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We have already spoken something of the birth of twins in the chapter of natural labour, for it is not an unnatural labour barely to have twins, provided they come in the right position to the birth. But when they present themselves in different postures, they come properly under the denomination of unnatural labours; and if when one child presents itself in a wrong figure, it makes the labour dangerous and unnatural, it must needs make it much more so when there are several, and render it not only more painful to the mother and children, but to the operator also; for they often trouble each other and hinder both their births. Besides which the womb is so filled with them, that the operator can hardly introduce his hand without much violence, which he must do, if they are to be turned or thrust back, to give them a better position.
When a woman is pregnant with two children, they rarely present to the birth together, the one being generally more forward than the other; and that is the reason that but one is felt, and that many times the midwife knows not that there are twins until the first is born, and that she is going to fetch away the afterbirth. In the first chapter, wherein I treated of natural labour, I have showed how a woman should be delivered of twins, presenting themselves both right; and before I close the chapter of unnatural labour, it only remains that I show what ought to be done when they either both come wrong or one of them only, as for the most part it happens; the first generally coming right, and the second with the feet forward, or in some worse posture. In such a case, the birth of the first must be hastened as much as possible and to make way for the second, which is best brought away by the feet, without endeavouring to place it right, because it has been, as well as the mother, already tired and weakened by the birth of the first, and there would be greater danger to its death, than likelihood of its coming out of the womb that way.
But if, when the first is born naturally, the second should likewise offer its head to the birth, it would then be best to leave nature to finish what she has so well begun, and if nature should be too slow in her work, some of those things mentioned in the fourth chapter to accelerate the birth, may be properly enough applied, and if, after that, the second birth should be delayed, let a manual operation be delayed no longer, but the woman being properly placed, as has been before directed, let the operator direct his hand gently into the womb to find the feet, and so draw forth the second child, which will be the more easily effected, because there is a way made sufficiently by the birth of the first; and if the waters of the second child be not broke, as it often happens, yet, intending to bring it by its feet, he need not scruple to break the membranes with his fingers; for though, when the birth of a child is left to the operation of nature, it is necessary that the waters should break of themselves, yet when the child is brought out of the womb by art, there is no danger in breaking them, nay, on the contrary it becomes necessary; for without the waters are broken, it will be almost impossible to turn the child.
But herein principally lies the care of the operator, that he be not deceived, when either the hands or feet of both children offer themselves together to the birth; in this case he ought well to consider the operation, of whether they be not joined together, or any way monstrous, and which part belongs to one child and which to the other; so that they may be fetched one after the other, and not both together, as may be, if it were not duly considered, taking the right foot of one and the left of the other, and so drawing them together, as if they both belonged to one body, because there is a left and a right, by which means it would be impossible to deliver them. But a skilful operator will easily prevent this, if, after having found two or three of several children presenting together in the passage, and taking aside two of the forwardest, a right and a left, and sliding his arm along the legs and thighs up to the wrist, if forward, or to the buttocks, if backwards, he finds they both belong to one body; of which being thus assured, he may begin to draw forth the nearest, without regarding which is the strongest or weakest, bigger or less, living or dead, having first put aside that part of the other child which offers to have the more way, and so dispatch the first as soon as may be, observing the same rules as if there were but one, that is keeping the breast and face downwards, with every circumstance directed in that section where the child comes with its feet first, and not fetch the burden till the second child is born. And therefore, when the operator hath drawn forth one child, he must separate it from the burden, having tied and cut the navel-string, and then fetch the other by the feet in the same manner, and afterwards bring away the after-burden with the two strings as hath been before showed. If the children present any other part but the feet, the operator may follow the same method as directed in the foregoing section, where the several unnatural positions are fully treated of.
Directions for Child-bearing Women in their Lying-in.
As soon as she is laid in her bed, let her be placed in it conveniently for ease and rest, which she stands in great need of to recover herself of the great fatigue she underwent during her travail, and that she may lie the more easily let her hands and body be a little raised, that she may breathe more freely, and cleanse the better, especially of that blood which then comes away, that so it may not clot, which being retained causeth great pain.
Having thus placed her in bed, let her take a draught of burnt white wine, having a drachm of spermaceti melted therein. The best vervain is also singularly good for a woman in this condition, boiling it in what she either eats or drinks, fortifying the womb so exceedingly that it will do it more good in two days, than any other thing does in double that time, having no offensive taste. And this is no more than what she stands in need of; for her lower parts being greatly distended until the birth of the infant, it is good to endeavour the prevention of an inflammation there. Let there also be outwardly applied, all over the bottom of her belly and privities, the following anodyne and cataplasm:—Take two ounces of oil of sweet almonds, and two or three new laid eggs, yolks and whites, stirring them together in an earthen pipkin over hot embers till they come to the consistence of a poultice; which being spread upon a cloth, must be applied to those parts indifferently warm, having first taken away the closures (which were put to her presently after her delivery), and likewise such clots of blood as were then left. Let this lie on for five or six hours, and then renew it again when you see cause.
Great care ought to be taken at first, that if her body be very weak, she be not kept too hot, for extremity of heat weakens nature and dissolves the strength; and whether she be weak or strong, be sure that no cold air comes near her at first; for cold is an enemy to the spermatic parts; if it get into the womb it increases the after pains, causes swelling in the womb and hurts the nerves. As to her diet, let it be hot, and let her eat but little at a time. Let her avoid the light for the first three days, and longer if she be weak, for her labour weakens her eyes exceedingly, by a harmony between the womb and them. Let her also avoid great noise, sadness and trouble of mind.
