S the Birth approaches, the Woman grows hotter and red in the Face; the Pains bear more strongly down; the internal Orifice opens; the Vagina or Passage, at its Entrance, becomes more swell’d, as the Child’s Head advances; and the Membranes are more and more tensely stretched; before the Birth, the Person is often seized with a Vomiting, and universal Tremor, without the Coldness of an Ague; and very often a Humour, discolour’d with Blood, immediately preceeds the Breach of the Membranes; when these Symptoms, or several of them, become urgent, ’tis Time to put the Woman in a proper Situation, as describ’d in the preceeding Chapter: The Midwife ought by no Means to break the Membranes, but encourage the Woman now to make the best of her Pains, by strongly bearing down, as if going to Stool; the Midwife with her Fingers well anointed, putting them gently within the internal Orifice, may cautiously, by separating them, assist its opening, and Removing it more behind the Child’s Head, thereby gradually promote its more easy Transmission, and at the same Time prevent, if necessary, the Womb from being too far protruded: After the Waters are broke, as it is called, and the Head of the Child comes into the Passage, the Midwife may lay hold on each Side of it, taking Care not to bruise it by rough Handling, and drawing it, by Waving her Hands, if necessary, to loosen it, when fixed, rather than in a strait Line, assist the Birth; and if obstructed by the Shoulders in the Passage, inserting a Finger under each Arm-Pit, extricate them by the like Action.

’Tis true, it happens, tho’ unobserv’d by Writers, as far as I remember, that many Women have no Waters breaking away, either before or after the Birth; whether absorbed or not, in Time of Labour, I shall not at present determine; this is called, by the Country People, a dry Labour, and often attended with Difficulty; however, if the Crown appear forward, the Issue may nevertheless be favourable.

The Child being born, the next Business is to tie the Navel-string with a waxed Thread, so doubled, as not to endanger cutting, about two Inches from the Child’s Body, making another Ligature near the Body of the Mother, so far distant from the former, as may be convenient for Cutting between both Ligatures, and separating the Infant from its After-birth. Midwives are too apt to leave a greater Length, which can be of no Service, but has been thought, on the contrary, by our Countryman CHAPMAN, to occasion Navel Ruptures.

After the Separation of the Navel-string, the Care to get the After-birth succeeds; this will often come by the Assistance of Nature, with a gentle Motion of the Hand gradually drawing and loosening it, by the Navel-string: But if it adheres to the Fund of the Womb, which is frequently the Case, whether from the Waters being come away before the Birth or otherwise; it must cautiously be separated, and extracted by the Hand, to prevent the most mischievous and fatal Consequences.

The Assistant holding the Navel-string with one Hand, must with great Caution introduce the other into the Womb, avoiding all Violence to any Part in the Way, ’till she reaches the After-birth, some Part of which probably, being loosened, will be found more forward than the rest; which taking between her Thumb and Fore-Fingers, she must, by an easy Motion of her other Fingers, between the Womb and After-birth, gradually separate the Parts adhering all round, ’till finding the whole free, before the Palm of the Hand and Fingers, she brings it intirely away; for should any Part remain, the poor Woman’s Labour would still continue, and occasion dangerous Floodings, requiring the immediate Assistance of an able Hand, to rescue the Patient from the immediate Hazard of Death.

Sometimes when the Womb has discharged its Waters, and the Child, by Reason of a Defect of Pains, or otherwise, remains long very forward near the Birth, the Womb so contracts about the After-birth, as to make the Separation of it very difficult; in which case Assistance is requisite, from one well acquainted with the Structure of the Body; and the longer this is delay’d, the more Danger there will be of all the bad Consequences of the Retention, and Corruption of the After-birth in the Body.

It requires great Care to prevent the Protrusion of the Womb in some Women of a large Pelvis, or Opening between the Bones; or if the After-birth remains closely fixed, the Womb, in a very open Pelvis, may be thrust by the Violence of the Pains; or drawn out of the Body by an unskilful Hand, which is commonly very soon fatal to the poor Woman; and I believe happens much oftner than is apprehended, tho’ industriously conceal’d, by guilty Midwives, under the Colour of the poor Woman’s dying in Child-bed, from some other Cause. DEVENTER says, he saw a sad Spectacle at the HAGUE, the Head of the Child excluded to the Shoulders quite without the Passage, when Three-fourth Parts of the Head were conceal’d within the Womb, the Crown appearing within its inward Orifice†.

† See Chir. Op. Part ii. Page 32.

A much worse Case happen’d in my Neighbourhood, Sept. 23, 1749. I was call’d to a Woman, whose Child, on the 21st came unexpectedly, without the least Assistance, in the Presence of an old Midwife of large Practice; she puzzled an Hour, as I was inform’d, to bring away the After-birth, which closely adhered to the Fund of the Womb; while the unfortunate Woman lay senseless, saving the Memory of being long expos’d to the Cold, when she came to herself; after which she continued in violent Labour-like Pains; upon Scrutiny, I found a large Substance in the Pelvis, of the Size of a Child’s Head, considerably resisting my Touch; I observ’d on Trial, a Part of the Woman’s Body every Way interposed between my Fingers and this Substance, by her Sensibility of my Touch; therefore contenting myself with giving her some palliative Medicines, and telling the Persons present, a Mole, as I thought, or Child still remain’d to come away, I for that Time, took my Leave: On the 24th, she was said to be much better; on the 29th, I was again call’d to this poor Woman, and inform’d, that upon her first going to Stool, since I had before seen her, which happen’d the same Day, the large Substance before-mention’d, came intirely out of her Body; to which it join’d by a thinner Substance, of some length: I now perceived it was no less than the Womb turned inside out, suspended by its Ligaments, and joining to the Vagina, but very much swell’d by the Obstruction of the circulating Humours; And an old Gentlewoman, who was present when the Child was born, inform’d me, she saw the Midwife draw this Body from the Woman, by the Navel-string, and indeed, the Impression of her Nails, in separating the After-birth, remain’d still visible at the Bottom of the Womb, and the Midwife having long expos’d the Patient, put this inverted Womb again into her Body.

The Condition of the Part, after so long Delay, did not admit the Possibility of rightly reinstating it; I therefore return’d it, as well as I could, into the Pelvis, and introduc’d a Pessary to retain it; and as this Person had already contracted a Hectick, I charg’d her, as she valu’d her Life, to confine herself strictly to a cooling Milk, or vegetable Diet; she has since had large Discharges of a bloody Corruption, with Portions of a fleshy Confidence from the Parts affected. In April, 1751, she told me the Discharge coming from her had long been much abated in Quantity, and what remain’d was the Whites; that she had an inward Fever, and the Piles, for which I gave her my Advice; her Complexion was chang’d from the most florid to a languishing Paleness.

My Brother, much better known in this Country, and longer practis’d in Midwifry, has been concern’d in furnishing Medicines for the Person, whose History I have given, altho’ by Means of his Absence, he did not attend her on the most emergent Occasions.

I have since been call’d to the Assistance of the old Midwife, who attended, and she frankly told me, she had another Woman under the like Circumstance, who died the same Day.

Having related such Things as occur in the most favourable Circumstances of Travil, about which all Midwives ought to be well inform’d, and those Injuries to which Women are sometimes liable, notwithstanding the most promising Appearances: In the next Place I proceed to shew, what are the Symptoms preceeding difficult Labours, which by timely Assistance, may be secured from the most dangerous, if not fatal Consequences, and are of great Moment to be known by Midwives, as well as Matrons and Child-bearing Women, to enable them to judge when it is absolutely necessary to recommend calling that Aid, which is beyond their Capacity to give.