BY this sort of BIRTHS, I mean such as are Preternatural, both in respect of the Situation of the CHILD, and of the Womb. Which complicated Preternatural BIRTH is (of all others) the most dangerous; because of an Indefinity of Accidents and Difficulties with which it is always attended, according to the many various Postures in which both the INFANT and the Womb are found: All which to enumerate here, and to guard particularly against them, as I have done in the preceeding Cases, would not only augment the Bulk and Charge of this WORK, but also be in some respect altogether Needless: Because if I was to content my self to treat this Chapter in general (without descending to particular) TERMS, I would not doubt but that the ingenious Reader would even thence readily form a clear IDEA of all such BIRTHS, from the many different Cases already stated and discussed; which if thoroughly well understood, the Rest cannot but be easily comprehended.
HOWEVER, that I may not leave the weaker Capacity, or the doubtful MIDWIFE to the Uncertainties of her own scrupulous Judgement, I shall propose and resolve some of the most difficult and dangerous Cases belonging to this preternatural Subject, and that as far as is really requisite, in manner following; viz.——
I. WE Shall suppose that the INFANT is ill-turned, and presents itself preternaturally, with Face, Chin, Hand, Elbow, Shoulder, Breast, Back, Belly, Side, Buttock, Knee, Foot, or any other Part or Member first, in a Womb tending obliquely forwards. In this Condition, I shall first show the MIDWIFE how, and by what Signs, she may know and discover such perverse Postures; and secondly how, and by what Means, These may be rectify’d, the CHILD extricated, and the MOTHER reliev’d in Life.
THEN as to the First Point, I would have it minded, that the Touch is the only Expedient, by which the Situation of the INFANT in any Womb, whether Oblique or Direct, is to be discover’d and perfectly known. Which when the MIDWIFE finds to be preternatural, she needs not much trouble herself about what precise Part offers or comes first in the PASSAGE: Because of this short Rule, which I would not have her to forget; namely, That, when the Head does not present itself first in this complicated Case, the CHILD is to be drawn out by the FEET. For in this ill Position of both the INFANT and the WOMB, the Version of the CHILD succeeds more easily than if the Head was foremost: Wherefore I would lose no Time, but as Soon as I had discover’d all Circumstances aright, I would commence my Business upon this Occasion, before either the MOTHER or the INFANT are much spent, that I may perform my Work, while they both can mutually concur with me towards their own Relief; That is, while the Womb is yet suspended in the upper Part of the Pelvis, and the Membrane not yet broken.
IN order to this Second Point, the Woman being commodiously placed, the MIDWIFE is to pass up her Hand into the VAGINA, and dispose the Orifice of the Womb to open, which is now sooner done than if the Head came first: This being done dextrously, she is to put first one or two Fingers, then all of them successively into the Aperture; and when that is sufficiently enlarged, she is to penetrate into the Womb, and either break the MEMBRANE, or wait its spontaneous Breaking, as she judges best by occurring Circumstances. In the next place, she is to look for and find the FEET; and, the TOES being always turn’d towards the Rectum, they are to be forthwith brought into the Passage: proceeding still farther in the due and regular Method of extracting the Child, as already taught[178] and dilucidated.
II. WE will suppose moreover, that the Infant is ill-seated, and presents itself preternaturally with any of the aforementioned Members first, in a Womb hanging obliquely to either Side. In this Case, I would sincerely advise the MIDWIFE, to lose no Time in opening the Womb, breaking the Membrane, turning the Child, and extracting it by the Feet: Because in this Posture of both the BIRTH and the WOMB, Experience has taught me that nothing can be safer and less dangerous than this Method, when ingeniously and presently perform’d with Dexterity.
IT is true indeed it may be objected, that I dissent in this Matter, from most (if not from all) Authors: To which I answer, in short, that Those from whom I do differ, were never acquainted with this complicated preternatural Condition, but always supposed the WOMB to continue in its proper Place, never dreaming of its various Motion, nor suspecting its oblique Situation; erroneously imagining all preternatural BIRTHS to proceed merely from the ill Version of the Infant: In which Circumstance however, when it happens so, I confess they are so far in the right, that the Head is to be first brought into the Passage, and the Child excluded by it with all possible Expedition.
BUT that I may farther elucidate the true State of this Case, as it becomes me to speak the Truth ingenuously, it is my candid Opinion that, in any oblique Posture of the WOMB, it is the safest, quickest, and most convenient Method to extract the Infant by the Feet, and that presently in the Beginning of the Labour, either before or at least presently after Flooding, as occasion requires. For this very Reason, and to this Purpose, I hope, I may farther justly lay down one certain Rule; namely, that all BIRTHS ill-turn’d, in a WOMB ill-seated, are to be rightly turn’d again, and drawn out by the Feet. Which Rule, if duly observed, will, I am positive, save a World of Women and Children, that otherwise must inevitably perish; since as for my part, I know no Situation of the Infant in an oblique WOMB, more difficult or dangerous than the Head’s offering itself first; and that because the BIRTH cannot be then turned without the greatest Difficulty and most extreme Pains.
THIS, in short, will be readily granted by All, who do consider or conceive that the WOMB (being fixed by Ligaments on both sides) is always more inclinable to fall Forwards or Backwards, than to either Side, and first most commonly bends back before it comes to any lateral Posture; and that from hence of consequence, the WOMB is distorted as well as obliquely situated. By reason of which Distortion, if the CHILD comes Head foremost, it falls down in the Pelvis obliquely; and tho’ a judicious MIDWIFE may bring the Head directly into the Pelvis, yet the Shoulders following, must needs fall upon the Pelvis a-cross, in its narrower Part; whereby of reasonable Consequence the Infant must be distorted in the Passage.
NOW in this Case, no Pains, how violent soever, can avail to force forwards the BIRTH so fixed upon these Bones; wherefore (I say) when the WOMB is thus seated, it is most safe in the Beginning of the LABOUR, to open its Orifice, break the Membrane, turn the CHILD, and take it out by the FEET; since by the Head’s coming now foremost, both Lives are at Stake and in great Jeopardy.
HOWEVER yet it may be again objected, that I have already prescribed another Method in Chap. 21; viz. of bringing the Orifice together with the Head into the Pelvis, and promoting the BIRTH in that Manner: To this I answer, that my Reason for so doing, was not only to convince some People, that I know their Method as well as my own; but also to whet or assist the Judgment of such good MIDWIVES as cannot forsake their own old By-Paths; Not that I ever design’d to recommend it to any, tho’ I must however acknowledge, that sometimes it may effect the desirable Ends; but according to the Rules of irrefragable Truth, and sound Judgment, we find that, in this Position of the Womb, let the BIRTH offer itself as it will, the only laudable Method is without Loss of Time to extract the Infant, and deliver the Woman as above-directed.
III. I observe upon the whole, that as the immediate present Case is applicable to either (right or left) Side; so what is said of the foregoing Condition, with respect to the Womb’s inclining forwards, may be easily apply’d to the Case of its tending backwards: Only with this considerable Difference, that the oblique forward Posture of the Womb, is the most commodious of the Four mentioned Extremes, and consequently admits of a more easy Exclusion of the BIRTH by the Head, than any of the rest mentioned.
NOT but that either of these grand or complicated preternatural BIRTHS imply and prognosticate imminent Danger to the MOTHER, or the CHILD, or Both; as well as incredible Labour and Fatigue to the faithful MIDWIFE; who, in such Cases, can less distinctly feel, less commodiously handle, and more difficultly come at the Matter, so as to dispose the INFANT’S Members for Attraction, than in any other Condition of BIRTH: Hence it is, in short, that so many MIDWIVES are liable to the most egregious Mistakes, and unaccountable Deceptions upon these unlucky Occasions. But——
AGAIN farther, I hope I may freely speak my Mind, and openly avow, that the most of these Births proceed merely from want of seasonable and skilful Assistance in the beginning of the Labour: Because the BIRTH (however well seated then) by reason of the bad Situation of the Womb, cannot possibly pass thro’ the Pelvis of itself; and not being judiciously assisted at that nice Juncture, behold, from a Natural, it falls on a sudden also into a Preternatural Posture. From hence we have this extreme difficult and most dangerous sort of Preternatural BIRTHS, as will more conspicuously appear from a deliberate Reflection upon the preceding Chapters. And This much (I hope) may finally suffice any intelligent Reader, to conceive the different Circumstances of all complicated Preternatural BIRTHS whatsoever. Whence I go on to the Fourth and last Sort of Preternatural BIRTHS proposed; namely, Those proceeding from intervening accidental Causes; which because they are also different, I shall handle briefly and separately in the ensuing Manner; viz.——