The compleat midwife's practice enlarged in the most weighty and high concernments of the birth of man containing a perfect directory or rules for midwives and nurses : as also a guide for women in their conception, bearing and nursing of children from the experience of our English authors, viz., Sir Theodore Mayern, Dr. Chamberlain, Mr. Nich. Culpeper ... : with instructions of the Queen of France's midwife to her daughter ... / by John Pechey ... ; the whole illustrated with copper plates.

CHAP. XXVIII. Of cases of Extremity; and first, what is to be done to a Woman, who in her Travail is accompanied with a flux of blood, and with Convulsions.

IN the first place, great care must be had, as to the situation of the Woman: The Woman in this case must be laid cross her Bed, where she must be held by some one that hath strength, that she may not slide, or move her self in the operations of the Chirurgion. Her thighs must be held hard and wide abroad, with her legs bent backwards towards her Hips, and her Head leaning upon a Bolster; the reins of her Back and her Crupper being a little elevated, with certain pillows put underneath her Thighs; besides this, she must be well cover'd with linnen Cloaths laid upon her stomach, Belly, and Thighs, to defend her from the cold and wind: Being thus situated, the Chyrurgion ought to put up his Hand, being first well opened within the neck of the womb, to remove all those clots of blood, which may lie there to obstrust the passages of the blood. He may then try if the interiour neck of the womb be

sufficiently dilated, that he may put in his hand, and move the Infant, if it be needful, which must be done as gently, and with as little violence as may be: He must anoint it on all parts with sweet-butter, or good Pomatum, and so opening it by little and little, he may put his hand quite in; and if the waters are not yet come down, he may without any difficulty let them forth; and then at the same instant, if the Infant comes with the head forwards he shall gently turn it. to find out the feet, and when he hath found one of them, he shall gently draw it forth, and immediately tye a riband about it, with a knot hanging down∣ward, then let him put it in again, suffering part of the riband to hang out, that he may more easily be able to find out the other foot; which he shall quickly do, by thrusting up his hand along the thigh of the Infant; when he hath found it, he shall take the other foot, and draw them both together at an even length, giving the woman now and then some leisure to breath, but urging her still to strain her self, when she feels the pains coming on her: Then shall the Chirurgion or Midwife take a fine linnen cloth, and wrap about the thighs of the Child, lest by taking it naked, his fingers should slip; in that manner drawing it forth, 'till it appear all come forth, observing still that the Belly and the Face be still kept downward.

Now if the woman hath a flux of blood, and that the neck of the Matrix be open, the Chirurgion ought to consider, whether the Infant or the Secondines come forth first of all, for it oftentimes happens that the Se∣condines passing toward the mouth of the Matrix, do so stop and obstruct it, that they do not give leave for the Child, or the Waters to come forth; so that some perceiving that softness, are presently of opinion that the mouth of the Womb is not open. But this the

Midwife or Chirurgion may easily discern, by thrust∣ing up the middle finger as high as may be, and feel∣ing therewith the circumference of the neck of the Womb, by which they will soon perceive whether the Womb be dilated or no, and whether it be the Secon∣dines that present themselves. Now when it is found to be the Secondines, and that they cannot easily come forth, the Midwife may with her two fingers widen the passage, that she may have thereby the liberty to put up her hand, and seek for the Infant. Now if the Secondines be not placed in the middle, they must be turned a little, as quickly as may be, that you may more conveniently seek for the feet of the Infant, to draw it forth as we have said.

In such a case as this, all care must be had that no∣thing be broken, and that every thing be brought out whole, for so though the woman should die, the Mid∣wife or Chirurgion would be blameless.

If the Secondines come first, the best way is to deli∣ver the Woman with all the expedition that may be, by reason of the great fluxes of blood that will follow, by reason that the veins are opened: But here are two things to be considered; the first is, whether the Secon∣dines are much, or little come forth; if they are but little advanced, they must be put back with care and diligence; and if the head of the Child appear first, it must be guided directly toward the neck of the Womb, as in the most natural birth; but if there appear any difficulty in the birth, by reason of the weakness, either of the Child, or of the Mother, then the most conve∣nient way will be to seek for the Feet, as we have said before.

Another thing to be observed is, that if the Secon∣dines be so far advanced, that they cannot be put back, and that the Child follow it close, then are the Secon∣dines

to be pulled away with all the care and expediti∣on that can be, and to be laid aside without cutting the Entrail that sticks to them, for by that you may be guided to the Infant, which whether it be alive or dead,* 1.1 is to be pulled out by the feet with as much care and quickness as may be; though it is not to be done but in case of great necessity, for otherwise the Secon∣dines ought to come last.

If the Child be dead in the Womb of the Mother, the Woman is then to be situated in the same posture, as when she is troubled with a flux of blood.

If it present it self dead, with the head foremost, and that there is little or no hope that the woman may be delivered without assistance, and that her strength be∣gins to fail her, the most certain and safe way is to put up the hand: For the Chirurgion must then slide up his left hand being hollowed, as when a Man strives to hold water in it, causing it to slide in the neck of the Womb, along the lower part thereof toward the feet, and that between the head of the Infant, and the neck of the Matrix: And having thus opened the Womb with his left hand, he shall with his right put up his hook above his left hand, between the head of the Child, and the flat of his hand, and fix in in the bone of the temple, toward the ear, or else in the hollow of the eye, or in the Occipital bone, keeping his left hand still in its place; after this, gently mo∣ving and stirring the head with his left hand, with his right hand holding the hook well fixed, he shall draw the Child forth by degrees, exhorting the Woman all the while to force and strain her self with all her power, and then is the best time to draw forth the Child, when the pains shall seize her; now if it happen that he lose his hold in one place, the danger is nothing, for he

hath the liberty to fix his Instrument better in another place. The head being thus drawn forth, he must with all speed that may be, slip his hands down the Child's arm-holes, to draw forth his shoulders, and the rest of his body: In the mean while it will be requi∣site to give the Woman a small draught of wine, or a tost sopt in wine of Hipocras.

If, after these Medicines following ad∣hibited,* 1.2 the Child make no haste into the World, but lies unmoved in the Womb, then you may proceed to Instruments after another manner. First of all, as soon as the Woman is brought to bed, let her take this following potion hot, and ab∣stain from all other meat, and remain quiet for the space of an hour or two, 'till she feel the power and efficacy of the Medicine.

Take seven cut Figs, Fenugreek, Motherwort-seed, and Rue, of each two drams, water of Peny-royal and Motherwort, of each six ounces, boil all these to the consumption of half, strain them; and to the straining add Trochischs of Myrrh one dram, three grains of Saffron, Sugar as much as is sufficient; make one draught of this, and spice it with a little Cinamon.

After she hath rested a little upon this, let her again return to her travel, at what time certain perfumes must be made ready of Trochischs, composed of these fol∣lowing Spices to be cast on the coals, and so used, as that the perfume may only come to the Matrix, and no further.

Take Castor, Sulphur, Galbanum, Opoponax, Pi∣geons-dung, Assa-faetida, of each half a dram, mingle all these with the juyce of Rue, and make a Trochisch of them in the form of a Filberd.

If these produce no effect, you may use this follow∣ing Emplaister.

Take Galbanum an ounce and a half, Coloquintida without the grains two drams, the juyces of Rue and Motherwort, new wax, as much of each as is suffici∣ent, of each make a plaister. Let this be spread upon a cloth to reach from the Navil to the Privities, and in breadth to both the sides, which she may keep on for the space of an hour or two. A Pessary may be also convenient, made of Wool, and closed over with silk, and then moistned in the following Decoction.

Take of round Birth-wort brought from France, Savin, and Coloquintida, with Grains, Staves-acre, black Ellebore, of each half a dram, bruise these toge∣ther, and make a Pessary, with as much of the juyce of Rue as is sufficient.

But now if all these things avail not, and that the Midwife is not able to dilate the passage for the Infant, then you must have recourse to the Chirurgion; to which purpose, she is to be placed in a seat, so that she may turn her crupper as much from the back of the Chair as may be; drawn up her legs as close as she can, but spreading her Hips abroad as much as may be. Or else if it seem more commodious, she may be laid upon the Bed, with her head down∣wards, her buttocks raised, and her thighs drawn up as much as can be: then you may go to work, either with your speculum matricis, or his Apertory; so that the womb being sufficiently widened by the help of these Instruments, the birth may be drawn out by the hands of the Chirurgion, together with the Secondines, if possible may be. The womb must then be washed and anointed, the woman then must be laid in her bed, and well comforted with spices, as also with some comfortable meat and drink. This course must be taken with all dead Infants, and also with Moles and Secon∣dines, which are hindred in their coming forth natu∣rally.

If by these Instruments the Womb cannot be suffi∣ciently widened for the egress of the Infants, there are yet other Instruments, by which the Womb may be widened without damage to the Mother, and the Birth be brought forth, such as are Drakes-bill, and the long Pincers, by which the Womb is not only widened, but the Birth taken hold of by them for the more forcible drawing it forth.

If there be any swelling, or inflammation, or con∣crete blood, gathered together in the preputium of the Matrix, under the skin, those tumours either be∣fore or after the Birth, where the matter appears thin∣nest and ripest, the Midwife may cut with a pen-knife and squeeze out the matter; anointing it after∣wards often with a pessary dipt in Oil of Roses, until it be whole.

If it happen that the Child be swollen in the Womb in any part of it, by reason of Wind or any watry Humour, yet if it be alive, such means are to be used, as may be least to the detriment of the Child and of the Mother; but if it be dead, in whatever part those hu∣mours be, either in the breast, arms, or legs, the Mid∣wife may then put up her hand, and with a little knife for that purpose, cut the swollen part, that by letting out of the Wind or humour, the Child may grow less and be brought forth with less difficulty.

Many times it happens that the Child comes into the World with the feet foremost; and the hands dilating themselves from the hips. In this case the Midwife ought to be well furnished with Oyntments, helping the egress of the Infant, by anointing and stroaking it, lest it be carried backward. Having also a great care to take hold of both the arms of the Infant, and keep them close to the hips, that the Child may come forth after its own manner. If by reason of this deduction of

the Arms, from the sides of the Infant, and the nar∣rowness of the Matrix, it so happen that the Child cannot make a total egress, the womb of the Woman, and the Infant it self, are to be well anointed, sneezing Powders being administred to the Woman, to help her endeavours; the womb is also to be pres∣sed hard with both hands, that the Child make no retirement back, but may still move forward.

It happens sometime that the Child comes forward with its feet, with the Arms not close to its sides, but extended above its head; which when it comes to pass, the Midwife is by no means to receive this Birth, unless the Child be very small, and the Matrix so wide, that it may afford an easie passage to the Child; yet may she not then receive it, till she hath well a∣nointed both the Child and the Matrix. But it would be much more safe and convenient, for both the Child and the Mother, to put back the Child into the Womb and bring it to its natural form, which may be done in this manner. The woman must lie on her back up∣on her bed, with her head downward, and her but∣tocks a little elevated, which being done, the Mid∣wife shall gently compress the belly of the Woman to∣ward the Midriff, thereby to put back the Infant into the Womb. But above all, things let her take care that she turn the Face of the Child toward the back of the Mother, raising up the thighs and buttocks of the Child, toward the navel of the Mother, to bring the Child to a more legitimate and natural production.

If the Child happen to come forth but with one Foot, the Arm being extended along the sides, with the other Foot turned backward, the Woman is instantly to be brought to her bed, and laid in the same posture as we have before told you, and then is the other foot which came forth first to be put back into the Womb; which being done, let the woman rock her self from one

[illustration]

side of the bed to the other, (lying alwaies with her head low, and her Buttocks raised) 'till she apprehend the Child to be turned, upon which she may immediately expect her pains with all the assistance that may be gi∣ven; and in the mean while to be comforted as much as may be with Cordial Potions, and wholsome Medi∣cines.

Many times it happens that the Child lies athwart, and falls upon his side, which when it comes to pass, the Mother is not to be urged to her labour, neither is the Birth to be expected after that manner, for it is impos∣sible that the Child should be so born without some conversion; and therefore the Midwife is to do all she can to reduce it to a more natural form of Birth, by moving the Buttocks, and steering the Head to the passage; if this succeed not, let her try by often rock∣ing the Woman to and fro, to bring the Child to its natural form of being born.

If it happen that the Child hasten to the Birth, with the Legs and Arms distorted, the Midwife ought not to hasten the Woman, but immediately cast her on her Bed, where she may direct the Woman to roul her self to and fro; or else she may gently stroke the womb of the Woman as she lies, 'till she have reduced the Infant to a better posture; If this profit not, the Midwife must take the Legs and close them together, then if she can, she must get her Hand about the Arms of the Child, and in the safest way she can, direct it to its coming forth; though it be the safest way to turn the Infant in the Womb, and by that means compose it to the na∣tural Birth.

If the Infant come into the World with both knees forward, with the Hands hanging down upon the Thighs. The Midwife may then put up both the Knees upward, 'till the Feet happen to come forward, and then with her left Hand let her take hold of the

Feet, and keep her right Hand about the sides of the Child, and in that posture endeavour the Birth of the Child; but if that succeed not, let the Woman as is said before, be brought to her Bed, and there wallow from side to side, 'till she have moved the Child into a better posture.

But when it happens that the Child hastens forwards, with one Arm extended upon the Thigh, and the other stretched over the Head, the Feet being stretched out at length in the Womb, the Midwife may by no means receive the Child in this posture, but must lay the Pa∣tient upon the Bed, as we have said before; then must the Womans Belly be gently pressed backward, that the Infant may retire into the Womb, and if it give not backward of its own accord, the Midwife may with her Hand gently thrust back the Shoulder, and bring the Arm that was stretched back to its right place.

The most dangerous of all those that we have spo∣ken of is this, and therefore the Midwife must take care to put back the Infant in this case into the Womb: First of all therefore anoint well her Hands, as also the Womb of the Woman, then, if she can, let her thrust in her Hand near the Arms of the Infant, and so move the Shoulders that the Infant may fall back into the womb; and then to bring it to the natural form, let her thrust up her other Hand, and reduce the Arms of the Infant to the sides of it; If this succeed not, the Woman must be laid on her Bed, and after a little rest, she must be ordered as before we have said: If this avail not, she must be brought back to her Seat, as we have before rehearsed; then must her womb, by the help of those Women that assist her be gently prest downward, and on both sides, while the Midwife having anointed the Matrix, and both the Arms of the Infant, joins them as close together as she can, and in that manner re∣ceives

the Infant. And there is the less danger in this form, if the Midwife be diligent, and the Child slender.

If the Infant thrust it self forwards with the buttocks formost, the Midwife must put up her Hand well a∣nointed, and so by heaving up and putting back the Buttocks strive to turn the Head to the Passage. Yet overmuch haste must not be made, lest the Infant should fall back into some worse Posture; and therefore if it cannot be turned by putting up the Hand, the Woman must be brought to her Bed, and ordered as we have often said before; comfortable things being convenient∣ly ministred to her.

If the Child come forward with the neck bowed, and the shoulders forward, with the Hands and Feet stretch∣ed upwards; in this case the Midwife must carefully move the shoulders backward that she may be able to bring the Head forwards, which may be easily done, for the shoulders being removed, the Head will soon ap∣pear formost, yet if this suffice not, the Woman must be laid on her back upon the Bed, and ordered accord∣ing to the former Precepts.

When the Infant thrusts forth the Hands and Feet formost care must be had to avoid the danger of this mishapen posture, and therefore the Midwife must strive by removing the Feet, to lay hold on the Head, and, as much as in her lies, to direct it to the passage; the Hands are also to be removed, unless of their own ac∣cord they fall down to the sides. If by this means it can∣not be done, the former Precepts of converting the Child are to be observed.

Sometimes it happens that the Child strives to force its passage in this posture which is very dangerous. First of all therefore let the Midwife anoint her Hands well, and the Womb of the Woman; which being done, let her put up her Hand, and seek for the Arms of the

Child, which when she hath found, let her hold them fast, till she hath hold of the Head also, which she must with all her skill endeavour to bring formost, then let her remove the Hands of the Infant, and fix them upon the sides of the Infant. Yet if this do not a∣vail, it will be the safest way to lay the Woman on her Bed, and to proceed according to the former Pre∣cepts, to try if by that delay she may have the more advantage to proceed as before

The same method which is to be observed in single Birth, is also to be observed in case of Twins or of tripple Birth; for as the single Birth hath but one na∣tural way, and many unnatural Forms, so is it with the Birth of many Children; and therefore when it hap∣pens that Twins appear, coming into the World ac∣cording to the natural form, the Midwife must ob∣serve to receive that first which is nearest the passage; yet be sure not to let go the other, lest it should fall back into the womb, and tumble into some other form, but the one being born, immediately to receive the o∣ther; this Birth is the more easie in the natural form, because the first Child widens the passage for the latter, but in unnatural Births there is most difficulty in the passage of the second Child: Care must be also had in the birth of Twins, that the Secondine be naturally brought forth, lest the womb being deliver'd of its Burthen, should fall, and the Secondine by that means be delay∣ed to the damage of the Woman in Child-bed.

If there be Twins in the Womb, and one of them endeavour to come forth with the Head formost, and the other with the Feet: First of all the Midwife must consider, which of the two the Woman may be deli∣vered of with most expedition; if the Head of the one be less forward than the Feet of the second, it will be most convenient to draw that forth by the Feet, turn∣ing

[illustration]

the head of the other a little to the other side; and that being delivered, she must presenty lay hold of the Head of that which is within, and direct it just to the passage of the Womb; which may be done with more ease, by reason of the gap which the formost hath made.

If it happen, in drawing forth the first by the feet, that the other change its situation, the Midwife may then draw forth the other by the Feet as she did the first; and if the head of the first be more forward, then she must put back the Feet of the first, and receive that which comes with the head formost.

If both of them press together to the passage of the Womb, the Midwife must take great care; and there∣fore she must put up her hand to see which of them is most forward, as also to try whether it be not some monstrous Conception, as two heads upon one body, or two bodies joined in one, either at the shoulders, or at the sides, which may be known, if she put up her hand gently between the two heads as high as she can; and if she find that they are twins, she may gently put the one to one side, to make way for the passage of the other, which is most advanced; which must be direct∣ed just to the orifice of the Womb, having a great care that she do not change the situation of the second; and as she feels the pains of the Mother coming on her, she must by all means bring forward the Child she would receive, still keeping the other back, with two or three fingers of the left hand: and thus having delivered the first, if the second be not well situated, she must bring the head to 〈◊〉〈◊〉 neck of the Womb, where it will find the passage 〈◊〉〈◊〉 to it, by the delivery of the first.

Now lest the first Child should be in danger of its life, you must take it from the Mother, and carefully tie up the Navel-string, as is formerly mentioned, and also bind again with a large and long fillet, that part of the

Navel which is fast to the Secondines, that they may be more easily found, Then the second Child being born the Midwife must see if there be not two Secondines, for by reason of the shortness of the ligature, it may have hapned to retire back again, to the damage of the Wo∣man; and therefore the Secondines must be hastened forth as soon as may be, lest the Womb should close.

If the two Infants have but one body, the better way is to turn the head upwards, and to draw it forth by the Feet, than by the head: Taking care when you come to the Hips, to draw it forth as quick as may be.

The second form of unnatural Birth is very dange∣rous, and therefore requires the greater care of the Mid∣wife. First, therefore let her well anoint the Womb of the Woman that the passage may be more slippery; which being done, let her take hold of the hands of one of the Infants, and keeping them close to the sides, di∣rect the head to the orifice of the Womb; that being born, let her proceed in the same manner toward the other. If she cannot come to take hold of either of the Infants Arms, she must bring the Woman again to her Bed, and try by the aforesaid Agitation of her body, if the Infants may be brought to a more convenient form of delivery.

Notes

• * 1.1

  Of the Child dead in the Mothers Bel∣ly.
• * 1.2

  Another way.