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If the dead child comes with the arm up to the shoulders so extremely swelled that the woman must suffer too great violence to have it put back, it is then (being first well assured the child is dead) best to take it off by the shoulder joints, by twisting three or four times about, which is very easily done by reason of the softness and tenderness of the body. After the arm is so separated, and no longer possesses the passage, the operator will have more room to put up his hand into the womb, to fetch the child by the feet and bring it away.
But although the operator is sure the child is dead in the womb, yet he must not therefore presently use instruments because they are never to be used but when hands are not sufficient, and there is no other remedy to prevent the woman's danger, or to bring forth the child any other way; and the judicious operator will choose that way which is the least hazardous, and most safe.
There is nothing more obvious to those whose business it is to assist labouring women, than that the several unnatural postures in which children present themselves at the birth are the occasions of most of the bad labours and ill accidents that happen to them in that condition.
And since midwives are often obliged, because of their unnatural situations, to draw the children forth by the feet, I conceive it to be most proper first to show how a child must be brought forth that presents itself in that posture, because it will be a guide to several of the rest.
I know indeed in this case it is the advice of several authors to change the figure, and place the head so that it may present to the birth, and this counsel I should be very much inclined to follow, could they but also show how it may be done. But it will appear very difficult, if not impossible to be performed, if we would avoid the danger that by such violent agitations both the mother and the child must be put into, and therefore my opinion is, that it is better to draw forth by the feet, when it presents itself in that posture, than to venture a worse accident by turning it.
As soon, therefore, as the waters are broken, and it is known that the child come thus and that the womb is open enough to admit the midwife's or operator's hand into it, or else by anointing the passage with oil or hog's grease, to endeavour to dilate it by degrees, using her fingers to this purpose, spreading them one from the other, after they are together entered, and continue to do so until they be sufficiently dilated, then taking care that her nails be well pared, no rings on her fingers and her hands well anointed with oil or fresh butter, and the woman placed in the manner directed in the former section, let her gently introduce her hand into the entrance of the womb, where finding the child's feet, let her draw it forth in the manner I shall presently direct; only let her first see whether it presents one foot or both, and if but one foot, she ought to consider whether it be the right foot or the left, and also in what fashion it comes; for by that means she will soon come to know where to find the other, which as soon as she knows and finds, let her draw it forth with the other; but of this she must be specially careful, viz., that the second be not the foot of another child; for if so, it may be of the utmost consequence, for she may sooner split both mother and child, than draw them forth. But this may be easily prevented if she but slide the hand up by the first leg and thigh to the waist, and there finding both thighs joined together, and descending from one and the same body. And this is also the best means to find the other foot, when it comes but with one.
As soon as the midwife has found both the child's feet, she may draw them forth, and holding them together, may bring them little by little in this manner, taking afterwards hold of the arms and thighs, as soon as she can come at them, drawing them so till the hips come forth. While this is doing, let her observe to wrap the parts in a single cloth, so that her hands being always greasy slide not in the infant's body, which is very slippery, because of the vicious humours which are all over it; which being done, she may take hold under the hips, so as to draw it forth to the beginning of the breast; and let her on both sides with her hand bring down the child's hand along its body, which she may easily find; and then let her take care that the belly and face of the child be downwards; for if they should be upwards, there would be the same danger of its being stopped by the chin, over the share-bone, and therefore, if it be not so she must turn it to that posture; which may easily be done if she takes a proper hold of the body when the breasts and arms are forth, in the manner we have said, and draw it, turning it in proportion on that side it most inclines to, till it be turned with the face downwards, and so, having brought it to the shoulders, let her lose no time, desiring the woman at the same time to bear down, that so drawing the head at that instant may take its place, and not be stopped in the passage, though the midwife takes all possible care to prevent it. And when this happens, she must endeavour to draw forth the child by the shoulders (taking care that she separate not the body from the head, as I have known it done by the midwife), discharging it by little and little from the bones in the passage with the fingers of each hand, sliding them on each side opposite the other, sometimes above and sometimes under, till the work be ended; endeavouring to dispatch it as soon as possible, lest the child be suffocated, as it will unavoidably be, if it remain long in that posture; and this being well and carefully effected, she may soon after fetch away the after-birth, as I have before directed.
Though the utmost care be taken in bringing away the child by the feet, yet if it happen to be dead, it is sometimes so putrid and corrupt, that with the least pull the head separates from the body and remains alone in the womb, and cannot be brought away but with a manual operation and great difficulty, it being extremely slippery, by reason of the place where it is, and from the roundness of its figure, on which no hold can well be taken; and so very great is the difficulty in this case that sometimes two or three very able practitioners in midwifery have, one after the other, left the operation unfinished, as not able to effect it, after the utmost industry, skill and strength; so that the woman, not being able to be delivered, perished. To prevent which fatal accident, let the following operation be observed.
When the infant's head separates from the body, and is left alone behind, whether owing to putrefaction or otherwise, let the operator immediately, without any delay, while the womb is yet open, direct up his right hand to the mouth of the head (for no other hole can there be had), and having found it let him put one or two of his fingers into it, and the thumb under its chin; then let him draw it little by little, holding it by the jaws; but if that fails, as sometimes it will when putrefied, then let him pull off the right hand and slide up his left, with which he must support the head, and with the right hand let him take a narrow instrument called a crochet, but let it be strong and with a single branch, which he must guide along the inside of his hand, with the point of it towards it, for fear of hurting the womb; and having thus introduced it, let him turn it towards the head to strike either in an eyehole, or the hole of the ear, or behind the head, or else between the sutures, as he finds it most convenient and easy; and then draw forth the head so fastened with the said instrument, still helping to conduct it with his left hand; but when he hath brought it near the passage, being strongly fastened to the instrument, let him remember to draw forth his hand, that the passage not being filled with it, may be larger and easier, keeping still a finger or two on the side of the head, the better to disengage it.
