storax liquid a drachm, round bitwort, sowbread, cinnamon, saffron, a drachm, with wax make an ointment and apply it.
If the birth be retarded through the weakness of the mother, refresh her by applying wine and soap to the nose, confect. alkermas. diamarg.
These things may be applied to help nature in her delivery when the child comes to the birth the right way, and yet the birth be retarded; but if she finds the child comes the wrong way, and that she is not able to deliver the woman as she ought to be, by helping nature, and saving both mother and child (for it is not enough to lay a woman if it might be done any other way with more safety and ease, and less hazard to woman and child), then let her send speedily for the better and more able to help; and not as I once knew a midwife do, who, when a woman she was to deliver had hard labour, rather than a man-midwife should be sent for, undertook to deliver the woman herself (though told it was a man's business), and in her attempting it, brought away the child, but left the head in the mother's womb; and had not a man midwife been presently sent for, the mother had lost her life as well as the child; such persons may rather be termed butchers than midwives. But supposing the woman's labour to be natural, I will next show what the midwife ought to do, in order of her delivery.
Of Natural Labour; What it is and what the Midwife is to do in such Labour.
There are four things which denominate a woman's natural labour; the first is, that it be at the full time, for if a woman comes before her time, it cannot be termed natural labour, neither will it be so easy as though she had completed her nine months. The second thing is, that it be speedy, and without any ill accident; for when the time of her birth come, nature is not dilatory in the bringing it forth, without some ill accident intervene, which renders it unnatural.
The third is, that the child be alive; for all will grant, that the being delivered of a dead child is very unnatural. The fourth is, that the child come right, for if the position of the child in the womb be contrary to that which is natural, the event will prove it so, by making that which should be a time of life, the death both of the mother and the child.
Having thus told you what I mean by natural labour, I shall next show how the midwife is to proceed therein, in order to the woman's delivery. When all the foregoing requisites concur, and after the waters be broken of themselves, let there rather a quilt be laid upon the pallet bedstead than a feather bed, having there-on linen and cloths in many folds, with such other things as are necessary, and that may be changed according to the exigency requiring it, so that the woman may not be incommoded with the blood, waters and other filth which are voided in labour. The bed ought to be ordered, that the woman being ready to be delivered, should lie on her back upon it, having her body in a convenient posture; this is, her head and breast a little raised, so that she may be between lying and sitting, for being so placed, she is best capable of breathing, and, likewise, will have more strength to bear her pains than if she lay otherwise, or sunk down in her bed. Being so placed, she must spread her thighs abroad, folding her legs a little towards her buttocks, somewhat raised by a little pillow underneath, to the end that her rumps should have more liberty to retire back; and let her feet be stayed against some firm thing; besides this, let her take firm hold of some of the good women attending her, with her hands, that she may the better stay herself during her pains. She being thus placed at her bed, having her midwife at hand, the better to assist as nature may require, let her take courage, and help her pains as best she can, bearing them down when they take her, which she must do by holding her breath, and forcing them as much as possible, in like manner as when she goes to stool, for by such straining, the diaphragm, or midriff, being strongly thrust downward, necessarily forces down the womb and the child in it. In the meantime, let the midwife endeavour to comfort her all she can, exhorting her to bear her labour courageously, telling her it will be quickly over, and that there is no fear but that she will have a speedy delivery. Let the midwife also, having no rings on her fingers, anoint them with oil of fresh butter, and therewith dilate gently the inward orifice of the womb putting her finger ends into the entry thereof, and then stretch them one from the other, when her pains take her; by this means endeavouring 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 it with fresh butter if it be necessary.
When the head of the infant is a little advanced into the inward orifice, the midwife's phrase is:—"It is crowned"; because it girds and surrounds it just as a crown; but when it is so far that the extremities begin to appear without the privy parts, then they say, "The infant is in the passage"; and at this time the woman feels herself as if it were scratched, or pricked with pins, and is ready to imagine that the midwife hurts her, when it is occasioned by the violent distension of those parts and the laceration which sometimes the bigness of the child's head causeth there. When things are in this posture, let the midwife seat herself conveniently to receive the child, which will come quickly, and with her finger ends (which she must be sure to keep close pared) let her endeavour to thrust the crowning of the womb (of which I have spoken before), 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 two sides with her two hands, that when a good pain comes she may quickly draw forth the child, taking care that the navel-string be not entangled about the neck or any 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 strings, both which are of bad consequence to the woman, whose delivery may thereby be rendered the more difficult. It must also be carefully observed that the head be not drawn forth straight, but shaking it a little from one side to the other, that the shoulders may sooner and easier take their places immediately after it is past, without losing time, lest the head being past, the child be stopped there by the largeness of the shoulders, and so come in danger of being suffocated and strangled in the passage, as it sometimes happens, for the want of care therein. But as soon as the head is born, if there be need, she may slide her fingers under the armpits, and the rest of the body will follow without any difficulty.
As soon as the midwife hath in this manner drawn forth the child, let her put it on one side, lest the blood and water which follows immediately, should do it any injury by running into its mouth and nose, as they would do, if it lay on its back; and so endanger the choking of it. The child being thus born, 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 more children in the womb; for sometimes a woman may have twins that expected it not; which the midwife may easily know by the continuance of the pains after the child is born, and the bigness of the mother's belly. But the midwife may be sure of it, if she puts her hand up to the entry of the womb, and finds there another watery gathering, and the child in it presenting to the passage, and if she find it so, she must have a care of going to fetch the after-birth, till the woman be delivered of all the children she is pregnant with. Wherefore the first string must be cut, being first tied with a thread three or four times double, and fasten the other end with string to the woman's thighs, to prevent the inconvenience it may cause by hanging between the thighs; and then removing the child already born, she must take care to deliver her of the rest, observing all the circumstances as with the first; after which, it will be necessary to fetch away the after-birth, or births. But of that I shall treat in another section, and first show what is to be done to the new-born infant.
