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There is also another method, with more ease and less hardship than the former; let the operator take a soft fillet or linen slip, of about four fingers' breadth, and the length of three quarters of an ell or thereabouts, taking the two ends with the left hand, and the middle with the right, and let him so put it up with his right, as that it may be beyond the head, to embrace it as a sling does a stone, and afterwards draw forth the fillet by the two ends together; it will thus be easily drawn forth, the fillet not hindering the least passage, because it takes up little or no space.
When the head is fetched out of the womb care must be taken that not the least part of it be left behind, and likewise to cleanse the womb of the after-burden, if yet remaining. If the burden be wholly separated from the side of the womb, that ought to be first brought away, because it may also hinder the taking hold of the head. But if it still adheres to the womb, it must not be meddled with till the head be brought away; for if one should endeavour to separate it from the womb, it might then cause a flooding, which would be augmented by the violence of the operation, the vessels to which it is joined remaining for the most part open as long as the womb is distended, which the head causeth while it is retained in it, and cannot be closed until this strange body be voided, and this it doth by contracting and compressing itself together, as has been more fully before explained. Besides, the after-birth remaining thus cleaving to the womb during the operation, prevents it from receiving easily either bruise or hurt.
Though some may think it a natural labour when the child's head come first, yet, if the child's head present not the right way, even that is an unnatural labour; and therefore, though the head comes first, yet if it be the side of the head instead of the crown, it is very dangerous both to the mother and the child, for the child's neck would be broken, if born in that manner, and by how much the mother's pains continue to bear the child, which is impossible unless the head be rightly placed, the more the passages are stopped. Therefore, as soon as the position of the child is known, the woman must be laid with all speed, lest the child should advance further than this vicious posture, and thereby render it more difficult to thrust it back, which must be done, in order to place the head right in the passage, as it ought to be.
To this purpose, therefore, place the woman so that her buttocks may be a little higher than her head and shoulders, causing her to lean a little to the opposite side to the child's ill posture; then let the operator slide up his hand, well anointed with oil, by the side of the child's head; to bring it right gently, with his fingers between the head and the womb; but if the head be so engaged that it cannot be done that way, he must then put up his hand to the shoulders, that by so thrusting them back a little into the womb, sometimes on the one side, and sometimes on the other, he may, little by little, give a natural position. I confess it would be better if the operator could put back the child by its shoulders with both hands, but the head takes up so much room, that he will find much ado to put up one, with which he must perform this operation, and, with the help of the finger-ends of the other hand put forward the child's birth as in natural labour.
Some children present their face first, having their hands turned back, in which posture it is extremely difficult for a child to be born; and if it continues so long, the face will be swelled and become black and blue, so that it will at first appear monstrous, which is occasioned as well by the compression of it in that place, as by the midwife's fingers in handling it, in order to place it in a better posture. But this blackness will wear away in three or four days' time, by anointing it often with oil of sweet almonds. To deliver the birth, the same operation must be used as in the former, when the child comes first with the side of the head; only let the midwife or operator work very gently to avoid as much as possible the bruising the face.
Sometimes the infant will present some other part together with its head; which if it does, it is usually with one or both of its hands; and this hinders the birth, because the hands take up part of that passage which is little enough for the head alone; besides that, when this happens, they generally cause the head to lean on one side; and therefore this position may be well styled unnatural. When the child presents thus, the first thing to be done after it is perceived, must be, to prevent it from coming down more, or engaging further in the passage; and therefore, the operator having placed the woman on the bed, with her head lower than her buttocks, must guide and put back the infant's hand with his own as much as may be, or both of them, if they both come down, to give way to the child's head; and this being done, if the head be on one side, it must be brought into its natural posture in the middle of the passage, that it may come in a straight line, and then proceed as directed in the foregoing section.
There are none but will readily grant, that when the hands and feet of an infant present together, the labour must be unnatural, because it is impossible a child should be born in that manner. In this case, therefore, when the midwife guides her hand towards the orifice of the womb she will perceive only many fingers close together, and if it be not sufficiently dilated, it will be a good while before the hands and feet will be exactly distinguished; for they are sometimes so shut and pressed together, that they seem to be all of one and the same shape, but where the womb is open enough to introduce the hand into it, she will easily know which are the hands and which are the feet; and having taken particular notice thereof, let her slide up her hand and presently direct it towards the infant's breast, which she will find very near, and then let her gently thrust back the body towards the bottom of the womb, leaving the feet in the same place where she found them. And then, having placed the woman in a convenient posture, that is to say, her buttocks a little raised above her breast (and which situation ought also to be observed when the child is to be put back into the womb), let the midwife afterwards take hold of the child by the feet, and draw it forth, as is directed in the second section.
This labour, though somewhat troublesome, yet is much better than when the child presents only its hands; for then the child must be quite turned about before it can be drawn forth; but in this they are ready, presenting themselves, and there is little to do, but to lift and thrust back the upper part of the body, which is almost done of itself, by drawing it by the feet alone.
I confess there are many authors that have written of labours, who would have all wrong births reduced to a natural figure, which is, to turn it that it may come with the head first. But those that have written thus, are such as never understood the practical part, for if they had the least experience therein, they would know that it is impossible; at least, if it were to be done, that violence must necessarily be used in doing it, that would probably be the death both of mother and child in the operation. I would, therefore, lay down as a general rule, that whenever a child presents itself wrong to the birth, in what posture so ever, from the shoulders to the feet, it is the way, and soonest done, to draw it out by the feet; and that it is better to search for them, if they do not present themselves, than to try and put them in their natural posture, and place the head foremost; for the great endeavours necessary to be used in turning the child in the womb, do so much weaken both the mother and the child, that there remains not afterwards strength enough to commit the operation to the work of nature; for, usually, the woman has no more throes or pains fit for labour after she has been so wrought upon; for which reason it would be difficult and tedious at best; and the child, by such an operation made very weak, would be in extreme danger of perishing before it could be born. It is, therefore, much better in these cases to bring it away immediately by the feet, searching for them as I have already directed, when they do not present themselves; by which the mother will be prevented a tedious labour, and the child be often brought alive into the world, who otherwise could hardly escape death.
