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(1) Use the same means of bringing away the after-birth, that you made use of to bring away the birth; for the same care and circumspection are needful now that there were then.
(2) Considering that the labouring woman cannot but be much spent by what she has already undergone in bringing forth the infant, be therefore sure to give her something to comfort her. And in this case good jelly broths, also a little wine and toast in it, and other comforting things, will be necessary.
(3) A little hellebore in powder, to make her sneeze, is in this case very proper.
(4) Tansey, and the stone aetites, applied as before directed, are also of good use in this case.
(5) If you take the herb vervain, and either boil it in wine, or a syrup with the juice of it, which you may do by adding to it double its weight of sugar (having clarified the juice before you boil it), a spoonful of that given to the woman is very efficacious to bring away the secundine; and feverfew and mugwort have the same operation taken as the former.
(6) Alexanders [10] boiled in wine, and the wine drank, also sweet servile, sweet cicily, angelica roots, and musterwort, are excellent remedies in this case.
(7) Or, if this fail, the smoke of marigolds, received up a woman's privities by a funnel, have been known to bring away the after-birth, even when the midwife let go her hold.
(8) Boil mugwort in water till it be very soft, then take it out, and apply it in the manner of a poultice to the navel of the labouring woman, and it instantly brings away the birth. But special care must be taken to remove it as soon as they come away, lest by its long tarrying it should draw away the womb also.
There are three sorts of bad labours, all painful and difficult, but not all properly unnatural. It will be necessary, therefore, to distinguish these.
The first of these labours is that when the mother and child suffer very much extreme pain and difficulty, even though the child come right; and this is distinguishably called the laborious labour.
The second is that which is difficult and differs not much from the former, except that, besides those extraordinary pains, it is generally attended with some unhappy accident, which, by retarding the birth, causes the difficulty; but these difficulties being removed, it accelerates the birth, and hastens the delivery.
Some have asked, what is the reason that women bring forth their children with so much pain? I answer, the sense of feeling is distributed to the whole body by the nerves, and the mouth of the womb being so narrow, that it must of necessity be dilated at the time of the woman's delivery, the dilating thereof stretches the nerves, and from thence comes the pain. And therefore the reason why some women have more pain in their labour than others, proceeds from their having the mouth of the matrix more full of nerves than others. The best way to remove those difficulties that occasion hard pains and labour, is to show first from whence they proceed. Now the difficulty of labour proceeds either from the mother, or child, or both.
From the mother, by reason of the indisposition of the body, or from some particular part only, and chiefly the womb, as when the woman is weak, and the mother is not active to expel the burden, or from weakness, or disease, or want of spirits; or it may be from strong passion of the mind with which she was once possessed; she may also be too young, and so may have the passage too narrow; or too old, and then, if it be her first child, because her pains are too dry and hard, and cannot be easily dilated, as happens also to them which are too lean; likewise those who are small, short or deformed, as crooked women who have not breath enough to help their pains, and to bear them down, persons that are crooked having sometimes the bones of the passage not well shaped. The colic also hinders labour, by preventing the true pains; and all great and active pains, as when the woman is taken with a great and violent fever, a great flooding, frequent convulsions, bloody flux, or any other great distemper. Also, excrements retained cause great difficulty, and so does a stone in the bladder: or when the bladder is full of urine, without being able to void it, or when the woman is troubled with great and painful piles. It may also be from the passages, when the membranes are thick, the orifice too narrow, and the neck of the womb not sufficiently open, the passages strained and pressed by tumours in the adjacent parts, or when the bones are too firm, and will not open, which very much endangers the mother and the child; or when the passages are not slippery, by reason of the waters having broken too soon, or membranes being too thin. The womb may also be out of order with regard to its bad situation or conformation, having its neck too narrow, hard and callous, which may easily be so naturally, or may come by accident, being many times caused by a tumour, an imposthume, ulcer or superfluous flesh.
As to hard labour occasioned by the child, it is when the child happens to stick to a mole, or when it is so weak it cannot break the membranes; or if it be too big all over, or in the head only; or if the natural vessels are twisted about its neck; when the belly is hydropsical; or when it is monstrous, having two heads, or joined to another child, also, when the child is dead or so weak that it can contribute nothing to its birth; likewise when it comes wrong, or there are two or more. And to all these various difficulties there is oftentimes one more, and that is, the ignorance of the midwife, who for want of understanding in her business, hinders nature in her work instead of helping her.
Having thus looked into the cause of hard labour, I will now show the industrious midwife how she may minister some relief to the labouring woman under these difficult circumstances. But it will require judgment and understanding in the midwife, when she finds a woman in difficult labour, to know the particular obstruction, or cause thereof, that so a suitable remedy may be applied; as for instance, when it happens by the mother's being too young and too narrow, she must be gently treated, and the passages anointed with oil, hog's lard, or fresh butter, to relax and dilate them the easier, lest there should happen a rupture of any part when the child is born; for sometimes the peritoneum breaks, with the skin from the privities to the fundament.
But if the woman be in years with her first child, let her lower parts be anointed to mollify the inward orifice, which in such a case being more hard and callous, does not easily yield to the distention of labour, which is the true cause why such women are longer in labour, and also why their children, being forced against the inward orifice of the womb (which, as I have said, is a little callous) are born with great bumps and bruises on their heads.
Those women who are very small and mis-shaped, should not be put to bed, at least until the waters are broken, but rather kept upright and assisted to walk about the chamber, by being supported under the arms; for by that means, they will breathe more freely, and mend their pains better than on the bed, because there they lie all of a heap. As for those that are very lean, and have hard labour from that cause, let them moisten the parts with oil and ointments, to make them more smooth and slippery, that the head of the infant, and the womb be not so compressed and bruised by the hardness of the mother's bones which form the passage. If the cause be weakness, she ought to be strengthened, the better to support her pains, to which end give her good jelly broths, and a little wine with a toast in it. If she fears her pains, let her be comforted, assuring her that she will not endure any more, but be delivered in a little time. But if her pains be slow and small, or none at all, they must be provoked by frequent and pretty strong clysters; let her walk about her chamber, so that the weight of the child may help them forward. If she flood or have strong convulsions she must then be helped by a speedy delivery; the operation I shall relate in this section of unnatural labours. If she be costive, let her use clysters, which may also help to dispel colic, at those times very injurious because attended with useless pains, and because such bear not downward, and so help not to forward the birth. If she find an obstruction or stoppage of the urine, by reason of the womb's bearing too much on the bladder, let her lift up her belly a little with her hands, and try if by that she receives any benefit; if she finds she does not, it will be necessary to introduce a catheter into her bladder, and thereby draw forth her urine. If the difficulty be from the ill posture of the woman, let her be placed otherwise, in a posture more suitable and convenient for her; also if it proceeds from indispositions of the womb, as from its oblique situation, etc., it must be remedied, as well as it can be, by the placing her body accordingly; or, if it be a vicious conformation, having the neck too hard, too callous, too straight, it must be anointed with oil and ointments, as before directed. If the membranes be so strong that the waters do not break in due time, they may be broken with the fingers, if the midwife be first well assured that the child is come forward into the passage, and ready to follow presently after; or else, by the breaking of the waters too soon, the child may be in danger of remaining dry a long time; to supply which defect, you may moisten the parts with fomentations, decoctions, and emollient oils; which yet is not half so well as when nature does her work in her own time, with the ordinary slime and waters. The membranes sometimes do press forth with the waters, three or four fingers' breadth out of the body before the child resembling a bladder full of water; but there is no great danger in breaking them, if they be not already broken; for when the case is so, the child is always in readiness to follow, being in the passage, but let the midwife be very careful not to pull it with her hand, lest the after-burden be thereby loosened before its time, for it adheres thereto very strongly. If the navel-string happen to come first, it must presently be put up again, and kept so, if possible, or otherwise, the woman must be immediately delivered. But if the after-burden should come first, it must not be put up again by any means; for the infant having no further occasion for it, it would be but an obstacle if it were put up; in this case, it must be cut off, having tied the navel-string, and afterwards draw forth the child with all speed that may be, lest it be suffocated.
