CHAP. XVIII.
Of the Method of Extracting the SECUNDINE,
&c.
AFTER all, to perfect or finish the Woman’s DELIVERY, it still remains that She be freed of her After-Birth, or Secundine. Now this I advise to be done with all imaginable Speed, after the Child is born, even before the NAVEL-STRING is cut: Because the Womb immediately contracts itself, so that This cannot be accomplish’d afterwards without great Difficulty.
HOWEVER, I know beforehand, that my Method of performing this Work, which I am about to lay down, will be thought a strange Innovation in Midwifery; but without any regard to that, in speaking to this Point, I shall First suppose this Body to be already loosen’d from the Womb; in which Case the Midwife has nothing to do, but to draw the STRING gently, which she holds in One Hand, twisted twice or thrice around one or more of her Fingers, while she passes the Other Hand into the Womb, following always the STRING (as her Guide) to the Place where the Burthen lies: And where, as in this Case, it naturally presents itself to the Orifice, She stretches her Hand up length-ways, taking hold of it betwixt her Fingers; and thus, by the Assistance of the other Hand always attracting softly the STRING, she brings it at last most commodiously away.
SECONDLY, I shall suppose, in the mean Time, this Body to continue fixed to the Womb, either in Part or in Whole: In which Case, if in Part, the Midwife finding by the Touch the other Loose Part, moves her Hand thither betwixt That and the Womb, shaking or stirring it gently backwards and forwards, until such time as it is entirely loosen’d, when she proceeds as Before: But if in whole, and that it sticks very Fast, then the MIDWIFE places her Hindmost Fingers on its Exteriour Part against the Womb, and her Fore-Fingers against the Inside; so that thus by pulling softly on all Sides quite round, it is easily loosen’d and extracted as Above.
THIRDLY, I shall suppose this SECUNDINE also (tho’ loosen’d successfully) to be so very Large, that it cannot pass through the ORIFICE: In this Case, I only desire my deliver’d Woman to concur with me, and behave herself as if she was forcing or expelling the CHILD; for then whilst I at the same time gently attract the STRING, it immediately follows.
I very well know that Mr. Mauriceau and all others either in and before his Time, teach quite different Methods of extruding the AFTER-BIRTH; such as are by the WOMAN’s blowing in her Fist, putting her Finger in her Throat, and the like; which when the poor Patient has done, and stood them All out ineffectually, together with their many other various uncertain Experiments to no Purpose, and none of them have succeeded (as it has often happen’d): Then at last, and not till then, they direct the aforesaid Method of the HAND to be used. But now-a-days, we know better Things than to run such indiscreet Risques, when we may go a safer Way to work; or to make use of Uncertainties, when we know more Infallible Means. As I shall, I hope, make this Method plainly appear to be; notwithstanding all the great Cautions of those Authors publish’d, and the Difficulties they make of it in our Practice of MIDWIFERY: And that I will endeavour to do from the following Considerations, viz.
I. IF after the Birth of the Infant, the Hand be presently pass’d into the Womb, it slips in together with Part of the Arm, as far as is needful, without the least Trouble or Inconvenience to the Woman; the Womb as well as its Orifice continuing always, so long as this may be done, sufficiently Open: And thus the Birth maybe skilfully accomplished or perfected, as it were, in an Instant; while others (trying their vain Projects) spend many trifling Hours about it, and it is ten to one, if at last they succeed.
II. BY these means, moreover, I presently know whether there be One, Another, or More INFANTS to follow; whether there be a dead CHILD, false CONCEPTION, or any Foreign Body whatsoever, lodged in the Womb; whether any Part, or Pieces of the Secundine, or Membranes, or Lumps of Clotted Blood, be left behind and retain’d: All which I propose to bring away either before, or after the Secundine, as Occasion serves, with the greatest Safety as well as Expedition.
III. AFTER having thoroughly searched on all Sides, and thus duly cleans’d the Womb, by continuing my Hand in it, until it contracts about that Hand, first above towards the Bottom, and then below towards the Orifice, which happens very quickly: I find myself then, by great Experience, able to rectify all Oblique and Preternatural Situations of the Womb; as in Case of a Prolapsus, (or Falling down) I can hereby move it carefully Up again: If it lies too much Backwards, by elevating it while it gradually contracts, I can easily bring it Forwards, to its Natural Position: If it hangs too much Forwards, I can quickly reduce it Backwards: If it tends to either Side, I can directly move it to its Center. And thus, in short, I hope I may be allow’d gently and gradually to restore the Womb to its Natural Place and Posture, how Preternaturally and Obliquely soever its Situation may happen to be disorder’d.
NOW This being so successfully done, I can, in fine, assure and secure any Lying-in-Woman, that her Womb is both duly purg’d, and naturally shut again as it ought to be; which I take to be the greatest Satisfaction the Child-Bed-Woman can conceive in her Condition. Whereas,
IV. THEY who leave all these Things to mere Nature, risque their Patient’s future Welfare, and very often her Life too, as innumerable Tragical Examples witness: For Nature itself most particularly requires our special Assistance in this Case. But (according to their indifferent Notions) it is Time enough to assist Nature, when it is found Deficient; and then, in Case of Extremity, they unanimously agree that there is no other way to help or save the Woman’s Life, but by this Method of Manual Operation. To which I answer, that Nature operates not in an Instant, but (in all Cases) requires a competent Time, to discharge its respective Functions; and being left too long to itself, for want of Help, is many a-time (by intervening Accidents) found at last Incapable: Upon which, then They, beginning their Endeavours to second it, generally come too late. For if the Case does not prove to be past all Remedy, it is at least (by this Protraction of Time) often rendred not only difficult, but also desperate; as will evidently appear in the Case in hand, from what follows, viz.
I. WHILE They (conformable to the general and universal Practice of common MIDWIVES) expect the Performance of Nature, or the Success of their trifling Means, in the mean time, the Orifice of the Womb is so closely shut up, that in the space of an Hour or two, it cannot be penetrated, without renovating the most severe racking Pains to the Woman, who (perhaps) has been sufficiently spent before, by the Delivery of her Infant, and is now consequently incapable of standing out the renew’d Pangs: whereby of course She must succumb at last, and give up the Ghost, for want of Timely Help; as innumerable Instances confirm for an undeniable Truth. But,
II. SUPPOSING the Woman to be able to undergo the PAINS, yet the Womb is however contracted, and the SECUNDINE bound so close up, that this Body, which before adher’d Cake-ways to its Bottom in a smooth and broad Form, is now so squeez’d into a small and long Figure, that it is even now a Difficulty next to Impossible, to reach the Bottom of the Womb, and still a harder Task to extract an entire Secundine, without prejudicing the Womb.
III. THEY who altogether neglect Manual Operation, may (I confess) sometimes deliver their Woman, when Success accidentally answers their Wish: But without this Mean, they cannot possibly restore a prolaps’d, fallen-down, or an obliquely situated Womb, to its natural Position. No, to the Contrary, Nothing is more common among ignorant unwary MIDWIVES, than to invert and draw down the Bottom of the Womb itself, by pulling the Navel-String, as they foolishly intend by means of it only to extract the SECUNDINE. Neither does the Mischief always end here, but mistaking this Body, when so found by their Touch, they immediately imagine it to be the Head of another Infant; and persevering in this false Conjecture, they manifestly expose the poor Woman to the Hazard of her Life. Neither,
IV. POSSIBLY can They, without the Use of the Hand, so cleanse the Womb of the Reliques of the SECUNDINE, which may stick up and down to the Womb; or of the Pieces or Parts of the Membranes, which may remain there; or of the clotted Blood, which commonly stays behind. From hence therefore it necessarily follows, that (without the Means of the Hand) They cannot be Positive or Certain in any Circumstance, relating to the True State of the Woman. They can neither assure Herself, nor those concern’d, that her Womb is duly purged; if (perchance) of the SECUNDINE, which they may guess at by the Sight, yet not of the Fragments of the Membranes, nor of the clotted Blood, which they can never be certain of, but by this Method. I mention these Things, because the least Part of Either being retain’d, or left Behind in the Womb, may cost the Woman her Life, as innumerable Precedents do testify. Nor,
V. CAN they possibly secure the Woman, that her WOMB is duly shut and contracted; much less can they (without these Means) affirm that it is orderly situated in its proper natural Center: By the Neglect or Fault of which Condition, she is not only rendred Barren afterwards, but also most infirm all the Days of her Life.
BUT notwithstanding how plain and easy soever, I have endeavour’d to make out the above-mention’d Method, I would over and above recommend It only to the judicious and well-qualify’d MIDWIFE; by no Means to those that are ignorant in the Parts of GENERATION, nor to any stiff clumsy-fisted Person: And that for the Two following Reasons; viz.
I. LEST the String (by some Accident or other) should break, and she, missing this Guide to the SECUNDINE, should take One Part for Another, and consequently dislodge the Womb instead of the After-Birth; which has undoubtedly often happen’d by such blind Doings, notwithstanding this very remarkable Difference between Them, that the SECUNDINE distinguishes itself from the Other, by a great many little Inequalities on the Outside, occasion’d by the Roots of the Umbilical Vessels. And,
II. LEST she should unwarily either break, tear, or scratch the Womb, with her thick, fleshy, rough, and rigid Hand, or with her stiff and crooked Fingers: Either of which Accidents, may give Origin to various Misfortunes; such as a Prolapsus, or Falling-down, a preternatural Flooding, an Inflammation, or Gangrene, &c.
BUT we will now, in fine, suppose that the Ingenuous MIDWIFE has after All discharged her faithful Duty in these Respects, with Care, Lenity, and good Conduct, as well as with great Art and Judgment: In which Case, it only remains, that she take the necessary and usual Care of the Child-Bed-Woman and Infant; as hereafter will be directed in the respective Chapters of SECTION VIth, to come.
IN the mean Time, these curious Things being thus amply premised in this Place, the Reader has no more superfluous Repetitions to expect concerning them in the following Performance: And therefore with these Preliminaries I conclude my Fourth SECTION.